Using Nature as a Therapeutic Partner

By Lindsey Phillips

April 2018

In 2013, officials in Melbourne, Australia, assigned the city’s trees ID numbers and email addresses to make it easier for citizens to report problems such as fallen limbs and unwieldy branches. However, Melburnians used the email-a-tree-service for another purpose: to talk directly to the trees. They sent emails to the trees expressing their love and appreciation, and they also treated the trees as friends, discussing topics such as school tests, tree biology, construction work and politics.

This unexpected exchange underscores the human desire to reconnect with nature, yet urbanization and technology often distance people from the natural world. “Nowadays, we’re spending close to 90 percent of our time indoors,” says Megan Delaney, an assistant professor in the Department of Professional Counseling at Monmouth University in New Jersey. “This is a major shift in how we utilize our time. And some of that has to do with how we live. We are in our cars. We are in our offices. … We don’t walk anywhere anymore.”

This disconnect comes at a cost because nature plays a role in our mental health. In fact, a prescription of nature may be just what the counselor ordered. Research suggests a possible link between increases in obesity, diabetes and attention-deficit/hyperactivity disorder (ADHD) symptoms and a lack of outside time, says Patricia Hasbach, a licensed professional counselor and clinical psychotherapist with a private practice in Oregon.

Delaney, who has a small private practice in New Jersey and recorded a podcast on ecotherapy this past year for The Thoughtful Counselor (thethoughtfulcounselor.com), says research also suggests a connection between the increase in anxiety and depression in children and their disconnection from nature. “There’s been a loss of this free play,” Delaney argues. “If [children] go outside at all, it’s controlled.”

Nature isn’t a panacea, but even going outside for as little as five minutes a day will provide a boost to well-being, Delaney contends. In addition, exposure to nature can help improve relationship skills, reduce stress and aggression, help with the ability to focus, reduce symptoms of ADHD, improve impulse control and even improve fetal growth and birth rate, she says.

Unwilding ecotherapy

Despite the positive benefits, the idea of incorporating nature into counseling often overwhelms clinicians and clients because they assume it means wholeheartedly embracing the “wild” — packing up their belongings and taking a solo hike on the Pacific Crest Trail (à la Cheryl Strayed) to “find themselves.” For others, the very thought of “wilderness” or “nature” raises fears of the possible dangers, ranging from bug bites and sunburn to life-threatening injuries and encounters with dangerous animals.

The word ecotherapy often evokes a common myth of being fully immersed in the natural world, living and sleeping on the ground, says Delaney, an American Counseling Association member whose book Nature Is Nurture: Counseling and the Natural World is under contract. “That’s not what [ecotherapy] is about,” she argues. “It’s about our reconnection to our relationship with nature in whatever form that feels right for you. It could be a window box with your tomato plants. … I think that dispelling that myth is important.”

Ryan Reese, an assistant professor of counseling at Oregon State University-Cascades, agrees that a misconception often surrounds the idea of integrating nature into therapy. “[Clinicians] don’t have to take clients out into a wilderness setting in order for it to be EcoWellness or ecotherapy,” he says. “It can be at a park or walking on a trail that’s flat.”

Thus, expanding counselors’ and clients’ definition of nature becomes key, Reese argues. “We all are going to define nature in our own sociocultural, political context. How I define nature is probably going to be different than [for] somebody who grew up in downtown Manhattan.”

Reese, who has a private practice in Oregon, finds that broadly defining nature is beneficial, especially for clients who lack access to more traditional natural settings such as rivers, woods and mountains. To achieve this, he says, counselors might work with clients to expand their assumptions about nature by asking if it could include a local park, their backyards or even a view of trees from an office window.

When Delaney presented at the ACA 2017 Conference & Expo in San Francisco on wellness and nature, she was shocked that approximately 150 people attended. At the end of the presentation, several clinicians approached Delaney and stated they were already conducting nature-based counseling but wondered if they were doing it correctly. To which she responded, “If it feels good, you are probably doing it right.”

“People are doing [ecotherapy] intuitively and don’t know the theory behind it,” she continues. “They probably are taking their clients outside. They probably are prescribing nature. They’re probably doing things with kids in natural spaces. Maybe they bring their dogs into the office. … When they read the science and research behind it and the theory … [they] get it.”

