Therapeutic Architecture

1 Therapeutic Architecture

1.

Introduction

Buildings, spaces between themmake different lives, influence how we think, feel,

behave-how we are (Christopher, 2002).

Many specialists of various fields, including sociologists, therapists and architects have

repeatedly argued about how place and the design of its spaces communicate with the human

psyche, affect the way in which people react to their lives and how they develop. And this

might be said to be rather crucial for any individual who requires long term constant care or

needs to recover from a period of physical, social and emotional instability such as the multi-

faceted break down and loss of self during any treatment or healing process. It is important to

note from the outset that architecture is not a treatment, but can most significantly become

part of the healing process through the creation of spaces that foster and provide meaning to

those activities utilized to achieve gradual rehabilitation through a therapeutic environment.

Light, colour and movement within a residence as well as landscape and location are essential

elements of this architectural therapy and the paper will seek to bring their relevance to the

fore.

..form and space can be insidious shapers of person and community or they can nourish and

spur development, both social and individual (Christopher, 2002).

It is a setting which readies for social inclusion and does not bunch up people as a group of

patients who simply need to take their medication or stay indoors for a prolonged period of

time but as active recipients of change and individuality. Not merely a number behind a

health facility door. Architectural design can provide the corner stone of this individuality,

with spaces built as an interactive process as opposed to holding a disorder within. As

Cynthia Leibrock puts it, even the little things in the design of a building can play their part in

the psychology of the healing equation; such as the way windows reflect the sunlight in a

therapeutic community residence.

The power of a healing environment comes from the design details that empower patients

to take responsibility for their own health (Leibrock, 2000).

Before delving into how building design can interconnect with the healing process and

activities in providing healing for individuals with long term problems, one must provide a

detailed outlook of the approach that can serve this type of architecture. And this is the


concept; or rather the healing principle of the therapeutic community, a relatively recent way

of creating the sort of environment that allows the ill and diseased reformation through the

development of a team spirit in conjunction with ways of restoring their misplaced

individuality.


2.

Therapeutic Community

2.1 The process of the Therapeutic Community

One of the most widely accepted definition of the therapeutic community is the 1993

Ottenberg thesis of an environment in which people live together in an organized and

structured way in order to promote change and make possible a free life in the outside

societythe community forms a miniature society in which residents fulfil distinctive

rolesdesigned to promote a transitional process

It must only be a foundation or facility in name. In essence, the therapeutic community should

become society away from society, a shadow of reality for those with the determination or

even so, the decisive push by family and relatives to rediscover and re-coordinate that inner

creativity self, the social and individual personality lost through illness. As argued, this type

of healing process, its residential philosophy aside (and this is where architectural design

comes in), does not usually apply to a fixed setting, but rather to the principles of the care

that is offereda communal approach which is also democratic, collaborative and

encourages participation ( OHara, 2010).

Thomas Main was the British psychoanalyst who coined this term in the 1950s, as the

response of psychoanalysis to the failure of psychiatry, incarceration programmes

which viewed addicts as mere criminals and stigmatized them as outcasts or even

mentally disturbed through abuse, as well as purely medication approaches. Strangely

enough though the therapeutic community model developed by Maine and other

analysts was based on a World War II experience in Britain, as army psychiatrists,

who had to deal with hundreds of traumatized soldiers returning from the front,

considered, in their desperation from the failure of the conventional medication or one

to one therapy approach, to apply a group method that would allow those who had

suffered severe distress to overcome their psychological fears and return to the front as

physically and emotionally healthy as possible.

Instead of medication treatment therefore, they provided the necessary tools to the community

of patients in dealing with their own problems, making them part of the process with which

they could overcome their traumatic experiences. As Crampling notes, this later became

known as the living-learning method. Maine took this and applied a psychoanalytic


approach to it. Some later appropriately dubbed it social psychiatry. It formed the

beginnings of an attempt to consider rehabilitation as a psychological awakening through a

group environment, in which members (not patients) and experienced professionals interact in

a setting promoting trust and individuals are encouraged to become part of a community with

the goal of rebuilding their social skills, such as responsibility and integration. This

community philosophy essentially places the healing process into the hands of addicts

themselves in a controlled and voluntary but not institutionalized environment, finding

methods that allow them to rebuild their ability of dealing independently with their own

problems.

Many of those seeking or being encouraged by their environment to follow the

therapeutic community approach have gone through an extended period of social and

behavioural dysfunction, the substance problems gradually eroding-in spite of what

educational or professional capabilities they might have had-every sense of societal

responsibility, creating a situation whereby they need to essentially re-invent

themselves, develop integration skills and individual creativity. This is why this form

of residential therapeutic community involvesan internal hierarchy of jobs and

progressive responsibilities, and a variety of medical, educational, and vocational

services (OHara, 2010).

