Psychological Messages from the Physical

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The International Journal of the Addictions, 25(7A &. 8A), 905-955, 1990-1991

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Psychological Messages from the

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Physical Environment: The Drug and

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Alcohol Treatment Center Environment , Suzanne L. Younge Eugene R. Oetting* James H. Banning Colorado State University

Kenneth A. Younge Brown University

Abstract The physical environment ofdrug and alcohol treatment centers provides

a rich source for both subtle and obvious messages to clients. Photographs

were taken in a sample of typical treatment centers, showing how differ

ent elements ofthe environment communicate messages to clients. Many

ofthe messages from the physical environment prove to be inappropriate,

confusing, or inconsistent with "espoused treatment philosophy. [Transla

tions are provided in the International Abstracts Section of this issue.]

*Com:spondence concerning this article should be addressed 10 Eugene Oetting at the Department of Psychology, Colorado Slate University, Fort Collins, Colorado 80523. 905 Copyright ~ 1991 by Marcel Dekker, Inc.

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TREATMENT CENTER ENVIRONMENT

Key Words. Alcohol; Drugs; Ecology; Environment; Treatment

907 Table 1

Concepts tor Understanding Messages from the Physical Environment

We shape our buildings and then they shape us. -Winston Churchill Historically, the nature of the person-environment relationship has been of in lerest to a number of psychologists (Lewin, 1936; Brunswick, 1955; Barker, 1968; Moos, 1986). Rapaport's (1982) recent work focuses attention on the linking mechanism between physical spaces and people. He suggests physical spaces have meaning for people and the mechanism of non-verbal behavior links the physical spaces to people. He reasons, "Since environments apparently provide cues for be havior, but do not do it verbally, it follows that they must represent a form on non verbal behavior" (Rapaport, p. 50). Rapaport summarizes, ..... environments are more than just inhibiting, facilitating, or even catalytic, they not only remind, they also predict and prescribe. They actually guide responses ..•" (Rapaport, 1982, p. 77). The question that forms the basis for this paper is, "In what ways do the physi cal environments of alcohol and/or drug treatment centers yield psychological cues or messages which may guide the behavioral responses from the client?" During the summer of 1987, 35 alcohol and/or drug treatment centers in Colorado were examined. The centers included in the study were a sample that provided a wide demographic range, covering ruraVurban, public/private,large/small, youth/adult, male/female, and social-economic class. The method of study was twofold: (1) permission was obtained to tour and photograph the treatment facility, and (2) in terviews were held with the staff to discuss elements of the environment that needed explanation or clarification. During the agency tours, the photographing of the environmental elements was guided by the general principle of assuming a us er's point of reference and photographiIig any aspects of the physical environment that were noticeable and that suggested inferences regarding the client/treatment transaction. Particular attention was paid to environmental messages that seemed to be unintentional or messages that were incongruent with the goals of treatment. A number of concepts found in the environmental psychology literature helped to focus observations and guide selection of views to be photographed (see Table 1). The photographs, Figs. 1-36, are presented in the Appendix, beginning on page 928.

Editor's Note: The reader will note instances when:: the paper touches on the work of environmenlal psychologists (e.g., proxemics, territoriality, personal markers, perceived control, etc.). Unfortu nately, becaw;e of space limilations, the aulhors were unable to explore the relevance ofbasic research in these areas to the applications discussed here.

Concepts

Environment as nonverbal communications •

Redundancy

•

FIxed

•

SemUIXed

• Nonl"lXCd

Behavioral lraccs

•

Remnants of w;e

•

Physical cues

•

Adaptive change

Functions of physical settings •

Security md shelter

• •

Social contact Symbolic identification

•

Task instrumentality

•

Pleasure

• Growth Ecological psychology •

Behavior setting

Dimensions of environment •

Ecological dimensions - Geographical

- Meterological

. - Architectural md design

•

Behavioral settings

•

Organiutional structure

•

OIaracteristics of inhabitants

•

OrganizatioDal climate

•

Reinforcement Analysis

Social interaction •

Sociofugal

•

Sociopetal

Author

Rapaport (1982)

Souroe

The Meanina of the Built Environment

Ziesel

SocioJocy md Archi

(1975)

tccturaI Design

Steele

Physical Setting md '

(1973)

Organizational Development

Barker

Ecological Psychology

(1968)

Moos

The Human Context

(1986)

Osmond (1959)

Psychialric Archilectun::

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Rapaport's work (1982), for example, not only provided the general perspec tive of viewing the physical environment as nonverbal communication, but his work also provided a stroctwe from which to view the many elements within the physical environment. Rapaport views environmental elements as fixed, semi fixed, and the nonItxed. For example, a fixed environmental element ofa treatment center would be the load-bearing walls. Changes in fixed elements are made only with considerable effort. The semiflXed environment within a treatment center would be a particular furniture arrangement, pictures, signs or other items that could be moved or rearranged without considerable difficulty. An example of a nonftxed element would be a receptionist behind the admission's desk. Of particu lar importance is Rapaport's observation that the semifixed environmental ele ments are more easily under the control ofpeople and therefore can be used to com municate meaning. For example, the arrangement of furniture in waiting rooms, group rooms, and bedrooms often signal important messages, and signage is a semiftxed element used to clarify staff or client intentions. Rapaport's (1982) concept of redundancy proved helpful in interpreting both multiple signage and "added on hand made signs. Increasing the numbers oftimes the message is given (redundancy), signals an attempt to increase the probability that the message will get to the client. Due to this phenomenon, multiple or added on handmade signs which attempt to clarify often signal a problem in the ability of the environment to cue an appropriate response. For example, if it takes several signs to point out the entrance to a center, then most likely the entrance is somehow obscured from vision or there is an abnormal traffic pattern that obfuscates the en trance. Zeisel's work (1975) also proved helpful in targeting the camera. Zeisel sug gests four types of physical cues within the environment: (1) Remnants ofuse cues are traces of use found in the physical environment that serve as a means of com munication. For example, worn floor areas within a center indicate the traffic pat tems used by staff and/or clients of the center. (2) Physical cues can also serve as a medium for group symbolic communications. For example, within the treatment facility staff messages as well as messages coming from clients as a group can be found. Often the staff messages attempt to signal status, for example the many "Staff Only" signs that appear in treatment settings. (3) Adaptive change is a third type ofphysical cue. Messages are sent as clients move furniture and redesign their spaces within the treatment center. (4) Displays ofself also provide physical cues. For example, personal items placed within a c1ient's bedroom by the client express client attitudes and feelings. Zeisel (1981) introduced a number of additional issues that need to be consid ered in examining how people relate to their physical surroundings. These include the classical issues of privacy, territoriality, and personalization, but he also made note of the concept of "wayfinding." Wayfinding concerns how people find their way through a setting, and what kinds of physical cues are present to clarify or M

