An older man sits on a love seat with his service dog.If you’ve just started out in private practice or a large clinic where you’ll have your own office space, you may be about to develop your own therapy space for the first time. As you plan the design for your office, you’ll likely consider a number of factors.

You likely want a space where the people you work with feel calm and safe but still ready to openly engage in the therapeutic process. Comfortable furniture, inviting color schemes, peaceful artwork, and natural office enhancements such as plants and fish might all be among your considerations.

But before you finalize your design, there’s one more important thing to consider: Does your therapy office welcome people with disabilities?

Accommodations for Individuals with Mobility Impairments

You may have already reviewed specific guidelines or articles about complying with the Americans with Disabilities Act to make sure people using mobility aids can access your hallways, bathrooms, and doorways. You’ll also want to ensure people using walkers, wheelchairs, canes, and crutches can navigate your office space easily.

Stick to a few basic pieces of furniture to avoid cluttering your office. In addition to making movement easier for people using mobility aids, having an open space can facilitate the therapy process: open space often seems more inviting, so an open room may help people feel more ready to share their thoughts.

Make space available for people using wheelchairs. If a large sofa or coffee table takes up most of the room, your office may feel crowded. The furniture could also give the impression people with disabilities aren’t welcome, even if that’s not your intention. Consider using a smaller loveseat, armchair, and/or end tables if you have a smaller office.

Don’t forget about your floors. If you have carpet, make sure the pile is no more than half an inch. Secure rugs to the floor or keep them out of the way so individuals don’t slip on them.

Accommodations for Individuals with Hearing or Speech Impairments

Effective communication is essential to the therapeutic relationship. When working with people who have hearing or speech impairments, you’ll need to be mindful of how you’ll communicate in therapy. For example, some people may need a sign language interpreter, assisted listening device, or other type of aid in order to fully understand and respond to you during a session.

It’s important for you and your client to address their needs together. Not all people with hearing or speech impairments may need or want an interpreter. Some people may prefer to write notes, while others may feel accustomed to communicating via tablet or other electronic device.

In order to judge if a communication method is effective, ask yourself if you have the same level of engagement with the person that you’d have with another client through spoken conversation. If not, you may need to consider an alternative approach to communication so you can provide the individual with the same care you provide to other clients.

Some clients may ask if a loved one who uses sign language can interpret for them during therapy. But the Department of Justice (the branch of government that enforces the Americans with Disabilities Act) recommends against this for a few reasons.

For one, your client may not realize the extent of the information they’ll be revealing to their loved ones in therapy. Having someone close to them involved in the session can put their confidentiality at risk. Some people may hold back important information about what they’re dealing with. For example, a person may not want to talk about suicidal thoughts if their mother is interpreting. Yet not discussing those thoughts could put their safety at risk.

Even if a client is willing to share anything they’d disclose to you with their loved one, details about mental health symptoms or challenges they’re experiencing may cause their loved one emotional distress. This can complicate the therapy sessions, take your focus away from your client, and stall progress.

If you and your client do decide an interpreter might help, it’s important to choose a trained interpreter who can remain impartial, regardless of the topics discussed. 

Accommodations for Individuals with Visual Impairments

If you’ll be working with someone who has a visual impairment, you may want to check with them before their first session to find out if they’ll need therapy documents in an alternate format. Potential clients need to fully review and understand intake forms, your informed consent paperwork, and documents about your policies.

Some individuals with visual impairments use computer software that reads information aloud to them. They may request you send documents before the first session so they can review them at their convenience. If there’s anything they need to fill out and return to you, choose a HIPAA-compliant software or make arrangements for them to bring it to the first session.

If the person you’re working with prefers documents in a large-print format, you may be able to create these yourself. Ask each person if there’s a specific font they prefer. Many people have an easier time reading sans serif typefaces, while others may struggle to read all but a few typefaces.

