ROBERT B. BECHTEL and ARZA CHURCHMAN

HANDBOOK OF

Edited by

"

ROBERT B. BECHTEL and ARZA CHURCHMAN "

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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

Printed in the United States of America .

10 9 8 7 6 5 4 3 2

2001026449

Contributors

Irwin Altman, PhD Department of Psychology University of Utah Salt Lake City, Utah

Kathryn H. Anthony, PhD Department of Landscape Architecture and

Women's Studies Program University of Il linois at Urbana·Champaign Champaign, Illinois

Robert B. Bechtel Department of Psychology University of Arizona Tucson, Arizona

Anders Siel, Ph 0 Department of Psychology Goteborg University Cateborg, Sweden

Stephen C. Bitgood, PhD Psychology Institute Jacksonville State University Jacksonvi lle, Alabama

Marino Bonaiuto Department of Developmental and Socia l

Psychology University of Rome 'La Sapienza' Rome, Italy

Mirilia Bonnes Department of Developmental and Social

Psychology University of Rome 'La Sapienza' Rome, Ita ly

Arline L. Bronzaft, PhD Lehman College, City University of New York Bronx, New York

v

Barbara B. Brown, PhD

Department of Psychology University of Utah

Salt Lake City, Utah

Margaret P. Calkins, PhD Innovative Designs in Environments for

an Aging Societ y Kirtland, Ohio

Janet R. Carpman, PhD Carpman Gran t Associates Wayfinding Consultants Ann Arbor, Michigan

Arza Churchman, PhD Faculty of Architecture and Town Planning Technion-Israel Institute of Technology Haifa, Israel

Ellen G. Cohn, PhD Department of Criminal Justice Florida International Universit y Miami, Florida

Victor Corral-Verdugo, PhD Department of Psychology Un iversit y of Sonora Hermosillo, Sonora, Mexico

Mihaly Csikszentmihalyi, PhD Department of Psychology Claremont Graduate University Claremont, Ca lifornia

Kristen Day, PhD Department of Urban and Regional Planning Un iversit y of California, Irvine Irvine, California

Contents

SECTION I. SH ARPENING THEORIES

CHAPTER 1 The Increas ing C01ltexts of Context in the Study of Environment Behavior Relations 3 Seymour Wapner and Jack Demick

CHAPTER 2 The Ethica l Imperative 15 Leafllle C. Rivlin

CHAPTER 3 Envi ronmental Psychology: From Spatia l-Physica l 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 Environmenta l 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: Histo rical Con texts, Current Conception, Prospective Direc tions 114

Allan W Wicker

SECTION II . SHARPENING LINKS TO OrHER DISCIPLINES

CHAPTER 8 Exploring Pathology: Relationships between C li nica l and Environmental Psychology

Kathryn H. Anthony and Nicholas J. Watkins

CHAPTER 9 Envi ronmental Anthropology Edward 8. Liebow

CHAPTER 10 Environmental Sociology Riley £. Dunlap

CHAPTER 11 Environme ntal Psychophysiology Russ Parsons and Louis G. Tassinary

CHAPTER 12 Environme ntal Psychology and Urban Planning: Where Can the Twain Meet? Arza Churchman

SECTION III. SHARPENING M eTHODS

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

xi

129

147

160

172

191

203

xii CONTENTS

CHAPTER 14 Meta-Analysis Arthllr E. Stamps fTl

CHAPTER 15 The Experie nce Sampling Method: Measur ing the Contex t and Content of Lives Joel M. Hektller and Mihaly Csikszetlllllihalyi

CHAPTER 16 The Open Door of GIS Reginald G. Goffedge

CHAPTER 17 Structural Equat ion Modeling Victor Corral-Verdugo

CHAPTER 18 Spat ia l Structu re of Environment and Behavior 101111 Peportis and leall Wineman

CHAPTER 19 Behavioral-Based Architectural Progranuning Roberl Hersllberger

CHAPTER 20 Postoccupancy Evaluation: Issues and Implementat ion Craig Zimrillg

SECTION IV. SHARPENING ApPLICATION

222

233

244

256

271

292

306

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 Wome n and Env ironment 347 Karen A. Fralick

CHAI>TER 24 Child ren's Environment Kaleu; Korpela

CHAPTER 25 Design and Demen ti a Kristen Day and Margaret P. Cal kilts

CHAI>TER 26 Healthy Residential Environments Roderick j. Lawrence

CHAPTER 27 Cri me Prevention through Environmental Design (CPTED): Yes, No, Maybe, Un knowable, and All of the Above

Ralpll B. Taylor

CHAPTER 28 Wayfinding: A Broad View Jallet R. Carplllall and Myroll A. crallt

CHAPTER 29 Work Environments jal/etta Mitchell McCoy

CHAPTER 30 Environmental Psychology in Museums, Zoos, and Other Exhibition Centers Stephen C. Bitgood

CHAI>TER 31 Climate, Weather, and Crime James Rattail mId ElIel! G. Colin

CHAI>TER 32 Noise Pollution: A Hazard to Physical and Mental Well -Being Arli/1e L. Brollzaft

363

374

394

413

427

443

461

481

499

Contents xiii

CHAPTER 33 The Histo ry and Fu ture o f Disaster Research 511 Lori A. Peek and Dennis S. Mifeli

CHAPTER 34 The Cha lle nge of Increasing Proe nviron ment Behav ior 525 E. Scott Geller

CHAPTER 35 Eme rg ing Theoretica l and Methodologica l Pe rspec t ives on Conservation Behav io r 541 Joa"ne Vining and Angela Ebreo

CHAPTeR 36 Conta mination: The Inv isible Built Environme nt 559 Miclwel R. Edelstein

CHA PTER 37 Environmenta l Conf lict and It s Resolutio n 589 Tamra Pearson d'Estree, E. Franklin Dukes, and Jessica NatNJrrete-Romero

CHAI'TER 38 A Methodology of Pa rticipatory Plann ing Uisa Horelli

CHAPTER 39 Susta ined Partici pat ion: A Community l3ased Approach to Address ing Envi ronmenta l Proble ms

Esther Wiesellfeld and £uc1ides Salle/lez

SEcnON V. THE FUTURE

CHAPTER 40 Personal Space in a Digita l Age Robert Sommer

CHA I'TER 41 Towa rd an Env ironmenta l Psychology o f the Interne t Oaniel Stokols and Maria MOlltero

CHAPTER 42 On to Mars! Robert 8. Bee/ltel

AUTHOR INDEX

SUBJECT INDEX

607

629

647

661

676

687

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 environmental psychology? What have these rela­tionships been in the past, and wha t potential do they have for the fut u re? How have cl in icians draw n upon the physical environment in their practice? And how have schola rs in the envi ronment behav ior fie ld relied upon cli nical psychology in thei r re­search? Has the relationsh ip between clinical and environmental psychology made an impact on act ual environments? What behavior has changed as a re­sult of new research or discove ries? This chapter addresses these issues.

We begin by describi ng some theoretical and con­ceptual frameworks that help explain the relation­ship between these two fields, focus ing on how a systems or socioecological approach can link the two. We next examine environmental approaches to clin­ical psychology. Our sources a re d rawn primarily from the clinical literat ure in psychology and psychiatry, and they include at least some reference-often not obvious to the casual reader- to the physical envi­ronment. For example, what places or spaces tr igger obsessive-compulsive disorders? What role does the physical environment play in post-traumatic stress disorder? We next examine treatme nt approaches in which the physical environment has begun to playa role in altering problema tic behavior. Following this is a sect ion analyzing the e nvironmen tal psychology of treat ment settings, that is, issues concerni ng the design and arra ngement of psychot herapists' o ff ices.

129

Late r we examine clinical approaches to environmental psychology. This section di scusses sources drawn p ri­marily from the environ men t behavior literat u re that add ress issues of interest to clinicia ns. For example, what are the psychological impac ts of moving o r visit ing a favorite home in which you no longer live? What kinds of design feat ures can elevate an individua l's psychological state? Finally, we d raw our conclusions about the li nks between these two disciplines.

THEORET I CAL AND CONCE PT UA L F R AMEWO R KS

Some theoretical and conceptua l frameworks shed light on the relationships between clin ical and e nvi­ronmental psychology.

