How can ambiences for Complementary and Integrative Practices help us to understand the therapeutic potential of architecture, interior design and its sensory aspects? In this blog Mariana Villela explores some recent case studies of CIPs in Brazil.
In this blog I explore ambiences for Complementary and Integrative Practices (CIPs) in Brazil. I ask how staff and users’ ‘well-being’ can be benefitted by architectural and interior design, from the reception and waiting room environments to the treatment room, especially for people who are more sensitive to environmental stimuli or find it more difficult to relax.
The term CIP is used ostensibly in Brazil (and officially in the public health system) as equivalent to the medical systems and therapeutic techniques popularly known as Alternative Medicine and defined by the WHO as Traditional and Complementary Medicine. Users in CIP treatments do not always call themselves patients. In therapies performed in individual sessions (such as craniosacral therapy, shiatsu, etc) the therapist’s aim is usually to lead the person being treated into a state of concentration, relaxation and receptivity to therapeutic techniques. CIP needs to be done in one session, on average lasting 30 to 60 minutes. In Brazil, these practices have been present in the public health system since 2006.
My research, carried out in three case studies, explored users’ ‘well-being’ in this type of environment and the environmental stimuli that influence it. I looked at The Centro de Práticas Naturais (Center for Natural Practices), clinic-school of the Naturology course at the Universidade do Sul de Santa Catarina (UNISUL) in Palhoça, Brazil; the Projeto Amanhecer/NUAM, at the Hospital Universitário Professor Polydoro Ernani de São Thiago at the Universidade Federal de Santa Catarina (UFSC) in Florianópolis, Brazil; and the Spa & Wellness Center, the spa-school at the Universidade Anhembi-Morumbi in São Paulo, Brazil. I identified the following as important for feelings of ‘well-being’: Welcomeness (feeling at ease in the environment), Motivation (willingness and motivation for therapy), Beauty (perception of environmental aesthetics), Concentration (degree of attention to the therapy), Trust (feeling safe and free of phobias for therapy), Relaxation (prior tranquility and rest during therapy) and Simplicity (perception of environmental aesthetics free from excesses).
Taking the waiting room of the spa-school at the Universidade Anhembi-Morumbi, in São Paulo, Brazil as an example, I identified several sensory stimuli that benefit users’ sense of ‘well-being’ in therapeutic CIP environments. The 1,162 m² spa has individual rooms, a swimming pool, hot tubs and other resources. The waiting room, however, is one of the places that attracts the attention of not only its users, but also some of the employees of the university where it is located (Fig. 1 and Fig. 2). One of the research interviewees, a university administrative employee, reported that she usually goes to the waiting room during her lunch break, lies down on a chaise longue and relaxes for a few moments. She said that her work is stressful and that just staying there for five minutes brings her to a state of tranquility. In the waiting rooms, in all the case studies, it was common to observe the behavior of people waiting for care in an introspective state, contemplating the environment, reading, as well as little interaction between them. Visually perceptible stimuli can be designed with the aim of helping people access states of tranquility, contemplation and relaxation in moments prior to treatment.
The spa waiting room includes 7 out of the 10 stimuli identified as positive in the therapeutic environments of CIPs: Artistic (presence of decorative and/or various artistic elements), Auditory (presence of silence or soft music), Biological (absence of toxic and /or contaminating agents), Luminous and Hygrothermal Comfort (presence of natural and/or artificial resources to control lighting, ventilation, temperature and humidity), Spatial (presence of elements and attributes configured from the building and its interior environment, such as shape, fenestration, colors, coverings, layout etc. that favor the performance of activities and promote positive feelings), Natural (presence of natural elements such as vegetation, water, natural sounds or views of nature) and Social (possibility of social relationships and social support). The other stimuli identified in the research — but not in this waiting room — are Energetics (anchoring vital and spiritual energy for treatments), Olfactory (presence of pleasant aromas) and Socio-Spatial (presence of spatial configurations that favor privacy, control of the environment and territoriality).
When people move from waiting rooms to their individual therapies, the prevalent stimuli shift to the non-visual, such as Auditory, Olfactory and Luminous and Hygrothermal Comfort. Silence (or the presence of soft music) is highly valued in these cases, as it favors relaxation, especially from the moment the person lies on the therapy bed (Fig. 3). As it is common for people undergoing treatment to keep their eyes half closed or closed during individual therapies, treatments can be carried out using a low light or dimmed light, with or without Chromotherapy resources (Fig. 4 and Fig. 5). Furthermore, when visual privacy is not possible, as in the case of an individual service performed collectively (one therapist per person served, but in a space with several beds), auditory privacy is even more important (Fig. 5).
Concerning the individual therapy rooms, even though the person undergoing treatment (and sometimes even the therapist) often has their eyes closed during the session, the presence of a window for natural ventilation and lighting is highly valued. The positive perception of the presence of windows can be related to ‘well-being’ concerning temperature, safety against accidents (due to the light), absence of phobias (such as claustrophobia), among other factors that can influence relaxation.
This finding relates to Ulrich’s well-known research from 1984, on how a window overlooking a garden in hospital rooms positively influenced the health of inpatients undergoing post-surgical recovery. Since then, a wide range of other studies have also shown that environmental factors favorable to health, in indoor spaces, may include: the presence of windows for natural lighting and ventilation, which contribute to healthiness; noise reduction to reduce stress; the presence of restorative elements of attention, such as artistic elements or vegetation, which favor cognitive escape; and universal design, which can prevent accidents, among others.
The most researched environments in the therapeutic context, however, have been those of ‘Western’ medicine. My work adds to this literature by considering CIPs, many of which come from specific local cultures beyond the ‘West’ or from so-called ‘alternative’ or ‘traditional’ health systems, and their environmental characteristics. For good architecture and design, the more we know the activities, behaviors and expectations of the users of the environments, as well as the sensitive qualities involved, the better they will be. This is important even if – or perhaps especially if – the objective is precisely to influence a person to disconnect from the environment around them, as is often the case in CIPs.
Mariana Silva Villela is an architect, architecture lecturer and researcher. She completed her master’s degree at the Federal University of Santa Catarina, Brazil, in 2017. Her dissertation was on therapeutic CIP environments — and she remains interested in the subject.
 Examples of CIPs are: Anthroposophical Medicine, Aromatherapy, Ayurveda, Chiropractic, Floral Therapy, Geotherapy, Herbal Medicine, Homeopathy, Hydrotherapy, Hypnotherapy, Massage Therapy, Meditation, Osteopathy, Spiritual Healing, Traditional Chinese Medicine, among others.
 VILLELA, M. S. A ambiência nas Práticas Integrativas e Complementares: estímulos ao bem-estar do usuário. Florianópolis: Universidade Federal de Santa Catarina (UFSC), 2017. Available at: <https://repositorio.ufsc.br/handle/123456789/188694>
 VILLELA, M. S.; BINS ELY, V. H. M. Stimuli towards well-being in an environment with Complementary and Integrative Practices (CIPs). Ambiente Construído, Porto Alegre, v. 20, n. 2, p. 441-456, abr./jun. 2020. ISSN 1678-8621 Associação Nacional de Tecnologia do Ambiente Construído. http://dx.doi.org/10.1590/s1678-86212020000200408
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