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confuse the users. For example, is the entrance to a treatment center easily found by the clients? Are there clear physical cues that point out the exits? The concepts of sociofugal and sociopetal (Osmond, 1959) also proved help ful in focusing on critical environmental elements. For example, some room ar rangements are sociopetal in that they center the group's attention and foster social interaction. Other furniture arrangements do not support or foster group interaction and are described as sociofugal. The work of Steele (1973) is important in helping to focus on other critical aspects of the physical environment. He suggests six categories of functions that a physical setting can provide the inhabitants of the setting: (1) security and shelter; (2) social contact; (3) symbolic identification; (4) task instrumentality; (5) pleas ure; and (6) growth. These dimensions contribute to the sociophysical nature of organization and are helpful in capturing organization-environment issues. The interview component of the study was not only valuable in tenns of ob taining more information regarding physical environmental elements, but it also allowed the opportunity to "hear the verbal message regarding treatment philoso phy as well as the rationale for policies and procedures. This information allowed contrasting the verbal and nonverbal messages. For example, one agency took con siderable time to indicate that their treatment philosophy included the notion of the agency being a "nonhospital" environment. However, this message was very much in contrast to the "Hospital Certification that was prominently framed and dis played in the entry hall to the facility. Assuming the goal of treatment staff is to help the client become engaged in the treatment process offered by the center, it is worthwhile for staff to assess any thing which could enhance or retard the level of commitment of the client. If the physical environment does send psychological messages which can have even a subtle effect on the degree of the clients' engagement in the treatment process, it is to the direct benefit of the center for the treatment staff to assess the quality ofthese messages. Engaging in the treatment process can be described by four areas: whether the client stays or leaves treatment, adaptation to group living in a positive way, understanding the information communicated in signs, and level of confor mance to the rules and behavior expected by the treatment program. Are the physi cal setting, cues, the signs, and the rules helping people at the treatment center to interact most productively? Touring the 35 alcohol and drug centers generated over 1,000 slides depicting a variety of physical environmental elements. The messages in these pictures may be interpreted differently, depending on the culture, beliefs, and attitudes of the observers, but we have tried to select illustrations that would communicate essen tially the same message to many different clients in this environment, Mid-Amer ica. Four areas emerged which served to help organize the response to the basic question of ~ln what ways does the physical environment of alcohol and drug treat M

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ment centers yield ~ychological messages which guide behavioral responses from the client?"

• • • •

What does the physical setting of the center communicate? What physical cues guide the logistics involved in group living? How are signs and other objects used to communicate information? How does the physical environment obtain conformance from clients?

WHAT DOES THE PHYSICAL SElTlNG OF THE TREATMENT CENTER COMMUNICATE? Probably the fIrst message that impacts the client is the sign that either directs the client to the center or identifIes the center. The sign in the fIrst picture (Figure 1) actually identiftes a treatment center but does not do so very well. One of us drives by this center frequently, and had always assumed that the sign at the bottom was the name of a small shopping center, the ·Hope Center," and that "Computer land" was the major tenant of that center. The treatment center is a "cottage like" building with a relatively "homey" atmosphere. The sign is not only confusing, but is inconsistent with the tone of the actual treatment center. In contrast, the ·Cenikor" and "Cottonwood Hills" signs shown in the other illustrations (Figures 2 and 3) are clear, and communicate more than just the loca tion of the center. The Cenikor sign is readable, easy to see, and very businesslike. The sign and the square brick building in a business area suggest solidity and middle-class respectability, and even, with the logo, that this location is part of a large, aubstantial organization. The Cottonwood Hills sign is visible from a coun try road, surrounded by greenery connoting a rural setting. It conveys a country homestead feeling, and, at the same time, the lettering chosen and the "restrained good taste" suggest that this will be a place suitable for people who have fmancial resources. These messages are consistent and are what treatment staff are trying to communicate about their centers. A sign we saw at the entrance to another center was not only unimpressive, it was confusing. It said, "HOURS, Doors open 8:00, no one admitted after 10:30 PM, Staff excluded, Thanks." It was a hand painted sign identifying a treatment center in downtown Denver where transients might be wandering by late at night. The sign was an attempt to prevent a late influx of potential clients, but it did not necessarily belong on the main entrance sign. The message seems to imply, "You are only wanted here when it is convenient." Perhaps the hardest step for a substance user to take is to walk into a treatment center. If it is difficult to locate the entrance to the center, it may be the fmal factor that prevents seeking treatment. Zeisel calls this "wayfmding." One center pro vided a perfect example of the problem. The pictures in Figure 4 show the four

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sides of this building. The top left picture (a) is the front of the building on the main street. The ramp, supposedly for the handicapped, is blocked off and has a "No admittance" sign, and the door at the top repeats that message. The attached store to the right prevents going around the building in that direction. Moving clockwise, therefore, you reach the side of the building (b) through a short alley. The door in this picture is locked and has no label. Continuing around the building, the bottom left picture (c) shows the back ofthe building. It looks good. There is a stairway and a door. No, the door at the top of the stairs is locked and says "No entrance." Fi nally, the bottom right picture (d), we reach the fourth side of the building. The little side door on the shedlike extension is the actual entrance to the building. There is even a sign, but the entrance and the sign appear much too late for easy -Wayfmding." The next photograph (Figure 5) shows how ~ awning can clarify the question about whether this is a front entrances. There is also a clear, professional sign indi cating the name and address of the facility and potential clients can easily fmd the place. Notice, however, that a nonfixed element, the hospital cart in front of the building, sends another message suggesting strongly that this is a center that pro vides "medical" treatment. The general surroundings and the type of building where the center is located can send important messages. For example, one center (not pictured here) was a frame building, next to a church, set in a wooded lot. In contrast, another treatment center was located in a long row of offtces that were set off a concrete ramp that looked like a loading dock. The two settings contrast personal vs. institutional, home vs. business, and caring vs. storehousing. All of these messages were accu rate. The former center provides private inpatient treatment for young women. The latter is a detox center for the city. If you get "falling down drunk" in pUblic, that is where you will be stored until sober enough to leave. As the prospective client approaches an entrance, the message sent by that en trance can become very important. Contrast the messages from the two entrance photographs here (Figure 6). One is welcoming and home-like. The shopping carts may have been stolen, but they show that people move in and out freely and take care of some of their own needs. The bicycle even communicated freedom of movement. The handrail at the other entrance may be very safe and practical, but its "bar-like" appearance suggests a prison, and is anything but welcoming. We don't know what could be done about this formidable handrail, once it is there, but per haps painting it a color other than black would help a little. It is clear that before clients even enter the door, they already have received many messages telling them what to expect and what not to expect from this place. If the messages are congruent with the real nature and treatment philosophy of the center, that is fine. If they are not, the center may lose clients, or may have to work hard to counter these first impressions.

