The Prefect room

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT BY MOLLY SHARP A Thesis Submitted to the Division of Social Sciences New College of Florida in partial fulfillment of the requirements for the degree Bachelor of Arts Under the sponsorship of Provost Callahan Sarasota, Florida April, 2011

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ii Acknowledgments I would like to thank my Thesis Sponsor, Professor Callahan, for working with me throughout my four years at New College and putting up with my incessant e mails regarding my Thesis. I would also like to thank my committee members, Professor Graham and Pro fessor Barton, for preparing me for my thesis through your courses. I would like to thank my roommates, friends, and family for all the support during my time at New College as well, especially during my Thesis work. Finally, I would like to thank my fourt h and fifth grade teachers, Ms. Malone and Mrs. Fennessey, along with Dr. Birkenstock, for teaching me the foundations of writing. This journey began with you.

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iii TABLE OF CONTENTS Page Number Acknowledgments ii Table of Contents iii Abstract iv Introduction 1 Why Does Environment Matter? 1 The Impact of Desk Position and Office Accessories 4 Proxemics, Seating Distance, and Orientation 12 Anxiety and Control 17 Seating, Control, and Envir onment 20 Why Does Nature Matter? 29 Other Influences 40 Method 43 Results 46 Discussion 47 References 51 Appendix 5 6 Figures 59 Tables 61

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iv THE PERFECT ROOM: PREFERENCES IN A THERA PEUTIC ENVIRONMENT Molly Sharp New College of Florida, 2011 ABSTRACT Preferences for control and naturalness in a therapeutic environment were examined. Specifically, preferences for seating arrangements, presence/absence of windows, presence/absence of natural objects, and presence/absence of status symbols w ere explored. Participants responded that they prefer to have moderate control and high naturalness in the counseling environment, with high consensus among participants. The exception to this consensus was that clients and non slightly, with a higher percentage of clients preferring the room depicting moderate control and high naturalness than non clients. The results suggest that control and naturalness are important in the therapeutic setting, and most people have similar pref erences regarding control and naturalness. Further research is necessary to clarify the similarity and differences between preferences of clients and non clients, and should include more characteristics of the counseling setting to get a more comprehensive understanding of what the ideal counseling room should resemble. _______________________ Provost Callahan Division of Social Sciences

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 1 The Perfec t Room: Preferences in Therapeutic Environment Why Does Environment Matter? A review of relevant literature assembled by Evans (2003) demonstrates the myriad ways that the components of the built environment may affect mental health. Those that have been shown to have direct impacts include: housing type, floor level, housing quality, neighborhood quality, furniture placement, privacy, residential density, noise, indoor air quality, and light (Evans, 2003, pp. 542 543). Influences on mental health may be even more pronounced in therapeutic settings. For example, the mental health of residents in psychiatric and substance abuse treatment programs is affected by the design, layout, features, and furniture arrangement (Timko, 1996). The physical characterist ics of hospital and community based programs were assessed based on dimensions such as community accessibility, space, and recreational activities. Hospital programs were found to be the most appealing and effective: these facilities had more physical amen ities, more social recreational and prosthetic aids, seating that promoted social interaction, more private and communal space, more decoration, more lighting, and better access to community resources than community based programs. These differences result ed in patients of hospital based psychiatric and substance abuse adult treatment programs being more involved in activities, more likely to successfully complete the program and to be discharged to independent living situation, and having better overall ou tcomes (Timko, 1996). This further illustrates the many influences that result from the design of a space.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 2 Although it might be desirable to explore the effects of each of the characteristics addressed in Evan's (2003) extensive review, the present study focused on the perceived impact of furniture and object arrangement as well as the presence of a window in a therapeutic setting, namely a hypothetical therapist's office. The influences of these specific room features were explored from the perspective of the psychosocial constructs of personal control, social support, and restoration. Shapiro, 1998; Taylor & Brown, 1988 as cited by Evans, 2003, p. 544). One can have actual control over the environment, or perceive that they have more or less control over the environment and actions around them then is actually the case. This perceived c ontrol can depend on the situation one is in, and thus changes. However, if a person always tends to have low perceived control, meaning they think they do not have control over what happens around them, they may develop an external locus of control, which is more static than perceived control. (An individual with an external locus of control believes that other control what happens while a person with an internal locus of control believes they control situations.) W hen people are unable to control the envi ronment, perceived helplessness can occur, which can lead people to surrender to whatever challenge faces them. This perceived helplessness can also occur if one feels no territoriality over the envi ronment (Evans, 2003, p. 544). In a c lear illustration of the ways that high perceived control can impact mental health Caldwell, Dracup, Ericks on, Hamilton, Moser & Westlake ( 2003 ) found that patients with chronic cardiac illness and high perceived control exhibited less emotional distress and were able to wal k farther than patients with

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 3 lower perceived control. This research will be described in more detail later. Thus, low perceived control and perceived helplessness can have a detrimental effect on physical and mental health, while high perceived control can have marked positive benefits. Also relevant to the current study is the concept of mental restoration. Researchers (e.g., Herzog, Maguire, & Nebel, 2003; Joye, 2007; Kaplan & Kaplan, 1989; Kaplan, 1995; Kaplan, 2001; Moore, 1981; Ulrich, 1984; and We st, 1986) have argued that experiencing the natural world can have positive effects on mental health. These researchers referenced the Biophilia Hypothesis, Attention Restoration Theory (ART), and previous research supporting these two concepts. The Biophi lia Hypothesis, according to Wilson, (1984 as cited by Gullone, 2000) suggests that humans are inherently attracted to nature and nature like objects, while the ART posits that continued directed attention results in its deterioration, and that conversely, exposure to nature allows for restoration of directed attention and can have other benefits such as relaxation (Kaplan & Kaplan, 1989). A simple, commonplace example of the Biophilia Hypothesis is provided by the real estate market: properties with large r yards or those closer to bodies of water are monetarily valued higher than properties with less nature. Berman, Jonides and Kaplan, 2008 offer a clear illustration of ART cognitive performance was better after a walk in a p ark than after no walk or a walk in an nature, fireplaces, fountains, aquariums, and animals as well as paintings of landscapes and other coherent, tranquil scenes are among the design elements with the potential to prefer according to the Biophilia Hypothesis.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 4 Ideally, these general findings related to the impact of furniture arrangement and the presence of elements of the natural environment can be used to guide the room design might enhance the therapeutic environment for both therapist and client. Unf ortunately very little research has been conducted on the impact of these features in the therapeutic setting. In addition, according to Evans (2003) many of the studies that have been conducted are methodologically flawed. The present experiment was desig ned to explore the impact of furniture arrangement and status symbols, and the presence of a window and restorative accessories on participants' preferences for room choices. It was assumed that furniture arrangement and status symbols would affect percei ved control, while the presence of a window and related accessories would be perceived as restorative. However, these specific constructs were not directly assessed. The Impact of Desk Position and Office Accessories Though Sommer (1969 as cited by Campbe ll, 1979, p. 648) reported that 1979, p. 649) found that the presence of a desk barrier did not affect perceptions of an interview situation between students and faculty. This was unexpected, since the relationship between a student and professor could be presumed to be one of a cooperative, working relationship, and the barrier desk should therefore be the less preferred configuration. Thus Campbell chose to further investigate the impact of desk placement in faculty office settings. Campbell (1979) conducted a complex simulation study in which he not only varied desk placement but th e presence of living things (e.g.,

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 5 plants, an aquarium), the presence of aesthetic interests (e.g., posters), and the overall tidiness of the office. Participants viewed sixteen color slides of a faculty office arranged in different ways and were asked to respond to each of the photos. The slides differed on four factors: the presence or absence of living things, the presence or absence of art objects, tidy versus messy office, and the desk placed either between the occupants or against a wall. The student s rated each slide, indicating how they would feel if they were visiting the office, and also were asked to make inferences about the professor/occupant ratings. There were slightly more positive (but not significantly different) ratings for the and welcoming. The open desk position also resulted in inferences that the professor was m ore welcoming. When art objects were present, participants rated the office and professor more positively; the effect for offices with plants was even stronger. The messiness of the office had the largest impact, with messy offices rated more negatively th an neat offices. In fact the messiness of the office accounted for 45% of the variance in ratings (Campbell, 1979, p. 651). Interestingly, results suggested that the position of the desk only affected ratings when the office was tidy and had no art objects This result office in the experiment overwhelmed the effect of desk position. Overa ll, males rated the resulting in greatest comfort for the visitor would include the desk against a side wall, plants, fish, posters, hanging art work all in an office free of disorderly piles of books,