Architecture fits into this process, as the outer shell providing the necessary support to the

inner self-corrective therapy. There are of course no guarantees of success in such cases.

However, at least the connection of interior design and community spirit as a means of

moulding a socially functioning individual forms an alternative that puts the individual first,

as opposed to the medication institution like processes that have not managed to make any

headway, both in attracting the trust of addicts who make the step to rehabilitation, as well as

eradicating existing prejudices and public opinion views. The therapeutic community, as

referred to earlier in the paper is not about being locked in, but a home in which the individual

with the need for care, becomes part of the method of their gradual return to physical and

emotional health, they become involved in the decision-making process, improving their

creativity through the group. The basic premise is to become the change within themselves, to

sense that even though they live in a treatment community, the environment surrounding them

is one in which they feel not part of the problem, but part of the solution on their way to re-

learning the social process.


Individual client members are involved in all decisions about their own care and treatment.

(OHara, 2010).

As heard in the 10th European Conference on Rehabilitation and Drug Policy, rehabilitation is

not about shutting the door of the world in the face of the addicts, but giving them the ability,

through sharing their life experiences to reach a glass door on their own, where they can see

social inclusion laying in the horizon.

for the suffering soul, world is healing (OHara, 2010).

2.2 The Fundamental Components and Basic Structure of Therapeutic Communities

Therapeutic communities, drug-free residential settings are primarily of a humanistic

philosophy in which the member gradually develops social group responsibility and a sense of

personal growth through structured activities but also the opportunity of more creative

expression such as theatre therapy, art, photography and prose writing that bring out untold

emotions and help the resident through this active self- help process, become aware of their

problems and finally come to terms with what brought them to that situation. The member is

forced to become part of their future, by developing on a daily basis individually and with the

group, having a daily routine, starting at seven in the morning, sharing and having a common

target, feeling responsible also through the choice of employment that can be provided at the

facility. For example many communities make their own furniture. Work is a means of

strengthening the sense of community and developing the communication and interpersonal

tools needed.

the therapeutic community movement holds a multidisciplinary view of health which is

based on ideas of collective responsibility, citizenship and empowerment (OHara, 2010).

The therapeutic community is usually at a distance from city centres where drugs are much

more accessible, (but not too far from the reminder of daily life-the sports facilities of the

Groot Klimmendaal rehabilitation centre in the Netherlands are also used by the general

public as a means for residents to feel social proximity) and close to the positive influence of

nature. Funding also determines the location of therapeutic communities. The ultimate aim is

for these residences to become a microcosm of real life, a placebo of a social situation,

whereby conditions proceed pretty similarly to a societal motif-providing solution to

situations that might come up through activities or assigned work, planning a schedule,

following necessary rules, having control over your life as well as realizing that the way one


conducts themselves must be respectful to the group. Individual and group therapy sessions

are conducted daily, lasting more than an hour and offering the opportunity of openly

expressing emotions.

Problems and their solutions are discussed in the community before action is taken. The

discussion is regarded as a learning opportunity (OHara, 2010).

Based on the sociological approach of community as method, residents gradually learn,

through a hierarchical system, open communication and expressing themselves in the group

and through activities, to discard negative emotions and are taught to use the peer

community to learn about themselves, to change lifestyle and identity. As Alcorn puts it,

gradually building or re-building a new life, for which they are fully responsible, always

having in mind that professional monitoring is daily and reviewing of the communitys

progress is conducted at a regular basis to establish whether the residence is achieving its

goals of gradually creating new identities that are well on the road to physical and mental

rehabilitation and are, through work and activities inside the community, building new

positive strategies of dealing with their problems. Strategies that they will be able to put into

practice once they are able to face real social situations. Therapeutic communities

provide a combination of therapeutic involvements between residents and staff and living

in a caring and challenging community as the principal mediums to encourage change and

personal development (Cindy, 1997).


3.

Therapeutic Architecture

3.1 The Role of Architecture in Therapy

If drug addiction rehabilitation is mostly about bringing positive feelings to the fore and

helping to build a new identity for members of therapeutic communities, then architectural

design, is perhaps the most decisive of factors in how space is utilized, both in practical terms

and landscape wise, to uplift the spirit and provide the necessary environment in which

community daily life and activities can become most effective. Christopher Day believes that

buildings have the life the architect gives them, a personality that is either positive or

negative, and that aura is captured by those who reside in them.

The more felt are buildings, the more connected to rhythms of daythey value the

individuals they will houseenvironment can heal as well as harmplaces of spiritnourish

both individual and societ (Christopher, 2002).

Place is not simply a set of coordinates, but is constructed through finding meaning in the

social and built forms we inhabit (Christopher, 2002).