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WHAT PHYSICAL CUES GUIDE THE LOGISTICS INVOLVED

IN GROUP LIVING?

Many treatment centers will be providing a sheltered living environment of some kind. Steele (1973) writes about task instrumentality as one of the functions that a physical setting can provide for living together. People give up some of their personal freedom when they enter treatment. They eat, sleep, recreate, meet, and may wash clothes in group situations. This is often very difficult for the alcoholic or drug user since much of their lifestyle has become increasingly isolated. This group living is, therefore, usually also viewed as an essential part of the therapeutic process. Every center has physical cues which guide the behavior of clients and staff in accomplishing basic group living tasks and can communicate psychologi cal messages to the client, messages that may be either congruent with the real goals of the treatment program or unintentionally incongruent or inappropriate. The next three photographs (Figures 7, 8 and 9), for example, have to do with personal hygiene. The frrst picture (Figure 7) shows a basket of goods sitting prominently at the admission desk; things to be handed to clients as they come in, toothbrushes, spray deodorant, and after shave lotion. Placing this at the admission desk could communicate different messages, both appropriate and inappropriate. For example, it could suggest "We think that you are dirty and need cleaning up, and that you will not have even the simplest of basic hygiene materials with you." That message might even be true in some detox centers, but is not necessarily true of all clients even there. The obvious placement at the admission desk might also suggest, "What this place is all about is staying clean and smelling good." These are notJlecessarily false messages, and being clean may be important, but should it be given this early prominence, or are there other messages that are more impor tant? Even moving the tray under the desk could get rid of some of the potentially false messages, while still making provision of these resources to needy clients possible. When we requested a bathroom at a detox center, we were explicitly told not to use the one the detox clients used. Looking at the picture of the heavily tiled and essentially "naked" bathroom in Figure 8, it is obviously planned so any conceiv able mess could be easily cleaned up. This might, in fact, be a very practical design. But the cold institutional image and the clear expectancy of lack of control, of vomit and excretion that will need to be washed from the walls, communicates other messages about what to expect in this place. It is always easy to explain these kinds of negative messages by saying, '1be person who ends up here should get that message, only then will they realize they are in the gutter and only then will they try to change." That may even be true, but was that message really planned ahead of time, or is it a rationalization after the fact? If the designers were actually thinking about what message it would convey, would they intentionally build in this message now? Or would they, for example,


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use a solid flooring and wood grained formica on the walls, just as easy to wash down, but a design that would communicate at least some respect for the client. The next picture (Figure 9) shows a 9-point instructional sign on hand washing technique, a sign that is clearly excessive. It seems to communicate, "You ~ dirty, and you don't know how to keep clean, and we are going to tell you every little detail about how to do this simple task." The sign is probably useless because the client who really does lack this primitive skill is also not going to read the direc tions, much less follow them, so it communicates a negative message with no posi tive utility at all. Each of these examples of messages about personal hygiene started with a practical need: clients and rooms need to be kept clean. The design and procedures are defendable from this pragmatic standpoint, but they certainly do nothing to en hance the self-esteem of the clients, and the psychological messages that were sent may not be the ones that should be sent. Steele (1973) states, "Settings also send messages to their users about a more inclusive process-the relative importance of the individual in relation to the system as a whole." The above personal hygiene messages seem to downgrade the importance of the individual. The next two pictures (Figure 10) show another aspect of drug treatment cen ters, the lounge. While both treatment centers provide treatment for adolescents, the messages from the two lounges are very different. The first lounge has a sterile, formal quality, both in the selection of furniture and its arrangement. Outside ofthe furniture, there are essentially no semifixed furnishings that soften and personalize this environment. The lounge may look neat and clean and impressive, but it is hard to picture adolescents relaxing in this lounge. In Steele's tenns, the adolescent does not seem very important. Order, neatness, and keeping the surroundings clean and nice seems to have a higher priority. The center needs to consult some of their youthful clientele for additions or changes in this lounge. In contrast, the second lounge photograph in Figure 10 is of the well-used lounge at a halfway house. It was 10:00 AM and the lamp was on, suggesting that the room is meant to be used. The overall impression ofthe room is informal, invit ing and friendly, connoting a high degree of interaction when people are present. In the previous room, the TV faced the hall, (perhaps to show visitors that the center had a TV). In this room, it faces the couch. There are numerous games and books in ready access. The two small stools are easily portable for TV viewing or to be used as game tables. The messages are welcoming and suggest that the users are valued, not just the physical environment. An interesting point is that the second center was furnished on a shoestring, largely from donations of materials, while the first was furnished by using an interior designer who was obviously more concerned with the artistic image that the room presented than with the youth who would be using it. It does not take wealth to make clients feel at home. We found a large variety of bedrooms, but almost no single rooms. Group liv ing was the norm. The physical cues in the bedrooms sometimes indicated the ex

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peeted length of stay. A room full of beds, with no room for personal effects would be, for instance, characteristic of a detox center. A dresser, reading lamp, and per sonal photographs would be more characteristic of residential treatment. As an ex ample, the fIrSt bedroom photograph was taken in a detox center (Figure 11). The nwnber above each bed might be convenient for directing traffic and keeping track of clients, but the secondary message of the numbers, that the client is a numbered commodity to be fit into a slot, was probably not intended. This center did soften the institutional effect by having colorful orange bedspreads. Perhaps each spread could have been a different color, providing some variety in the room and breaking up the "row of pigeonholes" effect, and allowing the admisSion staff to say, "Your bed is the one with the purple spread" instead of "You are number 7." The next photograph (Figure 12) was in a center for dually diagnosed people with "mental disorders" and "addictive disease." It is obvious at first glance that the bedroom is in a hospital. Do these clients, however, really need the standard hospital table between the beds that allows a seriously ill patient to eat in bed? Does the staff want to convey the message that the client is sick and incapacitated? The patient with a dual diagnosis, with emotional problems as well as substance use problems, may need, more than others, a sense of control and of personal space. Personal space can be marked by posters, pictures, personal objects, etc. There is no sign of that here. Patients are in these hospital beds for a prescribed stay of 90 days! The last bedroom photograph (Figure 13) was taken in a community intensive residential treatment program where the clients stay at least 28 days. The room is indistinguishable from a modem hotel bedroom. Even the pictures on the walls are "motel modem" style. The room does communicate a message that the center is probably trying to get across, that this is a place for fmancially substantial people. While each bedroom, however, is clean, functional, and attractive, it is impersonal. The psychological message might be that the clients are interchangable parts that are expected to have no impact on this environment, to leave no more trace oftheir passage than they would in a hotel. Recreation is another functional task with implications for group living. This photograph (Figure 14) is of an urban garden cultivated by clients who participate in growing vegetables for the center. Every patch ofearth not used for collection of trash is under cultivation. The center happens to be one utilized by Native-Ameri cans. Selecting gardening as an activity if purposeful, it reflects a sense of roral heritage, true for many of the clients. More important is that it says the center needs support and help, even from its clients; that the client can be a contributor to the welfare of the center, can share with others in mutually beneficial work, not just take but give, values consistent wi~h many Indian cultures and with the attitudes of the center staff. The communal exercise facility (Figure 15) at another treatment center pro vides a considerable contrast. It is a relatively new component, emphasizing physi

lREATMENT CENTER ENVIRONMENT

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cal conditioning of the clients as an important facet of treatment. The center had

hired a recreation therapist. One message is "Your physical well-being is impor

tant." There are other messages as well. Unlike the garden at the Indian center,

suggesting a need for any support and help that can be provided, the range of ma

chines and the wall graphics suggest considerable investment; that this is a place

for people who can afford treatment. For these wealthier people, however, the

room may look much like their familiar fitness clubs or their own personal exercise

equipment, and for them it may seem normal and not at all excessive.

