How to integrate walking therapy into your practice

Ten years ago, Maria Nazarian, PhD, was running her psychotherapy practice from an office in El Segundo, California. Nature had always played a role in her own healing, and she often urged her clients to seek it out. But something about the arrangement didn’t feel quite right.

“I found my own inner peace on the beach, and I felt like a hypocrite sitting in an office with no windows, encouraging my clients to spend more time in nature,” said Nazarian, who now holds walking therapy sessions on a nearby beach in Santa Monica.

Walking therapy, sometimes called walk-and-talk therapy or hiking therapy, is a new twist on an old idea: Moving the body outdoors can help people process difficult emotions and find peace. In some cases, a typical talk therapy session is simply held outside. In others, providers include interventions that foster a patient’s connection with the natural world.

“Most people have some variation of this in their own personal life—walking or talking with friends or family when they’re in dire straits. In a sense, it’s not that novel. But there are many assumptions about what therapy is, so this can seem revolutionary in relation to that,” said Thomas J. Doherty, PsyD, who runs an ecotherapy practice in Portland, Oregon, and founded one of the country’s first ecotherapy certificate programs at Lewis & Clark Graduate School. Ecotherapy refers to a series of approaches, including walking therapy, that blend nature with mental health care, often through outdoor sessions or activities related to environmental awareness.

Practitioners list a host of benefits that include everything from improved mental and physical health to a more collaborative therapeutic alliance. Walking therapy can be especially helpful for groups that tend to shy away from traditional therapy, such as men and adolescents.

As with introducing any new therapeutic approach, incorporating walking therapy requires proper planning, screening, and risk assessment. While no formal certification exists, training and consultation can help providers build competencies in key areas such as first aid and confidentiality. Here’s what to know if you’re considering adding walking therapy to your practice.

Walking therapy, like virtual therapy, was used as a safety measure during the COVID-19 pandemic and then gained traction because of its benefits for patients and practitioners alike. While most research to date has separately examined talk therapy, physical activity, and time in nature, early studies point to the benefits of combining the three.

Feasibility studies have found walking therapy to be acceptable for several patient groups and to offer benefits for anxiety, depression, and ­post-traumatic stress symptoms (Dickmeyer, A., et al., Clinical Psychology & Psychotherapy, Vol. 32, No. 1, 2025opens in new window; Koziel, N., et al.,The Canadian Journal of Psychiatry, Vol. 67, No. 2, 2021opens in new window). In a small qualitative study, participants reported feeling improved self-awareness, self-acceptance, and freedom of expression after walk-and-talk sessions (Prince-Llewellyn, H., & McCarthy, P., Counseling & Psychotherapy Research, Vol. 25, No. 2, 2025opens in new window). A 2020 meta-synthesis of outdoor therapies found benefits including more mutuality between therapist and patient and more interconnectedness between the mind, body, and natural world (Cooley, S. J., et al., Clinical Psychology Review, Vol. 77, 2020opens in new window).

Outdoor spaces can simply provide a backdrop for a session where psychotherapy happens while walking, hiking, or pausing to sit, depending on patient needs and preferences. Other providers consider the connection with nature to be central to their practice.

“In my practice, the natural environment plays an active role in the therapeutic process—it promotes reflection, cultivates connection, and helps clients feel a deeper sense of belonging,” said Salvia Artman, PhD, who offers outdoor therapy in Hawaii.

For some therapists, that means starting with a land acknowledgment, including how the area has been shaped by colonization and development. Other practitioners begin each session with a mindfulness exercise, inviting patients to use their senses to ground themselves and connect with their surroundings.

Throughout the session, nature-­informed interventions can continue to foster that relationship. Aimee Frazier, a counselor with a hiking therapy practice in Portland, Oregon, asks her patients to draw parallels between the surroundings and their internal world, such as a fallen tree that represents divorce or a sapling standing for resilience.

For some patients, walking therapy can reach a spiritual level, Doherty said, helping them ponder their mortality, find a sense of purpose, or grieve a loss. Practitioners may also close with a moment of gratitude to the natural world or incorporate elements from other cultures that draw on nature therapeutically, such as Green Care (a nature-based approach to health and social care) in Finland or shinrin-yoku (forest bathing) in Japan.

The power of walk-and-talk therapy rests partly in its ability to help regulate the nervous system, said Heidi Schreiber-Pan, PhD, founder and executive director of the Center for Nature Informed Therapyopens in new window in Towson, Maryland, a nonprofit that offers training, education, and retreats. Moving the body offers a somatic pathway for processing and releasing emotional energy.

