Taking Therapy Outside: What Happens When Therapists and Patients Walk and Talk in Nature

Most therapy happens in offices, with the therapist and patient sitting across from each other in a controlled, private environment. But what if therapy took place while walking through a forest instead? A recent study from Germany examined the experiences of therapists who transitioned their sessions outdoors, providing valuable insights into this alternative approach to mental health treatment.

Researchers at a German clinic interviewed seven therapists who had conducted sessions both in traditional office settings and while walking through nature with their patients. The outdoor sessions followed a predetermined 50 minute route that started at the clinic, wound through a nearby forest, and returned to more urban areas before ending back at the clinic.

The Appeal of Outdoor Therapy

The idea of combining therapy with nature and movement isn't entirely new. Even Sigmund Freud, often considered the father of modern psychotherapy, conducted some of his training sessions while walking. Today, there's growing interest in what researchers call "ecotherapy" approaches that incorporate natural settings into mental health treatment.

 Research shows that psychotherapy, exposure to nature, and mild exercise each provide mental health benefits on their own, particularly for people with depression. The question is whether combining all three elements might create even greater benefits.

What Therapists Discovered Outside

The therapists who participated in the study found several notable advantages to conducting sessions while walking in nature. Many reported feeling a deeper connection with their patients and experiencing a more balanced, less hierarchical relationship. The shared experience of being in a new environment together seemed to enrich their understanding of each other.

Movement itself proved beneficial in multiple ways. Therapists appreciated getting away from sitting for extended periods, and many noticed that conversations seemed to flow more naturally while walking. The reduced eye contact that naturally occurs while walking side by side helped create a more relaxed atmosphere for some patients.

The natural environment also provided rich material for therapy conversations. Therapists found they could draw on their surroundings for metaphors and comparisons that related to their patients' experiences in ways that might not emerge in an office setting.

Perhaps most notably, therapists reported that the outdoor setting had a positive impact on their own mood, which they felt benefited the therapeutic process.

Challenges of the Great Outdoors

Despite these advantages, conducting therapy outside presented real challenges that therapists had to navigate. The most significant issue was the lack of a controlled environment. Unlike the calm, predictable office setting, outdoor sessions involved potential distractions from traffic, other people, weather, and even uneven walking surfaces.

Privacy emerged as another major concern. Public spaces mean the possibility of being overheard during sensitive conversations or having patients encounter people they know. Therapists had to develop strategies for handling these situations, such as pausing conversations when others were nearby or discussing in advance how to handle unexpected encounters.

The therapists also had to pay attention to practical considerations they never faced indoors, such as finding a comfortable walking pace for both people, dealing with weather conditions, and maintaining appropriate physical boundaries when walking side by side rather than sitting across from each other.

Adapting to New Challenges

Interestingly, the therapists found ways to work around most of these challenges. They learned to prioritize their attention moment by moment, sometimes focusing on navigation or safety before returning attention to the patient's words. They developed protocols for protecting privacy and discussed potential scenarios with patients beforehand.

Many of the difficulties seemed related to inexperience with this type of therapy rather than insurmountable obstacles. The therapists suggested that with more practice and proper preparation, many challenges could be minimized.

The Verdict from Practitioners

Despite the challenges they encountered, all seven therapists expressed positive feelings about outdoor therapy and interest in incorporating it into their future practice. They felt that the advantages outweighed the difficulties, and several mentioned wanting to integrate nature more actively into their outdoor sessions rather than simply using it as a backdrop.

The therapists showed a clear preference for the more natural parts of their walking route compared to urban areas, suggesting that the specific outdoor environment matters significantly. They recommended choosing routes that minimize urban distractions and establishing consistent paths rather than varying the route each time.

Practical Considerations for Therapists

For therapists interested in trying outdoor sessions, the study participants offered practical insights. They recommended bringing essential items like cell phones for emergencies, tissues for emotional moments, and water during hot weather. They also emphasized the importance of route planning and advance preparation with patients about potential challenges.

The therapists noted that outdoor therapy felt like meaningful therapeutic work, with patients comfortable enough to discuss deeply personal issues while walking. This suggests that the change in setting doesn't necessarily compromise the therapeutic process, though the specific environment and preparation clearly matter.

Broader Implications

This research adds to growing evidence that alternative therapy settings can be both acceptable and beneficial. As mental health needs continue to rise globally, exploring different approaches to delivering effective therapy becomes increasingly important.

The findings are particularly relevant given growing awareness of how environmental factors affect mental health. Some therapy organizations are recognizing climate change and environmental degradation as significant mental health threats, making approaches that connect people with nature potentially valuable on multiple levels.

This study was designed as a pilot to test the feasibility of conducting larger research on outdoor therapy. The positive experiences of these therapists suggest that such research would be worthwhile and that outdoor therapy could become a valuable option for certain patients and situations.

The researchers plan to conduct larger studies examining not just therapist experiences but also patient outcomes and the quantitative effects of therapy while walking in nature. Future research might also explore how to integrate nature more actively into therapeutic conversations rather than simply using natural settings as a backdrop.

While walk and talk therapy represents just one approach to incorporating nature into mental health treatment, it illustrates how traditional therapeutic practices can be adapted and potentially enhanced. The key seems to be thoughtful implementation that addresses the real challenges while maximizing the unique benefits that natural settings can provide.

For now, the experiences of these German therapists suggest that taking therapy outside can offer meaningful benefits for both practitioners and patients, provided that proper attention is paid to training, preparation, and selecting appropriate outdoor environments. As research in this area continues to develop, outdoor therapy may become a more widely available option for people seeking mental health support.

Pischel, M., Wüster, A. L., Metz, K., Wulf, H., Lahmann, C., & Pfeifer, E. (2025). They Talk the Talk and Walk the Walk: Psychotherapists' Experiences of Psychotherapy While Walking in Nature. Counselling and Psychotherapy Research, 25(3), e70035.