Atlas›Domain XV · Nature, philosophy, social & rites of passage›Guide 019
Guide XV-019

Outdoor talking therapies (walk-and-talk)

A 32 · L 52 · M 1622 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: walk-and-talk and outdoor talking therapy as a way of delivering an existing talking therapy outdoors (not a separate school), in the form described by Jordan and Marshall (2010) and Jordan (2014) on the outdoor therapeutic frame, the British Psychological Society guidance on taking therapy outdoors developed at the University of Leicester (Cooley and Robertson, 2021), and service accounts from the NHS (James et al., 2021; Davies, 2024). Where these differ, the more cautious public-sector practice is followed.

Outdoor talking therapy means holding counselling or psychotherapy sessions in natural or semi-natural outdoor places, ranging from sitting on a park bench or walking a footpath ("walk and talk") to more active sessions with clients who already have a relationship with outdoor pursuits [source: BPS news item on the guidance]. Jordan and Marshall distinguish "nearby nature" (parks, woods) from wilder, more isolated places, and argue that moving outside changes the therapeutic frame, especially contracting around confidentiality and timing, and reshapes mutuality and asymmetry in the relationship [source: Jordan and Marshall 2010, abstract]. There is no single manual: a doctoral study of UK practice states there is no identified framework for practice and no shared theoretical underpinning; therapists bring their own modality (for example, person-centred experiential counselling for depression in an NHS Talking Therapies service) [source: Revell 2019; Davies 2024].

How change is thought to happen, as practitioners describe it: walking side by side reduces sustained eye contact and the intensity of the face-to-face gaze, which some clients find makes difficult feelings easier to speak; the shared, moving activity encourages a more collaborative, equal relationship; walking is felt to help clients move past feeling stuck and to support psychological processing; and the natural environment can act as backdrop, resource, container or "living third" in the work [source: Revell and McLeod 2016; Davies 2024; Hanrahan 2021; James et al. 2021]. The meta-synthesis by Cooley et al. (2020) is reported as finding greater freedom of emotional expression, mind-body holism, interconnection with nature, mutuality and improved practitioner wellbeing, with most research in private or educational rather than public healthcare settings [source: as summarised in James et al. 2021 and Hanrahan 2021] [uncertain: not verified]. Theories invoked to explain benefits (Attention Restoration Theory, Stress Reduction Theory) are the authors' interpretive frameworks [source: James et al. 2021]. Evidence status in one line: published studies are small, qualitative or uncontrolled feasibility work that supports acceptability more than effectiveness [source: James et al. 2021, own limitations].

Related guides: 015 green social prescribing; 022 blue care and open-water swimming (cold-water immersion and its harms are covered in Domain X 196, not here); behavioural activation framing for activity (Domain II 040).

2. Framework

There is no fixed phase model or session count in the sources; the structure below organises what the guidance and service accounts describe [synthesis, built from the sources cited per phase].

Phase 0: Therapist readiness. Goal: decide whether outdoor work fits your competence, setting and organisation. Reflect on why this approach, why this client and why now, and whether going outside deepens the therapeutic task or moves away from it [source: BACP University and College Counselling 2022]. Explore your own process in nature and seek outdoor-specific training and supervision [source: Hanrahan 2021]. Practitioners report a lack of training and supervision, and Revell and McLeod recommend research-informed guidelines and training for safe practice [source: Revell 2019; Revell and McLeod 2016]. Check organisational policy, risk procedures and insurance [source: BACP UCC 2022]. Move on when: insurer, employer and supervisor arrangements are in place and you have chosen and walked suitable venues.

Phase 1: Assessment and choice of setting. Goal: decide collaboratively whether, where and how to work outside. One NHS service used a one-hour telephone assessment covering conditions affecting movement, familiarity with the location, likelihood of meeting someone known, and emotional associations with green spaces [source: Davies 2024]. An inpatient service required appropriate leave, active engagement with psychology and consent, and excluded people without leave because of clinical risk or too unwell to take part, with multidisciplinary risk assessment [source: James et al. 2021]. The guidance covers suitability by client and presenting problem, choice of outdoor activity, practicalities, and safety, consent and confidentiality [source: NHS Forest summary of the Leicester guidance]. Move on when: the client has made an informed choice and risk is assessed.

