Why Outdoor Therapies Should Have Better Representation by a Professional Association
(The following is something I wrote as a companion piece to my Level 4 Diploma in Therapeutic Counselling research project on “Walk and Talk” therapy, documenting my personal journey, reflections on what I learned (and more importantly, didn’t learn), and conclusions drawn. I acknowledge that, since this was a Level 4 student project, more work could be done to either support or refute the arguments I make here. Regardless, I feel strongly enough in the validity of these arguments to present them in full).
Why Outdoor Therapies Should Have Better Representation by a Professional Association: A Student’s Perspective
“Walk and Talk” therapy is an approach to working with clients which takes the therapy out of the relatively protected confines of the traditional therapy room and into the outdoors, often practiced in public parks, walking trails, and other natural environments.
It’s often described as truly bringing to life the metaphor commonly used in counselling circles of “walking side by side” with clients.
It’s also described as a way of helping those clients to become “unstuck” in the therapeutic process and connect with nature in a way that, ultimately, helps them reconnect with the truest parts of themselves.
As a counselling student, and particuarly as a human being who has experienced first-hand the tremendous benefits of both talk therapy and physical activity in an outdoor environment, such descriptions resonate deeply with me, so much so that even as a student, I’m a passionate advocate for this approach to therapy.
However, I’m also an advocate for better representation, regulation, training, and guidance for those practicing “Walk and Talk,” as well as eco-therapy, running therapy, and the myriad of other practices that could fall under the umbrella of “outdoor therapy.”
In fact, I’d even go so far as to say that outdoor therapy should have its own professional association akin to the BACP or, if not an entirely separate body, at least more serious consideration by the BACP and similar organisations.
What I’m about to share with you is how I came to reach this conclusion.
I’d like to share with you my argument as to why a professional body could be so beneficial for both counsellors and clients, and how I came to feel that this was something worth arguing for in the first place.
Fittingly for this subject, the best way to do this is to describe to you a journey that I’ve been on before, during, and after my Level 4 research project.
2017 — The Journey Begins
“Nature has the power to heal because it is where we are from, it is where we belong, and it belongs to us as an essential part of our health and our survival.”
Dr. Nooshin Razani
I’m not too big on inspirational quotes, but I simply can’t deny that those words from Dr. Razani struck an incredibly powerful cord with me
Every one of those words speaks deeply to my own personal experience of using nature to help me overcome a dark, challenging period in my life.
In 2017, my mental and physical health had rapidly deteriorated.
I was three stone overweight.
I couldn’t move for weeks.
I spent a long period of time lying on my sofa in the dark, doing nothing more than binge-eating, sleeping, and feeling awful.
To make matters worse, the mental health support offered by the NHS was…well, let’s just be polite and call it “lacking,” shall we?
I couldn’t get the professional support that I felt like I needed to get better and so, feeling let down by the NHS, I determined that if I was going to get better, I’d have to figure out a way to do it myself.
The way I did it was simply by going outside.
I was lucky enough to live near a vast and beautiful nature reserve and began spending more time there, either riding my bike, running, or walking around taking photographs.
It helped tremendously.
Although it didn’t solve all of my problems, access to fresh air and sunlight, combined with the benefits of walking and moving around helped me to get into a better state of mind and improved my physical well-being to the point that I was able to then seek alternative (non-NHS) methods of addressing my psychological issues.
(Related story: How My 1,000 Mile Bike-Ride Saved me From Suicide)
My Experience as a Catalyst for My Career Ambitions
Not only did being outdoors help to improve my well-being, but the whole experience of going through that depression and coming out of the other side inspired me to pursue a career change and train to be a counsellor.
It wasn’t until I was already in training that I first learned about “Walk and Talk” Therapy and it struck me as something that I would very much like to practice once I eventually qualify.
After all, I had experienced the benefits of engaging in physical activity outdoors (the “Walk” part of “Walk and Talk”).
I had also experienced the truly life-changing benefits of therapy from a client’s perspective and had come to really appreciate the value of therapy from a trainee-practitioner’s perspective (the “talk part”).
So, it simply made sense to me that if you put the two together, you’d get an approach to helping people that was even greater than the sum of its parts.
As such, when I had to undertake a research project for my Level 4 counselling diploma, making “Walk and Talk” the focus of my research was pretty much a given.