There were many other messages related to recreation, too many to include pictures ofall ofthem. In fact, recreation-oriented spaces and objects may be one of the fIrSt places to look for subtle messages about how people are expected to live and work together. Several private treatment centers, for example, looked almost like country clubs, complete with swimming pools. When we read the sign, "Haz ard, no life guard on duty," it did seem ironic considering the potential swimmers were being treated for a problem much more threatening to life. One of these cen ters that had a large female clientele had lounge chairs angled for suntanning, wIUle a men's program had racquet ball courts, suggesting sex-role stereotypes that may be relatively realistic for these particular clients. The center for poorer clients had coin operated pop machines. In contrast, in the private centers for the wealthy, fruit, popcorn, coffee, and soft drinks were left on tables in the recreation room. The message is very clear, a sense of entitlement that goes with the privileges of wealth. Providing an environment as comfortable as home, seeming to say, "You are an important person, and we are going to meet your needs." In a center for relatively improvished clients, there was a basketball hoop out side but the net was missing and the playing area was blocked by parked cars. 11te clients were clearly not expected to play basketball. In other centers, volleyball courts were popular; in many of them nets were left up and the area was kept open, suggesting that group competitive play was an integral part of treatment and living together in this environment. Volleyball courts were so common. in fact, that we began to see them as stereotypes, and wondered whether they really did suggest any psychological messages, but to the new client who sees only one center, a vol leyball court may suggest that competition is part of the environment, but it also may suggest "teamwork." Staff who are attempting to engender a cooperative and noncompetitive environment may want to at least consider.the possibility of a con trasting message from inclusion ofcompetitive games, but agencies that encourage fonnation of tight, small teams may find this kind of equipment send an appropri ate message. Active physical games also suggest that the clients of a particular center are going to be both young and in reasonably good condition. This may not be realistic. To the client who is older, or who is physically debilitated, the message from these highly active recreational facilities may be "I don't belong here." or "I'm not up to

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what they expect of me. One treatment center was aware of the fact that many of their clients were not in good condition, and resurrected the old games of shuffle board and horseshoes. This center also stated that they tried to deemphasize the competitive aspect, reasoning that most alcoholic or drug users would benefit from a more cooperative approach to recreation. The norm was to expect clients to do their own laundry. Most centers had pay washing machines. What varied was the number of signs and how punitive the laundry rules and messages were. The number of signs may be a measure of how many problems are caused by part of an environment. From the large number of signs and notices that appeared in almost every laundry room, it is a facet of living together that creates constant problems. The most punitive laundry situation occurred in one detox center. Here, laun dry was used as a motivational tool and reflected the treatment philosophy which did not condone enabling behavior. Clients who agreed to treatment had their laun dry done completely and were provided with clean clothing to wear. The clothing of clients who did not agree to treatment was simply sealed in a plastic bag, dirt, vomit and all, and returned to them when they were ready to leave. More subtle, and less planned, were the many semipunitive messages that cen tered around doing laundry: signs that screamed. "00 NOT ....., extensive restric tions on time and methods for doing laundry, and heavily redundant messages. We can understand how these messages came about. Laundry is simply something that has to be done, it is hardly ever seen as a part ofgroup interactions and group living. When there is a laundry problem, instead of dealing with it as an individual prob lem behavior or an integral part of group living, a new rule or a new sign is pr0 duced. As these signs accumulate, it might pay to ask whether they enhance client self-esteem or set up an expectancy that says, "We expect you to mess this up too, just as you have messed up everything else." Another question that treatment staff may want to ask themselves is whether extensive and overdetailed rules and proce dures are enablers, encouraging lack of personal courtesy and responsibility? Chairs provided an arresting photographic theme. Research by Osmond (1959) introduced the concepts ofsociofugal or socioopetal arrangements of furni ture. A sociopetal arrangement occurs when chairs are arranged around a table, as in the photograph of a lounge/snack area (Figure 16). This particular arrangement communicates a message that people are expected to meet as a total group, even when they are having a snack. The fact that this is a visitor's area in the Colorado penitentiary is relevant since one-on-one intimate visitation is difficult with this particular sociopetal arrangement. These chairs have been set up this way for AA meetings and prison staff have never changed the arrangement for visitations. This may be either a conscious attempt at social control or may be an example of people having to line in an environment that subtly discourages opportunities for intimate interactions. H


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This contrasts with the far more frequent sociopetal arrangement offour chairs around each table that suggests meeting in small groups. Many dining rooms were set up in this "cafe-style." This arrangement provides a clear message that clients are expected to interact in small intimate groups and not as one large team. The only problem is that the dining arrangement may have occurred only because food services staff decided it was appropriate or because this kind of small table was available. Treatment staffmay never have considered the implication ofthe choice and arrangement of dining furniture. We found similar differences in arrangement of picnic tables.. In one location the picnic tables were linked together into one large table, but in the others they were separated. These chair and table arrangements dictate groupings and there fore dictate the style ofgroup interaction. People will rarely move chairs when they are by a table. Usually, however, little thought had gone into how the chairs and tables were arranged and the implications for group interactions. More often other factors dictated the arrangement. 11te maintenance staff may set the. tables , and chairs or picnic tables up in the way they feel is traditional, and no thought is given to whether it is consistent with treatment philosophy. Sociofugal arrangement ofchair placement discourages interaction, for exam ple, when chairs are placed in a line against the wall as in this photograph of the three chairs in the waiting room ofa center (Figure 16). Each person has the option of remaining isolated from his or her neighbor. The chairs actually send several messages. The style ofchair suggests a well-to-do clientele. The formality says the clients are expected to be adults. The formal arrangement suggests discipline, p0 liteness and formality of interactions. Even the picture suggests the whole environ ment will be attractive, upper class, and emotionally bland. For some clients, these chairs and this arrangement would suggest security and stability. There are others, such as adolescents or poorer clients, who would find the messages sent by these semifixed items indicated an environment that was going to be uncomfortable and inappropriate to meet their needs. Contrast the messages sent by the beanbag chairs in Figure 17. These beanbags were different colors, easily portable, and can be placed in any arrangement. The psychological message of ease of movement and comfort is aptly portrayed. The clients and staff are clearly also expected to be young, and interactions during group meetings are obviously expected to be informal and possibly more intimate and less polite. There is also a subtle message that at least some personal control may be present. The youth can choose a color and can place and personally shape the bag for comfort. Many treatment centers are limited by funding constraints in purchasing furni ture and often end up with an assortment of garage sale chairs. An ingenious and innovative treatment director suggested that as clients enter treatment, they be al lowed to choose their own chair, and bring it to the treatment room. The procedure was designed to engender a sense of personal space and empowerment. It allows