In other words, the building, a city and the way it is designed does not just form slabs of

concrete, but is literally a social construction, that can have an influence on those who reside

in it. As outlined earlier, this is truer of people, in this case, addicts who are in a process of

rehabilitation, a tough community healing programme that seeks to root out their negativity.

In such an instance, the energy and individuality their residence might project could be crucial

in how they respond to this process. Colour, they way they are able to move within the

building, staircases, connections between rooms, surrounding nature can all play a role, as

will be analyzed, not just in underpinning the mood of the residents, but also whether they

feel welcome in the building, whether it forms a connection to their emotions and physical

presence and by extension if it provides a motivation for them to follow the programme. A

rehabilitation centre in the Netherlands has left nothing to chance, paying particular attention

to natural but also artificial lighting as both aspects of mood and energy.

Natural daylight deep in the heart of the 30 metres wide building was allowed. The

interior was enlivened by interplay of striking but subtle colours and direct and indirect

artificial lighting.


The same connections are made about colour, with Day pointing out that preference in this

case is highly personal. For the individual in a therapeutic community the slightest detail in a

room, be it his personal space or a place of group therapy and activities might affect the way

the individual receives the treatment, bringing about as negative physical or psychological

reaction.

How different is the living grey of an overcast sky or a blue wash over brown to the dead

grey of a concrete wall. (Christopher, 2002).

Clearly, a building balance or imbalance, whether be it colour, the light in a building, design

or even the length of a corridor can affect the way in which residents in a therapeutic

community react to the energy of the space and can relax and release themselves. The

example of a group therapy session in Reading, England, provides quite an amazing example

of how architectural space can play with the psychology of the individual, particularly so

when this is a member of a therapeutic community, seeking positivity.

The dependency culture of being in an old asylum was symbolized every lunch time when

the food was delivered and plugged in by a porter (Crampling).

In essence, the daily life within community housing individuals who need to feel as close to a

home as possible must be designed having buildings in mind that are both practical but also

do away with any institutionalized emotions. According to Leibrock researchers in the field of

anthroposophic medicine have maintained that colour can be a major contributing factor

towards patients regaining health. She describes green as a colour which is psychologically

perceived as providing safe refuge, while coral, peach and yellow are seen as warmer choices

for a dining room and blue is considered relaxing. In her book Design details for health, in

which she associates good health with the positive aura of space, she argues that warm colour

hues are often associated with extroverted responses and social contact.

A monochromatic colour scheme throughout the building may be perceived as

institutionalIt can contribute to sensory deprivation which leads to disorganization of brain

function (Smith, Watkins, 2010).

3.2 Kinaesthetic and Landscaping

Kinaesthesia is the exploration of our environment through movement; this can be

movement with the eyes or with our body (Schaap)


The sense of movement in a space, deriving from the combination of the Greek words kinisi

and aisthisi has been said to affect the way the individual reacts to the building, how it

marks their behaviour, mood, how it creates and maintains a positive or negative attitude to

the particular situation they are facing. Architecture can become a strong determinant in the

successful kinaesthetic of individuals, particularly in the case of people with psychological

imbalances such as drug addicts, who have joined therapeutic communities seeking to regain

the peace of their inner self in order to build or regain their social identity. So the way they

are able to physically interact with their surroundings, the kinaesthetic of human bodies, can

be said to be decisive in how they adapt to their daily routine in a group community.

Laban refers to movements directed towards other objects and bodies. The latter, termed

spatial-movements, construct nearly imperceptible forms of social interaction (Zaida)

Ziada, utilizing the model of the ritual space of Muslim mosques and Soviet assemblies,

argues that building spaces for collective activities, (much like therapeutic communities), can,

through their design, produce a positive sense of kinaesthetic in individuals, who are in

situation of conjoined attention and communal practice. For people in drug reformation this

can be said to be highly relevant, as they need to adapt to their new tasks and responsibilities

and learn new skills that can change their mobility in a positive manner. So in other words,

improving ones kinaesthetic skills in a setting that encourages techniques and therapies to do

so is a highly significant step towards an improved physical presence that also brings about

internal changes. In simple terms, building positivity produces body positivity, as well as

techniques to further improve this positivity. Besides, movement is a major part of sensory

perception. According to Dutch architect Jasper Schaap, who co-wrote the paper Design your

own Mind in 2009, contemporary architecture must turn the tide of its alienation, through

buildings that are not monochromic and mono-visual, spaces that participate and affect human

movement and action, designs which encourage multi-sensory perception, bringing to the fore

the power of the senses, beyond the visual and the spatial. As the Design your own Mind

researchers point out, buildings which encourage a highly positive sense of kinaesthesia,

connect with the individuals that reside in them. The Schaap thesis is that moving through

space with the body, automatically makes the architecture experience less static. What

Pallasmaa calls the eyes of the skin If you manage to wake up these eyes, the building

immediately becomes a source of positive energy of particular importance to drug addicts

who need to develop a new self.