Phase 2: Contracting. Goal: an explicit outdoor contract. Services completed a shared written contract before the first outdoor session following BPS guidance, setting out the limits of confidentiality in public spaces [source: James et al. 2021; Davies 2024]. Contract content is detailed in section 4. Move on when: the contract is signed or recorded and the client knows what to expect at the venue.

Phase 3: Outdoor sessions. Format reported: a regular meeting place and route for predictability [source: Davies 2024]; sitting or walking chosen by risk assessment, formulation and preference; in one inpatient service sessions lasted 60 minutes [source: James et al. 2021]. Sessions may move indoors or to phone or video because of weather [source: James et al. 2021; Davies 2024]. Criteria for continuing: alliance and outcome measures hold up, anxiety stays at a level useful for therapy, and the frame is intact [source: BACP UCC 2022; James et al. 2021].

Phase 4: Review and re-contracting. Goal: revisit boundaries and the setting as needs change; psychologists re-contracted as needed, for example agreeing how the client would signal discomfort [source: James et al. 2021]. Move back to the room, or forward, by joint decision [synthesis].

Phase 5: Ending. Goal: close the therapy and support continued self-directed use of outdoor places; many clients in one service planned to keep walking after therapy ended [source: Davies 2024]. Structure of the ending itself is [synthesis].

Typical session count: not stated in the sources; follow the parent modality and service contract [uncertain].

3. Guiding principles

  • Environmental safe uncertainty. Stay open, curious and collaborative about where therapy happens rather than fixed on any one room; practically, ask the client about setting instead of assuming it [source: Cooley et al. 2022].
  • The client shares the choice. Involve clients in deciding the environment, and offer outdoor work collaboratively rather than as a default [source: Cooley et al. 2022; Revell 2019].
  • The frame moves, it does not disappear. Confidentiality, timing, start and end points must be re-made explicitly outdoors; practically, contract for each [source: Jordan and Marshall 2010; BACP UCC 2022].
  • Therapy, not friendship. The informal setting can feel like friendship; practically, monitor and name the boundary [source: James et al. 2021]. Multiple relationships: see APA Ethics Code Standard 3.05 [source: APA Ethics Code].
  • Safety is the client's felt safety as well as physical safety. Practically, assess both, including the risk of a client pushing themselves too far [source: BACP UCC 2022; Hanrahan 2021].
  • Predictability supports risk-taking. Practically, keep a regular meeting place and route [source: Davies 2024].
  • Individual tailoring. Adapt to the person, location and formulation; outdoor work is not suitable for every person or presentation (some families, couples and some trauma presentations were named by practitioners) [source: Revell 2019; James et al. 2021].
  • Accessibility and equity. Outdoor settings can widen access; practically, offer non-walking outdoor options for people with mobility needs [source: Davies 2024; Cooley et al. 2022].
  • Mutuality with retained responsibility. Side-by-side work is more equal, but the therapist still holds the frame, risk and roles such as navigator or first aider [source: Jordan and Marshall 2010; BACP UCC 2022].
  • Therapist regulation is part of the work. Practically, notice your own physical and emotional state (fatigue, cold, pace) and how it intrudes [source: Hanrahan 2021; Revell 2019].
  • Competence within limits. Practically, do adventurous activities only where trained and insured as national governing bodies require [source: BACP UCC 2022].
  • Nature's role is chosen, not assumed. Nature may be backdrop or active resource; decide with the client whether it is used [source: James et al. 2021; BACP UCC 2022].
  • Monitor outcomes. Practically, use routine measures to check the setting is helping [source: BACP UCC 2022; James et al. 2021].
  • Touch. Outdoors there may be moments of steadying or helping over obstacles; any touch needs consent before and during, the client can stop it at any time, and it is never sexual [synthesis].

