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The birth of Clinical Psychology was not detached from a broader historical and cultural process.Foucault (2011) argues that in the beginning of the XIX Century a new conception of medical care was created: one that had a scientific background. The war medicine that characterized the previous centuries no longer could define these new practices. Besides, as Fabiani (2019) points out, Europe and United States had a population growth in the XVIII Century, due to Industrial Revolution and improvements in health system. According to the author, this led to a pressure for specialized treatment. Clinical Psychology had this background when it was developed (Foucault, 2011).
In terms of practice characterization, the space in which the clinical psychologists performed their work were similar to those above-mentioned medical settings (Foucault, 2011). One space that was also part of psychological clinical practice was the waiting room.
Cambridge Dictionary (2024) defines the waiting room as “a room in a place where people can sit while waiting, as in an airport or a doctor’s office”. Those places are not restricted to private clinical settings, but are also part of the primary health care network of many countries.
In the Clinical Psychological literature, when analyzed from the perspective of therapeutic effectiveness, some variables are considered relevant for treatment engagement. Some authors consider that environments recognized as safe, with empathetic therapists capable of providing welcoming, bring better and more lasting results in terms of effectiveness, especially for those with more complex conditions like pediatric patients (Fryburg, 2021; Higuera-Trujillo et al., 2020).
In this sense, it is possible to suggest that the relational dynamics related to the therapist-client dyad is permeated by several and complex factors, ranging from expectations regarding treatment and the severity of the involvement to the quality of the relationship (Cuijpers et al., 2019). These factors are all imbricated in a multidimensional system, in which each variable fulfills its role. This relational dynamic can be broken down into several sub-processes such as knowledge about that clinician or the practice, recommendations of others, they all play a role on the efficacy of the treatment. The initial appointment, whether with the secretary or the clinician directly, can generate feelings of anxiety or anguish in the patient due to several factors, such as fear of facing the disease, not recognizing themselves as sick, or aversion to health professionals, which may delay the start of treatment due to this type of feeling (Noble & Devlin, 2021). All these variables are related to the efficacy of the treatment. Also, the physical space plays a role on this. In this case, the waiting room is an illustrative example.
During the Twentieth Century, many investigations were conducted that had the waiting room as an object (Lamb, 2021; Williams et al., 2019). Many clinicians were worried about how to improve their services reducing patient’s anxiety, like in dental clinics (Chabria et al., 2021), about the impact of music (Lai & Amaladoss, 2022), about educational practices (Yvonne Chan et al., 2010) and how to improve general satisfaction (Mowen et al., 1993). Many variables were identified to be enrolled in patient’s perception involving such space.
In the waiting room, the waiting time was also investigated as a relevant variable in the context of general satisfaction. Waiting time - defined as the actual time spent both in the waiting room and in the examination rooms prior to formal care (Chu et al., 2019) - seems to be directly related to the quality of care and the willingness to want to return to that service later.
Chu et al. (2019) conducted fifty-six interviews with patients diagnosed with HIV who were treated at a specialized clinic in the United States of America. The authors found that patients tolerate a certain level of waiting, but there is an impact when it is not justified by the clinician or the clinician does not apologize for it. Therefore, certain behaviors of the clinician due to possible delays can mitigate the negative experience of waiting time and increase the patient’s perception of the quality of care. The authors also point out that knowledge about the time spent waiting, as well as knowing about possible delays, reduces anxiety, stress and anguish, helps in the adjustment of expectations and tends to create greater tolerance. Also, according to this study, patients who have been diagnosed more recently, or who are more severely affected, tend to tolerate longer waiting times, as they tend to have greater anxiety or anguish.
As pointed out by Chu et al. (2019), shorter consultation time and longer waiting time generated lower satisfaction with the quality of care. Those patients who showed greater satisfaction with the services usually had a shorter waiting time and a greater willingness to return to the service. The research’s results showed a decrease of 2% in the willingness to return per minute spent waiting. These results suggested that reducing the time spent in the waiting room can positively impact satisfaction with care and increase patients’ willingness to use that service again in the future.
