Demystifying Walk and Talk Therapy

Q: I’m interested in having outdoor sessions with my clients, but I have a few concerns. What should I know?

A: By now, most therapists have heard of walk and talk therapy. Although this way of holding therapy sessions has been practiced formally and informally for decades, during covid, there was a surge of interest in it. Maybe you were one of the therapists who weighed the possibility of lacing up your sneakers, heading outdoors, and strolling with your clients. Or perhaps you dismissed the idea out of concern for the professional issues you imagined you might face in working beyond four walls: issues like confidentiality, safety, and even the vague sense that the mere act of walking and talking with a client in public somehow breaks the rules of therapy.

Research shows that walk and talk therapy sessions are as effective as—and sometimes more effective than—office-based sessions, but I, too, was apprehensive when I took my therapy practice outdoors more than 11 years ago. But once I’d researched best practices, checked in with my boards and insurers, and received direction from walk and talk therapists who’d come before me, it was easy to take satisfaction in the work, which I now train other therapists to do. Often, though, I must start these trainings by busting a few common myths about outdoor therapy.

Myth #1: Outdoor therapy isn’t confidential.

The number-one question people tend to have about doing therapy outdoors is whether their confidentiality will be compromised if they’re in a public space. “What if I see someone I know when I’m out walking with my client?” therapists often ask. “Or what if my client sees someone they know? And what if we’re approached by that person in the middle of our session?”

These are valid concerns, and I’ll often address them by sharing what I say to new clients about privacy. Take Nina, who was direct in her intake call. “I like to walk,” she said, “but I’m not sure how comfortable I feel about therapy with you if we’ll be passing by other people who can hear me.”

“Yes, we meet at a public park and walk together on the public paths,” I explained. “So, there is a small chance that others will hear us, but rarely for more than a moment or two. We might even run into someone you know. If that happens, we just wave and keep walking. It’s nobody’s business what we’re doing there together. That said, I try my best to keep our conversation private by directing us away from anyone who stays within hearing distance as we walk. I choose paths that allow for the privacy and quiet we need for a therapy session, but the truth is, in the 11 years I’ve been practicing outdoors, nobody’s ever stopped to ask us if we’re in the middle of therapy!”

Nina, like most of the potential clients I speak with, accepted this answer readily. Nonetheless, I always have my client sign an informed-consent form that states three essential things. Client will take responsibility for their own bodily safety and personal property. This therapist is a mental health provider, not a physical therapist, personal trainer, or running coach. Client agrees they are healthy enough to participate in a 45-minute walk during their therapy session.

I recommend calling your licensing board and malpractice insurance and consulting with an attorney in preparation for writing your comprehensive, personalized, walk and talk informed-consent form.

Myth #2: Outdoor therapy won’t offer a sense of safety and security.

No matter what our clinical approach is, all therapy hinges on the therapist’s creating a sense of safety and security for the client, and rightly so. But I challenge people to consider whether safety and security can be assured only in a building, with four walls and comfortable furniture. In terms of emotional safety and security, I believe that’s provided by you, the therapist, not the environment.

As I’ve mentioned, my informed-consent document requires clients to sign a statement that they consider themselves well enough to walk during sessions. I check in with clients regularly about their comfort levels as we walk. We meet in predictable locations and take familiar routes. We sit and rest if needed. We walk faster or slower if the client wants. And just as I would indoors, I remain a calm and steady presence from start to finish.

“Into the Wild,” a 2020 article on walk and talk therapy in Clinical Psychology Review, states, “Some clients and practitioners feel they benefit from a greater sense of shared ownership of a natural space and . . . whilst a therapy room can provide a safe, stable and containing space, it can also be anxiety provoking for those clients who find a more formal and clinical face-to-face encounter intimidating.”

Many of my clients, in fact, feel freer to be themselves outside in nature than they do inside someone else’s space, no matter how professionally or tactically designed it may be. Walking side by side on a trail, with a therapist dressed informally and comfortably can be a freeing experience.

Myth #3: Walking will inhibit people’s emotions.

