I see my therapist monthly, on a high floor of an office building in Washington DC’s bustling Georgetown neighborhood. Night is always falling when I ride the elevator up to her office. Even though its workday occupants, with their laptops and business casual slacks, have all left, an air of industry follows me into her waiting room, where a clock ticks like a rigid metronome against the classical concertos piped in from an invisible stereo system. From the window, the view is an Escher-like scene of almost identical buildings as far as the eye can see.
When my therapist emerges, broadly smiling to beckon me back, I feel myself relax a bit into the prospect of an hour of kindness and support in a city where work trumps any other human activity. But when we sit down across from one another, on two sleek leather chairs with matching ottomans, my body tightens up again with the pressure to meet some kind of expectation. Her smile loses its freshness as she interlaces her fingers in her lap and waits. What, she seems to be saying with her at-the-ready listening posture, will you be accomplishing tonight?
I often wish this would go differently. Perhaps at the moment in the hallway when she’s wearing that cheerful smile, and it still feels like I’m meeting a caring friend, we could shift the mood her office and our ritual seem to impose. In my fantasy, we’d leave her polished furniture behind and head down to the nearby river, where we could position ourselves under the glow of lamplight and peer into the swirling water while we chat. What a relief it would be, every once in a while, not to feel as if I had to produce something to talk about, but to have the space and setting to look out at something together, and for a moment, just be.
I’ve never asked to switch things up in this way. She’s the professional, and I respect how she does her work. And of course I know therapy is about more than good vibes and easy times with someone. My therapist is taking my money in part to take me and my needs seriously, not just to take me outside for a break.
I also know that when she offers me that closed door and an uninterruptible space, she’s observing what is professional protocol for many therapists. It’s certainly true that if I wanted to kvetch cruelly about others in my life or rail and scream into all that ageless leather in her office, no one—save the building’s night janitor—would likely ever hear me. Maybe on some level it helps us clients to know the possibility for a complete and private breakdown is there. After all, who would want to fall apart where everyone could see?
But beyond helping clients let loose in this way, are there other solid reasons why therapy is typically an indoor activity? Have we really asked ourselves if closing a door on the outside world ensures the best healing scenario? And are we sure that the claustrophobic atmosphere of an office doesn’t get in the way?
After all, if we didn’t have the office to go into, couldn’t the therapist–client interaction still be therapy?
Take It Outside
It turns out I’m not the only one with these questions. A growing group of practitioners are arguing that good therapy can take place beyond four walls. Billing themselves as walk-and-talk therapists, they stroll with their clients in public, not just every once in a while, but for almost every session; some have even conducted research into why both therapists and clients, once they’ve tried it, don’t want to go back indoors.
On a recent, sunny lunch hour, I met Jennifer Udler, the owner of Positive Strides Therapy, in the DC suburb of Rockville, Maryland. Udler beat me to the trailhead where we’d agreed to meet. When I spotted her, she was leaning against a waist-high rock wall, which was serving as a container for dense shrubbery and young, soft-limbed evergreens that shadowed the edges of a paved walking trail behind her.
Outfitted not in the casual office attire I’ve grown accustomed to with therapists, but in a gray cotton T-shirt, black skort, and Teva sandals, she looked more like a personal trainer of sorts. Beside her was a wooden bench we’d designated as our meeting spot. I’d soon learn that in a practice where she both greets and leaves clients outside, the bench is what passes for a seat in her waiting room.
Udler is bubbly, with a wide smile and, at least on this early fall day, an enviable tan. An occasional marathoner, she first came up with the idea of striding with clients while remarking to an acquaintance in her running club that the members, who don’t socialize much outside their shared runs, tell each other the most intimate things while in motion.
“You should do therapy while running!” the woman exclaimed.
“Interesting idea,” Udler tells me she thought at the time, “but what if I get a fast runner and can’t keep up?” Later, as the idea of therapy in motion stuck with her, she decided, “You know what does make a lot of sense? This walking thing.”
“This walking thing” now happens all year long for Udler, whatever the weather. She pays for part-time office space and will duck into it with clients for the occasional inclement day, or sometimes to do intakes. But mostly, she and her clients check in by phone or text about the weather and locations and almost always agree to dress for it and head out anyway. Working in an office when they can walk, she says, has lost its appeal.
In fact, a client from when Udler used to work inside recently returned to therapy and told her he preferred this new way of working both because the exercise felt good and because the whole experience was more relaxed. “There’s less pressure and awkward silence when you’re out and moving, and you don’t have to worry what the therapist sitting across from you is thinking,” he said.
