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Taking Therapy off the Couch

During the winter in the Midwest United States many clients display depressive symptoms due to inactivity, lack of sunlight and body chemical shifts. As an avid jogger myself, I recognize how my own activity level impacts my mood throughout the seasons. I have taken this information and have applied it to my own therapy practice by way of walking and talking with clients.

As clinicians we often tell our clients about the benefit they will experience through exercise. But, we don't often have the experience of movement with them or the ability to get them started. As a solo practitioner I have had the benefit of becoming more creative and flexible in my approach to healing and wellness.

Using physical activity is not necessarily new in the field of psychology and can actually be dated back to Anna Freud's (1928) use of play therapy. But this was primarily done with children and adolescents rather than with adults. Hays (1999) points out that recreation therapy is used with adults but this is confined mostly to institutions. Generally we give clients information about the benefits of exercise or just more daily movement and send them on their way.

Currently there is very little research out there on mild physical exercise within the confines of mental health treatment outside of relaying the importance of exercise to our clients. However, there are anecdotal reports of clear thinking and synthesizing new information during and just after exercise. As an EMDR clinician I could hypothesize that this clarity could be in relation to a bilateral activity such as walking while processing challenging information with a therapist. This is only an undeveloped theory of my own which could stand a research challenge.

A few years ago I decided to start asking some clients if they would like to try walking and talking. Originally I did this primarily with individuals suffering from depression. I knew if I could just get their body's feel-good chemicals working again they would find some relief. To my surprise many readily agreed. I would first make certain that there are no medical concerns that contraindicate a gentle walk. Then I would re-explain limits of confidentiality when we are outside. This does pose some unique challenges. However, where I am located there isn't much walking traffic to be concerned about. So I mapped out how long of a walk we would take in an hour's time. Turns out most clients are not speed walkers and will do a slow paced 2 mile walk during that time. It is a gentle walk for most and I always match their pace rather than them matching mine. I make certain we have water available for hydration and I check for weather limitations. Additionally, I am ready if a client wants to walk, but if they change their mind and do not wish to engage that day I just simply shift my approach and follow their lead. My client's safety and comfort is always first.

The anecdotal responses to walk and talk are nothing short of amazing. Moods improve, clients feel stronger, more motivated and begin to set goals. While on walks we point out things in life that may be missed (birds chirping, flowers blooming, etc). Clients can breathe, move and talk through their struggles. Clients find that walk and talk gets them moving--literally and figuratively; helps them cope with stress; improves sleep; improves focus and removes barriers and stigmas associated with traditional mental health treatment. Since we are not engaging in difficult exercise or personal training, I have found minimal challenges to doing the same therapeutic interventions on the road that we do in the office with added physical benefits (outside of traditional EMDR). Of course there will be challenges that have yet to be uncovered. But for the most part, engaging in walk and talk has had more emotional benefits than risks.

There is a cautionary tale here for the clinician. We must also be prepared for walk and talk with proper shoes and the ability to walk quite a distance in a day's time. For instance I have walked 9 miles in a day with multiple clients. This could be extreme for a clinician who is not used to so much activity so it would be important to schedule your walk and talk clients in intervals that can be easily accommodated.

An added benefit of walk and talk for me and for the client is being able to take my dog and therapy assistant, Linus with us on every walk and talk session unless contraindicated. Adolescents particularly love taking Linus and even get the opportunity to build mastery and self esteem by taking the leash and learning some dog handling techniques along the way. But that is another article in and of itself.

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