Have We Been Doing Therapy All Wrong?

The case for a more active approach to mental health.

Shannon Ashley
Aug 15, 2019 · 10 min read

Talk therapy is the gold standard of mental health treatment for whatever ails you. Many people find relief in pharmaceutical treatments, but most professionals recommend the use of medication in combination with talk therapy.

Personally, I get a lot out of talk therapy, but it’s always bothered me how we tend to paint the entire modality with one wide brush.

“You’ll feel better if you talk to someone,” is a phrase I’ve heard so much throughout my life, but that statement ignores the fact that no therapy is effective for everyone.

Your miles may vary.

Talk therapy is a broad treatment that means different things to each patient and professional. My first experience with talk therapy taught me that whether or not I “mesh” with a therapist matters.

My first therapist was chosen out of convenience. His office was near my workplace and truthfully I wanted to finally try out antidepressants.

He wanted me to try talk therapy first, before prescribing any drugs to me, and I could appreciate that approach. However, our appointments quickly became a source of significant stress.

It was a personality conflict. Anytime I brought up my inner fears or feelings, he made a suggestion of something I could do to fix it. Like it was no big deal.

If I was overly self-conscious, he suggested I join some meetup to connect with strangers. When I talked about wanting to write for a living, he suggested I take an in-person class. Finally, when I mentioned feeling paranoid at work and worried that I was doing a bad job, he suggested I ask my supervisors anytime I felt uncertain.

At that point in my life, none of his suggestions were solutions I was willing to try. There’s so much to be said for meeting patients where they’re at, and I simply wasn’t there for any of his ideas. Not back then, anyway.

Great rapport isn’t everything.

Years later, I was lucky enough to find a post-cult trauma therapist I really did mesh with, but I was disappointed to discover that our talk therapy didn’t actually “make me feel better.”

Not at all.

For nearly one year, I stuck with the therapy but discovered I always came home feeling irritated and in a bad mood. Yet I never felt that way in her office while we talked.

Whenever I talked out an issue out with this therapist, I felt sort of high. She helped me feel heard and valued. I left those sessions feeling inspired to change my entire life.

Until the drive home.

That’s when I began to feel my anxiety and irritation creep up to the point where I often felt worse. After feeling so high, I would crash back down into a new low.

I waited for that crash to dissipate. Surely with time, it would quit happening, right? But it never improved. Feeling bad seemed more or less like a side effect from talking about my most difficult issues, and I hated that.

A more active approach helped me.

I’m a person who has battled significant mental illness in her life and I have seen a variety of mental health professionals, yet there has only been one type of therapist with whom I have never felt worse.

As I’ve considered getting back into therapy, I’ve realized that for me, talk therapy isn’t everything it’s cracked up to be.

But that game changes when it’s walk and talk therapy.

A few years before I became a mother, I lived in the Twin Cities. To better manage my chronic depression, I started seeing a new therapist who exclusively walked with her clients.

Logistically, it was a dream come true because she would come to you. The first time we walked together, we sat in my apartment lobby to go over her procedures and philosophies.

She also told me about some preliminary research that said people were more likely to retain the things they learned in therapy when they walked at the same time.

To me, it seemed like a good way to combine my need for therapy along with my need for exercise. So, we walked weekly for 50 minutes around my Lowertown neighborhood in Downtown Saint Paul.

I still look back on those sessions fondly. Walking with my therapist felt like walking with a friend. I was more relaxed to talk about my issues, yet the walking left me feeling more energized too.

It felt like the additional movement helped me burn off my extra anxiety, so I always returned from our sessions feeling refreshed.

Not irritated or grumpy.

I’m ready to start walking again.

Today I am the single mom of a 5-year-old and I live in Tennessee. Therapy has often felt too much like a luxury for me to think about. But lately, I’ve been considering how nice it would be to get back into walk and talk therapy once again.

