Forest bathing and guided forest therapy

1. Introduction

Version followed: the Association of Nature & Forest Therapy (ANFT) model of guided forest therapy (the ANFT "Standard Sequence" of invitations, developed by Amos Clifford) as ANFT publishes it in outline; individual invitations as published by ANFT and in the Chicago Botanic Garden's self-guided invitation list; and Japanese shinrin-yoku / forest therapy (森林浴 / 森林セラピー) as Japanese public bodies describe it. Where the two traditions differ, this is said.

What it is. Forest bathing (shinrin-yoku, 森林浴) is unhurried, sensory time spent in a forest. Nagano Prefecture's forest therapy material states that the word 森林浴 came from a 1982 Forestry Agency (林野庁) event in Agematsu, Nagano, and that in 2004 forest bathing with demonstrated effects was named 森林セラピー (forest therapy); Japan certifies "forest therapy bases and roads" (森林セラピー基地・ロード) where trained guides offer programmes [source: Nagano Prefecture forest therapy lecture material]. The certifying body is commonly reported as the Forest Therapy Society (森林セラピーソサエティ) [uncertain: not verified]. ANFT describes its approach as weaving together Japanese shinrin-yoku ("developed in Japan in the 1980's"), ecotherapy (including vision fasts) and a response to environmental catastrophe, with Jungian depth psychology named as a major source for the Standard Sequence [source: ANFT, The ANFT Way of Forest Therapy]. ANFT guides lead slow walks over a short distance and offer sensory "invitations" along the way [source: ANFT, What Is a Certified Forest Therapy Guide?].

It is not a psychotherapy. Forest therapy guides are not presented by ANFT as clinicians, and ANFT's guide-training description gives no scope-of-practice statement [uncertain: not verified]. For a psychotherapist, forest bathing is a practice that you may (a) refer a client to, preparing and debriefing them; (b) deliver yourself if you also hold a guide certification, keeping the two roles distinct; or (c) draw on, adapted, inside outdoor or walk-and-talk therapy [synthesis].

How change is held to happen. ANFT attributes change to relationship with a forest experienced "as alive, sentient, and sacred", work that, in ANFT's words, "releases grief, kindles hope"; the guide's role is summarised as "the Guide opens the Doors" (attributed to Clifford) [source: ANFT]. These are ANFT's own framings, neither established nor refuted here. Japanese forest therapy frames change physiologically: walking, using the five senses and resting in a forest lower stress, with reported falls in cortisol and blood pressure [source: Nagano Prefecture]. A clinical reading is that slowed attention, sensory grounding and a calming setting reduce arousal and open reflection that therapy can then work with [synthesis].

Evidence status (one line each). Kotera, Richardson and Sheffield's meta-analysis (20 studies, all in Asia or Europe) found large short-term reductions in depression, anxiety and anger, but concluded that the research needs more rigour, that long-term effects are unknown, and that shinrin-yoku is not yet ready for mainstream intervention use [source: Kotera et al. 2020]. A 2026 GRADE-rated meta-analysis rated the certainty of all cardiovascular and mental-health outcomes as very low and called forest bathing a possible complementary health-promotion practice, not a treatment [source: Andrade et al. 2026]. Phytoncide and immune (NK cell) claims: Wen et al.'s systematic review reports that forest bathing "may" improve immune and inflammatory indexes and calls for stronger methods; the review abstract does not show phytoncides to be the mechanism, so phytoncide-immune claims should be presented to clients as preliminary [source: Wen et al. 2019; uncertain].

2. Framework

The practice has no psychotherapy-style phases. Two structures are relevant: the structure of a single forest therapy walk, and the therapist's arc around a client's participation.

A. The ANFT walk [source: ANFT]

Format: a small group (or individual) walk led by a certified guide, following the ANFT Standard Sequence; ANFT describes the walks as slow and over a short distance. It stresses that walks "aren't the same as traditional hikes."
Content: a sequence of invitations (e.g. "What's in Motion?"), with group sharing between invitations; guide training covers sequencing invitations, the language of invitation, somatic techniques for embodied awareness, expressive arts, facilitation of open group sharing, and trail choice and safety.
The named order of the full Standard Sequence is not set out in ANFT's public guide-training description [uncertain: not verified]; the Chicago Botanic Garden's self-guided list opens with "Pleasures of Presence" and "What's in Motion" and closes with a sit spot and a tea ceremony [source: Chicago Botanic Garden]. Whether this list reproduces ANFT's sequence is [uncertain].
Moving on within a walk: the guide moves to the next invitation when the group has had time with the current one and has had a chance to share [synthesis; ANFT's criteria not verified].