918

for at least some individuality within the group setting, feelings that are consistentJ with treatment goals of that center. ;\ Most of the nuts and bolts work of drug and alcohol treatment occurs in ther..) apy groups. We thought that the structure of group rooms would reveal differen~ in treatment philosophies. Sometimes that was true. All too often, the room tures and arrangements were not fully consistent with philosophy. The picturQ, showing the rows of chairs is of a meeting room for Alcoholics Anonymous (Fig,,: ure 18). The chairs are set up in a lecture format in identical rows. 1lUs chair pIace,.i ment is sociofugal; it limits interaction. A more serious problem that limits interac. tion even further, and might even interfere with honesty and opermess, is the low. wall that is not connected to the ceiling. Anything said in this room can be heatd outside of it; confidentiality is seriously compromised. The psychological message that may be conveyed by this group room is that it is not important to respect your anonymity and confidentiality. s The next picture (Figure 19) also shows a group treatment room, one that com'; municates a very different feeling. Group participation is almost always one of the goals of group treatment, and the arrangement of chairs into a circle in this room can be a physical inducement to become part of the group. Without a table, there can be no "hiding." The setting is also conducive to a wholesome feeling, with the) open window and the door to the outside. } There is a "back-to-the-wall" feeling when chairs are lined up against the wan.. but the room is small enough so there is no particularsense ofdistancing because of the bare open space across the room. The window does not open on a public area, so there is no compromise of con fidentiality. The art work cannot be seen in detail in this picture, but it provides important messages for the group. The artist, a landscape painter, is in treatmenL . He incorporates the nature setting of the center into the group paintings. Each member of the group signs a painting when he finishes it. The paintings show that an individual can contribute something and suggest sharing, participation, and us ing your own abilities to make a contribution, messages that are consistent with the treatment philosophy of this center. Figure 20 presents one of the most frightening and shocking environmental messages that we have ever encountered. The room is an AA meeting room. Al though the prison has now reintegrated mv positive prisoners into the general prison population, when this picture was taken all prisoners who tested positive for mv had been placed in a single controlled wing to keep them from infecting the rest of the prisoners. The prisoners who attend AA meetings and who sit in these chairs are intravenous drug users and/or homosexuals who have or will have AIDS. These prisoners, already marked for death by AIDS, sit in a semicircle facing the gas chamber. When we asked our tour guide and AA leader why he faced the chairs this way, he gave us an answer with profound implications by saying, "Well, we are all going to die sometime."


919

It is clear that nearly every aspect ofthe environment sends messages, some as subtle as the hint that formality and politeness might be expected when you sit in fonnal chairs, some as blatant as the gas chamber with its aura ofdeath. Center staff should look carefully to identify the subtle and the obvious messages in their own environment and decide whether those cues are congruent or incongruent to their treatment philosophy.

HOW ARE SIGNS AND OTHER OBJECTS USED TO

COMMUNICATE INFORMATION?

In the first section, we discussed the messages sent by the signs identifying the treatment center. There are other outside signs, however, that communicate infor mation about the center and its philosophy. Word choice may help set the tone of the center. The Cenikor sign shown in Figure 21, for example, refers to "guests," perhaps setting a warmer and more welcoming tone than the more usual "visitors" , of the other sign. An additional point made earlier in the article is illustrated again in the "visitors" sign; signs often provide excess information which can be confus ing. As it stands, the second sign is meaningless. It says, "Visitors, please use en trance." Do they expect the visitors to climb in a window? Maybe there was origi nally another word on this sign that helped it make sense, perhaps the word "this," or the word "front" or "rear" was painted over. The next picture (Figure 22) is the epitome of lack of careful thinking. The sign says "Visitors please read" and the arrow points to another sign that says "Of fice," a silly suggestion. The more likely alternative is that the visitors are supposed to read the two sheets of information printed in small type which are placed ap proximately two feet off the ground. We are willing to wager that no visitor has ever squatted or sat on the floor to read these two sheets ofpaper that are absolutely full of small print. Visitors will either ignore the request or retreat to the office, hoping someone will tell them what is important for them to know. Another way that treatment centers try to communicate is by passing out lit erature. Virtually every center had some kind of literature rack. The two pictures of contrasting literature displays in Figure 23 show how treatment center staff might communicate whether they believe that reading the literature is important ornot. In the ftrst photograph, while the rack is accessible, the small amount of literature available is placed out of the way on the bottom shelf, and just stacked there ran domly. The message seems to be "If you have to wait here, you might want to read this or you might not." In the second photograph an ample supply of literature is arranges under a reading light in a lounge. Here people can unobtrusively browse and take any pamphlets that interest them. The physical setting, the wealth ofmate rial available, the carefully laid out arrangement, all suggest the message, "This literature is available and important."

920

YOUNGE ET AL.

Without exception every treatment center we visited displayed the AA Twelve Steps and Twelve Traditions. AA has provided the single most Widespread phi losophy for treatment of substance use. The content of these signs is fixed. How ever, the formatting, the framing, and the placement were all variables that carried ancillary messages. For example, the photograph of the wall of the recreation lounge in Figure 24 shows the framed steps and traditions. They are legibly printed and prominently and permanently displayed on either side of the TV set. Anyone using the recreational facilities would have these principles in full view. Whether read or not, the message is, "These points are an important part of this environ ment." In contrast, the photograph of the piano in Figure 25 shows the twelve steps. They are on a roller so they can be rolled up, suggesting, perhaps that they are im portant only at meeting time. More important, however, is the fact that the piano covers everything beyond step 8. Sometimes we saw movable objeCts, such as a chair, that obscured part of the twelve steps. The piano, however, is heavy and es sentially immobile, and the coverup of steps 9 through 12 is permanent. Perhaps this center only gets people through step 81 We felt that if, indeed, these steps were important they should be placed where they would not be covered. The two most creative presentations we saw of the 12 steps were very differ ent. In the first example, a professional artist who had been a client had painted graphic illustrations of each step and these had become a part of the artwork of the center. The paintings, incidentally, were not hung to decorate, but were placed at eye level, in order, and were highly noticable. The second example is the most moving presentation we encountered of the twelve steps. It was printed in a child ish scrawl and had been done with great care and immense effort by a developmen tally disabled client. His contribution was placed prominently on the wall in the entrance area. In both cases, the message, "Clients can give something back to the center," is an important one. In the latter case, the message is even more potent, because despite his severe limitations, the client gave what he could and his contri bution was valued and respected. We saw both effective and ineffective use of small objects. One counselor's office was filled with his collection ofjars and bottles. The message seemed to say, "This is my hobby, this office is my personal space." The associated message, to some people, might be, "You are encroaching." We enjoyed, however, looking through one rack of bottles on a "bar" in the lounge (Figure 26). Most drinkers have their favorite brands of alcohol which are readily recognizable by color, shape, and label. Placing look-alike bottles on the shelf with treatment messages instead of the usual product information causes an effective double take. Information about cancer of the esophagus, pneumonia, mal nutrition, pancreatitus, impotency, cirrhosis, accidents, delirium tremens, and brain damage is linked to the bottle, a stimulus for drinking. The message is humor ous but clear; pick your poison.