"Cli nical psychology can most b road ly be seen as a field involvi ng proble ms, theories, a nd me thods that cut across a range of ac tiv ities (e.g., psychot her­apy, testing, su pe rvis ion, consu ltation, research , teach ing) and popu lations (e.g ., patients, trai ners, trainees, organizations) with potential applicabi lit y to a range of environmental psychological phenom­ena" (Demic k & Andreoletti, 1995, p. 58). Cl inical psycholog ists tend to foc us on some fo rm of pathol­ogy. For example, a child may have difficu lty adj ust­ing to parental divorce or an ad u lt may be experiencing chronic s igns of depress ion a nd eve n su icida l tendencies. Environ mental psychologists

130 HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY

tend to be less excl usive ly problem focused in the ir approach. Also, environmental psychologists are more concerned with the larger picture. Individua ls are conceptualized as members of socia l groups and cultures. In turn, these conglome rates of social groups and cultures affect the individual through· out a system composed of di ffe ring levels of analy· sis. Intrapsychic relationships within the indiv idua l are de·emphasized.

Clinicians are primarily concerned with the diag· nosis and treatment of emotional, biological, psy· chological, social, and behavioral ma lad justment, disability, and d iscomfort (Sayette, May ne, & Nor· cross, 1992, p. 1). Diagnosis often involves the use of sophisticated tests to measu re the incidence of a part icular condition. Neithe r diagnosis nor treat· ment is typically the goa l of environmental psychol· ogists. Often the aims of researche rs in environment and behavior are simply to gain a deeper under· standing of how the physical environment facilita tes or hinders a particu lar set of atti t udes and behav· iors. Issues of mutual interest include assessment of the effects of physical relocation, natural disasters, environmenta l s tressors, social support networks, and role transitions in the psychological functioning of patients, students, faculty, and organizat ions (Demick & And reoletti, 1995, p. 59).

Clinical psychologists generally focus on the indi· vidual as the un it of ana lysis. Most of thei r theoreti· cal approaches are person cente red. By contrast, environmental psychologists fOCllS on the person·in· environment system as the primary unit of analys is. Yet some of these concerns can overlap.

One can conceptualize an individual's SOcloeco­logical environment along different levels, from the micro- to the meso-, exo-, and macrosystems (Bron­fenbrenner, 1979). The microsystem is a "pattern of activities, roles, and in terpersonal relations exper i­enced by the developing person in a given sett ing with particular physica l and materia l characteris­tics" (p. 22). An example of the microsystem is the immediate home environment. Mesosystems involve settings in which indiv iduals e ngage for a s ign ifi­ca nt amount of time, such as school or work environ­ments. Exosystems include systems ou tside of individuals that affect t hem, for example, the local police. Finally, mncrosystems entail social and cul­tu ral values that exert a s trong in fluence on atti­tudes and behavior. We argue for the necessi ty of a systems or socioecolog icaJ approach in the concep­tion of a field of work that emb races both clinical psychology and environmenta l psychology.

As an example, an analogy can be drawn between the relationships of clinical and environmental psy­chology and an ecological analysis of health promo­tion. Siokois (1992) discusses how an ecological perspective is emerging in the f ield of health promo­tion, with an emphasis on linking individually fo· cused, sma ll-group, organizational, and community approaches. Along these li nes, he stresses the impor­tance of examining situations, sequences of individ­ua l or group activi t ies occurring at a particular time and place; settings, geographical locations where personal o r interpe rsona l situations occu r regularly; life domail/s, diffe rent spheres o f a person's life such as family, education, spi ritual activities, recreation, employmen t, and commuting; and overall life sill/a­tiOIlS, the major doma ins in which a person is in­volved during a particular period of life. Stokols argues that researchers still need to delineate spe­cific env ironmental leverage points that can help promote better healt h in society at large.

Clinical psychology could also benefit from a systems or socioecological approach. Clinical re­searchers need to identify environmenta l features that can exacerbate or minimize both psychological wellness as well as menta l illness on a variet y of lev­els. From t he perspective of environment behavior researchers, the type of problems that cl inicians ad­dress can not be fully understood without taking into account the e nvironme nt in which they are em­bedded. A systems approach wou ld allow a clinica l researcher to examine how mental disorders operate on a var iety of levels of human-environment interac* hons. Specific mental d isorders may operate along a variety of scales. For example, a teenage girl who suffe rs from bulimia is p reoccup ied with he r self image, wh ich is influenced by her family interac­tions and role models, her peers and teache rs at school, and social a nd cultural influences that she sees on telev ision and film.

Systems or socioecological theory also benelits from a transactionalist perspective. A transactional­ist approach views several aspects of persons and environment as mutually defining (Wapner, 1987). A person is comprised of physical and b iological traits such as age and sex, intrape rsonal and psycho­logica l traits such as self-esteem, and sociocultural traits such as roles. The environment is compri sed of physical (e.g., natu ral and built), interpersonal, and sociocultural (e.g., mores, rules) characteristics.

Important to note are traditional theories of psy­chology integrating both environment and intrapsy­chic processes in the etiology of mental disorders.

Exploring Patllology: Relations/lips between Clinical alld Environmental Psycllology 131

For example, attachmen t theory is one useful frame­work w ith which to view the relationships between the two field s of clinical and e nvironmental psychol­ogy when considering a socioecological or systems approach. Developmental psycholog ists have con­ducted decades of research about how infants and toddle rs form attachments w ith their parent figures . Joh n Bowlby and Mary S.,lter Ainsworth made major contributions to the understanding of attach­ment theory (Bowlby, 1969, 1973, 1980; Bretherton, 1992). The nature of these a tt achments can be ex­tremely significant when clinicians diagnose and treat adults later in therapy. Attachment theory is also systemic. Infants become attached to a secure base, usually their mother. From that base they g radually venture out to explore the hierarchical levels of the environment: home, neighborhood, community, region, then wider geog raphies. In close conjunction w ith attachment theory is an abundance of literatu re in phenomenological environmental psychology. Rather than mainly focusing on how in­dividuals become attached to other people, environ­mental psychologists have examined how people form attachment s to places; one of the most notable examples is Tuan's (1974) Topopllilia.

Certain pathological concepts merit discussion here as weli. Dissociation is ano ther key concept in understanding how the two fields of clinical a nd environmental psychology connect. It often occurs while an individual experiences a traumatic event (Bremner & Marmar, 1998). It ca n manifest itself in a variety of ways, from feeli ng di scon nected from one's body to believing that one is watching onesel f in a movie or a play so that it seems as if the trauma is happen ing to someone else. Trauma victims may experience alternate states of consciousness and compar tmentalize what ac tua lly occurred . Some ind iv iduals repress unpleasant parts of the past, al­lowing only fragments of memory to surface. Clin i­cal psychologists who handle traumatic events, such as child abuse, must uncover their client's dissocia­tion before they can begin to make headway in

therapy. And while it is rarely the primary focus of clinicians, these dissociative pattern s often include a n e nvironmental component. A particular object, place, or space may later serve as an unpleasant s timulus or trigge r that unleashes the memory of the trauma- what one has tried to bury in the subcon­scious- ali over again. For example, a young girl who had bee n molested by her father in an attic may have tried to mentally divorce herself from what was happening at the time, yet late r in life she may de­velop a phobia of a ttics, steps, or heights. A woman who was raped in a parking lot may later be te rror­ized s imply getting in and out of a car. As Rubin­stei n (1993a, 1993b) argues, traumatic events may weaken the person-place bond. Trauma surv ivors may become emotiona lly, cognitively, or behav­iora lly detached from the aspec t of lifespace associ­ated with the trauma.

Natura l disasters pose a different kind of trauma that may cause one to dissocia te as wel l. A you ng boy who survived a to rnado roaring through his neighborhood may tremble every time he hears not only a tornado siren but also an alarm clock or a tele­phone ringing. A camper who survived a devastat­ing fores t fire may become anxious simply smelling the smoke of a harmless barbecue. Here lea rning theory comes into play: The physical environment assumes the role of a cond itioned stimulus that elic­its a conditioned response. Just the s ight, sou nd , o r smell of a traumatic env ironme ntal experience may trigger a negative reaction. Suedfeld (1987) refers to these precipitating events as extreme experiences, and he notes the proliferation of te rms such as COII­

centration camp syndrome, disaster syndrome, and shell slwck.

Table 8.1 illustrates how the systems or socioeco­logical approach relates to the pathologies of disso­cia t ion, agoraphobia, and anorexia nervosa. In each disorder, notice how the different levels of micro, meso, exo, and macro have a bearing on each other. For example, dissocia tio n may operate at the micro­system, 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 dynamics playa role; at the exosystem, where ch ild sexual abuse (the trauma) may be detected by a school official or by the local police; and at the macrosystem, where the perpetrator is punishoble under the law.