My Approach to Research
Still, despite having absolute belief in the benefits of outdoor therapy, I didn’t want to approach my research with the sole aim of merely demonstrating/proving how good it could be.
Yes, it was important to look at the benefits in order to put this research into context.
Yes, it would help me to explain why I felt that this was a subject worth exploring, and yes, researching the benefits would help me to expand on the fairly basic knowledge I already had on the subject, but I felt that I could actually learn much more if I approached outdoor therapy from a more critical perspective.
It seemed obvious that if I was truly serious about pursuing “Walk and Talk” as a service I offered to my clients post-qualification, then it would be best to explore the challenges, disadvantages, and pitfalls of delivering that therapy, and how to overcome them.
That way, I’d achieve much more than giving myself a self-congratulatory pat on the back (See, Chris? You were right after all!). Instead, I could actually use this as an opportunity to teach myself about how to deliver “Walk and Talk” therapy in a safe, ethical, and effective way once qualified.
With all that in mind, I came up with the following hypothesis:
Walk and talk therapy can be very beneficial for clients if delivered safely, ethically, and effectively. However, in order to deliver therapy in such a way, there are certain challenges which must be overcome.
Again, it was the challenges -and more specifically, how to overcome those challenges- that I was most interested in, but looking at the benefits seemed important to help put things into context.
Testing My Hypothesis — The Benefits Of Physical Activity in an Outdoor Environment
Of course, I had my own experiences of seeing positive change by engaging in physical activity outdoors, but I was also aware that one person’s experience doesn’t conclusively prove much of anything, so I had to dive a little deeper.
To do this, I carried out some secondary research, namely looking for studies and research papers into the benefits of both being outdoors in general, and engaging in physical activity outdoors.
The first thing I came across was this:
The benefits of nature experience: Improved affect and cognition
“We randomly assigned sixty participants to a 50-min walk in either a natural or an urban environment in and around Stanford, California. Before and after their walk, participants completed a series of psychological assessments of affective and cognitive functioning. Compared to the urban walk, the nature walk resulted in affective benefits (decreased anxiety, rumination, and negative affect, and preservation of positive affect) as well as cognitive benefits (increased working memory performance).”
The above passage outlines the results of a study carried out by Greg Bratman and his colleagues at Stanford University.
Bratman & Co. took sixty students, split them into two groups, and had one group go on a 50-minute walk through a nice, green, leafy part of the Stanford Campus while a second group set off on a 50-minute walk near heavy traffic.
Before and after tests were carried out on the student’s well-being which revealed interesting results:
The students who went on the nature walk saw greater positive benefits (such as decreased anxiety, decreased rumination, and better preservation of existing positive mindset.) than those who walked in the urban area.
Given that the only difference between the two walks was the environment, it seems to fair to deduce that nature played a role in creating these positive benefits in students.
Bratman and his team also found that those who walked in nature had better working memory performance. This interested me greatly because it linked in with something I find very fascinating, which is this:
Attention Restoration Theory (ART)
Attention Restoration Theory (ART) is a theory first put forward by Stephen Kaplan in 1989 and then expanded upon in a 1995 paper The restorative benefits of nature: Toward an integrative framework (Kaplan, 1995).
In this paper, Kaplan explains that nature can have a positive impact on reducing mental fatigue, in turn improving working memory and performance of cognitive tasks.
In her systematic review of ART, Professor Ruth Garside sums up the theory better than I ever could:
“Attention Restoration Theory (ART) (Kaplan, 1989, 1995) suggests that mental fatigue and concentration can be improved by time spent in, or looking at nature. The capacity of the brain to focus on a specific stimulus or task is limited and results in ‘directed attention fatigue’. ART proposes that exposure to natural environments encourages more effortless brain function, thereby allowing it to recover and replenish its directed attention capacity.”
This strikes me as particularly fascinating as I associate “mental fatigue” with the concept of burnout. Knowing what an impact burnout can have on our mental wellbeing, it’s reassuring to read that time spent in nature can help to prevent this.
The Impact of Outdoor Environments on Serotonin Levels
There’s also been some work done that suggests that being outdoors can help to increase our levels of the neurotransmitter serotonin.
