Covid has transformed the way many of us work and that includes the people who look after our mental health. For much of lockdown, psychotherapists, counsellors, psychologists and psychiatrists have all had to venture into the world of online therapy, tackling their clients’ issues via a computer screen, and often the experience has felt less than ideal for all those involved.
But throughout much of lockdown, another option has become increasingly popular: combining therapy with the benefits of the great outdoors. The British Psychological Society (BPS) issued guidance on this outdoor approach last summer, advising its members on how best to take their work outside, addressing issues such as confidentiality and the absence of a boundaried space. Yet many therapists ditched the four walls and a couch approach a long time ago and have been working out in nature for years.
Psychotherapist Beth Collier is founder of the Nature Therapy School, which offers training to psychotherapists who want to practise outside. “Working outside is something that needs to be thought through by the therapist and reflected on with their supervisor or in a training setting,” she says. “There are boundaries and dynamics to be managed.” Collier walks with her clients in the woodlands and parks of Croydon, south London, and finds nature is more than simply a pleasant backdrop.
“There’s something hugely freeing about being in open space and some people go deeper far sooner than they would do in a room,” says Collier. “The part of the brain that is responsible for ruminative and negative thoughts – the subgenual prefrontal cortex – has been shown to quieten when we connect with nature, which gives people more space to process their problems.”
Collier also learns a great deal about a client from their body language, and how they respond physically to their environment. “Movement is a really meaningful part of the work – pace, the direction they choose to go in, whether they choose to pause, to lean against a tree or sit down. For example, people often walk faster and keep going if they’re angry or frustrated.” All these can offer insights and clues to their state of mind.
Sarah, 35, tried outdoor psychotherapy three years ago when she was suffering with severe depression and anxiety. A friend suggested that, as someone who loves being out in nature, she might seek the help of Lara Just (adadsu.com), a psychotherapist who works outdoors in Somerset and on Hampstead Heath in north London.
“I’ve always found nature soothing, so I was attracted to the idea,” says Sarah. “Lara immediately picked up on the fact that I was drawn to being under trees and touching them, so that quickly became an important feature of our sessions.” Sarah found it deeply reassuring to return to the same spot and also took comfort in the inevitability of each season. “You feel like part of the landscape – you see nature move on and change as you move on and change through the therapy. The seasons can reflect the therapeutic process – the renewal of spring, the shedding of old leaves in autumn.”
Collier also finds that this shift in seasons and the weather is key to exploring a client’s feelings. “Their response to the outdoors can reveal a lot about them and offers opportunities for reflection,” she says. “The rain might feel oppressive and unpleasant for one person and raw and exhilarating for another.”
This way of working also lends itself, she says, to supporting people who’ve experienced trauma. It can be easier to discharge difficult emotions – particularly fear and anxiety – through movement and pace, rather than being confined to a chair. “They might also feel more able to touch on uncomfortable feelings because they dissipate sooner, whereas in a room, they may hang around for longer,” says Collier.
There can be something more freeing about the idea of walking and talking, without the pressure of eye contact, away from the more enclosed environment of the consulting room.
Sarah certainly felt this was the case for her. “My breakdown was caused by unresolved traumas from many years before, such as the sudden death of my father in my early 20s. When that trauma started to come out during my therapy, I would have felt trapped in a room. Instead, I was in this neutral space where I could draw wisdom from nature as Lara questioned and reflected with me.”
Other therapists who work outdoors take it up a notch and use the outdoors in a different way. Psychotherapist William Pullen runs with his clients, practising what he has coined Dynamic Running Therapy.
After experiencing a period of depression 12 years ago, he went into therapy and also started running with a friend. Pullen believes it was the combined effect of the two that brought him back to health and when he went on to qualify as a psychotherapist himself, he offered outdoor sessions combining the two activities.
“We have a thinking brain and a doing brain,” Pullen says. “During periods of anxiety and depression, the thinking brain can go into overdrive and cause unhelpful ruminative thoughts, and we can lose motivation for almost everything. By moving our bodies, we can shift again towards the doing brain, discover that it’s still in there somewhere. It seems to bring hope and light back into people. Movement can also combat that feeling of being stuck, and we can work through a problem by literally moving from A to B. Being in nature has its part to play, but, for me, it’s the movement that’s the medicine.”
Pullen finds that men especially benefit from the format that he offers. “I think they find the side-by-side interaction more comfortable, rather than having to sit in a chair and look at me,” he says.
It tends to be people who already run that come to him, but the client leads the pace and direction. “This makes the power balance more even and can aid the therapeutic alliance,” says Pullen. “They have more ownership of the space than they do in a room.”
This echoes Sarah’s experience with her therapist. “I found it to be very democratic,” she says. “Everything was self-directed – I could walk where I liked, choose which path to take, when to sit down or lean against a tree. I was tentative at first, afraid of leading the way, but my confidence built up and the sessions had a real sense of exploration.”
The work of Collier, Pullen and Just within urban green spaces also shows that outdoor therapy isn’t only the preserve of people who live rurally. “Nature does not have to be wilderness and mountains,” says Collier. “As we’ve increasingly appreciated during this pandemic, parks and public gardens are incredible green spaces – there are lots of ways to connect with nature within them, too. Many of us live in survival mode in towns and cities, but when we immerse ourselves in green space, we remember what makes us feel good.”
“Find someone you like and trust to go on an empathy walk or run with you,” says William Pullen. “You decide on a set amount of time to speak (10 minutes, for example) and you talk about whatever you need to while the other person simply listens. At the end of that, they repeat back to you what they’ve heard. They don’t offer solutions, but simply allow you to feel heard. You then do the same for them. There is no pressure involved as no one is being asked to come up with answers. It just provides a small moment of community that can be so helpful if you’re struggling.”
William Pullen’s book, Run for Your Life: Mindful Running for a Happy Life, is published by Penguin at GBP9.99. Order it at guardianbookshop.com.
For more information on outdoor therapy: nature therapyschool.com and counselling-directory.org.uk