4. Intervention inventory

The sources describe mostly frame-setting and process procedures rather than named techniques; the inventory below gives those, plus therapist-side procedures marked [synthesis] where the sources name a task without describing its steps. The talking-therapy content itself comes from your own modality.

4.1 Therapist pre-referral reflection

  • Purpose / when: before offering outdoor work to any client [source: BACP UCC 2022; Hanrahan 2021].
  • Steps: (1) Write down why this approach, why this client, why now. (2) Ask whether going outside deepens the therapeutic task or moves away from it (for example, avoidance of the room or of intimacy). (3) Consider how the alliance and power balance will change. (4) Review your own relationship with nature and your comfort in different weather and terrain. (5) Take it to supervision.
  • Example language (illustrative): in supervision, "I notice I want to take this client outside; I want to check whether that is for them or for me."
  • Watch for: outdoor work as the therapist's preference imposed on the client (environmental certainty in reverse); unexamined wish to escape a stuck phase. Working: you can state a formulation-linked reason.

4.2 Suitability and health screening

  • Purpose / when: at assessment, before any outdoor session [source: Davies 2024; James et al. 2021; Revell 2019].
  • Steps: (1) Ask about health conditions that affect movement, stamina or comfort outdoors (mobility, breathing, heart, pain, epilepsy, pregnancy, allergies including pollen and insect stings, medication side effects such as sun sensitivity) without giving any exercise advice; refer questions about physical capacity to the client's GP or physician [synthesis, building on Davies 2024]. (2) Ask about familiarity with the location, whether they are likely to meet someone they know, and their emotional associations with green spaces (some have frightening or traumatic ones) [source: Davies 2024]. (3) Assess clinical risk and, in inpatient or secure settings, leave status with the multidisciplinary team [source: James et al. 2021]. (4) Consider presentations named as less suitable: some families, couples, some trauma presentations [source: Revell 2019].
  • Example language (illustrative): "Some people find walking makes talking easier, others find it distracting or uncomfortable. Before we decide, can I ask about anything that affects how you get around outdoors, and whether parks or woods carry any particular memories for you?"
  • Watch for: clients minimising health limits to please you; outdoor anxiety, which is then a treatment target rather than a reason to proceed casually (see 4.17). Working: a clear, recorded yes, no or not-yet.

4.3 Collaborative choice of setting (environmental safe uncertainty)

  • Purpose / when: at assessment and at reviews; Cooley et al. found practitioners often hold fixed setting preferences and rarely involve clients [source: Cooley et al. 2022; BACP UCC 2022].
  • Steps: (1) Present the options you can safely offer (room, outdoor seated, outdoor walking, phone or video). (2) Name pros and cons of each honestly, including privacy. (3) Ask the client's preference and reasons. (4) Agree a trial and a review point.
  • Example language (illustrative): "Where we meet is something we can decide together. I can offer the room, a bench in the park, or walking a set route. What appeals, and what worries you about each?"
  • Watch for: compliance; a client choosing outside to avoid closeness or the room to avoid being seen. Working: the client voices a preference and can change it.

4.4 Outdoor contract and informed consent

  • Purpose / when: before the first outdoor session; services used a written contract following BPS guidance [source: James et al. 2021; Davies 2024; BACP UCC 2022; Jordan and Marshall 2010].
  • Steps: cover in writing and verbally: (1) what outdoor therapy involves and its risks; (2) limits of confidentiality in public space; (3) what happens if you meet people, including people either of you knows (see 4.5); (4) where and when the session starts and ends; (5) the weather plan (4.7); (6) how either of you stops or returns indoors mid-session, and that the client may stop at any time; (7) how the client will signal discomfort; (8) travel arrangements; (9) that you carry a first aid kit and phone; (10) any touch (for example, a steadying hand) requires consent before and during and can be refused; (11) cost or timing differences; (12) record keeping. Record the agreement.
  • Example language (illustrative): "Outside, people may pass close by and we can't guarantee no one overhears. If that happens we can pause, change the subject, or move. If at any point you want to stop or go back indoors, just say so and we will."
  • Watch for: contracts signed without discussion; omitted items emerging later. Working: client can restate the key points.