Turning to agoraphob ia, at the individual level agoraphobics react negatively to endogenous (inter­nal) or exogenous (external) stimuli . Because of their intense fears, agoraphobics are usually con­fined to their homes. Public spaces such as super­markets or crowded environments often provoke panic attacks, and as a resu lt, persons with agora ­phobia avoid them. Agoraphobics often generalize from their exper iences with past panic attacks. They imagine that panic attacks will be repeated else­where in the future, even in places where they have never had any. The outside world itself, or the macroenvironmentallevel, becomes a source of pho­bia. Agoraphobics tend to associate personal catas­trophes with the macrolevel. Victims of panic attacks often feel they are at the point of no return, fearing that they are going to die. They view the out­side world holistically, and specif ic contexts become irrelevant compared to the overwhelming exper i­ence of being threatened by a hostile environment.

In the case of anorexia nervosa, a young woman's body image may be shaped by her family, classmates at school, neighborhood norms, and social and cul­tural ideals of beauty that she sees in advertise­ments on televis ion and in magazines. In order for therapists to understand and treat anorexia nervosa d isorder, they must disenta ngle a woman's relat ion­ship with each part of this sOcioecological system.

Note that Table 8.1 represents a gross simplifica­tion of processes that shift constantly from one level to another. For example, cases of dissociation popu­lari zed by the media might propel this disorder into nat ional prominence, albeit for a short time. Changes in policies or laws may result from widespread expo­su re and political awareness of this disorder. We may also see a trickle-down or bubbling-up effect from one level to another.

In sum, from a theoretica l perspective, the physical environment can deepen psychologists' understand­ing of the development. diagnosis, and treatment of various mental disorders. Socioecological, systems, and lransactionalist approaches to environment and behavior help explain the multiple levels on which the physical environment operates. Attachment the­ory offers insights about how people become attached

to places and objects, an attachment that, if tampered with, can playa role in precipitating certain mental disorders. The concept of dissociation often includes an environmental link whereby a space or place serves as a trigger of traumatic memories. With this frame­work in mind, we turn to an examination of how the physical environment is presented in the clinical literature.

ENVIRONMENTAL APPROACHES I N

CLINICAL PSYCHOLOGY

Despite over 30 years of environment behavior re­search, the role of the physical environment in clini­cal psychology remains somewhat minimal. A review of recent clinical literature reveals that the physical environment is rarely mentioned. Clini­cians and researchers tend to use the word environ­ment to denote situational rather than physical surroundings. For instance, clinicians ana lyzing children's home environments are likely to focus primarily on the relationships among children, their parents. and their peers-but ra rely on the physical dwelling. Similarly those addressing children's school environments usually examine the relation­ships among children, their teachers, counselors and other staff members, and peers-while ignoring the physical condition of the classroom or school build­ing. Diagnostic and treatment measures rarely stress the physical environment.

Our examination of the Diagnostic and Statistical Manual of Mental Disorders, FOllrth Edition (1994), or DSM-IV, revea ls that the physical environment is mentioned only in a peripheral manner. DSM-IV is the primary source used by psychiatrists, physi­cians, psychologists. socia l workers, nurses, occupa­tional and rehabilitation therapists, counselors, and other health and mental health professionals to di­agnose mental disorders. One section of the DSM-IV addresses multiaxial assessment, that is, different domains of information that can assist clinicians in planning and predic ting outcomes. Five axes are in­cluded: Axis I, Clinical Disorders, Other Conditions That May Be a Focus of Clinical Attention; Axis II, Personality Disorders, Mental Retardation; Axis III, General Medical Condit ions; Axis IV, Psychosocial and Environmental Problems; and Axis V, Global Assessment of Functioning.

Axis IV is most relevant to environment and be­havior. "Ax is IV is for reporting psychosocial and

Exploring Pathology: Relationships between Clinical alld EflvironmClltal Psychology 133

e nvironmental proble ms tha t may affect the d iagno­sis, treat ment, and prognosis of me nta l disorders (Axes I a nd II ). A psychosoc ial or environmental problem may be a nega ti ve li fe even t, an env iron­mental difficu lt y or def iciency, a famil ial or ot her interpe rsona l stress, a n inadequacy of social suppo rt or persona l resources, o r o ther proble m rela ti ng to the context in whic h a pe rson's difficu lt ies have de­veloped" (DSM-IV, 1994, p. 29). The manual suggests tha t clinic ian s sho uld note only those psychosocial or env ironment a l problems prese nt dur ing the yea r preced ing the cu rre nt eva luation a nd that cl inicians may opt to note such p roblems that occurred prior to the previous year if they clearly contribute to the menta l d isorder o r have become a focus of trea t ment. In practice, most psychosoc ial o r e nvironmenta l problems are indicated on Ax is IV; howeve r, if such a problem is the p rimary focus o f cl in ica l attent ion, it wou ld a lso be recorded on Ax is I w ith a code de­rived from the sect ion on "Other Cond itions Tha t May Be a Focus of Cli nica l Atte ntion."

Psychosocia l a nd environme nta l p roblems a re grouped under the following categories: problems with primary support group, problems related to ti,e social envirollment , educational problems, occupational prob­lems, IIolIsing problems, economic problems, problems with access to IIealth care services, problems related to in­teractioll witl, the legal system/crime, and other psychoso­cial and envirO/lmenta/ problems. Problems related to fh e social environmen t include the death or loss o f a friend , inadeq uate socia l support, liv ing alone, and difficu lt y w ith accultu ration, discriminat ion , a nd adjust ment to li fe-cycle transition, such as re t ire­ment. Note that these ref lect situationa l rather tha n phys ical issues. Housing problems include ho me less­ness, inadequate ho usi ng, unsa fe neig hborhood, a nd discord wit h neighbors o r land lo rd. Other psychoso­cial and environmental problems incl ude ex posure to disasters, war, or other host ilities; discord with non­fa mily caregivers such as a counselor, socia l worker, o r physician; a nd unava il abi lity o f socia l service age ncies. The categories of /lol/sing problems and other psychosocial and environmental problems reveal a t least some atte ntion paid to the physka l env ironment, bu t mainly in the form of ex tre me proble ms such as homelessness or d isasters. For example, an individ­ua l troubled by an inadequate phys ica l work envi­ronment, rat her than home envi ronment, is no t included here.

Along with sit uat iona l fac tors, howeve r, the physical envi ronment can not be ignored. Although

clinicians ra rely pay the environme nt the attention it deserves, we argue that it can often playa sig­n ificant role in deepening o u r understa nd ing of psychopa tho logy such as anxiety disorders (panic disorders, agoraphobia, specific phobias, obsess ive­compu lsive d isorders, a nd post-traumatic stress dis­order [PTSDJ), eating disorders (a norex ia nervosa, bulimia ne rvosa), and substance-related d isorders (alcohol use disorde rs, d rug use or dr ug-induced disorders, a nd nicotine-related disorders). The e n­vi ronment may well p laya role in p romoting a nd in reducing other u nhealthy behav ior patte rns such as overeating and smoking.

Pa nic di sorder fa ll s under the rubric of anx iety disorde rs in the DSM-/V. It can occur with or with­out agoraphobia. Conversely, persons w ith agora­phobia often have a h is tory of pa nic d isorde rs, but some do no t. Pan ic attacks usua lly come on sud ­de nly, last ing on ave rage from 30 to 90 mi nutes. Somet imes they can be on ly a few minutes in length. Panic attacks occur frequen tly in noncli n ica l popu­lations as well as in those w ith a varie ty of psychi­atric a nd physical di so rders. The initia l att ack most frequently occu rs away from home, o fte n in a set­ting w here indiv iduals feel trapped or liable to draw att ention to the mselves (Sw inson & Kuch, 1990). Sit­ua tiona l precipita nts o r e nvironmental conti ngen­cies of the f irs t panic attacks expe rienced are often desc ribed in terms of the exte rna l contex t; clients re­ca ll where they were a nd wha t they were doing. In Great Britain, Burns and Thorpe (1977) investigated the fears o f agoraphobics who responded to a ques­tionnaire by mail in a la rge survey of 963 subjects. Results showed that the most freque ntl y feared sit u­a tions we re joining a li ne in a s to re, having to keep a definite appoi ntmen t, fee ling trapped at the hair­d ressers, a nd increasing the d istance fro m home. In la rge cit ies, agoraphobics tend to avoid confining sit­ua tio ns like the subway, driv ing on a n e levated h igh­way, taking an elevator beyond the firs t few floors, or us ing a n underground park ing ga rage. Swinson and Kuch (1990) fou nd it strik ing that few agorapho­bics we re awa re of the fu ll range of their avoidance until they were asked spec ific questions abou t their mObility. "Similarly," they also s tate, " it is s triking how few the rapists, who a re no t engaged in behav­iora l assessment and treat ment, dete rm ine the extent of the ir patients' disabi li ty from avoida nce behav ior" (Sw inson & Kuch, 1990, p. 18). Research in the 1990s began toexamine how panic attacks and pan ic d isorders vary cross-cult urally (Katschnig &