In a study conducted in an emergency department (Shaikh et al., 2012), it was noted that participants tend to have a maximum tolerance for waiting for care in about two hours for half of the participants (n=170). In this study, there was no association between willingness to wait and gender, financial status, or perception of symptomatologic severity (Shaikh et al., 2012).
Some authors point out that the adverse effects related to waiting time can be minimized by increasing the physical attractiveness of the environment (Zhang et al., 2022). These authors argue that such perception impacts the level of anxiety and the perception of quality of care since they would function as explicit distractors, affecting the internal clock and diverging attention from the actual passage of time. The authors conducted an experiment in a hospital ward with preand post-testing, in which artistic visual elements were implemented such as paintings with natural motifs, such as flowers, fields or open spaces. They also changed the content of the television in the waiting room, all focusing on this natural theme. The time spent observing these objects, social and individual interaction (e.g., using a cell phone), getting up and stretching were observed. The authors observed that after the insertion of the artistic elements in the environment, which did not have them initially, there was a decrease in the behavior of looking at others, which increases the feeling of privacy, there was a reduction in restlessness, that is, the clinic attendees remained more seated in their seats and stretched less. An increase in socialization was also noted, which was measured through the greater number of social interactions by the participants. There was also a significant decrease in noise and people began to speak at a lower decibel frequency, which was interpreted as indicative of a more serene mood. Finally, it was possible to suggest that, in this context, the use of positive distractors, such as the presentation of artistic elements with a focus on natural elements, and the reduction of noise in the environment, seemed to generate more sense of serenity, which can impact the perception of waiting time and pre-service emotions.
Lai and Amaladoss (2022) conducted a systematic review on the effects of musical intervention in waiting rooms, whether through formal processes such as music therapy or less explicit such as ambient music, it was recognized that it was able to produce several therapeutic effects, such as the reduction of stress levels, anxiety and isolation, distraction of painful signs and reduction in certain emotional afflictions (Lai & Amaladoss, 2022). In another study, an anxiolytic effect was found by a non-pharmacological route from musical interventions, which suggests that it can be used as a therapeutic adjunct (Fryburg, 2021). However, for music to have such an effect, it seems to be necessary that there be an appreciation for the musical style. Tansik and Routhieaux (1999) conducted a study in a hospital with patients undergoing cancer treatment about the effects of music in the waiting room. They found that lounge music, followed by classical and jazz, increased the participants’ level of relaxation. This choice was due, as the authors point out, to the more melodic and pleasant character to listen to, which makes the lounge the type of choice of excellence for most people (Tansik & Routhieaux, 1999).
The smell of the environment was also considered an important route of action for improving mood and reducing anxiety (Chabria et al., 2021). Specifically, the smells of lavender seemed to produce relaxing sensations and greater calming effects. The use of specific essential oils in the clinical environment, based on these sedative properties, is considered beneficial and adjuvant in the treatment, at least for dental practices.
Stroke patients who underwent counseling, watching videos in the waiting room, and reading materials available in this environment were more engaged in behavioral change practices for healthier behaviors such as smoking reduction and diet, when compared to a control group (Smalley et al., 2020). Authors suggested that the waiting room is a space for educational interventions.
The waiting room is a space that can be used for clinical and salutogenic interventions as seen above. Over time, numerous factors were analyzed that aimed to reduce the negative feelings generated by the consultations, or that aimed to generate useful information, or that sought to generate relaxation. However, most of the literature were conducted on hospitals or dentists or medical contexts, leaving few clues for clinical psychologists in a private care context. To date, only one thesis investigated simultaneously clinicians and patients’ perception on the waiting room (Noble & Devlin, 2021). In order to fill this gap, and to better understand the local variables, this study was carried out investigating how a series of elements usually found in waiting rooms are frequent and considered important for both clinicians and patients.
METHOD
PARTICIPANTS
The target population for the application of our research were clients attending to some modality of Cognitive-Behavioral Psychotherapy (group 1) and cognitive behavioral therapists (group 2). The following inclusion criteria were established: (a) minimum age of 18 years for both groups; (b) attending, at the time of data collection, some modality of Cognitive-Behavioral Psychotherapy, in any of its traditions, for group 1 and (c) being enrolled at Brazilian Federation of Cognitive Therapies (FBTC)’s database at data collection time for group 2, since the research was distributed this way.
