Outdoor talking therapy is an evidence based practice that can enrich the outcomes of conventional indoor therapy.  It can also improve equity of care in offering an alternative context for people who find an enclosed indoor therapy room or digital therapy difficult to engage with.  However, despite the great potential for outdoor talking therapy to reduce health inequalities, the evidence currently suggests the opposite is true: if you are seeking therapy, statistically speaking, you are more likely to have the option of therapy outdoors if you are a) living in a rural location, b) white, and c) paying for private therapy.  Thankfully there are exceptions, including individuals, organisations and charities working hard to increase the availably of outdoor talking therapy.  I wanted to use this post to share my thoughts on certain privileges that still exist and what changes need to be made to reduce exclusivity and release the full potential of outdoor talking therapy.  More specifically, I am focussing here on issues surrounding ‘connecting with nature’.

Should all outdoor talking therapy aim to connect people with nature?

The extent to which the outdoor environment is incorporated into the therapy discussion can be considered on a continuum.  At one end, the outdoors is actively integrated into the therapy, with various links made to the surroundings and with explicit intentions for the therapy to support a deeper and more reciprocal relationship with the natural world.  At the other end of this continuum, the outdoor environment is used purely as a ‘context’ or ‘container’ for the therapy, with the therapy content remaining similar to that of conventional indoor therapy.

Some outdoor practitioners have argued that outdoor therapy should always seek to connect people with the natural world.  Some have gone further in suggesting that outdoor therapy in the absence of ‘nature connection’ is inappropriately using the natural world as a ‘commodity’ or ‘utility’, and is another example of human beings taking advantage of the natural world when it suits them, without giving back.

I too am a keen advocate for conservation and the many benefits of connecting with the natural world.  However, I would like to share a number of reflections on why it feels problematic to limit outdoor therapy to only those who can appreciate and ‘buy into’ the power found within an intimate human-nature relationship. 

A ‘connecting with nature’ prerequisite risks privileging some clients and practitioners over others

The belief that outdoor talking therapy should be reserved only for practitioners and clients with a shared interest in ‘connecting with nature’, is at risk of privileging those able to identify, value and aspire to this as one of life’s goals. The desire to connect with the natural world often stems from a variety of (often privileged) experiences, including: living in an environment with access to safe outdoor spaces; having had primary needs met to support your exploration of the natural world; having parents/schools/friends who encourage and value outdoor play; enjoying family holidays and school trips in natural places; having access to equipment, resources, knowledge and skills that enable engagement with outdoor activities; having experienced positive interactions with animals and pets; having an absence of traumatic life experiences/fears/phobias associated with particular outdoor contexts, to name a few..

On social media, we often see people posting selfies in beautiful natural landscapes, whilst at the same time criticising those who don’t ‘respect’ and ‘engage’ with nature in this way.  These messages are no doubt coming from a good place with important intentions, but perhaps they are at times forgetting some of the privileges that afford such a position.  For someone living in poverty and experiencing mental health difficulties, surrounded by concrete and violence with no safe green spaces, ‘connecting with nature’ may understandably rank pretty low on their list of priorities.  But should a person in this position be denied the option of having their therapy outdoors because they do not present to their therapist with a desire to connect with nature?

The evidence-base shows all people benefit from being outdoors

The growing evidence base for the positive effects of spending time outdoors and in nature (i.e., nature restoration) has demonstrated numerous physiological, psychological and sociological benefits.  However, none of this evidence has suggested these benefits are exclusive to those who enter into an outdoor experience with a particular stance towards nature.  Having a reciprocal and active connection to nature may well enhance the benefits of nature exposure.  But this does not mean that individuals who are ‘disconnected’ from nature will not benefit from a more passive form of exposure.  In other words, individuals are not required to be actively seeking a ‘reciprocal connection with nature’ for the restorative benefits of being in nature to occur. 

People are drawn to outdoor talking therapy for reasons other than ‘connecting with nature’  

Some people are drawn to outdoor talking therapy, not because they want to ‘connect with nature’, but because they find the prospect of indoor therapy too uncomfortable, pressurised and inaccessible.  The outdoor environment is also being used during the COVID-19 pandemic as a way of offering therapy more safely, including for those who don’t have the technology or digital literacy to access alternatives.  In these cases, the option of outdoor therapy is directly supporting access to services at a critical time in humanity.  These clients shouldn’t be refused outdoor talking therapy or be accused of ‘using the outdoors as a commodity’, simply because their reasons for wanting to be outdoors don’t align with a philosophy of nature connection.

Definitions of ‘outdoor therapy’ vary considerably

Despite efforts to shape a more clear-cut definition of ‘outdoor therapy’, it still remains a loosely defined, umbrella term for all sorts of therapy and therapeutic activities that are situated outdoors (e.g., outdoor talking therapy, ‘walk and talk’, forest bathing, outdoor adventure experiences, youth development activities, horticultural projects etc.). Terms such as ‘ecotherapy’, on the other hand, refer much more specifically to the practice of supporting a person’s connection to nature. All of these practices are important and valuable; however, we need to be careful not to confuse them – ecotherapy sits under the umbrella as one type of outdoor therapy. Whilst the principle of ‘connecting with nature’ underpins the philosophy and objectives of ecotherapy, this does not mean that this is a primary or explicit goal underpinning all types of outdoor therapy. For example, urban street therapy is another form of outdoor therapy, which has been used in work with homelessness and in gang cultures. The purpose of being outdoors in this work is usually to meet people where they are at, not to connect them with nature.

Let’s not make an ‘exclusive club’ even more exclusive!