There is growing interest in ecotherapy among counselors and, thus, more options for training, says Hasbach, an ACA member who teaches ecotherapy at Lewis & Clark College in Oregon. Her continuing education course, “Prescribing Nature: Incorporating Ecotherapy Methods Into Your Clinical Practice,” quickly fills up with professional counselors and therapists from all over the country.

Reese, an ACA member who occasionally offers a one-day workshop on interventions and ethics for integrating the natural world into therapy, recommends that counselors take training courses to help them consider things they might not think about otherwise. For example, he has noticed that his boundaries can change when he is outdoors with a client. Because he feels calm and relaxed, he is more susceptible to getting lost in the beauty of nature and being less focused on what is going on with the client. He advises clinicians to be aware of how the counselor-client interaction might differ in an outdoor setting versus an indoor setting.

“It’s not that you don’t allow yourself to engage in the experience too. It’s just making sure that the client is ultimately who you’re there for and not yourself,” Reese says. “Sometimes, I just get the vibe [from people who want to] do this outdoor work … that it’s more about the clinician than it is about the client.” Thus, counselors need to be mindful of their own reasons and motivations for incorporating nature into their practice.

More than a ‘beautiful backdrop’

“Ecotherapy is one of those techniques that therapists and counselors can have in their toolbox, but they also need to know how to use it effectively,” Hasbach asserts. Ecotherapy goes beyond simply walking in nature or playing with a dog, she points out. Instead, she explains that it involves a triadic relationship between the client, the counselor and nature.

Thus, nature operates as a therapeutic partner. “[Nature] is an active agent in the work that we’re doing with our clients. It’s not just a beautiful backdrop,” Hasbach says.

Hasbach, a pioneer in the practice of ecotherapy, has co-edited two books on the subject — Ecopsychology: Science, Totems and the Technological Species and The Rediscovery of the Wild. She stresses the importance of incorporating a “nature language,” which is a way of speaking about patterns that represent how humans interact with nature in meaningful ways, such as sleeping under the night sky. “These interactive patterns can be really powerful if [clinicians] use them skillfully and intentionally in asking clients to incorporate them into some of their homework,” she says.

Hasbach had one client who was struggling with the end of an important relationship. Hasbach knew the client was a good photographer, so she asked her to take photographs of the sunset while contemplating the end of this relationship. The client’s journal of the experience reflected the similarity between the ending of the light and her relationship. Without being asked, the client also brought in a portfolio of sunrise pictures to discuss how this was also a new beginning for her — which was going to be Hasbach’s next assignment.

Nature can also operate as a metaphor in therapy. “There [are] metaphors in nature every day about things that we’re going through in our lives that can be powerful,” Delaney points out.

For example, Reese asked a client who had severe anxiety to identify with a section of the path they would walk. The client picked a picnic table with a view of a river. “We would go there each time, and we would talk about his view of that experience and his view of himself in that experience and how it continued to change. … Over time, he would go there on his own, and to me, that was the real special part,” Reese says.

Hasbach keeps a basket of 20-25 nature objects such as stones, feathers, shells and pieces of bark in her office. When clients are struggling for words, she asks them to see if any of the objects depict what they are feeling. Hasbach once had a client who was depressed about a breakup, but the client initially had a hard time talking about it. Hasbach asked the client if anything in the basket resonated with her in that moment, and the client picked out a naturally woven ball of vines. She said she felt like her life was a tangle and empty inside, just like the ball of vines. “It was just a prop that allowed her to be able to begin to talk about what she was feeling,” Hasbach says.

Nature can also be a metaphor for resiliency, Delaney points out. “After a … forest fire, the forest regrows. It starts over. It regenerates. It heals. Those are things we can talk about with our clients — being able to see how nature is reborn from even that horrific experience. … [The client’s] natural tendency as a natural being or animal being is to be resilient and to finds ways of growing and rebuilding.”