134 HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY

Amering, 1990); the epidemiology of panic disorde r and agoraphobia (Weissman, 1990); coping sty les that agoraphobia sufferers adopt when attempting to cope w ith symptoms of anxiety and panic (Hughes, Budd, & Greenaway, 1999); and mecha ­nisms involved in the observationa l condi t ioning of fear (Mi neka & Cook, 1993). Hughes et al. (1999) de­sc ribe several cognitive strategies for coping with agoraphobic a nd panic-induced anxiety relating to four possible direc t ions of attention: to the self, away from the self, to the environmen t, and away from the environment. In addition, the researchers cite the use of positive self-talk and relaxation as coping strategies.

Research on spec ific phob ias also has an environ­mental component. Psycholog ists have long been in­vestigating fear of heights, fear o f fly ing, a nd, more recently, fear of driving. Findings reveal that non­phobics have had a sa fe exposure to a stimulus that invokes a phobia in o ther ind ividua ls. Menzies and Clarke (1993) discovered that on ly 18% of height­fearfu l subjects attr ibu ted their fear to a direct condi­t ioning experience. In a subsequent study using only clinical subjects, they found that only 11% of acro­phobic cases studied could be directly attributed to direct traumatic experiences involving heights (Men­zies & Cla rke, 1995). As a result, the etiology of height phobia d iffers sharply from tha t of othe r phobias, such as dog phobia and den tal phobia, where high levels of direct conditioning ex periences p laya major role. Davey, Menzies, and Ga llardo (1997) suggest tha t the freque ntly found comorbidity between ago­raphobia and acrophobia may be explai ned by cogni­tive biases in the discr imination and interpretation that agoraphobia and acrophobia have in common. According to cognitive-behavioral theory, anxiety disorders arise when situations are perceived as more dangerous than they actua lly a re. Once a threat is perceived-or more accurately, misperceived-at least three mechanisms may help maintain pers istent high levels of anxiety: selective attention to threat­relevant s ti muli, physiological arousal, and safety­seeking behav io rs. People then engage in coping responses to control anxiety and in avoidance re­sponses to preven t perceived danger (Sa lkovskis, Clark, Hackmann, WeBs, & Gelder, 1999).

Va n Gerwen, Spinhoven, Diekstra, and Van Dyck (1997) investigated the association of flight anxiet y with different types of phobia among 419 people who sought help for fea r of flying. They identif ied four foci of fear: fear of an aircraft accident and the need to be in control of the situation; fear of loss of

self-control or socia l anxiety; fear of water or claus­trophobia, agoraphobia, or both with panic attacks; and acrophobia. Taylor, Deane, and Podd (2000) ex­amined fear of driving. Taylo r's research team cites that previous studies of driving phobia found a mix­ture of cognitions associated with diffe rent anxiety d isorde rs, such as fear of accidents (specific phobia), fear of anxiety and its symptoms (panic disorder), and fear of embarrassment (social phob ia). Their own st udy sampled 190 volunteers recruited through media advertisements asking for respon­dents who had a fear of driving; 85 of these partici­pated in a follow-up study. Findings revealed that subjects had high expectations of negative events and that there were no significant diffe rences in te rms of fear severity between those who had had and had not had a motor vehicle accident.

Research on obsessive-compulsive disorder (OeD) has revealed tha t environmental cues may have an impact on the waxing and waning of this d isorder (R istvedt, Mackenzie, & Chr istenson, 1993). Eighty­one subjects with OCD completed a 339-item cues checklist (eel) developed by Mackenzie, Ristvedt, Christenson, lebow, and Mitchell (1992) of ratio­na ll y derived cues and ci rcumstances that might be expected to elicit or worsen symptoms. Analyses of principal components identified four components: household order and organization, contamination and cleal/ing, negative affect, and prevention of harm alld checking. HOllsehold order and organization cues in­cluded housework and daily activ it ies around the home: cleaning the kitchen, organiz ing things, vac­uum cleaning, a rra nging th ings, house cleaning, washing dishes, ma king beds, washing clothes, packing suitcases, cooking, returning home, sorting through bureau drawe rs, and prepar ing for bed. COlltamination and cleaning included: the touch of others, germs, blood, public restrooms, dirt, trash, AIDS, garbage cans, an illness, a doctor's v isit, hos­pitals, money, hand washing, and door knobs. The negative affect component contained severa l cues in­volving depression, anxiety, and anger and situa­tions that would evoke nega tive affect, but only three environmental items: one's workplace, shop­ping, and shopping malls. Finally, prevention afharm and checking cues included objects and activities that normally require some level of care and attention to prevent harm to oneself or to others: locking doors, turning off appliances, oven, locks, leaving your home, light switches, writ ing checks, stoves, being uncertain, and driving a car. Th is body of research 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 as a preCipitant of symptoms. Oepressive affect may heighten an OCD patient 's reac tions to affect-laden stimuli, which later impedes habituation to these stimuli. The researchers also note that the format of the CCL does not allow individuals to comment on the potency of ind iv idua l cues or the extent to which each cue may resu lt in pathologica l behav ior on any one occasion. They argue that a Single cue may prove equally troublesome as several other mi nor cues combined. The use of the CCL requires still further refinement.

Other scholars have been investigating the extent to which the family accommodates patients with OCD. For example, one study examined the experi­ences of spouses or parents for 34 patients with UCU and found that 88% of these caregivers reported ac­commodating the patient. Among the more extreme findings: "The mother of one patient regu larly used a neighbor's bathroom because hers was constan tly occupied by her son; one wife was unable to cook or clean because her home was entirely cluttered w ith hoarded newspape rs" (Calvocoressi et ai., 1995, p. 442).

In fact, hoarding behavior is one form of OCD that has only recently been the subject of e mpirical resea rch. Until the mid-l990s, most research in this area focused on food hoarding among rodents, small animals, and birds-with hardly any on humans. Yet of all the disorders examined, hoarding reflec ts one of the strongest ties to the phYSical environment. When people hoard, they hoard things, and this in turn affects their primary territory and those of ot h­ers around them. Frost and Gross (1993) and Frost, Krause, and Steketee (1 996) conduc ted one of the first series of empirical stud ies exami ning the asso­ciation of hoarding anri obsec;.c;ivp-com pu lsive symp­tomatology, for wh ich they developed a 21-ite m Hoa rding Scale (referred to in the subjects' materi­als as the "Question naire on Sav ing Things"). Two groups of subjects comprised their st udy. The fi rst group responded to a newspaper advertiseme nt so­liciting volunteers who were "pack rats o r chronic savers" to participate in a study. The subjects quali­fied for inclusion in the study if they saved a large number of items that were not part of collections, and if a large percent of what they saved went un­used. The second inclusion criterion was a cu toff score of 70 on the Hoarding Sca le (Frost & Gross, 1993). The second g roup compri sed staff members at a small libera l arts college. randomly selected from the telephone directory. who scored below the

median (60) on the Hoa rding Scale. The final subject pool included 11 hoarders a nd 16 nonhoarders. Results showed that hoarders had s ignificantly and substantially scored higher on the Yale-Brown ObseSSive-Compulsive Scale (Goodman el ai., 1989). Among a community sample, hoarding was strongly associated with obsessive and compulsive symptoms in genera l and wi th severa l related charac teris t ics includi ng indec isiveness and pathological responsi­bi lity, as well as w ith genera l psychopathology symptoms and distress. The findings suggest that hoarding behavior is widespread, even in nonclini­ca l populations, and that more research is needed to identify the extent to which hoarding poses a prob­lem that requires intervention.

