Therapists exchange the couch for the outdoors
Sometimes a pine cone is just a pine cone.
But one day in January, the rough edges of the cone — and the lone feather sticking out of it — meant something different to Rachel Oppenheimer, 25, a counselor at the Chesapeake Mental Health Collaborative in Towson, Maryland.
“Growing up, I had some challenges,” Ms. Oppenheimer said, referring to her irritable teenage past, “some problems with controlling my emotions.”
But her grandmother, who died four years ago, was as gentle as a feather and gave her unconditional love that reminded Mrs. Oppenheimer how important it was to treat herself with “soothing tenderness,” especially when she became self-critical.
Ms. Oppenheimer and her clinical supervisor, Heidi Schreiber-Pan, were visiting Talmar, a nonprofit farm that offers therapeutic programs and vocational training—a short drive from the busy road and nondescript shopping centers near their office. On the farm, the only sounds were a babbling brook, birds quivering, and several inches of snow crunching under their feet. It was the perfect location to teach Ms. Oppenheimer therapeutic techniques that utilize the natural world.
During their session, they set up camping chairs under a clear blue sky – a makeshift office without walls – and discussed how to create a circular design called a mandala. They then arranged items that Mrs. Oppenheimer found on the floor, all of which symbolized the complex feelings that came from mourning her grandmother.
Dr. Schreiber-Pan is one of them a growing number of therapists who take their therapy sessions away from home and in some cases train other counselors to do the same. They say combining traditional talk therapy with nature and exercise can help clients feel more open, find new perspectives and express their feelings, while helping them connect with the outside world.
“It's the feeling of being part of something bigger – and that, I think, is a very powerful 'aha!' moment for many people,” said dr. Schreiber Pan. As humans evolved, they spent much of their time outdoors, she added, but our modern lives are mostly spent indoors, looking at digital devices.
Outdoor therapy falls under the umbrella of ecotherapy, a broad and vague term that includes activities as varied as equine therapy and outings such as wilderness therapy and adventure. While many therapists moved online during the pandemic, others held sessions outdoors, seeking a safer way to meet in person. But the concept has been around for much longer.
Decades ago, psychiatrist Dr. Thaddeus Kostrubala, author of the 1976 book 'The Joy of Running', known for his jogging next to his patients. The practice never really caught on, partly because most therapists are trained to meet with clients in controlled indoor environments, to maintain confidentiality and strong boundaries.
Now, however, students are being trained in ecotherapy at a few schools, including Lewis and Clark College in Oregon and Prescott College in Arizona.
And some therapists, like Dr. Schreiber-Pan, create their own curricula. In 2020, she founded the Center for Nature Informed Therapy, which offers certification and continuing education credits to any social worker or certified counselor who completes the program. More than a hundred people have graduated so far.
Outdoor sessions are not one size fits all. For example, not every customer will want to walk in the snow. Dr. Schreiber-Pan and other therapists also give clients the opportunity to explore nature indoors, drawing from a collection of shells, rocks, sticks and spiky gumballs. And there is no special license for this therapy – no established best practices that prescribe the exercises or activities therapists should use when meeting with clients outside the home.
Some in the field are suspicious of the emerging discipline. Dr. Petros Levounis, the president of the American Psychiatric Association, said he would be a bit “skeptical” about taking a patient to the park.
“There is a formality in psychotherapy – tried and tested parameters,” he said. “You sit across from them; there is the 45 minute session. And I don't know exactly what would happen in the open air. It starts raining. What do you do with the patient?”
Psychiatrists should think about it more carefully, he added, and consider special training “before we sign the dotted line on such new interventions.”
Still, he added, a number of studies have found that immersion in nature can be beneficial for mental health. a Analysis from 2023 of the effects of 'forest bathing', the Japanese practice of taking a relaxing walk through the forest, suggested that it can significantly reduce symptoms of depression and anxiety. And being physically active is associated with a lower risk of depression. A judgement several studies even went so far as to conclude that 'physical activity should be a mainstay of the approach' when dealing with mental health problems.
'It connects me with being human'
Outdoor or nature-oriented therapy has become a particular draw for men and people under 40, according to Dr. Schreiber-Pan and other therapists.
Chase Brockett, 36, who lives in Portland, Oregon, started walking therapy in 2022 and continued for about a year and a half, despite having to pay for the sessions out of pocket.
“It connects me to being human, to life,” he said. “Not to be subject to the world, but to be part of it.”
During his sessions, he and his therapist, Aimee Frazier, went outside in all weather conditions, including rain.
“You have to be uncomfortable and just accept that this is what's happening,” he said, a lesson that became an analogy for his feelings of anxiety. “I think a lot of fear comes from A) seeing fear as a bad thing and B) trying to escape it at all times,” he said.
Therapists also see other benefits: clients who are more receptive and relaxed.
“I think therapy feels very prescribed for some young people,” says Andrew Tepper, the founder of Boda Therapy, who often works with adolescents and young adults in New York City and the Catskills. “It's one lane. Oh, let's sit down. We'll talk and maybe play a board game. And with that comes, I think, some resistance.”
Mr. Tepper, a psychotherapist, steers his clients toward outdoor exercise — hiking or skiing — if they are open to it. During a retreat in early February, he took three clients snowshoeing, taking long walks and cooking lunch over a campfire.
“I believe therapy can be fun, and part of that is pre-assessing what your clients like to do,” he said.
'I started to look a lot like my wilting office plant'
Therapists are finding that a nature-based practice can improve their own well-being and also help prevent professional burnout.
Years ago, after completing a clinical internship in a dimly lit, windowless office, Ms. Frazier realized she needed a “more enlivening environment” — for her clients and for herself.
“I started to feel a bit like my wilting office plant in the dark corner,” she said. “I longed to be outside in the sun and rain, surrounded by the soothing presence of nature.”
In 2021 she started offering walking therapy to clients under the guidance of Thomas J. Doherty, a Portland psychologist who founded the ecotherapy certificate program at Lewis and Clark College. For some clients, she says, the setting makes therapy feel more accessible and less intimidating.
Maria Nazarian, a clinical psychologist in Santa Monica, California, doesn't rent an office. She only sees clients virtually or while walking on the beach, which she described as her “happy place.” And, she said, her clients have benefited from getting off the couch.
Walking side by side promotes cooperation, said Dr. Nazarian, and being on the coast often brings moments of wonder and awe, all of which help build 'connection and trust'.
'Winter has to happen'
Amy Fuggi, 63, visits Dr. Schreiber-Pan has been going on and off for six years to deal with the grief over her mother's death.
“You want to push it away, you want to bury it, you want to ignore it,” she said. “But that doesn't work very well.”
While outdoors, she says, she feels a “tremendous bond” with her mother, who loved the outdoors and often planned camping trips for Ms. Fuggi and her siblings.
“I feel like she's walking with me,” Ms. Fuggi said.
On a recent sunny Monday, she and Dr. Schreiber-Pan waded through the snow to visit a nearby college campus, then disappeared into a tree-lined path near a small pond, where they played with the concept of hibernation—the ability to lean against the ground. the dark times in our lives.
“They have a purpose, you know, just like winter has to happen before we can enjoy spring,” said Dr. Schreiber Pan.
After the session, Ms. Fuggi said she felt lighter.
“When you walk around, you have fresh air and all this openness,” she said. “It's very easy to just relax and talk about things.”
Rosem Morton contributed reporting for this story.