Often referred to as a “mood regulator,” increasing levels of serotonin is seen as one way of helping people overcome depression, a prime example of which comes to us courtesy of our old mate, the NHS.
One of the primary methods by which the NHS aims to treat depression is by prescribing anti-depressants known as Selective Serotonin Reuptake Inhibitors (SSRIs) which work by preventing serotonin from being reabsorbed by our nerve cells, ultimately ensuring that we have more serotonin available in the body.
But what do we actually know about the impact of being outside on serotonin levels?
Well, for one thing, we know what a difference access to light can make.
Studies such as Light therapy and serotonin transporter binding in the anterior cingulate and prefrontal cortex (Harrison, S.J, Tyrer, A.E, et al, 2017,) show us that light can have a positive impact on serotonin levels, so it makes sense that exposure to natural sunlight through being outdoors can be just as good.
Sunshine, Serotonin, and Skin: A Partial Explanation for Seasonal Patterns in Psychopathology?
“Given that the relationship between sunshine and serotonin is probably a multimediated phenomenon, one contributory facet may be the role of sunshine on human skin. Human skin has an inherent serotonergic system that appears capable of generating serotonin.”
The above passage is from an interesting study in which Sansone & Sansone looked at the skin’s capability of absorbing sunlight and converting it into serotonin, making another argument for the benefits of being outdoors.
This all gets more interesting when you consider the following:
“It would be too simplistic to say that depression and related mental health conditions are caused by low serotonin levels, but a rise in serotonin levels can improve symptoms and make people more responsive to other types of treatment, such as CBT.”
This passage from the NHS’s explanation of SSRIs is particularly interesting with relation to Walk and Talk therapy.
If it is shown that serotonin levels can be improved by being outdoors, and if the NHS are arguing that an increase in serotonin makes people more responsive to other types of treatment, then it’s not a huge leap to reach the conclusion that delivering therapy outside can be very effective.
The NHS may only mention CBT (Cognitive Behavioural Therapy), but I’m going to take the cynical view this is only because CBT is the NHS’ preferred form of therapy.
Although I’ve no evidence to support this, I can’t see how, if increased serotonin makes people responsive to one form of therapy, it wouldn’t also make them more responsive to another.
The Impact of Physical Activity on Chemical Activity
Physical activity has been shown to increase the reward chemical dopamine (High impact running improves learning, Winter, B. et al, 2006) as well as endorphins (Catecholamines, dopamine, and endorphin levels during extreme exercise, Bortz, W.M, et al, 1981) which are commonly referred to as “the body’s natural painkiller” and said to have an impact on our mood and well-being.
Beyond this, there is more evidence which points to physical activity also having a positive impact on serotonin.
“A comprehensive review of the relation between exercise and mood concluded that antidepressant and anxiolytic effects have been clearly demonstrated…The most consistent effect is seen when regular exercisers undertake aerobic exercise at a level with which they are familiar…”
In the paper quoted above, Simon Young follows up by listing numerous studies which have shown links between exercise and increased serotonin. I won’t list them here for the sake of brevity (or at least as much brevity as it’s possible to have in a 6,000+ word piece!) but Young’s list does seem to strengthen the argument that being outdoors can do us a lot of good.
What We’ve Learned So Far
So. We’ve learned that being outdoors is good for us.
We’ve learned that physical activity is good for us.
But when we’re talking about “Walk and Talk” therapy, we’re not merely talking about going outside and getting a boost of serotonin to “feel better.”
We’re talking about meaningful therapeutic work, the type that helps people to make profound self-discoveries, break free from the shackles of their conditions of worth, and potentially even heal what hurts.
This means engaging in the kind of psychotherapeutic work for which no amount of serotonin can serve as an adequate substitute.
Still, if we go back to the earlier passage from the NHS which stated that raised serotonin levels can make someone more responsive to therapy (in that case CBT), then we can see the value of doing therapy outdoors.
Being outdoors is good for our mental wellbeing. Physical activity is good for our mental wellbeing, and this can all be combined with effective therapy to help clients achieve worthwhile results.
There is some evidence which supports this.
Support for Walk and Talk Therapy
In 2016, Stephanie Revell and John McLeod conducted an excellent project in which they spoke to 32 practitioners about their experiences of delivering “Walk and talk” therapy (Experiences of therapists who integrate walk and talk into their professional practice, McLeod, J., Revell, S., 2016).