In the 6 or 7 years since my last walk and talk session, my life has become much more sedentary and screen-based. As a full-time writer attempting to build a solid career, I struggle to find balance or even take regular breaks.

Of course, I know I’m not the only creative in such a predicament. A growing number of us all need better ways to quiet our minds in a technologically noisy world.

With many of us spending so much time indoors, I can’t help but wonder if we’ve been going about therapy the wrong way. Rather than talking about our issues in stuffy offices, which may or may not feature a place to lie down, perhaps we should take those problems outside.

What is walk and talk therapy anyway?

Just what it sounds like: you walk and talk with your therapist, usually outdoors. Walk and talk therapy replaces the traditional office setting in which clients are seated or even lying down on a couch.

While it’s hard to know just how many therapists now offer a walk and talk modality, experts say it’s a rapidly growing trend across the United States. Denice Crowe Clark is a walk and talk therapist based in Atlanta, and she’s personally located at least 135 clinics across the US which now offer patients the option to take a walk.

This number is only expected to grow. Tammie Rosenbloom’s practice is based in the Twin Cities, and she says she knows the therapy is growing rapidly as she’s been entertaining more and more requests for calls and interviews with writers like myself.

Forging a new path.

Right now, there isn’t a great deal of research surrounding walk and talk therapy. However, many professionals point out the mounting evidence of exercise and nature being good for our mental health.

Even the American Psychological Association has called walk and talk therapy “A Natural Fit.”

Considering that there are currently no standards of practice, walk and talk advocates say that in a sense, the implementation has outpaced the practice. It’s something that must catch up for the therapy to gain more universal ground.

Even so, the therapists I’ve spoken to say their patients love it. In fact, most folks treated by Denice and Tammie report a desire to never go back to traditional therapy again.

I can certainly relate to such sentiments.

Releasing the pressure of the day.

“Talking in person anytime would be considered a remedy to our noisy tech world. When we are walking, our heads are not looking down towards a screen. We are walking next to each other, making eye contact, listening, connecting in a real relationship, [in] real time. With the added element of walking in nature, it taps into more of our senses than just vision on a screen. Walking and talking provides opportunities for self-soothing, improved communication, and improving our connectedness to others.” -Tammie Rosenbloom

So, what makes walk and talk therapy such a positive experience for patients? For patients, it seems to release pressure in a way that simply talking can’t.

Denice says she’s interviewed different clients across the US and they all report the feeling that outdoor activity has both a calming and energizing effect. Being outside seems to help solidify their lessons, makes it easier to talk through challenging issues, and removes some of the pressure those clients felt with traditional therapy.

For Tammie, the benefits abound for patients and therapists alike. Clients with trauma who may have difficulty opening up often feel more relaxed outside. The same thing goes for those with autism, or people who have issues with intimacy.

It even benefits the therapists who would otherwise sit indoors all day.

What makes walking so special?

“Taking things outside and walking side-by-side appears to level the playing field and help clients feel more in control of their therapy sessions as they co-navigate the outdoor space with their therapist.” -Denice Crowe Clark

Many people today are looking to co-work with their medical professionals, especially when it comes to treating their mental health.

For people who suffer from body dissociation, counting their steps and taking a walk can be a great modality for treatment. The therapist can ask, “What do you smell, what do you see?”

Such questions help make patients more aware of their bodies and learn how it feels to be present with themselves.

Patients don’t need much preparation for these sessions, but they do need to be flexible and take along water and comfortable shoes. “It’s like traditional therapy,” Tammie says. “There’s going to be work involved.”

But perhaps that work is a little bit easier in an open, outdoor setting. Therapists get to use more vivid and active metaphors. Nature brings up memories and the entire walk is more experiential than simply sitting in a chair.

Walk and talk patients may even start walking more for themselves at home, so they not only benefit from increased exercise and mood-boosting endorphins, but also actively working out their feelings on their own.

