Making the most of the great outdoors: Bringing ecotherapy into the mainstream

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Brought up in a remote part of South Wales, Dr Joanna Cates always found being outdoors good for her emotional wellbeing. In this article, she explores how her work as a clinical psychologist and the natural world come together in the form of ecotherapy.

Summary points

  • Ecotherapy can be used as an umbrella term for all psychological work that takes place outdoors.
  • This approach can include outdoor sessions, walk-and-talk therapy, nature-based homework, or many other iterations.
  • Spending time in natural environments has also been shown to improve mood and cognitive performance for individuals with depression, and to have other health benefits.

The relationship between nature and human wellbeing is a rapidly expanding field, and includes numerous types of therapy such as green therapy, nature therapy, outdoor therapy, adventure therapy, wilderness therapy and horticultural therapy to name a few. This article uses the term ecotherapy as an umbrella term to refer to all and any of these approaches.

Given this wide range of methods, it’s perhaps not surprising that there is no single definition or comprehensive model of how to practise therapeutic work in nature. Examples range from a short session in a small green urban space to weeks spent camping in wild and remote areas.

At the risk of stating the obvious, one of the few unifying criteria seem to be that this sort of work takes place outside. The other is the idea that closer contact with nature and the ‘more-than-human world’, a term I’ve come across many times in the ecotherapy literature, is good for us physiologically, cognitively and emotionally – arguably even spiritually too.

Evidence to suggest that nature has a beneficial effect

When I started researching this article I uncovered a mountain of studies that have found various beneficial effects of ecotherapeutic approaches on physical health and psychological wellbeing. Depending on the type of ecotherapy, this could relate to a number of factors: increased activity, improved self-esteem through taking part in and overcoming various practical challenges, and more social connections that act to reduce loneliness and social isolation. Even simply being more exposed to natural light has been linked to improved sleep (specifically falling asleep faster and waking up less), a fundamental requirement for good mental health (Figueiro et al, 2017).

But being surrounded by nature and natural materials has in itself been shown to be good for us (Atchley et al, 2012; White, 2019) and neuroscientists, psychologists and policy makers are all now turning their attention to the increasing body of evidence that shows that when we spend time in nature, something remarkable happens to our brains and our bodies.

One key idea to come out of this research is Attention Restoration Theory (Kaplan, 1995), which proposes that when we spend time in nature, and away from the constant bombardment by social media, attention-grabbing headlines and adverts that is our modern world, this allows our pre-frontal cortex (the area responsible for multitasking, critical thinking and problem-solving) to take a well-earned rest. This theory explains why studies have shown significantly improved results on tests of cognitive functioning and creative problem-solving after time spent in natural surroundings (Berman et al, 2012). The concept of nature as a restorative force is not new, but the science proving it is now more substantial than ever before.

Even having a view of trees and grass from a hospital window, relative to staring at a blank wall, has been shown to be linked to a speedier recovery in patients recuperating from gall bladder operations (Ulrich, 1984). This idea that a view of nature is psychologically beneficial for us is explored by the evolutionary psychologist Stephen Pinker (1998) in his book How the Mind Works. He explains that humans have evolved to find certain landscapes more appealing because they contain features that were advantageous to the survival of our ancestors. He argues that our sense of natural beauty is what attracted our ancestors to suitable habitats.

It therefore makes sense that being in such an environment would be innately rewarding. It explains the lowering of stress that we experience in natural environments and that so many studies have now begun to demonstrate, whether they are measuring heart rate, stress hormones in the blood or brain waves.

Ways in which one might practise ecotherapy

There are myriad ways in which proponents of ecotherapy are already successfully practising their craft, and these ideas are often compatible across a whole range of models of therapy. In my work I frequently use Acceptance and Commitment Therapy (ACT), a key part of which is the teaching and practising of mindfulness skills in order to change the way a person relates to problematic thoughts and feelings. The outdoors is an ideal place in which to practise mindfulness, whether sitting or walking, as it is an infinitely rich source of stimuli for our senses.

Whether using ACT, or any other model of therapy, working outdoors could involve simply moving the conventional therapy room set-up into a secure outdoor space. Martin Jordan, author of Nature and Therapy (2015), conducted sessions with clients for many years in a purpose-built willow dome in his garden. In his book he explores many fascinating considerations when practising one-to-one therapy outside in relation to the therapeutic frame and therapeutic boundaries. For example, he writes about the issue of confidentiality and how this might be impacted by being outdoors and not within the confines of a room. He also talks about the democratising influence of nature on the therapeutic relationship. Rather than a client visiting a therapist in a room owned by the therapist or the organisation for which they work, meeting outdoors brings a levelling to the relationship and a reduction in the power differential between therapist and client.

