ROBERT B. BECHTEL and ARZA CHURCHMAN HANDBOOK OF

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Library of Congress Catalogi"g-in-Publication Data:

Bechtel, Robert B. Handbook of environmental psychology / Robert Bechtel, Arza Churchman. p. cm. Includes bibliographical references and index. ISBN 0-471-40594-9 (hardcover: a lk. paper) l. Environmental psychology. I. Ts'erts'man, Arzah. II. Title. BF353 .B425 2001 155.9-dc21 2001026449 Printed in the United States of America.

10 9 8 7 6 5 4 3 2 Contributors

Irwin Altman, PhD Barbara B. Brown, PhD Department of Psychology Department of Psychology University of Utah University of Utah Salt Lake City, Utah Salt Lake City, Utah

Kathryn H. Anthony, PhD Margaret P. Calkins, PhD Department of Landscape Architecture and Innovative Designs in Environments for Women's Studies Program an Aging Society University of Il linois at Urbana·Champaign Kirtland, Ohio Champaign, Illinois Janet R. Carpman, PhD Robert B. Bechtel Carpman Grant Associates Department of Psychology University of Arizona Wayfinding Consultants Tucson, Arizona Ann Arbor, Michigan

Anders Siel, Ph 0 Arza Churchman, PhD Department of Psychology Faculty of Architecture and Town Planning Goteborg University Technion-Israel Institute of Technology Cateborg, Sweden Haifa, Israel

Stephen C. Bitgood, PhD Ellen G. Cohn, PhD Psychology Institute Department of Criminal Justice Jacksonville State University Florida International University Jacksonvi lle, Alabama Miami, Florida

Marino Bonaiuto Victor Corral-Verdugo, PhD Department of Developmental and Social Department of Psychology Psychology University of Sonora University of Rome 'La Sapienza' Hermosillo, Sonora, Mexico Rome, Italy Mihaly Csikszentmihalyi, PhD Mirilia Bonnes Department of Developmental and Social Department of Psychology Psychology Claremont Graduate University University of Rome 'La Sapienza' Claremont, Ca lifornia Rome, Italy Kristen Day, PhD Arline L. Bronzaft, PhD Department of Urban and Regional Planning Lehman College, City University of New York University of California, Irvine Bronx, New York Irvine, California

v Contents

SECTION I. SH ARPENING THEORI ES

CHAPTER 1 The Increasing C01ltexts of Context in the Study of Environment Behavior Relations 3 Seymour Wapner and Jack Demick CHAPTER 2 The Ethical Imperative 15 Leafllle C. Rivlin CHAPTER 3 Environmental Psychology: From Spatia l-Physical Environment to Sustainable Development 28 Mirilia Bonnes and Marino BOllaiuto CHAPTER 4 Environmental Management: A Perspective from Environmental Psychology 55 Enric Pol CHAPTER 5 The New Environmental Psychology: The Human Interdependence Paradigm 85 Tommy Garling, A'iders Biet, and Matilias G listafsson CltAPTER 6 The Phenomenological Approach to People-Environment Studies 95 Carl F. Graummm CHAPTER 7 Ecological Psychology: Historical Contexts, Current Conception, Prospective Directions 114 Allan W Wicker

SECTION II . SHARPENING LI NKS TO OrHER DISCIPLI NES

CHAPTER 8 Exploring Pathology: Relationships between C li nical and Environmental Psychology 129 Kathryn H. Anthony and Nicholas J. Watkins CHAPTER 9 Environmental Anthropology 147 Edward 8. Liebow CHAPTER 10 Environmental Sociology 160 Riley £. Dunlap CHAPTER 11 Environme ntal Psychophysiology 172 Russ Parsons and Louis G. Tassinary CHAPTER 12 Environme ntal Psychology and Urban Planning: Where Can the Twain Meet? 191 Arza Churchman

SECTION III. SHARPENING M eTHODS

CHAPTER 13 Transactionall y Oriented Research: Examples a nd Strategies 203 Carol M. Wemer, Barbara B. Brown, and Irwi" Altman

xi xii CONTENTS

CHAPTER 14 Meta-Analysis 222 Arthllr E. Stamps fTl CHAPTER 15 The Experience Sampling Method: Measuring the Context and Content of Lives 233 Joel M. Hektller and Mihaly Csikszetlllllihalyi

CHAPTER 16 The Open Door of GIS 244 Reginald G. Goffedge

CHAPTER 17 Structural Equation Modeling 256 Victor Corral-Verdugo

CHAPTER 18 Spatial Structu re of Environment and Behavior 271 101111 Peportis and leall Wineman CHAPTER 19 Behavioral-Based Architectural Progranuning 292 Roberl Hersllberger CHAPTER 20 Postoccupancy Evaluation: Issues and Implementat ion 306 Craig Zimrillg

SECTION IV. SHARPENING ApPLICATION

CHAPTER 21 Ma king a Difference: Some Ways Environmental Psychology Has Improved the World 323 Robert Gifford CHAPTER 22 Bridging the Gap: How Scientists Can Make a Difference 335 Frances E. Kilo CHAPTER 23 Women and Environment 347 Karen A. Fralick CHA I>TER 24 Children's Environment 363 Kaleu; Korpela CHAPTER 25 Design and Dementi a 374 Kristen Day and Margaret P. Cal kilts CHAI>TER 26 Healthy Residential Environments 394 Roderick j. Lawrence CHAPTER 27 Crime Prevention through Environmental Design (CPTED): Yes, No, Maybe, Un knowable, and All of the Above 413 Ralpll B. Taylor CH APTER 28 Wayfinding: A Broad View 427 Jallet R. Carplllall and Myroll A. crallt CHAPTER 29 Work Environments 443 jal/etta Mitchell McCoy CHAPTER 30 Environmental Psychology in Museums, Zoos, and Other Exhibition Centers 461 Stephen C. Bitgood CHAI>TER 31 Climate, Weather, and Crime 481 James Rattail mId ElIel! G. Colin CHAI>TER 32 Noise Pollution: A Hazard to Physical and Mental Well -Bei ng 499 Arli/1e L. Brollzaft Contents xiii

CHAPTE R 33 The History and Future of Disaster Research 511 Lori A. Peek and Dennis S. Mifeli CHAPTER 34 The Challe nge of Increasing Proenvironment Behavior 525 E. Scott Geller CHAPTER 35 Eme rging Theoretical and Methodologica l Pe rspectives on Conservation Behavior 541 Joa"ne Vining and Angela Ebreo CHAPTeR 36 Contamination: The Invisible Built Environme nt 559 Miclwel R. Edelstein CHA PTER 37 Environmental Conflict and It s Resolution 589 Tamra Pearson d'Estree, E. Franklin Dukes, and Jessica NatNJrrete-Rome ro CHAI'TER 38 A Methodology of Pa rticipatory Planning 607 Uisa Horelli CHAPTER 39 Susta ined Participat ion: A Community l3ased Approach to Addressing Envi ronmental Proble ms 629 Esther Wiesellfeld and £uc1ides Salle/lez

SEcnON V. THE FUTURE

CHAPTER 40 Personal Space in a Digital Age 647 Robert Sommer CHA I'TER 41 Toward an Environmental Psychology of the Interne t 661 Oaniel Stokols and Maria MOlltero CHAPTER 42 On to Mars! 676 Robert 8. Bee/ltel