B. Japanese forest therapy programme [source: Nagano Prefecture]

Walking in a certified forest; using the five senses (looking at scenery, hearing forest sounds, smelling); resting by sitting or lying down; at some bases breathing practice, meditation or yoga, with guides offering programmes.
Season and time of day: Nagano's material suggests going in winter on clear days with protection against cold, and in summer in the morning or evening before strong sun. It also notes that neglected or dense plantation forest can feel dark and anxiety-provoking.

C. The therapist's arc [synthesis]

Assessment and suitability (medical, mobility, allergy, trauma, outdoor fears, goals).
Decision: refer to a guide or certified base, deliver yourself (if certified), or adapt within therapy.
Contracting and preparation (consent, confidentiality outdoors, weather and safety plans, expectations).
Participation (accompanied or not).
Debrief and meaning-making in the next session.
Integration: self-guided practice, links to behavioural activation (II 040), and review of whether it is helping.

No source gives a number of sessions for clinical use; decide with the client and review [synthesis]. Criteria to move from 1 to 2: medical concerns cleared with the client's physician where needed and a clear purpose agreed. From 3 to 4: client understands the format, the optional nature of each invitation, and the safety plan. From 5 to 6: the client can name what the experience gave them and wants to continue [synthesis].

3. Guiding principles

Invitation, not instruction [source: ANFT, "the language of invitation"]: everything is offered; the client may change or decline any invitation.
Slowness and presence [source: ANFT; Chicago Botanic Garden]: the pace is deliberately slow; you are not covering distance.
The guide opens doors; the experience belongs to the participant [source: ANFT]: do not interpret the client's experience for them; ask.
Sensory before conceptual [source: Nagano Prefecture; Chicago]: begin with the five senses and the body, not with talk about problems.
Not a hike, not exercise [source: ANFT]: no fitness goals. Exercise advice belongs to the client's physician or a qualified exercise professional [synthesis].
Attributed concepts [source: ANFT]: ANFT's view of the forest as alive and sacred, and Japanese physiological claims, are presented as each tradition holds them; the client's own spiritual or secular view leads.
Honest evidence [source: Kotera et al. 2020; Andrade et al. 2026]: describe it as a promising complement with short-term effects, not a replacement for evidence-based treatment.
Safety and access first [source: ANFT, trail selection and safety; CDC]: choose terrain to suit the person, plan for weather, and plan tick checks.
Choice of setting matters [source: Nagano Prefecture]: dark, neglected woodland can raise anxiety; pick open, cared-for places for anxious or traumatised clients.
Distinct roles [source: APA Ethics Code, Standard 3.05]: if you are both therapist and guide, assess whether combining roles risks impairing objectivity or exploiting the client, and set the frame explicitly.
Confidentiality is weaker outdoors [synthesis]: agree in advance what you will do if you meet someone, and that group sharing is not confidential in the clinical sense.
Competence [synthesis; ANFT certification described below]: deliver guided walks only if trained; otherwise refer and collaborate.
Client as author of meaning [synthesis]: the therapist's job afterwards is to help the client make their own sense of the experience.

4. Intervention inventory

The inventory has three parts: therapist-side procedures before a walk (4.1-4.4); the invitations of a walk as ANFT and the Chicago Botanic Garden publish them, plus Japanese programme elements (4.5-4.22); and therapist-side procedures after a walk (4.23-4.26). The sources give the names and outlines of invitations; step wording below is written in this guide's own words. The therapist-side procedures are [synthesis] unless marked otherwise.

4.1 Suitability screening [synthesis]

Purpose / when: before any referral or outdoor session, to decide whether forest bathing fits and what adjustments are needed.
Steps: (1) Ask what draws the client to it and what they hope for. (2) Ask about mobility, balance, chronic pain, heart or breathing conditions, pregnancy, epilepsy, and severe allergies (insect stings, pollen, plants); if any is present, ask the client to check with their physician before taking part, and do not advise on any medicine. (3) Ask about fears and histories linked to forests, darkness, being lost, insects, dogs, or being alone outdoors, and about trauma that occurred outdoors. (4) Ask about current risk, dissociation and psychosis; very low mood or high risk means stabilisation comes first. (5) Ask about access: transport, cost, toilets, dietary or hydration needs, sensory sensitivities. (6) Record the outcome and agreed adjustments.
Example language (illustrative): "Before we look at a forest walk, I'd like to check a few practical and health things so it is actually restful for you."
Watch for: a client who wants the walk to replace treatment they need; fears that surface only when the plan becomes concrete. Working: a clear, shared yes or no, with adjustments named.