If we succeed in enticing the senses, people can participate again in their surroundings

and regain their identity in the contemporary world (Schaap).

A 2000 paper on a Rehabilitation and Education village for Drug Addicts uses the same

premise in designing an art therapy room. The senses are prodded through a wide space that

allows rich daylight, distance between individuals so each one can feel the space of their own

creativity, as well as an informal furniture setting, that further encourages a spontaneous

reaction, limiting the emotion, the perception of you will, that this is an exercise or an

obligatory activity. But landscape can also contribute to a heightened positive kinaesthesia in

therapeutic communities, with Ling providing the case study of The Good Samaritan

Regional Medical Centre in Arizona, whereby the space triggers the senses through an award

winning health design. The surrounding garden awakens

patients senses of sight, smell and touch, prompting body movement by inspiring the

patient to explore the garden (Jean- Mary,2009).

Water flowing through the garden as well as proximity of plants to all patients, allows, as

pointed out in the Ling paper, the interactive sense of touch.

But the same effect, it is underlined, can be achieved through keeping an open space

landscape simple, without elaborate additions, such as the case study provided of the Harrison

hospital in Washington, where the architect focused on creating a stony pattern with the least

of plants, creating curvy pathways, a process known as abstraction, that awakens the

individual to the realization of their problems and smoothly allows them to concentrate on the

therapy.

Leibrock introduces the concept of the Healing Garden, whereby nature, through landscaping,

becomes part of the therapeutic process. Many addict communities might not have the means

to create such conditions, but as the paper will argue through two case studies, when it is

possible through design it can provide a much needed psychological boost. Leibrock cites

studies linking sunlight exposure to wellbeing and details the architectural innovation of

American James Burnett, outlining his plan of a bed-accessible garden so that contact with

nature can be re-established.


3.3 Light and shadow

Architecture is the masterly, correct and magnificent play of volumes brought together in

light ...the history of architecture is the history of the struggle for light. (Le Corbusier).

Light and particularly the life-giving rays of the sun, have been well documented as a major

determinant of vitality and well being, more so in therapeutic environments where such

positive natural stimulants can go a long way towards developing the desired attitude to

individual change. In therapeutic architecture therefore, the way sunlight is utilized is one of

the factors in creating a healthy environment and psychological motivation. The way the

corridors are lit, the way the windows are placed throughout the building to reflect warmth

and how light and shadow appears in the space, can affect the balance or imbalance of rooms,

always in conjunction with colour, shape, interior design and landscape features. Once again

its all about the way the senses perceive the surrounding environment, the degree that space

resonates with the individual self. Marilyne Andersen of MIT is amongst a group of young

architects and researchers who have become increasingly aware of the importance of

incorporating sunlight in building design. They have realized that

Light is not only an amount of energy," Andersen said. "It also provides us with the

means to reveal spaces and volumes and interact with our environment." (Smith, Watkins,

2010).

For Day, sunlight is a great part of the spirit of place and directly associated with physical and

psychological health. Its all about energy and mood and how it positively connects people

with their environment, particularly so when it comes to a long and arduous process of self-

healing, such as in addict therapeutic communities. Daylight is also closely associated with

kinaesthesia and as Day argues, natural light through what he calls interactive directions,

constantly changes the colours and shadow dynamic, stimulating the eye, which is essentially

for health,

as NASA sensory-deprivation research has demonstrated (Christopher, 2002).

Leibrock offers a host of ideas on how public areas in treatment centres can become more

sensory-positive, for example waiting areas, as she points out, where patients and their

families will feel more comfortable when provided access to nature and natural light. This can

be achieved with the waiting area (or for example group therapy areas in the case of

therapeutic communities), being designed in an atrium or adjacent to a courtyard. What is


clear to Leibrock is that natural light deinstitutionalizes and humanizes the space, making

residents feel they are not enclosed, but receiving therapy in a home-like environment. More

so in terms of therapy

sufficient lighting is particularly important in areas where concentration is required,

decisions are made or danger is present. (Christopher, 2002).


4.

Therapeutic Environment

4.1 Introduction

Healthcare facilities are designed not only to support and facilitate state-of-the-art medicine

and technology, patient safety, and quality patient care, but to also embrace the patient,

family, and caregivers in a psycho-socially supportive therapeutic environment. The

characteristics of the physical environment in which a patient receives care affects patient

outcomes, patient satisfaction, patient safety, staff efficiency, staff satisfaction, and

organizational outcomes. The effects can be positive or negative. No environment is neutral.

