‘Walk and Talk’ Might Be the Future of Therapy
If you’ve ever taken a long walk with a close friend and talked about difficult personal problems, you get the gist of “walk and talk” therapy.
Denice Clark, PhD, a therapist based in Atlanta, has been providing walk-and-talk therapy professionally since 2015. She’s well known as Dr. Walk and Talk (her company is called Sole to Soul Therapy), and a few months after the pandemic hit, therapists started contacting her about how best to offer this kind of therapy to their clients. “Therapists and clients alike are getting tired of online therapy,” she says, “so walk-and-talk seems to be the one way they can meet in person while feeling safe in the midst of the pandemic.”
It makes sense that this type of therapy is on the rise: There’s strong evidence that spending time with other people outdoors is relatively safe, plus research shows that eye contact can increase anxiety levels, which suggests that walking side by side with a therapist (with masks and appropriate distancing, of course) could feel more comfortable for some folks.
Thanks to months of isolation, record-breaking unemployment rates, and the absurdity of a death toll that keeps on going unchecked, the mental health fallout of Covid-19 has been and will continue to be huge. “The virus and the kinds of stresses it creates have complicated the reasons why people have decided to come to therapy at this point in time,” Clark says. Though it’s never the only reason, she thinks that what really puts people over the edge, and what might ultimately drive them to seek therapy for good, is when pandemic life starts affecting their relationship, their work, or simply their ability to function on a daily basis. As they look for therapeutic ways to feel better in a world where a pandemic has upended their livelihoods, people realize that they need their lives to be, quite literally, a walk in the park again.
“I’ve had people beginning therapy from their cars, or in a basement, or in a bathroom because it’s the only space in which they can have privacy, or they will drive in their car and go to the parking lot of a grocery store.”
Walk-and-talk therapy has also proven to be a stress reliever for people who don’t consider their home a safe space for online therapy — whether they can’t find enough privacy to feel comfortable opening up, or their family or partner disapproves of therapy, or someone they live with is the reason they’re seeking therapy in the first place. When shelter-in-place orders were enforced, the therapists I’ve talked to had their clients use safe words or pan the camera around the room to make sure they were alone. “I’ve had people beginning therapy from their cars, or in a basement, or in a bathroom because it’s the only space in which they can have privacy, or they will drive in their car and go to the parking lot of a grocery store,” Sarah Gray, PsyD, a Boston-based clinical psychologist and an instructor at Harvard Medical School, tells me. Walk-and-talk therapy is a welcome and necessary change for them, since saying “I’m going for a walk” or “I’m going to meet up with a friend” may be easier than trying to sneak around with a phone or laptop.
The benefits of this kind of therapy go beyond pandemic-times convenience, says Diane Wilson, LCPC, a Chicago-based psychotherapist who incorporated walking into her therapy practice two months ago. She quickly realized that her clients feel more “candid and open when they walk and talk with me.” She even mentions that research shows walking helps reduce the likelihood of Alzheimer’s disease and dementia, along with many important aspects of brain health.
Walking also contributes to feeling more engaged in the process of therapy, and clients feel like they accomplish more. Gray notices that patients with ADHD thrive in walk-and-talk therapy because “they’re often processing information through their body and not necessarily through words as much,” she says, “so they want to be absorbing the information as they’re also taking it in in a physical sense.” Gray warns, though, that it’s not a panacea: She’s seen some patients use the fact that they’re outside and not looking their therapist in the eye as a way to avoid getting in touch with some stronger emotions. When she suspects this might be happening with a client, she advises that they come back for an in-office or online therapy session to do some deeper work and figure out what might be going on.
Walking also contributes to feeling more engaged in the process of therapy, and clients feel like they accomplish more.
Proximity to nature is a hallmark of walk-and-talk therapy. Gray is moving to a new office soon, and just like the one she chose back in 2013, she specifically looked for a location on a beautiful nature path in order to provide walk-and-talk therapy sessions; it also means her backdrop for video therapy always includes a dose of nature for her patients, whether they realize it or not. Walk-and-talk therapists all praise the healing properties of nature, as a strong and still-growing body of ecotherapy research finds that interacting with the natural world during therapy can provide health benefits, such as reduced stress and improved mood, well-being, and self-esteem. Clark also points out that “people bring up things in walk-and-talk sessions that never come up in face-to-face office settings,” and they’re better able to assimilate the milestones they reach because they tie them in with the natural environment they interact with.
The mental health fallout of Covid-19 is disproportionately affecting health care workers and communities of color, so it’s crucial that walk-and-talk therapy be accessible to all. This kind of therapy makes a strong case for framing climate change as a mental health issue, one that wreaks havoc in low-income communities and communities of color who don’t have as much access to nature as upper-middle-class households.
Walk-and-talk therapy also needs to be inclusive. Gray, the Boston-based psychologist, also works as a health psychologist in her private practice, so many of her patients come to her for help in accepting and coping with a disability. “I had some patients who are self-conscious about the way they’re moving after a stroke,” she says. “So, part of the exposure walk-and-talk therapy that I’m doing with them is helping them to be out in public, moving around, and hopefully feeling more comfortable with themselves.”
Much of this work would be impossible without direct action toward the preservation and expansion of green spaces, the maintenance of sidewalks and paths, and the reduction of air pollution. The World Health Organization, among other agencies that focus on public health, encourages local decision-makers, politicians, and public authorities with responsibility for urban development and environmental management to invest in urban green spaces to improve quality of life, and they’re doubling down on this message during the pandemic. Gray sees those influences play out in different ways, but a notable one for her walk-and-talk therapy sessions is that “some nonprofit groups make sure there’s no potholes or crumbling asphalt anywhere. That way, my patients who have difficulty walking, use a cane or a wheelchair can move safely.” (Gray wants to call the latter “walk and roll and talk,” which rules.)
There’s no database or professional organization tracking how many therapists offer this kind of therapy, but when Clark was doing her dissertation, she located approximately 135 in the United States who advertised walk-and-talk therapy. (She also knows of running and walking therapists in Europe and Australia.) If no therapist in your area is part of this ever-growing list, Clark recommends you simply ask your existing therapist if they’d be able to. If they accept, they should consult with therapists who have been conducting walk-and-talk therapy for a while or even pay to experience a walk-and-talk session. Among other things, they will learn that before they start walking with their clients, they will need to talk about what to do if they cross paths with someone their clients know — an awkward moment for many on a normal walk, but something utterly different when you’re in the middle of a therapy session.
But in the end, the one universal contraindication to walk-and-talk therapy that will outlive the pandemic might just be bad weather. My conversation with Wilson had to be cut short because of a push notification she received on her phone: a tornado warning. Needless to say, she canceled her remaining sessions for that day.