921

Signs can provide information clearly and concisely and in a way that gets the message across. They can also confuse, irritate, and send messages that are not in tended. The "Meeting in Progress" sign in Figure 27 seems to communicate clearly, so what is wrong with it? It is bolted to the door. How could a meeting be permanently in progress? Perhaps any time the door is closed there is a meeting, otherwise the door is supposed to be open, but the permanently attached sign can still cause problems. If the door is closed accidentally, even occasionally, people learn not to trust or believe the sign. They will open it to check and see if there really is a meeting. If the sign merely marks an area open only to staff, the sign is simply dishonest. Perhaps the most common failing in signs was lack of forethought. We often found crude, hand-painted, and confusing signs,just tacked up or taped up without much consideration about what they communicated. There were centers, for exam pie, that had spent hundreds of thousands of dollars to remodel and refurnish and then haphazardly stuck up hand printed signs. We also often wondered ~y some signs were needed. Does some staff members really believe, as Figure 28 shows, that the clients are too dumb to know what the word "Exit" means? Perhaps the easiest and cheapest intervention in the physical environment is to improve the internal signs. For example, see Figure 29. tricolored, attractively lettered home made sign is an excellent example of a clear, effective message that confidentiality is an important part of this center's treatment philosophy. All too often signs are not this clear; they have been added over a period of time and their impact has never been fully evaluated. Many are sloppily constructed, hastily at tached, and are sometimes attempts to solve problems that don't really exist. Other signs have subtle and probably unintended messages which are sarcastic or hostile. Many signs are attempts to control behavior, to make people conform to the rules and regulations needed ifpeople are to live together. is such an important area, in fact, that we will deal with it separately as part of the next section on con formance.

nus

nus

HOW DOES THE ENVIRONMENT OBTAIN CONFORMANCE

FROM CLIENTS?

People who live together fight together. They impinge on each other's space. Their different needs conflict. Tempers flare as emotions are explored. Group liv ing can present particular challenges for the alcoholic or drug user. Because oftheir obsession with substance use, they may have long ignored even the simplest of rou tines for living together. such as keeping a clean or picked up, getting to meetings on time. or doing their share of whatever needs to be done. A treatment center needs to have a certain amount of general conformance, rules for behaving that let people live together reasonably well and that allow the program to function.

room

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YOUNGE ET AL.

Many treatment centers have standard "punishments" for failures to conform to specific rules. When semifixed objects used in these punishments are left in view, they provide continuous messages about the need to confonn. The "Monad bench" provides for time out. Clients who are acting up sit on the bench until they settle down. Treatment staff indicated that an exaggerated and oversized high chair that sits in the treatment room of another center is only used once in a while, but its presence in the meeting room also continues to say, "Don't be a baby" or you will have to sit in it. A "sleepy hat," a long, knitted nightcap, hangs over a radiator in an adolescent center, saying, "Get up in the morning or wear this all day." The confor mance messages from these objects seem to be immediate, strong, and relatively clear. Rules and regulations may be a primary reflection of the real treatment phi losophy. For example, treatment staff and a center's literature may expound on "developing personal responsibility," but long lists of posted rules fordoing laun dry, eating, using the telephone, etc., suggest that the real treatment philosophy may be focused more on confonnance and external control than on independence and personal control. Without discoursing on the merits of different treatment approaches, keeping the client actively engaged in the treatment process is probably essential to an ef fective outcome regardless of treatment. With that in mind, external control im posed on the client may be essential to some extent, particularly in early stages of treatment, but should probably be balanced by some rights to personal control. Wandersman and Moos (1981, p. 503) comment: "Residents of sheltered living environments are generally viewed as dependent and powerless. 1bey are often cared for and planned for, but they have little or no opportunity to play active roles in their environments. Recent evidence suggests that participation increases feel ings of control over the environment and thus may enhance physical and psycho logical well-being." How does a treatment center provide some clients with reasonable control over their environment? We noted previously the center that let clients chose their own chair. Another creative suggestion carne from an interior designer, encourage clients to rearrange the furniture in common rooms. It costs nothing, allows the group to negotiate among themselves, and contributes to the clients feeling of em powerment and ownership in the environment. We noted many client attempts to personalize space, to use semiftxed ele ments of the environment to gain some control. They ranged from elaborate dis-' plays of personally chosen posters, to moving dressers to block off a little personal space, to a simple cross, cut out ofa cardboard packing crate and tacked to the wall. Personal effects in clients rooms such as hair dryers, stereos, books, and magazines can be client's message marking part of the environment as ..theirs" and making physical statements about their values.


923

We became fascinated by a simple object that was present in every treatment center, the thennostat. When we began photographing thermostats, treatment staff were incredulous. When we explained that thermostats provided subtle, but very real, messages about the control clients had over the space they lived in, the staff sometimes began to see their physical environment in a new way. Regulating the temperature of their environment is a right most people take for granted in their homes. People are so different in their reactions to temperature, however, that tem perature often becomes an issue in a group living situation. There could be differ ent ways to handle this issue. Temperature control could be dealt with as a topic in group meetings. It could then provide lessons in sharing simple and nonthreatening feelings ("I feel cold"). It might be an example showing the need to be concerned about feelings and comfort of those the client lives with. It might provide an effec tive means ofshowing how negotiation and seeking alternative solutions can solve problems. But that has not happened in any center we observed. Instead, almost invariably, temperature regulation is a right reserved for staff. The control over thermostats ranged from signs to locks (Figure 30). A(least, in the top photograph, the center has explained the rationale and have used the words "thank you." In the next photograph, the cellophane tape, hastily attached to the face, provides a graphic and clear non-verbal message. The locked box is prob ably our favorite. It is a very well constructed wooden box with a solid padlock. What the picture does not show is that the glass is missing, leaving the thennostat fully exposed; most likely an act of an irate chilled client who wanted to control the temperature. Instead of a simple message, this is an example of a whole conversa tion. "You are NOT going to mess with this thermostat!" "Oh, yes I am!" The next photograph has a nice but puzzling sign. Why "Joe and the cooks"? At least the message is clear about who can turn this control. The last photograph shows a really serious effort to keep people away from the thermostat. It would take a crowbar to break into this box. Nearly all treatment centers regulate telephone use. The range of approaches, however, was marked and said a great deal about how centers viewed their clients. At one extreme was the public pay telephone. The phone was placed high on the wall so users had to stand. They also faced half a dozen signs listing telephone rules one after another. At the other extreme were open phones at a high-cost private treatment center, with no notice about payment and placed on end tables next to comfortable chairs. This was the one exception, however, all other centers had posted telephone rules. The most frequent rule limited length of calls, but some centers allowed unrestricted use. One center even listed_the number of the hospi tal's patient representative next to the phone in case the client had a complaint, a nice touch. This composite of signs found in various centers illustrates a continuum of different approaches designed to elicit conformance from clients (Figure 31). The first one is handdrawn, but highly appropriate for the center where it appeared. The