If your client requires Braille documents, you’ll most likely need to arrange a HIPAA-compliant service to produce these for you. It’s possible your client’s insurance may cover the cost, but this isn’t always the case.

It is possible you may work with someone who asks you to read any necessary documents to them, but don’t assume this approach will work for everyone. Always ask how someone would like to receive important documents, and let this preference guide you.

Also, consider your practice website. Is it accessible to people with visual impairments or other disabilities? The DOJ offers guidelines to help you improve website accessibility. If you aren’t sure how to begin, consider reaching out to a web design specialist.

Accommodations for Individuals with Sensory Issues

Although awareness of sensory issues is increasing, not everyone realizes the distress certain sounds and smells can cause. Certain developmental disabilities and mental health diagnoses can cause extreme sensitivity to noise or sound. Sensitivity to sound and smell can also have physical causes, such as head injuries, ear infections, smell disorders, or severe allergies.

These tips can help you respect the needs of people with noise and sound sensitivity:

  • Avoid using scented candles or air fresheners.
  • Choose office plants that have no fragrance.
  • Avoid playing background music during sessions—unless a client specifically requests it. Consider a white noise machine if you work in a noisy building.
  • Avoid wearing perfume and scented lotion to therapy sessions.
  • Keep unscented soap in your office bathroom.

Service Animals

Some people living with disabilities may have service animals to help them perform essential tasks. Here are a few things to keep in mind about service animals:

  • If you rent your office, let your landlord know a service animal will be present. This can help protect your client from being stopped on their way to and from therapy if your landlord happens to be in the building.
  • You must allow service animals in your office unless a) they aren’t housetrained, or b) their behavior interrupts therapy, and they can’t be controlled by your client. Once the client restrains their service animal, you must resume the session if they want to continue.
  • If you’re allergic to animals, you may not be able to work with clients who use service animals. Consider including a small note that mentions your allergy anywhere you advertise your services to save potential clients time and trouble.

You’re only legally permitted to ask the following questions about service animals:

  1. Is your service animal required because of a disability?
  2. What work or task has your service animal been trained to perform?

Remember, it isn’t legal to ask clients for proof they require a service animal. You cannot require a client to answer anything beyond the above questions.

However, a service animal is not the same as an emotional support animal. Emotional support animals are allowed in certain places pets aren’t, but they aren’t trained to perform disability-related assistance. You might choose to allow emotional support animals in therapy, but this is at your own discretion.

Conclusion

Making sure your office complies with the standards outlined in the ADA is a good first step to an office that welcomes people living with disabilities. But truly serving your clients’ needs requires more than simple compliance. The considerations above can help you create a space that welcomes all individuals.

References:

  1. ADA office checklist: Is your office accessible? [PDF] (2008). Office of Compliance. Retrieved from https://www.ocwr.gov/sites/default/files/wp-content/uploads/2010/03/fastfacts_ada.pdf
  2. ADA update: A primer for small businesses [PDF]. (2011, March 16). U.S. Department of Justice. Retrieved from https://www.ada.gov/regs2010/smallbusiness/smallbusprimer2010.htm
  3. Best practices and guidelines for large print documents used by the low vision community. (n.d.). Council of Citizens with Low Vision International. Retrieved from https://www.acb.org/large-print-guidelines
  4. Hyperacusis. (n.d.). UCSF Health. Retrieved from https://www.ucsfhealth.org/conditions/hyperacusis
  5. Novotney, A. (2018). Evaluate your website for ADA compliance. Monitor on Psychology, 49(2). Retrieved from https://www.apa.org/monitor/2018/02/website-compliance
  6. Tran, A. (2011). Barriers, psychotherapy, and the ADA. The Therapist. Retrieved from https://camft.org/images/PDFs/AttorneyArticles/Ann/barriers_psychotherapy_ada.pdf
  7. What is the Americans with Disabilities Act? (2019). ADA National Network. Retrieved from https://adata.org/learn-about-ada