Walk and Talk Therapy: A Therapist’s Guide

Mental health professionals understand that therapy must be tailored to meet each client's unique needs. This often involves exploring different methods and techniques while remaining adaptable and ready to refine and adjust the therapeutic approach as treatment progresses.

Embracing flexibility and innovation in therapeutic practices is vital to facilitating significant breakthroughs and supporting clients in achieving their goals. Among the diverse strategies employed by therapists, integrating the healing aspects of nature and physical movement into therapy sessions has gained prominence. This approach, known as walk-and-talk therapy, offers an alternative to traditional in-office sessions and telehealth consultations. It has gained traction over the past several years as therapists faced finding alternatives to traditional in-office sessions.

What Walk and Talk Therapy is?

Walk-and-talk therapy, or hiking therapy, moves therapeutic sessions outside into nature. Sessions can be conducted in public parks or along local trails, incorporating fresh air and physical activity into the therapeutic process.

Movement, whether a leisurely walk or a brisk hike, can better facilitate the discussion of feelings. Clients might like to walk or move around instead of sitting and talking to their therapist in an office or looking at a computer screen.

Some therapists discovered that walk-and-talk therapy works well with younger clients. Some clients may feel more at ease in nature, which improves their ability to share. Taking therapy outdoors can help relieve some of the pressure clients may experience.

Is Walk and Talk Therapy a Good Option for Your Practice?

Just like with any therapy method, think about your clients and what they need before you recommend walk and talk therapy. This option may be best for clients who are fidgety or exhibit excess energy during sessions. Perhaps specific clients feel uncomfortable with maintaining direct eye contact and sitting still. Physical movement encourages psychological movement and can even accelerate client breakthroughs (Revell & McLeod, 2017).

Exercise produces endorphins, positively impacting mental health (Mahindru et. al., 2023). Clients may be more energized at the end of outdoor therapy sessions, and for generally healthy clients, outdoor sessions can enhance their problem-solving abilities.

Clients’ physical and mental health must be considered before suggesting walk-and-talk sessions. Walk-and-talk therapy is not physically strenuous, and the client sets the pace of the walk. Before making the leap, investigate the local terrain, accessibility to benches and water fountains on your route, and any underlying health concerns your client may have. Plan outdoor sessions around weather conditions.

Therapists considering integrating walk-and-talk therapy into their practice must consider therapeutic style, client population, and the logistics of conducting sessions outside a traditional office setting. This modality is especially suitable for therapists open to non-traditional therapy settings and comfortable conducting sessions while walking. It appeals to clients who might feel confined by four walls, those seeking a less formal therapeutic experience, or individuals who find that movement helps them think and communicate more freely.

Walk-and-talk therapy may not be suitable for all clients or therapists because it requires access to a safe and private outdoor space where confidentiality can be maintained. Finally, therapists must consider their own physical ability to walk for extended periods and the logistics of scheduling and conducting sessions outdoors.

Benefits of Walk-and-Talk Therapy

Walk-and-talk therapy offers several benefits, including the following:

• Exercise improves mental health.
• Physical activity is known to reduce symptoms of anxiety and depression. It can enhance mood and mental alertness through the release of endorphins.
• Regular walking improves cardiovascular health, aids in weight management, and boosts overall physical well-being.
• Spending time in nature can have a calming effect, reduce stress, and enhance a client's connection to the environment, promoting mindfulness and present-moment awareness.
• Supports emotion regulation.
• Facilitates therapeutic alliance and integration of therapy skills.
• Can help build the habit of walking.
• May allow clients to view a situation with more clarity and insight.
• Clients may feel less intimidated, fostering openness and making it easier to discuss challenging topics.
• Movement and a changing environment can stimulate thinking, creativity, and problem-solving, offering new perspectives.

Ethical Concerns About Walk-and-Talk Therapy

While innovative and beneficial for many, walk-and-talk therapy raises several ethical concerns that therapists must navigate carefully to uphold their clients' best interests and confidentiality.

Confidentiality and Privacy.

One of the foundational elements of therapy is confidentiality. In traditional settings, therapy rooms provide a private space where clients can share their thoughts and feelings without fear of being overheard. In contrast, conducting sessions outdoors inherently risks breaches of confidentiality. Therapists must carefully choose locations to minimize the risk of being overheard by passersby and discuss with clients the potential for unintended encounters.

Professional Boundaries.