We’ll revisit this study later because it proved to be the best piece of work done on the subject that I could find, but for now I’ll just point out that their quantitative approach found that outdoor therapy could help to shift “stuckness.”
Revell & McLeod did not elaborate on what “stuckness” actually meant, but I took it to mean “hitting a wall” in the therapeutic process with the client no longer making any meaningful progress. I also took from this the idea that by physically getting up and moving, the therapeutic process too could get moving again.
Their findings also suggest that clients benefit from “walking alongside” the therapist, as this “levels the playing the field” (reduces perceptions of power imbalance) and minimizes eye contact which can actually be useful for helping people to open up.
Case Study Four: Walk and Talk, Right Here Sheffield/Counselling on the Move
Another really interesting project was done in Sheffield in which young people with complex needs engaged in a “Walk and Talk” counselling project (Case Study Four: Walk and Talk, Right Here Sheffield/Counselling on the Move, Sheffield YMCA et al.)
These were young people not in education, employment, or training (NEET) as well as young people with mental health problems, LGBTQ young people, those from ethnic minorities, or those with previous engagement with the criminal justice system.
The project found that engaging with outdoor therapy led to an increase in:
· General well-being
· Coping skills
· Social connectedness
And a decrease in:
· Self-harm and suicidal anxiety.
Testing My Hypothesis — The Challenges of Outdoor Therapy
So far, so good then, but if you recall, I was actually less interested in the benefits of outdoor therapy and more concerned with the challenges and how to overcome them.
I wanted to learn what could potentially get in the way of safe, ethical, and effective delivery of “Walk and Talk” counselling and how to overcome those challenges.
Nothing we’ve looked at so far taught me that, so I had to dive a little deeper.
I thought that if I could find enough information about overcoming the challenges of “Walk and Talk” therapy, that would make my life easier. I could wrap up my assignment as a pure secondary research project and, you know, move on with my life.
In an attempt to find that information, I began with a very broad Google search and gradually narrowed things down to see what was out there.
The good news was that there is a lot of information online about “Walk and Talk” therapy:
- The Benefits of Walking and Talking Therapy by Eileen Wise
- What is Walk & Talk Therapy by Kelvyn James
- A different article of the same name by Lara Just
All three of these -and more- proved interesting reads and a great introduction to the subject.
However, they weren’t quite right for meeting the aims of this project for the following three reasons:
1. They mostly focussed on the benefits of outdoor therapy and how good it is.
2. They paid minimal attention to the challenges, sticking with obvious things like going inside when it rains.
3. It could be argued that there is a financially motivated bias in all three pieces.
All three were written by people who charge money to deliver “Walk and Talk” therapy, so of course they’re going to approach it from a positive view point.
That’s not a criticism of the articles themselves. They were very well written, very informative, and would have been excellent sources had I only been interested in learning about the benefits.
Nor is it a criticism of the therapists themselves. Posting an article about the positive benefits of a service you offer is a perfectly legitimate way of marketing and doesn’t mean for a second that these people aren’t passionate about what they do.
It’s just that their pieces weren’t quite right for this particular endeavour.
Experiences of therapists who integrate walk and talk into their professional practice (Revisited)
The best piece of work that identified the challenges was the aforementioned study by Revell & McLeod.
They found that:
· While the reduced eye contact may have been beneficial in terms of clients opening up, it presented new challenges for therapists who would normally rely on being able to see a client’s face in order to work effectively with them.
· Likewise, while walking side by side with their therapist may have empowered clients, it could make listening more difficult. Since listening is 90% of what counsellors do, this could present a challenge.
The study also identified a need for the development of new skills to better hold the therapeutic process.
Qualifications, Guidelines and Best Practice
In summing up their findings, Revell & McLeod wrote:
“There appear to be a growing number of practitioners who are offering walk and talk despite a lack of ‘best practice guidelines’. Given the variety of factors present in walk and talk that can be experienced as either helpful or hindering, consideration by the therapist needs to be given to how these factors might be managed before venturing out with a client. It would be valuable to develop research-informed guidelines and training opportunities to support safe and effective practice in this area of work”
This really interested me, especially the part about “best practice guidelines” and “training opportunities to support safe and effective practice.”
