Could walk and talk therapy become the norm?

Before we all were forced to slow down, most of us tended to think of spending time in nature as a benefit, something we squeeze in between all our running around. But, as studies have shown, getting outside should be considered more than a luxury. We should think of it as a requirement for both physical health and optimal cognitive function. In fact, one 2019 United Kingdom study shows that a minimum of 120 minutes of outdoor time per week is associated with higher levels of self-reported health and well-being.

As the 2020 pandemic churns onward, therapists are looking for new ways to connect beyond the limitations of Telehealth. While some psychologists have long been prescribing outdoor time as “homework,” there are others who go a step further and incorporate outdoor time into therapy. Could this “walk and talk therapy” become a new normal for those who want to meet in person but are restricted from doing so?

As an intern at a residential treatment center for adolescents, Heidi Wells, Psy.D, first began to encourage walks across the beautiful campus as part of therapy more than a decade ago.

Finding it an enjoyable way to get herself out of her office chair a few times a day and to give her clients another option for therapy, she has incorporated it in her Massachusetts and Maine practices ever since.

She has found that, for many of her trauma patients, walking helps them work through emotional stress.

“Walking helps to move energy through their body,” she said. “That is important if they are working on processing their emotions. I would be in my office and someone with trauma would be jumping out of their skin, having a hard time sitting still, so I would say ‘let’s go out for a walk.'”

Anne Cooper, a postdoctoral psychologist at Medical Psychology Center in Beverly, Mass., has been offering outside therapy for all clients and found that, before COVID-19, about 50 percent took her up on it. With the pandemic, she is seeing a rise in client inquiries.

“I noticed, especially more recently, an increased interest in walk and talk therapy,” she said. “More people have been interested in finding alternative ways to meet with clinicians and doctors.”

Like any treatment modality, walk and talk therapy may not suit everyone. There may be physical difficulties with moving. Or, for some with more acute symptoms, there may be distractions or perceived dangers.

“Walking therapy is not a good fit for all clients at all times,” said Marciana J. Ramos, Ph.D, a clinical psychologist with a practice in Winchester, Mass.

“Since walking therapy occurs outside of the traditional therapy office, the client and therapist may encounter passersby during therapy sessions. For some clients, this possibility may create anxiety or discomfort that is not in the best interest of the therapeutic process.”

Some of the important factors to remember when thinking about adding the option of walking therapy include being aware of the limitations. For instance, picking up on non-verbal cues can be more difficult when not sitting face to face. Of course, some clients will open up more if they feel they are under less scrutiny.

Be aware, however, that open discourse may not meet the same confidentiality requirements as an in-office meeting.

“I can’t promise the same confidentiality when we are walking,” said Wells. “Some kind of confidentially statement is vital and I repeat it every time. That is an ethics issue and I think it is important.”

Walking outdoors could also open a therapist up to liabilities just by being outside.

“There is a waiver I have created with my practice to cover anything that might happen,” said Cooper, “If someone were to twist an ankle or something.”

Wells also recommends making sure to let the client know that taking therapy outside is a choice.

“If you say to someone, `would you like to walk today?’” she said, “they might agree because they think that’s what you want. Make it really clear that it is one option amongst other options.”

Since getting outside is so important, the additional time doing it in therapy may help encourage clients (and the therapist) to find time to incorporate more al fresco activities at other times.

“Walking therapy increases activity level during the sessions,” said Ramos. “For some clients, walking becomes a method of reflective self-care that extends outside of sessions and even beyond the course of therapy.”