Frost and Gross (1993, p. 374) confirmed the prl!s­ence of hoarding behav ior by visit ing several of their subjec ts' homes. They found that the degree of clut­te r va ried; it could be highly visible in the major liv­ing areas of the home or hidden completely in selected spaces. According to the researchers, "One subjec t 'S house was a series of ma ze-like paths through rooms piled to the cei ling with miscella­neous objects . Another subject had virtually no clut­ter in her house; however, her base ment and attic had hundreds of boxes neatly labeled and stacked in rows from floor to ceil ing- like the s tacks of a li­brary." Hoarders tend to buy extras of certain th ings so that they are not caught without them. They a lso tend to carry more possessions with them in their purses or cars "j ust in case . ... " Self-reported hoard­ers reported higher levels of emotional attachment to their possessions. Hoarders had more firs t degree relatives who engaged in excessive saving than non­hoarders, and hoarders were less likely to be married. Throwi ng things away upsets hoarders emotionally and physically such that hoarders engage in the be­havior to prevent some future harm-being withou t somet h ing they need . Surprisingly, hoarding was not related to material deprivation . The researchers suggest a model that conceptualizes hoarding as an avoidance behavior tied to indecision and perfec­tionism. Saving allows hoarders to avoid the deci­s ion required to throw something away and the fear or worry that they have made a mistake in tossing something ou l. 11 also allows hoarders to avoid emo­tional react ions that accompany parting w ith cher­ished possessions, resulting in a greater perceived sense of control over their environment.

Sexua l abuse, whether it occurs in childhood or adulthood, has been a major sou rce of post-trauma tic stress disorder and has been the focus of an extensive

136 HANOaoDK OF ENVIRONMENTAL PSYCHOLQCY

body of research. Dissociation occurs both peritrau4 matically-at the time of the traumatic event-and posttraumatically- as a long4term consequence of traumatic exposure. Dissociative symptoms deriving from childhood abuse frequently include depersonal4

ization, derealization, dissociative amnesia, fragmen4

tation of identity, and posttraumatic reexperiencing phenomena such as flashbacks of traumatic events (Chu, 1998). When a trauma occurs, whether it be abuse or another form of traumatic stress, people begin to dissociate what is happening through an al4

tered sense of t ime, e ither much slower or accelerated than it actually is; profound feelings of unreality, that the event is not ac tually happening to them; confu­sion and disorienta tion; feelings of being discon­nected from their bodies (Marmar, Weiss, & Metzler, 1998).

Holman and Stokols (1994) analyzed child sexual abuse, drawing upon theoretica l constructs from clinical, social, developmental, and environmental psychology. They examined contextual influences on the etiology and psychosocial outcomes of child sexual abuse and suggest clinical and environmental dlO-sign :,tral~git:::, Iv r~tluct! the prt!valence and dis4 ruptive impacts of this pressing social problem. They speculate that microlevel sociospatiai factors may increase opportunities or motivations for per­petrators to molest children. Conversely the degree 10 wh ich the layout of a home includes a sense of de­fensible space may in flue nce pa tterns of territorial and self-protective behavior. A home that offers a strong sense of control over persona l space without extreme physical, visual, or auditory isolation may reduce opportunities fo r abuse.

The study of PTSD has mushroomed in recent decades. In the Un ited States this was in part precip­itated by thousands of Vietnam War veterans who had experienced gruesome traumas on the battle­fie ld that continued to plague them long after they returned home. Many returning soldiers watched in shock as bullets struck their buddies only inches away. Others witnessed the enemy exploding in a wall of fire. Still others were tortured and beaten themselves. Scenes like these resurfaced in flash­backs or tormented them in dreams years after the war had ended.

More recently, hundreds of those who have wil4

nessed terrorist attacks, such as the 1993 bombing of the World Trade Center in New York City or the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, have suffered from PTSD. Buildings

that had been safe workplaces for years became death traps in a matter of seconds.

Even before terrorism became relatively wide­spread, building failures have occasionally precipi­tated PTSD. For example, the 1981 collapse of a walkway in the Hyatt Regency Hotel in Kansas City, MilSsouri, left 114 people dead and over 200 injured. The disaster occurred dur ing an atrium tea dance when the lobby was packed. Thousands of Jives were adversely affected by this catastrophic event. One resea rcher st udied the psychological effects of this structural failu re on those who survived (Wilkin­son, 1983).

Environmental d isaste rs such as the 1989 Loma Prieta earthquake, which rocked the San Francisco Bay Area; the 1991 firestorm in Oakland, California; and the 1993 devastating wildfires in Orange County, Ca lifornia, also left thousands of PTSD vic­tims in their wakes. The 1989 earthquake caused the collapse of the Nimitz Freeway near downtown Oak­land. Some fascinating research involved interviews of 367 emergency services personnel who responded to the Bay Area disaster, 154 of whom were involved in the freeway collapse (Marmar, Weiss, & Metzler, 1996; Weiss, Marmar, & Metzler, 1995). These in­cluded emergency medical technicians, paramedics, firefighters, police, and California Department of Transportation workers. Several predictors of cur­rent symptomat ic distress were measured, including level of critical incident exposure, psychologica l traits, locus of control, social support, general disso­ciative te ndencies, and peri traumatic dissociation. Results lent further support to a growing body of literature linking dissociative tendencies and experi­ences to distress resulting from exposure to trau­matic stressors. The same research team investigated the relationship between peritraumatic dissociation and posHraumatic stress response in greater Los Angeles area residents who survived the 1994 Northridge earthquake (Marmar et aI., 1998). Re­searchers evaluated 60 men and women working for a large private insurance company who lived close to the epicenter of the quake. Again, reports of dissoci­ation during the traumatic event predicted current post-traumatic stress response symptoms.

In sum, upon close examination, it appears that a wide variety of mental disorders have at least some relationship to the physica l environment. In some of these, such as agoraphobia, specific phobias, and cer­tain forms of obsess ive-compulsive disorder (such as hoarding behavior) the environmenta l li nk is stronj2;,

Exp/oring Pathology: Relationships between Clinical and Environmental Psychology 137

holding promise for both diagnosis and treatment. With that in mind, let us now examine ways in which the physical environment has been used in treatment of mental disorders.

TREATMENT Because the physica l environment is mentioned only tangentially in the clinical literature, it has been a challenge to find examples of how clinicians have used the physical environment in treatment. None· theless, we were able to locate a few examples. Un· doubtedly, there must be others as well.

Frueh, Turner, and Seidel (1995) examined the role of exposure therapy for combat·related PTSD, an issue that they argue remains underdeveloped. The researchers studied exposure therapy, a general term for the category of treatments, and distinguish between intensive exposure (sometimes referred to as flooding) and graduated exposure (systematic desen· sitization). They reviewed single case studies, group outcome studies, and studies based on other exposure·based strategies. Their research provides considerable evidence that intens ive exposure to trauma·related cues benef its patients suffering from combat-related PTSD, especially in alleviating symptoms of intrusion and physiological reactivi ty to stimuli associated with traumatic events. None· theless, data fail to indicate that exposure therapy has a s ignificant effect upon the negative symptoms of PTSD, such as avoidance, social withdrawal, and emotional numbing, nor on certain aspects of man· aging emotions, such as anger control.

A technique ca lied attention fixation trainillg (AFT) has proven effective in helping agoraphobics habitu ­ate to phobic settings (Kallai, Kosztolanyi, Osvath, & Jacobs, 1999). AFT has three components. First is di­rected QUelltjoll to the physical environment. Clients are taught to pay attention to their surrounding en· vironments as they experience them. Second is topo­graphical syntheSiS, whereby clients are encouraged to experience the environment in the here and now as opposed to using preconceptions. Topographical syn­thesis is used to update stunted cognitive maps that clients carry around with them internally. Third is di­rected orientation in space-time. In this procedure, clients are encouraged to explore objects in the space of the present while also recalling their past memo­ries. Thus clients advance spa tially and temporally in their thought process as related to the environment. The "goal object" under exploration successfu lly

integrates present experiences with the past and the future to c reate an ongoing spatiotemporal context. Researchers used AFT to examine nine individuals diagnosed with panic disorder with agoraphobia and how they handled five panic-inducing situa­ti ons while walk ing a standa rd 2.5 kilometer route: walking along near a busy street with the examiner following close behind; walking alone near a busy street with the examiner out of client's visual field; shopping with the examiner present; traveling on a bus a lone; and shopping alone. Heart rate activity was monitored during each of these situations as an indicator of the effects of individual external stimuli, triggers, and the stimulus complex. Researchers dis­covered that, with the exception of using public trans­portation, AFT resulted in considerably decreased heart rate activity as well as in decreased panic anxi­ety. They suggest that longitudinal studies are needed to test the long-term effects of AFT.

