Despite recent restrictions on outdoor activity, there is a worldwide attempt to reconnect with the natural world. Everyone is dependent – whether they like it or not – on technology. The majority of us are hooked, and the promotion of the outdoors is a way to show people there is more to life than the screen in front of us. It is a trend that some industries do not have the luxury of adjusting to greener environments. Many are trapped in offices, in front of computers. For therapists, this is not an issue. The outdoors is a realistic alternative, when trying to help people recover. It is a movement – known as ‘green care’ – that seeks to ‘enlist the context and processes of the natural world in order to promote physical and psychological wellbeing as recovery from physical and mental ill health.’[1]

The majority of things in life, when placed outdoors, feel far more enjoyable. People will opt to work outside, socialise outside and exercise outside if the conditions suit – there is something about the outdoors that we find irresistible, especially here in Britain. For many types of therapy, this is no different. Traditionally, it has been seen as an activity conducted within an indoor space with two chairs and two people.[2] Like all things it is now branching out into outdoor spaces. There is a growing body of literature in favour of this topic,[3] and more and more therapists are taking their sessions outside. Here, we explore the different types of outdoor therapy, and how effective it can be.

Different Types of Outdoor Therapy

First of all, when defining outdoor therapy, it is fairly self-explanatory: it is therapy that takes place outdoors. There is, however, more to it than sitting in circles around fire pits. Outdoor therapy has many forms, designed to treat different cases of mental or physical health issues. It is important to remember that each case requires a different solution and setting. For some outdoor therapy may not be suitable; for others the setting of a therapy room, largely controlled by the therapist, is inappropriate for some client groups to feel comfortable in and may in fact hinder their engagement with the therapeutic process.[4] To accommodate the various types of mental and physical disorders, the outdoors offers a range of therapy options.

Under the broad label of Outdoor experiential therapy, comes both Adventure and Wilderness therapy. Adventure therapy utilises the element of risk. This could be real or perceived, but the uncertainty of an outcome is designed to encourage personal and quick decision-making.[5] This type of therapy may include activities like canoeing, high ropes or rock climbing.[6] It is not always ‘risk associated’. Sessions are often physically and emotionally challenging, but the primary feature is putting patients in novel situations, prompting them to develop new ways of thinking and acting.[7] Wilderness therapy is similar, but there is a remote element. People are placed in relatively isolated natural settings – a drastic change from ‘normal’ living.[8] Both of these versions of Outdoor Experiential therapy are very popular with young people considered at risk.

The other branch of outdoor therapy is known as Eco-therapy. This positions itself as great way to heal and develop the human-nature relationship. It is much broader category than Outdoor Experiential therapy, as many of its forms would not necessarily be considered psychotherapy. If you are out on a nature walk, you are engaging with Eco-therapy. There is confusion as to what can or cannot be classified in this category, but there are strong beliefs that any form of activity which develops the human-nature relationship, is very much Eco-therapy.[9] The renowned forms include horticultural therapy; animal-assisted therapy, such as equine-assisted methods; and ‘green exercise.’ All of these aim to strengthen the bond between ourselves and the natural world – a connection prevalent in many types of therapy.

What are the benefits?

There are several positive effects of being outdoors. The most obvious is, of course, the sense of freedom. There are few restrictions. People thrive outside – especially if they live in urbanised areas or are constantly-engaged with technology. There is an element of escapism when discussing outdoor therapy. Nature is seen as a restorative place where people can connect with their surroundings, but also disconnect from painful and potentially traumatic experiences at home.[10] The outdoors is also versatile. It can be used as a calming and passive backdrop or a fully integrated setting, as seen with Outdoor Experiential therapy. Either way, studies have revealed how therapy can be enriched by nature. When taking place beyond the walls of a therapist’s room, sessions have given patients added mutuality, freedom of expression, mind-body holism and interconnectivity.[11]

Outdoors benefits all. There is also evidence that shows a positive effect, not only on patients, but therapists too. The healing and restorative effect of nature initiates therapists’ own relationship with the natural world, which in turn improves their ability to work with and understand clients.[12] Studies have also revealed how being outdoors, does more for patients than the actual relationship with their therapist.[13] The great outdoors has no limits, but is this the case for outdoor therapy?

Limitations

As with all types of therapy, there are problems. The benefits suggest that if it was easy, outdoor therapy would be far more accepted and utilised. But because it is outdoors, there are issues simply beyond the control of therapists and organisations. The first is the most obvious, and in the UK, the most restrictive: the weather. Negotiating around the weather is tricky, especially in temperamental and unpredictable climates. It can severely disrupt planning and the effectiveness of a session. If it rains or becomes too cold, therapy may not be able to take place.[14] Even if the activity can endure the rain, miserable weather may have an adverse impact on certain patients, and their capacity to cope.