AUTHOR INDEX 687

SUBJECT INDEX 709 CHAPTER 8

Exploring Pathology: Relationships between Clinical and Environmental Psychology

KATHRYN H. ANTHONY and N ICHOLAS J. WATKINS

WHAT ARE THE RELATIONSHIPS between clinical a nd Later we examine clinical approaches to environmental environmental psychology? What have these rela­ psychology. This section discusses sources drawn pri­ tionships been in the past, and what potential do marily from the environment behavior literature that they have for the fut ure? How have clin icians drawn add ress issues of interest to clinicians. For example, upon the physical environment in their practice? what are the psychological impacts of moving o r And how have scholars in the environment behavior visiting a favorite home in which you no longer field relied upon cli nical psychology in their re­ live? What kinds of design feat ures can elevate an search? Has the relationship between clinical and individua l's psychological state? Finally, we d raw environmental psychology made an impact on actual our conclusions about the li nks between these two environments? What behavior has changed as a re­ disciplines. sult of new research or discoveries? This chapter addresses these issues. We begin by describing some theoretical and con­ THEORET I CAL AND ceptual frameworks that help explain the relation­ CONCE PT UA L F R AMEWO R KS ship between these two fields, focus ing on how Some theoretical and conceptual frameworks shed a systems or socioecological approach can link the light on the relationships between clinical and e nvi­ two. We next examine environmental approaches to clin­ ronmental psychology. ical psychology. Our sources a re d rawn primarily from "Cli nical psychology can most broad ly be seen as the clinical literat ure in psychology and psychiatry, a field involving proble ms, theories, a nd methods and they include at least some reference-often not that cut across a range of activities (e.g., psychother­ obvious to the casual reader- to the physical envi­ apy, testing, supe rvision, consu ltation, research, ronment. For example, what places or spaces tr igger teach ing) and populations (e.g., patients, trainers, obsessive-compulsive disorders? What role does the trainees, organizations) with potential applicability physical environment play in post-traumatic stress to a range of environmental psychological phenom­ disorder? We next examine treatment approaches in ena" (Demick & Andreoletti, 1995, p. 58). Cl inical which the physical environment has begun to playa psychologists tend to focus on some fo rm of pathol­ role in altering problematic behavior. Following this ogy. For example, a child may have difficu lty adjust­ is a section analyzing the e nvironmental psychology ing to parental divorce or an adult may be of treatment settings, that is, issues concerning the experiencing chronic s igns of depression a nd even design and arra ngement of psychotherapists' off ices. suicidal tendencies. Environmental psychologists

129 130 HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY tend to be less exclusively problem focused in their As an example, an analogy can be drawn between approach. Also, environmental psychologists are the relationships of clinical and environmental psy­ more concerned with the larger picture. Individuals chology and an ecological analysis of health promo­ are conceptualized as members of social groups and tion. Siokois (1992) discusses how an ecological cultures. In turn, these conglomerates of social perspective is emerging in the field of health promo­ groups and cultures affect the individual through· tion, with an emphasis on linking individually fo· out a system composed of di ffe ring levels of analy· cused, small-group, organizational, and community sis. Intrapsychic relationships within the individual approaches. Along these li nes, he stresses the impor­ are de·emphasized. tance of examining situations, sequences of individ­ Clinicians are primarily concerned with the diag· ual or group activities occurring at a particular time nosis and treatment of emotional, biological, psy· and place; settings, geographical locations where chological, social, and behavioral maladjustment, personal or interpersonal situations occur regularly; disability, and d iscomfort (Sayette, Mayne, & Nor· life domail/s, different spheres of a person's life such cross, 1992, p. 1). Diagnosis often involves the use of as family, education, spiritual activities, recreation, sophisticated tests to measu re the incidence of a employment, and commuting; and overall life sill/a­ particular condition. Neither diagnosis nor treat· tiOIlS, the major domains in which a person is in­ ment is typically the goal of environmental psychol· volved during a particular period of life. Stokols ogists. Often the aims of researchers in environment argues that researchers still need to delineate spe­ and behavior are simply to gain a deeper under· cific environmental leverage points that can help standing of how the physical environment facilitates promote better health in society at large. or hinders a particular set of attit udes and behav· Clinical psychology could also benefit from a iors. Issues of mutual interest include assessment of systems or socioecological approach. Clinical re­ the effects of physical relocation, natural disasters, searchers need to identify environmental features environmental stressors, social support networks, that can exacerbate or minimize both psychological and role transitions in the psychological functioning wellness as well as mental illness on a variet y of lev­ of patients, students, faculty, and organizations els. From t he perspective of environment behavior (Demick & And reoletti, 1995, p. 59). researchers, the type of problems that clinicians ad­ Clinical psychologists generally focus on the indi· dress can not be fully understood without taking vidual as the unit of analysis. Most of their theoreti· into account the e nvironment in which they are em­ cal approaches are person centered. By contrast, bedded. A systems approach wou ld allow a clinical environmental psychologists fOCllS on the person·in· researcher to examine how mental disorders operate environment system as the primary unit of analysis. on a variety of levels of human-environment interac* Yet some of these concerns can overlap. hons. Specific mental d isorders may operate along One can conceptualize an individual's SOcloeco­ a variety of scales. For example, a teenage girl who logical environment along different levels, from the suffers from bulimia is preoccupied with her self micro- to the meso-, exo-, and macrosystems (Bron­ image, which is influenced by her family interac­ fenbrenner, 1979). The microsystem is a "pattern of tions and role models, her peers and teachers at activities, roles, and interpersonal relations exper i­ school, and social a nd cultural influences that she enced by the developing person in a given setting sees on television and film. with particular physical and material characteris­ Systems or socioecological theory also benelits tics" (p. 22). An example of the microsystem is the from a transactionalist perspective. A transactional­ immediate home environment. Mesosystems involve ist approach views several aspects of persons and settings in which individuals e ngage for a s ignifi­ environment as mutually defining (Wapner, 1987). cant amount of time, such as school or work environ­ A person is comprised of physical and biological ments. Exosystems include systems outside of traits such as age and sex, intrapersonal and psycho­ individuals that affect t hem, for example, the local logical traits such as self-esteem, and sociocultural police. Finally, mncrosystems entail social and cul­ traits such as roles. The environment is compri sed of tu ral values that exert a strong infl uence on atti­ physical (e.g., natu ral and built), interpersonal, and tudes and behavior. We argue for the necessity of a sociocultural (e.g., mores, rules) characteristics. systems or socioecologicaJ approach in the concep­ Important to note are traditional theories of psy­ tion of a field of work that embraces both clinical chology integrating both environment and intrapsy­ psychology and environmental psychology. chic processes in the etiology of mental disorders. Exploring Patllology: Relations/lips between Clinical alld Environmental Psycllology 131

For example, attachment theory is one useful frame­ therapy. And while it is rarely the primary focus of work with which to view the relationships between clinicians, these dissociative patterns often include the two fields of clinical and e nvironmental psychol­ a n e nvironmental component. A particular object, ogy when considering a socioecological or systems place, or space may later serve as an unpleasant approach. Developmental psychologists have con­ stimulus or trigger that unleashes the memory of the ducted decades of research about how infants and trauma- what one has tried to bury in the subcon­ toddle rs form attachments w ith their parent figures. scious- ali over again. For example, a young girl Joh n Bowlby and Mary S.,lter Ainsworth made who had bee n molested by her father in an attic may major contributions to the understanding of attach­ have tried to mentally divorce herself from what was ment theory (Bowlby, 1969, 1973, 1980; Bretherton, happening at the time, yet later in life she may de­ 1992). The nature of these a ttachments can be ex­ velop a phobia of a ttics, steps, or heights. A woman tremely significant when clinicians diagnose and who was raped in a parking lot may later be terror­ treat adults later in therapy. Attachment theory is ized s imply getting in and out of a car. As Rubin­ also systemic. Infants become attached to a secure stein (1993a, 1993b) argues, traumatic events may base, usually their mother. From that base they weaken the person-place bond. Trauma survivors g radually venture out to explore the hierarchical may become emotionally, cognitively, or behav­ levels of the environment: home, neighborhood, iorally detached from the aspect of lifespace associ­ community, region, then wider geographies. In close ated with the trauma. conjunction with attachment theory is an abundance Natural disasters pose a different kind of trauma of literature in phenomenological environmental that may cause one to dissociate as well. A young psychology. Rather than mainly focusing on how in­ boy who survived a tornado roaring through his dividuals become attached to other people, environ­ neighborhood may tremble every time he hears not mental psychologists have examined how people only a tornado siren but also an alarm clock or a tele­ form attachments to places; one of the most notable phone ringing. A camper who survived a devastat­ examples is Tuan's (1974) Topopllilia. ing forest fire may become anxious simply smelling Certain pathological concepts merit discussion the smoke of a harmless barbecue. Here learning here as weli. Dissociation is another key concept theory comes into play: The physical environment in understanding how the two fields of clinical a nd assumes the role of a conditioned stimulus that elic­ environmental psychology connect. It often occurs its a conditioned response. Just the s ight, sound, or while an individual experiences a traumatic event smell of a traumatic environme ntal experience may (Bremner & Marmar, 1998). It can manifest itself in trigger a negative reaction. Suedfeld (1987) refers to a variety of ways, from feeli ng discon nected from these precipitating events as extreme experiences, one's body to believing that one is watching oneself and he notes the proliferation of terms such as COII­ in a movie or a play so that it seems as if the trauma centration camp syndrome, disaster syndrome, and shell is happening to someone else. Trauma victims may slwck. experience alternate states of consciousness and Table 8.1 illustrates how the systems or socioeco­ compartmentalize what actually occurred . Some logical approach relates to the pathologies of disso­ individuals repress unpleasant parts of the past, al­ ciation, agoraphobia, and anorexia nervosa. In each lowing only fragments of memory to surface. Clini­ disorder, notice how the different levels of micro, cal psychologists who handle traumatic events, such meso, exo, and macro have a bearing on each other. as child abuse, must uncover their client's dissocia­ For example, dissociation may operate at the micro­ tion before they can begin to make headway in system, where an individual's conception of sel f is