In addition to the many disorders described ear­lier, clinicians diagnose and treat eating disorders such as binge eating, anorexia nervosa, and bulimia nervosa. Eating disorde rs become problematic when they interfere w it h how a person functions in every­day life, and at their worst, they can even be fatal. Certain environmental stimuli may fu nction as trig­gers for promot ing and reducing eating disorders. Organizations such as Overeaters Anonymous and Weight Watchers address the needs of the nonelini­ca l population, that is, individuals who do not neces­sarily seek out formal clinical treatment but who nonetheless desire an informal support group in order to help control their problematic eating habits. Such organizations counsel their members to beware of setti ngs where they tend to engage in overeating. For example, in an effort to prevent weight gain over the 2000 holiday season, a public service announce­ment from the American Dietetics Association cau­tioned party goers to stay away from the food table. They are urged to take only a small plate of food and eat only what is on it instead of munching away con­tinuously without knowing how much food they con­sume. Avoiding a specific environment-in this case, a buffet table filled with an array of tempting appe­ti zers-can affect a spec ific behavior, overeating.

The treatment of substa nce-rela ted disorders, such as alcohol use disorders, drug use or drug-induced disorders, and nicotine-rela ted disorders, may have env ironmental components as well. Here too those who do not seek out formal clinical expertise often benefit from support groups such as Alcoholics

138 HANDBOOK OF ENVIRONMENTAL P SYC HOLOGY

Anonymous or smoki ng cessation groups to curb their habits. Such organizations often alert their members to avoid env ironmental settings that may trigger the addictive behavior. For exa mple, people prone to alcoholism and smoking are less likely to conti nue the ir harmful add ictions if they avoid hanging around bars filled with cigarette smoke.

THE ENVIRONMENTAL PSYCHOLOGY OF

TREATME N T SETT I NGS

One of the most intriguing areas where env ironmen­tal and clinical psychology overlap is the study of treatment se ttings. From a histo rical perspective, Nata lija Suboti ncic (1999a, 1999b) provides a fasci­na ting ana lysis of Sigmund Freud's office and its relationsh ip with his theories and practices. She in­vestigated how Freud arranged the rooms in which he lived and worked during several periods of his pro­fessional life, including the famous 19 Berggasse in Vien na , Austria, his home and offices from 1891 to 1938. In add ition to constructing measured d rawings of the consulting room whe re Freud met with his pa­tients, she also studied how he orga nized furniture as wel l his large collec t ion of antiquities. As Subotin­cic (1999b) argued, "he carefu ll y and sel f consciously assembled the contents of his work spaces in a man­ner that reflected the orga ni zation of his thoughts a nd beliefs." Around 1890, a grateful patient, Madame Benevisti, gave him a memo rable present, what later became his world-famous psychoa nalytic couch. While at first he collected copies, photo­g raphs, prints, a nd plaster casts of Florentine s tat­ues, when he became more financially secure, he decided to collect original statues and vases from Egyptia n, Greek, Roman, and later Chinese periods.

Subotincic's resea rch revealed that major shifts in the development of Freud's theories of psychoanaly­sis were either directly preceded or followed by phys ica l and spatial a lterations that he made to h is office. Freud often refer red to his antiquities, espe­cially the statuettes which decorated h is writi ng table and which he greeted each morning, as his "au­dience." He was so attached to his coll ection that he took a substa ntial part of it w ith h im during his sum­mer holidays. By 1938, he had placed at least six stat­ues of Eros, the God of love, in a glass display cabinet at the foot of the couch . His pat ie nts were staring s traight at them-rather than at Freud himself-dur­ing analysis. Hi s consulting room addresses themes

of dreams, sexua lity, and life. By contrast, behind his desk in his study was an assemblage o f antiques based on the theme of death; all these themes were central to Freud's intellectual development. These included an Egyptian funera ry barge and two mummy masks. A Greek vase give n to him by his pupil and friend, Marie Bonaparte, sat on a round glass tabletop behind Freud's chair; a fter his death his ashes were placed in it.

From a conte mporary perspective, Division 34 of the Ame rican Psychological Association, Population and Envi ronmental Psychology, sponsored a sympo­sium at the 1998 annual convention on "Environ­ments for Psychotherapy-Problems in Office Design." The session was one of the fir st to explore the links between clinical and environmental psy­chology and the first to examine this topic. The dis­cussion drew about 60 attendees. In preparing for the symposium, organizer James Richards (1998) conducted a n intriguing pi lo t study. He selected a number of therapists' offices from the Yellow Pages o f the Tucson, Arizona, phone book. He then drove around the city to see what these offices looked like from the o u ts ide. Results of h is study revealed that all the sites he visited had an institut ional feel. Most were part of a medical complex, a nd they created a visual impression of a doctor's office. All were de­signed for occupancy during dayligh t hours, and he specula ted that night lighting could potential ly be a problem. Security for both clients and therapists is a significa nt issue. Accessibility, too, may be another problem area. It appeared that most met only the minimum standards for accommodat ing wheel­chairs. Richards also noted that the vast majority of therap ists' offices were located in a more affluent area of Tucson. Therapists may have selec ted the lo­cat ion o f their offices on purely economic grounds without giving much thought to other issues that may be relevant to clients.

At the same APA symposium, Richards delivered a paper on behalf of Penny McClellan (1998), a prac­titioner e mpl oyed by the American India n Healt h Center in San Diego, California. Her presentation addressed how the rapists selec t an off ice and what they failed to learn about this process in graduate school. She stressed that the quality of the neighbor­hood in which the therapist's office is loca ted is es­pecially important. It shou ld be accessible from the freeway and fro m public transportation and ideally should have parking nearby. Therapists must be at­tentive to such issues as air quality, freeway noise,

I I ! I

cxpwrmg t'ntnolOgy: KelatlOtlslrips between Clinical and Environmental Psychology 139

and airplane flight paths, all of which influence the environment in wh ich they practice. Concurring with Richards's findings, McClellan argued that safety a t night is another important concern. Thera· pists will a lso find it useful to have some type of sig­nal system in p lace, for example, to announce whe n cl ients arrive or to contact someone in case of an emergency. Accommodating children in a waiting area may a lso be an issue for cl ients who cannot af­ford babysitting or child ca re arrangements.

As a fina l part of the APA symposium, Anthony (1998) presented an analysis of environment behav­ior issues in the design of psychotherapists' offices. She began by reviewing images of therapists' offices in American film, such as Ordinary People (1980), Prince of Tides (1991), and Good Will Hunting (1997). She also noted that director Woody Allen has fea­tured therapists' offices in several of his films, for example, Husbands and Wives (1992) and Deconstruct­ing Harry (1997). What kinds of stereotypes about the field do these films promote or reflect? What roles do therapists' offices play in film: backdrop or center stage? How do these mass-produced images help or hinder the psychological profession?

Two examples of how therapists' offi ces are por­trayed in film are analyzed here: Good Will Hunting and Husbands and Wives. In the former, the main character, Will Hunting (Matt Damon) visits severa l therapists in an attempt to address his psychological problems. The first office reflects a formal academic setting with Gothic architecture, dark woodwork, and high bookshelves. At the second office Will Hunting reclines on a couch whi le a therapist per­forms hypnosis. Lights are dimmed and curta ins are shut. A decorat ive screen is positioned beh ind the therapist, perhaps symboli zi ng the hidden self. The third office is that of Or. Sean McGuire (Robin Will iams), the only therapis t with whom Hunting eventually connects and opens up to psychologi­cally. In contrast to the previous two office environ­ments, McGuire's office appea rs much more lived in, personalized by a coatrack, plants, and pictures, even a paint-by-numbers painting of the sea. Opaque glass windows shield his office from view. Further­more, McGuire's physical appearance contrasts with those of his two predecessors. While the first two dressed formally, McGuire dressed more casually. In all three cases, the therapists' clothing reflected the overall ambience of their offices.

In Husbands and Wives, the psychologist is merely a voice offscreen, and the main characters often

change therapeutic settings. Office settings tended to be shown for sessions with individuals, while more domesticlike settings were backdrops for ses­sions with couples. During one ind iv idual counsel­ing session, Judy (Mia Farrow) is show n in front of a backdrop of venetian blinds, and at another she is positioned in front of a semicircular window. In this film, one gets the impression that therapeutic set­tings are used as props to ampli fy the trite angst of New York yuppies.