People often worry that moving during a session might interrupt the flow of feelings. What they’re really wondering is whether clients will be able to let their guard down and speak freely, cry freely, or even scream freely outside of a contained space. Will the movement, the sounds, and the sights distract them?

I like to reassure practitioners that clients are still coming to therapy needing to process and unload, and they are absolutely capable of doing that while moving and observing things around them. A few months ago, I met my twentysomething client Dylan on a cool, clear day in the park where we usually walk and have our sessions. I noticed the pond had a thin layer of ice on it as I smiled and greeted him on the path. As we set out around the perimeter, he said, without any prompting or hesitation, “I’m feeling really sad today. I didn’t get into the music program I wanted, and I really miss my dad. He would’ve known exactly what to say to make me feel better.”

Dylan’s dad had died suddenly last year, and grief has had a powerful hold on him ever since. He’s been applying to graduate programs that he and his dad had been excited about. While he’s made a concerted effort to carry on with their plan, he’s struggled to move forward every day.

“I’m sorry to hear that, Dylan,” I say. “What sorts of things did your dad say to encourage you?”

While we walk, the unfiltered sun lights our path and sparkles on the water as Dylan thinks. “He’d tell me—.”

He begins to tear up, and I offer him the option to sit on a nearby bench. He knows I keep a travel pack of tissues in my hip bag, but he doesn’t ask for it.

“No, I just want to keep moving, if that’s okay,” he says. “I know I’m going to be sad, and I want to just work on moving through this. As long as I’m walking, I feel like I’m not stuck in my sadness.”

Dylan, and many other clients, feel most comfortable being vulnerable while moving side by side. It feels natural and doesn’t involve an unspoken pressure to look me in the eye. Like all practitioners, walk and talk therapists practice staying with feelings, going deep, and exploring options for growth. Walking and moving in tandem creates an active, emotional energy that supports this.

Myth #4: Nature will get in the way.

On occasion, I’ll need to reschedule a session or move it online because of inclement weather, but nature, wildlife, weather, and terrain rarely hinder good therapeutic work, since they’re all incredible metaphors for life! I’ve come to rely on the elements and natural world as my cotherapists and will regularly incorporate what they represent into our talks. Here are a few examples:

I ask my teenage client to pick up a stick, imagine labeling it with her feelings about being left out of a certain friend group, and throw it in the creek. As we watch it float away, she smiles.

A raging creek after a storm helps a client talk about the anger she feels about her childhood.

Leaves changing through the seasons remind us how change is inevitable in life.

I ask a 10-year-old client to pick up acorns to represent his feelings about his fear of starting at a new school. He piles them up at the base of a tree and decides he’ll leave them there for the week. No need to bring those worries with him.

A young client is upset that she can’t stop thinking her anxious thoughts. Just as we’re digging into this, an owl flies overhead. We pause to take in this beautiful, rare sight, in which we’re thinking about nothing but the owl. Then we marvel at the gift of being fully present.

While I might initially be the one to point out a connection between nature and whatever my clients are experiencing, they soon learn to join me in creating these metaphors on our walks. Just the other day, I was walking with Candace, a client who’s spent decades beating herself up over what she perceives as her limitations in all aspects of life: parenting, work, relationships. As we walked down a wooded trail, we had to avoid overgrown shrubs, mud puddles, downed branches, and rocks. At one point, she paused for a minute and looked around. I braced myself for either a complaint about the less-than-ideal walking conditions or more self-immolation. Instead, she said, “Spring is beautiful, isn’t it? Just look at the greenness of everything, the bright blue sky. Even the birds are chirping.”

“Not only that,” I said, “but you’re noticing that beauty, letting it in. That’s pretty wonderful too.”

She continued to absorb the feelings and sensations of that moment; then, with no prompting from me, she impressed upon herself that this practice of seeing and savoring was worth repeating in different contexts in her life.

Over the years, I’ve noticed how walk and talk therapy lends itself to powerful transformations, much more often than anything I ever did inside four walls. In my experience, and that of many other practitioners, taking therapy outside facilitates clients’ positive revelations.