Walk-and-talk therapy blurs the traditional physical boundaries of an office setting, potentially affecting the therapist-client relationship. Therapists must maintain professional boundaries even in less formal settings and ensure that the therapeutic dynamic remains clear.

Accessibility and Inclusivity.

This therapy mode may not be suitable for all clients, including those with physical disabilities or those who may not feel comfortable in outdoor settings due to personal preferences or phobias. Therapists must consider inclusivity and accessibility when offering walk-and-talk therapy, ensuring alternatives are available for clients who may not benefit from this approach.

Safety and Liability.

Conducting therapy outside the controlled environment of an office introduces safety concerns. Therapists must consider and plan for potential risks associated with outdoor activity, such as uneven terrain or inclement weather. Additionally, liability insurance may have specific clauses related to conducting therapy in public spaces, which therapists should review and adhere to.

Therapeutic Effectiveness.

While walk-and-talk therapy can be effective for some, assessing its appropriateness on a case-by-case basis is essential. Therapists should evaluate whether the benefits of being outdoors and incorporating movement align with each client's therapeutic goals and needs.

Environmental Factors.

External factors such as weather, noise, and seasonality can influence the success of outdoor sessions. Therapists must have contingency plans for when conditions are not conducive to outdoor therapy and communicate these plans clearly to clients.

Ethical Considerations in Practice.

Ethical practice in walk-and-talk therapy also involves obtaining informed consent, which is when clients are made aware of the potential risks and limitations of this therapy mode. It includes discussing confidentiality, privacy, the possibility of being seen by others, and how these situations will be handled.

Addressing these ethical concerns requires thoughtful planning, clear communication, and client consent. Therapists must weigh the benefits of walk-and-talk therapy against its potential drawbacks and work collaboratively with clients to choose the most effective and comfortable therapeutic approach.

Insurance, Legal Concerns & Limitations

Insurance and legal considerations play a crucial role in walk-and-talk therapy because of the inherent increase in risks when sessions are conducted outside the traditional office setting, whether physical or virtual. The unpredictable nature of outdoor environments, even in well-maintained areas such as groomed trails or public parks, introduces variables not present in more controlled settings.

Before integrating walk-and-talk therapy, ensure that all parties are fully aware of and prepared for potential risks. This preparation involves a comprehensive informed consent process that communicates the scope of professional licensure and the specific nature of walk-and-talk therapy. It should explicitly outline any potential risks associated with conducting therapy outdoors, ensuring that clients understand these factors before starting their first session.

Additionally, verify that legal safeguards adequately protect the practice. This may require adjustments to existing insurance policies or additional coverage to account for the unique aspects of providing therapy in public or semi-public spaces. Consulting with regulatory boards and insurance providers is a crucial step, as they can offer guidance tailored to the practice's needs, outlining the complexities of liability while ensuring compliance with professional standards.

Addressing these insurance and legal concerns is not merely a formality but a fundamental aspect of ethical practice. It demonstrates a commitment to client safety and professional integrity, laying a solid foundation for the therapeutic relationship. By taking these steps, therapists can confidently offer walk-and-talk therapy as a valuable option for clients, secure in the knowledge that they have diligently addressed this innovative approach's practical and ethical implications.

Insurance Coverage for Walk-and-Talk Therapy

Insurance companies ' coverage for walk-and-talk therapy varies and depends on each provider's specific policies and regulations. Therapists interested in offering this modality should contact insurance providers directly to determine whether the outdoor nature of sessions affects billing codes or requires specific documentation. Detailed information on the therapeutic benefits and rationale for walk-and-talk therapy can support coverage claims.

Conclusion

Innovative approaches complement traditional therapy settings and cater to a broader range of client needs and preferences. One such approach gaining traction is walk-and-talk therapy, a modality that combines the therapeutic process with physical activity in an outdoor setting.

Walk-and-talk therapy offers an innovative approach that can benefit many clients by incorporating physical activity, nature, and a less formal therapeutic setting. Before integrating walk-and-talk therapy, consider its suitability for your clients and practice style, understand the insurance implications, and ensure you have a comprehensive consent form. With the proper preparation, walk-and-talk therapy can be a valuable addition to your therapeutic toolkit, offering a dynamic and holistic approach to mental health care.

References:

• Mahindru A, Patil P, & Agrawal V. (2023). Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus, 15(1):e33475.

• Revell, S., & McLeod, J. (2017). Therapists’ experience of walk and talk therapy: A descriptive phenomenological study. European Journal of Psychotherapy & Counselling, 19(3), 267–289.