4.2 Contracting and consent for outdoor work [synthesis; APA Standard 3.05]

Purpose / when: before any session you hold outdoors, or before combining a guide role with therapy.
Steps: (1) Explain that outdoor confidentiality is limited: others may see or overhear. Agree what you will say if you meet someone the client knows (for example, nothing about being in therapy). (2) Agree the meeting point, how each of you travels (avoid shared car journeys unless agreed and insured), timing, and how the session ends. (3) Agree a weather plan (indoor fallback or rescheduling) and who decides. (4) Agree touch rules: you will not touch the client except to prevent an immediate fall, and only with consent where possible; any touch can be refused or stopped at any time; never sexual. (5) If you are also a certified guide, explain the two roles, which one you are in, and the right to have the walk with another guide instead (APA Standard 3.05 on multiple relationships). (6) Check your professional insurance covers outdoor work and, if relevant, guiding; record consent.
Example language (illustrative): "If we pass someone you know, I'll follow your lead. I won't mention that we're working together."
Watch for: blurred social feel outdoors (chatting as friends), pressure to extend time, a client who cannot say no to suggestions. Working: the client raises preferences and declines things without discomfort.

4.3 Choosing, evaluating and collaborating with a guide or programme [synthesis; source: ANFT; Nagano Prefecture]

Purpose / when: when referring rather than delivering.
Steps: (1) Identify options: an ANFT-certified guide (ANFT lists certified guides on its guide map), or in Japan a certified forest therapy base with guides. (2) Ask the guide or programme about training (ANFT certification combines a six-month remote course and an in-person immersion), group size, route and terrain, accessibility, weather and safety arrangements, first aid, insurance, and what they do if a participant becomes distressed. (3) Ask how they describe health effects; prefer those who do not promise cures. (4) With the client's written consent, share only what the guide needs to keep them safe (for example, mobility needs or a wish to sit out sharing), not clinical detail. (5) Agree that the guide contacts the client, not you, unless there is an emergency.
Example language (illustrative): "Would it help if I passed on to the guide that you may want to skip the group sharing? I'd only say that, nothing about our work."
Watch for: programmes that claim to treat illness, pressure to buy courses, routes unsuitable for the client. Working: the client feels informed and the guide knows what is needed.

4.4 Preparing the client for a guided walk [synthesis; source: ANFT; CDC]

Purpose / when: in the session before a first walk.
Steps: (1) Describe the format as ANFT does: slow, short distance, sensory invitations, sharing between them; not a hike. (2) Stress that each invitation and all sharing are optional. (3) Rehearse a way to step back ("I'll just listen this time"). (4) Plan clothing and footwear for the weather, water and snacks, and any medication the client usually carries; plan tick prevention (repellent, staying on the centre of trails) and a tick check afterwards, as CDC advises. (5) Agree a grounding plan if distress arises and a contact point. (6) Set a small intention, if the client wants one.
Example language (illustrative): "You don't have to share anything in the circle. Listening counts as taking part."
Watch for: performance anxiety ("what if I do it wrong?"), over-high expectations. Working: the client can describe the format and their own opt-outs.

4.5 Pleasures of Presence (opening invitation) [source: Chicago Botanic Garden; position in the ANFT sequence uncertain]

Purpose / when: to arrive and shift attention from thinking to the senses at the start of a walk.
Steps (as Chicago Botanic Garden outlines it, own words): stand still; breathe as if from roots below up to the sky; then tune in to each of the other senses; then turn slowly in a circle, taking in the surroundings. Movement of the arms is optional, "If you are comfortable doing so."
Example language (illustrative): "Let your feet settle. Notice your breath for a moment, then let your attention go to what you can hear... and smell... and feel on your skin."
Watch for: dizziness on turning (offer to turn the head only, or sit); closed eyes may unsettle trauma survivors, so keep eyes optional. Working: slower breathing, softer posture, the client naming sensory details.