Table 8.1 A Socioecological or Systems Approach to Mental Disorders Level of Analysis Mental Disorder Body/Self Micro Meso Exo Macro Dissociation Trauma Family Community Police Laws Agoraphobia Bodily sensations Home Public spaces Avoided environment Catastrophes Anorexia Nervosa Image Family School Neighborhood Cultural ideals 132 H AN06(X)K OF ENVIRONMENTAL PSYCHOLOGY deeply affected; at the mesosystem, where family to places and objects, an attachment that, if tampered dynamics playa role; at the exosystem, where child with, can playa role in precipitating certain mental sexual abuse (the trauma) may be detected by a disorders. The concept of dissociation often includes sc hool official or by the local police; and at the an environmental link whereby a space or place serves macrosystem, where the perpetrator is punishoble as a trigger of traumatic memories. With this frame­ under the law. work in mind, we turn to an examination of how Turning to agoraphobia, at the individual level the physical environment is presented in the clinical agoraphobics react negatively to endogenous (inter­ literature. nal) or exogenous (external) stimuli. Because of their intense fears, agoraphobics are usually con­ fined to their homes. Public spaces such as super­ ENVIRONMENTAL markets or crowded environments often provoke APPROACHES I N panic attacks, and as a result, persons with agora ­ CLINICAL PSYCHOLOGY phobia avoid them. Agoraphobics often generalize Despite over 30 years of environment behavior re­ from their experiences with past panic attacks. They search, the role of the physical environment in clini­ imagine that panic attacks will be repeated else­ cal psychology remains somewhat minimal. A where in the future, even in places where they have review of recent clinical literature reveals that the never had any. The outside world itself, or the physical environment is rarely mentioned. Clini­ macroenvironmentallevel, becomes a source of pho­ cians and researchers tend to use the word environ­ bia. Agoraphobics tend to associate personal catas­ ment to denote situational rather than physical trophes with the macrolevel. Victims of panic surroundings. For instance, clinicians ana lyzing attacks often feel they are at the point of no return, children's home environments are likely to focus fearing that they are going to die. They view the out­ primarily on the relationships among children, their side world holistically, and specific contexts become parents. and their peers-but ra rely on the physical irrelevant compared to the overwhelming experi­ dwelling. Similarly those addressing children's ence of being threatened by a hostile environment. school environments usually examine the relation­ In the case of anorexia nervosa, a young woman's ships among children, their teachers, counselors and body image may be shaped by her family, classmates other staff members, and peers-while ignoring the at school, neighborhood norms, and social and cul­ physical condition of the classroom or school build­ tural ideals of beauty that she sees in advertise­ ing. Diagnostic and treatment measures rarely stress ments on television and in magazines. In order for the physical environment. therapists to understand and treat anorexia nervosa Our examination of the Diagnostic and Statistical d isorder, they must disentangle a woman's relation­ Manual of Mental Disorders, FOllrth Edition (1994), or ship with each part of this sOcioecological system. DSM-IV, reveals that the physical environment is Note that Table 8.1 represents a gross simplifica­ mentioned only in a peripheral manner. DSM-IV is tion of processes that shift constantly from one level the primary source used by psychiatrists, physi­ to another. For example, cases of dissociation popu­ cians, psychologists. social workers, nurses, occupa­ lari zed by the media might propel this disorder into tional and rehabilitation therapists, counselors, and nat ional prominence, albeit for a short time. Changes other health and mental health professionals to di­ in policies or laws may result from widespread expo­ agnose mental disorders. One section of the DSM-IV sure and political awareness of this disorder. We may addresses multiaxial assessment, that is, different also see a trickle-down or bubbling-up effect from domains of information that can assist clinicians in one level to another. planning and predicting outcomes. Five axes are in­ In sum, from a theoretical perspective, the physical cluded: Axis I, Clinical Disorders, Other Conditions environment can deepen psychologists' understand­ That May Be a Focus of Clinical Attention; Axis II, ing of the development. diagnosis, and treatment of Personality Disorders, Mental Retardation; Axis III, various mental disorders. Socioecological, systems, General Medical Conditions; Axis IV, Psychosocial and lransactionalist approaches to environment and and Environmental Problems; and Axis V, Global behavior help explain the multiple levels on which Assessment of Functioning. the physical environment operates. Attachment the­ Axis IV is most relevant to environment and be­ ory offers insights about how people become attached havior. "Ax is IV is for reporting psychosocial and Exploring Pathology: Relationships between Clinical alld EflvironmClltal Psychology 133

e nvironmental problems tha t may affect the d iagno­ clinicians rarely pay the environment the attention sis, treatment, and prognosis of me nta l disorders it deserves, we argue that it can often playa sig­ (Axes I a nd II ). A psychosocial or environmental n ificant role in deepening ou r understa nd ing of problem may be a negati ve li fe event, an environ­ psychopathology such as anxiety disorders (panic mental difficult y or deficiency, a familial or other disorders, agoraphobia, specific phobias, obsessive­ interpersonal stress, a n inadequacy of social support compu lsive d isorders, a nd post-traumatic stress dis­ or personal resources, or other proble m rela ti ng to order [PTSDJ), eating disorders (a norexia nervosa, the context in which a person's difficult ies have de­ bulimia nervosa), and substance-related d isorders veloped" (DSM-IV, 1994, p. 29). The manual suggests (alcohol use disorders, d rug use or drug-induced that clinician s should note only those psychosocial disorders, a nd nicotine-related disorders). The e n­ or environmental problems present during the year vi ronment may well playa role in promoting a nd in preceding the cu rre nt evaluation a nd that clinicians reducing other u nhealthy behavior patte rns such as may opt to note such problems that occurred prior to overeating and smoking. the previous year if they clearly contribute to the Pa nic disorder fa ll s under the rubric of anxiety mental d isorder or have become a focus of treat ment. disorde rs in the DSM-/V. It can occur with or with­ In practice, most psychosocial or e nvironmental out agoraphobia. Conversely, persons w ith agora­ problems are indicated on Ax is IV; however, if such phobia often have a h istory of panic d isorders, but a problem is the primary focus of cl inical attention, some do not. Panic attacks usually come on sud­ it would also be recorded on Axis I w ith a code de­ denly, lasting on ave rage from 30 to 90 minutes. rived from the section on "Other Conditions That Sometimes they can be only a few minutes in length. May Be a Focus of Cli nical Attention." Panic attacks occur frequently in nonclinical popu­ Psychosocial a nd environme ntal problems a re lations as well as in those with a varie ty of psychi­ grouped under the following categories: problems atric a nd physical disorders. The initial attack most with primary support group, problems related to ti,e social frequently occu rs away from home, ofte n in a set­ envirollment, educational problems, occupational prob­ ting w here individuals feel trapped or liable to draw lems, IIolIsing problems, economic problems, problems attention to the mselves (Swinson & Kuch, 1990). Sit­ with access to IIealth care services, problems related to in­ ua tional precipita nts or e nvironmental contingen­ teractioll witl, the legal system/crime, and other psychoso­ cies of the first panic attacks expe rienced are often cial and envirO/lmenta/ problems. Problems related to fh e described in terms of the exte rnal context; clients re­ social enviro nmen t include the death or loss of a ca ll where they were a nd what they were doing. In friend, inadequate social support, living alone, and Great Britain, Burns and Thorpe (1977) investigated difficult y w ith acculturation, discrimination, a nd the fears of agoraphobics who responded to a ques­ adjust ment to li fe-cycle transition, such as retire­ tionnaire by mail in a la rge survey of 963 subjects. ment. Note that these reflect situational rather tha n Results showed that the most freque ntly feared sit u­ physical issues. Housing problems include homeless­ a tions were joining a li ne in a store, having to keep a ness, inadequate housing, unsafe neighborhood, a nd definite appointment, feeling trapped at the hair­ discord with neighbors or land lord. Other psychoso­ d ressers, a nd increasing the d istance from home. In cial and environmental problems include exposure to la rge cities, agoraphobics tend to avoid confining sit­ disasters, war, or other hostilities; discord with non­ ua tions like the subway, driving on a n elevated high­ fa mily caregivers such as a counselor, social worker, way, taking an elevator beyond the first few floors, or physician; a nd unavail ability of social service or us ing a n underground parking garage. Swinson agencies. The categories of /lol/sing problems and other and Kuch (1990) fou nd it strik ing that few agorapho­ psychosocial and environmental problems reveal a t least bics were aware of the full range of their avoidance some atte ntion paid to the physkal environment, but until they were asked specific questions about their mainly in the form of extreme proble ms such as mObility. "Similarly," they also state, "it is striking homelessness or d isasters. For example, an individ­ how few therapists, who a re not engaged in behav­ ua l troubled by an inadequate physical work envi­ ioral assessment and treat ment, dete rm ine the ronment, rather than home environment, is not extent of their patients' disabili ty from avoida nce included here. behavior" (Sw inson & Kuch, 1990, p. 18). Research Along with situational fac tors, however, the in the 1990s began toexamine how panic attacks and physical environment can not be ignored. Although panic d isorders vary cross-culturally (Katschnig & 134 HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY

Amering, 1990); the epidemiology of panic disorder self-control or social anxiety; fear of water or claus­ and agoraphobia (Weissman, 1990); coping styles trophobia, agoraphobia, or both with panic attacks; that agoraphobia sufferers adopt when attempting and acrophobia. Taylor, Deane, and Podd (2000) ex­ to cope w ith symptoms of anxiety and panic amined fear of driving. Taylor's research team cites (Hughes, Budd, & Greenaway, 1999); and mecha­ that previous studies of driving phobia found a mix­ nisms involved in the observational conditioning of ture of cognitions associated with different anxiety fear (Mineka & Cook, 1993). Hughes et al. (1999) de­ d isorders, such as fear of accidents (specific phobia), scribe several cognitive strategies for coping with fear of anxiety and its symptoms (panic disorder), agoraphobic a nd panic-induced anxiety relating to and fear of embarrassment (social phobia). Their four possible directions of attention: to the self, own study sampled 190 volunteers recruited away from the self, to the environment, and away through media advertisements asking for respon­ from the environment. In addition, the researchers dents who had a fear of driving; 85 of these partici­ cite the use of positive self-talk and relaxation as pated in a follow-up study. Findings revealed that coping strategies. subjects had high expectations of negative events Research on specific phobias also has an environ­ and that there were no significant differences in mental component. Psychologists have long been in­ terms of fear severity between those who had had vestigating fear of heights, fear of flying, a nd, more and had not had a motor vehicle accident. recently, fear of driving. Findings reveal that non­ Research on obsessive-compulsive disorder (OeD) phobics have had a safe exposure to a stimulus that has revealed that environmental cues may have an invokes a phobia in other individuals. Menzies and impact on the waxing and waning of this d isorder Clarke (1993) discovered that only 18% of height­ (Ristvedt, Mackenzie, & Christenson, 1993). Eighty­ fearful subjects attributed their fear to a direct condi­ one subjects with OCD completed a 339-item cues tioning experience. In a subsequent study using only checklist (eel) developed by Mackenzie, Ristvedt, clinical subjects, they found that only 11% of acro­ Christenson, lebow, and Mitchell (1992) of ratio­ phobic cases studied could be directly attributed to na ll y derived cues and circumstances that might be direct traumatic experiences involving heights (Men­ expected to elicit or worsen symptoms. Analyses of zies & Clarke, 1995). As a result, the etiology of height principal components identified four components: phobia differs sharply from that of other phobias, household order and organization, contamination and such as dog phobia and dental phobia, where high cleal/ing, negative affect, and prevention of harm alld levels of direct conditioning ex periences playa major checking. HOllsehold order and organization cues in­ role. Davey, Menzies, and Gallardo (1997) suggest cluded housework and daily activities around the that the frequently found comorbidity between ago­ home: cleaning the kitchen, organizing things, vac­ raphobia and acrophobia may be explained by cogni­ uum cleaning, a rranging things, house cleaning, tive biases in the discr imination and interpretation washing dishes, ma king beds, washing clothes, that agoraphobia and acrophobia have in common. packing suitcases, cooking, returning home, sorting According to cognitive-behavioral theory, anxiety through bureau drawers, and preparing for bed. disorders arise when situations are perceived as more COlltamination and cleaning included: the touch of dangerous than they actually a re. Once a threat is others, germs, blood, public restrooms, dirt, trash, perceived-or more accurately, misperceived-at AIDS, garbage cans, an illness, a doctor's visit, hos­ least three mechanisms may help maintain persistent pitals, money, hand washing, and door knobs. The high levels of anxiety: selective attention to threat­ negative affect component contained several cues in­ relevant sti muli, physiological arousal, and safety­ volving depression, anxiety, and anger and situa­ seeking behaviors. People then engage in coping tions that would evoke negative affect, but only responses to control anxiety and in avoidance re­ three environmental items: one's workplace, shop­ sponses to prevent perceived danger (Sa lkovskis, ping, and shopping malls. Finally, prevention afharm Clark, Hackmann, WeBs, & Gelder, 1999). and checking cues included objects and activities that Va n Gerwen, Spinhoven, Diekstra, and Van Dyck normally require some level of care and attention to (1997) investigated the association of flight anxiet y prevent harm to oneself or to others: locking doors, with different types of phobia among 419 people turning off appliances, oven, locks, leaving your who sought help for fea r of flying. They identified home, light switches, writing checks, stoves, being four foci of fear: fear of an aircraft accident and the uncertain, and driving a car. This body of research need to be in control of the situation; fear of loss of suggests a link between DSM-IV Axis II pathology Exploring Pathology: Relationships between Clillical and Ellvirollmellial Psychology 135 and OCD symptoms, so that negative affect serves median (60) on the Hoarding Scale. The final subject as a preCipitant of symptoms. Oepressive affect may pool included 11 hoarders a nd 16 nonhoarders. heighten an OCD patient's reactions to affect-laden Results showed that hoarders had significantly and stimuli, which later impedes habituation to these substantially scored higher on the Yale-Brown stimuli. The researchers also note that the format of ObseSSive-Compulsive Scale (Goodman el ai., 1989). the CCL does not allow individuals to comment on Among a community sample, hoarding was strongly the potency of indiv idual cues or the extent to which associated with obsessive and compulsive symptoms each cue may result in pathologica l behav ior on any in general and with several related characteristics one occasion. They argue that a Single cue may prove including indecisiveness and pathological responsi­ equally troublesome as several other minor cues bility, as well as w ith genera l psychopathology combined. The use of the CCL requires still further symptoms and distress. The findings suggest that refinement. hoarding behavior is widespread, even in nonclini­ Other scholars have been investigating the extent cal populations, and that more research is needed to to which the family accommodates patients with identify the extent to which hoarding poses a prob­ OCD. For example, one study examined the experi­ lem that requires intervention. ences of spouses or parents for 34 patients with UCU Frost and Gross (1993, p. 374) confirmed the prl!s­ and found that 88% of these caregivers reported ac­ ence of hoarding behavior by visiting several of their commodating the patient. Among the more extreme subjects' homes. They found that the degree of clut­ findings: "The mother of one patient regularly used ter va ried; it could be highly visible in the major liv­ a neighbor's bathroom because hers was constantly ing areas of the home or hidden completely in occupied by her son; one wife was unable to cook or selected spaces. According to the researchers, "One clean because her home was entirely cluttered w ith subject'S house was a series of maze-like paths hoarded newspapers" (Calvocoressi et ai., 1995, through rooms piled to the ceiling with miscella­ p. 442). neous objects. Another subject had virtually no clut­ In fact, hoarding behavior is one form of OCD ter in her house; however, her basement and attic that has only recently been the subject of e mpirical had hundreds of boxes neatly labeled and stacked in research. Until the mid-l990s, most research in this rows from floor to ceiling- like the stacks of a li­ area focused on food hoarding among rodents, small brary." Hoarders tend to buy extras of certain things animals, and birds-with hardly any on humans. so that they are not caught without them. They a lso Yet of all the disorders examined, hoarding reflects tend to carry more possessions with them in their one of the strongest ties to the phYSical environment. purses or cars "j ust in case . ..." Self-reported hoard­ When people hoard, they hoard things, and this in ers reported higher levels of emotional attachment turn affects their primary territory and those of oth­ to their possessions. Hoarders had more first degree ers around them. Frost and Gross (1993) and Frost, relatives who engaged in excessive saving than non­ Krause, and Steketee (1 996) conducted one of the hoarders, and hoarders were less likely to be married. first series of empirical studies examining the asso­ Throwing things away upsets hoarders emotionally ciation of hoarding anri obsec;.c;ivp-com pulsive symp­ and physically such that hoarders engage in the be­ tomatology, for which they developed a 21-ite m havior to prevent some future harm-being without Hoarding Scale (referred to in the subjects' materi­ someth ing they need. Surprisingly, hoarding was als as the "Questionnaire on Saving Things"). Two not related to material deprivation. The researchers groups of subjects comprised their study. The fi rst suggest a model that conceptualizes hoarding as an group responded to a newspaper advertiseme nt so­ avoidance behavior tied to indecision and perfec­ liciting volunteers who were "pack rats o r chronic tionism. Saving allows hoarders to avoid the deci­ savers" to participate in a study. The subjects quali­ sion required to throw something away and the fear fied for inclusion in the study if they saved a large or worry that they have made a mistake in tossing number of items that were not part of collections, something oul. 11 also allows hoarders to avoid emo­ and if a large percent of what they saved went un­ tional reactions that accompany parting w ith cher­ used. The second inclusion criterion was a cutoff ished possessions, resulting in a greater perceived score of 70 on the Hoarding Scale (Frost & Gross, sense of control over their environment. 