I was disheartened to see that most of the training that exists on this subject takes the form of professional development courses such as:
I’m by no means questioning the validity of these courses or suggesting that they aren’t useful, I’ve no doubt that they are.
It’s just that, I’m convinced that in order to ensure clients receive the best possible therapy in an outdoor environment requires more good quality training than a simple CPD course can provide.
Research-Informed Best Practice Guidelines
On the subject of researched-informed best practice guidelines, little seemed to exist.
I did a website search of the BACP website, and was surprised and saddened to find that there didn’t seem to be any guidelines for outdoor therapies published prior to the COVID-19 pandemic.
I can’t say conclusively that they never published any, just that if they did, they proved impossible for me find.
This is discouraging because, as I’ll discuss later, “Walk and Talk” therapy is generally as old as modern psychotherapy itself, even if it hasn’t necessarily always been called by that name, so it’s pretty alarming that it took a global pandemic for the BACP to decide to offer any guidance on it.
What’s even more disappointing is that the guidance it offers isn’t really guidance at all but merely a list of common sense things that practitioners should consider such as:
How will you assess whether your client is suitable to work outdoors?”
Well, I don’t know, BACP, why don’t you offer me some actual guidance on how to do that rather than simply giving me something to think about and sending me away to figure it out myself?
As a trainee counsellor with ambitions of one day practicing outdoor therapy, such guidance seems insufficient and very disappointing given that it comes from the BACP.
Taking a Different Path — Conducting Interviews
This journey to learning about how to overcome the challenges of “Walk and Talk” therapy clearly wasn’t getting me very far. So, I decided to change course and take a different path by conducting interviews.
Originally, I had hoped to interview both clients and counsellors.
I thought that if I could speak to clients about their experiences, I could learn from them:
· What they liked
· What they didn’t like
· What, if any, preconceptions they had about “Walk and Talk” therapy
· If those perceptions changed once the therapy commenced
· If they felt the therapy was successful
· What, if anything, they felt the therapist could have done differently to improve the experience.
I posted on Facebook (just through my own personal account to my network of friends) and on the Mental Health forum of the social media site Reddit.
I received very little response, and the majority of those responses fell into two categories:
· People who had never heard of “Walk and Talk” therapy but thought it was an interesting concept
· People (normally friends and peers with no connections to counselling) who saw it as being a “new age” kind of thing.
I received no responses from anyone who was able to actually help me with what I need.
Instead, I focused purely on interviewing counsellors.
I contacted 12 counsellors.
Sure, that’s a relatively small amount, and if this project had been on a larger scale, I would certainly have attempted to contact more, but 12 seemed sufficient given the amount of time that I had and the fact that this was only a Level 4 diploma assignment.
Of those 12.
· 5 didn’t reply.
· 1 wanted to charge me a £40 consultation fee (I politely declined!)
· 1 wanted to do it but we couldn’t get the timing right.
I ended up speaking to five counsellors via Zoom.
Before the interview, I made a basic list of questions that I could use if I needed them, but I approached this with the aim of having an informal conversation and being led by the counsellors rather than conducting a rigid “question and answer” session.
This seemed like the best approach as I came at this with frame of mind that “you don’t know what you don’t know.”
I trusted, perhaps naively, that my interview subjects would guide me and reveal what was most important.
All of the counsellors were friendly, passionate about what they did, and very generous with their time. Some of the information they gave was useful, but I felt that we didn’t go into the kind of depth I would have liked.
What We Talked About
Over the course of these five conversations, certain patterns began to emerge, particularly with regards to the practical, logistical challenges of delivering “Walk and Talk” therapy.
All of the counsellors agreed that one of the biggest risks to consider was the likelihood of bumping into someone known to either the counsellor or the client and how that would be handled, though only two of the five said that this had ever been a real problem they’d had to handle.
All of the counsellors said that their approach was to discuss this risk with their clients, explain that it could happen, and agree with the client on how to manage it.
This might simply be a case of introducing the other person (either the client or counsellor) as a friend or giving no explanation and making an excuse to leave.
This seemed like a logical approach, but it left me with more questions.
How would the counsellor handle a vulnerable client?
What if a client was in an abusive relationship and was spotted either by the abuser, or by someone who could “report back” to the abuser that they were spotted out and about with a stranger?
