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News / Health / Health Wire

More Seattle-area therapists are taking their sessions outdoors

By Taylor Blatchford, The Seattle Times
Published: June 1, 2024, 6:00am

SEATTLE — It’s no secret that spending time in nature has mental health benefits. Getting out into the natural world, particularly green spaces like parks and forests, can improve mood and attention, lower stress and reduce the risk of psychiatric disorders.

A growing number of Seattle-area therapists are incorporating nature into their practices, meeting clients outside in local parks and green spaces for talk therapy sessions. They say the practice, commonly called “walk-and-talk therapy,” enhances traditional one-on-one sessions while bringing clients the benefits of being outdoors.

Walk-and-talk therapy is just one form of ecotherapy, a category that can include different types of nature-based activities like wilderness therapy, forest bathing and classes focused on plants and the natural world.

Even within walk-and-talk therapy, sessions look different depending on the therapists’ approach. For some, nature is primarily a setting for a conversation; for others, plants, rocks or water are integrated more directly to connect with what a client is discussing.

Research on walk-and-talk therapy is still limited but backs up these experiences. Studies have found that outdoor sessions stimulate thinking, help the flow of conversation and facilitate the connection between mind and body.

“It’s a pretty big gift as therapists to be able to have our sessions outside, but it’s also great for people who don’t want to be inside to be able to have these alternatives available,” said Seattle therapist Ari Bonagofski. “As more people become aware of ecotherapy and the different types of nature-based therapies available, I think it’s only going to continue to grow.”

A growing practice

Walk-and-talk therapy wasn’t as common in Seattle before the COVID-19 pandemic forced therapists to abruptly switch to holding sessions on Zoom or other video platforms.

Becky Robbins, a therapist in Bothell, was in an ecotherapy training program in 2020 when the pandemic hit. Clients started asking her if they could see her outside, particularly those who had just moved to the Seattle area and had no “bubble” of people to safely spend time with in person.

Her office was next to a private beach in Edmonds, near the ferry terminal, which gave her an opportunity to hold sessions outside.

“I almost instantly became a nature therapist because I wanted to see people in person and I didn’t want to be Zoom all the time,” she said. “The pandemic actually really helped as far as getting to learn how to do all of that, working with people and putting it into practice.”

The Seattle Times spoke with eight therapists with experience with walk-and-talk therapy for this story. Most said nature therapy was barely discussed in their formal schooling, and they learned more by doing their own research.

Robbins teaches classes that help other therapists understand the legal and ethical considerations involved in holding a walk-and-talk session. She says interest in outdoor therapy is rising, and other Washington therapists agree.

“When I started, I only knew of one other therapist doing this work,” said Rachel Duthler, a Seattle therapist who holds individual outdoor sessions and leads outdoor group therapy trips. “Now there’s a nature-based therapy Facebook group for providers, and a number of people popping up and offering this. I think it’s been growing.”

What does the research say?

Academic research into walk-and-talk therapy has primarily focused on the therapists’ perspective. Denice Crowe Clark, an Atlanta-based therapist, focused her Ph.D. dissertation on three clients’ experiences with walk-and-talk therapy.

Some clients were initially hesitant to try walk-and-talk therapy, but they enjoyed the outdoor setting and told her it was equally or more therapeutic than indoor therapy. Walk-and-talk therapy could also “normalize the experience of therapy for some and reduce the stigma associated with seeking help for mental and emotional issues,” she wrote in her 2019 dissertation. Clients told Clark the natural setting made them feel more comfortable than walking into a therapists’ office; others in the park weren’t paying attention and didn’t realize they were in a therapy session.

“They felt like more things came up for them when walking side by side,” Clark said in an interview. “It was less intimidating. Content and conversation just flowed more effortlessly.”

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Professor Arie Greenleaf built on this work while teaching at Seattle University, interviewing clients after walk-and-talk sessions at Cal Anderson Park. Six out of seven participants in a 2023 study reported the outdoor sessions spurred creative thinking and helped them process thoughts and feelings more clearly.

“That’s exactly the state of mind you want a client to be in: problem solving, creative, open, mental clarity,” said Greenleaf, now a counseling professor at Nova Southeastern University in Florida.

Outdoor therapy sessions also put therapist and client on even footing, Greenleaf said. In a traditional session in a “counselor’s lair,” the environment is out of the client’s control: The therapist has chosen the furniture and decorated the office, and their degrees are often hanging on the wall.

“It levels the power differential and puts people at ease,” Greenleaf said. “They’re more likely to open up in that way.”

Some therapists use the natural surroundings directly, as an integral part of their conversation during sessions. Kaela Koepke, a Seattle therapist, focuses on the specific qualities of plants and trees and brings them into her work with clients, helping them examine their natural posture and movement.

“A cedar is really soft and swoopy. Douglas fir is straight and stiff and tall,” Koepke said. “If you feel like your body is rigid, cedar can help you soften. If you feel like you’re collapsed, Douglas fir or alder can help bring more strength and structure.”

“We can do therapy in a more holistic way”

There’s a lot that therapists must consider before deciding to hold sessions outside, starting with a mental map of the park or space they’re using. Where are the bathrooms or water fountains? What does foot traffic look like at different times of the day?

“It is as simple as taking your therapy session outside, and yet it’s not,” Clark said. “There are a lot of components in walk-and-talk therapy that therapists who haven’t done it before, and clients, don’t consider.”

Comfortable walking shoes are a must, and clients should be prepared to handle allergies or other environmental concerns. Western Washington’s rain is a factor, too. Duthler, the Seattle therapist, said people are usually prepared to dress for the weather year-round, but occasionally “it’s just too much” and she’ll move a day of sessions to telehealth.

It’s impossible to guarantee privacy for a therapy session in a public park. Therapists said they discuss this up front with clients and talk through different scenarios; some have clients sign an additional consent form before outdoor sessions.

“There’s always the chance somebody might recognize me as a therapist or recognize the client as a friend,” said Sam McCann, a therapist and co-owner of Green Coast Counseling in SeaTac. “We talk about this beforehand and I say, if you’re talking about something hard, someone might see you cry. How do you feel about that?”

But the therapists interviewed said the benefits are worth the extra considerations, for them as well as their clients.

“I’ve seen interest in it grow as people find out more and more that we can do therapy in a more holistic way, and it doesn’t have to fit into the old idea of being face-to-face in a room closed off together,” McCann said. “If we can do therapy in a different way that makes (clients) feel more supported and comfortable, let’s try to make it happen.”