Connecting through nature

Reese also finds that engaging nature as a co-facilitator helps with building trust between the counselor and client. “Whether we are out in [nature] or we’re talking about it inside, that’s what we’re connecting through. We’re talking about [the clients’] nature connection,” meaning what they like doing outdoors. “We go for a walk. We just talk about other kinds of things, not their issues, and then, inevitably, what comes up are their issues,” he explains.

“[Nature] doesn’t explicitly judge you,” Reese continues, “[so] that offers … a pathway for people presenting with trust challenges, which [are] oftentimes based in relational trauma.” The fact that clients can talk and process in a space where no one is critiquing or yelling at them can be restorative and healing, he adds.

Reese has been piloting the Fishing for Wellness project with an alternative treatment community for people presenting with adverse life experiences. He explains that for clients dealing with complex trauma, building trust and engaging in conversation directly can be difficult. So, Reese integrates fishing as a means of creating a nonjudgmental space that bolsters wellness and mindfulness.

While teaching clients the mechanics of fly-casting and the general principles of fishing, Reese talks about being open to experiences and accepting of one’s self in the casting process. If clients get frustrated, Reese checks in with them and often slows the process down. Once, when a client was upset that he wasn’t catching any fish, Reese asked him to put down the fishing rod and pay attention to what was happening for him in that moment. Next, he invited the client to notice one thing he found beautiful or appreciated around him. Later, he processed what this experience was like for the client and what it brought up. Together, they identified patterns around the client’s frustration tolerance and behaviors in his life.

“The nature piece is a window into people’s challenges [and] presenting problems, and it’s also this amazing coping resource, especially when people can develop an effective connection with it,” Reese says. “The goal is that [clients] begin accessing some of these outdoor resources on their own without [the counselor].”

Some nature-based techniques work well with certain mental health issues. For example, Hasbach has found that walk-and-talk therapy is often effective with teenagers and people who are dealing with anxiety and social skills deficits. These clients typically find it more comfortable to walk side by side with the counselor rather than sitting and looking at each other face-to-face, she says.

Hasbach also believes that nature-based interventions are effective for clients with posttraumatic stress disorder. “It’s a way of helping [clients] recognize this calming effect that nature can have and this sense of belonging because many times, they feel very disassociated. So, this sense of belonging to something bigger than [themselves] can be very helpful,” she explains.

Integrating nature into holistic wellness

Even after dispelling the myth that ecotherapy must involve complete immersion into a natural setting, counselors still might find it difficult to think of nature-based techniques that work well in office settings. After realizing there wasn’t a clear guide on how to intentionally incorporate nature into a traditional counseling setting, Reese, along with the late Jane Myers, who was a leading proponent of wellness in the counseling profession, developed the EcoWellness model. It explores the extent to which one’s connection to nature affects wellness. The model includes seven domains — physical access, sensory access, connection, protection, preservation, spirituality and community connectedness — that are correlates of wellness.

The EcoWellness model “is not necessarily a specific intervention. … It’s more of a way of thinking or conceptualizing how to be effective in integrating this human-nature connection into counseling,” Reese says. Other wellness models do not explicitly mention the nature connection, but nature is another part of wellness and a way to aid in the healing process, he adds.

Because research clearly shows the wellness effects of nature contact, Reese encourages all counselors to include nature-based questions (for example, how much time clients spend outdoors, what clients enjoy outdoors) in their intake process, even if they simply ask clients about their experience outdoors in the context of exercise or physical wellness. He argues that if a client’s relationship with nature isn’t included in the intake process, then counselors are missing out on a vitally important part of holistic wellness.

Reese addresses the seven domains of EcoWellness with all of his clients by having a conversation with them about their experiences with nature. “My goal is to develop a pretty contextualized understanding of what that person’s connection with nature is like, how they benefit from it [and] how they don’t benefit from it,” he says.

Hasbach also weaves in a few questions in the intake session to gain a better understanding of clients’ histories and current interactions with nature. Sometimes the answers to these questions also reveal details about clients’ family life, she adds, such as hunting with their grandfather or hiding in the woods to escape violence in the home. Her questions include asking what recollections clients have about being outside in nature as a child, what their family members’ views were of the natural world, what clients like to do outdoors now and how often they engage in that.