It was calculated from the Gpower software (Mayr et al., 2017) that at least 73 participants in each group would be needed assuming analyses of the family of t-tests of independent samples, considering a statistical power of 85%, assuming a two-tailed criterion for type 1 errors with an error rate equal to 0.05, to detect a significant difference in the effect size of 0.5 (Field, 2020). The sample consisted of 184 participants in which 105 were therapists and 79, clients.
For the clinician’s group (n=105), 93 participants identified themselves as women (88,57%). The mean age was 38.4 years old (SD 13.4). In terms of geographic distribution, 10 were from the Midwest, 18 from the Northeast, 6 from the North, 46 from the Southeast and 25 from the South. On the time they were psychotherapists, 4 were less than 2 years ago, 37 between three and six years, 18 between seven and ten years and 46 for more than ten years.
For the client’s group (n=79), 58 identified as women (73,41%). The mean age was 34.6 years old (SD 12.2). Regarding geographic distribution, 9 were from the Midwest, 2 from the Northeast, 1 from the North, 50 from the Southeast and 17 from the South.
INSTRUMENTS AND MATERIALS
Sociodemographic variables were initially collected from all participants (gender, age, and region of the country). In addition to those, for the group of therapists, they were asked how long they had been cognitive-behavioral psychotherapists.
Besides that, the authors of this study created a questionnaire in order to assess participant’s perception of items. The same questionnaire was applied to both groups, with linguistics adaptations for each group such as “in your psychotherapist’s office” and “in your office”. Participants were presented with a set of 12 items (music, paintings, television, if patients stayed alone in the waiting room, if they have secretary, beverages, carpets, windows, flavorings, magazines and/or newspapers, food and toys). For each item, participants had to perform two judgments and one justification. The first was if that item was available in their waiting room (or their psychotherapist). The second judgment participants had to rate, using a 5-point Likert scale, how important they considered those items. And finally, they could provide justifications for their answers.
PROCEDURES
Data collection was carried out online for both groups, using the sogolytics.com platform. Participants were instructed to answer the survey in their own time, individually, and to make their judgments according to what most closely matched their judgment about the items. The platform itself ensures that links could not be forwarded, so it is possible to ensure that all respondents were part of the FBTC database or clients related to the private clinical.
Participants received a link, in which they were presented the survey. They all had to read the objectives of the research and to sign the online version of the Consentment Form. After that, they responded the sociodemographic questions and, then, the ones related to the items.
For the group of psychotherapists, the board of directors of the Brazilian Federation of Cognitive Therapies (FBTC) was contacted in order to explain the objectives and relevance of the research and to request its dissemination among the members. After obtaining approval for the research by FBTC’s Scientific Committee, a cover letter was sent via e-mail to the Federation’s members. On that e-mail, they were informed about the research, the FBTC’s approval, as well as a hyperlink that led the participants to the research itself. Its objective was to enlightened the participant about the scientific and social relevance of this research, in addition to highlighting the issue of confidentiality. In a period of three days, the total number of participants expected for this group had already been reached and the research with this group was concluded.
For the client’s group, they were recruited due to their connection to a private clinical center, which is also training center, for cognitive-behavior therapists in the Southwest. This clinical had many units in the whole country. The research was sent to clients and they responded the survey online.
ETHICAL CONSIDERATIONS
This study was reviewed and approved by the local Ethical Board (CAAE 09985718.2.0000.5145) and it is in accordance with the prerogatives of the Resolution of the National Health Council (Resolution number 510/2016) stipulated by the Ministry of Health.
DATA ANALYSIS
Descriptive and inferential analyses were performed with the support of Jamovi software, version 2.3.3 (Şahin & Aybek, 2020), which is a free software used for descriptive and inferential statistics. The frequencies, means and standard deviations of the sociodemographic variables collected were calculated. To perform inferential statistics, all data were submitted to the Shapiro-Wilk normality test. In the case of a non-normal distribution of the data, they were submitted to a non-parametric Mann-Whitney test, considering the statistical significance of p<0.05. Effect sizes were also calculated for the significant results.