Is walk and talk therapy a good fit for everyone?

Both Tammie and Denice say a patient should never be coerced into walking with their therapist. Some people simply aren’t interested and it isn’t a therapist’s job to convince them to try.

Walk and talk therapy comes with different challenges than traditional talk therapy, but neither therapist has found a problem that’s been too difficult to overcome.

Weather is likely the biggest variable, as Denice says, “You never know what’s going to happen outside.”

Therapists who offer walk and talk therapy must consider what to do if the day is particularly hot, cool, or rainy. In Minnesota, Tammie must be mindful of the snow or ice in fall and winter months.

Most professionals leave the choice to walk outside in their client’s hands if the weather isn’t so nice, and there are indoor alternatives to keep the walk going.

Some folks who are easily distracted or particularly concerned with how much time they get with their therapist may need to reconsider walk and talk therapy. But it’s subjective, personal, and up to each client to decide exactly what works for them.

Walk and talk therapy is not for every therapist, either. There are a lot of moving pieces which have to be considered and monitored as a facilitator. Clients need the comfort to set their own pace and therapists need the awareness to help slow them down when their anxiety peaks.

Tammie says her patients often don’t even realize how much their anxiety has sped up their pace. It’s eye-opening when she purposefully slows them down.

And while walking seems especially helpful for teens with anxiety about opening up to an adult, some of them don’t want to try walking right away. Most become more receptive to it as they get comfortable with Tammie.

In cases of anorexia, Tammie won’t walk with patients unless their nutritionists approve the sessions beforehand. She doesn’t want therapy to become an excuse for them to over exercise.

Walking should never be used as a way to avoid our issues, but to get through them.

But what about privacy?

When I mentioned to a friend that I was writing a story about walk and talk therapy, her first response was that she’d feel too self-conscious talking about her issues where other people can overhear. And she’d worry about getting too emotional.

While many patients do seem to worry (at least at first) about whether or not they might get caught crying outside, every therapist I’ve spoken to says it has never been a hindrance in the end.

There are less populated walking routes available, and most patients find that walking and talking flows too naturally for any passersby to hear. Plus, the soothing effect of being outdoors in nature seems to mitigate the fears they once had about actually crying.

Conversations and issues which might feel too intense behind closed doors may feel much more manageable on a walk. While walking, the client gets to decide how much or how little eye contact they will give. Any feeling of scrutiny from their therapist typically melts away as they move.

Is walk and talk therapy right for you?

I may be biased, but say it’s worth a try. Walking and talking simply feels like an intuitive answer for better navigating the everyday stress of our modern world.

Like many of you, I spend most of my time indoors. I work exclusively from a tablet and smartphone, so I’m staring at small screens all day long.

I am positive that technology, social media, and screen time all drain my energy to a high degree and I definitely suffer from anxiety about being plugged in all the damn time.

Am I ready to go back to a simpler, mostly screen-free time? Not so much. That’s why you’re not likely to see me on any monthly or weeklong sabbaticals from all the noise of technology.

But for an hour, once or twice a week? I can definitely commit to that, and I can feel my mind and body thank me for investing that time in myself.

So, if you’re you’re curious about asking your own therapist to take a walk, or you want to find an exclusively walk and talk practice? I’d suggest you go ahead and take the plunge.

Like Tammie says, “It’s probably not as scary as you think it’s going to be.”

Honestly Yours

Essays with heart

Shannon Ashley

Written by

It's not about being flawless, it's about being honest. 🍵 https://ko-fi.com/shannonashley 📧shannon.ashley.medium@gmail.com

Honestly Yours

No topic is off-limits, and nothing human is unmentionable. Read on.

Shannon Ashley

Written by

It's not about being flawless, it's about being honest. 🍵 https://ko-fi.com/shannonashley 📧shannon.ashley.medium@gmail.com

Honestly Yours

No topic is off-limits, and nothing human is unmentionable. Read on.

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