Surprisingly, an extensive search of several data­bases covering thousands of scholarly journals, newspapers, and popula r magazines, revealed virtu­ally no information a t all about the office designs of psychot herapists, therapists, or counselors. A request to the e-mail bulletin board of Division 12 of the American Psycholog ical Associat ion yielded on ly one response. Nonetheless, informal interviews with therapists combined with the author 's personal re­flections revealed severa l issues to be important in the design of therapists' offices:

• Location. How convenie nt is the location of the office for cl ients? If the office is right off a b usy freeway intersection, for example, the stress of traffic can pred ispose one to an even more stressful sess ion with the psychotherapist.

• Image. Does the building where the office is 10· cated have a homelike or an institutional image?

• Degree of visibility. Do some clients want to hide? Do they fear running into people they know? Or, at the other extreme, do some wish to advertise they a re seeing a therapist?

• Proximity to rest rooll!. How far away is the rest room? Having one nearby gives clients a place to escape. A long hike down a hallway can make clients anxious.

• Privacy. This is one of the most important con­cerns. Can clients be seen or heard by others outside the therapist 's office? Can clients see or hear other clients in adjoining therapy rooms?

• f,asy-to-read clocks. Are clients surprised when their appointment time has ended ? Have thera­pists paced themselves adequately throughout the therapy session?

• Elltrallces and exits. Are the number and place­ment of entrances and exits helpful or harmful? One therap ist said that in seeking out new of· £ice space she was concerned that the client could leave her office without wa lking through the waiting room, thus minimizing the need

140 H ANDBOOK OF ENVIRONMENTAL P SYCHOLOGY

to interact or be seen in a state of emotional fragility.

• Furniture. Is the therapist face-to-face w ith clients or side by side? Which seating arrange­ment is most/ leas t intimidat ing? How much choice is available? Might certa in types of fur­niture make clients more or less li kely to lose emotional control? Or do some t ypes of furni­ture actually help clients feel better?

• Lig1Jtirrg. How bright or dim is the therapist 's office? Bright lights may seem cheerful to some clients, but glaring or overwhelming to others. Conversely, dim lights can seem soothing to some but spooky or depressing to others. Who controls the light ing? How much control does a client have or need? Are lights overhead or on side walls or tables? Glare may affect how pa­tients view their therapists and vice versa.

• Views. What role does an outside view play? A view of nature could have a healing effect, as has been demonstrated in medical settings (Ul­rich,1984).

• Plauts. In what condition are plants kept? Dead plants can send a s ignal to clients: If therapists can't even take ca re of the ir plants, how well can they take care of their clients?

• Artwork. Color, text ure, intensity, degree of ab­straction, and subjec t matter may all playa role in how clients respond.

In sum, the physical envi ronment of therapi sts' offices may well significantly influence the attitudes and behavior of cl ients, and the success or failure of the the rapeutic process itself. It may exacerbate cl ient s' preexisting conditions- for better or for worse. Environment behavior researchers, architects, inte rior designers, and psychotherapists must collab­orate to further investigate these important issues.

CLINICAL APPROACHES IN ENVIRONMENTAL

PSYCHOLOGY

In addition to the work just described examining the role of the physica l environment in therapeutic set­tings, other distinct areas of work have emerged where clinical approaches have been used to exam­ine issues in envirpnmental psychology. One body of research has addressed the expe rience of moving. Another body of work has examined the role of the home in family conflict and it s role in precipitating

and adjusting to a divorce. Another area of concen­tration has addressed the house as a symbol of self and the environment as an autobiography of self. No doubt there may be others as well.

The process of moving is one area where clinical and environmental psychology intersect. Indiv iduals who have recently experienced a move may present themselves to clinicians with a variety of psychologi­cal problems. In their classic Social Readjustment Rat­ing Scale, T. H. Holmes and R. H. Rahe (1967) and T. S. Holmes and T. H. Holmes (1970) cite a change in residence and change in living conditions as events likely to inc rease life stress. One of the earliest pieces to examine the phenomenon of losing one's home was done by Fried (1963). Several resea rchers have com­pared the process of moving to the grief reac tion of losing a loved one (Bronfenbrenner, 1967; Marris, 1974; McCollum, 1990; Weissman & Paykel, 1972). Anthony (1984a) ex plored memories of favorite homes, the experience of moving away and late r re­turn ing to visit them. Interviews with 97 Southern California res idents revea led that most fee lings about moving out of the favorite home we re negative (57%), as were return visits to the home afte r mov­ing out (88%).

In an early study, Anthony ana lyzed the role of the home environment In family conflict (1984b). Forty therapists in the Los Angeles area involved in mar­riage, family, and child counseling were interviewed as part of an exploratory study. Counselors were asked to describe their clients' problems about territo­riality and privacy in the home. Most therapists failed to focus on the physical envi ronment as a key concern in their pract ice yet, after hav ing been questioned about it, recognized its importance. The physical envi­ronment often served as a significant backdrop to problems reported by their clients. Results showed that the bedroom was most prone to territorial and privacy conflicts. Closely following the bed room were the kitchen, bathroom, and living room. Pieces of fur­niture that sparked the greatest conflict were televi­sions, stereos, and desks. Today computers, cellu la r telephones, and other elec tronic equipment might pro­voke domestic controversy as well.

Subsequent work by Anthony (1997) examined parents' and ch ildren's perceptions of their housing environments before and after a sepa ration or di­vorce, as well as the role that the home may play during a marriage. Two phases of resea rch were in­volved: first, an exploratory study at the Center for the Family in Transition in Corte Madera, Ca lifornia;

Exploring Pathology: Relationships between Clinical alld Ellvironmental Psychology 141

and second, a study of 58 indiv iduals in two support organizat ions for ch ildren and parents of divorce in St. Louis, Missouri . Survey and interview findings revealed that w hile the home is rarely the direct cause of divorce, it often exacerbates preex isting conditions in a marr iage . Subsequent to a divorce, some pa rents and children still maintain a strong emotional attachment to the home they inhabited while the marriage was intact. Moving out of that home can take a se rious toll on family members and, for some, cause severe g rief much like the loss of a loved one. Respondents' perceptions of their post­divorce ho usi ng arrangements were also discussed. Based on her research, the author concluded that the physica l housing environment, ty pically viewed as a backdrop to everyday life, may well mer it center stage.

Clare Cooper Marcus (1974, 1995) has stud ied in­d ividuals' relationsh ips with their home environ­ments for decades, beg inni ng with he r seminal paper "The House as a Symbol of Self" and cu lmi­nating in the publication of her book The HOl/se as Mirror of Self She draws upon the theo ries of Ca rl Jung, particularly his notion of archetypes, to un­dersta nd how people rela te to their houses. The book attracted widespread publicity including an appearance on the popular Oprah Winfrey Show, an event that caused the book to go into a second print­ing almost overnight.

The methodological tool of environmental autobi­ography (Cooper Marcus, 1978; Hester, 1979) has been widely used among envi ronment behavior re­sea rchers, and it holds great promise fo r clinicians as well. One of the most sign ificant findings from this method has been that adults often look upon their ch ildhood home as " haven," a standard upon which to base their ideal home environment. Yet the opposite can also be true. For those who experienced an unhappy childhood or, even worse, who were the victims of trauma, the home can serve as a trap, one that triggers unpleasant memories. In fac t, for this reason some students who are asked to wr ite an envi­ronmental autobiography as part of a course require­ment have been unable to complete the aSSignment. Although the tool can be an excelle nt means of un­covering one's environmenta l biases and va lues, for some vulnerable individuals the technique ra ises a host of ethical p roblems (Rubi nstein, 1993a, 1993b). Yet when used by a clinician with the appropriate psychological training, the technique ca n elicit in­sights that no o ther assessment measure can offer.

Peled and Schwar tz (1999) published two case st udies exploring the role of the ideal home in psy­chotherapy. As part of the ir therapeutic approach, they used the method o f eeo-analysis in the analysis of homes. Eco-analysis involves a compar ison of the client's concept of a n ideal home with his or her present home. This compa rison is the n used as a project ive measure in therapy. Similarly, Pe led and Ayalon (1988) published a case study examining the role of the spatial organization of the home in family therapy. The expe rience of a couple in therapy who underwent eco-a na lys is revealed similar dimen­s ions of conflic t in their re lationsh ip and in the spa­tial con figurations of thei r respective idea l homes.

Rowles (1983, 1984) examined place and personal ident ity in old age as manifested in a small Ap­palachian commun ity. He argues that, for many el­der ly, the environment is an autobiography of the self and refers to th is phenomenon as aldobiograplJi­cal insidedness. [ns ide versus o utside represents the d ichotomy between what the elderly v iew as the ir community and as the outside world. This concept has strong implicat ions for the rapeutic approaches. Autobiographica l recollections of Significant spaces and places may reveal inte rna li zed geog raphies that influence how clien ts cope with PTSD and o ther mental disorders a nd changes in the physical envi­ronment.