4.5 Encounter plan for being seen

  • Purpose / when: contracting; review before sessions in busy places [source: BACP UCC 2022; Hanrahan 2021; Davies 2024].
  • Steps: (1) Ask how the client would like to handle meeting someone they know. (2) Agree whether you acknowledge each other if the therapist is greeted by someone (default: the therapist does not introduce the client) [synthesis]. (3) Agree a short, honest line the client can use; the BACP article offers something like "I'm in the middle of something, we'll catch up later" [source: BACP UCC 2022]. (4) Agree what happens afterwards (resume, move, debrief).
  • Example language (illustrative): "If you see someone you know, you decide what to say. I won't introduce myself unless you want me to. Afterwards we can talk about how it felt."
  • Watch for: shame or paranoia after an encounter; Hanrahan reports clients were generally not worried, but escorted inpatients found privacy harder [source: Hanrahan 2021; James et al. 2021]. Working: encounters are handled without the session collapsing.

4.6 Venue and route selection and reconnaissance

  • Purpose / when: before first use of any site [source: Davies 2024; Hanrahan 2021].
  • Steps: (1) Walk the route yourself in advance. (2) Check criteria reported by one service: even, paved paths, seating, shelter, toilets, and public transport or parking; a park busy enough for safety and large enough for confidentiality [source: Davies 2024]. (3) Note hazards qualitatively: wet or muddy ground, sun exposure, pollen, cold, busy roads [source: James et al. 2021]. (4) Note sensory features that might trigger distress and calmer spots nearby [source: Hanrahan 2021]. (5) Identify the nearest facilities and emergency access, especially for remoter places [source: BACP UCC 2022]. (6) Fix a regular meeting point and route [source: Davies 2024]. (7) Tell the client what to expect: busyness, sitting and walking options, private spaces [source: Hanrahan 2021].
  • Example language (illustrative): "We'll meet by the main gate. The path is paved, there are benches every so often and a café with toilets halfway round."
  • Watch for: routes too long, steep or remote for the client; seasonal changes (mud, closures, events). Working: the client knows the venue and feels oriented.

4.7 Weather and contingency plan

  • Purpose / when: contracting and before every session [source: Davies 2024; James et al. 2021; BACP UCC 2022].
  • Steps: (1) Agree the default (one service went out in any weather except a Met Office weather alert, when it offered phone, video or rescheduling) [source: Davies 2024]. (2) Agree clothing and what each person brings; one ward lacked sun protection and waterproofs, so plan for equipment [source: James et al. 2021]. (3) Agree an indoor fallback (some sessions moved indoors because of weather or clothing) [source: James et al. 2021]. (4) Agree how and when the decision is communicated.
  • Example language (illustrative): "If there's a weather warning, I'll message you and we'll switch to a phone session at the same time."
  • Watch for: the client or therapist being cold, overheated or wet and unable to attend to the work; weather used as a repeated reason to cancel (see section 5). Working: changes happen without lost sessions or confusion.

4.8 Lone-working and emergency procedure

  • Purpose / when: every outdoor session [source: Davies 2024; BACP UCC 2022; James et al. 2021].
  • Steps: (1) Use a check-in and check-out system (one service posted start and end in a private messaging group monitored by at least one practitioner) without client-identifying details [source: Davies 2024; identifying-detail point is synthesis]. (2) Tell someone where you are going and when you expect back [source: BACP UCC 2022]. (3) Carry a first aid kit and charged phone, tell the client you have them [source: BACP UCC 2022]. (4) In inpatient services, have a colleague available on the ward [source: James et al. 2021]. (5) Hold outdoor first aid training where activities require it [source: BACP UCC 2022]. (6) Know how you would respond to a medical emergency, a client walking off, or a risk disclosure outdoors [synthesis].
  • Example language (illustrative): "I carry a first aid kit and my phone, and a colleague knows when our session starts and ends."
  • Watch for: check-outs missed; the procedure lapsing over time. Working: every session has a logged start and end.