For lexicometric analysis, IRaMuTeQ was used. Interface de R pour les Analyses Multidimensionelles de Textes et de Questionnaires (IRaMuTeQ) is a free software whose function is to perform lexicometric analysis. This consists of an analysis of textual data in a probabilistic manner (Faiad et al., 2021). The program uses lemmatization criteria, that is, it deflects words of the same origin, from the dictionary of Portuguese within the program, in order to determine its lemma and group words with the same theme, providing a series of textual analyses.
In line with the research objectives, four textual analyses were performed with IRaMuTeQ. The first was the word cloud, which is a representation in graphic format in which the distribution of words as a function of their absolute frequency is demonstrated. Specificities analysis was also performed. This type of analysis associates the words generated in the database with the variables of interest. Similarity analysis was also performed, which is an analysis in which it is possible to identify the co-occurrences between words, verifying the connections between them in a graphical way (Faiad et al., 2021).
RESULTS
Regarding the importance of the waiting room, 9 clients out of 79 and 5 psychotherapists out of 105 considered that this is not an important space. Some of the psychotherapists’ statements on that deserve to be highlighted: “The patient has a goal, which is to talk to his therapist” and “I work in an office with and without a waiting room, I don’t see any difference in the way the client arrives for the session”. In addition, some of the clients’ perception on that are also presented: “It doesn’t interfere with anything, the content is more important”, “I feel like it’s uncomfortable when you leave the session in a fragile state and there’s a stranger in the waiting room” and “I like to come to therapy without an intermediary environment.”
Despite the abovementioned indifference or negative perception about how the waiting room for some clients and therapists, the vast majority of the clientele (n = 70) considered the waiting room to be an important space, as can be seen in the following sentences: “[...] I arrive anxious for all the sessions and the waiting room calms the euphoric self”, “[It brings] … comfort”, “[It is] … welcoming”, “being present”, “[It is a] moment of change of pace” and “it is the place where I disconnect from my problems and prepare for the session”. As for the therapists’ group (n = 100), most considered it to be an important space and, as can be seen in phrases such as: “it is the true starting point of the session, and through it is already possible to identify possible beliefs of the patient”, “[It is the] moment in which the patient’s functioning can already be observed”, “[It is the] place for initial reception”, “[It is the] place where the client can reflect on his demands” and “it is the first reception that the patient receives”.
Regarding the presence of the items in the waiting room, the Table 1 shows the number of participants who reported positively regarding the presence of the items.
Table 1 Frequency of items in waiting rooms
| Items | Presence of items in waiting rooms | |
|---|---|---|
| Psychotherapists | Clients | |
| Magazines | 95 (51,6%) | 70 (38,0%) |
| Beverage | 93 (50,5%) | 72 (39,1%) |
| Music | 72 (39,1%) | 48 (26,1%) |
| Painting | 70 (38%) | 65 (65,3%) |
| Flavoring | 69 (37,5%) | 40 (21,7%) |
| Being lonely | 65 (35,3%) | 34 (18,5%) |
| Window | 49 (26,6%) | 59 (32,1%) |
| Food | 58 (31,5%) | 37 (20,1%) |
| Secretary | 48 (26,1%) | 49 (26,6%) |
| Television | 36 (19,6%) | 22 (19,6%) |
| Carpet | 35 (19,0%) | 40 (21,7%) |
| Toys | 17 (9,2%) | 22 (12%) |
In the table 1, it was possible to see that magazine (51,6%) and beverages (50,5%) were present in more than 50% of the psychotherapist’s waiting room. The less frequent item were toys (9,2%), followed by carpet (19,0%) and television (19,6%). In terms of the clientele, none item reached 50% of presence. Magazines (38%,0) and beverages (39,1%) were also frequent, however, they were less frequent than painting (65,3%). Toys (12%) were also the less frequent item, followed by being alone (18,5%) and television (19,6%).
Regarding the judgment of how important these items are, the normality of the data was assessed using the Shapiro-Wilk test. The results show that statistical results had not normal distribution (W=0.291, p-value <0.01).
