Therapy in nature

Counselling is an odd experience. Once a week you arrive at someone's office and wait outside until your appointment time, probably stewing over what we're going to talk about, and then you go in, sit down, stuck in a room facing another person for 50 minutes. They ask you how you are, you respond politely, then they ask you how you really are, then you cry, and then you go home. 

This has been the accepted practice since Freud. No one questions that it works. Being confined with a therapist forces us to confront our issues. To heal. I'm the therapist in those situations but even I'll admit that it's odd.

It first struck me just how odd the accepted practice is when I began youth counselling: the last thing a teenager wants is to be stuck in a room for an hour answering questions from an adult. And don't think it isn't awkward for the adult either.

Of course, there are benefits to this practice and ways to work within this, get around it, push through it and built a therapeutic relationship that can help, but I'm not teaching therapy here, so I'll just say that I wondered if there might be other ways to work.

There are good reasons to work in a closed environment: confidentiality, health and safety, time constraints, focus on the task at hand, ethical considerations, and because we've always done it - the brain does love the familiar.

But I wondered if there might be other ways. So a colleague and I pioneered an international online therapy service just before the pandemic hit. Using video call technology we can talk to anyone anywhere in the world, delivering therapy to people in their own convenient and safe space. It's a really accessible and effective way of working, with its own challenges and limitations, but it's a good way to work.

By now you're probably wondering why this article is called therapy in nature, when it seems to be about the exact opposite. Well, when you spend your life as a therapist in enclosed confidential spaces or communicating via laptop screen, you really start to appreciate the outdoors. Especially after pandemic impacts. So I started exploring the realm of ecotherapy, or nature therapy.

People have embraced the therapeutic benefits of nature since the dawn of time, but only recently has a formal approach to delivering therapy in nature been developed; with all the health and safety, ethical considerations, and limitations included.

We spend so much time cooped up inside, under artificial light, breathing stale or air-conditioned air, walking on concrete rather than the earth and running inside from the rain, that we sometimes forget how good it feels just to walk on the land, to breathe of the air, to feel the rain and the warmth and light of the sun. It brings us back to the real. Not the 'real world' of money worries, work responsibilities and family drama, but the real world of being alive, mortal and finite. Perspective is so much easier when you can 'get out of your mind, and into your senses' as Fritz Perls said. Things become less overwhelming, even when they are impossible to solve. 

There's something I call 'a five-bar gate moment' when I'm walking with a client and we reach a quiet safe space to lean on a gate and look into the distance. There's a sigh, and then a truth is spoken of. A truth we might have needed some time to get to in an office, staring at each other.

It's important to talk through in advance the concept of 'lessons outside' as one of my clients called it, reminiscent of summer school days. Accessibility, safety and confidentiality are the key elements to consider and the client has to agree to share the responsibility for these things. An assessment of the route taken and the therapist's and the client's physical ability is vital.

One of the most arduous walks at the Devil's Punchbowl in Hindhead, Roam 639, is named for Richard Overall, a man who died from muscular dystrophy, as a reminder of how fortunate those of us who can enjoy physical exercise are. 639 is the number of muscles in the human body and the distance of the walk. Accepting our limitations can be therapeutic too.

So who does therapy in nature work best for?

In my experience, nature offers so much pleasing sensory stimulation that mindfulness practices like 'forest bathing' and 'mindful walking' are almost too easy to facilitate, even for those who have found mindfulness a challenge previously. Sensing leads to awareness of what we're feeling, and that really feeds the therapeutic process.

Not to feed into gender biases too much, but men benefit enormously. There's nothing more conflicting for the male psyche than sitting and making eye contact with another man in a confined space (even if you're gay) and yes, this can become a power dynamic which can be used in therapy, but walking alongside each other in nature, paying attention to what your senses are experiencing and speaking truths as they occur is just more natural for a lot of men.

Now, I'm a male therapist, and I'm acutely aware of the reality of the safety and boundary aspects that female therapists would have to consider if they're going to walk in remote places with an emotional male client. Most of my female colleagues would only do this with a client they know and a gut feeling they can trust. They would also have safety and boundary mechanisms in place. The same considerations have to be made clear if I'm out in nature with a female client. If we have the slightest doubt, we stick to the office.

The same considerations apply to youth counselling, but working with teenagers in nature is incredibly effective. The phone goes in a pocket and the multi-tasking of walking and talking and paying attention to all the sensory stimuli is enough to keep therapy interesting. Many young people experience climate anxiety, described by one client as 'the sense that the world is ending because old people are stupid' which aptly taps into both the fears and frustrations that bring young people into therapy. Eco-therapy can be a balm for this.

Where therapy in nature really comes into its own, is with groups. The freedom and sense of community that is built in nature is wonderful. As someone who has taught and led process groups in classrooms and offices, there is nothing like a campfire or a circle of people sitting in nature for building trust.

The dual aspects of nature as both nurturer and potentially challenging environment bring out the bonds of survival that human beings in tribal communities have always experienced. The first sign that the community is bonding is that people start to share food or lean in to help each other. That's when you can be heard in the group, and feel part of something. The pandemic meant that we all lost a little bit of that sense of community- group therapy in nature starts to heal that. 

Not everyone has access to green fields, rolling hills, the beach and public footpaths. Nature therapy is more difficult in the urban environment but that doesn't mean it's impossible. We don't have to bring our clients into nature to bring nature into our practice. We offer an online course for our clients in bringing nature into our lives as part of therapy - exercises and activities that the client can do in an apartment block in Hong Kong or a Surrey garden.

Embracing the therapeutic aspects of nature can be as easy as going to the supermarket - there's a reason that all the fresh fruit and vegetables are at the front, to give a sense of abundance as a marketing trick to make you buy more. But the sense of abundance is real. A London street market has as much fresh nature as a garden. You just have to know how to pay attention to it, and let it heal you.

So whether you just want to embrace nature as part of your healing process or want to bring more of the natural world into your therapy work, there is a place for therapy in nature, and nature in therapy - it's extra effort, but it's worth it.