A healthcare environment is therapeutic when it does all of the following:

Supports clinical excellence in the treatment of the physical body

Supports the psycho-social and spiritual needs of the patient, family, and staff

Produces measurable positive effects on patients' clinical outcomes and staff

effectiveness

4.2. Theory / Background

Therapeutic Environment theory stems from the fields of environmental psychology (the

psycho-social effects of environment), psychoneuroimmunology (the effects of environment

on the immune system), and neuroscience (how the brain perceives architecture). Patients in a

healthcare facility are often fearful and uncertain about their health, their safety, and their

isolation from normal social relationships. The large, complex environment of a typical

hospital further contributes to the stressful situation. Stress can cause a person's immune

system to be suppressed, and can dampen a person's emotional and spiritual resources,

impeding recovery and healing.

Healthcare architects, interior designers, and researchers have identified four key factors

which, if applied in the design of a healthcare environment, can measurably improve patient

outcomes:

Reduce or eliminate environmental stressors

Provide positive distractions

Enable social support

http://www.wbdg.org/design/health_care.phphttp://www.wbdg.org/design/hospital.phphttp://www.wbdg.org/design/hospital.php


Give a sense of control

The application of these factors has been focused on the patient and patient's family.

However, there are also recognized potential benefits for staff and caregivers in terms of

satisfaction, effectiveness, and staff retention, from environmental factors such as:

Noise reduction

Same-handed patient rooms

Access to daylight

Appropriate lighting

Providing 'off-stage' areas for respite

Proximity to other staff

Appropriate use of technology

Decentralized observation, supplies, and charting

The benefits staff receives from these environmental factors may impact the quality of care

patient experience.

In general, Therapeutic Environments have been proven to be cost-effective by improving

patient outcomes, reducing length of stay, and by enhancing staff satisfaction, recruitment,

and retention of staff.

4.3 Practice

To create a therapeutic environment, all members of the design teammedical planner,

architect, engineer, interior designer, site and landscape designer,are responsible for using

the power of design to find solutions that will affect the patients and staff in positive ways,

throughout the facility; from the parking lot, approach, and entry, to the public spaces, clinical

spaces, and ultimately the patient room. Following are some specific design criteria that are

used or are being studied:

4.3.1 Reduce or Eliminate Environmental Stressors

For example:

Artwork and aesthetics can enhance the soothing and calming qualities of a space

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Adequate space should be provided in public areas and waiting rooms to avoid

crowding

Perceived waiting time can be mitigated by positive distractions

Visual and noise privacy

Odors that are objectionable or 'medical' can create stress

Wayfinding; the built environment should provide clear visual cues to orient patients

and families, and guide them to their destination and return. Landscaping, building

elements, daylight, color, texture, and pattern should all give cues, as well as artwork

and signage

Reduce or eliminate sources of noise; other patients, public address systems,

equipment 'clatter', loud conversations at nurse stations

Acoustical treatment of corridors adjacent to patient rooms; carpet tiles, rubber

flooring

Acoustical separation of staff work areas from patient rooms; "even low noise levels

(40-58 dB) combined with poor acoustics can reduce sleep quality and negatively

affect other outcomes" (Roger Ulrich, Ph.D., Healing Environments Virtual Seminar,

AIA, 2003)

Appropriate lighting systems; "lighting can be a stressor that alters mood, increases

stress, disrupts daily rhythms, and modulates hormone production" (J. Roberts)

Provide lighting that supports natural circadian rhythm; "Provide natural daylighting

where possible, or bright white lights (400-600nm) in the daytime. Ensure absolute

darkness in the evening; for nighttime movement only red lights (650-700nm) should

be present in the rooms." (J. Roberts)

Maintain good indoor air quality; 100% outside air where climatic conditions allow

Color, while subjective, can be a design factor in reducing environmental stress when

understood and used in the context of the color preferences of a project-specific

population.

4.3.2 Provide Positive Distraction

For example:

Views of nature, from patient rooms, and wherever possible in lobby, waiting, and

other 'high stress' areas

Access to nature, healing gardens

http://www.wbdg.org/design/ieq.php


Chapel, meditation room, and meditation gardens

Artwork depicting nature, including back-lighted photographs of nature

Music; live piano in public area, recorded music in patient room when programmed

specifically to create a healing environment

Mild physical exercise; corridors, public spaces, and gardens that invite walking when

appropriate

Pets and other activities or elements that allow for a sense of stimulation that help

nurture a patient's sense of positive well-being

4.3.3 Enable Social Support

For example:

Family zone in patient room; with furniture for sleeping, phone and internet

connection, reading light with separate control, and out of the way of staff

Provide places where patients can engage socially with family and other caregivers,

such as the Planetree feature of a Family kitchen on inpatient units where family

members can prepare food for patients and families to eat together

Provide accommodation for accompanying family member to be with patient

throughout the examination and treatment process

Organize Family Focus Groups and Patient and Family Advisory Councils to be an

active part of the design process, tuning in to the specific needs of the population and

community to be served, as recommended by the Institute for Family-Centered Care

Ensure culturally appropriate environments

Consider sociopetal versus sociofugal spaces: Sociopetal spaces facilitate social

behaviors and the development of social groups (nonfixed seating, round tables, etc).