1993). The second g roup comprised staff members Sexual abuse, whether it occurs in childhood or at a small libera l arts college. randomly selected adulthood, has been a major source of post-traumatic from the telephone directory. who scored below the stress disorder and has been the focus of an extensive 136 HANOaoDK OF ENVIRONMENTAL PSYCHOLQCY body of research. Dissociation occurs both peritrau4 that had been safe workplaces for years became matically-at the time of the traumatic event-and death traps in a matter of seconds. posttraumatically- as a long4term consequence of Even before terrorism became relatively wide­ traumatic exposure. Dissociative symptoms deriving spread, building failures have occasionally precipi­ from childhood abuse frequently include depersonal4 tated PTSD. For example, the 1981 collapse of a ization, derealization, dissociative amnesia, fragmen4 walkway in the Hyatt Regency Hotel in Kansas City, tation of identity, and posttraumatic reexperiencing MilSsouri, left 114 people dead and over 200 injured. phenomena such as flashbacks of traumatic events The disaster occurred during an atrium tea dance (Chu, 1998). When a trauma occurs, whether it be when the lobby was packed. Thousands of Jives were abuse or another form of traumatic stress, people adversely affected by this catastrophic event. One begin to dissociate what is happening through an al4 researcher st udied the psychological effects of this tered sense of time, either much slower or accelerated structural failu re on those who survived (Wilkin­ than it actually is; profound feelings of unreality, that son, 1983). the event is not ac tually happening to them; confu­ Environmental d isasters such as the 1989 Loma sion and disorientation; feelings of being discon­ Prieta earthquake, which rocked the San Francisco nected from their bodies (Marmar, Weiss, & Metzler, Bay Area; the 1991 firestorm in Oakland, California; 1998). and the 1993 devastating wildfires in Orange Holman and Stokols (1994) analyzed child sexual County, California, also left thousands of PTSD vic­ abuse, drawing upon theoretical constructs from tims in their wakes. The 1989 earthquake caused the clinical, social, developmental, and environmental collapse of the Nimitz Freeway near downtown Oak­ psychology. They examined contextual influences land. Some fascinating research involved interviews on the etiology and psychosocial outcomes of child of 367 emergency services personnel who responded sexual abuse and suggest clinical and environmental to the Bay Area disaster, 154 of whom were involved dlO-sign :,tral~git:::, Iv r~tluct! the prt!valence and dis4 in the freeway collapse (Marmar, Weiss, & Metzler, ruptive impacts of this pressing social problem. 1996; Weiss, Marmar, & Metzler, 1995). These in­ They speculate that microlevel sociospatiai factors cluded emergency medical technicians, paramedics, may increase opportunities or motivations for per­ firefighters, police, and California Department of petrators to molest children. Conversely the degree Transportation workers. Several predictors of cur­ 10 which the layout of a home includes a sense of de­ rent symptomatic distress were measured, including fensible space may in fl uence patterns of territorial level of critical incident exposure, psychologica l and self-protective behavior. A home that offers a traits, locus of control, social support, general disso­ strong sense of control over personal space without ciative tendencies, and peri traumatic dissociation. extreme physical, visual, or auditory isolation may Results lent further support to a growing body of reduce opportunities fo r abuse. literature linking dissociative tendencies and experi­ The study of PTSD has mushroomed in recent ences to distress resulting from exposure to trau­ decades. In the Un ited States this was in part precip­ matic stressors. The same research team investigated itated by thousands of Vietnam War veterans who the relationship between peritraumatic dissociation had experienced gruesome traumas on the battle­ and posHraumatic stress response in greater Los field that continued to plague them long after they Angeles area residents who survived the 1994 returned home. Many returning soldiers watched in Northridge earthquake (Marmar et aI., 1998). Re­ shock as bullets struck their buddies only inches searchers evaluated 60 men and women working for away. Others witnessed the enemy exploding in a a large private insurance company who lived close to wall of fire. Still others were tortured and beaten the epicenter of the quake. Again, reports of dissoci­ themselves. Scenes like these resurfaced in flash­ ation during the traumatic event predicted current backs or tormented them in dreams years after the post-traumatic stress response symptoms. war had ended. In sum, upon close examination, it appears that a More recently, hundreds of those who have wil4 wide variety of mental disorders have at least some nessed terrorist attacks, such as the 1993 bombing of relationship to the physical environment. In some of the World Trade Center in New York City or the 1995 these, such as agoraphobia, specific phobias, and cer­ bombing of the Alfred P. Murrah Federal Bu ilding in tain forms of obsessive-compulsive disorder (such as Oklahoma City, have suffered from PTSD. Bu ildings hoarding behavior) the environmental li nk is stronj2;, Exp/oring Pathology: Relationships between Clinical and Environmental Psychology 137 holding promise for both diagnosis and treatment. integrates present experiences with the past and the With that in mind, let us now examine ways in future to create an ongoing spatiotemporal context. which the physical environment has been used in Researchers used AFT to examine nine individuals treatment of mental disorders. diagnosed with panic disorder with agoraphobia and how they handled five panic-inducing situa­ ti ons while walking a standard 2.5 kilometer route: TREATMENT walking along near a busy street with the examiner Because the physical environment is mentioned only following close behind; walking alone near a busy tangentially in the clinical literature, it has been a street with the examiner out of client's visual field; challenge to find examples of how clinicians have shopping with the examiner present; traveling on a used the physical environment in treatment. None· bus alone; and shopping alone. Heart rate activity theless, we were able to locate a few examples. Un· was monitored during each of these situations as an doubtedly, there must be others as well. indicator of the effects of individual external stimuli, Frueh, Turner, and Seidel (1995) examined the triggers, and the stimulus complex. Researchers dis­ role of exposure therapy for combat·related PTSD, covered that, with the exception of using public trans­ an issue that they argue remains underdeveloped. portation, AFT resulted in considerably decreased The researchers studied exposure therapy, a general heart rate activity as well as in decreased panic anxi­ term for the category of treatments, and distinguish ety. They suggest that longitudinal studies are between intensive exposure (sometimes referred to as needed to test the long-term effects of AFT. flooding) and graduated exposure (systematic desen· In addition to the many disorders described ear­ sitization). They reviewed single case studies, lier, clinicians diagnose and treat eating disorders group outcome studies, and studies based on other such as binge eating, anorexia nervosa, and bulimia exposure·based strategies. Their research provides nervosa. Eating disorders become problematic when considerable evidence that intensive exposure to they interfere w it h how a person functions in every­ trauma·related cues benefits patients suffering day life, and at their worst, they can even be fatal. from combat-related PTSD, especially in alleviating Certain environmental stimuli may fu nction as trig­ symptoms of intrusion and physiological reactivity gers for promoting and reducing eating disorders. to stimuli associated with traumatic events. None· Organizations such as Overeaters Anonymous and theless, data fail to indicate that exposure therapy Weight Watchers address the needs of the nonelini­ has a significant effect upon the negative symptoms cal population, that is, individuals who do not neces­ of PTSD, such as avoidance, social withdrawal, and sarily seek out formal clinical treatment but who emotional numbing, nor on certain aspects of man· nonetheless desire an informal support group in aging emotions, such as anger control. order to help control their problematic eating habits. A technique ca lied attention fixation trainillg (AFT) Such organizations counsel their members to beware has proven effective in helping agoraphobics habitu­ of settings where they tend to engage in overeating. ate to phobic settings (Kallai, Kosztolanyi, Osvath, & For example, in an effort to prevent weight gain over Jacobs, 1999). AFT has three components. First is di­ the 2000 holiday season, a public service announce­ rected QUelltjoll to the physical environment. Clients ment from the American Dietetics Association cau­ are taught to pay attention to their surrounding en· tioned party goers to stay away from the food table. vironments as they experience them. Second is topo­ They are urged to take only a small plate of food and graphical syntheSiS, whereby clients are encouraged to eat only what is on it instead of munching away con­ experience the environment in the here and now as tinuously without knowing how much food they con­ opposed to using preconceptions. Topographical syn­ sume. Avoiding a specific environment-in this case, thesis is used to update stunted cognitive maps that a buffet table filled with an array of tempting appe­ clients carry around with them internally. Third is di­ ti zers-can affect a specific behavior, overeating. rected orientation in space-time. In this procedure, The treatment of substance-related disorders, such clients are encouraged to explore objects in the space as alcohol use disorders, drug use or drug-induced of the present while also recalling their past memo­ disorders, and nicotine-related disorders, may have ries. Thus clients advance spatially and temporally in environmental components as well. Here too those their thought process as related to the environment. who do not seek out formal clinical expertise often The "goal object" under exploration successfully benefit from support groups such as Alcoholics 138 HANDBOOK OF ENVIRONMENTAL P SYC HOLOGY