A Mann-Whitney test was performed, which is an appropriate statistical test for non-parametric samples, to compare client’s and psychotherapist’s groups score on items perception. The test revealed a significant difference between the two groups (n1=79, n2=105) on the items magazines (Mdn n1=3, Mdn n2=4, U=3095, p=0.002, r=0.25), food (Mdn n1=2, Mdn n2=4, U=3162, p=0.005, r=0.23), flavoring (Mdn n1=3, Mdn n2=4, U=3359, p=0.002, r=0.25), music (Mdn n1=4, Mdn n2=4, U=2874, p=0.001, r=0.25) and window (Mdn n1=4, Mdn n2=4, U=3265, p=0.001 r=0.21), as shown in the Table 2. These results suggested that magazines, food, and flavoring and were considered to be more important for the therapists than they are for the clients. The items music and window were considered to be more important for clients than they are for therapists. Although these results are significant, the effect sizes are considered small (r=0.2) for all the variables (Field, 2020).
Table 2 Comparison of the importance of the items between psychotherapists and client’s groups
| Item’s relevance | Group | N | Median | Standard deviation | Statistic U | p-value | Effect size |
|---|---|---|---|---|---|---|---|
| Food | Client | 79 | 2.00 | 1.31 | 3162 | 0.005* | 0.23** |
| Therapists | 105 | 4.00 | 1.36 | ||||
| Secretary | Client | 79 | 3.00 | 1.57 | 4120 | 0.938 | 0.006 |
| Therapists | 105 | 3.00 | 1.47 | ||||
| Beverage | Client | 79 | 5.00 | 1.02 | 3893 | 0.413 | 0.061 |
| Therapists | 105 | 5.00 | 1.05 | ||||
| Carpet | Client | 79 | 2.00 | 1.41 | 4016 | 0.703 | 0.031 |
| Therapists | 105 | 2.00 | 1.38 | ||||
| Window | Client | 79 | 4.00 | 1.35 | 3265 | 0.010* | 0.21** |
| Therapists | 105 | 4.00 | 1.28 | ||||
| Flavoring | Client | 79 | 3.00 | 1.50 | 3359 | 0.023* | 0.19 |
| Therapists | 105 | 4.00 | 1.32 | ||||
| Magazines | Client | 79 | 3.00 | 1.42 | 3095 | 0.002* | 0.25** |
| Therapists | 105 | 4.00 | 1.17 | ||||
| Toys | Client | 79 | 3.00 | 1.52 | 4120 | 0.936 | 0.006 |
| Therapists | 105 | 3.00 | 1.48 | ||||
| Television | Client | 79 | 2.00 | 1.38 | 3879 | 0.437 | 0.064 |
| Therapists | 105 | 2.00 | 1.33 | ||||
| Painting | Client | 79 | 4.00 | 1.41 | 4089 | 0.866 | 0.014 |
| Therapists | 105 | 4.00 | 1.21 | ||||
| Music | Client | 79 | 4.00 | 1.55 | 2874 | <.001* | 0.30** |
| Therapists | 105 | 4.00 | 1.05 | ||||
| To stay alone | Client | 79 | 3.00 | 1.63 | 3699 | 0.199 | 0.21** |
| Therapists | 105 | 3.00 | 1.17 |
Note.
*Statistical significance at <0.05.
**Small effect size.
In order to better comprehend the difference between the perception of the clientele and therapists, a lexicometric analysis was also performed in the software Iramuteq. The corpus used for lexicometric analysis was composed of 319 text segments (TS), with a number of 9675 occurrences (words, forms or vocabulary), of which 1700 were distinct occurrences and 888 were unique. 269 text segments were classified out of 319, which represents 84,33% retention rate, which is superior to the 75% recommended (Faiad et al., 2021).
