Spaniels and frogspawn in low intensity CBT work
12 May 2021
Childhood & Adolescence (3-18 years) Clinical Practice
I was always aware of the evidence linking feeling good outdoors to feeling good inside, but I had expected this would occur outside of session times with clients. As a Children’s Wellbeing Practitioner I worked in a research clinic, seeing young people aged 7-17. I enjoyed a lunchtime stroll through a green campus and occasionally bought a new pot plant for the waiting room but would then return to my “real work” with young people in small clinic rooms.
This all changed when one young person, attending the clinic for six weeks of low intensity treatment for Separation Anxiety and Generalised Anxiety Disorder, grew silent, then angry, then tearful in the course of our first two sessions. His mum apologetically phoned to say he would not be returning – he felt there was too much theory and he didn’t know what to say in sessions.
I felt helpless. When I told my supervisor, she asked what he enjoyed doing, and I remembered that he’d mentioned having a dog. “See if you can take it for a walk” she advised. And so we did. For the next sessions I would meet him and his mum outside the clinic, and then she (and my supervisor) would wave us off for a walk through the woods with Olly (a lovely cocker spaniel). In the remaining four weeks of working together, Olly’s owner achieved all his goals of going upstairs alone, being able to get to sleep at night and stay at home on his own without worrying.
All our work together was done whilst also stopping to admire a funky mushroom, watch Olly chasing a squirrel or checking the stream for frogspawn. In this way, the outdoors provided what Dr Sam Cooley calls “a passive backdrop to therapy”, but nevertheless certainly allowed us both to feel more relaxed and less pressured than during our sessions indoors.
Greenspace exposure is associated with decreased heart rate and blood pressure (Twohig-Bennett & Jones, 2018), and Hays (1999) writes about how walking can aid psychological processing. McKinney (2011) identified that walking side-by-side with the practitioner means more client and practitioner equality, leading to a sense of collaboration with Olly’s owner that, despite my best efforts, had felt lacking in the clinic room.
But more than this, I don’t know about dogs. And sometimes I couldn't work out how to open a gate. That meant that Olly’s owner and I benefitted from what Berger and McLeod (2006) spoke of as a kind of shared ownership of a natural space – my young client could problem-solve the trickiest of gates, and taught me how to give Olly treats, when to put him on the lead and even how to pick up poo expertly! When we were outside, it seemed that Olly’s owner’s problems were just a part of his world, not the whole of it. This changed the quality of our relationship, so that work could be done to help Olly’s owner acknowledge his fears whilst retaining a sense of himself as the competent and able young person he was. As Dr Sam Cooley writes “Talking therapy is an established and effective form of support for a range of mental health difficulties, but it appears the four walls of the therapy room aren’t always the most effective place for it.”
As a practitioner I always felt refreshed during these sessions, energised and humble. Noticing, and sharing the reflection of scudding clouds in a puddle, or the way that bubblegum pink blossom stuck to our trainers as we walked through the wet Spring grass was a shared joy, a reminder that all of us can enjoy the simple pleasures of being outside, without words or worksheets. I didn’t ask Olly’s owner if he liked the sight of the first bluebells in the wood – the fact that he kept coming back, that he made progress and that he faced me proudly in our final session to tell me exactly how he’d cope if he feels this way again, meant that whatever had happened was a good thing.
Berger, R., & McLeod, J. (2006). Incorporating nature into therapy: A framework for practice. Journal of Systemic Therapies, 25(2), 80-94.
Cooley, S. J., Jones, C. R., Kurtz, A., & Robertson, N. (2020). ‘Into the Wild’: A meta-synthesis of talking therapy in natural outdoor spaces. Clinical psychology review, 77, 101841.
Hays, K. F. (1999). Working it out: Using exercise in psychotherapy. American Psychological Association.
McKinney, B. L. (2011). Therapist's perceptions of walk and talk therapy: A grounded study.
Revell, S., & McLeod, J. (2016). Experiences of therapists who integrate walk and talk into their professional practice. Counselling and Psychotherapy Research, 16(1), 35-43.
Twohig-Bennett, C., & Jones, A. (2018). The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environmental research, 166, 628-637.