When Nature and the clinic meet - a personal journey

 When Nature and the clinic meet - a personal journey

September 06, 2021

Many books and articles have been written about the healing properties of nature, various and sometimes even strange approaches have been developed that are based on treatment with and with the help of nature, for example, eco-therapy, journey therapy and adventure, attention restoration theory (Kaplan & Kaplan), therapeutic gardening, shamanism and more.

Common to most of the literature and approaches dealing with therapy and nature is that they seemingly have no place in the clinic. I would like to invite you, dear reader, to a short trip where I will share how nature and the clinic are intertwined in my work, and perhaps even inspire you to find a place to incorporate elements of nature in your clinic as well.

The first time I felt, and not only understood the theories in practice occurred while working with a boy I was mentoring in youth-at-risk project. The framework defined in the program was (non-therapeutic) sessions that would allow the youngsters to experience a meaningful relationship for good. The standard setting was meeting at a cafe.

After several meetings with one of the participants in the program, I realized that the setting was not appropriate. I decided (with his consent) to try something new. Meet in nature. For that young man, it was his first time outdoor in nature. While walking, he stopped me and said, "Adam, you know, I think God created us so that we are better off when we are in nature." There was no attempt here to flatter or please, simply an authentic reflection of his experience. Full disclosure, I'm excited even now, after almost a decade, when I remember that occasion.

Over the years I have facilitated thousands of hours of outdoor workshops with different groups. Managers, leaders,  computer programmers, police officers, boys, youth trainees, teachers and more. The method I worked with was based on Wilderness Adventure Therapy. I met wonderful people such as the late Leiv Einar Gabrielsen, a clinical psychologist and one of the most serious researchers in the field who worked with youths in a psychiatric ward with wilderness adventure therapy programmes.

And yet the lines were parallel. Therapeutic work in nature. Work in the clinic. Will never meet the lines I loved?

During one of my treatments with a guy who was dealing with dysthymia, I felt stuck. My facilitator suggested getting out of a clinic setting. "Go out for a coffee or beer with him." So we went out. Not for a cafe. To the sea. An isolated area in the dunes in Ashdod. We sweated a bit together, sand got into our shoes. We felt. together.

When I set up a clinic for myself, it took me a long time to gain courage and once again push the boundaries of the clinic. I have found that there are patients for whom the clinic's setting is overwhelming. Suffocating. We started meeting at different points in nature near the clinic. Entire sessions outside. Sometimes walking, sometimes sitting. Nature was a setting, and sometimes a tool as well. We practiced listening, shifting attention with the help of our senses. Sometimes nature was a resource, at times a convenient place to be present. Sometimes - provided us with challenging experiences that we could watch in real-time and face together. The inexplicable noise from the field, the jackals approaching us at sunset. The unknown. Nature provides innumerable metaphors and if we want isomorphs as well.

Making coffee/tea over a gas burner gave an opportunity, to slow down. To deepen the discourse. A structured ritual usually in the second half of our meetings where we could process, write and close. Until the next meeting.

The encounters in nature were significant, but there are challenges. Planning ahead. Another 15 minutes of travel before and after a meeting. Appropriate weather, light/darkness time… For me the sessions were helpful, but from a clinical perspective or more accurately use of time, not always efficient.

And so I moved on to the next development for me. The outings. spontaneous. Sometimes for a few minutes. Sometimes for the most part of a session. Start at the clinic and if necessary - go outside. "Maybe we'll go out for a few minutes." Take a bottle of water from the fridge and leave. I live in a rural locality. Admittedly very close to the fields, but still need to walk. At first, I was apprehensive about how the patients and passers-by would react, I found out for them it did not bother. It's my problem! The ability to combine walking in nature flexibly for me creates the ideal encounter between the worlds. The focus of the clinic and the experience in nature. Going out into nature can allow experimenting with tools and techniques learnt, calming down, practicing experiencing emotions, paying attention to the senses - and sometimes simply because it feels right.

An example I often recall is a patient who was experiencing a significant anxiety attack during a session. A winter night. We tried a number of exercises - then I suggested we go outside. "Take a coat, it's going to be very cold." There was a bone-chilling wind. We started walking. Focus on feeling cold. It was hard not to feel it. We increased the pace. We noticed our pulse. We stopped. We were able to see the stars. The impact was phenomenal. The anxiety did not go away (although its intensity weakened significantly according to his testimony), but the effect of the anxiety almost faded. The patient was in control. We were able to enjoy the night smells together and still allow the anxiety to be present. Then back to the clinic and we processed.

This post does not purport to be a literary review or a theoretical explanation of therapy and nature, but rather an attempt to inspire and motivate. However, I will briefly mention some relevant principles, and in a future post, will try to delve deeper.

• Challenge by choice - the patient will always choose the level of challenge.
• The experience in nature is a collaborative experience ('we both get wet together in the rain,') and is very compatible with collaborative approaches such as CBT, ACT, EDT.
• Being in nature helps lower inhibitions
• Development of attentional flexibility
• Experience enhances learning assimilation
• Risk management - it does not have to be complicated. Sometimes - just make sure there is water. Kit in the car. Charged phone in the pocket.
• Nature benefits us!

Wishing us all days of nature, flexibility and choice!

Resources:

Gabrielsen, L. E., & Harper, N. J. (2018). The role of wilderness therapy for adolescents in the face of global trends of urbanization and technification. International Journal of Adolescence and Youth, 23(4), 409-421.

Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of environmental psychology, 15(3), 169-182.

Osimo, F., & Stein, M. J. (Eds.). (2018). Theory and practice of experiential dynamic psychotherapy. Routledge.

Priest, S., & Gass, M. (2018). Effective leadership in adventure programming, 3E. Human Kinetics.

Jordan, M. (2014). Nature and therapy: Understanding counselling and psychotherapy in outdoor spaces. Routledge.

Strosahl, K. D., Robinson, P. J., & Gustavsson, T. (2015). Inside This Moment: A Clinician's Guide to Promoting Radical Change Using Acceptance and Commitment Therapy. New Harbinger Publications.