4.9 Marking the start and end of the session

  • Purpose / when: every session; outdoors there is no waiting room or clock, and timing is a frame element [source: BACP UCC 2022; Jordan and Marshall 2010].
  • Steps: (1) Agree a physical starting point and an explicit opening statement. (2) Plan the route so the end returns to a known point near time. (3) Signal time remaining as the route turns back. (4) Close at an agreed place, with a clear ending statement, and part ways rather than walking on together [synthesis for steps 1-4 beyond the source's principle].
  • Example language (illustrative): "We've started now." ... "We've about ten minutes left, so we'll head back towards the gate." ... "This is where we finish today."
  • Watch for: sessions drifting over time; social chat continuing after the end. Working: the client recognises the session's boundaries.

4.10 Side-by-side walking and pacing

  • Purpose / when: the core walk-and-talk position; side-by-side walking reduces eye contact, feels less intense, and supports collaboration [source: Revell and McLeod 2016; Davies 2024; Hanrahan 2021].
  • Steps: (1) Walk alongside, not ahead. (2) Let the client set the pace; mismatched walking speeds were a reported difficulty [source: James et al. 2021]. (3) Listen differently: without face-to-face cues, attend to voice, breathing, pace changes and pauses [source: Revell 2019]. (4) Turn to face the client or stop when you need to see their face, for example at a key disclosure [synthesis]. (5) Notice your own physical state and how it intrudes [source: Revell 2019].
  • Example language (illustrative): "You set the pace; if you want to stop or slow down, we will." / "I noticed you slowed right down when you mentioned your dad."
  • Watch for: missed nonverbal cues; the client walking faster when distressed (possible avoidance or arousal); therapist breathlessness. Working: clients report talking more freely.

4.11 Managing privacy in the moment

  • Purpose / when: when others come within earshot [source: James et al. 2021].
  • Steps: (1) Follow the client's contracted preference: some clients wanted conversation paused when others were near, others were comfortable with the therapist managing privacy through phrasing. (2) Pause, lower voice, or use neutral phrasing until people pass. (3) Use pauses as thinking time; one study found pausing interrupted flow but sometimes gave clients space to reflect. (4) Return to the thread explicitly. [source: James et al. 2021; step 4 synthesis]
  • Example language (illustrative): "Let's let them pass." ... "You were saying about the argument on Sunday."
  • Watch for: paranoia or distress at being overheard, particularly with escorted inpatients [source: James et al. 2021]. Working: interruptions are absorbed without loss of trust.

4.12 Working with silence and presence

  • Purpose / when: when the client goes quiet; clients reported less pressure to talk constantly and could simply be present in their surroundings [source: Davies 2024].
  • Steps: (1) Allow walking silence without filling it. (2) Notice whether the silence is restful, avoidant or dissociative (see 4.15). (3) After a while, invite a brief reflection on what was going on inside [synthesis].
  • Example language (illustrative): "We can just walk for a bit." ... "What's been going through your mind while we've been quiet?"
  • Watch for: silence becoming a way to avoid the work over many sessions; blank or glazed responses. Working: the client returns from silence with material.

4.13 Choosing and switching between sitting and walking

  • Purpose / when: at contracting and within sessions; services chose sitting or walking by risk assessment, formulation and preference [source: James et al. 2021; Hanrahan 2021].
  • Steps: (1) Offer both where the venue allows. (2) Suggest sitting for moments that need face-to-face attunement, writing or grounding; walking when movement helps regulation or the client feels stuck [synthesis, consistent with Revell and McLeod 2016]. (3) Let the client initiate a change. (4) For people with mobility needs, plan a fully seated outdoor option [source: Davies 2024].
  • Example language (illustrative): "Shall we sit on that bench for this part?"
  • Watch for: the client never wanting to stop (possible avoidance). Working: positions are used purposefully.

