Questioning the “Ditch the Desk” Theory of Therapy By Howard Rosenthal, EdD on 7/7/20 - 1:14 PM

A fellow therapist and I were leaving the local massive business furniture outlet and headed toward my new private practice office with a brand spanking new desk stuffed into the trunk of his trusty 1976 Buick Regal. The desk was sitting on its side, protruding from the trunk and looking like a chimney or perhaps a missile without fins. It might have looked a bit odd, but this mode of transportation was going to save a starving new private practitioner (that would be me) a hefty delivery charge.

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This was the easy part. Getting it up several flights of winding stairs ourselves was going to be the real challenge, and to this day, I still have an almost imperceptible spot on one of my fingers briefly smashed in the process to remind me of that glorious event.

As we drove to my new office, he explained that having a large, expensive-looking desk made a therapist appear successful and this would work to my advantage as a placebo, giving clients more confidence in my ability to help. However, while attempting to navigate the Buick with no view out the rear window, my colleague gave me a stern warning, that a desk was merely intended to make the office look stylish, since it played no part in the treatment process.

Now, don’t get me wrong! I was well-aware of his statement that the desk plays no part whatsoever in the treatment process. That fact had been drilled into my head by every professor whose course I had ever taken.

We were taught in no uncertain terms that when you are doing therapy with a client, you are face-to-face, with no desk in the middle. You have a chair, as does the client. However, sitting behind a desk makes you look like some big expert. Not good. Sitting behind a desk contributes to the imbalance of power already inherent in the therapeutic relationship. Here again, not desirable. It makes the helper look more important. You are perceived as being better or special. The explanation we were given depended on the professor, but the bottom line was always the same: get the darn desk out of the helping equation — and get it out now!

If your office has a desk at all, sit beside it or use it as window dressing. But whatever you do, do not sit behind it.

It was quite easy for me to acquiesce, since I had previously done home-based treatment for many years, where the closest thing to a desk was a client’s kitchen table or workbench cluttered with an endless array of flat-head screwdrivers in the garage.

Then came the dawn. One fine day when I was ready to begin a therapy session, my client remarked, “Look, I know this sounds stupid, or maybe a bit old fashioned, but I like it better when you sit behind the desk.”

Rather than hiding behind my notes from grad school or reflecting the statement back, I merely moved behind the desk for old school therapy, and everything seemed to go well.
Since that time, this has occurred maybe 20 or so times over the years. That is not a lot; however, it is certainly enough to take it seriously. Although this request is not the rule, it is in the realm of possibilities.

Looking back, my graduate faculty got it right maybe 95% of the time, but there are clients who do not fit the model. In those instances, although they may be statistically rare, I would say pull up a chair behind the desk rather than trying to pay homage to a mentor from the past textbook author you admired.

One day, when I was recounting my ditch-the-desk experiences with a physician, he noted that it made a lot of sense. He reminded me that for many years, physicians wore lab coats. Then there was a period when the profession thought it would be better to dress in street clothes. Physicians traded in their traditional medical threads for suit coats, sports shirts, silk ties and scarfs, blazers, and, on occasion, yoga pants.

According to the physician I was conversing with, some, though certainly not all patients insisted upon seeing a physician who looked... well... like a physician rather than a dignitary attending a high-ticket fund raiser or somebody gearing up for a sweaty jog in the neighborhood.

Like the counseling client who wants to see you sitting behind the desk, a cadre of patients came forward and said they felt more comfortable having a doctor who dressed like a doctor, complete with a stethoscope and a name tag. Thus, in many instances the doctor’s outfit of yesteryear, like vinyl in the music industry, is making a comeback.

Could conducting therapy from behind the therapy desk be the next big thing? Frankly, I rather doubt it, but it could be worth its weight in gold for helping a select group of clients.


Postscript: Dr. Rosenthal’s new book is the Human Services Dictionary 

File under: The Art of Psychotherapy