The young literary agent had been seeing a woman psychiatrist once a week for several months. But there was something wrong. The office was pleasant enough, pink and green chintz-covered couch, dried flower arrangements. Suddenly, in the middle of a session, she shouted at the psychiatrist, "You're too color-coordinated! You're too WASPy!"
It was the office. "I was totally repelled by [it]," the patient says now. "It was all pink and green. The way the room looked spelled a WASP repression which came out in the therapy. She [the psychiatrist] was a woman who did not give a lot of feedback or support. The furniture was Pappagallo shoes. Probably it was her, but the office became symptomatic of that. I stopped going."
She says she feels more comfortable now in dark leather. "I wanted a smart Jewish man," she says. "I wanted Freud." The Inside Story
What a psychiatrist's office reveals about his or her personality may be significant in determining whether or not the therapist and patient will be compatible. Will be able to communicate. If you both wear Gucci loafers, that's a start. But the office will probably reveal more.
The first psychiatrist's office, Sigmund Freud's Vienna apartment, was richly furnished in dark wood and Oriental rugs. Cluttered, yet comfortable, with collections of objects d'art, antiquities and two of the family's dogs scampering in and out during sessions. The patient, propped up by pillows, reclined on a small couch. The father of analysis sat in an armchair, wedged against the wall perpendicular to the couch.
The office was a blueprint of Freud's mind. His interest in antiquity mirrored his obsession with digging into the past. In fact, Freud often compared analysis to an archeological dig.
T. George Harris, former editor of Psychology Today, calls psychiatrists' decor "the furniture of the mind." Chances are, if you don't like the ottoman, you won't like the man.
Nowhere is this more important than in Washington -- the shrink capital of the world. There are 1,352 psychiatrists in the nation's capital, more per capita (45 per 100,000) than any other city. One office building alone, 3000 Connecticut Ave. NW, houses more than four dozen psychotherapists and is fondly referred to as "The Freud Hilton."
According to the Washington Psychiatric Society, approximately 4,000 Washingtonians -- enough to fill Constitution Hall -- visit psychiatrists every day. Picture it: 4,000 people staring at buff-colored walls, clutching Harvest Gold tissues and wondering if the therapist is as beige as the shag carpet or as abstract as the Jackson Pollock on the wall. Clutter and Conflict
One Washington woman recently complained about her psychiatrist's office. "It's a mess," she said. "There are boxes all over the floor, piles of books. He's been there for a while and he still hasn't unpacked. Frankly, I think he's having some conflict over whether nor not he wants to be a success."
How to tell if you and your shrink are on the same brain wave? Here are the The Seven Deadly Signs:
Bookcase. "Look at the library first," warns Harris. "If he has a four-volume biography of Freud, go very very carefully." Case 1. Therapist has autographed copy of "I'm OK, You're OK." Conclusion: It's not okay. Self-help literature usually means they'll suggest group therapy.
Diplomas. "Penis envy" for more difficult sciences, says Harris. Case 1. More than five diplomas on the wall. Conclusion: Insecurity about accomplishments and/or wishes to reassure certain patients who can only relate to Ivy Leaguers.
The Kleenex Box. One of the most important clues, usually signals which chair is the patient's. Case 1. White tissue in square flat box. Conclusion: Your shrink buys from a hospital supplier and probably gets a discount, which may mean therapist is a tightwad. Case 2. Boutique tissue with floral design. Tissue box cover optional.Conclusion: Spouse buys them at Drug Fair. Probably feels threatened by your relationship and wants some input into the sessions. Case 3. No tissue. Conclusion: Your psychiatrist doesn't believe in being a parent. After all, who gave you your first Kleenex?
The Couch. Rarely used these days, except for patients in analysis which means five days a week for a minimum of five years. Case 1. The couch is covered in plastic. Conclusion: Obsessive-compulsive. Case 2. Castro Convertible couch. Conclusion: Doesn't know which end is up. Case 3. Therapist objects when you want to lie on your stomach. Conclusion: You'll see therapist dozing off during the session. Case 4. Therapist lies down beside you. Conclusion: It's time to trade places.