4.14 Sensory grounding and orienting

  • Purpose / when: for relaxation, regulation, anchoring in the present; used in inpatient and trauma-informed outdoor work [source: James et al. 2021; Hanrahan 2021; BACP UCC 2022].
  • Steps: (1) Invite the client to notice what they can see, hear, smell and touch around them. (2) Help them orient towards what is pleasant or restful in the environment [source: Hanrahan 2021]. (3) Distinguish engaging activities from effortless fascination, such as watching moving water, and use whichever helps [source: BACP UCC 2022]. (4) Ask what changed in the body. Hanrahan cites Barrows and Marshall's "5Rs" (Relax, Receive, Remember, Release, Resource) as one structure; the steps of that model are not described here [uncertain: not verified].
  • Example language (illustrative): "Take a moment to notice three things you can hear right now." ... "Is there anything here your eyes want to rest on?"
  • Watch for: sensory cues (a smell, a sound) that trigger distress; allergies [source: Hanrahan 2021]. Working: breathing and speech slow; the client reports feeling more present.

4.15 Movement for regulation and titrating trauma material

  • Purpose / when: with trauma histories; outdoor work can bring dissociated material to the surface more quickly [source: Hanrahan 2021].
  • Steps: (1) Use the rhythm of walking to support regulation. (2) Take trauma material in small doses ("titrate"). (3) If distress rises, slow down, stop, or move to a calmer spot nearby, and ground (4.14). (4) Help the client regulate before the session ends and before they travel home [source: Hanrahan 2021; step 4 synthesis]. (5) Follow your trauma model's own rules for processing work; outdoor setting does not replace them [synthesis].
  • Example language (illustrative): "Let's slow down here. Feel your feet on the path. We can come back to that memory in a little while, a small piece at a time."
  • Watch for: dissociation, flashback, disorientation in an unfamiliar place; Revell reports practitioners viewed some trauma presentations as unsuitable [source: Revell 2019]. Working: the client can approach and step back from material.

4.16 Nature as metaphor and the route as reflection

  • Purpose / when: when the client or therapist notices a resonance between the environment and the client's life [source: BACP UCC 2022].
  • Steps: (1) Notice how the client navigates the route, which may reflect their inner world (for example, always choosing the safe path, rushing, getting lost). (2) Offer tentatively, or wait for the client's own metaphor. (3) Decide with the client whether the outing frames nature as escape or return. (4) Work with the client-nature-therapist relationship: the therapist as witness, container, mediator or partner [source: BACP UCC 2022]. Burns' experiential metaphor model (goal setting, a journey in a natural setting, time for experience, focus on the person-environment relationship, anticipating change) is cited in UK literature as a structured option [source: as cited in Revell 2019] [uncertain: not verified].
  • Example language (illustrative): "You chose the path round the edge of the field again. Does that fit anything about how you're approaching things at the moment?"
  • Watch for: therapist-imposed meanings; spiritual or ecological framings described as the client's own beliefs, not as fact. Working: the client generates and uses their own metaphors.

4.17 Graded exposure to outdoor environments

  • Purpose / when: for clients with anxiety about outdoor or public places, as one inpatient service did [source: James et al. 2021].
  • Steps: (1) Formulate the anxiety and agree goals within your exposure protocol. (2) Build a hierarchy of outdoor settings together. (3) Get consent for each step and agree a stop signal. (4) Review after each step. Note that lower comfort scores in that study came mainly from people doing this work [source: James et al. 2021; steps 1-4 synthesis].
  • Example language (illustrative): "Today's step was the bench by the ward entrance. How anxious did you feel at the start compared with now?"
  • Watch for: excessive distress, safety behaviours, consent under pressure. Working: anxiety reduces across repetitions. Contraindications and consent per your exposure model.

4.18 Shared practical tasks and roles

  • Purpose / when: in more active sessions (for example fire-lighting) [source: BACP UCC 2022].
  • Steps: (1) Agree who takes responsibility for each task and how autonomy and support will work. (2) Do only activities you are trained and insured for. (3) Reflect afterwards on how the collaboration went and what it shows [source: BACP UCC 2022].
  • Example language (illustrative): "Do you want to have a go at this yourself, or shall we do it together? Afterwards I'd like to hear what that was like."
  • Watch for: the client pushing themselves too far physically [source: BACP UCC 2022]; therapist sliding into instructor role. Working: the task yields reflective material.