Going Public with Feelings
As she and I start down the trail, we walk slowly and closely enough to hear one another. When I ask her if our gait needs to change, she tells me there’s no perfect speed and no expectation for distance. The pace of the walk is set by the client.
This small responsibility thrills me a bit, and I glance down the trail to decide what speed makes sense. It’s fully paved, with about 500 yards of tree cover that opens up to sun and sky. I decide I’ll take it slow at first and maybe move it along later, when we’re under full sun.
“I always try to match the client’s pace,” Udler says. “Being a runner, I’m usually ready to go, but I’ve had some very depressed people who walk slowly, and I go as slowly as they want. Sometimes we’ll cover less than a mile in 50 minutes. Then I’ve got some pretty anxious teens who are on the cross-country team, and they really move!”
Although she sees a variety of clients, Udler specializes in teens. And as we continue in step alongside each other, I can easily imagine what a relief working this way would be for a kid.
Ambling along feels more empowering than that constricting feeling that can follow taking a seat across from a therapist; and walking offers a reprieve from eye contact. Udler and I periodically look at each other as we chat, but we have to watch the path too, to keep our footing.
Once we’ve headed down the trail, a couple of joggers run around us—a reminder that we’re navigating a shared space and need to stay aware. But in place of that eye-lock pressure of an office session, I already feel as if I’m getting exactly what I’d been wanting: the informal, soothingly familiar, more relaxed feel of taking a healing walk with someone.
Aside from keeping up this modest awareness of our surroundings, we face fewer distractions to talking intimately than one might think. The trail’s pleasing mix of trees and well-kept backyards are set back from the asphalt. Overhead, a bird occasionally casts a quick shadow, and at our feet the pavement is clear, save for the rare caterpillar or beetle trundling into our way. I find myself noticing, but not concentrating on, the other humans who pass us. They certainly don’t care about us either. Many of them have headphones in place.
It’s highly doubtful anyone who didn’t know Udler on this trail would suspect that she’s a therapist: we really do look like nothing more than friends catching up. But I think about the protective soundproofing of my therapist’s high office and ask her if clients might be hesitant to share in the same ways out in public.
“Do they feel they can’t go as deep with you out here as they do inside? Are they concerned about others overhearing them? And what if they need a good cry? Are they too self-conscious?” I wonder.
“All the parks I choose for these walks are lightly populated—for safety’s sake—but there’s not enough foot traffic for clients to feel super self-conscious,” she replies. “There have been times when another walker is very close: some clients will go right on talking; others, in nuanced ways, will communicate that they’re uncomfortable. So I’ll say, ‘Do you want to stand here for a minute and look at this flower?’ Or perhaps, ‘Shall we talk a little softer?’”
Before heading out with Udler, I’d spoken with Denice Crowe Clark, the owner of Atlanta’s Sole to Soul Therapy, who practices in the city’s Piedmont Park, a larger and more crowded setting than the one Udler and I are in. Clark did her dissertation on walking with clients and reports that being outdoors around others can change a client’s experience of their emotional struggles by bringing them into an immediate awareness of a bigger world—one full of people who may well be trying to sort through similar problems.
She asked her interviewees if it mattered if those other people heard them. “At first,” she said they told her, “they worried about who might see them walking out there with their therapist and what they’d say if they ran into somebody they know. But then they came to realize that nobody’s really paying attention, nobody cares what you’re doing, and anybody could see you walking into your therapist’s office anyway. If they do run into someone, they typically just make the introduction, ‘Here’s my friend so-and-so,’ and then everybody goes on their merry way.”
I think about some of the things I’ve said in public spaces to my friends and family and realize there’s little I could say to Udler out here that I’d worry about others overhearing. Still, I think, as we pass a small playground, I might feel a little self-conscious about bursting loudly into tears.
I ask her about that, Udler pauses, unzips an inconspicuous black bag belted around her waist, and shows me her pack of tissues. Crying does happen regularly on the trail, she explains, but there’s a different quality to tearful outbursts when walking and talking. A New York practitioner named Clay Cockrell, who works in Central Park and is often credited with founding modern walk-and-talk practice, says that when clients escape an office—where they’d be forced “to sit in their feelings”—and walk instead in an open setting, it’s often easier for them to move through the emotional issues they’re dealing with. They make a sort of literal progress as they go.
I ask Udler about this, pointing out that some might say it’s a bad thing not to be able to “sit” with one’s feelings. “Isn’t that a fundamental promise of therapy?” I ask.
