Part 1:

Aim and objectives: To explore the importance of the physical space of therapy rooms (used for counselling/psychotherapy) to clients and therapists. To identify which aspects of therapy rooms are most important to clients and therapists and how these aspects contribute to an environment that is conducive or hindering to the therapy process.

Method: This was a mixed-methods study, using a concurrent triangulation de- sign. Data were gathered using an online survey and semi-structured interviews. Quantitative and qualitative data were analysed using statistical analysis and thematic analysis, respectively. Participants were twenty-four clients who had experienced counselling or psychotherapy and twenty-one qualified therapists (psychologists, counsellors and psychotherapists).

Findings: From the survey data, comfortable seating and room temperature, sound- proofing, no interruptions and accessibility of the room were identified as most important to clients and therapists. Participants reported that feeling physically comfortable and safe in a room enabled a greater engagement with the therapeu- tic process. Rooms with a clinical appearance were described as unhelpful. From the interview data, themes identified were as follows: comfort, the appearance and meaning of the room and the room as a workspace.

Conclusions: The physical environment of the therapy room can play an important role in clients feeling comfortable and able to engage. It is important to consider the appropriateness of rooms for particular client groups/issues and consult with clients and therapists about therapy rooms. Further research is needed into the interaction between clients presenting issues and the room and the effect of cultural differ- ences upon the experience of therapy rooms.

Part 2

THE PRESENT STUDY AND RESEARCH QUESTIONS

The present study addressed the gap in the literature by employ- ing a mixed-methods approach to explore clients and therapists experiences of the physical environment of the therapy room. In doing so, it provides important data on which features of the phys- ical environment are important to clients and therapists within the UK; this is important to therapy providers and individual thera- pists, in terms of creating an environment conducive to talking therapies.

The aim of the proposed mixed-methods study was to inves- tigate the importance of the physical environment of rooms used for talking therapies (all types of psychotherapy, counselling and high-intensity CBT) to clients and therapists. The mixed-methods design enabled the range of data gathering necessary to achieve this, both at breadth and at depth. A wide scope of settings and modalities was included, in order to get a breadth of data that would incorporate the wide range of ways that talking therapies are delivered in the UK.

The objectives were to determine which features of the physi- cal environment of therapy rooms are most important to UK ther- apists and clients in contributing to a helpful setting and how these features contribute to creating an environment that is conducive or hindering to the therapy process. A further objective was to under- stand more about how clients and therapists experience the physical environment of the therapy room generally.

There were two strands to the study: an NHS strand that col- lected data from NHS therapists and a non-NHS strand that col- lected data from former clients and non-NHS therapists; this is so that information regarding a variety of different settings could be

gathered. Current NHS clients were not included for research ethics reasons.

Part 3

The two strands used the same research questions.

The first research question built on one of Backhaus (2008) re- search questions by asking not just which aspects of therapy rooms were important to clients and therapists, but also why?

The research questions were as follows:

RQ1: Which aspects of the physical environment of the therapy room are important to clients and therapists and why?

RQ2: How do clients and therapists experience the physical en- vironment of therapy rooms?

This study gave equal weight to the quantitative and qualitative data; however, a thorough discussion of both is not possible within the constraints of this paper. Therefore, following the methods sec- tion, a brief overview of the quantitative component will be given, before an in-depth focus on the qualitative data.

Part 4

Study design

The study was a mixed-methods study, using a concurrent triangula- tion design (Creswell et al., 2003), with quantitative and qualitative data analysed separately and then combined to form a discussion addressing the research questions. A mixed-methods approach can help to build a more complete picture through complementarity and through combining quantitative and qualitative methods, and the strengths of each of the respective methods can be drawn on and weaknesses offset (Bryman, 2006). Other than for comple- mentarity, a mixed-methods design was also chosen for two further reasons: firstly, in order to give a wider and triangulated account (convergence) of the role of the physical environment of therapy rooms and capture the whole experience of therapy rooms, which is a complex area; and secondly, to look for any differences (interro- gation) between the quantitative and qualitative data. Divergence between different types of data in mixed-methods studies is not, in itself, a weakness, and curiosity towards the divergence can bring greater insight and understanding. Brannen and Moss (2012, p. 2) outline that a mixed-methods study works best when exploit [ing] the potential to see different things.

The mixed-methods design also effectively enabled the different research questions to be addressed. Quantitative data enabled an identification of which variables (aspects of rooms) therapists and clients thought were the most important. The qualitative data gave more context to the way that the individual variables were experi- enced and allowed a deeper understanding of why room variables might be rated more importantly by clients or therapists. This is im- portant, given the wide range of client groups, issues and therapy settings. Furthermore, the qualitative data also provided data relat- ing to how the individual variables combined to provide a helpful/ unhelpful setting.

The article currently uses Critical realism paradigm. Using interpretivism as an alternative paradigm:

1. Construct a new research problem for the study.
2. Formulate new research questions for your study .
3. Formulate a new hypothesis or objectives based on the alternate paradigm
4. Choose a new data collection method, show the motivation behind the new data collection .
5. Choose a new data analysis method