4.19 Boundary review and re-contracting

  • Purpose / when: at planned reviews and whenever the frame wobbles; services re-contracted as needed [source: James et al. 2021].
  • Steps: (1) Review the contract items (4.4). (2) Name signs of drift toward friendship, which the informal setting can invite. (3) Agree changes, such as a discomfort signal. (4) Re-record [source: James et al. 2021; step 4 synthesis].
  • Example language (illustrative): "Walking like this can start to feel like a chat between friends. It matters that this stays your space, so I want to check how the arrangement is working."
  • Watch for: gifts, invitations, social contact requests, offers of lifts (dual relationship; APA Ethics Code Standard 3.05). Working: the client understands the frame and both feel it holds.

4.20 Between-session outdoor tasks

  • Purpose / when: to extend benefit; Hanrahan suggests nature-based homework such as imagining favourite natural places, and in one service many clients planned to keep walking after therapy [source: Hanrahan 2021; Davies 2024].
  • Steps: (1) Frame any outdoor activity as behavioural activation (Domain II 040), chosen by the client. (2) Give no exercise prescriptions; for questions about how much activity is safe, refer to the client's physician or a qualified exercise professional. (3) Review what happened next session [synthesis].
  • Example language (illustrative): "Is there a place outdoors you'd like to spend some time in this week? What would make that more likely to happen?"
  • Watch for: activity becoming compulsive or linked to weight or eating concerns; if so, screen for disordered eating and refer to a registered dietitian or eating-disorder service [synthesis]. Working: the client uses outdoor places independently.

4.21 Outcome and alliance monitoring

  • Purpose / when: routinely [source: BACP UCC 2022; James et al. 2021].
  • Steps: (1) Use your service's routine outcome measures. (2) Use an alliance measure; the inpatient study used the Session Rating Scale (noting it was validated in community samples). (3) Compare indoor and outdoor periods if both are used. (4) Watch for changes in the client's situation and for anxiety beyond the level useful for therapy [source: James et al. 2021; BACP UCC 2022].
  • Example language (illustrative): "Before we finish, can you rate how today went for you, including where we met?"
  • Watch for: measures completed outdoors in rain or haste [synthesis]. Working: scores stable or improving.

4.22 Post-session health checks and ending outdoor work

  • Purpose / when: after sessions in grass, woods or heathland, and at the close of therapy.
  • Steps: (1) Remind clients that ticks occur in parks and gardens as well as countryside; advise covering skin and sticking to clear paths, checking skin after time outdoors, prompt removal with fine-tipped tweezers or a tick tool, and contacting their GP if they feel unwell or notice a spreading rash after a bite [source: NHS Western Isles leaflet]. (2) Prompt hydration and sun protection qualitatively [synthesis]. (3) At ending, review what the client has learned about using outdoor places, and plan continued self-directed use [synthesis, consistent with Davies 2024]. (4) Consider whether the final session is outdoors or in the room, chosen together [synthesis].
  • Example language (illustrative): "We walked through long grass today, so it's worth checking your skin for ticks this evening." / "For our last session, where would you like us to meet?"
  • Watch for: unreported allergic reactions or bites; endings that feel abrupt when the shared walk stops. Working: the client leaves with a clear plan.

5. Handling problems

Practitioners name working with uncertainty, maintaining boundaries and needing new skills as the main hindering factors [source: Revell and McLeod 2016]. Responses below are [synthesis] unless a source is given.