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 6 directly applied to a therapeutic setting as well, and could be used as a template in fice. The findings influenced the hypotheses and variables included in the current study, which explores preferences for desk placement and natural accessories in therapeutic settings. It has been established that office design can act as a form of nonver bal communication to office vi sitors, and Ackerman, McElroy, and Morrow (1983) sought to clarify the ways that visitor impressions are affected by the design of an office. They studied design features of an office, including desk placement and visitor chair arrangement (with a closed seating arrangement considered to b e an office in which the desk acts as a complete barrier between occupants facing each other across a desk); an intermediate arrangement where the chair is next to the desk but the desk acts as a partial barrier; and an open seating arrangement referred to as offices in which the desk does not act as a barrier between occupants (no desk or desk against a wall). The researchers tested three hypotheses: (1) occupants with open seating arrangements will exhibit greater internal control orientations than occupa nts with closed arrangements, (2) occupants with open seating arrangements will exhibit more extroversion orientations than occupants with closed arrangements, and (3) occupants with open seating arrangements will exhibit greater (interpersonal) LPC (Least Preferred Coworker) orientations than occupants with closed seating arrangements (Ackerman et al., 1983, p. 542). Forty University faculty members completed a personality questionnaire that included Rotters I/E Scale (Rotter, 1966 as cited by Ackerman e t al., 1983, p. 542), Extroversion Scale (Eynsenck & Eysenck, 1975 as cited by

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 7 closeness (Fiedler, 1967 as cited by Ackerman et al., 1983, p. 542). T he actual desk placement and visitor Faculty members with an open desk placement showed lower external locus of control orientation than faculty members with a closed desk arrangement. Additi onally, participants with open visitor chair arrangements had significantly lower external orientations than did those with an intermediate or closed chair seating arrangement. esis also was supported: faculty members who had open desk placements had higher ratings of extroversion than faculty members with closed des k arrangements. Moreover, those faculty with open visitor chair arrangement had higher extroversion orientations th an participan ts with any other chair arrangement. The third hypothesis was partially supported, as faculty members with open desk placements reported significantly higher LPC orientations than faculty members with closed desk placements. The researchers in cluded an intermediate category of desk placement and prior research has only included open and closed arrangements, but such instances were rare: 80% of offices with an open desk placement also made use of an open chair arrangement, while 55% of offices w ith closed desk arrangements also included closed seating. Faculty members with completely open offices were more extroverted than occupants of completely closed arrangement office. Though insignificant, there was also a pattern of open arrangement offices belonging to occupants who were more interpersonally oriented. Results confirm that different seating and desk arrangements are associated with different personality

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 8 characteristics, and that visitors' impressions of occupants of a room based on its arran gement tend to be grounded in reality. which suggested that the tidiness of an office has the strongest effect on visitor response. e impact of desk placement may be um tidiness condition, called included the presence of status symbols (e.g., diplomas) in their replication in order to explore how office design affects the (perceived) sta tus of the occupant. Finally, reaction items (comfort and welcomeness), 12 attributions of the office occupant n check items (tidiness was used by McElroy and Morrow (1981): one hundred students viewed twelve different slides of a faculty office with the environment differing on the variables of desk ent. Participants rated the offices, but also increased perceptions of faculty busy

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 9 Once again, males rated all arrangements more positively than females. Unlike stronger while the effects of tidiness were weaker on ratings. Desk placement alone accounted for 1% to 10% of the variation in the dependent variables, with an open desk placement producing higher reported feelings of comfort and welcomeness and higher r interest in service, interest in students, confidence in dealing with others, friendliness, and status symbols had no significant effect on visi tor feelings, the presence of credentials resulted in perceptions of higher rank, interest in research, interest in service, and the accounted for between 1% and 60% of the variation in ratings and perceptions. The single design factors have on visitors. These findings emphasize the importance of desk placement and the strong impact i can affect the continuation and outcomes of therapy (Gass, 1984). As such, the impact cou nselors design their offices they should be aware of those environmental features that tend to influence clients' perceptions. For example, they might want to ensure that the office is at the very least organized. Because multiple environmental features te nd to detract from any individual feature, the current study focuses primarily on seating

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 10 arrangement, presence of windows, presence of natural objects, and presence of status symbols. fortable and welcome if seated in a generally clean office with living elements (plants) and accessories (posters) and in offices in which they perceived they had more control over results, environment on client self disclosure and discovered that intimacy of self disclosure was greater in a warm, intimate counseling setting (i.e., pictures on the wall; soft, cushioned furniture; rugs, soft lighting) than in a cold, non intimate environment (i.e., unadorned, (as cited by Pressly & Heesacker, 2001, p. 152). ADA standards must also be met when arranging an office to ensure that physically disabled clients can move around freely, and the standards prescribe a 5 foot circumference to allow for this (Pressly & Hee sacker, 2001, p. 153). Pressly and relationship between perceived control and office fur niture arrangement is further explored in the present experiment. Zweigenhaft (1976) explored how desk placement in a faculty office affects r tended to be those of older, higher academically ranked professors and were rated more negatively than offices without a desk between student

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 11 Zweigenhaft, 1976, p. 529 ) research, that the placement of a desk in a faculty office can affect the nature of interaction between students and professors, and is thus a meaningful feature of the office. Zweigenhaft (1976) attempted to relate the desk placement in a faculty office to occupants' characteristics, hypothesizing that professors that placed a desk between themselves and students would be more "distant" from the students. Sixty three faculty members at a small college were mailed a letter with an invitation to take part in the study, a diagram of an office including the placement of the desk, chairs, windows, door, etc. and a blank area. The participants were instructed to draw a diagram of their own office layout in the blank area and return the letter. The responses we re then coded based on desk placement into two groups: desk between, with the desk between the student and professor, and desk not between, with the student sitting next to the professor or with only the corner of a desk between them. These groups were com pared demographically and according to responses on student evaluations of professors on items that described the interaction between the studen t and professor. There were no significant differences in desk placement related to gender of professor or acade mic department. However, status did affect placement: senior faculty were more likely to use the desk between arrangement and junior faculty more likely to use the desk not between configuration. Age was also a factor, with the desk between group older ( M = 48.0 years) than the desk not between group ( M = 43.1 years). However, age and status may be related in the academic setting, as achieving higher credentials and status takes time to accomplish. The desk not between group yielded significantly more posit ive evaluations than the desk between group on two student evaluation items. The desk not between

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 12 ratings were higher. The results clearly indicate that there is a rel ationship between seating, desk arrangement, and student faculty interaction in the educational setting. t witnessed its share of frustration, anxiety, anger, embarrassment, elation, and excitement, as well as the routine py often induces a variety of emotions positive, negative, and mundane, and perhaps stronger feelings than those elicited in a professor student interaction. As such, these and similar findings may be applicable to the design of therapeutic settings. Pro xemics, Seating Distance, and Orientation Over 50 years ago Sommer (1959) reported that people prefer to sit across from others if the distance between the two individual is equal to or less than an available side by side position. Lott and Sommer (1967 ) further demonstrated that people sit farther away from higher and lower status others than from peers. Around the same time, anthropologist Edward Hall (1966) coined the term "proxemics" to describe the study of the effects of the use of interpersonal sp ace on social interactions. Hall's original approach to proxemics dealt with three types of spaces: fixed features, moveable objects, and informal spaces, such as the distances between interacting individuals. While Hall is best known for his interpersona l space zones and cross cultural variations in uses of

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 13 personal space, his model generated a great deal of empirical research on the effects of measurable distances and features of the environment on social interactions. In early research on social situa tions, DiMattia and Haase (1970) investigated the ways that preferences for seating positions vary depending on individuals' roles in the setting. They focused on the preferences of counselors, administrators, and clients for seating arrangements in the co unseling setting, and hypothesized that members of each group would have different seating preferences. Photos of a male female dyad in four different seating positions were presented to participant. The configurations were: two chairs side by side at a 45 degree angle (Position 1), two chairs opposite from one another with a table along the side of the chairs (Position 2), two chairs at a 45 degree angle with the corner of a table intervening (Position 3), and two chairs facing each other across a desk (Po sition 4). The distance between the chairs in all of the pictures was 54 inches. After viewing each picture, participants completed Semantic Differential scales that were presumed to reflect their attitudes toward the different proxemic arrangements. Resul ts, when pooled, revealed no significant differences within the counselor, client, and administrator groups. However, counselors endorsed the seating position with a desk between two seated people the least (Position 4), while the administrators group pref erred this position the most, and clients fell between the two (DiMattia & Haase, 1970, p. 322). Counselors preferred all other seating arrangements more than Position 4, with a greater difference in ratings between the four arrangements than clients or ad ministrators. Clients were found to prefer Position 1 least of all the participant groups. Overall, the most preferred configuration was for people sitting at an angle with the corner of a desk between them (Position 3). Clearly, administrators and counsel ors view desks differently,