Jordan observes that working outdoors can be helpful for some who find the experience of being with a therapist in a one-to-one situation too intense. In such a scenario, nature can be seen to act as an intermediary and as a co-therapist, diluting the intensity of the process and facilitating the work. On the other hand, others may feel less contained in an outdoor space and so careful consideration needs to be given to individual clients’ needs.

As well as simply moving the one-to-one setup outdoors, another option might be ‘walk- and-talk therapy’. Adrian Harris, a counselling psychologist and ecotherapist, talks about some of the practicalities to bear in mind when working in this way. He recommends always having a first session in a consulting room prior to undertaking any outdoor work, and discussing how to manage certain situations. For example, what to do if either the therapist or the client sees someone they know while they are out and about.

He also makes the important point that when working in this way, it’s important that the therapist is completely comfortable in the outdoors and know the space really well. Other dimensions of this work that need to be considered, in a way that wouldn’t necessarily be so in a more conventional setting, are those of weather and the physical safety of clients. Indeed, these are important considerations to think about in relation to all forms of ecotherapy.

For the therapist working within a large organisation such as the NHS, they may not have as much freedom to conduct sessions outdoors. Yet it is still possible to incorporate ecotherapy ideas into their work, for example through discussion of the benefits for the client of contact with the natural world between sessions, and possibly even ‘prescribing’ nature-based homework. They can also consider signposting to other local programmes, of which there are a rapidly growing number. These include opportunities to volunteer with gardening or conservation projects, all of which might be considered forms of ecotherapy (see mind.org.uk for a wide range of ecotherapy programmes).

The future for ecotherapy

As a species, our relationship with nature is under greater strain than it has ever been. Massive changes to, and destruction of, our natural world continues. Sadly, this is manifesting in phenomena such as eco-anxiety, particularly among young people who are concerned about climate change and plastic waste, and feel powerless to change things for the better.

A separate but related issue is that more people than ever before live lives completely disconnected from nature. The term nature deficit disorder has been used to describe those for whom this disconnection is having very real and negative consequences for their physical and emotional wellbeing.

An ecotherapeutic approach that can work to address both these concerns as an inherent part of the ecotherapy ethos is that of connection with, and respect for, the natural world. In addition to this, the benefits of being in nature for the wellbeing of us as humans are absolutely undeniable. For all these reasons I believe that, as a field of therapeutic endeavour, the area of ecotherapy is definitely one to watch for the future.

Further information

  • Atchley, R.A., Strayer, D.L. & Atchley, P., ‘Creativity in the Wild: Improving Creative Reasoning through Immersion in Natural Settings’ (2012) PLOS ONE 7(12): e51474. https://doi.org/10.1371/journal.pone.0051474
  • Berman, M.G., Kross, E., Krpan, K.M., Askren, M.K., Burson, A., Deldin, P.J., Kaplan, S., Sherdell, L., Gotlib, I.H., and Jonides, J., ‘Interacting with Nature Improves Cognition and Affect for Individuals with Depression’ (2012), Journal of Affective Disorders, 140, 300–05.
  • Figueiro, M.G., Steverson, B., Heerwagen, J., Kampschroer, K., Hunter, C.M., Gonzales, K., Plitnick, B., Rea, M.S., ‘The impact of daytime light exposures on sleep and mood in office workers’, (2017) Sleep Health, 3, 204–15.
  • Jordan, M., Nature and Therapy, Routledge, 2015.
  • Kaplan, S., ‘The restorative benefits of nature: towards an integrative framework’ (1995) Journal of Environmental Psychology 16, 169–82.
  • Pinker, S., How the Mind Works, Penguin, 1998.
  • Ulrich, R.S. ‘View through a window may influence recovery from surgery’ (1984) Science, 224, 420–21.
  • White, M.P., Alcock, I., Grellier, J., Wheeler, B.W., Hartig, T., Warber, S.L., Bone, A., Depledge, M.H. & Fleming, L.E., ‘Spending at least 120 minutes a week in nature is associated with good health and wellbeing’ (2019) Scientific Reports, 9, Article number: 7730.
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Dr Joanna Cates qualified as a Clinical Psychologist in 2005 and has worked in numerous adult mental health settings in the NHS. She has worked as a tutor for the Association of Psychological Therapies and received an honours diploma in Freelance and Feature Writing from the London School of Journalism. Email: joannakcates@yahoo.co.uk

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