  • Client reluctant to try outdoor work. Reluctance is reported in the literature [source: Revell 2019]. Explore the specific fear (being seen, fitness, weather, past experiences in green spaces) [source: Davies 2024], offer a seated or short trial in a known place, or stay indoors; the room is a legitimate choice under environmental safe uncertainty [source: Cooley et al. 2022].
  • Stuck client. Walking is felt to help move past stuckness [source: Revell and McLeod 2016]; if still stuck outdoors, review the formulation rather than the venue, try a change of position (sit, stop, face each other), or return to the room for focused work [synthesis].
  • Avoidance through the activity. Constant walking, sightseeing chat or problem-free talk can build rapport [source: James et al. 2021] but can also become avoidance. Name the pattern gently and agree a point in each session to turn to the agreed focus [synthesis].
  • Overwhelm or dissociation outdoors. Stop, slow, move to a calmer spot, ground with the senses, titrate [source: Hanrahan 2021]. Do not part company until the client is regulated and able to travel safely [synthesis].
  • Risk disclosure or crisis mid-walk. Stop somewhere quieter, complete your usual risk assessment, and follow your service's crisis pathway; know in advance how you would get help from your location (4.8). Give crisis resources where relevant: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland) [synthesis].
  • Client walks off or refuses to return. Agree in the contract what you will do (for example, phone contact, then your service's missing-person or risk procedure for inpatients) [synthesis, building on James et al. 2021 on leave and MDT procedures].
  • Non-attendance and weather cancellations. Apply the agreed weather plan; if cancellations recur, explore their meaning and consider switching to the room or remote sessions [source for weather plan: Davies 2024; rest synthesis].
  • Rupture from a confidentiality breach or encounter. Acknowledge it, invite the client's feelings about being overheard or seen, repair, and revisit the encounter plan (4.5) [synthesis]. Escorted inpatients may experience reduced privacy as distressing or paranoia-provoking [source: James et al. 2021].
  • Drift toward friendship. Name and re-contract (4.19) [source: James et al. 2021]. Avoid shared social activity outside sessions; for dual roles see APA Ethics Code Standard 3.05.
  • Dual roles with other outdoor qualifications. If you are also a forest therapy guide, outdoor instructor or similar, be clear with the client which role you are in, keep to the competence and insurance the certifying or national governing body requires [source: BACP UCC 2022], and do not mix guided-activity groups with individual therapy clients without discussing it [synthesis].
  • Insurance and liability. Confirm with your insurer, in writing, that outdoor sessions and any activities are covered, and check vehicle insurance if you ever travel together [source: BACP UCC 2022]. Separate travel is simpler; if travelling separately, have a backup plan if the client's transport fails [source: BACP UCC 2022].
  • Physical incidents (falls, bites, allergic reaction, heat or cold). Give first aid within your training, call emergency services if needed, record the incident and inform your supervisor and insurer [synthesis]. Ticks: see 4.22 [source: NHS Western Isles leaflet].
  • Water nearby. Routes beside rivers, lakes or the sea carry drowning risk if someone slips or enters the water; choose paths set back from edges and do not include swimming or immersion in talking-therapy sessions. Open-water and blue-care work is covered in 022 and cold-water immersion in Domain X 196; route clients interested in swimming to the RNLI or national lifesaving bodies' safety guidance [synthesis].
  • Touch. If a client needs steadying or help over an obstacle, ask first, keep it brief and functional, stop if they withdraw consent, never sexual; discuss any touch in supervision [synthesis].
  • Photography or recording by others, dogs, crowds, events. Choose times and routes to minimise these; pause or move as for privacy (4.11) [synthesis].
  • Therapist discomfort or fatigue. The therapist's physical state can intrude on listening [source: Revell 2019]; dress for conditions, plan routes within your own capacity, and take this to supervision [synthesis].
  • Organisational resistance. Leaders cite therapy traditions, internalised risk, business models and biomedical approaches as barriers [source: Cooley et al. 2022]. Prepare a written protocol covering contracting, risk, lone working and insurance, using the BPS guidance as the basis [source: BPS news item; Davies 2024].
  • Families, couples and some trauma presentations. Practitioners report outdoor walking may not suit these [source: Revell 2019]; prefer the room or a seated outdoor option and review with supervision [synthesis].

Sources

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