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 14 possibly due to the different professional roles they must play in their office. The researchers suggested that counselors may view a desk between themselves and a client exchange necessary to the be concluded that in the counseling setting, and not necessarily in other professional settings, the ideal seating position is one in which two people sit at a 45 degree angle with only the corner of a table intervening. The results of this study are particularly relevant to the current study, which specifically explores the role of desk position in the counseling setting. Broekmann and Mo ller (1973) hypothesized that people would prefer different seating positions in different social situations. They arranged two office chairs and a table in four different positions: chairs facing each other with table next to chairs (Position 1), chairs f acing each other with the corner of the table between the chairs (Position 2), two chairs angled toward each other with the table behind the chairs (Position 3), and chairs facing each other across a table (Position 4). These positions were photographed fo ur times with the distance between the chairs varying at 1 meter, two meters, and two photographs at a distance of 1.5 meters. In order to explore the possibility that personality characteristics were related to seating position preference, participants co mpleted The Sixteen Personality Factor Questionnaire (Cattell, Saunders, & Stice, 1957 as cited by Broekmann & Moller, 1973, p. 505) and The Personal, Home, Social, Formal Relations Questionnaire (Human Sciences Research Council, 1968 as cited by Broekmann & Moller, 1973, p. 505). Participants, who were equal numbers of males and females who were currently freshman at the University of Stellenbosch, Republic of South Africa, then

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 15 viewed the photographs of the four seating positions at 1.5 meters and were as ked to indicate where they would prefer to sit in several situations: a counseling situation, a formal situation (apply for a job), a social general situation (visit friend of same sex), social specific situation (visit a friend of the opposite sex) or a h ome situation (talking with a parent). The participants then viewed the remaining photographs and were asked to indicate which distance they would prefer between the chairs regardless of the social situation. Seating position preferences in the home situat ion differed significantly from seating preferences in any other setting. Participants preferred the furniture arrangement in which chairs were angled toward one another with the table behind for a hypothetical home situation. The seating position with cha irs facing across a table was most preferred in the counseling, formal, and social specific settings. Overall, participants tended to prefer a middle distance of 1.5 meters between chairs regardless of the seating position, though personality affected this Participants whose personality questionnaire responses indicated they were submissive and dependent tended to prefer the larger distance of 2 meters, while independent minded participants tended to prefer middle and near distances. This suggests that par ticipants interpreted the counseling setting as a formal social situation, but the study requires replication with participan ts who have participated in counseling. The results could assist counselors in choosing furniture arrangement in terms of distance between chairs or attempting to make the counseling setting less formal to promote a relaxed setting. These results conflict with that of other research (i.e. DiMattia & Haase, 1970; Sommer, 1959) which suggests that the counseling setting is perceived as a less formal setting than is suggested here. As a result, the current

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 16 experiment varies desk placement, with each placement indicating different levels of formality and control in the setting. Other evidence suggests that the perceived level of intimac y of the actors affects preferences for distance, but not necessarily preferred seating orientation (Gifford & seating arrangements (distance and orientation) and they explor ed how both dimensions affect perceptions of intimacy. The first study re study in which participants viewed 37 seating arrangements and were asked to rate the based on a fine grained analysis of the data, so Gifford an specific distance and orientation in his 37 arrangements. Their analysis revealed that intimacy was negatively correlated with distance, with the side by side seating orientations rated as more intimate than face to face orientation s. Sommer (1968) used tables and was a simulated study rather than presenting live interactions, whereas in a second study Gifford and O'Connor used a live situation method in which distance and orientation of seating was varied systematically and orthogon ally. The distances and orientations were varied in a living room like setting with a coffee table, lamp, carpet, and other accessories. The researchers selected four distances and five seating orientations and presented all combinations in live, table les s social interactions. The distances between individuals ranged from 60 cm to 244 cm, and the seating positions ranged from face to face (0 degrees), to intermediate orientations (45, 90, and 135

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 17 degrees), to side by side (180 degrees) seating orientations The order of conditions was randomized for participants; each participant entered the room and sat in a chair with the experimenter in another. For each condition, participants rated the intimacy of the arrangement implied solely by the environment and n ot the relationship between the subject and experimenter. The results reflected that distance was strongly negatively related to intimacy as expected. Additionally, although orientation was statistically significantly related to intimacy, orientation did n ot significantly account for variance in intimacy. The results suggest further replication is necessary to reexamine the way in which seating orientation influences intimacy in social interaction. Since the therapeutic setting is meant to be an intimate se tting, the current research varies distance and orientation to explore seating preferences in a counseling office. Anxiety and Control Edwards (1977) found that an individual's gender, locus of control, and tendency for arousal seeking, as well as the sex of experimenter can affect perceptions of crowding Seeking T endency (AST) the No wicki Strickland scale of locus of control (ANSIE), a crowding perception test (CPT), and a figure placement task that measured perceived comfortable interpersonal distance (CID) to assess individual differences and perceptions. He hyp othesized that high arousal seekers would demonstrate a higher tolerance for crowding, and that a positive correlation between AST and CPT would be found. He also hypothesized that distances (as measured by the CID) would be larger for interactions with a stranger than a friend, a lecturer than a peer, and a person of the same sex than someone of the opposite sex. Finally, it was expected that CID dist ances would positively

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 18 correlate with externality of locus of control for interactions with strangers, but not with friends. Although the expected correlations were not found, and CPT scores were not (Edwards, 1977, p. 226). He also found a significant interaction between locus of control and gender, as well as locus of control and CID distances. The effect of gender was not as strong for subjects in the internal group, but in the int significantly larger distances, while in the external group, females preferred a significantly larger distance. Sex of experimenter also affected AST scores, with male experimenters scoring higher. These effects were not f ound on ANSIE scores. These findings were unexpected, so Edwards stressed the need for further research Overall, it is clear that people preferences for distance may vary according to personality and gender. subdisciplines has indicated that a lack of perceived control can result in subjective, behavioral, and physiological indications of Sanderson, Rapee & Barlow, 1989; Weiss 1972 as cited by Barlow et al., 1996, p. 279). The manner in which people interpret control over events can become a static characteristic of an individual, and this characteristic is known as either internal locus of control or external locus of control A person who believes that outcomes are a result of their own actions is said to have an internal locus of control, while a person who interprets events as simply happening to them has an external locus of control (Rotter, 1966 as cited by Barlow et al., 1996, p. 280). Expanding on these categories of control,

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 19 1990; Barlow, 1988, 1991; Lang 1985 as cited by Barlow et al., 1996, p. 280), thus, individuals with emotional disorders tend to have a more external locus of control. The relationship between perceived control and anxiety was the focus of research conducted by Barlow, Brown, Craske and Rapee (1996). Based on their investigations, they concluded that the Anxiety Control Questionnaire (ACQ) was a reliable, valid measure. Their concluding study demonstrated that ACQ responses are affected by psychological treatment. Nineteen participant s meeting the criteria for panic disorder with agoraphobia completed the ACQ before and after 12 weeks of cognitive behavioral therapy. Results reflected a significant positive change in ACQ scores; thus, the ACQ was an effective tool in measuring changes in perceived control and anxiety over the course of psychological treatment. The authors conclude from the research that the ACQ has strong internal consistency, has strong external validity, is stable over time, and assesses perceived control over anxiety related events. As such, the ACQ can be used to measure the efficacy of therapy for clients with anxiety disorders. Research on patients with chronic cardiac illness showed that patients with higher perceived control were able to walk further distances a nd had less emotional distress than did patients with low perceived control (Caldwell, Dracup, Erickson, Hamilton, Moser & Westlake, 2003). Fryback and Reinert (1993, as cited by Caldwell et al., 2003, p. 90) ty accompanying heart failure (HF) as have found that perceived control can reduce emotional distress after heart surgery or heart attacks (Miller, 1979 and Dracup, K. & Ziemann, K.M., 1990 as cited by Caldwell

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 20 et al., 2003, p. 90). These researchers explored the relationships among sociodemographics and clinical characteristics and perceived control, and the relationship between perceived control and emotional states. Pa rticipants first completed a 6 minute walking test to establish baseline walking distances. Next, participants completed scales the Control Attitudes Scale (CAS) that measured perceived control, and the Multiple Affect Adjective Checklist (MAAC) to measure anxiety, depression, and hostility. Finally, the participants completed another 6 minute walking test. Overall, the patients indicated a moderate level of perceived control, high levels of depression, moderate levels of anxiety, and moderate levels of hos tility (Caldwell et al., 2003, p. 91). anxiety, and depression and had better functional status. Sociodemographic variables had no significant effects. These results sugg est that people with heart problems generally experience negative psychological effects as a result of the heart problems, but that perceived control can improve these psychological effects. If this can be generalized to other people with psychological dif ficulties, one can infer that attempts to increase perceived control may result in partial alleviation of psychological problems. Seating, Control, and Environment How Do They Relate? Seating arrangements can convey a sense of control in the environment, but most research has been conducted on control alone. Research suggests a link between exposure to chronic environmental stressors and learned helplessness, and exposure is also correlated with mental health. This chronic exposure also results in deterio rated task performance and can bring about a depressed affect (Evans & Stecker, 2004). According

