A Chair By Any Other Name

The NY Times Penelope Green asks “What’s in a Chair?“. In this three page piece, she delves into the home-based practice of some psychoanalysts.

There was the strict Freudian whose couch was covered in plastic and who barely spoke, though every once in a while a phrase like “mother’s milk” might have slipped out. Another’s office featured phallic African statuary and pictures of a young wife, who was herself always audible somewhere in the background. A licensed clinical social worker had lots of comfy, overstuffed furniture and encouraged patients to sit anywhere (sessions ended in long hugs that suggested much countertransference). Her last analyst, with whom she spent a fruitful decade, did not see patients in his home, but in an office building, and his room there held nothing more than two nondescript leather chairs, a bookcase lined with medical texts and a table holding a box of tissues.

The piece talks about how the home office of a psychoanalyst can negatively affect the patient/client. One past patient, who is a doctor now herself says:

“The session was on Saturday mornings and so I’d see her son, the glaring teenager, who was obviously resenting her time away from him. I felt guilty. I felt angry. They were wealthy; I was just starting out. The first session, the door was opened by a maid. For someone who didn’t come from money it was very intimidating.” At the same time, it was a deeply nurturing experience, she said, adding this caution: “Just because it feels good in the moment doesn’t mean that it’s ultimately therapeutic.”

I have to agree with Dr. Maroda on this one. There are so many ways that office furniture can negatively affect a patient. If, for instance, I was victimized in a home with a thousand knick-knacks, I would prefer to be in an office with only a desk a couple of leather office chairs. Or vice versa. And I wouldn’t want to think that their family members were listening while I was pouring my heart out- or that I was somehow at fault for causing family rifts. There are some really compelling reasons for a therapist to have a separate office space, the above are just a few.

A doctor that doesn’t agree with Maroda said:

I think there is always a dialectic tension between the personal and the professional and we lose a lot by making the setting too clinical. There is something engaging in seeing the therapist has a real life, and is a real person.

But in talk therapy is that what the patient needs? Do they need to relate so well to the therapist? Isn’t there always a danger, without the overt familiarity, that the patient will identify too much with the doctor? If I sit down with a therapist, I don’t want to know what’s happening in his or her life. I’m sorry. But I’m there to get help with my problem in my life. I don’t want the distractions of knowing the good doctor could and should be seeing little Suzie’s play instead of listening to me.

Dr. Robert Langs says this about home offices:

there is only one archetypal unconscious view of a home office. And that is that the home office is totally inappropriate and destructive to the patient. And what about the impact on the therapist’s own family?

That’s an excellent question. What about the young teen who peeks in to mom’s office and sees someone freaking out during a “breakthrough”? What about doctor’s with young children? How do those kids react to patients coming in and raising a fuss (which is what some patients do when trying to make progress)? The children aren’t allowed into the room, obviously, but it’s a part of their home that’s closed off to them. Not only that, what they do hear and see can negatively impact them for years to come- possibly causing them to seek out their own therapist as adults.

The article is interesting in that it focuses on some things that patients seeking doctors might not think about. Sure, when you’re seeking therapy, a home-based therapist might seem the best way to go. But that isn’t necessarily conductive of a good relationship between the doctor and patient and/or the doctor’s family and the patient. My opinion is that therapists need an office away from home.

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