Maintaining privacy when attending therapy can be challenging enough for vulnerable people, if you take away the relative safety provided by a therapy room and leave the therapy exposed like that, it could potentially cause a whole host of problems.
The counsellors I spoke to said they had not encountered this, and offered a counter-argument that if this was something the client was concerned about, then they might advise against outdoor therapy.
This is a logical answer that seemed to address the BACP’s rather unhelpful “how do you assess suitability?” question, but even still, I was left feeling like this was an issue that could be taken more seriously.
On a similar note, two of the counsellors offered that most people in their social circle knew what they did for a living, therefore if they (the counsellor’s friends etc.) saw the counsellor out and about, they would likely know that it was a counselling session and be mindful not to interupt.
At the time, I accepted this as being a good answer, but the more I think about it, the more I feel it raises yet more serious concerns about client confidentiality.
After all, it’s pretty easy to make something up if the third party has no idea that a therapy session is taking place, but if they’re well aware that their friend is a counsellor and this is where they carry out their “Walk and Talk” sessions, then it’s just as easy for that third party to put two and two together and deduce that the person with the counsellor is in the process of recieving therapy.
Perhaps I’m over-thinking this, but it’s only now -months after my project concluded and I’m editing this piece to post on Medium- that I find myself reaching the conclusion that perhaps real consideration should be given to choosing a suitable location where neither the counsellor nor the client are likely to run into anyone they know.
Health and Safety Hazards
Health and safety should be a serious consideration regardless of where the therapy takes place.
However, the very nature of moving around in an outdoor environment means that the risks of trips, falls, and other accidents are greater in “Walk and Talk” than in therapy rooms.
Only one therapist said that they had needed to deal with an accident, but that it had been a very minor incident in which the client simply “dusted themselves off and carried on.”
The approach was the same as with encountering others — discuss the risks with the client in advance and gained informed consent that the client knows what they’re getting themselves into.
While this made sense, I couldn’t help but feel like it was something that should be taken more seriously, and it was only afterward, when I was reflecting on my research journey, that I realised not one of the five counsellors mentioned that they had received first aid training.
As someone who would like to deliver “Walk and Talk” therapy once qualified, I personally could not imagine doing this without first undergoing first aid training. It also seemed very smart to have a first aid kit, if not about my person then at the very least in the boot of my car.
In terms of insurance, all of the counsellors agreed that they did not need to take out special insurance and that their current policy covered them.
Limits of Confidentiality
Even if a session was carried out with neither client nor counsellor meeting anyone they knew, there is still a risk that the conversation could be heard by passers-by.
Again, the general consensus was that this was discussed in advanced and agreed as a potential risk that the client was happy to accept.
All of the counsellors said that they had never encountered this problem, thus I felt it was kind of glossed over.
However, on reflection I still think it’s something which needs more serious attention.
After all, while it may be fine that the client agrees that this is a risk, we never really got onto discussing what the consequences of an overheard conversation could potentially be, how they could affect the client and potentially the counsellor.
This is mostly on me as it didn’t occur to me to dive deeper into this subject, though again, I’ll state that I was mostly being led by the counsellors and would have liked them to have offered more information about this.
The challenges listed above dominated my discussions with qualified counsellors, though other interesting issues were also raised.
I was glad that this was raised as it’s something I never would have considered.
It was generally agreed among all counsellors that clients set the pace of the walking much as they set the pace of the therapy. However, I did discuss with one counsellor the idea of client competitiveness, that a client might try to constantly up the pace or try to get ahead of the therapist.
They said that the best way to approach this was through congruence and immediacy, with the counsellor noting that the competitiveness and addressing it.
Again, this was something that would have never have occurred to me prior to researching this subject but now seems glaringly obvious.
I mentioned earlier that “Walk and Talk” could present challenges in terms of eye contact and reading facial expressions. Naturally, wearing sunglasses on a sunny day could make this even more difficult.
The suggestion on how to overcome this was simply to agree with clients not to wear sunglasses. That might be OK, but it still made me think that more serious consideration needs to be given to the role of eye contact and how to compensate for the lack of it in outdoor therapy.
All of the counsellors discussed the importance of having pre-set routes for “Walk and Talk” therapy and walking these routes in advance.