“Natural elements such as sunlight, breeze, and bird songs can also gently support the nervous system to shift from a stress response to a more grounded and regulated state,” Artman said.

Research has linked time in nature to enhanced awe, prosocial behavior, and sense of purpose; reduced depression, anxiety, and negative affect; and physical health benefits such as improvements in heart rate variability, blood pressure levels, and cortisol response (Monroy, M., & Keltner, D., Perspectives on Psychological Science, Vol. 18, No. 2, 2022opens in new window; Capaldi, C. A., et al., International Journal of Wellbeing, Vol. 5, No. 4, 2015opens in new window; Coventry, P. A., et al., SSM - Population Health, Vol. 16, 2021opens in new window; Yao, W., et al., Urban Forestry & Urban Greening, Vol. 57, 2021opens in new window).

Walking together outdoors, rather than sitting face-to-face, can also promote a positive shift in the therapeutic alliance, Nazarian said.

“This format softens the hierarchy in the therapeutic relationship because we’re walking side by side, sharing a common space,” she said. “It feels a lot more collaborative.”

That can be tricky at times, Frazier said, because the outdoor environment comes with surprises—like a blocked trail or a splinter in the foot—that both therapist and patient must adapt to in the moment. She sees these disruptions not as setbacks but as opportunities.

“We have to be flexible sometimes, but cocreating the experience together can be incredibly empowering for the client,” Frazier said. “They get to decide where they go physically—and also psychologically—as we navigate their challenges together.”

Moving therapy outdoors can offer similar physical and mental health boosts for providers, Nazarian said, which may reduce the risk of burnout.

“My work now is very different from what I did in the office,” she said. “I feel like a different therapist when I’m on the beach, because it’s my own happy place.”

When considering whether walking therapy might benefit a patient, Doherty suggests taking a similar approach to how therapists approach integrating religion or spirituality—for example, by asking about a person’s past experiences and current views during an intake appointment. Given the patient’s background, health status, and comfort outdoors, could walking offer added value?

The British Psychological Society recommends exploring the subject with questions such as: How would you describe your current relationship with the outdoors? How has that relationship been at other times in your life? When and where do you feel safe (or unsafe) in nature? How do you feel about meeting outdoors for some of our therapy? (The Use of Talking Therapy Outdoors, British Psychological Society, 2020opens in new window).

Some populations, including those less inclined toward traditional therapy formats, may be particularly well served. Myles Young, PhD, an associate professor of psychological sciences at the University of Newcastle in New South Wales, Australia, launched a walk-and-talk program for men, spurred in part by the finding that one fifth of Australian men who dropped out of therapy left because it was either unhelpful or “didn’t feel right” (Seidler, Z. E., et al., American Journal of Men’s Health, Vol. 15, No. 3, 2021opens in new window).

“Men are socialized, either explicitly or implicitly, not to reveal emotions or to burden others with their problems,” he said. “It’s not that surprising that showing up to therapy—in an unfamiliar place with an unfamiliar person—often doesn’t feel quite right. Could moving outdoors be a small way to help keep men engaged?”

In a randomized pilot study, men assigned to six walking therapy sessions had slightly higher attendance and reported greater improvements in stress and anxiety than men who did therapy indoors (Clinical Psychology & Psychotherapy, Vol. 32, No. 1, 2025opens in new window). Young now has funding for a clinical trial comparing walk-and-talk to indoor therapy among 160 Australian men.

Walking therapy is also a natural fit for many adolescentsopens in new window, said Jennifer Udler, LCSW, founder of Positive Strides Therapy in Maryland and author of Walk and Talk Therapy: A Clinician’s Guide to Incorporating Movement and Nature into Your Practiceopens in new window. The format tends to feel less intense, partly because it minimizes eye contact, which can feel less vulnerable or confrontational. Walking side by side can also allow space for longer pauses.

“Sometimes it can feel like a lot of pressure to be in a therapy session, where teens feel they’re expected to behave a certain way,” Udler said. “Walking side by side changes that completely. It just takes the pressure off.”

Nature-informed therapies are a powerful way to help treat addiction, said Schreiber-Pan, who trains counselors at BriteLife, a network of addiction recovery centers. The “sit spot” intervention, which involves simply observing nature for 10 or more minutes, can help build stress tolerance and mindfulness skills.

