Life

The pathway to better mental health is getting more literal

Walk-and-talk counselling has gone from quirky offering to timely solution for the pandemic era

The pandemic has propelled many Canadians toward an activity that heretofore was mainly the domain of characters on The West Wing and stroller-pushing new parents. As the feet move, so do the lips. For more than a year, meeting for chit-chat at one’s house or at a café has been discouraged (or outright illicit); even hanging out beneath open skies—in backyards, say, or at picnic tables—is often frowned upon by public health officials. That has left the noble walk-and-talk as one of the few kosher ways to interact with a friend or non-household relative. When you’re chatting and moving, the thinking goes, you’re not occupying anyone else’s aerosol space for any dangerous length of time. If you keep a distance and wear masks, all the better.

The convergence of perambulation and conversation has coincided with another, more disconcerting by-product of the pandemic: the growing need for mental health services. There’s rising demand for therapy, but talking to somebody in a closed office for hours can contribute its own stresses and anxieties, and some provinces have urged a halt to non-essential in-person services. Across Canada, many counsellors have suspended in-office therapy and nearly all have shifted most of their sessions online or to the telephone.

Walk-and-talk therapy, then, is a third way that seems ideally suited to this moment—a means of providing in-person service while harnessing the therapeutic benefits of nature trails or paved promenades. But it remains a niche offering in Canadian counselling that is not taught in university psychology departments. And each of its few practitioners appears to have stumbled on the idea in their own novel way.

It came to Rebecca Barrett-Wallis one day as she walked to work in Toronto, dreading the notion of being stuck in a chair with a rotation of clients for six hours. “I thought, I can’t be the only person who is feeling like that is a lot of sitting.” In Edmonton, Cory Donald considered his passion for long, meditative runs, and how he’s more able to solve his own problems while moving. And it percolated in the mind of Vancouver’s Adrian Juric when he was a middle-school counsellor, with a student sitting across his desk who had trouble sitting still, let alone being expressive about his parents’ separation and other home-life struggles. Juric suggested they get outside and walk around the schoolyard. Within 15 minutes of fresh air and movement, Juric says, “he was able to find his words.”

Years later, when Juric started up a practice for adults, he named it Vancouver Walk & Talk Therapy. He built up a base of dedicated clients as word got around, but since the onset of the pandemic he has seen a 75 per cent uptick in inquiries. “There are some people who are nervous, as I am, about going into an indoor office setting in the moment,” he says. “Being outside eliminates all that fear about being in a tight, confined space.”

He often takes patients through majestic Stanley Park—two metres apart, with masks on. Something about moving in tandem with another person and being in a different environment, Juric says, helps people open up and stop dwelling on things. He likes, as he puts it, to get people out of their heads and into their bodies. There’s some science underpinning it, too, with studies showing that time spent in nature can reduce cortisol, the primary stress hormone. Walking is also known as a potent way to curb anxiety. “It seems to drop us out of our fight and flight responses in our amygdala,” Juric says, referring to a part of the brain where decision-making and emotional reactions are processed, “and to restore executive functioning in the brain.”

One approach to treating trauma, known as “eye movement desensitization and reprocessing” (EMDR), uses visual or tactile experience to facilitate emotional processing. The idea is to generate alternating left- and right-brain stimulation, says Dave Segal, a Victoria counsellor who has put it to work in his practice. The rhythm of conversing and walking, says Segal, who co-authored a book on outdoor-based therapy, can move clients “from a heightened state into a more relaxed state,” allowing them to more easily “assess and navigate the stressors in their lives.”

Many therapists’ promotional materials talk of “walking the path together,” or “walking alongside my client through dark times.” More than giving substance to those metaphors, walk-and-talk therapy exposes patients to real-world symbols of life, like the growth of garden flowers and trees’ cycle of death and renewal—the sort of thing that office art and babbling-brook MP3s on speakers feebly emulate.

Hope Schreiber, a nurse practitioner in Victoria who receives walking therapy from Segal, has found she can work through issues in a less cluttered way in her brain when outside. She’s done it for five years, and during the pandemic it’s been one of the few parts of her life that has seemed normal and consistent. “Particularly since we’re all burned out with yet another Zoom call, actually seeing somebody is better than just talking on the phone,” she says. Vancouver Island offers an embarrassment of year-round temperate strolling options, but she’s particularly fond of the grounds of the lieutenant-governor’s residence, where walkers can scale the hill to the mansion. “There’s this beautiful expanse of nature and the ocean, and when I’m there, it helps me put my issues and challenges in perspective; that this is part of a bigger system, this is for now, this isn’t going to be forever.”

Schreiber was drawn to outdoor counselling after seeing how well her son responded to it. “I’m sure he would have rather put hot pokers in his eyes than sit in an office and talk about his feelings,” she says. Segal has seen referrals to his practice—especially child and teen clients—roughly double during the pandemic. They increasingly need mental health supports amid this crisis, he says, and for many kids, online video sessions don’t work.

Segal is executive director at Human-Nature Counselling. Its complement of nine therapists may be the biggest practice of its kind in Canada. In recent months, he’s instructed other counsellors on providing nature-based therapy, drawing interest from across Canada, as well as the U.S. and Australia.

It’s not a choice for everybody, he acknowledges. For practitioners, it requires more energy and time—beyond the hours of daily exercise or the commutes to walking sites. Because they can’t take notes mid-session, they must commit observations to memory and jot them down immediately afterward. And while many clients benefit from the shifted power dynamic of walking alongside their therapist, some find it disorienting.

Outdoor sessions might also pose a risk to a client’s confidentiality, that sacred aspect of counselling. Some practitioners have a special waiver for walking sessions. While many counsellors swear off busy areas, Kevin Barry has occasionally taken clients on walks through downtown Vancouver. If they bump into someone they know, they’re not obliged to introduce Barry at all, let alone as their therapist. And a bustling street can confer its own form of anonymity. “I’ve had a few clients tear up or cry, but when you’re downtown nobody cares because there’s always people crying or yelling—that’s just part of being downtown.”

Many walk-and-talkers in the Lower Mainland and Vancouver Island—even in chilly Edmonton—do it year-round. But Barry only offers outdoor sessions between March and September. Barrett-Wallis, the Toronto therapist, began offering walk-and-talk in High Park as an alternative to phone therapy in November, but has thus far only found three clients interested. That may change as the weather warms, she says.

In Hamilton, therapist Kayleen Edwards had been taking clients on walks through a serene part of the Bruce Trail before the pandemic hit and she suspended all in-person counselling. But she expected to resume this spring, after the ice had melted from the trails. In normal summers, about one-quarter of her clients walk their sessions, and she anticipates that share rising. People are keen to get fresh air, Edwards observes, and COVID-19 has normalized long walks. She’s offering a beautiful route, and a keen ear.


This article appears in print in the May 2021 issue of Maclean’s magazine with the headline, “Therapy goes outside the box.” Subscribe to the monthly print magazine here.