924

YOUNGE ET AL.

message is clear and concise, and someone took the trouble to put a zebra pattern on the letters. The treatment center where this sign appeared is a converted hunting lodge whose walls have mounted animal heads in the main lounge. The sign is courteous, direct and clear, and cleverly reflects the theme of the building. The top "smoke elsewhere" sign is also legible, and was done in bright colors that attract attention. The slight touch of humor may help take away the sting of control. In contrast, the last three signs attach consequences. In the first, there is a monetary frne, small but significant. The last two signs provide for strong conse quences, penalties that are, perhaps, too harsh for the nature of the offense? The wording seems unnecessarily antagonistic unless a real safety issue is involved. In looking at message after message about rules and control, we found little correla tion between seriousness of the offense and proposed penalties. Perhaps the little "hassles" seem more important to staff because they occur so frequently. 11le most frequently encountered control and conformance message was about smoking. Smoking was regulated in all but one center. The only exception was a center for the wealthy, where "smokeaters," filters to take the smoke out of the air, were prominent in every public room. Most alcoholics and drug users smoke, and there is debate about whether they should be asked to give up two addictions at the same time. The state of Colorado, however, is taking an active stance in limiting smoking in public buildings for health reasons. Boulder, in fact, has now outlawed all smoking in city buildings. Treatment centers are being forced to comply with the new regulations. 11le photo graph ofthe "butt can" in Figure 32 shows the result. It is a creative solution to keep the entrance area free of cigarette butts. The center is in an urban area, where laws prevent smoking inside and there is no other place for clients to smoke except out side at the main entrance. It may be ugly, but it is effective, and the sign does say "please." Caffeine, just as nicotine, is a drug which is used by almost all alcoholics and drug users. While "no smoking" messages were direct and obvious, the environ mental messages about caffeine use were always indirect. Centers vary signifi cantly in their philosophy about the appropriateness of caffeine use. The soft drink . machine at one center, for example, provides a message about the center's philoso phy; nothing but caffeine free soft drinks are sold showing that, in this center, caf feine is viewed as a drug (Figure 33). In contrast, one detox center collects alumi num cans (most of them from soft drinks with caffeine) and sells them to raise money for a cigarette fund. What is viewed as an addiction and what is not varies greatly. One center, for example, had a poker table and allowed games for money. In that center, at least, gambling is not viewed as a possible cross-addiction. In the other direction, in the . process of providing copies of our pictures and discussing them with the staff of another center, we were informed several months later that the staff had taken out \ the cigarette machine in their main eating area. They told us that seeing it in the ~


925

photographs brought home the problem of selling cigarettes when more people die of tobacco use than other forms of substance use. While we do not necessarily agree with that change, and the counter argument can be made that the immediate danger from alcohol and drugs should be handled first, the example shows that changes can occur when staff are sensitized to the messages sent by the environ ment. The photograph in Figure 34 illustrates another kind of environmental mes sage about nicotine and caffeine use. Zeisel (1975) introduced the concept "rem nants of use" to capture the physical traces left in an environment which serve as a means of communication. The filled ash tray and empty can (Diet Coke with caf feine) show that these substances are tolerated in this center. Using the concept of remnants of use to assess the physical environment at another center, we noticed wastebaskets filled with empty coke cans and cigarette butts, but only partially eaten apples. We could hypothesize that caffeine and nicotine are more heartily consumed and heavily preferred over potentially more nutritious fruit. Among the more disturbing "control" messages that we encountered'\vere the obvious surveillance devices installed in some treatment centers. Examples were observation mirrors in long halls, video cameras in toilet areas, "antishoplifting" mirrors in comers, and tape recorders in group therapy settings. These physical cues suggest lack of confidentiality and distrust. There may be valuable uses for these pieces of equipment, and with attention, the negative impact might be re duced. Perhaps, for instance, there could be explicit notices about when these de vices are used and the purpose for their use. A folding, lOCked screen covering the one-way mirror and sending the message that it will be used only with prior notice might help. The "No violence" sign in Figure 35 is direct and the message is clear. Al though home-made, it is neatly made and firmly hung. It is clearly a major mes sage, not a tacked-on afterthought. Contrast the "Rules of the Group." There are 18 (count them, eighteen!) rules. We found ourselves getting progressively discour aged as we read through the list. Many of the "rules" are simply behaviors that should be dealt with individually as they occur and as part of group treatment. The rules are a mixture of required conformity (no radios) and suggestions for healthy interactions (eye contact). The long list and mixed purposes make the messages ineffective. We suspect, by now, that rule 19 has been added. . The final photographic examples in Figure 36 are conformance messages that have elements that could be interpreted as explicitly hostile. The "no parking" sign is a challenge from authority. It may work. and might be seen as humorous, but we had clients tell us, "When I first saw it, I immediately wanted to park right there." The last picture is of a supposedly "funny" sign found in a counselor's office. The sign suggests that certain behaviors are outlawed. The sign may have a private, and useful, meaning for the counselor and for that counselor's experienced clients. But substance using clients may have enough trouble revealing themselves to a coun

YOUNGE ET AL.

926

selor, and new clients are not likely to know what Kdumping" is and what it is not. Clients may feel that they are not important and are perceived as a burden by Kdumping" their problems on the staff, even though this should be the staff's main purpose, helping, not discouraging, the client. The sign, to us and probably to some clients, sends a message that could block or prevent communication.