“I’ve found that a person who really needs to break down is going to do it anyway; being outside isn’t much of an impediment,” she says. “But truthfully most clients don’t do it that often, whether inside or outside. I have a man who gets emotional every once in a while: then he zips it back up and keeps walking, and maybe that’s okay. We might want to ask ourselves, ‘What’s wrong with feeling in control?’ When I worked inside, I remember people letting it all go and really falling apart in a session, and then never coming back.”
The Venn Diagram of Healing
Being out in nature, as most of us know by now, has its own healing properties. Eco-therapists have long prescribed it for mental wellness, urban planners include or revive green space in cities to reduce residents’ stress, and countries around the world encourage their citizens to get out for walks in parks and woods—what’s called “forest bathing” in Asia. Udler considers it an essential part of the healing she’s generating for clients, and ultimately says she thinks of the power of walking therapy as the intersection of three central components: nature, movement, and talk. She calls it a Venn diagram of healing.
“The therapeutic skills and training that I have, that’s the biggest piece. At a basic level, the walking frees us from the sense of being so stuck in life. We can keep going; we can work things out. People feel better when they’re moving. It gets the dopamine going and often allows them to generate new ideas and more positive thoughts. Nature is my partner. It’s soothing in an essential way, and I use it throughout the session as a source of metaphors for life and a way to ground my clients, especially with mindfulness exercises.”
To illustrate, she suggests we stop and face a tree. The particular tree she chooses is paler than the dark-trunked trees around it, with soft, fernlike leaves and twisting branches. Its elegant tangle of knotted, bare roots extends from the minor hillside above us to the edge of the trail. She tells me to stand comfortably for a moment, take in the sight of it, and tune into the sounds and sensations I’m experiencing. “Breathe in deeply and say ‘I am,’” she guides me. “And on the exhale, say ‘here.’”
We do this exercise, which she learned from Life Force Yoga’s Rose Kress, together, our eyes open, until I start to marvel that I hadn’t noticed this tree when we’d first passed it. As we keep repeating the phrase and I become focused enough to absorb the stunning natural complexity that’s in front of me, my feet feel as if they’ve momentarily grown roots of their own, and I can hear birdsong. As we step away, a cobalt blue butterfly the size of my palm flies between us. I shake my head at the wonder of it all.
“That was an amazing thing to take in, with the sun and the sounds and the smells,” I tell her. “It felt fundamentally different from doing a mindfulness exercise indoors.”
She nods enthusiastically, and we stay where we are for a minute and talk about whether the heightened sensory experience of being outdoors makes the moment feel richer and more memorable. A week later, as an airplane I’m in dips and shudders in turbulence, my chest tightens and breath goes shallow, and the tree comes back to me. I close my eyes, think of its aged roots, the dappled sunshine, and the butterfly, and easily ride out the panic.
More Bang for Your Buck
By now, we’ve turned back toward the start of the trail, where there’s more of a tree canopy, and our surroundings become more verdant. As we move along, Udler talks about the ways she incorporates these surroundings into her sessions. Walkways over brooks become places to do mindful exposure sessions as clients imagine crossing higher bridges in cars. Butterflies are reminders of metamorphosis for clients stuck in pain and fearing they’ll never be free of it or feel alive again. The quality of therapy isn’t necessarily different from what she’d do inside, she says, but all this nature and movement give her new tools to make it all come alive.
“Since I’ve started doing this work full time,” she says, “one case that stands out for me is a thirteen-year-old boy whose dad had died very suddenly. The boy didn’t understand his grief and would vacillate between anger and sadness, not knowing what to do with himself. He talked a lot about the anger getting in his way. During a session in the fall, we were collecting acorns as we walked, and it got to the point where I was holding them for him and my hands were full—to the point that they were getting to be too much to carry.”
We slow to a stop, and Udler turns both of her palms up like cups. “I suggested to him that all these acorns represented all the anger he’s carrying, including the anger of being abandoned. And we’re just going to leave them in the bushes and let them be there, and if an animal eats some, it’s okay. ‘You can let this go,’ I told him. It was such a silly thing that I did on a whim, but he was so relieved. He said later I was right: he didn’t need to hold onto all that anger, and putting the acorns down made him feel much better.”