4.6 What's in Motion? [source: ANFT, "What's in Motion?" story; Chicago Botanic Garden]

Purpose / when: early in a walk, to train slow noticing.
Steps: (1) Invite the person to slow right down and notice things moving in nature (grasses, leaves, insects, clouds, light). (2) Invite them to get closer to anything that catches their attention. (3) The guide models a very slow pace. (4) ANFT's account describes a sound cue (a kalimba) as a reminder to return to the moment when the mind wanders.
Example language (illustrative): "For a while, just notice what is moving. If something draws you, go closer to it."
Watch for: rushing ahead, commentary instead of noticing; hypervigilant clients may scan for threat rather than notice; name this gently. Working: the client lingers, notices small things, reports surprise or awe.

4.7 Other senses / the five senses [source: Chicago Botanic Garden; Nagano Prefecture]

Purpose / when: to deepen sensory contact; central in Japanese forest therapy (looking at scenery, hearing forest sounds, smelling the forest).
Steps: invite the person to notice in turn what they smell, feel (texture, temperature of air, ground underfoot), hear, and see; tasting only what is known to be safe, such as one's own tea later; never forage-tasting unknown plants [synthesis].
Example language (illustrative): "What do you notice if you let your nose lead for a minute?"
Watch for: allergy or asthma triggers; sensory overload in autistic or sensory-sensitive clients (offer one sense only). Working: richer, specific descriptions.

4.8 Breathe with a tree; breathing practice [source: Chicago Botanic Garden; Nagano Prefecture]

Purpose / when: a calming, embodied invitation; Japanese bases may also offer breathing practice, meditation or yoga.
Steps: (1) Invite the person to find a tree they are drawn to. (2) Invite them to breathe with it in their own way, standing or sitting near it, touching it only if they wish. (3) No breath-holding or forced breathing [synthesis].
Example language (illustrative): "Find a tree that interests you. Spend a little time breathing near it, at whatever pace feels natural."
Watch for: breath focus can trigger panic in some anxious clients; switch to an outward focus (bark, colour). Working: the client reports feeling steadier.

4.9 Forest Friend [source: Chicago Botanic Garden]

Purpose / when: to set down worries symbolically at the start of a walk.
Steps: invite the person to pick up a stone or other natural item to hold their worries during the walk; at the end they may keep it, return it or leave it [synthesis on ending].
Example language (illustrative): "If you like, pick something up that can hold your worries for a while, so you don't have to."
Watch for: worries that grow by being named; leave-nature-as-found rules at the site. Working: the client reports lighter thoughts or uses the object as a cue later.

4.10 Bent [source: Chicago Botanic Garden]

Purpose / when: a perspective invitation that may evoke metaphor.
Steps: invite the person to look up and compare bent and straight trees, noticing without judging.
Example language (illustrative): "Notice the trees that grew straight and the ones that bent. What do you see?"
Watch for: do not push metaphors about the client's life; let them arise. Working: the client links an image to their own life unprompted, or simply enjoys looking.

4.11 Family, or Lean on Me [source: Chicago Botanic Garden]

Purpose / when: to reflect on support and connection.
Steps: invite the person to observe how trees support each other, and to consider whether that relates to their own life.
Example language (illustrative): "Look at how these trees lean on or shelter each other. Does anything here connect with your own life?"
Watch for: grief, estrangement or abuse histories can make this invitation painful; offer it only where you can debrief. Working: the client names supports, or names a loss that can be taken into therapy.

4.12 Up and Looking Up [source: Chicago Botanic Garden]

Purpose / when: to shift perspective and widen attention.
Steps: "Up": use a small mirror to look upward or from a new angle. "Looking Up": let the eyes travel from a trunk up to the treetops.
Example language (illustrative): "Let your eyes climb the trunk, slowly, all the way to the top."
Watch for: neck strain, vertigo, uneven ground while looking up; stand still first. Working: the client reports a sense of space or wonder.

4.13 Who said that? [source: Chicago Botanic Garden]

Purpose / when: a listening invitation that engages imagination.
Steps: invite the person to close their eyes (or lower their gaze), listen, and imagine who is "speaking" in each sound and what the message might be.
Example language (illustrative): "Listen for a while. If a sound were saying something, what might it be?"
Watch for: eyes-closed work can unsettle trauma survivors; a lowered gaze is an alternative. Some clients find animistic framing alien; keep it playful and optional. Working: the client becomes absorbed and curious.

