Sometimes a pinecone is just a pinecone.
But one January day, the jagged edges of the cone — and the lone feather sticking out — meant something different to Rachel Oppenheimer, 25, a counselor at the Chesapeake Mental Health Collaborative in Towson, Md.
“Growing up, I had some challenges,” Ms. Oppenheimer said, referring to her rough teenage past, “some struggles with managing my emotions.”
But her grandmother, who died four years ago, was gentle as a feather and gave her unconditional love that reminded Ms. Oppenheimer how important it was to treat herself with “soothing tenderness,” especially when she was self-critical.
Ms. Oppenheimer and her clinical supervisor, Heidi Schreiber-Pan, were visiting Talmar, a nonprofit farm that offers therapeutic programs and job training — a short drive from the busy road and nondescript shopping centers near the office their. At the farm, the only sounds were a babbling brook, chirping birds and several inches of snow crunching underfoot. It was the perfect location to teach Ms. Oppenheimer healing techniques that make use of the natural world.
They set up camping chairs under a bright blue sky during their session — a makeshift office without walls — and discussed how to create a circular design called a mandala. They would then arrange objects Mrs. Oppenheimer found on the ground, each symbolizing the complex emotions that arose from her grandmother’s grieving.
Dr. Schreiber-Pan is one of them an increasing number of therapists who conduct their therapy sessions outdoors and, in some cases, train other counselors to do the same. They say combining traditional talk therapy with nature and movement can help clients feel more open, find new perspectives and express their feelings, helping them connect with the outside world.
“It’s the feeling of being part of something bigger — and that’s, I think, a very powerful ‘aha!’ moment for many people», said Dr. Schreiber-Pan. As humans evolved they spent much of their time outdoors, he added, yet our modern lives are mostly spent indoors, looking at digital devices.
Outdoor therapy falls under the umbrella of ecotherapy, a broad and nebulous term that includes activities as diverse as hippotherapy and outings like wilderness and adventure therapy. During the pandemic, while many therapists have moved online, others have held sessions outside, looking for a safer way to meet in person. But the idea has been around for a long time.
Decades ago, psychiatrist Dr. Thaddeus Kostrubala, author of the 1976 book “The Joy of Running,” was known for jogging alongside his patients. The practice never really caught on, in part because most therapists trained to meet with clients in controlled internal settings, maintain confidentiality and strong boundaries.
Now, however, students are trained in ecotherapy at several schools, including Lewis and Clark College in Oregon and Prescott College in Arizona.
And some therapists, like Dr. Schreiber-Pan, create their own curricula. In 2020, she founded the Center for Nature Informed Therapy, which offers certification and continuing education credits to every social worker or certified counselor who completes the program. More than 100 people have graduated so far.
Outdoor sessions are not one size fits all. Not every customer will want to walk in the snow, for example. Dr. Schreiber-Pan and other therapists also give clients the option to explore nature indoors, drawing from a collection of shells, stones, sticks and sharp gums. And there is no specific license for this therapy — there are no established best practices that would dictate what exercises or activities therapists should use when meeting with clients outdoors.
Some in the field are wary of the emerging discipline. Dr. Petros Levounis, president of the American Psychiatric Association, said he would feel a little “skeptical” about taking a patient to the park.
“There is a formality to psychotherapy — tried and true parameters,” he said. “Sit across from them. there is the 45 minute session. And I don’t know exactly what would happen in the countryside. It’s starting to rain. What are you doing with the patient?’
Psychiatrists need to think more carefully, he added, and consider special training “before we sign on the dotted line for such innovative interventions.”
Even so, he added, a number of studies have found that immersion in nature can be beneficial for mental health. ONE resolution 2023 of the effects of ‘forest bathing’, the Japanese practice of taking a relaxing walk through the forest, suggested that it can significantly reduce symptoms of depression and anxiety. And being physically active is is associated with a lower risk of depression. A review A variety of studies have concluded that “physical activity should be a key approach” when managing psychological distress.
“It connects me to being human”
Outdoor or nature-based therapy has especially become a big draw for men and people under 40, said Dr. Schreiber-Pan and other therapists.
Chase Brockett, 36, who lives in Portland, Ore., started walking therapy in 2022 and continued for about a year and a half, even though he had to pay for sessions out of pocket.
“It connects me to being human, to being alive,” he said. “Not to be subject to the world, but to be a part of it.”
During his sessions, he and his therapist, Aimee Frazier, went outside in all kinds of weather, including rain.
“You have to be uncomfortable and just accept that it happens,” he said, a lesson that became an analogy for his anxiety. “I think a lot of stress comes from A) seeing stress as a bad thing and B) trying to escape it at all times,” she said.
Therapists also see other benefits: clients who are more receptive and relaxed.
“I think for some young people, therapy is too much of a push,” said Andrew Tepper, founder of Boda Therapy, who often works with teens and young adults in New York and the Catskills. “It’s one lane. Oh, we’ll sit down. We’ll talk and maybe play a board game. And with that, I think, comes some resistance.”
Mr. Tepper, a psychotherapist, steers his clients toward outdoor movement — hiking or skiing — if they’re receptive to it. During a retreat in early February, he took three clients on snowshoes, went on long walks and cooked lunch over a campfire.
“I think therapy can be fun, and part of that is doing a little pre-assessment of what your clients like to do,” she said.
“I’m starting to feel a lot like my wilting office plant”
Therapists note that a nature-informed practice can improve their own well-being and help prevent burnout.
Years ago, when Ms. Frazier had finished a clinical practice in a dimly lit, windowless office, she realized she needed a “more vibrant environment” — for her clients and for herself.
“I started to feel a lot like my wilting plant in the office sitting in the dark corner,” she said. “I long to be outside in the sun and the rain, surrounded by the calm presence of nature.”
In 2021, he began offering walking therapy to clients under his supervision Thomas J. Doherty, a Portland psychologist who founded the certificate program in ecotherapy at Lewis and Clark College. For some clients, she said, the setting makes treatment feel more accessible and less intimidating.
Maria Nazarian, a clinical psychologist in Santa Monica, California, doesn’t rent an office. She only sees clients virtually or by walking on the beach, which she described as her “happy place.” And, she said, her clients have benefited from getting off the couch.
Walking side by side promotes cooperation, Dr. Nazarian said, and being on the shore often brings moments of wonder and awe, all of which help build “connectedness and trust.”
“Winter must be done”
Amy Fugee, 63, has been watching Dr. Schreiber-Pan fade away for six years to deal with the grief of her mother’s death.
“You want to push it away – you want to bury it, you want to ignore it,” he said. “But that doesn’t work very well.”
While outside, she said, she feels a “tremendous connection” to her mother, who loved the outdoors and often planned camping trips for Ms. Fuggi and her siblings.
“I feel like he’s walking with me,” Ms. Fugee said.
On a recent sunny Monday, she and Dr. Schreiber-Pan trudged through the snow to visit a nearby college campus, disappearing into a tree-lined path near a small lake, where they played with the meaning of winter—the ability to lean into the dark moments of our lives.
“They have a purpose, you know, just like winter has to happen in order for us to enjoy spring,” Dr. Schreiber-Pan said.
After the session, Ms. Fuggi said she felt lighter.
“When you walk, you have fresh air and you have all this openness», he said. “It’s very easy to relax and talk about things.”
Rosem Morton contributed reporting for this story.