For some patients, the benefits of walking therapy do not outweigh the risks. People with a history of trauma or serious mental illness, including psychotic disorders, are likely to be safer in a more predictable therapeutic setting. Providers should also screen for physical health limitations, such as asking about heart and respiratory conditions, as well as eating disorders, because some patients may be drawn to walking therapy as a weight control strategy, Udler said.

“Therapists should also be mindful that outdoor spaces still aren’t safe or inclusive for everyone—particularly for people with marginalized identities, including those related to race, gender, sexuality, and disability,” Artman said, so it’s important to approach outdoor therapy collaboratively with clients and in a ­trauma-informed way.

In addition, providers should be aware of the potential vulnerabilities that come with meeting in secluded outdoor settings where colleagues aren’t nearby. Frazier incorporates extra screening questions in cases where patients have a history of interpersonal aggression to assess whether both parties will feel safe on the trail. 

“Therapy can be vulnerable and challenging, and I want safety to extend both ways in the relationship. If the outdoors isn’t the right format, then we plan to meet in the office or via telehealth,” she said.

For patients who are not a fit for walking therapy, Nazarian suggests other small ways to incorporate nature into therapy. That may include placing natural objects in the office or adding mindfulness exercises that draw on natural imagery. “Even a small sensory connection to nature can be beneficial,” Nazarian said.

While walk-and-talk therapy may be simple in theory, implementing it requires providers to develop new competencies through training, supervision, or consultation, Doherty said.

“With any form of ecotherapy, the onus is on the practitioner to ensure their competence, because this is an emerging area,” he said.

Here are some best practices to consider.

• Get permission and coverage. Before starting walking therapy, providers should check that their professional liability insurance covers walk-and-talk sessions. If applicable, gain permission from your employer to move sessions outdoors.

Check with local authorities in the area where you plan to conduct sessions to find out whether a permit is needed. One-on-one meetings in public access areas are generally acceptable, but frequent use or larger groups may require special permission, Doherty said.

• Gain informed consent. One critical difference between outdoor and indoor therapy is confidentiality: When therapy happens in public, conversations may be overheard.

Before starting walking therapy, make a plan with each patient. When passing someone on a walk, you may choose to pause the conversation or switch to a neutral topic. It’s also important to rehearse what to say if the patient or provider runs into someone they know.

In addition to details about confidentiality, providers suggest including clauses on risks and benefits, potential for bodily injury, and logistical policies (such as how to handle no-shows and weather changes) in the informed consent document. Have the consent form reviewed by a legal expert to ensure it addresses liability and confidentiality concerns specific to walking therapy.

Informed consent should be rechecked regularly, Schreiber-Pan said. Ask patients if walking therapy still feels right—and be ready to move sessions indoors or online if necessary.

• Plan ahead and adapt as needed. Map out your route in advance, including understanding where crowds tend to gather and how weather conditions can change the terrain. Have a contingency plan for inclement weather, such as contacting the client an hour before to adjust the meeting location.

In his informed consent, Doherty lets clients know that sessions happen rain or shine. He cancels only in extreme conditions, such as during a major storm that would also close schools or other businesses, but encourages therapists to determine what makes sense for their own practices.

Keep in mind that outdoor sessions may require different note-taking procedures, so plan ahead to have what you need during each session.

• Prioritize physical safety. Anticipate and minimize potential risks during walking therapy by choosing a well-maintained route that’s aligned with your patient’s physical abilities, Artman said. Stay attuned to their physical and mental state during walks, adjusting the pace as needed if heat or fatigue become an issue.

Get basic first aid training, including how to respond to sprains, scrapes, and allergic reactions, and carry a first aid kit during sessions. Avoid remote areas where emergency services may be difficult to reach, as well as high-risk activities such as climbing, swimming, or other types of strenuous exercise. Consult with your professional liability insurance provider and your employer (if applicable) to ensure your safety protocols align with professional guidelines.

• Get formal training. In addition to learning basic first aid, therapists should seek training on the therapeutic effects of nature to better support patients. Ecotherapy programs provide education on the physiological benefits of walk-and-talk therapy, how to practice mindfulness outdoors, and other nature-informed techniques.

Prior training as an outdoor guide, environmental educator, or camp counselor can also add helpful skills and knowledge for navigating natural spaces, Doherty said. Regardless of background, consulting with an experienced walk-and-talk therapist can help providers apply the approach safely and effectively.

“There are so many ways therapists can bring their training and existing strengths into this work,” Artman said. “At the same time, offering therapy outdoors presents some unique clinical, logistical, and ethical considerations, so consultation can help therapists build the skills and insight to navigate it well.”