4.14 Treasure Hunt and expressive making [source: Chicago Botanic Garden; ANFT training includes expressive arts]

Purpose / when: a creative, playful invitation, good with children, families or clients who find stillness hard.
Steps: invite the person to find fallen woodland items and make a small art piece or a "home" for a forest creature; leave the site as found [synthesis on leaving no trace].
Example language (illustrative): "Gather a few things that are already on the ground and make something with them, anything at all."
Watch for: perfectionism; picking living plants or protected material; site rules. Working: absorption, play, and something the client wants to talk about or photograph.

4.15 Big and Little [source: Chicago Botanic Garden]

Purpose / when: to shift scale and attention.
Steps: invite the person to find the biggest and the smallest things nearby.
Example language (illustrative): "What's the biggest thing you can find here, and the tiniest?"
Watch for: ticks and stings when crouching in leaf litter or long grass [source: CDC on tick habitat]. Working: absorption in small detail.

4.16 Be like Bambi [source: Chicago Botanic Garden]

Purpose / when: an imaginative invitation to move and sense differently.
Steps: invite the person to imagine hearing, seeing and moving as a deer would.
Example language (illustrative): "Imagine you're a deer for a few minutes. How would you listen? How would you move?"
Watch for: self-consciousness in adults; in clients with hypervigilance this may amplify scanning for threat, so pair with a calm debrief. Working: playful movement, quieter footsteps, laughter.

4.17 Gratitude or quiet walk [source: Chicago Botanic Garden]

Purpose / when: a reflective transition, often late in a walk.
Steps: invite a period of walking quietly, reflecting on what the person feels grateful for in the forest.
Example language (illustrative): "For this stretch, walk quietly and notice anything here you feel thankful for."
Watch for: gratitude as a demand can shame depressed or grieving clients; offer "anything you appreciated, even a little" [synthesis]. Working: the client names specific things without strain.

4.18 Sit spot [source: Chicago Botanic Garden]

Purpose / when: a longer still period in one place, often near the end of a walk; the Chicago list suggests returning to the same spot regularly and optionally sketching or journalling.
Steps: (1) Help the person choose a safe, comfortable spot within sight or earshot of the group or guide. (2) Invite them to sit and notice whatever arises. (3) Optional sketching or journalling. (4) Call them back with an agreed signal.
Example language (illustrative): "Find a place to sit that feels right to you. Just be there. I'll call when it's time."
Watch for: sitting alone can trigger fear of abandonment or intrusive memories; keep the spot near and agree a signal. Damp or cold ground: bring a mat. Working: settled stillness, a wish to return.

4.19 Rest: sitting or lying down in the forest [source: Nagano Prefecture]

Purpose / when: Japanese forest therapy includes resting by sitting or lying down as a programme element.
Steps: offer a place to sit or lie on a mat or bench; invite the person to rest, look at the canopy and listen.
Example language (illustrative): "You can sit or lie back here and simply rest. Nothing to do."
Watch for: lying down can feel exposed for some clients, including survivors of assault; offer sitting. Check for ticks after contact with ground vegetation [source: CDC]. Working: physical relaxation.

4.20 Group sharing between invitations [source: ANFT, facilitation that supports open group sharing; details uncertain]

Purpose / when: after each invitation in a guided walk, so participants can say what they noticed.
Steps (own words; ANFT's exact format is [uncertain: not verified]): gather the group; invite anyone who wishes to say what they noticed; listen without comment, advice or interpretation; allow silence and passing.
Example language (illustrative): "Would anyone like to share what they noticed? Passing is fine."
Watch for: disclosures in a group that is not a therapy group; group sharing is not clinically confidential. Advise clients beforehand to share only what they are comfortable with others knowing [synthesis]. Working: brief, sensory, present-focused sharing.

4.21 Tea ceremony (closing) [source: Chicago Botanic Garden]

Purpose / when: to mark the end of the walk and the return to ordinary activity.
Steps: serve or invite a favourite herbal tea; invite a last reflection or a quiet moment.
Example language (illustrative): "Let's close with a cup of tea. You might notice how you feel now compared with when we arrived."
Watch for: only use tea bought from a known source, check allergies and any interactions the client's doctor has warned about; do not forage teas [synthesis]. Working: the client can compare before and after.