In the word cloud shown in the Figure 1, only those with an absolute frequency greater than 15 repetitions were presented. The longer and more central the word, the more frequent it is. Patient (f=159), wait (f=146), environment (f=118) , room (f=93), water (f=86), important (f=82), find (f=80), coffee (f=59), child (f=59), attend (f= 56), service (f=48), session (f=46), welcoming (f=42), good (f=42), place (f=42), client (f=41), moment (f=39), pleasant ( f=38), stay (f=36), tea (f=33), office (f=33), turn (f=33), arrive (f=32), space (f=31), therapy (f=31), desk (f=30), welcome (f=29), help (f=29), distract (f=27), person (f=27), comfortable (f=26), see (f=24), pass (f=23), need (f=22), comfort (f=21), time (f=21), place (f=21), even (f=21), therapist (f=21), case (f=20), depend (f=20), music (f=19), leave (f=18), need (f=18), sound (f=18), cozy (f=17), believe (f=17), candy (f=17), consultation (f=17), taste (f=17), care (f=16), giving (f=16), form (f=16), better (f=16), prefer (f=16), sensation (f=16), lonely (f=16), welcome (f=15), cell phone (f=15), clinic (f=15), fundamental (f=15), necessary (f=15), magazine (f=15), come (f=15).
An analysis of specificities was also performed. Through this analysis, it was possible to make comparisons between the clients and therapists’ groups based on their hypergeometric score. Only words whose hypergeometric index is greater than 2.000 are reported below due to their greater significance (Faiad et al., 2021).
For the “Clients” group, the most associated words, in descending order and with the hypergeometric score indicated after the word, to the group were: Finding (3,503), good (2,5913), place (2,526), therapy (2,392), moment (2,379), better (2,372), important (2,237). For the “Psychotherapists” group, the words were: Patient (6,832), attend (3,242), client (2,782), come (2,251), coffee (2,135), need (2,048).
A similarity analysis was also performed, the result of which is shown in the Figure 2 below. It was possible to verify that there was a connection between words from the lexicometric analysis in question. It should be noted that six words were of special importance for the textual corpus, namely, “important”, “wait”, “water”, “patient”, “environment” and “child”. From these words with greater prominence, branches of other words emerged that were associated with these words, as can be seen in the Figure 2.
In relation to the word “important”, it is noted that the word “find” was the most strongly associated with it, as demonstrated by the intensity of the line that unites both, when compared with the other two associated words that emerged from this branch “believe” and “place”. Regarding the word “wait”, the strongest association of the set-in terms of line thickness with the word “room” followed. “Same”, “consultation”, “better”, “place” and “service” were also associated.
The word “water”, in turn, was associated more strongly with “coffee” and the latter, in turn, with “tea”. From the word “water” came the ramifications “fundamental” and “secretary”. The word “patient” was the one with the highest absolute number of associates, as evidenced in the figure under analysis. Among the associates, we mention “feel”, “welcoming”, “comfortable”, “necessary”, “wait”, “mobile” and “care”. As for the word “environment”, several associated words also emerged, such as “welcoming”, “need”, “pleasant”, “sound”, “cozy” and “taste”. For the word “child,” it was linked more strongly to the word “attend” than compared to its other branches, such as “stay,” “distract,” “search,” and “depend”.
DISCUSSION
Regarding the objectives of the research, that is, to investigate client’s and therapists’ perception of item on the waiting room, it was possible to suggest that some items were considered to be more relevant to this environment and also that client’s and therapists’ perception differ on some of them.
In terms of therapists’ perception on the items investigated, magazines were considered to be an important item. Previous research demonstrated that waiting time increases anxiety’s levels and the perception of quality of care (Zhang et al., 2022) and, in this sense, magazines could be an explicit distractor. However, our results suggests that magazines may not be considered a valuable item for clientele probably because of the presence of smartphones.
In terms of the item food, it could be noticed that therapists considered it to be more important than they were the clientele. This item may be interpreted by therapists as an explicit distractor (Zhang et al, 2022), in order to provide a more welcoming and cozier environment for clients. However, our sample did not consider it to be an important item. It should be noticed that the group of clients was composed by adults, whose perception may differ from younger samples.
Previous research indicated that the environment smell was also considered an important route of action for improving mood and reducing anxiety (Chabria et al., 2021). Our results indicated that this item was judged to be more important for therapists than they were for clients.
