There is no one way to hold space for a client and we all have our own style or are learning our own style of being thoughtful health care workers.
In planning the physical space that you will see clients in there are a few things to consider.
Making an effort to provide a calming, inclusive space signals to our clients that we are aware and willing to support in an individual and intentional way. There may be things that you don’t have control over and you may not be able to adapt everything as you may like; but small changes and offerings for clients can aid in signaling that you have the aim of creating a space with the intention of emotional safety.
We can not determine what emotional safety is for individual clients and we can not assume the microaggressions, trauma and experience they bring. We can let them know we are aware that these experiences may be part of their experience and we are considerate of how it may impact them and that we want to adapt to their needs where we can.
Of course it is important to ask each client if there is anything you can do to make them more comfortable, at each session. Here are some things to consider before your first client even walks in the room.
In coming to a session with a new clinician for the first time a client may be very activated, distressed or overwhelmed with the anticipation of the unknown. With clients emotional safety in mind and possible anticipatory activation we need to consider what we can do in the physical space to aid in calming clients nervous systems.
Clients you see may have experienced harm within the medical system. This may have left them feeling invalidated, failed in their illness or stigmatized. Some may have experienced trauma in previous attempts to seek care for their eating disorder. Just being in a medical space may be triggering for some clients. If sharing a GP office it is worth considering that a clinical room may be unsettling for clients if they have previously experienced medical trauma such as misgendering, weight and body shaming or invalidating support. We may not be able to “un medicalise” a space but we may be able to add things to the space to help soften it and signal consideration.
We can inform clients before they attend that we work from a medical clinic or a GP room. Your website could include a photo of the room and a short description of what the waiting room and treatment room will look like. This could also be flagged in any automated appointment confirmation or reminder emails.
Some of the offerings below may help to soften a room, assist in grounding the nervous system; for yourself and your client and flag your consideration of people’s experience in your wider culture.
Having posters and flags in the general area, waiting area and office directly communicates that as an organization and/ or individual practitioner. you acknowledge the experiences of and have considered the possible traumas experiences by marginalized groups.
This may include (Taken from an Australian context):
Flags may include:
Consider including artwork on the walls that include calming colors. You may choose to support independent artists from marginalized groups (prints or framed cards are often inexpensive options).
Furniture should be set up so that when a client is seated they have a clear view and unobstructed thoroughfare to the door and feel that they can easily leave the room if they become activated or overwhelmed. This is especially important for clients who have a history of trauma.
People in higher weight bodies have generously shared their experience of fear that there will not be seats that can accommodate them in public and private spaces. This may include chairs with arms that are too narrow or chairs that they fear won’t hold their weight. Consider this when looking at the seating options in the space you see clients. Is the seating available able to accommodate a range of bodies? Size, shape, weight and accessibility needs?
Positioning ourselves and our bodies in the room with our clients and their bodies is another important consideration. Set the room up so that you can sit facing the client or slightly to the side of the client.
Sitting behind a desk may be disconnected to attunement with the client and may be perceived as a barrier. Consider if you are going to be taking notes while sitting with a client. Will this be with a tablet, laptop or paper? Have you considered what impact this will have in the interaction with the client?
It may be commonplace for some generations to type on a laptop while listening; but not for all!
Consider asking clients at the start of sessions for permission to take notes on your laptop/ table/ notepad. Explain how these notes will be used; i.e. to assist in writing clinical notes for their file.
Consider that the screen of a tablet or notebook may interfere with you being fully present, attuned and engaged in the conversation. If you need to attend to the screen to open a file or open a browser to communicate what you are doing with the client. Being transparent in what you are doing and why with the client will help the client to feel considered, included and at ease.
Walk into your space and try to put yourself in the shoes of your client. How do you feel in space? What can you see? So common items in health practitioner officers we may be used to and not notice. Something such as a scale. For so many reasons the sight of the scale in the room may be jarring for a client. Their head may be flooded with thoughts that are so distracting that they can’t be present and engaged.
“Are they intending to weigh me ?
When ?
Why ?
What if it’s different from the other scales ?
Will they tell me the number ?
What will I feel if I do ?
What will they think of the number ?”
Weight and the process of weighing is triggering and complex for all of our clients. If the scales can be stored out of sight, consider doing this. If they can’t be moved, can they be covered or can you acknowledge them in the room and discuss it with the client.
“ There are scales permanently in this room as I share it with other practitioners and am unable to move them. I won’t be using them as part of our assessment today and if at some point there is a reason to weigh you I will discuss this in detail with you and we will come up with a way to do this they feel most comfortable for you.”
If we go back to the exercise of thinking like a client, what else is in the room to consider?
Health promotion posters that may be triggering? Measuring tapes?
How could you move these things or discuss them with the client overtly?
Calming the nervous system
We are unable to decide what creates emotional safety and helps others to feel calm; but we can be aware of providing the ingredients in the hope that each client can access what they need.
Lights can be deliberately soft, with warm globes and extra lamps used to create a softer light in the rooms without windows.
If you have the opportunity to control the colors in the room you can consider which colors will help to create a calming and inviting atmosphere. This may include warm shades, greens, blues, violets, pinks, tans, soft whites and warm grays. You may not be able to paint the walls but you can consider this in the soft furnishings, artwork and decor of the room.
You can consider offering a range of tactile experiences for the clients that may be calming. This may include soft furnishings such as pillow, blankets, and/ or weighted lap pads,
Diffuses could be used with the aim of olfactory calming of the nervous system. Always check with clients to make sure it isn’t too overwhelming for them and ensure it can be easily removed. Some people are very sensitive to fragrance.
Plants, real or not, are known to be calming and can be added to a space. Consider if you are able to offer water or tea for clients. Warm cups can give anxious hands something to do; as do fidgets.
It may be worth considering a range of fidgets and other activities that clients can use while they are in the session. These are helpful for all, not just for people who identify as neurodivergent. Activities such as coloring in and puzzles may be something that can be a focus for people who are overwhelmed – aiding in them feeling more able to talk about what may be difficult topics.
Orientate a client to the space if they are new. Let them know where the bathroom is. Offer them a range of seating options. Offer them a drink. You may detect that someone is activated before the session commences; this may be anticipatory anxiety or the process of finding a new office may be stressful. Check in with the client and allow them to speak about getting there, getting a park etc. The process of coming to a new space and the logistics can be very activating and clients may need a little time to debrief and settle.
If you notice the client is activated you may offer them a moment to ground and arrive in the space. This may be a few minutes to catch their breath and settle. If it is a new client and you are unsure how they will respond to this invitation you can always model some grounding. This may be something like.
“ Oh, it has been such a busy day, I like to take a pause and a few deep breaths at the start of a session so I can be fully present and calm with you.
*take a few deep breaths*
That’s better – shall we get started?”
This is not an extensive list but some ideas to prompt reflection and planning. Check in with your clients and act on what they share; They are the greatest teachers you will have.
We’re Jo and Christie—Accredited Practising Dietitians and Credentialed Eating Disorder Clinicians with a shared passion for disordered eating, eating disorders and body image work.
Our resources are developed alongside people with lived experience and designed for health professionals who want to deliver high-quality, client-centred care.