COVID-19 spurs outdoor therapy boom
Just being in nature helps some patients
Amid the pandemic, Jami Grich, a psychologist in San Francisco, set up space in her backyard to see people.
“With small kids at home, I needed to find a way to meet patients face to face. My backyard was the perfect solution because it’s spacious and easy to maintain social distance,” she says.
Due to the coronavirus, many mental health providers, like many other medical professionals, are conducting therapy remotely.
While research shows teletherapy can help treat anxiety and depression, virtual meetings don’t work for everyone.
I’m a therapist and it can be challenging to observe patients’ non- verbal behaviours or convey empathy via Zoom. When someone cries, for instance, it can be helpful to hand them a tissue. Teletherapy disrupts this simple in- person expression of care.
Tania Paredes, a bereavement therapist in Miami, counsels grieving parents. She now offers “walk- andtalk” therapy.
“Bodily movement,” she says, “can help families reflect and open up about their loss.”
At a time when mourning rituals such as funerals are discouraged, this connection can be a lifeline. One patient told Paredes that “walking and talking helped her move through her grief.”
Outdoor therapy is practised elsewhere in the world and has been shown to be helpful.
In Zimbabwe, “community grandmothers” counsel women on “friendship benches” in parks. A 2017 study found that “friendship bench counselling” helped women recover from depression, anxiety and trauma.
In addi t ion, a nature- based therapy called “Forest Bathing” has been found to lower stress, boost the immune system and reduce anxiety.
Since 2018, San Francisco Bay area therapists Adam Moss and Nathan Greene have led a surf therapy group for teen boys who struggle with family issues, relationship concerns and anxiety.
Moss and Greene teach the teens how to ride the ocean waves and read the water’s currents. “Surfing requires the guys to challenge themselves and learn their limits,” Greene says.
After the lesson, the boys gather on the beach and share their experiences with one another. One group member observed, “the ocean, like life, is powerful and unpredictable.”
“Early research suggests outdoor therapy is effective,” says clinical psychologist C. Vaile Wright of the American Psychological Association. She adds that “research suggests outdoor therapy can also be useful for kids and adolescents diagnosed with” attention-deficit/hyperactivity disorder.
Stefanie Haug, a family therapist in Cambridge, Mass., says remote therapy, via phone or video, doesn’t always benefit children. “Because kids spend hours in front of a screen, many of them find it hard to stay present, focused and connected during teletherapy sessions,” she says.
Haug meets children and their parents in their backyard or at a park. Being outdoors sparks creativity, which can help children feel more engaged. “I’ve had sessions on swing- sets and played bocce ball with some of my patients,” Haug says.
Outdoor therapy has also bolstered her own well- being. “Outdoor sessions have rejuvenated my energy and enthusiasm for my work.”
Working with children, it’s easy to incorporate nature into play therapy. “When it snows, making a snowperson together could be a great way for kids to discuss goal setting,” Haug says.
Of course, holding a session outdoors does have pitfalls. “The conversation may be overheard,” Wright says. And patients have to be warned that COVID-19 can be transmitted even outdoors so mask- wearing and social distancing must be maintained.
Patients without privacy at home or internet access present special challenges. When it comes to successful therapy, the therapeutic relationship matters most. If teletherapy hinders the patient’s recovery, meeting in person should be considered, the APA says.
From the start of the pandemic until September, Moss and Greene held their “surf
therapy group” on Zoom. “The guys missed the healing powers of nature and being together in person,” Moss says.
The therapists decided to resume socially distanced meetings on the beach.
“We began by standing in the knee- deep water of the ocean. Then we sat on the beach ( six feet apart) and reflected on the strangeness of the pandemic,” Moss says. Several group members expressed their feelings of sadness and isolation and the group members felt a sense of closeness and community from each other.
Outdoor therapists who practise in cold climates may still try to hold outdoor sessions in winter. Other therapists say they’re undecided about that.
Sam Nabil, a therapist in Boston who works with adults, has been offering “walk- and- talk” therapy since April. But a recent spike in COVID-19, and the growing darkness and dropping temperatures, has him now preparing to go back to remote sessions for the winter months.
While conducting therapy in public spaces has pros and cons, therapists say they seem to be a hit with those needing therapy. “One patient said it was ‘uplifting’ to walk outside,” Nabil says.
Stephanie Korpal, a psychotherapist in St. Louis who works primarily with new mothers, says meeting patients for walks has added a sense of “normalcy” to their lives.
“Many postpartum moms say that seeing another adult and spending time outside boosts their mental health” she adds.
When possible, Grich, in San Francisco, relies on nature’s beauty to deepen her therapeutic work. During a recent session, a patient noticed a falcon in a tree nearby. The observation served as a conversational prompt about awe and the meaning of life.
“At a time when life is unstable, knowing that nature keeps flowing — no matter what — is a powerful message,” she says.
ONE PATIENT SAID IT WAS ‘UPLIFTING’ TO WALK OUTSIDE.