Israel (1998, 1999) has been using environmental autobiography met hods to unde rstand the roots un­derlyi ng the work of well-known designers. She con­ducted in-depth interviews with arch itect Michael Graves and arch itecture critic Charles Jencks, based on a series o f exercises derived from topoanalysis (see Bachelard, 1969). Her tools included an environ­mental genealogy exercise. Israel's research uncov­ered how both Graves and Jencks had unconSCiously reworked their histo ry of p laces to create thei r own homes as well as their well-known public buildi ngs.

[n their firm, Forrest Pai nter DeSign, Consta nce Forrest (1999a, 1999b) and Susan Painter (1999) rou­tinely rely upon clients' un ique relationships with t heir physica l environments as par t of the ir design and clinical practice. Forrest, a clin ical psycholo­g ist, and Painter, an interior designe r who is also a developmental psychologist, have b randed their ap­proach "design psychology." Design psychology relies upon interviews and assessment tools from clinical psychology. The information derived from these tools is used as the basis for des ign. Their objectives are to create spaces that function as therapeutic

142 HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY

environments. This is achieved in part through a de­sign prescription the goal of which is to create envi­ronments that s upport and enhance both privacy and social affiliation, positive beliefs about the self and self-esteem, sense of controL optimism about the future, and reminders about the meaning of life.

Forrest has developed three assessment tools to determine the environmental facto rs that evoke such positive psychological states for individual clients: developmental history of place, five objects, and favorite place. The first, developmental llistory of place, asks clients to recall where they have lived, when they lived there, and what impo rtant eve nts occurred. The second is a projective assessment technique whereby clients are asked to select five objects about which they feel so positively that the feeling could be characterized as love. Forrest then asks her clients to describe what about each object drew them to it and what emotions and associations the object evokes. The third tool asks clients to describe a fa­vorite place, the place in which they have felt the best of all places they have ever been, not necessarily a place whe re they have lived . With th is image of the place in their minds, Forrest uses a relaxation tech­nique to gUide clients to enhance their memories and recreate the experience of each of their senses, focusing on sound, color, texture, visual image, tem­perature, and spatial relationships. Her objective as a design psychologist is not to try to recreate the fa­vorite place but rather to bring elements into the de­sign that will recreate the exper ience that clients feel in this place. She weaves togethe r info rmation from all three assessment tools to produce a design for each individua l client.

Painter (1999) has extended the principles of de­sign psychology to des ign fo r groups of people rat her than for individuals. She draws upon three principles from developmental psychology. Security-exploration balance is the notion that emotional well-being is fostered by the proper balance between familiarity and novelty in the environment. Environmellt-as­mirror is the principle that people experience the en­vironment as a reflection of themselves and their in­trinsic worth. The caregivillg for tire caregiver principle asserts that in order to do their job effectively, those who care for others must meet their own psychologi­ca l and physical needs as well. All three psychologi­cal principles are used as the basis for a needs assessment, a series of needs statements about the clients and the environment, which becomes the basis for subsequent design work.

O ther works involving clinical approaches to envi­ronmental psychology have included ethnographies, interviews, and surveys examin ing the relationships between institutions and the large-scale communities in which persons wi th mental disorders reside. They exemplify the aforementioned systems approach as they involve different levels of analysis from macro­to microsystems. For example, Roosens (1979) ana­lyzed Geel, Belg ium, Europe's first therapeutic com­munity. The city soon became a pilgrimage site for those with mental disorders, in response to the cult of St. Dymphna. St. Dymphna was the daughter of a seventh-century Irish king. After refUSing to commit incest with her father, she fled to Flanders. Her fa­ther later discovered her there and murdered her. By refus ing her father's desires, legend has it that she defeated his madness. Si nce the mid-thirteenth cen­tury, persons su ffering from mental illness have en­tered the Chu rch of St. Dymphna to partake in a series of exorcisms. Many patients moved perma­nently to Ceel, and the city benefited economica lly from its fame.

Shoultz (1988) addressed the needs of individuals with mental disabilities and disorders at a mkrosys­tern level w ith macrosystem implications. She ar­gues that placing these individuals on a continuum with inst itut ional care at one end of the scale and community livi ng on the other can be problematic. Committing most troubled persons to institutions isola tes them from normality. Clients are assumed to progress along the conti nuum from inst it utional to community living: By contrast, Shou ltz proposed what she called "permanency planning," a concept whereby individuals remain within the confines of their own homes and communities. They a re encour­aged to become active and normalized members of their communities, and any treatment they rece ive is given at home. In fact. permanency planning reflects principles s imilar to those seen at the therapeutic communit y of Ceel.

At the institu tional [evel, Colarell i and Siegel (1966) explored the effects of cha ngi ng social roles in Ward H, a psychia tric ward in Topeka State Hos­pital in Topeka, Kansas. Aides assumed management positions formerly held by psych iatrists, nurses, so­cial workers, and other staff members. No longer were the aides passive recipients of their superiors' orders. Instead they had the au thorit y to make piv­ota l decisions about the ward. In order to help schizophrenic patients bette r distinguish between fantasy and rea lit y and between themselves and the

Explorillg Pathology: Relationships between Clinical and Environmental Psychology 143

surrounding environment, the aides initiated exe r· cise routines and focusing activ ities for them. They also improved the ward's appearance, which had previously been stripped of sharp objects, picture frames, and o ther potentially dangerous items. A four-year longitudinal study revealed that patients became more sociable and better oriented, strong in­dicators of normalization.

Fairweather, Sanders, Maynard, Cressler, and Bleck (1969) demonstrated the important relation­ships betwee n psychiatric patients and their physi­cal surroundings. They supervised an experiment in which patients from a mental hospital were relo· cated to a lodge in the commu nit y. At the lodge, pa­tients felt a sense of autonomy that led to leadership roles and empowerment. The mental health of the patients improved at half the cost of institutionaliza­tion. Furthermore, living in the lodge had an even greater positive effect on patients who had been hos· pitalized for the longest t ime.

In sum, wi th the exception of the body of work cited here, clinical approaches to environmental psychology are relatively few and far between. Nonetheless they offer many possibil ities for fu­ture resea rch.

CONCLUSIONS

Has the relationship between clinical and environ­mental psychology made an impact on actua l envi­ronments? For the most part, not yet. Because the links between these two diSCiplines have only emerged in the last decades of the twentieth cen­tury, not much has changed since then. A handful of enlightened designers are using clinical techniques in their p ractice, and the insights they have gained through these approaches have been s ignificant. Some enlightened psychologists have begun paying attention to the role that the physical envi ronment can play in diagnosing and treating mental disor­ders. The research that we uncovered holds tremen­dous promise for the future.

What behavior has changed as a resu lt o f new re­search or discoveries? Intensive exposure to trauma­related cues appears to benefit pat ients suffer ing from certain forms of PTSD, such as combat- rel ated PTSD, especially in alleviat ing symptoms of intru­sion and physiological react iv it y to stimu li associ· ated with traumatic events. Attention fixation training can help reduce the symptoms of agorapho­bia. And the few clinical psycholog ists who have

participated in environment behavior research have become more aware of the role of the physical envi­ronment.

Much more rigorous research is needed to link the two disc iplines of clinical and e nvironmental psy­chology. More clinical case studies and more studies of g roup outcomes are required. More sophisticated assessme nt techniques that incorporate environ· mental issues need to be developed. A handful were identified here, but many more are needed. Assess· ment tools that focus on the physica l environment need to be made widely available to clinical psychol­og ists. Eventually, studies with larger sample s izes are needed. Ultimately, future versions of the DSM need to better incorporate the physical environment in their descriptions of mental d isorde rs. This could have a major impac t on all those involved in diagnos­ing and treating mental disorders. Finally, research needs to be published concurrently in both clin ical and env ironmenta l literature, so that each may learn about the other.

Just as design practitioners and design educators need to be bette r informed about the role that psy­chology can play in spaces and places, clinicians and clinical psychology facu lty must be better informed about the role that spaces a nd places may play in the etiology, diagnOSiS, a nd treatment of mental disor­ders. It may well take a new generation of clinical psychologists in the twenty-first century to pay even greater attention to the built environment and g ive it the recognition that it righ tly deserves.

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