Seating Arrangement. Case 1. Matching pecan-brown Barcaloungers. Conclusion: Therapist wants to appear equal with patient. Case 2. Matching black Barcaloungers. Conclusion: They ran out of pecan-brown. Case 3. Patient insists on sitting in doctor's chair. Conclusion: Need to identify with authority.Case 3. Psychiatrist insists on sitting in patient's chair. Conclusion: It's more comfortable.
The Clock. Case 1. Clock is turned away from you. Conclusion: Psychiatrist needs to feel in control of the session. Case 2. Therapist turns clock toward you. Conclusion: Psychiatrist doesn't know how to tell time and will rely on you to say after your allotted 50-minute period, "That's a good place to pick up next week."
Behavior. Case 1. Therapist does needlepoint during session. Conclusion: Deep-seated sexual conflict and/or sweaty palms. Case 2. Psychiatrist putts a golf ball across his wall-to-wall carpet during session. Conclusion: Needs to improve handicap for next APA convention.
Discussion. What does it all mean?
Says Washington psychiatrist Dr. John McGrath, "What do you think it means?" Pet Peeves
Clyde Dorset knows a lot about psychiatrists' offices.
For the last 18 years, he's been the senior architectural adviser for the National Institutes of Mental Health. "I don't know why they call me senior," Dorset says, puffing on a pipe. "I'm the only one here."
Dorset, a 56-year-old, silver-haired bureaucrat, advises hospitals and mental health clinics across the country on how to furnish and decorate psychiatric facilities. He's also designed a dozen private psychiatrists' offices in Washington.
"Some psychiatrists say environment is not important. But it's been proven that it is," Dorset says.
He recommends leather over plastic, fabric-covered chairs with arms, a beige and brown color scheme, plants, fish tanks and knickknacks for the patient to fondle.
Dorset picks up a heavy marble paperweight. "Of course, it depends on the kind of patients you have. Some psychiatrists might go around the room and remove objects like this before the patient comes in."
He doesn't like the Kleenex box. And he hates the clock turned away from the patient. "I think that's crazy," he says. "I think there's more anxiety built up when the clock is turned away from them.And the therapist is always looking at the clock!"
But what disturbs Dorset most is the artwork psychiatrists hang on the walls. "Some of them are so disturbing. I walk into the room and turn the painting back on the wall. I don't know where they get these weird things. Maybe their patients do them for them."
He also recommends that psychiatrists make house calls, conduct therapy sessions outdoors in nice weather, and have a pet or two.
One psychiatrist on the West Coast reportedly built a plexiglass indoor/outdoor rabbit hutch in his office.
"I know one psychiatrist whose basset hound greets the patients. The old dog wobbles up to the front door, sniffs around. Some of the patients like it. Of course, some of them don't like it," Dorset says. "Sometimes, they'll kick it." The Cookie Caper
Zigmond M. Lebensohn shares a Dupont Circle town house with four other psychiatrists. Each office is as unique as the men themselves.
"This subject has interested me for a long time," the 70-year-old Lebensohn says. "I happen to be traditional."
He is tall, with carefully combed gray hair and a voice smoother than Spread-Satin. His manner is so soothing he once hypnotized a patient without knowing it. The office is Ivy League conservative: large wooden desk, straight-backed green leather chair for the patient, well-stocked bookshelves, an etching of Freud and green wall-to-wall carpet the color of the tiny turtles on his necktie.
Lebensohn rarely uses the couch. "The last time I used it was to treat a psychologist. He was a very unstable person. He insisted on using the couch. I agreed, but afterward, it didn't really do that much good."
Lebensohn travels a great deal, and speaks three languages. He once treated a Russian defector who brought a translater along.
Was the defector suffering from depression? Separation anxiety?
"No," says Lebensohn. "Alcoholism."
Down a narrow white hallway is the office of Dr. Michael J. Petite, a dead ringer for Dan Rather. He wears Gucci loafers, pale pink oxford-cloth shirt, tank watch and pin-striped suit. His office is tiny, with a comfortable love seat, chocolate brown walls, potted palms, modern sculptures and pop-art paintings which he changes every four months.
On the glass table is a giant replica of an Oreo cookie. "One schizophrenic patient of mine comes in here and says she doesn't know who the patient is," Petite laughs.