4.22 Shorter and indoor adaptations [source: Chicago Botanic Garden]

Purpose / when: for limited time, limited trail access, disability, or in-room use.
Steps (Chicago's options): limited time: Pleasures of Presence, What's in Motion and a sit spot. No trail: Pleasures of Presence and a regular sit spot. Indoors: Pleasures of Presence, a sit spot by a window, and the tea ceremony.
Example language (illustrative): "We can try a short version by the window today and see what it's like."
Watch for: do not present a window version as equivalent in effect; no source tests it [synthesis]. Working: the client can use the practice where they are.

4.23 Debrief after a walk [synthesis]

Purpose / when: in the first session after a walk.
Steps: (1) Ask what the client noticed first, in sensory terms. (2) Ask what they felt, in body and mood, before, during and after. (3) Ask which invitation stayed with them and why. (4) Ask about anything difficult (fear, sadness, memories, group discomfort). (5) Ask what, if anything, they want to carry forward. (6) Check for tick checks and any symptoms since (rash, fever, aches); advise seeing a doctor if present [source: CDC].
Example language (illustrative): "Take me back to the walk. What's the first thing you remember noticing?"
Watch for: idealisation or disappointment; difficult memories that surfaced. Working: the client links the experience to their goals in their own words.

4.24 Meaning-making and integration into therapy [synthesis]

Purpose / when: when an image or experience from the walk carries personal meaning.
Steps: (1) Invite the client to describe the image (a bent tree, a resting place). (2) Ask what it means to them; do not supply meaning. (3) Link it, if the client agrees, to current goals, values or grief. (4) Use it as a grounding image in later sessions if helpful. (5) Respect religious, spiritual or secular readings equally; if the experience raises a spiritual or religious difficulty, explore it with the DSM-5-TR Cultural Formulation Interview's spirituality, religion and moral traditions module; the code Z65.8 includes religious or spiritual problem [source: ICD-10-CM Z65.8 (Unbound Medicine); DSM-5-TR wording uncertain].
Example language (illustrative): "You keep coming back to that tree. What does it say to you?"
Watch for: imposing ANFT's animist framing or your own beliefs. Working: the client develops their own meaning and uses it.

4.25 Self-guided home practice and behavioural activation [synthesis; source: Chicago Botanic Garden]

Purpose / when: to extend benefits between sessions.
Steps: (1) Pick one or two invitations the client liked (for example, Pleasures of Presence and a sit spot). (2) Plan when and where, framed as a valued, pleasant activity in behavioural activation (cross-refer II 040), not as exercise. (3) Plan safety: tell someone where they are going, weather check, tick check afterwards. (4) Review in session.
Example language (illustrative): "Which part would you like to try on your own, and where could you do it this week?"
Watch for: turning practice into a fitness target (no exercise prescriptions here; route to the physician or an exercise professional), avoidance, guilt over missed practice. Working: the client does it and reports mood or stress changes.

4.26 Working with eco-anxiety and climate grief [source: ANFT; synthesis]

Purpose / when: when time in forests brings up grief or fear about environmental loss; ANFT states it was founded as a response to global warming and environmental catastrophe, and describes the work as releasing grief and kindling hope.
Steps: (1) Normalise the feelings as understandable responses. (2) Separate grief from risk: ask about hopelessness and suicidal thinking. (3) Explore meaning and values; identify actions the client values. (4) If the client wants group support, offer climate-emotion groups run by bodies such as the Climate Psychology Alliance or the Good Grief Network, as those organisers describe their groups [uncertain: not verified].
Example language (illustrative): "It sounds as if being among the trees made the loss feel very close. Can we stay with that for a moment?"
Watch for: despair, hopelessness or suicidal thinking: assess risk; in crisis use 988 (US) or Samaritans 116 123 (UK and Ireland). Working: grief can be felt and spoken without collapse; values-based action.

5. Handling problems

The sources on forest bathing describe the practice, not clinical difficulties; nearly all guidance below is [synthesis] unless a source is named.

