Learning from experience in new boundaries: reflections from an outdoor therapy service
Katarina Horrox wrote a piece for our magazine New Associations in Spring 2022 entitled “Creative Thinking within New Boundaries: An outdoor therapy service” discussing psychoanalysis treatment in outdoor settings and specifically her work with young people and ex-service personnel in Scotland.
Over a year on since these initial reflections, we wanted to know more about Katarina’s work and what’s she’s learned since her New Associations piece. To mark World Mental Health Day, Katarina has written an update to her piece with her most recent takeaways and lessons learned from outdoor therapy.
"Practising therapeutically outdoors should be undertaken thoughtfully and ethically... there are challenges, as well as benefits."
Since writing the article “Creative Thinking within New Boundaries: An outdoor therapy service”, our understanding within the Venture Trust Outdoor Therapy Service of the benefits of working therapeutically outdoors has developed, and with it, our sense of the value of transposing therapeutic work to this setting.
The service has extended its reach and is now available for free to all adults in areas defined as “deprived” (Scottish Government, 2020) across the Central Belt of Scotland. Through reflective practice, client feedback and monitoring we have learnt more about what can be helpful when working in these outdoor environments.
The service continues to work from the premise that practising therapeutically outdoors should be undertaken thoughtfully and ethically, and that there are challenges, as well as benefits. This short piece will summarize a part of our learning from the last year.
Having therapy in a mutually shared space, such as a park, has been identified by some clients as valuable. They have referenced the sense of agency that they feel in being able to decide the location of the work and for the therapist to travel to them. This appears to be particularly the case for clients that have had significant engagement with statutory services, such as social work or the justice system, where they may have developed an (understandable) ambivalence towards engaging with institutional settings. In defining the location of the work, the power dynamic can shift a little, because the therapist is stepping into the client’s environment, rather than vice versa.
Because the location of the therapy is generally chosen by the clients, it will tend to be a place that is known to them. The familiarity and relative spaciousness of the outdoor setting can be comforting for clients that have experienced trauma. The ex-service personnel that we work with will often describe the discomfort they feel sitting opposite a professional in a room feeling they need to make eye contact, and the relief of being outside walking side-by-side. Clients who have a tendency to dissociate have described that the movement in sessions can help to limit their dissociation which can support their engagement with the work.
The service has also observed that meeting clients who suffer from social anxiety in their community can assist the person in engaging with the therapy. For clients that experience severe anxiety, particularly since the Covid-19 pandemic (Kindred & Bates, 2023), being able to work with them close to their homes, sometimes accompanying them from the doorstep, can help open up therapy for “hard-to-reach” clients.
Through clinical monitoring and client feedback we have understood that outdoor therapy might have the potential to develop a connection with nature. Research has linked nature connection with having a greater sense of eudaimonic wellbeing (Pritchard et al, 2020). It has also been indicated that a greater connection to nature has implications for a person’s capacity to engage with the climate crisis (Weintrobe, 2022).
Being in the world
Reflective practice has highlighted that clients can learn a lot about themselves through their encounter with the environment, when they engage with it as a live, dynamic space full of information. Through their encounter with the setting, accompanied by the therapist, the clients can potentially find themselves in relation to a wider world which may encourage a sense of ‘being-in-the-world’ (Heidegger, 1996).
Experience has also taught us that for some clients outdoor therapy is perceived as less formal than traditional therapy and perhaps more accessible. We have seen that for clients who experience breakdowns in relationships with professional workers, particularly those with diagnoses such as unstable emotional personality disorder, that working therapeutically in this way may help in the journey to reconnect with wider statutory services.
These are some of the benefits the outdoor therapy service has been exploring and will continue to consider.
- Kindred, R. & Bates, G. W. (2023) ‘The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review’. International Journal Environmental Research and Public Health. 29;20(3):2362
- Heidegger, M. (2008) Being and time. Albany, New York: State University of New York Press.
- Pritchard, A., Richardson, M., Sheffield, D. et al. (2020) ‘The Relationship Between Nature Connectedness and Eudaimonic Well-Being: A Meta-analysis’. Journal of Happiness Studies 21, 1145–1167
- Scottish Government. (2020) Scottish Index of Multiple Deprivation 2020.
- Weintrobe, S. (2022) ‘The new bold imagination needed to repair the ecological self’. In Hollway, W., Hoggett, P., Robertson, C., Weintrobe, S. (eds) Climate psychology: A matter of life and death. Phoenix Publishing House, pp. 98-144.