Outdoor therapy vs therapy outdoors

As it's becoming more mainstream and common for clients to take their therapeutic work outdoors, people may wonder what exactly is outdoor therapy and how/if that differs from counselling that happens to take place outdoors. This is not just about semantics, rather, looking at some of the underlying principles in both approaches.

Outdoor therapy

Outdoor therapy and it's underlying principles can be connected to ecopsychology, environmental psychology and ecotherapy; to my mind, outdoor therapy is about the intersection between these three elements - client, therapist, outdoors. The outdoors themselves can be part of the therapeutic process, they can be a catalyst, they can offer both client and therapist an additional element to the work. How big a role the environment plays is something that would depend on several factors but it feels at least like it's an offering which is there for the client.

The outdoors and what they may mean to a client is open to interpretation, but in my practice, I think of the outdoors as both a setting and tool for therapeutic change; research suggests that clients feel they find the sense of space and expansiveness of being outdoors somewhat freeing, and as such, it can be easier to talk through feelings of being stuck, for example.

The landscape itself can also be used as a catalyst for therapeutic change – finding connections and metaphors in the environment which may help you to articulate certain feelings or emotions that otherwise could have seemed difficult.

Therapy outdoors

Therapy outdoors differs from outdoor therapy. In simple terms, therapy outdoors can still be 'traditional' therapy, be that person-centred therapy, cognitive behavioural therapy (CBT) or Gestalt therapy, but it happens to take place in an outdoor setting. This can simply be having a seat on a bench, this can be walking with your therapist around an urban park, for example, or this can be a combination of both. 

It's hard to pin down some precise data, but anecdotally at least, there's been an increase in interest in working outdoors (from both client and therapist perspective) and therefore an increase in therapists offering this option to clients.

Differences and similarities

It's important to make the distinction that while there are obvious similarities - the setting, the face-to-face therapy, the non-traditional environment - there are also distinct differences and one of the main things you may want to consider is privacy, boundary setting and how working outdoors in an uncontrolled environment may impact this. In my experience, however, I have found this provides a way which the client/therapist can work collaboratively and cooperatively to discuss, establish and set these boundaries and have a shared understanding about privacy and how it might differ outdoors.

Benefits

Both approaches may have similar physiological benefits;

• Fresh air is good for your health. There is evidence which shows that fresh air can help you digest food more effectively, it can improve your blood pressure and heart rate and strengthen your immune system.
• Fresh air leads to an increase in serotonin (the happy hormone) levels, which can help regulate mood, levels of happiness and levels of anxiety.
• In the right conditions, sunlight can help with the production of Vitamin D which helps to support our immune system and strengthen skin, bones and teeth.
• Spending time outdoors in the fresh air can lead to an increase in oxygen levels which can help rid the body of toxins, helps with white blood cell function, increases mental clarity and concentration levels.

Summary

With an increase in interest, particularly against the backdrop of COVID-19, considering therapy outdoors may be something more clients are open to. While outdoor therapy and having therapy sessions outdoors are not the same thing, they both can have similar benefits and perhaps we'll see an increase in therapists offering this to clients to meet the increasing demand.