4.3.4 Give a Sense of Control

The ability of the patient to control the environment directly contributes to successful patient

outcomes. A sense of control extends from privacy and lighting to choosing artwork being

hung in the patient's bedroom during the hospitalization, to ordering meals from room service.

For example:

Private patient rooms result in better outcomes, according to recent studies

commissioned by the Facilities Guidelines Institute and conducted for CHER

http://www.planetree.org/


Give the patient as much privacy and control over it, as is consistent with the need for

nursing supervision

Give the patient control over the immediate environment; i.e., radio, TV, reading light,

night light

Wayfinding; the built environment should provide clear visual cues to orient patients

and families, and guide them to their destination and return. Landscaping, building

elements, daylight, color, texture, and pattern should all give cues, as well as artwork

and signage

Provide mini-medical library and computer terminals so patients can research their

conditions and treatmentsas in the Planetree model

Choice of lighting; patients and staff can benefit from personal dimming controls

Choice of artwork

Volume and programming control of televisions in waiting areas

Room service/menu selection

Storage area for patient belongings

4.3.5 Tools

Every healthcare project should begin with a review of existing available literature on design

interventions that have been proven to improve patient outcomes, staff effectiveness and

patient safety, and a decision made with the users as to how each one might apply to the

project, and what outcomes / benefits would be expected. Checklists can assist designers and

users in evaluating existing conditions and in setting goals for new facilities planning and

design. Design goals that are set and clearly defined at the beginning of a project can serve as

research questions to be answered by Post-Occupancy Surveys, data collection, and

evaluation.

4.3.6 Operational Models

Aligning the healthcare organization's operational model with the design goals early in the

process is a key to success in creating a collaborative, emotionally, spiritually, and socially

supportive environment.


5.

Case Study

5.1 Groot Klimmendaal Rehabilitation Revalidation Centre-Arnhem Netherlands

This is the magnificence of therapeutic glass where the sunlight is ever-present, bringing

residents as close to nature as they might ever hope to be. The overarching characteristic of

this two-storey glass rehabilitation centre is direct contact with nature, a landscaping decision

that places this building in an idyllic forest environment, but not at a great distance from the

city of Arnhem, as the sports facilities of the centre are also used by the community, as a

means of encouraging addicts to feel a sense of belonging.

Despite its size, the brown-golden anodized aluminium facade allows the nearly 14.000sqm

building to blend in with its natural surroundings (Koen Van Velsen, 2011).

Figure 5.1: The exterior facade of the Groot Klimmendaal Rehabilitation Revalidation Centre

Source: Website

Improving positive kinaesthesis is clearly the concept guiding the continuity between exterior

and interior, through an innovative height glazing along the central area of the community

that connects the internal aspects of the building in a subtle but importantly practical design,

which ensures that residents dont feel enclosed, cut off. The brightly lit faade of the

restaurant establishes warm emotions during day meals, with the hall windows virtually

touching the surrounding forest in a welcoming environment.


A strong visual and tangible presence everywhere because of the surrounding nature. The

user was allowed to revalidate whilst walking. (Koen Van Velsen, 2011).

Fig 5.2: Restaurant inside the centre Fig 5.3: Connection between the interior and exterior

Source: Website Source: Website

All recreation, fitness and other common use spaces such as the gym, swimming pool,

restaurant and theatre are located in close proximity at entrance level. The facilities are also

used by residents families as well as members of the local community. The philosophy

behind facilities being used by locals is that the patient, who is placed at the centre of the

community gradually, begins to feel re-integrated. The concept behind the design is first and

foremost, care and therapy not through detachment and negative seclusion, but designing the

building and its spaces to become part of the surroundings and the community. A centre

designed to encourage the self-awareness of the residents about their problems and enhance

their degree of responsibility in overcoming their problems through their own personal

involvement, but also interaction with the group. The open environment of the interior design

is set to promote self-confidence, with great emphasis also placed on recreational activities

and therapy through arts expression. Architect Koen van Velsen made sure no part of the

building is detached by creating a direct route between the different floors, as well as

alternative routes to reach different areas. This brings about both a positive sense of physical

movement, as well as a community spirit. The interplay between light and shadows is also

evident, in combination to other psychologically boosting effects, such as colour and shapes.

Natural daylight deep in the heart of the 30 meters wide building was allowed. The

interior was enlivened by striking but subtle colours and direct and indirect artificial

lighting. (Koen Van Velsen, 2011).


