I'm out of the office
BACP Workplace, January 2021

I grew up in rural Sussex where the outdoors was my playground. As children, we were sent off for the day, where our imaginations were ignited by playing in the woods (where the purple people-eaters lived), making camps out of hay bales and claiming old house ruins (which were castles to be defended). At primary school, I remember going on walks where one inspirational teacher taught us to look closely at our surroundings – to be curious about what we saw and to learn about the interconnectivity between plants. She helped us to develop our own relationship with nature – and this remains. With adulthood came city living, and before long, the craving to rediscover my earlier connection with nature. Now I live in Wiltshire where the landscape is varied and beautiful – rolling hills, ancient forests, and monuments shrouded in mystery. I feel a sense of deep connection with where I live and, owning dogs and a horse, I’m outside as much as I can, whatever the weather.

Moving online

Like most of the therapy profession during 2020, I swiftly shifted to working online and undertook further training to enable me to do so. It’s turned out well, and feedback from clients is mostly positive (although many have said they wish we could return to meeting in person). I’ve settled in to a steady rhythm, am now working at full capacity and theoretically, all is good; though if you can sense a ‘but’ coming, you’d be right. I’m feeling ‘boxed in’. I find working online more tiring and it’s hard on my eyes, despite the measures I’ve put in place to mitigate this. Above all, I miss the connection with the ‘whole’ person when I meet a client. The short commute, when we used to travel up my garden path towards my therapy room, was always a space where together we would share the cottage garden which I’ve created and where we’d connect. Since moving online, I’ve learnt just how much I’m missing this brief connection on the path with the client and the natural world.

Aware of the benefits of nature, I had been thinking of how to integrate this into my therapy practice, when in 2016, I attended The Psychotherapy and The Natural World Conference , held at The Eden Project in Cornwall. It was an eye-opening event, with talks and workshops from practitioners who’ve being working therapeutically outdoors with clients for years. One of the keynote speakers, Hayley Marshall, is a UKCP-registered TA psychotherapist, supervisor and trainer specialising in outdoor therapy, and I found her talk, Taking Therapy Outdoors, hugely inspiring. This drew me to take part in Hayley’s workshop, which was co-facilitated with Dr Joe Hinds, an integrative psychotherapist who has published a number of papers on wilderness and nature interventions. It challenged the traditional view of the two chairs in a room as the dominant mode of therapy and explored how, instead, it could be more co-creative and relational to be outdoors to explore and heal ourselves while maintaining a deep respect for nature.

Finding the right training

When the first lockdown forced us all inside, the pull of the outdoors grew stronger and led me to reconnect with Hayley Marshall. I signed up for her four-day training, Taking Therapy Outdoors, in October 2020, facilitated in a beautiful and tranquil woodland location in Derbyshire. The course, which has been running for some years, was exactly what I was after – well structured, experiential and very safely held. It was hugely important to me that my training would actually be outdoors, and though this might sound obvious, while researching courses, to my surprise, I found that there are some that are delivered online.

Planning

We received briefings in advance via email with the timetable, location and instructions of what to pack (I had to look up what a ‘sit-mat’ was, and unless you know too, maybe you’ll be curious and have to Google it as well!). Due to the pandemic, I wondered whether the course would be cancelled at the last minute because of changes in the rules and restrictions, but fortunately, with guidelines adhered to, it went ahead over four somewhat rainy days. Due to COVID-19 restrictions, we weren’t able to stay in the woodland hostel but arranged our own accommodation, with some opting to wild camp. Much as I love being outdoors, I also love a hot bath and a comfy bed, so I found myself a small Airbnb nearby.

Training outdoors

The wet weather meant that as we sat on logs around the firepit, there was plenty of talk in our group about the best make of waterproof trousers, sit-mats and jackets. That said, the rain didn’t matter one bit. As the famous writer and walker Alfred Wainwright wrote: ‘There’s no such thing as bad weather, only unsuitable clothing’.¹

My experience of being in the group of 10 and learning in this new way was profound and transformative. We checked in each day at 9am, sitting around the fire, establishing our group rules and our way of working together. We had structured exercises within the whole group, and in pairs, and time going off solo into the woods, which led me to a deeper connection and understanding of the work and how it might feel for a client to be invited to consider their own responses.

For those few days, it felt as though the world outside, with all the awfulness of the pandemic, existed in a parallel universe. I was able to immerse myself fully in the connection of being with the natural world as opposed to seeing nature as a separate entity. It was such a gift for me to experience the healing effects of nature – and it’s exactly what I hope future clients working outdoors with me will be able to experience too.

Putting training into practice

I returned home feeling confident and with some practical tools to help me integrate working outdoors into my practice, such as looking at contracting, risk assessments and confidentiality agreements. I needed a separate supervisor who was experienced in working outdoors, and drawing on the knowledge of my new ‘outdoor’ network, I have found one to support my changing practice.

I’m aware that not everyone is comfortable with being outdoors – it depends on our relationship with nature, as for some, it can be frightening and potentially triggering. The client needs to choose whether they think outdoor therapy is a good fit, and to ascertain this, I carry out a full assessment prior to starting therapeutic work outside. This includes establishing the client’s physical fitness to take part and making any adjustments to take this into account (such as looking into alternative venues, if required).

Are EAPs and employers ready to change?

Aside from private clients who contact me wishing to work outdoors, I’m aware that one of the challenges I’m now facing, is whether employers and EAPs will ‘buy into’ this new way of delivering therapy. It’s understood that the pandemic has impacted on the mental health of the working population, with concerns about key workers in frontline services being at risk of contracting the virus, as well as those working from home having increased isolation and disconnect from colleagues, in a climate of increasing redundancies and job insecurities.² It’s a worrying picture for workplace mental health, and anecdotally from friends, families and our clients, it seems that one of the downsides of working from home is the absence of daily informal support from colleagues. Zoom catchups and WhatsApp groups can’t always replace the face-to-face contact of being with others and having time to debrief and offload about work pressures in the moment.

