While most psychologists have flocked to online therapy because of COVID-19, a few lucky practitioners have another alternative: walk-and-talk therapy.
Walking with patients while talking with them for clinical sessions isn’t new – at least one New York social worker has been doing it for years. But in a worldwide pandemic where outdoor togetherness is a much safer option than indoors, the practice is being noticed by psychologists who had never considered it before.
“I’ve had a number of therapists call me about it,” said Denice Clark, Ph.D., whose Sole to Soul Therapy practice in Atlanta specializes in walk-and-talk – now with client and therapist wearing masks and walking in a socially distanced manner. “One of the positive things about the pandemic is people are realizing the importance of both physical activity and being outdoors for their well being.”
Clark, dubbed Dr. Walk and Talk, said the advantages of therapy while walking are many. Some clients feel more comfortable side-by-side rather than facing a therapist. The physical activity boosts mood. It’s less confrontational and more informal than therapy in an office. And clients tend to take more ownership over their experience because they’re in a neutral space, not one that reflects the therapist’s style, she said.
Social worker Tania Paredes, Ph.D., LCSW, has used walk-and-talk therapy for about 10 years in her practice in Miami. She particularly recommends it when treating teenagers and new mothers, as well as clients who have been working from home or have multiple family members at home together during the pandemic.
“It’s great to be able to put a baby in a stroller and move outside for a session,” Paredes said. “People drop their guard a bit and are a little more open. A lot of negative thinking slows down too because you’re thinking about where you’re walking.”
Paredes and Clark both had to switch to online therapy at the beginning of the pandemic but have since resumed walk-and-talk.
Clark lost some clients when she temporarily halted walk-and-talk, but her practice picked up again when she resumed it. Old clients returned and new clients showed up.
“Those who work from home are finding their home is not the respite it once was,” she said. And for many, finding a place at home to do an online therapy session in private is nearly impossible.
Before she started her practice in 2015, Clark did extensive research on walk-and-talk therapy and spent hours in the park she intended to use walking the pathways. She figured out which ones were most appropriate for private conversations, which would be better for sunny days and which would be better for cooler days. She wrote up an informed consent document that included special contingencies for the outdoors and did a walk-and-talk therapy session with a therapist who has used the practice for years.
And while Clark doesn’t usually have the problem of cold weather interfering with walking, the Atlanta heat during the summer is a consideration.
“I like to joke, but I’m serious, that there’s no bad weather – just bad clothing,” she said. She plans sessions during hot weather in the morning to avoid the heat. If it’s raining, she’ll put on a raincoat or carry an umbrella.
“I’m up for most everything but thunderstorms and big winds,” Clark said. “But I always leave the weather decision up to the client.”
Keeping conversations private while walking is another concern, but Clark said that hasn’t been much of an issue for her.
“When people see you, they just think it’s two friends walking and people come to realize that others really don’t listen to you,” she said. “But I tell clients if they feel that a session is going to be particularly intense, let me know and we’ll go back inside.”
Another consideration is insurance payments. She said some insurers won’t pay for walk-and-talk sessions unless they start and end in an office.
Lori Klett Roberto, Ph.D., a clinical psychologist in Sacramento, Calif., has found walk-and-talk therapy useful for some clients who are depressed or shut down.
“Movement can help with that, and there’s the idea that as you’re waking, you’re moving forward,” Roberto said. “It also can be helpful when someone is holding more emotion than they feel they can hold; it may lessen the intensity a bit.”
Ironically, Roberto had to stop walk-and-talk therapy when the pandemic hit; the paths she used became crowded and were too narrow to provide confidentiality for patients. She said she misses the outdoor sessions, which were a welcome alternative to sitting in an office during therapy.
Toronto psychologist Kate F. Hays, Ph.D., began using walk-and-talk therapy in the 1990s, several years after she began running for exercise and realized the impact it had on her.
“Moving has a positive impact on one’s mental health, and there’s also the way in which walk-and-talk is like driving in a car with a reluctant teenager and having a really wonderful conversation because you’re not looking at one another,” Hays said.
She said she recognized the effectiveness of walking and talking decades ago with a client who wouldn’t talk in an office setting but became much more engaged when they were walking.
Hays discussed the value of walk-and-talk therapy in her 1999 book, Working It Out: Using Exercise in Psychotherapy. While she has retired from seeing patients, she’s still eager to offer advice to psychologists who want to try the therapy modality.
First, she said, ask patients if they’re interested in trying walk-and-talk once, then evaluate how it goes. Encourage patients to wear adequate footwear and clothing, depending on the weather. Before beginning, talk with clients about what to do if either of you encounters someone they know during the session.
Finally, watch out for the “slippery slope” created by the informality of walk and talk.
“It has the potential of the client viewing the relationship as more of a friendship, and the responsibility is on the therapist to stay mindful of that,” she said.