Too often, clients’ connections to nature are left out of the conversation. These initial nature-based questions demonstrate that it is an appropriate topic and invite clients to discuss it in a therapeutic setting, Hasbach explains. In addition, the questions help counselors determine the best approach for integrating nature into therapy based on the client’s personal experiences.

Hasbach also finds eco-genograms to be a helpful technique for discovering clients’ connections to nature. Counselors often use genograms to encourage clients to think and talk about their family histories in more depth, but, traditionally, only people are included in genograms, Hasbach says. With eco-genograms, clients can include pets or even natural elements such as mountains or rivers that were important to them. They can also include facts such as living near a farm, having a garden or hunting their own food, Hasbach explains.

Counselors shouldn’t assume that everyone’s early experiences with nature were positive, Hasbach warns. That is why asking about a client’s experience with nature as a child during the intake session is important. If a client discloses that he or she had a frightening experience in the woods, then the counselor shouldn’t take the client on a walk in the woods. “[Clinicians] have to understand the client’s experience of the natural world, just like [they] have to understand the client’s experience of society, family [and] interpersonal relationships,” Hasbach explains.

In fact, taking clients outdoors may not always be beneficial for them, Reese notes. One of his clients who had been assaulted by a man told Reese that she didn’t feel comfortable working with him in an outdoor space. When they went back into the office, the dynamic shifted, and she felt safer.

Bringing nature inside

There’s good news for counselors who are hesitant about taking clients outside: They can stay inside and still use ecotherapy.

“The logistics of … meeting in a park or going to a specific place for individual sessions can present a challenge for many clinicians,” Hasbach notes. Instead, counselors can assign nature-based homework for clients to extend the therapeutic hour, she advises.

Hasbach and Delaney both find that nature-based assignments encourage clients to go outdoors, unplug from technology and incorporate the healing and restorative aspects of nature outside of the session.

For example, Hasbach sometimes asks clients to sit in their backyards or to take a walk on the beach and think about a question with which they’ve been struggling. She also uses a “special place” assignment in which clients select a special place that they agree to visit several times each week — during varied weather conditions and at different times of the day — for a specific number of weeks. This exercise fosters heightened sensory perception, a reconnection with and expanded knowledge of a natural place, and a sense of belonging, Hasbach explains.

Counselors can also make their office spaces greener. Hasbach first realized the powerful influence of nature during an office session before she was intentionally incorporating ecotherapy into her practice. On this particular day, she forgot to turn on a water feature that she regularly used. During her first session, the client noticed and asked about the absence of the water sound.

This experience taught Hasbach to be mindful of the elements in her office setting. She still has a rock fountain that provides the soothing sound of trickling water, and she often brings in freshly cut flowers. She has also purposefully arranged her office so that her clients face a window overlooking a tree canopy.

Research supports this idea of greening the office space. As Delaney points out, high-quality natural light from windows has been shown to decrease employee discomfort and improve productivity. As a result, she advises counselors to let in more natural light to their offices when possible, add plants, put up pictures of natural places and play nature sounds such as gurgling streams and distant thunder. Delaney even uses her computer screen as a way of displaying various nature scenes.

Technological nature

With an increase in urbanization and technology use, people often can find themselves even more removed from the natural world and spending more time in front of screens than outside, Hasbach points out. According to a 2010 Kaiser Family Foundation report, children ages 8-18 spend more than 7.5 hours a day on average with media. Common Sense Media reported that the amount of time young children (up to age 8) spent on mobile devices tripled from 15 minutes a day in 2013 to 48 minutes a day in 2017.

“Technology is with us,” Hasbach acknowledges. “We are technological beings as well as natural beings. We have always been toolmakers, so it’s not going away.” Rather than fight that fact, counselors need to help clients achieve a better balance between their technological and natural selves. “Richard Louv [author of Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder and The Nature Principle: Reconnecting With Life in a Virtual Age] … says, ‘The more high-tech we become, the more nature we need,’ and I think that speaks beautifully to the balance that we have to find,” Hasbach reflects.

It is perhaps fortunate then that technological nature — digital representations of nature, including nature music and videos — can have benefits for one’s well-being. Research suggests that technological nature has similar properties to the real thing, Reese says. Although being out in nature is most effective, technological nature is better than no nature at all, he adds.