On the music item, Lai and Amaladoss’s (2022) systematic review on the effects of musical intervention in waiting rooms concluded that music was able to reduce stress and anxiety levels. Our results suggested that clients considered it to be also important, however, as Tansink and Routhieaux (1999) pointed out, not all music genres may produce such effects, so it should be considered genres like lounge, classical music or jazz.
In terms of the presence of windows in the waiting room, clients reported that “I do not feel well in closed spaces”, “It is very important a clear and ventilated space”, “I hate closed spaces with artificial ventilation”. Previous research indicated that client’s perception of welcoming space depends when this place is well illuminated (Noble & Devlin, 2021).
The frequency of the presence of items in the waiting rooms is also an indication of how important professionals consider them. As can be seen in the Table 1, the items magazines and beverages are frequent item for both groups. The less frequent ones are toys and television. The lower frequency of toys may be a sampling bias, which could be better explored by future research. As for television, a possible hypothesis for this is that, with the advent of smartphones, they have decreased their relevance in these spaces.
Regarding the absolute frequencies of the words, as analyzed by the word cloud, the terms “patient” and “important” appeared with high frequency. Sentences like “It is important that the patient had a safe and comfortable place to wait for his/her appointment” and “This environment may help the patient to slow down and get in touch with him/herself” were reported by both clients and therapists, which may indicate the general concern with the wellbeing of clients in such space.
Items related to beverages, such as water and coffee, appear with great frequency, which suggests that these are elements considered relevant. It is possible that there is a cultural relationship of the “coffee” element for Brazilians, since this country is internationally recognized as a major producer of the fruit of excellent quality, which may not be observed in other local contexts, such as Arab and Far Eastern countries, where it is customary to maintain eating habits with teas and infusions.
Equally relevant are the references to the terms “important”, “welcoming” and “comfortable”. As can be seen through the statement of participant 174 (psychotherapist): “In the waiting room that the patient receives the first reception” and also of participant 55 (client): “I think it is important, because it is the place that precedes the session, it is where it is possible to organize last ideas or suffer from some anguish for the last time before being able to elaborate during the session”. These statements suggest that the waiting room is an important space, as it can act as a discriminative stimulus capable of eliciting a series of thoughts in clients. As stated by participant 149 (psychotherapist): “this is a space that is often of anxiety or access to intense emotions, so it needs to be welcoming”. In this sense, depending on what is generated in this environment in terms of thoughts and emotions, it is important that it is both comfortable and welcoming, so that this deal is as aversive as possible.
Regarding the difference found between the two groups in the analysis of specificities. It is important to note that there were differences in relation to the terms generated for the psychotherapist groups and clients. For the first, the most strongly associated was the term “patient” and the third was “client”. This result suggests that for the clinical group, the waiting room space is, in fact, designed for patients/clients.
Similarity analysis, the results found about the ramifications of the term “environment” are consistent with the analysis of the absolute frequency in which the terms “welcoming”, “pleasant”, “cozy” and “taste” appear linked.
CONCLUSION
This research aimed better comprehend how therapists and clients evaluate the relevance of the waiting room as well as items present there. Even though it was found a significative difference between clients and therapists’ perception on some items, this result should be careful considered. The magnitude of the difference between the two groups is low, so generalizations should consider cultural and client’s age effects.
In our research there was a sampling bias related to the therapist’s group, since most of them reported that they did not had items such as toys, which may indicate a therapist sample that provide care for adolescents, adults or the elderly. Results in our research should, then, be not be extended for childcare. Future investigations may investigate therapists and clientele items perception on childcare.
The use of mixed methods allowed us to understand in greater depth what psychotherapists and clients think about the items investigated. In this sense, we recommend future research to use this mixed method approach once it provided a detailed perception of the variables analyzed.
Noble and Devlin (2022) concluded that spacious, emptier, more organized, and less noisy waiting rooms were considered more comfortable and more capable of generating effective care. Our research suggested that items such as window and music were considered important for clients, which is in accordance with Noble and Devlin’s (2022) study.
From this research, clinicians from the most varied areas of health, architects, designers could better understand which items on a waiting room are deemed important and, with that information, it may reduce costs and provide an environmental design that may be able to reduce possible negative emotional states and discomfort.
