The National Post of Canada – Jan 25, 2005 – Samantha Grice – Some therapists are asking patients to get off the couch and take a hike – Six months ago, Dr. John F. Murray had an epiphany. At the time, the sport performance psychologist was in a counselling session with a client in his Florida office. His client, a tennis player, was having a hard time putting his feelings into words.

“Hey,” Murray said, “Let’s go for a walk.”

So successful was that first walking and talking session in emotionally unblocking the tennis player that Murray now offers all his clients the option of trading the couch for the sidewalk.

It helps that Murray’s office is in picturesque Palm Beach, where one can choose to walk the ocean side of the island or the lake side. On that particular afternoon, they chose the lake side — rated among the top 10 walking destinations in the world — and then headed to a cafe for a cappuccino and a slice of pizza before walking back.

Murray says the session was conducted just as it would have been had they stayed inside. “It was just as serious. There was nothing frivolous about it and he opened up more than he would have sitting,” he says.

“When you’re moving, your blood is flowing and you feel more relaxed and then you can get more in touch with your thoughts. You think clearer.” About 60% of Murray’s patients have been keen to take their therapy sessions on the road.

As a clinical and sport psychologist as well as a former coach and athlete, Murray says it was a natural step to employ walking and talking therapy in his practice. It helped that Murray recently started walking a lot himself.

“I was on national television over a year ago, and I looked terrible because I had gained so much weight,” he says. “And during the process of losing it I did a whole lot of walking. Because I had already learned to love to walk, when I had this client who wasn’t talking, a light went off in my head and I realized how fun and beneficial it could be for both of us.”

While there are only a sprinkling of psychologists across North America who use walking therapy, most have come to it like Murray — after seeing first-hand the mental benefits of exercise.

And some, such as Dr. Keith Johnsgard, an emeritus professor of psychology from San Jose State University from 1955 to 2001 and a practising clinical psychologist since 1956, have long held that exercise is a wonderful treatment for depression and anxiety.

Johnsgard first started walking with patients around 1970. The idea came to him after he started exercising with a few colleagues, instead of “eating, drinking and smoking” to combat the stress of the job. “And I discovered that when I came back for an afternoon of clinical work, I wasn’t tired, but energized and calm and really de-stressed,” he says. “So I thought, gosh, if this has such a profound effect on me, it might work for clients.”

He began prescribing exercise for depressed and anxious patients and occasionally started walking with them.

“This was pretty non-traditional stuff back then,” he says. “It wasn’t even until 1979 that the first article came out showing that exercise reduced clinical depression. It’s still not a widely accepted or acknowledged treatment.”

Johnsgard’s office at the university was near a park and a quiet neighbourhood, with direct access to the outside, so it was easy for him to wander out with a patient.

But he has also met patients at trailheads and gone running with those fighting depression.

Johnsgard says these techniques help people open up. “If you’re walking side by side and looking ahead rather than sitting in a chair in an office and having a shrink stare at you and interpret every change in modulation or facial expression, [you] tend to be more open.”

And, he says, walking vigorously with people who aren’t normally active will get their physiology aroused in the same way strong emotions do. “And people get in touch with their feelings more, is my experience. Sometimes they will get very angry or stop and sob. Ultimately, what they discover is when they’re done walking, they feel better.”

Johnsgard has written extensively on the subject of exercise and depression, and his latest book is called Conquering Depression and Anxiety through Exercise.

Kate Hays, PhD, a clinical and sport psychologist in Toronto, has also published several books on the subject, her most recent being Move Your Body, Tone Your Mood.

Hays has been practising psychotherapy in motion for almost 20 years. And while it’s not something she offers to all her clients, it is particularly relevant for some.

“I can think of someone who was using walking as part of her weight loss plan and also in psychotherapy, and so we used the occasion of being outside to do the therapy,” explains Hays. “And when walking along a street that had an incline she would say, ‘OK, today I’ve got something really difficult to discuss so I want to walk those hills and I want to really push myself.’ So she was using the metaphor of the activity.”

Hays reasons that exercise can open a person up to thoughts and feelings and, as that is what therapy is about, the two can work together.

Working downtown in the concrete jungle that is the intersection of Toronto’s Yonge Street and Bloor Street, Hays will stroll to the less-trafficked area of Queen’s Park. And while she admits that sometimes there are distractions, they can be useful.

“It’s hard to imagine this time of year, but seeing a wonderful flower planting might be very relevant in terms of paying attention to the beauty that surrounds us.”

Both Hays and Johnsgard say their only hesitation in taking clients out of the office is the potential for the relationship to be misconstrued.

“I’m aware there are potentials for all kinds of gender implications and that’s why the only people I’ve mentioned it to are women clients,” says Hays. “I want to make sure that whatever we are doing is something that feels safe and appropriate to the client.”

Jon Mills, PsyD, PhD and ABPP, of the Canadian Psychological Association, sees far greater issues with leaving the therapeutic office environment.

“It seems quite unprofessional. And first and foremost it seems to minimize the seriousness of therapy,” he says. ” ‘Let’s go for a walk and a chat,’ seems more what one does with a friend.”

Mills says the outside distractions and noise could interfere with a genuine therapeutic process. “And it certainly can encumber getting in touch with certain emotions, particularly if you have people breaking down crying on the street.”

When Hays is working with a highly emotional client, she asks them if they would rather stay inside that day — or if she should take along some tissues.

Murray maintains that walking and talking is a most natural human activity. “The ancient Greeks did this all the time. Aristotle walked while teaching his students, people throughout history have done this, but as a psychologist I was trained to have people sit on a couch,” he says. “I like to say, if you so choose you can toss out the couch and go for a walk. It’s much more healthy.”

Dr. John F. Murray is a sports psychologist and clinical psychologist providing sports psychology and counseling services based in Palm Beach, Florida.