Anonymous or smoki ng cessation groups to curb of dreams, sexuality, and life. By contrast, behind his their habits. Such organizations often alert their desk in his study was an assemblage of antiques members to avoid environmental settings that may based on the theme of death; all these themes were trigger the addictive behavior. For exa mple, people central to Freud's intellectual development. These prone to alcoholism and smoking are less likely to included an Egyptian funerary barge and two continue their harmful addictions if they avoid mummy masks. A Greek vase given to him by his hanging around bars filled with cigarette smoke. pupil and friend, Marie Bonaparte, sat on a round glass tabletop behind Freud's chair; after his death his ashes were placed in it. THE ENVIRONMENTAL From a conte mporary perspective, Division 34 of PSYCHOLOGY OF the American Psychological Association, Population TREATME N T SETT I NGS and Envi ronmental Psychology, sponsored a sympo­ One of the most intriguing areas where environmen­ sium at the 1998 annual convention on "Environ­ tal and clinical psychology overlap is the study of ments for Psychotherapy-Problems in Office treatment settings. From a historical perspective, Design." The session was one of the first to explore Natalija Subotincic (1999a, 1999b) provides a fasci­ the links between clinical and environmental psy­ nating analysis of Sigmund Freud's office and its chology and the first to examine this topic. The dis­ relationship with his theories and practices. She in­ cussion drew about 60 attendees. In preparing for vestigated how Freud arranged the rooms in which he the symposium, organizer James Richards (1998) lived and worked during several periods of his pro­ conducted a n intriguing pi lot study. He selected a fessional life, including the famous 19 Berggasse in number of therapists' offices from the Yellow Pages Vien na, Austria, his home and offices from 1891 to of the Tucson, Arizona, phone book. He then drove 1938. In addition to constructing measured d rawings around the city to see what these offices looked like of the consulting room where Freud met with his pa­ from the outside. Results of his study revealed that tients, she also studied how he organized furniture all the sites he visited had an institutional feel. Most as well his large collection of antiquities. As Subotin­ were part of a medical complex, a nd they created a cic (1999b) argued, "he carefull y and self consciously visual impression of a doctor's office. All were de­ assembled the contents of his work spaces in a man­ signed for occupancy during daylight hours, and he ner that reflected the organi zation of his thoughts speculated that night lighting could potentially be a a nd beliefs." Around 1890, a grateful patient, problem. Security for both clients and therapists is a Madame Benevisti, gave him a memorable present, significant issue. Accessibility, too, may be another what later became his world-famous psychoanalytic problem area. It appeared that most met only the couch. While at first he collected copies, photo­ minimum standards for accommodating wheel­ g raphs, prints, a nd plaster casts of Florentine stat­ chairs. Richards also noted that the vast majority of ues, when he became more financially secure, he therapists' offices were located in a more affluent decided to collect original statues and vases from area of Tucson. Therapists may have selected the lo­ Egyptian, Greek, Roman, and later Chinese periods. cation of their offices on purely economic grounds Subotincic's research revealed that major shifts in without giving much thought to other issues that the development of Freud's theories of psychoanaly­ may be relevant to clients. sis were either directly preceded or followed by At the same APA symposium, Richards delivered physica l and spatial alterations that he made to h is a paper on behalf of Penny McClellan (1998), a prac­ office. Freud often referred to his antiquities, espe­ titioner e mployed by the American Indian Health cially the statuettes which decorated h is writi ng Center in Sa n Diego, California. Her presentation table and which he greeted each morning, as his "au­ addressed how the rapists select an office and what dience." He was so attached to his coll ection that he they failed to learn about this process in graduate took a substantial part of it w ith h im during his sum­ school. She stressed that the quality of the neighbor­ mer holidays. By 1938, he had placed at least six stat­ hood in which the therapist's office is located is es­ ues of Eros, the God of love, in a glass display cabinet pecially important. It should be accessible from the at the foot of the couch. His patie nts were staring freeway and from public transportation and ideally straight at them-rather than at Freud himself-dur­ should have parking nearby. Therapists must be at­ ing analysis. His consulting room addresses themes tentive to such issues as air quality, freeway noise, cxpwrmg t'ntnolOgy: KelatlOtlslrips between Clinical and Environmental Psychology 139