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 21 chronic stressors such as noise, crowding, traffic congestion, and pol lution, to Learned helplessness occurs when recurring attempts to control or cope with aversive environmen tal stressors fail and this failure can generalize from one set of uncontrollable stimuli to other settings. The most widely used method to study the motivational effects of helplessness is the behavioral aftereffects paradigm (Glass & Singer, 1972 as cite d by Evans & Stecker, 2004, p. 144) during which perseverance on a difficult or impossible task is observed after exposure to environmental stressors. Even the first learned helplessness study on humans by Hiroto (1974 as cited by Evans & Stecker, 2004, p 144) found that participants working under inescapable versus escapable noise were less successful at completing a later task as compared to those under the escapable noise condition. This effect was stronger for participants with an external locus of co ntrol, suggesting that beliefs about control affect susceptibility to helplessness induction. Interestingly, Miller and Seligman (1975 as cited by Evans & performance among a sample of nondepressed individuals closely resembled the suggesting that depressed individuals are naturally more vulnerable to helplessness and may ha ve an external lo cus of control Baum and Valins (1977, as cited by Evans & Stecker, 2004, p.145) reported that perceived control over stressors was inversely related to reduction in motivation. The authors also reported individual differences in vulnerability to impact on motivation and induction of helplessness, with the most

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 22 vulnerable groups being depressed individuals, adolescents, females, people with external loci of control, those who make internal failure attributions, and people with a high need for environmental control. As a result, clinical practitioners must be aware of the the office, as well as conduct therapy, accordingly. Desks and Anxiety People who are considered to have low anxiety levels interpret a desk between &Widgery, 1972). With highly anxious people, the opposite is true; they view an interviewer as more credible and less hos tile when no desk is present between themselves and the interviewer. Forty four participants were told that they would have an interview Widgery, 1972, p. 174). Half of the participants participated in a desk between condition and half were in a no desk between condition. After the interview, participants reported their anxiety during t were divided into low and high anxiety groups based on their answers. (The researchers recognize in their conclusion that a pre test should have been used to measure the ine anxiety levels before the experiment). The researchers found a significant interaction between anxiety level of participant and desk position. In the desk between condition highly anxious participants considered the credibility level of the interview er to be lower than participants in the low anxious group. The opposite was true for the no desk condition, with the interviewer viewed as more credible by highly

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 23 anxious participants. These results suggest that people who have low anxiety perceive a desk between themselves and an interviewer as increasing the credibility of the interviewer, but highly anxious people may perceive a desk between themselves and an level perception of the therapist. As such, counselors should consider arranging furniture so that clients can choose to sit behind a desk or simply sit near the counselor. Desk Place ment and Seating Arrangement in a Therapeutic Environment According to Pressley and Heesacker, 2001) there are eight elements that make up the counseling environment: accessories, color, furniture and room design, lighting, smell, sound, texture, and therm al conditions Though the way furniture is arranged in a convey a sense of enclosure, define spatial movement, function as walls, and communicate visible or invisible bou Heesacker, 2001, p. 151). In a therapeutic setting, it is necessary for the therapist to determine the message the space should convey and guide how clients interpret the space. As an example, th e authors describ e by Pressly & Heesacker, 2001, p. 151). More specifically, the distance between furniture must be considered, as indi viduals have unique comfort levels at different interpersonal distances, known as the body buffer zone (Pressly & Heesacker, 2001, p. 151). Few studies have examined interpersonal distance preferences in the therapeutic setting, but in this area [interpersonal space] indicate that clients prefer and

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 24 intermediate distance, ranging from 1.2 m (48 in.) to 1.5 m (60 in.) (Broekmann & Moller, 1973; Dinges & Oetting, 1972; Knight & Bair, 1976; Lassen, 1973; Lecomte, Bernstein, & Dumont, 19 81; G. L. Stone & Morden, 1976; as cited by Pressly & Heesacker, 2001, p. 151). as can gender (women tend to have smaller body buffer zones) and mental health status (people w ith schizophrenia tend to have larger body buffer zones) of the individual (Pressly & Heesacker, 2001, p. 151). As such, clinicians would benefit by having furniture that is easily moved and by adjusting the distance between themselves and their client acc affected by furniture arrangement, (Gass, 1984 as cited by Pressly & Heesacker, 200 1, p. 152) it was found that women respond more negatively than men to the counselor when seated behind a desk. Additionally, Widgery and Stackpole (1972 as cited by Pressly & Heesacker, 2001, p. 152) found that clients with higher anxiety levels responded negatively to a desk between themselves and the therapist, while people with low anxiety responded positively. Chaikin, Derlega, an d Miller (1976) found that warmer, more intimate settings yield higher self p. 479) and its characteristics can include resisting alteration, bare cement, a lack of windows, and increasing feelings of noncontrol. Sommer (1974 a s cited by Chaikin et al., 1976, p. 479) suggests that the characteristics of hard architecture may cause feelings of

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 25 counseling setting should yield the opposite effect and lead to greater self disclosure. Fifty riginal asphalt floor, cement walls, condition, the room was decorated with a rug, indirect lighting, pictures, smaller objects such as magazines, and a more comfortable ch air for the participants. Each participant took part in an interview with an experimenter which was videotaped to ensure consistency of experimenter (interviewer) behavior. Questions for the interview were ordered so that higher intimacy questions which w ould require more self disclosure were asked later in the interview. Afterward, the recorded interviews were watched by a rater blind to the hypothesis who rated the interviews on intimacy. Additionally, participants rated the experimenter, intimacy/warmth of the room, and their own level of relaxation. and feelings of relaxation, as well as a more intimate level of self disclosure than in the ion. Males and females did not differ in their responses. The comfortable settings, thus leading to more self disclosure. As such, the authors conclude alienation and counselor client distance and by increasing self

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 26 1976, p. 481). This study clarifies the importance of softness in the architecture and decor of a counseling setting. counseling interview analogue were assessed, and they were asked how this impression might influence future behavior. Participants listened to a taped segment of an adapted initial interview therapy session while watching a synchronized slideshow of a therapist in one of four conditions cross sports coat) and seating arrangement (b ehind desk vs. no desk). After watching the slide show and listening to the recorded session, participants completed The Counselor Rating Form (CRF) (Barak & LaCrosse, 1975 as cited by Gass, 1984, p. 54) to measure their tworthiness, expertness, and attractiveness. Overall, results showed that in the no desk situation, the casual apparel showed higher attractiveness ratings than did formal or casual attire in the behind desk situation. Differences were found between gender s in relation to desk presence: in the desk condition, males responded more favorably and perceived the therapist to be more expert and trustworthy, as well as males being more willing to enter therapy with the therapist seen. Females, on the other hand, r ated the therapist as less attractive when a desk was present. These results could be due to the gender of the therapist shown; people tend to prefer different distances between themselves and others depending on their gender and the gender of the person t hey are interacting with, thus the male participants may have simply wanted more space between themselves and another man. Regardless, results

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 27 showed that a desk between client and therapist can affect how the client views the therapist, and this perceptio abandoning the therape utic process. Because of this, counselors must be aware of the impression their attire and furniture arrangement have on the clients so as to facilitate the continuation of therapy. Hanyu and Miwa (2006) found that the interior design of a counseling room can rooms in general might (and should) have a calm, tense, and inactive atmosphere rather 7). All aspects of the setting can affect the communication and relationships in the counseling room. Gifford (1988, as cited by Hanyu & Miwa, 2006, p. 487) points out that home like decorations and dim lighting may create a more comfortable, intimate, cal ming atmosphere, which in turn can promote communication. More specifically, Flynn (1988, impression of relaxation and privacy that implied feelings people could talk more like decorations would evoke c lighting and home like decorations] may accentuate the pleasant feelings more than either 488). To test these hypotheses, participants