The evidence shows that the majority of clients provided with the option of outdoor talking therapy are those paying for private therapy.  Broadly speaking, therapy outdoors is uncommon in mental health services such as the NHS.  Despite evidence clearing demonstrating that outdoor talking therapy can support those unable to engage with indoor therapy, most clients in the public sector will be faced with conventional indoor therapy or nothing.  Therefore, equity of care is sadly far from evident in the field of outdoor talking therapy.

To address this inequality, outdoor talking therapy needs to become a more available option in public mental health services.  One way of doing this is to introduce it (at least in the first instance) as a means to achieving other therapy goals, rather than as an end in itself.  It’s fair to say that of the many thousands currently on NHS waiting lists for taking therapy, only a very small minority will identify an explicit desire/goal to develop their ‘connection with nature’ as part of their therapy.  It is also true that for most of them, ‘connecting with nature’ won’t be the golden ticket to resolving their difficulties.  This does not mean, however, that they wouldn’t appreciate and benefit from the option for some of their therapy to take place outdoors.

A primary focus on connecting with nature excludes most therapists

A talking therapist who has specialised in ecotherapy will understandably attract clients who have a desire to ‘connect with nature’. Similarly, a therapist who advertises their services as ‘walk and talk’, will also attract a particular type of client. As mentioned above, these clients and practitioners represent a small minority of the broader therapist and client population. The vast majority of talking therapists (e.g., clinical psychologists, counsellors and psychotherapists) are not employed for the purpose of ‘connecting people with nature’, nor will there have been a need for them to develop advanced skills and training in outdoor activities. They will have different client groups and different priorities to negotiate. But just as you don’t need to be an architect to offer therapy inside a building, you don’t need to be an outdoor expert to offer your therapy outdoors.

Humans are nature, whether we are ‘connected’ or not

 To separate human beings as those who seek ‘connection with nature’ and those who don’t, feels like an unhelpful dichotomy that is missing a vital point – we are nature!  The narrative of ‘humans vs. nature’ feels equally unhelpful.  Well established theories such as biophilia and ecological systems dispel both these stances.  For example, these theories explain how 99% of human existence has been as hunter gatherers immersed in the natural world, and a connection with nature is therefore deep-rooted within our biological, psychological and social make-up – ultimately we are all affected by the health of our planet, and all our actions collectively contribute to the health of our plant.  A ‘connection’ and ‘reciprocal relationship’ with the natural world therefore resides in all of us, even those who some might class as ‘disconnected’ because their current circumstances have limited their access to actively being with nature.

Where would we draw the line? 

If developing a deep and reciprocal relationship with nature is a perquisite for using the outdoors for talking therapy, does that mean we need to demonstrate this relationship before it’s considered ‘ok’ to utilise the outdoors in other areas of life (e.g., taking your dog for a walk, sitting in your garden, going on holiday?).  And what about those who demonstrate a reciprocal relationship in one area of life (e.g., volunteering for the RSPCA), does this mean they have earned a right to ‘take from nature’ in other areas of their life, such as by moving their business meetings outdoors or engaging in outdoor talking therapy without an aim of connecting with nature)?  Surely we can’t expect every outdoor activity to ‘connect with nature’ and actively contribute towards the health of our planet.  We need to be careful not to mistake practitioners and clients who wish to ‘utilise’ the outdoors, with people who have little regard for the natural world and engage in environmentally damaging behaviour.

A ‘connection’ with nature doesn’t have to come first

All of us have a responsibility to conserve nature and protect our planet.  We know from experience and evidence that supporting individuals to feel more connected with nature is an effective way of doing this.  However, this desire to ‘connect’ with nature doesn’t need to come first:

Let’s take an example of a client and therapist who decided to use the outdoors as a convenient context to enable their therapy to continue during COVID-19. The client was unable to access digital alternatives and so they located a quiet spot in a local park where they both felt comfortable to meet. Initially, the client was not fond of connecting with nature and typically spent most their time indoors and in their surrounding urban environment. The outdoor therapy work began without any goal or intention of connecting with nature. The content of their therapy continued on from where their indoor therapy had left off, and there was limited interaction with the surrounding outdoor environment. In this way, the outdoors was being ‘utilised’ as nothing more than a context. Yet, through spending time outdoors, the client and practitioner, sometimes without thinking, began to allow the outdoor environment to enter the therapy, such as through the use of nature-based metaphors and practicing stabilisation techniques that incorporated their surroundings. The client slowly began to feel more connected with nature and started to associate the outdoors with their therapy outcomes. As a result, the client started to spend more time in nature in between therapy sessions. As the client continued to interact and appreciate their new relationship with the outdoors, this relationship began to evolve into a more reciprocal one. For example, the client started engaging in more positive environmental behaviours such as supporting local wildlife and recycling.

In this example, what started out as utilising nature as a convenient context, soon developed into a positive and reciprocal relationship for the client.  If a ‘connection with nature’ had to come first, the client would have missed out on this life changing experience.  As mentioned above, as modern humans we rarely start out with a reciprocal relationship with nature.  The process stems from positive experiences in nature, which leads to feelings of connection to nature, which leads to reciprocal and pro-environmental behaviours.  We shouldn’t be privileging those who have reached a certain stage in this sequence by allowing them special access to outdoor talking therapy, whilst denying others this opportunity.

In summary

We need to support outdoor talking therapy in being more widely available and inclusive.  This includes empowering therapists to explore the outdoors as an alternative context for therapy, rather than ring fencing and commodifying this practice for a select few.  This may require a consideration of our own biases and privileges before specifying how outdoor talking therapy should and shouldn’t be practiced.  I welcome any responses to these thoughts.  For further reading, I have reviewed the literature on outdoor talking therapy and written guidance for the British Psychological Society. 

@samjoecooley