Fig 5.4: View of the interiors Fig 5.5: Visual connection

Source: Website Source: Website

In practical terms, the design of mechanical and electrical installations was energy saving,

particularly through thermal storage. Designed to be easily maintained for a long period of

time, the rehabilitation revalidation centre forms a sustainable multiuse, closely-knit building

exuding stimulating therapeutic components. A building arranged not just for use exclusively

by residents but also the community, forging a feeling of social belonging for everyone.

Complex in its web of connected floors, rooms and public spaces, but also simple in its desire

to unite and encourage residents to use and benefit from the whole area, making it practical

and accessible, it establishes continuity and a diversity of use, utilizing nature, light, colour

and kinaesthetic. This was the winner of the 2011 Architecture Festival in the field of health.

The design ambition was not to create a centre with the appearance of a health building

but a building as a part of its surroundings and the community (Koen Van Velsen, 2011).

Figure 5.6:The exterior

Source: Website


5.2 Muktangan Rehabilitation Centre, Pune

The Muktangan de-addiction centre is run by Muktangan Mitra, a Pune based NGO. The

institute is located in Pune and is designed by architect Sirish Beri taking into account the

natural topography and terrain of the immediate surroundings. It is a small institute

consuming 3700sq.m of built-up area. Muktangan has been involved in the herculean task of

creating a drug free society for the past 12 years, Muktangan has treated over 14,000 patients

and has been involved with the creation of awareness amongst the public of the problems

faced by a drug addict.

Sirish Beris concern for this project included whether architecture could provide the required

therapeutic spaces by bringing man closer to nature to its beauty and harmony and whether

the quality of outer space can affect our inner psychological space. To create this natural

therapeutic ambience, natural stone, plants, creepers, the sky and the clouds were made a part

of architectural vocabulary. Features such as raised planters with spread of flowers at the

window sill, help cheering up the patients while entering the consulting room.

Figure 5.7: Cultural activity in the centre

Source: Website

A sense of freedom is also very important while dealing with the drug addicts as closed

environment may not foster the therapeutic environment. To create this sensation Beri has

used a system of courtyards which cut right through the centre of the entire volume providing

the sense of transparency in the mass. This in turn also helps break all visual and physical

barriers and promote healthy interaction. Beri however did not take into account that


continuous visual interaction with outside visitors may not always be helpful to the patients,

or safe. By providing a continuous open street along the entire volume the potential for escape

exists. A sense of privacy is thus not very strong due to this over provision of freedom.

The use of natural stone was to ensure a sense of belonging. The patients would know their

natural surroundings and the buildings gels well with the immediate surroundings. However

the continuous rock faade all around the building gives it a fortress like connotation, which

in turn speaks of not only a highly secure zone but also a very isolated environment. It

contradicts the welcoming attitude which Beri might have wanted to create when he added an

exhibition hall as a dominant function. Both the ideas of creating public awareness by

bringing people into the institute, and creating the sense of security and privacy and treatment

like environs, are apt for a drug de-addiction centre. But Beris enforcement of these ideas

within the same space has resulted in a contradictory structure.

5.2.1 Visual clarity

The site is designed on contours with proper utilization of levels.

The massing of structure allows the expression of freedom and helps the patients to

feel more secure.

Fig 5.8: View from amphitheatre to entrance Fig 5.9: Raised planters at window sill

Source: Author Source: Author

A balance is struck between a sense of freedom and disciplinary control of the centre,

Diffused light entry creates a peaceful and serene atmosphere within the hall.


Raised planters with the spread of flowers at the windowsill are used to cheer the

patients as soon as they enter the consultation room.

5.2.2 Natural elements

The natural stone, plants, creepers, the sky and clouds becomes the architectural

vocabulary to create a natural therapeutic ambience.

Fig 5.10: View of amphitheatre from the building

Source: Author

5.2.3 Facilities

With the provision of libraries, exhibition hall and a gym along with the kitchen courts

and large play areas, Beri has managed to create the required interaction spaces, yet

there is lack of diversity in the workshops available to the patients, which tends to

create a sense of monotony for the users.

An exhibition hall or an amphitheatre promotes a healthy interaction but a common

waiting area does not.

There are different therapies for the patients like music therapy, art therapy etc which

tries bringing their actual potential bringing them confidence in living.

There is a dining room which has attached kitchen to it where in these patients are

assigned to certain tasks related to cooking.

An important inference of this case study is massing of the built. Beri has created a

transparency in the mass and has in turn allowed for the movement of the patients through

outdoor spaces, which is therapeutic in nature. He has also provided certain degree of sense of


security through the use of wall stones and exterior faade. Thus Beri has incorporated three

things on this rehabilitation centre, sense of security. Sense of openness, ambience of hope

and trust.