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 28 completed an interview with a counseling psychology graduate student (representing an initial intake session with a therapist) who read from a script based on the Ego Identity Status Interview for university students (Muto, 1979 as cited by Hanyu & Miwa, p. 490) in one of four room conditions. Each room had the same dimensions, no windows, white walls, two fluorescent lamps in the ceiling, two incandescent lamps on the wall, an incandescent table lamp, and two chairs separated by a table. The four room con ditions were: (a) without decorations and bright lighting in which no decorations were present, the incandescent lamps were off, and the fluorescent ceiling lights were on; (b) with decorations and bright lighting in which the ceiling lights were on but th e lamps were off and decorations were placed throughout the room (i.e., a carpet, tablecloth on table, small objects like a doll and flowers, and a drawing hung on the wall ) ; (c) without decorations and dim lighting in which there were no decorations and o nly the incandescent lights were on; and (d) with decorations and dim lighting in which there were the same decorations present (as in the with decoration and bright lighting condition) and only the lamps were on. Males and females did not differ in their responses; however, dim lighting was rated higher in the pleasant calming factor than bright lighting. Another effect of lighting emerged: the interviewer was rated significantly more positively in the dim lighting conditions on an evaluative factor, which included characteristics such as pleasant, familiar, pretty, good humored, and modest, than in bright lighting conditions. Also, participants in dim lighting conditions spoke significantly longer than participants in bright lighting conditions, and a simi lar effect with self reported feelings about self disclosure was found. The researchers conclude that although decoration did not impact

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 29 and the amount of self disclos their intimate behavior that is, moderate self disclosure 2006, p. 496 497). The authors note that these results may have been affected by the interviewer who could have acted differently in interviews based on the type of lighting. The researchers recommend that counseling professionals should be more aware of the environment in which therapy takes place and suggest that these professionals should be made aware of enviro nmental psychological research on counseling settings. Why Does Nature Matter? The Biophilia Hypothesis The Biophilia Hypothesis, proposed by Wilson (1984, p. 1 as cited by Gullone, e and lifelike humans still value nature. Ulrich (1993 as cited by Gullone, 2000, pp. 294 295) points being, reduc es the stress related with modern living and promotes physical well noticeable efforts to increase contact with nature, as seen by the elaborate gardens ancient peoples grew and maintained (Gullone, 2000, p. 294). Th e explanations for the Biophilia Hypothesis related to human evolution are supported in that the aspects of nature that humans tend to value or find attractive also tend to have survival value. For example, animals generally congregate toward bodies of wa ter and plants grow near water, providing opportunities to hunt and forage.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 30 Wilson (1993) further expanded upon his hypothesis by describing Biophilia (the innate attraction to/focus on nature) as arbitrated by learned associations between certain aff orda nces and dangers of nature. natural settings during our evolutionary history may have been so central to survival that natural selection favoured those individuals who acquired and retained certain pos itive or Support for the Biophilia Hypothesis is also found in preferences for natural elements. For example, adults and children prefer scenes that include a body of water i n the view (e.g., Bernaldez et al., 1989; Chokor & Mene, 1992; Shafer et al., 1969 as cited by natural landscapes (e.g., power lines) has a significant detrimental effect on preference simulated environments demonstrate a strong preference for a simulated natural environment over urban environments (e.g., Berto, 2005 as cited by Berman et al., 2008, p. 1209). Natural environments also provide intangible affordances: environments and 9, as cited adaptive by promoting recovery from physical or mood states, often associated with a decline in cognitive functioning or performance, such as illness or fatigue that interfere patients in rooms with a window view of nature recovered more quickly than patients

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 31 whose window faced a brick wall, in addition to having fewer negati ve comments in their files and requiring fewer pain killers. Gullone (2000) further relates the Biophilia Hypothesi s to cultural differences in the prognosis of the two most disabling psychopathologies, schizophrenia and depression. In less developed and non industrialized nations and cultures, such as Africa and regions 307). One ex planation for this phenomenon is the difference in lifestyle between industrialized and developing countries. Factors that result in industrialized countries having poorer prognoses for the mentally ill include care, computers, living by the clock, and lar ger communities whereas developing countries have less strict social rules and closer proximity to extended family (Cooper & Sartorius, 1977 as cited by Gullone, 2000, p. 308). Cultural differences also may contribute to the prognosis variation between cou ntries, as culture affects the manifestation and expression of psychological states modern environment to express our biophilic tendencies may impact negatively upon ou r Attention Restoration Theory s rich with inherently fascinating stimuli (e.g., sunsets) invokes involuntary attention modestly, allowing directed as cited by Berman, Jonides, & Kaplan, 2008, p. 1207). In short, attention is restored

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 32 when viewing nature. Specifically, directed attention, which is attention that supp resses overwhelming stimulation of the environment, is restored. Directed attention is not required when viewing nature, as natural elements automatically draw attention without the need to focus on the stimuli, providing an opportunity for the cognitive m echanisms responsible for directed attention to restore. Berman, Jonides and Kaplan (2008) expanded on prior research that illustrates the restorative potential of nature on cognition, and improved on previous methods by using a within nature. Mos t importantly, the researchers wanted to specify what kind of attention is types in an attention task p. 1208 ). Experiment 1 explored the cognitive performance effects of interactions with nature versus urban environments by using a backwards digit span task. This task involved participants being read digits and asked to repeat them in backwards order. A backward s digit span task was utilized because it requires directed attention since one must move the digits in and out of attentional focus. Participants first rated their moods on the Positive and Negative Affect Scale (PANAS; Watson, Clark, & Tellegen, 1988 as cited by Berman et al., 2008, p. 1208) to determine changes in mood over the course of the experiment. Participants then immediately completed the backwards digit span task, and after a directed forgetting task was given to fatigue participants. (By fatigu ing environments). Next, participants were randomly assigned to take a walk in either a park or downtown; walks were of equal distance and within five minutes of equal t ime taken

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 33 to complete the walk. Participants returned to the lab to complete the backwards digit span task and PANAS again, and also responded to questions about their walk. A week later, participants returned to complete the same experiment but in the oth er location; the order of walking assignment was counterbalanced for participants. Performance on the digit span task improved significantly after walking in the park but not after walking downtown. The performance on the task was not shown to be affected by mood or weather conditions, but mood improved after nature walks and not walks downtown. There were also no main effects of walking location order found. The second experiment aimed to expand upon the results of the first and to determine whether only directed attention is restored by interactions with nature. The Attention Network Task (ANT; Fan et al., 2002, 2005 as cited by Berman et al., 2008, p. 1209) was used in the second experiment in addition to the PANAS and backwards digit span task. The ANT differentiates between three separate attentional functions: alerting, orienting, and executive attention. The researchers hypothesized that only executive functions would improve after interactions with nature since the other two functions do not require as much cognitive control. Participants completed the PANAS and backwards digit span task as in Experiment 1, then performed the ANT. After, participants viewed either pictures of nature or urban settings for about ten minutes and rated their liking of eac h picture. Pictures were used in Experiment 2 rather than walks to show that the restorative effects of nature occur even when simply viewing them, as has been shown by previous research (e.g., Berto, 2005 as cited by Berman et al., 2008, p. 1209). After v iewing pictures, participants again completed the backwards digit span task, the ANT, and the PANAS. As in the first experiment, participants returned a week later to repeat

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 34 the procedure but viewing pictures of the other (nature or urban) environment. The parts of the ANT, which only occurred after viewing pictures of nature. Additionally, performance on the digit span task also improved only after viewing pictures of natu re. No differences were found on the alerting or orienting portions of the ANT after viewing nature or urban environments, suggesting that these cognitive mechanisms are not affected by the restorative potential of nature. Similar to the first experiment, participants rated pictures of nature more positively and rated them as more refreshing, suggesting that people may be aware of the restorative potential that nature holds. Overall, the results of these experiments strongly support the ART, and demonstrat e that only directed attention is restored by nature, not all cognitive mechanisms. Further research should consider including the ANT to advance support that only directed attention is restored, as other studies may suggest that all cognitive mechanisms a re improved or restored by nature. Exposure to natural environments leads to improvement in mood and concentration, and people tend to rate natural environments as more beautiful than built environments (Kool, van den Berg &van der Wulp, 2003). The prefere nce for natural over built environments has been well documented (Kool et al., 2003, p. 135 ) The (Kool et al., 2003, p. 136), and suggest that this effect may be more significant among stressed or fatigued individuals. Kool and colleagues (2003) conclude that the preference for natural environments is mediated by this perception of functionality and restorative potential of

