Outdoor therapy: how can nature support the healing process?

Outdoor therapy is talking therapy that takes place outside rather than in a consulting room, often walking side by side or sitting together somewhere in nature rather than face-to-face. It isn't a single method so much as an approach: the same core therapeutic skills, held in a different kind of space.

It's not a new idea that surroundings affect how we heal. Back in 1984, a well-known study found that hospital patients recovering in rooms with a view of trees healed faster, needed less pain relief, and had shorter hospital stays than matched patients whose windows faced a brick wall (Ulrich, 1984). Nothing else about their care changed, just what they could see. It's a simple finding, but it says something outdoor therapists often feel is obvious once you hear it: where we are changes how we heal.

What does a session typically involve?

Outdoor therapy sessions vary depending on the therapist and the setting, but generally follow the same shape as an indoor session: a confidential, boundaried space for talking, just relocated.

Sessions might involve:

• walking together at a gentle pace, side by side rather than face to face;
• sitting somewhere sheltered, a bench, under trees, near water;
• noticing and using what's present – the weather, the season, wildlife – as material for reflection rather than distraction;
• the same structure as any therapy session: a beginning, the work itself, and a closing.

Outdoor therapy isn't a nature walk with some chat thrown in, or therapy with a scenic backdrop. The outdoor setting is part of the therapeutic work itself, not incidental to it.

Who is outdoor therapy suitable for?

Outdoor therapy can suit a wide range of people, but tends to be a particularly good fit for:

• people who find traditional, face-to-face talking therapy too intense or exposing;
• younger clients and teenagers who often find it easier to talk when there's something else to focus on;
• anyone processing loss, grief, or transition, where the changing seasons can offer a helpful mirror;
• people who already feel more grounded, physically and emotionally, when they're outside.

It isn't necessarily right for everyone. Some people feel more exposed outdoors, or need the privacy and containment of a closed room to feel safe enough to begin. A good outdoor therapist will discuss this with you before starting, not assume it's the right fit by default.

What the research says

Outdoor and nature-based therapeutic approaches now have a growing evidence base. A 2021 systematic review and meta-analysis of nature-based interventions found measurable improvements in depression, anxiety, and both positive and negative mood, with the most effective interventions running for 8 to 12 weeks, in 20- to 90-minute sessions (Coventry et al., 2021, SSM - Population Health). None of that surprises those of us who do this work day to day. It just gives a name to something that's always felt obvious with cold hands and mud on your boots.

Practical considerations

Outdoor therapy asks for more thought about structure and safety, not less, precisely because the setting is less controlled than four walls and a closed door.

A properly run outdoor practice should cover the following before you begin:

Weather and clothing

What happens if it's raining, and what you'll need to wear.

Privacy

Where you'll go if a session needs more shelter or a quieter, more private spot.

Location and access

Somewhere realistic for you to get to regularly.

Confidentiality

Being mindful of other people nearby, and agreeing what happens if a session is interrupted.

Physical ability

The pace and terrain should suit you, not the other way round.

Each season brings something different to the work. Spring often stirs things up; new growth outside seems to give people permission to talk about what's trying to grow in themselves. Autumn has a way of inviting people toward loss, and what needs to fall away.

There's a particular kind of relief in realising the therapy room doesn't have to be a room at all. The work doesn't become easier because it's outdoors, but it stops feeling so contained. There's somewhere for the difficult feelings to go that isn't just back into you.

References

Ulrich, R.S. (1984) 'View through a window may influence recovery from surgery', Science, 224(4647), pp. 420–421. Available at: https://pubmed.ncbi.nlm.nih.gov/6143402/

Coventry, P.A. et al. (2021) 'Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis', SSM - Population Health. Available at: https://www.sciencedirect.com/science/article/pii/S2352827321002093