I and airplane flight paths, all of which influence the change therapeutic settings. Office settings tended environment in which they practice. Concurring to be shown for sessions with individuals, while with Richards's findings, McClellan argued that more domesticlike settings were backdrops for ses­ I safety at night is another important concern. Thera· sions with couples. During one indiv idual counsel­ pists will also find it useful to have some type of sig­ ing session, Judy (Mia Farrow) is shown in front of a ! nal system in place, for example, to announce when backdrop of venetian blinds, and at another she is cl ients arrive or to contact someone in case of an positioned in front of a semicircular window. In this I emergency. Accommodating children in a waiting film, one gets the impression that therapeutic set­ area may a lso be an issue for cl ients who cannot af­ tings are used as props to ampli fy the trite angst of ford babysitting or child care arrangements. New York yuppies. As a final part of the APA symposium, Anthony Surprisingly, an extensive search of several data­ (1998) presented an analysis of environment behav­ bases covering thousands of scholarly journals, ior issues in the design of psychotherapists' offices. newspapers, and popular magazines, revealed virtu­ She began by reviewing images of therapists' offices ally no information at all about the office designs of in American film, such as Ordinary People (1980), psychotherapists, therapists, or counselors. A request Prince of Tides (1991), and Good Will Hunting (1997). to the e-mail bulletin board of Division 12 of the She also noted that director Woody Allen has fea­ American Psychological Association yielded only one tured therapists' offices in several of his films, for response. Nonetheless, informal interviews with example, Husbands and Wives (1992) and Deconstruct­ therapists combined with the author's personal re­ ing Harry (1997). What kinds of stereotypes about flections revealed several issues to be important in the field do these films promote or reflect? What the design of therapists' offices: roles do therapists' offices play in film: backdrop or center stage? How do these mass-produced images • Location. How convenient is the location of the help or hinder the psychological profession? office for clients? If the office is right off a b usy Two examples of how therapists' offi ces are por­ freeway intersection, for example, the stress of trayed in film are analyzed here: Good Will Hunting traffic can predispose one to an even more and Husbands and Wives. In the former, the main stressful session with the psychotherapist. character, Will Hunting (Matt Damon) visits severa l • Image. Does the building where the office is 10· therapists in an attempt to address his psychological cated have a homelike or an institutional image? problems. The first office reflects a formal academic • Degree of visibility. Do some clients want to setting with Gothic architecture, dark woodwork, hide? Do they fear running into people they and high bookshelves. At the second office Will know? Or, at the other extreme, do some wish Hunting reclines on a couch while a therapist per­ to advertise they a re seeing a therapist? forms hypnosis. Lights are dimmed and curtains are • Proximity to rest rooll!. How far away is the rest shut. A decorative screen is positioned behind the room? Having one nearby gives clients a place therapist, perhaps symboli zing the hidden self. The to escape. A long hike down a hallway can third office is that of Or. Sean McGuire (Robin make clients anxious. Williams), the only therapist with whom Hunting • Privacy. This is one of the most important con­ eventually connects and opens up to psychologi­ cerns. Can clients be seen or heard by others cally. In contrast to the previous two office environ­ outside the therapist 's office? Can clients see or ments, McGuire's office appears much more lived in, hear other clients in adjoining therapy rooms? personalized by a coatrack, plants, and pictures, • f,asy-to-read clocks. Are clients surprised when even a paint-by-numbers painting of the sea. Opaque their appointment time has ended? Have thera­ glass windows shield his office from view. Further­ pists paced themselves adequately throughout more, McGuire's physical appearance contrasts with the therapy session? those of his two predecessors. While the first two • Elltrallces and exits. Are the number and place­ dressed formally, McGuire dressed more casually. ment of entrances and exits helpful or harmful? In all three cases, the therapists' clothing reflected One therapist said that in seeking out new of· the overall ambience of their offices. £ice space she was concerned that the client In Husbands and Wives, the psychologist is merely could leave her office without walking through a voice offscreen, and the main characters often the waiting room, thus minimizing the need 140 H ANDBOOK OF ENVIRONMENTAL P SYCHOLOGY