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 35 the environment. Restorative potential involves four aspects of restorative experiences: being away, fascination, extent, and compatibility. The researchers hypothesized that: (a) natural environments would be rated more positively than built environments, (b) exposure to natural environments would be associated with more restoration from stress than built environments, (c) preferences for natural environments would be mediated by differences in restorative potential, (d) highly str essed participants would show more pronounced effects after exposure to different environments, and (e) that strength of negative changes after stress would be positively related to preferences for natural environments. Participants were randomly assigned to one of four conditions: (a) a natural environment with water, (b) a natural environment without water, (c) an urban environment with water, or (d) an urban environment without water. First, participants completed the Profiles of Mood States Scale (POMS ; Wald, 1984 as cited by Kool et al., 2003, p. 139) and rated their overall level of happiness and stress to establis h baseline ratings of the participan ts. Next, participants viewed a stressful movie, after which participants completed the POMS and overal l ratings of stress and happiness level again. Following this, the participants viewed simulated walks that included sounds in their randomly assigned environment. After watching the video, they rated the viewed environment on characteristics such as beaut y and naturalness, and completed the POMS and overall stress and happiness ratings a third time. Finally, participants finished the d2 Mental Concentration Test (Brickenkamp & Zillmer, 1998 as cited by Kool et al., 2003, p. 140), which is a letter cancella tion task, and speed and accuracy on the task were measured. Mood ratings after viewing the frightening movie were significantly more negative, indicating that the stress induction was effective. No

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 36 significant effects were found due to presence or absence of water, so it was dropped from further analyses. Participants who viewed the natural environment had greater restoration on all measures as compared to those who viewed built environments, as well as marginally better concentration. Natural environments were also rated as more beautiful than built environments. Even when the influence of environment was held constant, analysis reflected a positive relationship between affective restoration and beauty ratings. The authors conclude that preferences for nat ural over built environments were at least partially mediated by changes in affective restoration from the two environments. Finally, higher levels of stress were associated with higher preference for natural environments and significantly lower preference for built environments. These results suggest that the tendency to prefer natural environments is linked to affective restoration, and that this is more pronounced for stressed individuals. As such, highly stressed individuals should place more importance on exposing themselves to natural environments that those who have lower levels of stress. Why Windows Matter f the definition and quality of Heesacker, 2001, p. 153). Sunlight, in particular, has an even distribution of all wavelengths and contributes to physiological functioning; in the extreme sense, without sufficient exposure to sunlight, people can develop Seasonal Affect Disorder (Pressly & Heesacker, 2001, pp. 153 154). Thus, therapists sho uld consider incorporating as much

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 37 natural light as possible in their office, and if no windows exist, using full spectrum lighting. Views from a window that include nature positively affect the satisfaction and well being of humans (Kaplan, 2001). Though excellent light, good air quality, and interesting things to look at it is often not a days (Kaplan, 2001, p. 507). Looking o ut windows, depending on the view, is a frequent but brief activity that may provide restoration (Kaplan, 2001, p. 507). A great deal of evidence supports the claim that windows that view nature are more beneficial than those ies carried out in the contexts of hospitals and prisons has demonstrated the role of view content in the effectiveness of windows in speedy recovery 1986; West, 1986 as cited by Kaplan, 2001, p. 509). Even in a workplace setting a regardless of the content of the view. Additionally, research (Leather, Pyrgas, Beale, & Lawrence, 1998, p. 739 a s cited by Kaplan, 2001, p. 510) found that views of natural have a similar, albeit marginal, effect on general well being," suggesting that the beneficial effects of views of nature from a window are universal regardless of the setting. apartment communities with varied nature content surrounding the apartment complexes; thus the views from wi ndows varied. Participants rated how dominant 17 different

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 38 characteristics were in their window view and reported how often they check the weather, traffic, people walking by, and wildlife (Kaplan, 2001, p. 515). Participants also received a booklet of 40 black and white photographs depicting scenes within the six communities that were possible window views, and that contained varied natural elements, weather, and built components. For each photograph, participants rated how similar the image was to the vi ew from their apartment window(s) and rated how much they would like the view if it was from their window(s). Background information, nature related activities, and frequency of nature related activities were also recorded. Most importantly, participants r esponded to questions concerning their satisfaction with their residential environment as well as measures of well being. The most significant result was that 41% of the variance in satisfaction with nature was accounted for by the effect of nature views, and views of gardens and landscapes were the leading predictors. Views of nature were also predictors of well window views were preferred, and preference for a scene ac counted for 30% of the variance in satisfaction with nature and satisfaction with the neighborhood. Photographs of nature scenes with fairly unmanaged woods were most preferred and a view of trees was rated as relaxing, suggesting that the ideal view from a window overlooks woods that are undisturbed. Additionally, satisfaction and effective functioning were positively The more nature related activities participants engaged in, the higher their scores on

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 39 significantly detracted from residenti al satisfaction but did not affect well nature are important to satisfacti on and well being, and must therefore be taken into consideration when building or landscaping. Different types of lighting, even in the same room, can affect impressions of a room (Duraka, Gurcinar, Guvenc, Olgunturk & Yener, 2007). The visual impression s one the same lighting arrangement a ffect impressions of people walls, and a table in a corner. Individual participants completed a qu estionnaire about their impressions of the clarity, spaciousness, relaxation, privacy, pleasantness, and order of the room. Participants could vary the types of lighting in the room at 500 lux by controlling switches. The three variations in lighting type were general lighting (G), cove lighting (C), and wall washing (W).They found that different lighting arrangements hypothesis. The second hypothesis was also confirmed, as i mpressions differed at different illuminances. Clearly, different types of lighting affected impressions. For the therapeutic setting, cove lighting would be ideal as therapy should convey a sense of privacy/confidentiality, as well as be a relaxing, pleas ant place.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 40 Other Influences Many other factors of an environment affect the occupants of the space. For example, Bringslimark, Hartig, and Patil, (2009) suggest that exposure to indoor plants has psychological benefits for humans, such as higher pain tol erance and relaxation. modern societies spend most of their time indoors (e.g., U.S. Department of Labor, varied in methodology and operationalization of definitions and variables, such as time of exposure to plants and type of plant, but in general their results are in agreement. Several of the researchers reported gender differences (e.g., Kim & Mattson, 200 2; Liu et al., 2003 as cited by (Bringslimark et al., 2009, p. 429). Explorations of the effects of indoor plants on affect yielded inconsistent results, but it appears that plants had at least a moderate positive flowering plants have a greater effect comp 2009, p. 423). The authors conclude that indoor plants have a positive influence psychologically, but females are more impacted by the presence of indoor plants. This review highlights the need for more consis tent methodologies and replications, but makes clear the beneficial potential of indoor plants. Olfactory cues -smells -also affect mental health processes such as mood, and can influence behavior (Pressly & Heesacker, 2001, p. 154). For example, res earch by

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 41 unpleasant smell than following exposure to a smell Pressly & Heesacker, 2001, p. 154). The fact that smell affects cognition should be ta ken into account in a therapeutic setting. Unpleasant smells in the office can be masked and the therapist should not apply too much cologne or perfume (Pressly & Heesacker, 2001, p. 154). Just as smells can affect humans, so can noise; too much sound can have physiological effects and repeated exposure to loud noise can even lead to chronically tensed muscles or permanent hearing loss (Pressly & Heesacker, 2001, p. 155). Sound can be perceived differently depending on the setting. For example soft fabrics and sound panels absorb noise while higher ceilings can lead to echoes (Pressly & Heesacker, 2001, p. 155). Sound is particularly undesirable when the noise is unexpected, so white noise machines can be utilized in therapeutic settings to reduce startling clients and detracting from the therapeutic process as well as increase privacy (Pressly & Heesacker, 2001, p. 155). Texture of fabrics also impacts the perception of a room; soft textures can both absorb sound and lead to perceptions of privacy or intima cy, while heavy textures can cause perceptions that the room is cold (Pressly & Heesacker, 2001, p. 156). The thermal conditions of a room must also be considered when trying to able in able to be controlled by the therapist or client and humidifiers may be used t o maintain a comfortable level of humidity. Since people have individual preferences for room temperatures, blankets or sweaters should be available to clients and fans for those who

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 42 prefer cooler temperatures. Much more research is necessary on the topic of the change. The focus of the current experiment is on furniture placement and room design, though all eight elements discussed by Pressly and Heesacker (2001) should be taken into consideration when creating a therapeutic space. artwork, one must consider th at it may be interpreted differently by individuals, and the authors conclude that people prefer artwork that depicts a different environment than the one they are currently in, especially natural environments (Pressly & Heesacker, 2001, p. 149). Additiona lly, natural accessories could be especially beneficial to humans, with the 2001, p. 149). Clearly, there are a plethora of components that make up the therapeutic env ironment. A therapist should consider all of these components when arranging and decorating an office. However, the current study explores desk placement, window presence/absence, presence/absence of natural objects, and presence/absence of status symbols. Due to the research described previously, it is expected that all participants will prefer a high degree of naturalness (window and natural objects present) and a high degree of control (no desk or status symbols present). No gender differences are expect ed.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 43 Method Participants Participants were 382 respondents recruited from the general population that agreed to complete an online survey. (Participants who did not consent to take the survey, did not complete the survey, or checked both male and female as gender were excluded, resulting in N = 352). All participants indicated that they were at least 18 years old. They were recruited through word of mouth, online requests, and use of a snowballing method. Thirty initial participants were excluded for not co nsenting to take part in the experiment and/or not completing the entire survey. Materials An online survey (See Appendix ) was created using SurveyMonkey (Surveymonkey.com). It included a section that asked for the participants' informed consent to participate in the research. Questions asked participants to indicate their gender, whether they had been clients in therapy, and whether they were certified t herapists/counselors. The survey included 6 images, labeled with numbers, which depicted different furniture arrangements of an office. These arrangements included desk against a wall with or without a window present, desk between therapist and client with our without a window present, and no desk with or without a window present. Images with no desk were considered to project a high amount of control, those with a desk against a wall a moderate amount of control, and images with a desk between client and t herapist were considered to project a low amount of control. Images with a window present indicated a high amount of naturalness, while those with a window absent