Privacy is also paramount for therapy to take place. Indoors, patients can rest assured sessions are conducted in private, with confidentiality secured. Working outside removes all forms of security. Confidentiality is a central challenge to outdoor therapy, and some patients may feel uncomfortable.[15] You never know who is listening outside. Indoors, it is just you and the therapist. Outdoors, it could be anyone.

Taking therapy outside is largely feasible. It is an activity, that to a certain extent, can function beyond the conventional setting. As many industries try their best to enforce ‘green care’ and more natural ways to operate, therapists are in a strong position. Not only are therapy sessions versatile, but the effect of embracing the natural world is largely positive. It is a solution that can be stripped back; completely remove itself from technology and the urbanised world. Due to the nature of therapy as a private discussion, the outdoors does pose some problems. There is also the issue of weather conditions – it is more than a case of bring your umbrella.

These are obstacles that may slow the rise of outdoor therapy, but they will likely be managed and dealt with. The main principle? Giving patients the chance to connect with nature. Many settings or activities can be modified to ensure this fundamental aspect remains intact – like greenhouses. Connecting with the outside world is so important right now. Therapy has the perfect window, that allows patients to do so.

Sources:

[1] The British Psychological Society. Blog. 2020. Taking therapy outside benefits patients and therapists. [online], available at: https://www.bps.org.uk/news-and-policy/taking-therapy-outside-benefits-patients-and-therapists [accessed 13 June 2020].

[2] Jordan, M. 2013. Taking therapy outside - a narrative inquiry into counselling and psychotherapy in outdoor natural spaces. [online], available at: https://research.brighton.ac.uk/en/studentTheses/taking-therapy-outside-a-narrative-inquiry-into-counselling-and-p [accessed 14 June 2020].

[3] ibid.

[4] Jordan, M. 2013. Taking therapy outside - a narrative inquiry into counselling and psychotherapy in outdoor natural spaces. [online], available at: https://research.brighton.ac.uk/en/studentTheses/taking-therapy-outside-a-narrative-inquiry-into-counselling-and-p [accessed 14 June 2020].

[5] Ewert, A.W., McCormick B. P. and Voight. A. E. 2001. Outdoor Experiential Therapies: Implications for TR Practice in Therapeutic Recreation Journal. [online], available at: https://www.researchgate.net/profile/Alan_Ewert/publication/268042762_Outdoor_experiential_therapies_Implications_for_TR_practice/links/56f17bc008ae4744a91ef116/Outdoor-experiential-therapies-Implications-for-TR-practice.pdf [accessed 14 June 2020].

[6] Jordan, M. 2013. Taking therapy outside - a narrative inquiry into counselling and psychotherapy in outdoor natural spaces.

[7] Ewert, A.W., McCormick B. P. and Voight. A. E. 2001. Outdoor Experiential Therapies: Implications for TR Practice in Therapeutic Recreation Journal.

[8] ibid.

[9] Jordan, M. 2013. Taking therapy outside - a narrative inquiry into counselling and psychotherapy in outdoor natural spaces. [online], available at: https://research.brighton.ac.uk/en/studentTheses/taking-therapy-outside-a-narrative-inquiry-into-counselling-and-p [accessed 14 June 2020].

[10] Jordan, M. 2013. Taking therapy outside - a narrative inquiry into counselling and psychotherapy in outdoor natural spaces. [online], available at: https://research.brighton.ac.uk/en/studentTheses/taking-therapy-outside-a-narrative-inquiry-into-counselling-and-p [accessed 14 June 2020].

[11] The British Psychological Society. Blog. 2020. Taking therapy outside benefits patients and therapists.

[12] Jordan, M. 2013. Taking therapy outside - a narrative inquiry into counselling and psychotherapy in outdoor natural spaces.

[13] Revell, S. 2013. Helpful aspects of outdoor therapy experiences: An online preliminary investigation. [online]. available at: https://doi.org/10.1080/14733145.2013.818159 [accessed 14 June 2020].

[14] Jordan, M. 2013. Taking therapy outside - a narrative inquiry into counselling and psychotherapy in outdoor natural spaces. [online], available at: https://research.brighton.ac.uk/en/studentTheses/taking-therapy-outside-a-narrative-inquiry-into-counselling-and-p [accessed 14 June 2020].

[15] ibid.