to interact or be seen in a state of emotional and adjusting to a divorce. Another area of concen­ fragility. tration has addressed the house as a symbol of self • Furniture. Is the therapist face-to-face with and the environment as an autobiography of self. No clients or side by side? Which seating arrange­ doubt there may be others as well. ment is most/ least intimidating? How much The process of mov ing is one area where clinical choice is available? Might certain types of fur­ and environmental psychology intersect. Individuals niture make clients more or less li kely to lose who have recently experienced a move may present emotional control? Or do some types of furni­ themselves to clinicians with a variety of psychologi­ ture actually help clients feel better? cal problems. In their classic Social Readjustment Rat­ • Lig1Jtirrg. How bright or dim is the therapist's ing Scale, T. H. Holmes and R. H. Rahe (1967) and office? Bright lights may seem cheerful to some T. S. Holmes and T. H. Hol mes (1970) cite a change in clients, but glaring or overwhelming to others. residence and change in living conditions as events Conversely, dim lights can seem soothing to likely to increase life stress. One of the earliest pieces some but spooky or depressing to others. Who to examine the phenomenon of losing one's home was controls the lighting? How much control does a done by Fried (1963). Seve ral researchers have com­ client have or need? Are lights overhead or on pared the process of moving to the grief reaction of side walls or tables? Glare may affect how pa­ losing a loved one (Bronfenbrenner, 1967; Marris, tients view their therapists and vice versa. 1974; McCollum, 1990; Weissman & Paykel, 1972). • Views. What role does an outside view play? A Anthony (1984a) ex plored memories of favorite view of nature could have a healing effect, as homes, the experience of moving away and later re­ has been demonstrated in medical settings (Ul­ turning to visit them. Interviews with 97 Southern rich,1984). California residents revealed that most fee lings • Plauts. In what condition are plants kept? Dead about moving out of the favorite home we re negative plants can send a signal to clients: If therapists (57%), as were return visits to the home after mov­ can't even take ca re of their plants, how well ing out (88%). can they take care of their clients? In an early study, Anthony analyzed the role of the • Artwork. Color, text ure, intensity, degree of ab­ home environment In family conflict (1984b). Forty straction, and subjec t matter may all playa role therapists in the Los Angeles area involved in mar­ in how clients respond. riage, family, and child counseling were interviewed as part of an exploratory study. Counselors were In sum, the physical environment of therapists' asked to describe their clients' problems about territo­ offices may well significantly influence the attitudes riality and privacy in the home. Most therapists failed and behavior of cl ients, and the success or failure of to focus on the physical envi ronment as a key concern the therapeutic process itself. It may exacerbate in their pract ice yet, after having been questioned cl ients' preexisting conditions- for better or for about it, recognized its importance. The physical envi­ worse. Environment behavior researchers, architects, ronment often served as a significant backdrop to interior designers, and psychotherapists must collab­ problems reported by their clients. Results showed orate to further investigate these important issues. that the bedroom was most prone to territorial and privacy conflicts. Closely following the bedroom were the kitchen, bathroom, and living room. Pieces of fur­ CLINICAL APPROACHES niture that sparked the greatest conflict were televi­ IN ENVIRONMENTAL sions, stereos, and desks. Today computers, cellula r PSYCHOLOGY telephones, and other electronic equipment might pro­ In addition to the work just described examining the voke domestic controversy as well. role of the physica l environment in therapeutic set­ Subsequent work by Anthony (1997) examined tings, other distinct areas of work have emerged parents' and children's perceptions of their housing where clinical approaches have been used to exam­ environments before and after a separation or di­ ine issues in envirpnmental psychology. One body of vorce, as well as the role that the home may play research has addressed the experience of moving. during a marriage. Two phases of research were in­ Another body of work has examined the role of the volved: first, an exploratory study at the Ce nter for home in family conflict and it s role in precipitating the Family in Transition in Corte Madera, California; Exploring Pathology: Relationships between Clinical alld Ellvironmental Psychology 141 and second, a study of 58 individuals in two support Peled and Schwartz (1999) published two case organizat ions for children and parents of divorce in studies exploring the role of the ideal home in psy­ St. Louis, Missouri. Survey and interview findings chotherapy. As part of their therapeutic approach, revealed that w hile the home is rarely the direct they used the method of eeo-analysis in the analysis cause of divorce, it often exacerbates preexisting of homes. Eco-analysis involves a compar ison of the conditions in a marriage. Subsequent to a divorce, client's concept of a n ideal home with his or her some parents and children still maintain a strong present home. This comparison is then used as a emotional attachment to the home they inhabited projective measure in therapy. Similarly, Pe led and while the marriage was intact. Moving out of that Ayalon (1988) published a case study examining the home can take a serious toll on family members and, role of the spatial organization of the home in family for some, cause severe g rief much like the loss of a therapy. The experience of a couple in therapy who loved one. Respondents' perceptions of their post­ underwent eco-analysis revealed similar dimen­ divorce housing arrangements were also discussed. s ions of conflic t in their relationship and in the spa­ Based on her research, the author concluded that the tial configurations of their respective ideal homes. physica l housing environment, typically viewed as a Rowles (1983, 1984) examined place and personal backdrop to everyday life, may well mer it center identity in old age as manifested in a small Ap­ stage. palachian community. He argues that, for many el­ Clare Cooper Marcus (1974, 1995) has studied in­ der ly, the environment is an autobiography of the d ividuals' relationships with their home environ­ self and refers to this phenomenon as aldobiograplJi­ ments for decades, beginning with her seminal cal insidedness. [ns ide versus outside represents the paper "The House as a Symbol of Self" and culmi­ d ichotomy between what the elderly view as their nating in the publication of her book The HOl/se as community and as the outside world. This concept Mirror of Self She draws upon the theories of Carl has strong implications for therapeutic approaches. Jung, particularly his notion of archetypes, to un­ Autobiographical recollections of Significant spaces derstand how people rela te to their houses. The and places may reveal interna li zed geographies that book attracted widespread publicity including an influence how clients cope with PTSD and other appearance on the popular Oprah Winfrey Show, an mental disorders a nd changes in the physical envi­ event that caused the book to go into a second print­ ronment. ing almost overnight. Israel (1998, 1999) has been using environmental The methodological tool of environmental autobi­ autobiography methods to understand the roots un­ ography (Cooper Marcus, 1978; Hester, 1979) has derlying the work of well-known designers. She con­ been widely used among environment behavior re­ ducted in-depth interviews with arch itect Michael searchers, and it holds great promise fo r clinicians Graves and architecture critic Charles Jencks, based as well. One of the most significant findings from on a series of exercises derived from topoanalysis this method has been that adults often look upon (see Bachelard, 1969). Her tools included an environ­ their childhood home as " haven," a standard upon mental genealogy exercise. Israel's research uncov­ which to base their ideal home environment. Yet the ered how both Graves and Jencks had unconSCiously opposite can also be true. For those who experienced reworked their history of places to create their own an unhappy childhood or, even worse, who were the homes as well as their well-known public buildings. victims of trauma, the home can serve as a trap, one [n their firm, Forrest Painter DeSign, Consta nce that triggers unpleasant memories. In fac t, for this Forrest (1999a, 1999b) and Susan Painter (1999) rou­ reason some students who are asked to write an envi­ tinely rely upon clients' unique relationships with ronmental autobiography as part of a course require­ t heir physical environments as par t of their design ment have been unable to complete the aSSignment. and clinical practice. Forrest, a clin ical psycholo­ Although the tool can be an excelle nt means of un­ g ist, and Painter, an interior designer who is also a covering one's environmental biases and values, for developmental psychologist, have branded their ap­ some vulnerable individuals the technique raises a proach "design psychology." Design psychology relies host of ethical problems (Rubinstein, 1993a, 1993b). upon interviews and assessment tools from clinical Yet when used by a clinician with the appropriate psychology. The information derived from these psychological training, the technique can elicit in­ tools is used as the basis for design. Their objectives sights that no other assessment measure can offer. are to create spaces that function as therapeutic 142 HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY environments. This is achieved in part through a de­ Other works involving clinical approaches to envi­ sign prescription the goal of which is to create envi­ ronmental psychology have included ethnographies, ronments that s upport and enhance both privacy interviews, and surveys examin ing the relationships and social affiliation, positive beliefs about the self between institutions and the large-scale communities and self-esteem, sense of controL optimism about in which persons with mental disorders reside. They the future, and reminders about the meaning of life. exemplify the aforementioned systems approach as Forrest has developed three assessment tools to they involve different levels of analysis from macro­ determine the environmental factors that evoke such to microsystems. For example, Roosens (1979) ana­ positive psychological states for individual clients: lyzed Geel, Belg ium, Europe's first therapeutic com­ developmental history of place, five objects, and favorite munity. The city soon became a pilgrimage site for place. The first, developmental llistory of place, asks those with mental disorders, in response to the cult clients to recall where they have lived, when they of St. Dymphna. St. Dymphna was the daughter of a lived there, and what important events occurred. seventh-century Irish king. After refUSing to commit The second is a projective assessment technique incest with her father, she fled to Flanders. Her fa­ whereby clients are asked to select five objects about ther later discovered her there and murdered her. By which they feel so positively that the feeling could refusing her father's desires, legend has it that she be characterized as love. Forrest then asks her clients defeated his madness. Si nce the mid-thirteenth cen­ to describe what about each object drew them to it tury, persons suffering from mental illness have en­ and what emotions and associations the object tered the Church of St. Dymphna to partake in a evokes. The third tool asks clients to describe a fa­ series of exorcisms. Many patients moved perma­ vorite place, the place in which they have felt the best nently to Ceel, and the city benefited economically of all places they have ever been, not necessarily a from its fame. place where they have lived . With this image of the Shoultz (1988) addressed the needs of individuals place in their minds, Forrest uses a relaxation tech­ with mental disabilities and disorders at a mkrosys­ nique to gUide clients to enhance their memories tern level w ith macrosystem implications. She ar­ and recreate the experience of each of their senses, gues that placing these individuals on a continuum foc using on sound, color, texture, visual image, tem­ with institutional care at one end of the scale and perature, and spatial relationships. Her objective as community living on the other can be problematic. a design psychologist is not to try to recreate the fa­ Committing most troubled persons to institutions vorite place but rather to bring elements into the de­ isolates them from normality. Clients are assumed sign that will recreate the experience that clients to progress along the conti nuum from inst it utional feel in this place. She weaves together information to community living: By contrast, Shou ltz proposed from all three assessment tools to produce a design what she called "permanency planning," a concept for each individual client. whereby individuals remain within the confines of Painter (1999) has extended the principles of de­ their own homes and communities. They are encour­ sign psychology to design fo r groups of people rather aged to become active and normalized members of than for individuals. She draws upon three principles their communities, and any treatment they receive is from developmental psychology. Security-exploration given at home. In fact. permanency planning reflects balance is the notion that emotional well-being is principles similar to those seen at the therapeutic fostered by the proper balance between familiarity community of Ceel. and novelty in the environment. Environmellt-as­ At the institutional [evel, Colarell i and Siegel mirror is the principle that people experience the en­ (1966) explored the effects of changing social roles vironment as a reflection of themselves and their in­ in Ward H, a psychiatric ward in Topeka State Hos­ trinsic worth. The caregivillg for tire caregiver principle pital in Topeka, Kansas. Aides assumed management asserts that in order to do their job effectively, those positions formerly held by psychiatrists, nurses, so­ who care for others must meet their own psychologi­ cial workers, and other staff members. No longer cal and physical needs as well. All three psychologi­ were the aides passive recipients of their superiors' cal principles are used as the basis for a needs orders. Instead they had the authority to make piv­ assessment, a series of needs statements about the otal decisions about the ward. In order to help clients and the environment, which becomes the basis schizophrenic patients better distinguish between for subsequent design work. fantasy and rea lity and between themselves and the Explorillg Pathology: Relationships between Clinical and Environmental Psychology 143 surrounding environment, the aides initiated exer· participated in environment behavior research have cise routines and focusing activities for them. They become more aware of the role of the physical envi­ also improved the ward's appearance, which had ronment. previously been stripped of sharp objects, picture Much more rigorous research is needed to link the frames, and other potentially dangerous items. A two disciplines of clinical and e nvironmental psy­ four-year longitudinal study revealed that patients chology. More clinical case studies and more studies became more sociable and better oriented, strong in­ of group outcomes are required. More sophisticated dicators of normalization. assessment techniques that incorporate environ· Fairweather, Sanders, Maynard, Cressler, and mental issues need to be developed. A handful were Bleck (1969) demonstrated the important relation­ identified here, but many more are needed. Assess· ships between psychiatric patients and their physi­ ment tools that focus on the physical environment cal surroundings. They supervised an experiment in need to be made widely available to clinical psychol­ which patients from a mental hospital were relo· ogists. Eventually, studies with larger sample s izes cated to a lodge in the community. At the lodge, pa­ are needed. Ultimately, future versions of the DSM tients felt a sense of autonomy that led to leadership need to better incorporate the physical environment roles and empowerment. The mental health of the in their descriptions of mental d isorders. This could patients improved at half the cost of institutionaliza­ have a major impact on all those involved in diagnos­ tion. Furthermore, living in the lodge had an even ing and treating mental disorders. Finally, research greater positive effect on patients who had been hos· needs to be published concurrently in both clinical pitalized for the longest time. and environmental literature, so that each may learn In sum, with the exception of the body of work about the other. cited here, clinical approaches to environmental Just as design practitioners and design educators psychology are relatively few and far between. need to be better informed about the role that psy­ Nonetheless they offer many possibilities for fu­ chology can play in spaces and places, clinicians and ture research. clinical psychology fa culty must be better informed about the role that spaces a nd places may play in the etiology, diagnOSiS, a nd treatment of mental disor­ CONCLUSIONS ders. 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