We also now know far more about the physiological impact of working online. An article in National Geographic, for example, explained the term ‘Zoom fatigue’ and its effect on the brain.³ Given the parallel processes that both therapists and employees are experiencing, and the isolation of employees working from home for the foreseeable future, if we can offer outdoor therapy face to face, doesn’t it make sense for employers and EAPs to be able to at least offer this to their workforce as an intervention?

I’ve asked some of the EAPs I work with whether they would consider offering outdoor therapy to clients (delivered by their affiliated therapists who have undertaken additional training and who are appropriately insured), and so far, I’ve mostly experienced resistance. That said, one EAP (a member of UK EAPA) is potentially considering it and has asked me to provide a copy of my CPD certificate.

Assessing risk

This leaves me wondering what this means: does it come from some sense of the outdoors being perceived as risky and more dangerous than being indoors? If so, it’s important to state that the need for risk assessments was fully covered during the outdoor therapy training, as well as clear contracting with clients, including flagging up external considerations, such as weather conditions. Another ‘barrier’ that was mentioned was a concern about client confidentiality. Again, this is something we addressed in the training, and it’s important to discuss this in an initial assessment with the client and agree, in the contracting phase of the work, what you will do (eg ‘What do we do if we pass a dog walker? We’ll just pause until we pass and can speak safely without being overheard’). 

If therapists can assure EAPs and employers that they have taken additional measures to ensure safe working practices, I’m hopeful that providers will become more open to offering therapy outdoors to clients. Reflecting the growing trend in our society to acknowledge the positive impact of the natural world on our mental health, it’s vital that ethical practice and professional standards are maintained, explains Hayley Marshall: ‘Therapists are coming, wanting to understand the nuts and bolts of “how” to deliver therapy outdoors. It’s about the therapeutic frame, and practitioners want to have a really good understanding of how to maintain that when they work outdoors.’ Through my own training, I’ve become aware of how much I hadn’t previously considered about working outdoors and, of course, as therapists, we have an ethical responsibility to be aware of this in terms of our own competency to integrate outdoor therapy into our practice.

Growth in demand

Given that the pandemic is with us for the foreseeable future, it seems likely that our need for human connection will drive a surge in demand for finding ways to take our work outdoors. I asked Hayley whether she had any evidence of this: ‘Having delivered therapy outdoors for 13 years, the numbers of people looking to work outdoors, whether in therapy, supervision or training, are definitely up on previous years, particularly since the arrival of the pandemic. I’m also noticing a big increase in enquiries about how to become an outdoor therapist and from therapists seeking supervision for their outdoor work.’

It’s a trend that BACP is well aware of, according to Caroline Jesper, BACP’s Head of Professional Standards: ‘We recognise that many therapists are taking their work outdoors in response to the pandemic and that this is a growing area of practice. Professional Standards therefore has a plan to develop an evidence-based competence framework for working outdoors. The aim of the framework will be to identify the knowledge and skills needed for effective outdoor therapy to support practitioners, trainers, supervisors and services to deliver best practice. This work is due to start in autumn 2021.’

EAPA UK (the Employee Assistance Professionals Association) is following the development of outdoor therapy with interest, as Eugene Farrell, the Association’s Chair, explains: ‘While we can see the benefits of outdoor therapy, we are keen to see a set of clear competences, along with advice from professional bodies and insurers, which address issues such as how to carry out the therapy safely, given the context that the EAP affiliate is representing the EAP provider, who has a contract with the paying customer. Health and safety is also an important area of concern as well as accessibility/making adjustments so that it could be potentially open to all.’

Our connection with nature is so often on the list of self-care rituals for therapists, but Hayley is noticing an increase in practitioners specifically seeking support from outdoor therapists as a way of attending to their own professional wellbeing: ‘There seems to be a realisation that the outdoors is an excellent resource for professional self-care and reflection. Clients too have caught wind of the fact they can have their therapy outdoors, and the word is spreading exponentially. However, it’s not all about simply being able to meet face to face; many people are actively seeking the outdoors as a therapeutic space, and these are the people who would not usually access therapy because it is typically held in a room.’

Interestingly, I think that Hayley’s last point highlights how working outdoors is making therapy more accessible rather than less – if working outdoors attracts people who would normally shy away from being in a room, for whatever their reasons and preferences, maybe as a profession we actually have an ethical responsibility to consider offering this? Hayley agrees: ‘Practitioners are also concerned about working with climate change and find that more of their clients are also looking for a space where they can bring these important concerns. There’s a general sense for me that as a profession (at long last), we are undergoing an accelerating shift, incorporating the outdoor world into our frame. This is exceptionally good news for those clients who have not previously found the profession to be receptive to earthly matters.’

Closing thoughts

As I move into 2021, I’ll be working both indoors and outdoors with clients, and actively offering outdoor therapy as an alternative for those clients who may be exhausted and depleted from being isolated indoors or suffering from burnout due to supporting others during the pandemic. Looking to the future, it’s my hope that as a society and as a profession, we can learn lessons from the pandemic and become more receptive to new and creative ways of thinking outside the box – both literally and physically, in terms of how therapy is delivered. I believe that short-term, solution-focused work can be incorporated into working outside with our clients, and that the traditional toolboxes that we use in the therapy room can be expanded to include our landscapes and natural surroundings.