As we keep going toward the start of the trail, I give some thought to what we’ve shared and seen on this walk: acorns, butterflies, trees, sunshine, other people passing by with their own thoughts and needs. With the indoor frame we currently have for therapy, we might mistake these things for potential distractions—but outdoors, I feel as if they’ve brought to life my sense of being part of a larger system, one that holds us all, and in which each of us, by turns, like the boy with the acorns, suffers and thrives.
Rather than secretly tending to our pain in an isolated room, might being out and moving in the world serve as the ultimate reminder that our pains are shared and mutable?
As we come out of the sunshine and go into the shadows of branches near the trailhead, the restful feeling I’ve gotten from walking and talking for all this time is tinged with regret for our stopping. That regret is a familiar experience for clients who work indoors, too, but having to leave a therapist and go back indoors is intensifying that feeling for me. I can imagine that the reverse—anticipating the next session—might also be stronger.
Don’t get me wrong: I look forward to seeing my therapist each month. I think just knowing that she’s there, and that there’s an hour on the calendar just for me to download the stuff that’s overwhelmed me between our sessions, takes an edge off my anxieties and frustrations. But if I were meeting her out on a trail, with the two of us able to move together, and the promise of the sun shining down, I have a feeling my anticipation might take on an even warmer and more energizing hue.
I imagine Udler’s lucky clients might also feel some of what I’m feeling, but who’s likeliest to benefit the most from adding nature and movement to therapy?“Going outdoors isn’t for everybody,” she says, “but the mind–body connection becomes really tangible when you work this way. It seems especially suitable for the anxious adults or the teens I see. When we do breathing exercises outside, or expend more energy going up a hill, it’s a living, breathing reinforcement of the mind–body connections I’m trying to help them tap into. Outdoor sessions are particularly good for working through anxiety and anger.
“Just yesterday, I saw a client who was angry at the two most important people in her life: her partner and her mom. We were scaling a bit of a hill, and she was into her anger as we struggled in the heat and the dust to get up this hill. We talked about how part of coping with her overwhelming feelings could be accepting that she could pause them, and, just as we hit on that, the trail became flatter, and the repair work we were doing seamlessly fit with the setting. It’s the same sort of therapy we might’ve done inside, but this is what happens with walk-and-talk therapy. Out here, you get more bang for your buck.”
Good for Clients and Therapists
After walking with Udler, who has an infectiously upbeat and positive presence, I wondered if encouraging my therapist to go outside might also be a win for her.
Clark, who came to walking therapy after burning out in an especially bleak indoor environment, says working outdoors definitely offers psychological benefits for practitioners. She used to practice in a converted mall, in treatment rooms that were mostly windowless squares. The only light came from the former mall entrance, where a bank of glass allowed the sun to shine on the reception area.
Clark would dash out of there for every lunch break just to get some natural light, and the minute she got home, she’d go for a run to be soothed by the natural world. “It was miserable to be inside, and I would bolt out that door. I knew I needed nature and physical activity, and then I read about walking therapy,” she says. “I couldn’t do it there: we were surrounded by asphalt. But once I moved near the park, that was it. I opened up this practice and never looked back.”
Maybe clients and therapists sit down together not necessarily because it’s a better way of working, but because it’s a practical way of doing business: there’s an office address that doesn’t change, a space where the weather is never inclement, and no one has to lather on sunscreen or don a heavy coat. Maybe walking just sounds tiring, or we’re not so able-bodied anymore.
But in just one relatively short walk with Udler, I discovered a quality of experience that felt fundamentally different from the usual office-bound encounter. The more she and I propelled ourselves alongside each other, the more grounded in my body and in nature I felt. All the fresh air and natural light and trees and harmless critters, rather than creating distractions and impediments, seemed to open me up to a fuller, more embodied internal exploration—like a hike in the woods reflexively does for so many of us. Later, on the train back to my home, I did have a chance to “sit” in my feelings. And as I looked out the window at the blurring trees, I felt an echo of the ease of moving beside Udler, talking freely. It was mixed with a sense of gratitude and a pinch of excitement at the prospect of a new, more relaxed way to heal.
Ultimately, I don’t know that therapists’ reasons for seeing clients exclusively indoors add up. After all, isn’t there a downside to meeting all the time within a man-made space designed primarily according to one person’s idea of what’s therapeutically appropriate and professional? I still want to go back to my lovely indoor therapist, but I also look forward to letting her in on my new, more capacious experience of connection. And to talking with her about whether meeting within four dry walls really matters as much as we think.
Lauren Dockett is the senior writer for Psychotherapy Networker. Rich Simon, PhD, is the editor.
PHOTO © LEO PATRIZI
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