There is one thing about the office that bothers his patients. He pulls the venetian blinds behind his desk. There is a small window covered with black iron bars inches from a red brick wall. "There used to be a tree there," he says. "They cut it down." His patients, he says, "are very disturbed by this wall."
In the front of the house is Dr. Thayer MacKenzie's office. Files are piled willy-nilly on the couch, boxes of books sit unpacked in front of the fireplace and the desk is cluttered with papers six inches deep.
"Some people say, 'Oh, I see you're moving,'" MacKenzie laughs. He is tall, with bushy eyebrows and a shock of white hair. His tie is stained, his coat is checkered, his socks stop several inches from his pants and his lace-up shoes are brown and battered. "When I'm here, I know what I'm about," he says. "It's almost my home. But there's also something this office suggests to patients. One: disorganization. Two: lack of self-respect."
There is a musty odor to the room and a vase of wilted flowers. "Say," MacKenzie says, "did you know there was a time when patients in analysis brought their own pillow?"
MacKenzie conducts his sessions behind his desk. The patient's chair is pulled as close to the doctor's as it will go. Is the closeness characteristic of MacKenzie's cozy personality?
"No," he says, "I'm hard of hearing." Dark Secret
One Washington psychiatrist tells the story of a patient who complained about his former therapist who always kept the blinds drawn during his sessions. The room was dark and gloomy and became very depressing. The patient eventually transferred. Months later, he discovered that his former psychiatrist had been going through a painful divorce at the time. Into the Woods
It's not easy being a psychiatrist. Many suffer from hemorrhoids (sedentary profession) and have chronic back problems. Many complain that their patients don't even notice the trouble they've gone through to decorate the office.
"You would be amazed at how many people come into this office, week in and week out," says Dr. Fred Hilkert, "and then say, 'That painting! Did you just put that painting there?'"
Hilkert shakes his head. His office, in the basement of his Northwest Washington home, was not "consciously contrived" to imitate Freud's. In the center of the room is a wooden Empire couch covered in red velvet with carved lion's paws for feet. One patient said it reminded him of Belle Watkins' boudoir.
"A lot of patients in analysis don't use the coach," he says. "It's not an absolute necessity. But it facilitates the inward turning of the eye."
There is an etching of Sigmund Freud on the wall with an Egyptian urn underneath, a Navaho blanket at the foot of the couch, a Chinese rug on the floor, carved lions' heads on the drawer pulls, a large bronze lion on the hearth, 18th-century Chinese marble-top tables and a box of designer boutique tissues.
A towering, bespectacled man wearing a conservative suit and brown wing tips, Hilkert changes the paper napkin (often referred to as the "psychoanalytic doily") on the couch pillow after each patient. "I did the needlepoint pillow," he says. "I don't like hair oil. I wouldn't want to place my head necessarily on somebody's else's hair oil."
Like many other analysts, Hilkert's office provides a different exit than entrance, to ensure that the patient not be seen by other patients.
"There are some people who are very concerned, with some legitimacy, that they not be seen. That anonymity is very important."
Hilkert says he changes the decor of his office from time to time. "Right now," he says, "I'm in my wood phase." Couch Call
A Washington housewife recently went to a psychiatrist for the first time. She walked in the office, glanced around and said, "Where's the couch?" The psychiatrist looked up, smiled and said, "Do you want a couch?" Privacy Act
The waiting room to Dr. John McGrath's office is the size of a phone booth. Suddenly, a door opens. Then another door. He stands there, tall and trim, with long white hair combed over his ears.
The office is stark. No frills. There is a tweedy gray couch, a tweedy gray chair (for him) and a red swivel chair for the patient. The wall behind the couch is painted Aspergum pink.
"Okay, what did I try for here? Most of all, privacy. Double doors. You leave by another entrance. You don't pass patients on the way. I tried to make it somewhat less than dreary, without giving a whole lot of myself away. I'm not given to collections of any sort. I consider them clutter. I have to say I'm rather neat. I'll even buy straight."
McGrath doesn't believe in revealing himself through his office. Not like Dr. Nelson Hendler, assistant professor of psychiatry at Johns Hopkins University, who keeps big-game trophies in his waiting room (souvenirs of a safari) and a full leopard-skin rug, including head, on the office floor.
"The patients don't like it," Hendler says. "But I tell them it stems from my Hemingway complex."