The main reasons for doing so were:
· To identify any health and safety hazards
· To ensure familiarity so that the counsellor can spend the session focussing more on the client and less on the route
· To avoid getting lost.
However, three of the counsellors I spoke to also mentioned that planning the route in advance is also important for timing. It would be inappropriate to walk for one hour in one direction, reach the end of the therapy session, and then both client and counsellor have another 20-minute walk together back to their cars.
Things I Wish We’d Discussed More
There were a few things which, on reflection, I wish my conversations with the counsellors had covered in more detail:
One of these was the lack of first aid training mentioned above, but I was also disappointed that we didn’t properly cover:
New and/or Vulnerable Clients
Even attending regular therapy can be a daunting prospect for some clients, especially for those who are vulnerable.
Outdoor therapy could intensify any anxieties around meeting a new therapist and engaging in the process.
After all, what’s really being asked of the client is to meet someone they don’t know that well in an open setting, without the relative safety and sense of legitimacy afforded by a therapy room.
What I was interested in -and still am interested in- is to what extent this trust needs to be built up beforehand.
Does some work need to take place in the therapy room first in order to build trust and develop rapport, or is the therapist’s professional status and credentials enough to establish enough trust that the client feels safe meeting their therapist outdoors?
On the subject of credentials, another thought occured to me:
Given that anyone in the United Kingdom could technically call themselves a counsellor without any training or qualifications, is it beyond the realms of possibility that somebody with nefarious intentions could advertise themselves as a “Walk and Talk” therapist and put vulnerable clients in grave danger?
Sure, you could argue that a person with intent to harm could still do so in indoor space, but having rented therapy rooms for my hypnotherapy practice, I’m aware that legitimate venues ask for a copy of your insurance and professional credentials which provides a modicum of protection for clients.
The Impact of Walk and Talk Therapy on the Quality of Therapy
During my initial conversations with the counsellors, most of the focus was on the practical side of “Walk and Talk” therapy and the logistics of it.
While conversation would sometimes veer into talking about things like eye contact, we never really got into a deep discussion about the quality of therapy and how to help clients have the same meaningful and profound therapeutic experiences outside of the therapy room as they would have inside of it.
This became more apparent during a discussion with my tutor and peers, after which I really felt like this was something that needed to be explored further.
To repeat something I said earlier:
Outdoor therapy isn’t just about “going outside and feeling better,” it’s about using the advantages of an outdoor environment combined with good therapy to help people achieve meaningful outcomes from their work with a therapist.
I went back and spoke to two of the original five counsellors that were available and we spoke about this.
The conversations where interesting and insightful, but could be summed up as “use the core conditions and you’ll be fine.”
(Related reading: The Best Bits from Carl Rogers’ On Becoming a Person)
On the one hand, I absolutely respect that, especially as Rogers originally said that the original six conditions were enough (“necessary and sufficient”), but it still left me with yet more questions, particularly:
How do you ensure the conditions are met while working outdoors?
What if the client cries?
Is managing silence any different outdoors than indoors?
Putting it All Together
With the counsellor interviews concluded, I had time to reflect on what I’d learned and -perhaps more importantly- what I hadn’t learned.
I had time to think about the challenges that I’d faced in trying to learn more about practicing “Walk and Talk” therapy, including:
· Lack of awareness and people not knowing what “Walk and Talk” is
· Misconceptions about it being a “new age” concept
· Lack of quality training outside of CPDs
· Safeguarding for vulnerable clients
· Lack of proper guidelines
· Limited information or concern about delivering quality therapeutic experiences
· The relaxed attitudes of therapist towards what I consider to a method of practice that deserves to be taken more seriously.
Reflecting on all of this, I came up with the following idea:
What if there was a professional association similar to the BACP but specifically for outdoor therapies?
After first presenting this idea in class, I was informed that the BACP has it’s own “special divisions” catering to niche interests such as children and young people, spiritual and pastoral counselling, and even coaching.
At the very least, I thought that it might be a good idea to have one for outdoor therapy and, honestly, it seems strange to me that there isn’t such a “special division” in the first place.
In the absence of such a division, a dedicated association could help address many of the issues listed above, including:
Lack of Awareness
Though it may not have always been known by this name, the practice/concept of “Walk and Talk” therapy has been around for a very long time.