In 2016, Reese co-authored a study published in The Journal of Humanistic Counseling that examined the use and preferences of nature media accessed through YouTube and found that people often use nature media to help them sleep, study or destress. “People are still accessing a form of nature even in digital form and saying that they are benefiting from it,” Reese says. This finding might help counselors and clients expand their concept of what nature can be, he adds, especially for people who may not have easy access to outdoor spaces or those presenting with a severe pathology such as paranoid schizophrenia or severe obsessive-compulsive disorder. Thus, for people with no access or limited access to nature, such as those in prisons, nursing homes or health care environments, technological nature can play an important role.

Hasbach was part of a study that incorporated nature imagery into a prison that used solitary confinement to determine if it would affect the inmates’ behavior and well-being. The inmates spent either 23 or 24 hours per day confined to individual cells. Four or five times each week, they were allowed to spend an hour alone in the exercise area (another cellblock) or the recreation yard (a concrete enclosure with the top open to the sky).

The prison installed a projector in the exercise cell. Half of the inmates were given the option of watching a nature video during their hour of exercise time; the other half were not. The findings revealed a 26 percent decrease in violent offenses among the inmates who watched the nature videos. When Hasbach interviewed some of the inmates, she learned that the natural scenes had a restorative value for them. Some inmates said that when they were agitated, recalling the nature scenes helped them calm down. Hasbach explains that they were using the images to self-regulate.

However, Hasbach is concerned that technological nature may become a convenient substitute, even when real nature is available, especially in schools. Instead, she stresses that counselors should incorporate technological nature only as an augmentation to authentic nature.

Ethical considerations

Hasbach identifies confidentiality, avoiding harm and competency as three ethical considerations central to ecotherapy. Reese says he has encountered negative reactions about including EcoWellness in counseling in part because some counseling professionals have concerns about how to implement it ethically. Thus, both Hasbach and Reese recommend that counselors who want to pursue nature-based work have a solid plan for what they are doing, why they are doing it, what their hopes or outcomes are and how they can incorporate nature to be most beneficial to the client.

In terms of confidentiality, counselors and clients need to discuss the differences between going outside for a session and staying inside the office, Hasbach says. Among questions to consider: What happens if you and the client are discussing a sensitive issue on a trail and someone walks up behind you? What if you encounter someone whom either you or the client know? What happens if the client gets emotional on a trail?

After having a discussion, Hasbach documents how clients say they want to handle these situations. Some clinicians might take it a step further and have clients sign a waiver, she notes. Counselors also need to ask clients about allergies or physical limitations and document those as well. Reese spends at least two sessions indoors with clients discussing these possible scenarios and clients’ concerns before he even thinks about taking them outside.

Physical safety is another big consideration when working with groups, Reese says. “[Group work] adds an element of risk. You’ve got more people that you need to manage … so having a co-facilitator, having at least another person there who can help, in my mind is really important for the physical safety [of clients].”

Counselors must be competent and prepared for the environment they are taking clients into, Hasbach emphasizes. Walking on a bike path or working in a garden outside a home office doesn’t require as much physical competency as taking clients out by a river where they could be walking on rocks and have a heightened level of wilderness, she explains. Whenever she goes outside with a client, she takes a small emergency bag with a cell phone, water and allergy medicine. She says the only time she has had to use this bag was when offering water to a client who had gotten emotional.

Finding a balance

Melbourne’s email-a-tree initiative aimed to help with city maintenance, but it also revealed people’s need to reconnect with nature and find a balance between their technological and natural selves. It also reaffirms Louv’s claim that the more high-tech we become, the more we need nature.

“We are nature. We are a part of it, not apart from it,” Hasbach says. Ecotherapy provides a healthy environment for counselors and clients, and it gives clients permission to admit that they are out of balance and need to change, she continues. Ecotherapy also provides counselors and clients with tools to help clients balance the pace and stress of life, she adds.

For Hasbach, helping humans reconnect with nature and find (or rediscover) their balance is an exciting area for the counseling profession to explore. “When we really look at what is at the heart of people’s well-being, the environment that we’re in is part of that, so I think ecopsychology and ecotherapy [have] a [role] to play.”