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 44 represented a low amount of naturalness. Images were created using SweetHome3D. The instructi ons asked the participant to imagine that they were sitting in the blue chair depicted in the image and to choose which room they would prefer as a setting for therapy. The last section of the survey contained a list of objects, and participants were asked to indicate whether they would want the object present in a therapeutic setting. Some objects represented naturalness (i.e., window, plants, fountain, etc.), some represented control and status (i.e., awards and diplomas), and some objects were simply fil lers to ensure that participants did not simply select objects at random (i.e., tr ash can, calculator, etc.). The order of objects listed was randomized for each participant as a further control. Stimuli Each of the images created using SweetHome3D softwar e was a 3 D model of the tall and 3 feet wide, was present in every picture. The images varied according to furniture arrangement and presence as described above. The tall. The window, when present, was always in the same location. The blue chair was between chairs when present and not against a wall.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 45 Procedure o their convenience and schedule. The introduction of the survey contained a consent form which informed participants of the confidentiality, purpose, and risks of the experiment, and emphasized that no responses were wrong. There were no risks associated with this experiment, but participants were told at multiple points in the survey that they could stop participating at any time should the experiment elicit any negative emotions. Participants were thanked for taking part in the experiment, and informatio n that would allow them to contact the researcher with any questions or comments was provided.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 46 Results Participants indicated a clear preference for the room stimuli that projected a moderate amount of control and a high degree of naturalness in their depiction of a therapeutic setting (See Figure 1 Figure 2, and Table 1). Participants selected image 5 most often (53%), image 2 second most often (21%), and image 4 third (12%), A Chi 2 (5, N = 352) = 379.01, p < .0001, Cramer s V = .734 suggesting that the room selection responses were significantly different and not due to chance. Of the object selection responses, the majority of participants indicated they wanted some of the natural objects present (particula rly plants and windows), while fewer participants wanted status symbols present (see Table 2). Male and female participants did not differ significantly in their room selection responses. Fifty six percent of males selected image 5 first, 13% chose image 4 and 15% chose image 2; 51% of females chose image five, 12% number 4, and 23% chose image two (see Table 3) A 2x6 Chi 2 (5, N = 339) = 9.126, p V = .164. A minority of both males and females wante d status symbols present, while the majority of participants wanted plants and windows present but only a minority wanted the rest of the natural objects present (see Table 4). The majority of both therapists (63%) and non therapists (52%) chose image num ber five, 21% chose image four, and 5% chose image two; 12% of non therapists differ significantly from non 2 (5, N = 339) = 7.15, p V = .209. As depicted in detail in Table 6, more participants indicated they wanted diplomas than awards present, and a significant majority selected plants and windows

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 47 present. A moderate number of participants, therapist and non wanted the other natural objects presents. Finally, participants that had experience as clients differed significantly from those that had no experience in therapy. A 2x6 Chi Square test of independence 2 (5, N = 339) = 25.44, p < .000 V = .274. Although the majority of all participants chose image number 5, as shown in table 7, more clients selected image 5 (59%) than did non clients (42%), and non image selections had more variation. Of clients, 17% chose image tw o while 9% chose number 4; non client responses showed that 30% chose image number 2 and 19% chose image four. Of object selections (see Table 8), participants most often indicated they wanted plants and windows present, while fewer participants wanted awa rds and diplomas present in the therapeutic environment. Discussion Although participants, as expected, preferred a high degree of naturalness, they indicated that they wanted a moderate, rather than high, amount of control. A significant majority preferr ed the image depicting high naturalness and moderate control, and also indicated they preferred to have plants and windows present. Unexpectedly, participants preferred to have diplomas but not awards present in the counseling room; diplomas and awards are considered status symbols, and the presence of these symbols can communicate a lack of control to the visitor. Thus, by choosing only one of the two status symbols, participants indicated they would prefer to have a moderate amount of control.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 48 Participan ts did not choose images at random as supported by the statistic al examinations. The analysis of males and females showed similar results, thus no significant gender differences were found. When comparing therapists to non therapists, nearly identical find ings emerged; the majority of both groups selected image five, so no significant differences existed between image selections of therapists versus non therapists. The final analysis comparing clients to non clients showed a pattern that responses were not due to chance, but participants who had never participated in therapy had more variation in their responses, while clients were more in agreement. Overall, the results were significant and similar across all participants, with the exception of clients when compared to non clients, suggesting that the experiment was effective and reliable, with no possibility that the results were due to chance. Additionally, these results suggest that experience in therapy has an effect on preferences in a counseling settin g. As discussed, results from the object choice question yielded significant results, somewhat in the expected direction. Though participants indicated they wanted some natural objects, particularly windows and plants, they did not select other natural obj ects as much such as candles and zen gardens. Additionally, participants preferred the presence of diplomas present more than awards. It is possible that people did not perceive certain objects as natural, or not as natural as plants/windows, so the natura lness of the objects included in this study may need to be examined in terms of how people actually perceive them. In order to more fully understand how people feel toward different objects being present in a therapy setting, future studies should conside r having participants rank, rather than select objects. By doing so, researchers could assess the extent to which people want

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 49 an object present. This suggestion is based on a few comments made by participants who indicated that they had selected certain ob jects about which they did not feel strongly, while other objects were things that they would absolutely want present. In addition to assessing the strength of the preference, researchers could ask participants to explain their selections in order to bette Participants also indicated that the 3 D model of the room was hard to imagine as real, as all of the images were too bare. There was also only one seating option for participants, and the window and do or were always in the same place. Participants strongly indicated that they would have liked different seating options, and many indicated that they would like a couch present in the room. To alleviate these problems in further replications of this study, more detailed 3 D images should be utilized. If possible, perhaps a computer program could be designed so that participants could design the room themselves, allowing them to decide the distance between furniture, the placement and orientation of furniture the type of furniture, and the decorations and objects present in the room. Another way to accomplish the open endedness of that design would be to give participants a physical scale 3 D model of a room with scale furniture, objects, decorations, and mov The third option would be a live interaction method in which participants were given a real room with objects and furniture that could be arranged according to preferences. Finally, multiple rooms arranged and decorated for participants to choose from rather than the digital 3 D images of the current experiment could be an effective method for replications of this study

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 50 As the review of the empirical literature predicted, participants stro ngly indicated they preferred the presence of a window and a moderate amount of control as dictated by furniture arrangement. However, there are a plethora of other factors that contribute to our perceptions of our surroundings. Future studies should explo re what other characteristics of the c ounseling setting people prefer such as wall color, type of artwork, odor, brightness of room, type of furniture, and temperature. To completely understand what a therapeutic setting should resemble, all aspects of the environment must be explored. By and large, however, the results of this study are a step in the right direction for the design of the perfect counseling room.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 51 References Ackerman, R., McElroy, J. & Morrow, P. (1983). Personality and interior office design: Exploring the accuracy of visitor attributions. Journal of Applied Psychology, 68, 541 544. doi:10.1037/0021 9010.68.3.541 Akalin Baskaya, A., Hidayetoglu, M.L. & Yldirim, K. (2007). Effects of indoor color on mood and cognitive performance. Building and Environment, 42, 3233 3240. doi: 10.1016/j.buildenv.2006.07.037 Barlow, D., Brown, T., Craske, M. & Rapee, R. (1996). Measurement of perceived control over anxiety related events. Behavior Therapy, 27, 279 293. do i: 10.1016/S0005 7894(96)80018 9 Berman, M., Jonides, J. & Kaplan, S. (2008). The cognitive benefits of interacting with nature. Psychological Science, 19, 1207 1213. doi: 10.1111/j.1467 9280.2008.02225.x Brinslimark, T., Hartig, T. & Patil, G. (2009). The psychological benefits of indoor plants: A critical review of experimental literature. Journal of Environmental Psychology, 29, 422 433. doi:10.1016/j.jenvp.2009.05.001 Broekmann, N. & Moller, A. (1973). Preferred seating position and distance in various situations. Journal of Counseling Psychology, 30, 504 508. doi: 10.1037/h0035103