Sigmund Freud was known to walk with his clients around his University in Vienna, so it could be argued that “Walk and Talk” is almost as old as modern psychotherapy itself, and yet it’s nowhere near as widely known as other forms of therapy.
This is evidenced in how difficult it was for me to find anyone to talk about it from a client perspective, and by the fact that it gets nowhere close to the kind of attention or serious consideration given to “in room” therapy.
This is disappointing.
As we’ve seen, “Walk and Talk” Therapy can be really beneficial, and a lack of awareness may mean that some people are missing out on a therapy that could prove to be incredibly useful to them, all because they simply don’t know that it exists.
A professional association (or at least more attention from an existing association) could work to raise awareness of “Walk and Talk” and other outdoor therapies.
If more people knew that it existed, there’s every chance that more people who would otherwise dismiss traditional “in-room” therapy may seek it out as an option for help.
There were times when I was discussing my research with friends and family members in which they saw it as some kind of “new age” thing that was basically one step removed from “tree-hugging,” modern spirituality, or some kind of pseudo-science.
While there’s absolutely nothing wrong with spirituality, the combination of neuroscience (increase in serotonin etc.) and what we know about the value of good therapy certainly elevates this practice beyond merely a “new age” gimmick.
Such misconceptions trivialise a legitimate form of therapy, and this trivialisation could put people off accessing something which could actually help them.
Part of the awareness-raising work of a professional association could involve legitimising outdoor therapy and presenting it as a viable option for people who may be otherwise put off other forms of therapy.
The association may even be able to invest in research to provide more evidence about the effectiveness of outdoor therapy.
This research could be used not only as the basis of an awareness-raising campaign but also to inform training and guidelines as recommended by Revell & McLeod.
Lack of Proper Training and Safeguarding
As discussed earlier, outside of a handful of CPDs, there’s not much training for therapists working outdoors.
Technically anyone could run a course teaching you about outdoor therapy but it would always be optional.
I don’t know about you, but I find it weird that I could qualify as a counsellor on a Friday and start “Walk and Talk” the following Monday with no practical experience or accreditation.
Throughout my research, I got the impression that the attitude of the counselling profession seems to be that no real training is needed and that good old-fashioned common sense would suffice.
I have to keep my own inexperience in mind here and consider that they may be right and I may be wrong, but as a student counsellor, it just seems baffling that very little exists on how to ensure the same kind of meaningful therapeutic experiences outdoors that you’d get indoors.
This got me thinking that professional association could help to formalize an approach — maybe even devise a formal qualification.
It could arm therapists with the skills, practical experience, and knowledge they need to deliver walk and talk safely, effectively, and ethically.
What’s more, a formal approach to training could help to further legitimize “Walk and Talk” therapy and other outdoor therapies in the eyes of clients and thus present is as a viable option for those who may be put off traditional “in-room” therapy.
I still believe that “Walk and Talk” therapy is a legitimate way to help people that can prove incredibly beneficial.
However, it isn’t given same kind of legitimacy or serious consideration as other therapeutic approaches.
Even practicing therapists seemed to have a very relaxed attitude towards it while the industry’s most recognisable professional body didn’t seem to take it too seriously until it was absolutely necessary.
Ultimately, all of this left me with a feeling that, as invaluable as outdoor therapy can be, there simply isn’t enough out there to help therapists deliver it safely, ethically, and above all, effectively.
Of course, there’s an insecure part of me that wonders if I’ve got this all wrong. I have to acknowledge my own inexperience and respect that those who got here before me must surely know what they’re talking about, but it’s this very same inexperience -coupled with a determination that if I’m going to do this, I’m going to do it properly- that led me to the conclusion that there really needs to be more out there for outdoor therapists.
It just doesn’t sit right with me that somebody with no prior experience could set up shop as an outdoor therapist armed with little more than common sense and an umbrella, especially when what may be common sense to you may not be to me, and vice versa.
This is why I feel strongly that outdoor therapies could benefit from their own professional body, or at least better represenation and support from bodies such as the BACP.
At the very least, such an organisation could work to legitimise the therapeutic approach and present it as a viable alternative for clients.
At most, it could ensure that therapists are equipped with exactly what they need to ensure that those clients are able to engage in truly meaningful therapy which is surely the whole point of what we do, is it not?