SUMMARY We would be overwhelmed by stimuli if we paid explicit attention to every message from our physical environment, so we adapt to and get used to our sur roundings. No one uses a shower on the 2nd floor because there is a sign that says it is dangerous, but the staff of the center that we talked to did not know why. A sign in group therapy sessions lists human rights, but the 9th and last right has been blackened out so that you cannot read it. The message might be that a "right" has been lost, but staff are used to the sign and not aware of its subtle message. Staff drive into the parking lot of a treatment center day after day, completely unaware that the trees have grown so big that they totally obscure the front identification sign. A KHandicap Entrance" sign blocks the ramp intended for use by handicapped clients. The "hospital green" walls have been that color for so long, staff cease to imagine what a fresh coat of paint in a cheerful color might do to enhance the envi ronment. Every diploma ever earned is hung on the office wall, including work shop certificates and service awards. The message is one of professional compe tence, but perhaps the client is looking for messages of warmth and personal con cern and is only intimidated by this wall of credentials. Kleenex is placed next to every other chair in a group room without realizing that this might set up an expec tancy for what the content of the group session should be: tears. Staff in a crowded center try to maximize the use of space with folding sliding doors to make two group rooms out of one, without thinking about compromised confidentiality. Mehrabian (1971) concluded that nonverbal messages can be more potent in com munications than spoken words. Psychological messages such as these from the agency's physical environment may hinder the treatment program. At the level of the individual treatment center, we would suggest that staff members pick up a camera and start taking pictures of their physical environment. * The resulting slide show could lead to inexpensive and common sense changes in an agency's physical environment. One center director, for example, indicated he was appalled to notice that their fee schedule was posted directly above the drink ing fountain. Another director started a project to remedy the difficulty of fmding

*Dr. Stanley Einstein has made the interesting suggestion that clients could be given cameras and asked to lake pictures of messages in their environment, of those things that encourage and support them and of th05e that discourage them or make negative suggestions.


927

the entrance to the treatment center. Efforts such as these can help make physical design more intentional and compatible with treatment philosophy. What else needs to be done? We have looked at the physical environment in treatment centers, in part because we could do so without violating the anonymity of staff and clients. But what are the messages sent by the physical appearance of staff, or for that matter, of clients? What does their clothing convey? How do they position themselves in groups? What are the typical interpersonal distances? Bloom, for example, did a series ofstudies on client's responses to office fur nishings. titles, fees, and testing (Bloom and Trautt, 1978; Bloom, Weigel, and Trautt, 1977; Trautt andBloom,1982). He and his students found that, if the thera pist was presumed to be male, furnishing that reflected warmth and caring lead to a more positive response. If the therapist was female, furnishing that emphasized competence were better. It seems as though the college student clients assumed competence in the male and caring in the female and looked for the other dimen sion when responding to office decor. Similar studies, looking at drug treatment environments, might be highly informative. , We have also looked only at one relevant environment. What about the envi ronments outside of treatment centers, the work settings, school settings, homes, and the communities where clients live? One of us (Banning) has spent several years looking at and photographing messages about alcohol use on college cam puses. At the same time, he has examined environmental messages related to ra cism and sexism. The messages range from signs put up by the administration, to murals, posters, entrances, and personal messages and ads in the campus paper. He will be producing an article that examines these campus messages in the near fu ture. But there is an incredible range of other relevant environments that should be explored. How would environmental messages differ across cultures? We would be very interested in sharing ideas and pictures, looking at different kinds of messages that appear in different cultures. We would also like to hear from people who could tell us how the messages that we have interpreted in this article might be viewed differ ently if they appeared in a different cultural context. Are there objective and reliable ways for determining how environmental messages actually impact clients? We have interpreted these messages in the light of how clients might respond to them. How do clients actualIy respond? The photographs and descriptions shared in this study illustrate the importance of physical environmental messages in communicating general characteristics of the treatment center, the logistics involved in group living, task and procedural in formation, and information regarding the obtaining of conformance. These four areas, however, are not meant to be inclusive of all the ways in which the environ ment of treatment centers communicate to clients. In fact, there is a vast array of possible enhancing and conflicting verbal and physical environmental cues within treatment centers. To examine the environment carefully in order to review these


YOUN(,E ET AL

92R

messages with the intent of increasing the compatibility of the physical and psy chological messages and the treatment philosophy of the program should benefit both slaff and c1ienL

r

,

FIg. 7.

A ·dean body· kit lJll the adrnis

siOlL!l desk.

Fig. 6. Contrasting messages com municated by the entrance.

Fig. 8.

Bathroom in detOll center.

YOUNGE ET AL

934

FIg. 9.

Sip in the bathroom of a treabnent center.


935

, Fig. lOb.

Informal (designed to be used) lounge in youth lrcalment center.

:~, ~

.

LlJJ

Fig. lOa.

Formal (designed to impress) lounge in youth treatment center.

Fig. 11.

Bedroom in a detox center.

936

YOUNGE ET AL.

FIg. 12.

Bedroom in a treatment center for dual-diagnosis patients.

Fig. 13.

Bedroom in

II

private inpatient treatment center.


Fig. 14.

Fig. 15.

Backyud glll'den lit II Native-American treatment center.

Exetcise room in

II

treatment center for high-income clients.

937

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YOUNGE ET AI..

mEATMENT CENTER ENVIRONMENT

Fig. 17.

Beanbag chairs in a meeting room in an adolescent treatment center. '

Flg. 16. Sociopelal and sociofugal chair arrangements: a prison lounge area and an adult treatment center waiting room. Fig. 18.

Meeting room for AA showing "classroom" chair arrangemenl

939

YOUNGE ET AL.

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941


• "PARKING fOR CENIKOB

CU~STS •

ONLY, •

, Fig. 19.

Chair arrangemenl in a meeting room in a treatment center.

Fig. 21.

Fig. 20. An AA meeting room in a prison wing for HIV positive prisoners-chairs surrounding the . gas chamber.

Signs outside of lreatment centel"5 related to visitors.

943


, Fig. 23.

Fig. 22.

Fig. 13. Conlrasling literature racks at two different treatment centers.

(continued)

A confusing sign.

Fig. 24.

A prominent BIld clear presentatioo of the Twelve Steps BIld Twelve Traditions.

YOUNGE ET AL.

944


94S

, FIg. 27. A sip pennanently bolted to 8 doOI".

Fig. 25.

The Twelve Steps on 8 roller behind the piano.

Fig. 26.

A MbarMin

8

treatment center.

Fig. 28.

"This way to the egressM_P.T. Barnum.

946

YOUNGE ET AL.

,

.~"",..i, -1!J" '..,,,,.~

:""',... ,,;."1

. • .0,..

"."#"t

r'

'k ..

I

,,,

Fig. 29.

,

A well-done sign OIl confidentiality.

Fig. 30.

Therm05tats, showing attempts to maintain staff control.

YOUNGE ET AL.

948

S~_E -

._. -----:"""":""::;;=:==

~LSi~.RC I't'f lUfrl~~.-'" WIll.

,

Btl: tAf

rol~

0,.-

r-, it 6Ji/1

eosl

!loa..