Our friends graduate to subsequent weeks and evolve in a wonderful group. Just like defence

staff and college students. The five week program is designed keeping in view the emotional

cognitive and awareness levels of our friends.-Dr.Sanjay Bagath

5.2.4 Zoning

The building is planned as an inward looking structure applying the concept of

drug rehabilitation therapy itself i.e. to create an environment for the patients away

from the outside world.

The building has an introvert concept with all rooms opening to the central court.

All rooms opening to the central court provides a central interaction space for the

patients at all times making the place look lively.

No separate space has been provided for recreation which plays a major role in the

recovery of the patients.

Fig 5.11: Ground floor plan

Source: Website


5.2.5 Landscaping

Space has been specially created just outside the windows, having lush green

planters to provide patients with pleasant view outside.

The amphitheatre is also largely landscaped with long creepers and pavers

intercepted with grass.

The small central courtyard forms the core of the radial planning of the building.

On the faade for ornamentation as well as climatologically creepers have been

provided.

Open spaces being one of the most important elements are not available.

5.2.6 Built form and architectural expression

By using subtle colours scheme and natural and smooth structural elements the

interiors of the building provide a warm soothing environment contrary to the

outer faade.

This makes the place more seem like a naturopathy centre compared to a prison

environment.

Fig 5.12: Entrance

Source: Author


5.2.7 Lighting and ventilation

Ample natural lighting is provided throughout the building due to large window

openings and through the open courtyards and the amphitheatre.

Lighting according to various psychologists at Muktangan, is the vital part of the

treatment process ad a dark corner or space reminds the patient of his depression

and past where as bright light takes the patient away from such situations.

Fig 5.13: View of central lobby

Source: Author

The idea of this project was to design a building that would have a therapeutic value

contribution to the healing process of the drug addict. A balance was struck between the sense

of freedom and disciplinary control. The design unifying transparency becomes expressive of

this freedom and increases the physical and visual interaction, there by reducing the isolated

alienated feeling. Even the main entrance is transparent. The transparency, the cut-out, the

terraced balconies and the seating, encourage the patients to open up. The small enclosed

landscaped amphitheatre breathes light and joy in the building; it binds the various functions

together, creating a much-needed sense of belonging.


6.

Conclusion

The recent declination of architects from conventional principles of design in the field of

health care has been spectacular. Professionals have realized that multi-dimensional

practicality but wrapped in simple details is the way forward, with light, colour, kinaesthetics,

connection of spaces and nature at close proximity (wherever possible) forming the

ingredients. Therapeutic architecture has taken a strong anthropocentric turn.

When it comes to drug addiction rehabilitation centres, the focus is now firmly towards

constructing buildings that is de-institutionalized. Where addicts gradually gain the feeling of

awareness, self-confidence and dont feel they are closed in by a rejecting finger pointing

society, but merely passing through the therapeutic community on their way to recovery, re-

integration into the group and re-invention of the self. Through group counselling, community

work, responsibility, recreational therapy, group exposure, interaction. But in buildings that

nudge the senses into self-healing, not push them back oblivion. It has to be architecture that

brings about a continuous process of change, even if the start is just a window reflecting

sunlight in the right place. It will act as a research and information centre on substance abuse

in the state.

The needs of the individual sufferer-and dont use complex constructs-but the materials nature

and simplicity of space can provide as the ingredients of a healing design. Truth, beauty,

good. That was Platos philosophy.

To make the drug addicts feel comfortable which enhances the pace of recovery by providing

the best environment that helps in psychological treatments. The seminar helps to arrive at an

architectural proposal for rehabilitation centre that that helps the addicts to integrate

themselves to return to sobriety and become a productive member of the society. This aim can

be achieved my fulfilling the following objectives.

The rehabilitation centre designed keeping in view the welfare of all affected population in

the context of drug addiction. It should be an eco friendly structure which blends into the

surroundings. It should give a feeling of vast space and freedom without compromising

security.


Natural elements must be greatly included in design as it is part of certain treatments like

psychological, managements.

The concept behind the proposed drug rehabilitation centre at Kolkata intends to emphasize

on the therapeutic environment. The following will be addressed while creating therapeutic

environment:

Reduce environmental Stress by using familiar material, cheerful with varied colours, natural

lighting, outdoor- views and access, mediation rooms/ gardens. Music and art, easy way

finding process, attention to proportions, scale, colour, detail, bright open public spaces, noise

reduction, no medical odours, good indoor air quality, play on light and shadow.

Provide Positive Distractions by making surrounding cheerful, bright colours, group therapy

halls with areas to respite.

Enable social support outdoor views, access, activities, large open social gathering spaces,

privacy, and accommodation for family members.

The centre will also give a sense of control to the patient by giving them colour corrected

light where natural light is not possible, controlled views but access to outdoors, changes to

be allowed in rooms, easy way finding, the design will be on human scale, will be homelike

with intimate environments, areas of respite, privacy, medical library.