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 52 Caldwell, M., Dracup, K., Erickson, V., Hamilton, M., Moser, D. & Westlake, C. (2003). Perceived control reduces stress in patients with heart failure. The Journal of Heart a nd Lung Transplantation, 22, 90 93 doi:10.1016/S1053 2498(02)00454 0 Campbell, D. (1979). Interior office design and visitor response. Journal of Applied Psychology, 64, 648 653. doi: 10.1037/0021 9010.64.6.648 Chaikin, A., Derlega, V. & Miller, S. (1976). Effects of room environment on self disclosure in a counseling analogue. Journal of Counseling Psychology, 23, 479 481. doi: 10.1037/0022 0167.23.5.479 DiMattia, D. & Haase, R. (1970). Proxemic behavior: Counselor, administrator, and client preference for seating arrangement in dyadic interaction. Journal of Counseling Psychology, 17, 319 325. doi: 10.1037/h0029662 Durak, A., Gurcinar, Y., Guvenc, D., Olgunturk, N. & Yener, C. (2007). Impact of lighting arrangements and illuminances on different impression s of a room. Building and Environment, 42, 3476 3482. doi: 10.101016/j.buildenv.2006.10.048 Edwards, D. (1977). Perception of crowding and personal space as a function of locus of control, arousal seeking, sex of experimenter, and sex of subject. The Jour nal of Psychology, 95, 223 229. doi:10.1080/00223980.1977.9915884 Emmers Sommer, T., Engstrom, E. & Jackson, D. (2007). Think leader, think male and female: Sex vs. seating arrangement as leadership cues. Sex Roles, 57, 713 723. doi: 10.1007/s11199 007 9289 y

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 53 Evans, G. (2003) The built environment and mental health. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 80, 536 556. Evans, G. & Stecker, R. (2004). Motivational consequences of environmental stress. J. of Environmental Psychology, 143, 1 23. doi: 10.1016/S0272 4944(03)00076 8 Gass, C. (1984). Therapeutic influence as a function of therapist attire and the seating arrangement in an initial interview. Journal of Clinical Psychology, 40, 52 56. doi: 10.1002 /1097 4679(198401)40:1<52::AID JCLP2270400109>3.0.CO;2 6 distance and orientation. Journal of Nonverbal Behavior, 10, 207 214. doi:10.1007/BF00987480 Gullone, E. (2000). The Biophilia hypothesis and life in the 21 st century: Increasing mental health or increasing pathology? Journal of Happiness Studios, 1, 293 321. doi: 10.1023/A:1010043827986 Hanyu, K. & Miwa, Y. (2006). The effects of interior design on communication and impressions of a counselor in a Counseling Room. Environment and Behavior, 38, 484 504. doi: 10.1177/0013916505280084 Hartig, T. & Staats, H. (2006). The need for psychological restoration as a determinant of environmental preferences. J. of Environmental Psychology, 26, 1 12. doi: 10.1016/j.envp.2006.07.007 Heesacker, M. & Pressley, P. (2001). The physical environment and counseling: a review of theory and research. J. of Counseling & Development, 78, 148 161.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 54 Herzog, T., Maguire, C. & Nebel, M. (2003). Assessing the restorative components of environments. J. of Environmental Psychology, 23, 159 171. doi: 10.1016/S0272 4944(02)00113 5 Joye, Y. (2007). Architectural lessons from environmental psychology: The case of biophilic architecture Review of General Psychology, 11, 305 328. doi: 10.1037/1089 2680.11.4.305 Kaplan, R. (2001). The nature of the view from home: Psychological benefits. Environment and Behavior, 33, 507 544. doi: 10.1177/00139160121973115 Kool, S., van den Berg, A. & va n der Wulp, N. (2003). Environmental preference and restoration: (How) are they related?. J. of Environmental Psychology, 23, 125 146. doi: 10.1016/S0272 4944(02)00111 1 Lott, D. & Sommer, R. (1967). Seating arrangements and status. Journal of Personality and Social Psychology, 7, 90 95. doi: 10.1037/h0024925 McElroy, J. & Morrow, P. (1981). Interior office design and visitor response: A constructive replication. Journal of Applied Psychology, 66, 646 650. doi: 10.1037/0021 9010.66.5.646 Miller, S. (1979). Controllability and human stress: Method, evidence, and theory. Behavioral Research and Therapy, 17, 287 304. doi:10.1016/0005 7967(79)90001 9 Sommer, R. (1959). Studies in personal space. Sociometry, 22, 247 260. doi: 10.2307/2785668

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 55 Stackpole, C. & Widg ery, R. (1972). Desk position, interviewee anxiety, and interviewer credibility: An example of cognitive balance in a dyad. Journal of Counseling Psychology, 19, 173 177. doi: 10.1037/h0032709 Timko, C. (1996). Physical Characteristics of Residential Psyc hiatric and Substance Abuse Programs: Organizational Determinants and Patient Outcomes. American Journal of Community Psychology, 24, 173 193. doi: 10.1007/BF02511886 Zweigenhaft, R. (1976). Personal space in the faculty office: Desk placement and the stud ent faculty interaction. Journal of Applied Psychology, 61, 529 532. doi:10.1037/0021 9010.61.4.529

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 56 Appendix Online Survey 1. Have you ever been a client in therapy or counseling? Yes No 2. Are you a professional therapist or counselor? Yes No 3. Are you? Male Female 1.

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 57 2. Please indicate any objects that you would like present in the therapy setting. (Check all that apply). Tissues Sweaters Stress ball/tactile objects Candles Pictures Games Paper weight Fan

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 58 Awards of professional Blankets Shelves Clock Trash can Diplomas of professional Mints/candy Textbooks Fountain/waterfall Fish tank Calculator Plants Rug Windows Calendar Zen garden (sand tray) Paintings on wall Pen and paper Other (Please specify)

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 59 Figure 1 Image Choices by Percentage of Participants

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 60 Figure 2 Object Choices of Participants

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 61 Table 1 Image Choices by Percentage of Participants Image Number % Chose One 2.27% Two 21.02% Three 4.26% Four 12.22% Five 52.84% Six 7.39%

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 62 Table 2 Object Choices by Percentage of Participants Object % Selected Diploma 51.99% Award 33.52% Plant 76.70% Fish Tank 50.57% Candle 30.97% Stress Ball 49.72% Waterfall 35.23% Window 78.98% Sandtray 35.23%

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 63 Table 3 Image Choices by Percentage of Males vs. Females Image Number Males Females One 1.90% 2.43% Two 15.24% 23.48% Three 7.26% 2.83% Four 13.33% 11.74% Five 56.19% 51.42% Six 5.71% 8.10%

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 64 Table 4 Object Choices by Percentage of Males vs. Females Object % Males % Females Diploma 49.52% 53.04% Award 37.14% 31.98% Plant 61.90% 83.00% Fish Tank 45.71% 52.63% Candle 23.81% 34.01% Stress Ball 44.76% 51.82% Waterfall 32.38% 36.44% Window 76.19% 80.16% Sandtray 36.19% 34.82%

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 65 Table 5 Image Choices by Percentage of Therapists vs. Non Therapists Image Number Therapists Non Therapists One 5.26% 2.10% Two 5.26% 21.92% Three 5.26% 4.2% Four 21.05% 11.17% Five 63.16% 52.25% Six 0.00% 7.81%

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 66 Table 6 Object Choices by Percentage of Therapists vs. Non Therapists Object % Therapists % Non Therapist Diploma 73.68% 50.75% Award 36.84% 33.33% Plant 78.95% 76.28% Fish Tank 31.58% 51.65% Candle 42.11% 30.33% Stress Ball 31.58% 50.75% Waterfall 36.84% 35.14% Window 73.68% 79.28% Sandtray 26.32% 35.74%

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 67 Table 7 Image Choices by Percentage of Clients vs. Non Clients Image Number Clients Non Clients One 2.14% 2.54% Two 16.67% 29.66% Three 3.85% 5.08% Four 8.97% 18.64% Five 58.55% 41.53% Six 9.83% 2.54%

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THE PERFECT ROOM: PREFERENCES IN A THERAPEUTIC ENVIRONMENT 68 Table 8 Object Choices by Percentage of Clients vs. Non Clients Object % Clients % Non Clients Diploma 51.28% 53.39% Award 35.04% 30.51% Plant 76.92% 76.27% Fish Tank 49.15% 53.39% Candle 30.34% 32.20% Stress Ball 49.57% 50.00% Waterfall 33.76% 38.14% Window 75.21% 86.44% Sandtray 35.90% 33.90%