"Nothing happened" / bored or stuck. Expectations may have been too high, or the pace may feel empty to an anxious mind. Respond: normalise; ask for one small sensory detail they noticed; try a more active or playful invitation (Treasure Hunt, Big and Little) next time, or a shorter version (4.22). [synthesis; Chicago options]
Scepticism ("this is hippie stuff"). Respect it. Offer the plain description (slow walk, using the senses, resting) and the honest evidence status: short-term mood benefits in reviews, low certainty, not a treatment. Leave ANFT's spiritual framing aside unless the client is drawn to it. [source: Kotera et al. 2020; Andrade et al. 2026; synthesis]
Overwhelm, panic or flashback outdoors. Stop the invitation; move to open ground with a clear view and path; use eyes-open grounding (naming colours, feeling feet on the ground); offer water and a seat; end early if needed. Afterwards, map triggers (darkness, dense woodland, isolation, smells, sounds) and choose more open, cared-for sites, which Nagano's material notes feel less anxiety-provoking than dark, neglected woodland. [source: Nagano Prefecture; synthesis]
Dissociation during stillness (sit spot, lying down, eyes closed). Keep eyes open, keep movement, keep the client within sight, shorten still periods, and agree a signal. [synthesis]
Risk. If hopelessness or suicidal thinking appears (including in climate grief), assess risk as usual; in crisis use 988 (US) or Samaritans 116 123 (UK and Ireland). Forest bathing is not a substitute for crisis or evidence-based care. [synthesis]
Non-adherence to home practice. Explore barriers: time, access, safety, weather, low mood, guilt. Reduce to the smallest version (one opening invitation at a window or a nearby green space); frame it as a valued activity (II 040), not exercise. [synthesis; Chicago indoor option]
Physical problems on the day. Bad weather: use the agreed fallback; do not go out in storms, high winds or extreme heat or cold. Insect stings or allergic reaction: follow the client's own medical plan and call emergency services if severe. Slip or fall: stop and get help; do not move someone who may be seriously injured. Ticks: check afterwards and see a doctor for a rash, fever or aches in the following weeks. Route group safety questions to the guide's or site's published safety guidance. [source: CDC; synthesis]
Water features. Forests often have streams, lakes or coast. Forest bathing does not involve entering water; if a client wants wild swimming, cold-water shock, hypothermia and drowning are real risks and medical screening (heart conditions, epilepsy, pregnancy, medications) is needed. Route to the RNLI, the Outdoor Swimming Society, Swim England or national lifesaving bodies; cross-refer 022 (blue care) and Domain X 196 (cold-water immersion). [synthesis]
Accessibility. Mobility, sensory or chronic-illness needs: choose level, short, accessible paths, benches and toilets nearby; the slow, short-distance ANFT format helps; the window adaptation exists for those who cannot go out. Ask the guide about access before referring. [source: ANFT; Chicago Botanic Garden; synthesis]
Being seen and confidentiality breaches. If the client meets someone they know, follow the agreed plan; afterwards, check how it felt and whether to change the site. [synthesis]
Boundary drift outdoors. Walking side by side can feel social. Keep the session's start, end and purpose clear; avoid shared travel or meals; discuss if the client seeks friendship. [synthesis]
Dual-role rupture (you are therapist and guide). If the client felt pressured in the group, or disclosed too much in front of others, repair in session; consider referring them to another guide for future walks (APA Standard 3.05 on multiple relationships). [source: APA Ethics Code; synthesis]
Conflict with an outside guide or programme. If a guide promises cures, discourages medical treatment, or the walk felt unsafe, support the client to raise it, help them find another provider, and do not refer there again. [synthesis]
Group discomfort. Social anxiety or difference within a group (culture, faith, body size, disability, sexuality): offer individual walks, prepare a script for passing, and debrief. [synthesis]
Spiritual framing conflicts. A client of a religious tradition may find animist or "sacred forest" language troubling, or a secular client may find it off-putting; a client may have a powerful spiritual experience. Explore with the Cultural Formulation Interview's spirituality, religion and moral traditions module; collaborate with the client's religious leader if the client wishes; Z65.8 may apply where a religious or spiritual problem is the focus. [source: ICD-10-CM Z65.8 (Unbound Medicine); synthesis]
Replacing needed treatment. If a client wants forest bathing instead of treatment for moderate or severe depression, anxiety or other conditions, explain the evidence status and offer it as a complement. [source: Kotera et al. 2020; Andrade et al. 2026; synthesis]
Children and young people. Get parental consent and the young person's assent; follow safeguarding procedures; never be alone with a child out of sight of others unless your service's safeguarding policy permits it; plan for allergies and supervision near water or roads. [synthesis]
Getting separated. Agree in advance what a client does if separated (stay put, call), carry a charged phone, and know the site layout. [synthesis]

Sources

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