Show Notes

Kayla: Welcome back to The Designer Practice Podcast, and I’m your host, Kayla Das.

In today’s episode, Julie Desjardins Registered Psychotherapist, clinical director and clinical supervisor share strategies for maintaining confidentiality when conducting walk and talk therapy.

Hi, Julie, welcome to the show. I’m so glad to have you here today.

Julie: Thank you so much, Kayla, for having me.

Kayla: Julie, before we dive into today’s episode, please introduce yourself, where you’re from, and tell us a little bit about your practice journey.

Julie: Absolutely. So I’m a registered psychotherapist, clinical director, and a supervisor based in Ottawa, Canada. I am proud to say that I’m a Franco-Ontarian and my journey in the mental health field began in 2007.

I initially opened my so practice in 2017, and after the pandemic I expanded to a group practice. We’re now a team of eight therapists and three administrative staff dedicated to providing bilingual mental health services to our local community and virtually across Ontario.

A core aspect of our practice involves integrating nature and nature-based therapy to support our client’s wellbeing. So we do recognize that there is profound healing power of the natural world and we try to actively incorporate it into our therapeutic approaches.

Our goal is to leverage the calming and the restorative effects of nature to help clients reduce stress, alleviate symptoms of anxiety and depression enhance self-awareness and foster a deeper connection with themselves and their environment.

Kayla: I love it. So I know we’re talking about two things here. We’re talking about walk and talk therapy, and we’re also talking about therapy in nature. So first of all, what is walk and talk therapy and are there differences between walk and talk therapy and therapy in nature?

Julie: Absolutely, and it’s a great question, Kayla. So walk-and-talk therapy and nature-based therapy. They’re both related, but they do have some distinct differences.

First, I’ll start to talk about the walk-in talk therapy. It is a unique approach to psychotherapy where the client and therapist engages in a therapeutic conversation while walking outdoors. It typically occurs in a park on a trail in the forest or in a quiet neighborhood. Unlike traditional office sessions the primary focus remains on the talk therapy. But the physical movement and outdoor setting provides a less formal and more comfortable environment for discussion.

The side-by-side dynamic movement can reduce the intensity of direct eye contact, which for many clients can be liberating and fostering more of a relaxed and open dialogue. So while walk and talk therapy inherently involves being outdoors, therapy in nature is a broader concept that places a more intentional and sensual emphasis on the natural environment as a therapeutic tool in walk and talk therapy, nature serves as a beneficial backdrop offering incidental calming effects and promoting a sense of ease.

However, in contrast, therapy-in-nature actively integrates elements of the natural world into the interventions. This can involve not just walking and talking, but also structured mindfulness exercises in nature, sensory awareness activities, utilizing the natural metaphors for personal growth or even engaging in activities like forest bathing or horticultural therapy.

The aim of therapy and nature is to leverage the intrinsic healing qualities of the environment to facilitate wellbeing and growth. Seeing nature as a co-therapist.

Kayla: I love that. And really what I’m hearing it’s walk and talk therapy still focuses on the talk aspect of it. It’s just in a different setting such as outside. Whereas therapy-in-nature focuses more on nature as the modality, so to speak.

Julie: Yes, exactly that. So I like the emphasis that nature becomes the co-therapist, right? So we use what we see around us in nature to help us as therapists guide the client into a more mindfulness approach. More in tune with nature. We use nature as metaphors to represent, traumatic experiences, things like that. It just makes better sense.

Kayla: I love that. How can walk and talk therapy help clients and clinicians and who would be the best fit for walk and talk therapy?

Julie: Walk and talk therapy offers numerous benefits for clients. First of all, the physical activity of walking releases endorphins, which are a natural mood booster and helps to reduce the symptoms of anxiety, stress, and depression. This can lead to an immediate improvement in mood and overall wellbeing.

However, the less formal atmosphere of an outdoor setting can reduce inhibitions, making it easier for clients to open up about difficult topics. For those who feel restless or stuck in a traditional office, the movement to outdoors can be incredibly beneficial, allowing nervous energy to be channeled constructively, and often leading to enhanced emotional processing and clearer thinking.

The calming effect of nature, even in an urban park helps to reduce stress and promotes relaxation. While the change of scenery can offer a fresh perspective on problems. It can also reduce the perceived stigma of therapy, making it feel more like a supportive conversation than a clinical appointment.

Clinicians can also benefit from walk and talk therapy. It offers an opportunity to move their bodies, get some fresh air, connect with nature, but it can also significantly combat therapist burnout and enhance their own wellbeing after spending hours in an office. Engaging in a shared activity like walking can strengthen the therapeutic bond and rapport with clients fostering a sense of collaboration.

The dynamic outdoor environment can also stimulate new therapeutic insights and observations that might not emerge in a static office setting. As natural surroundings can provide rich metaphors or opportunities for sensory engagement that deepen the therapeutic process, it adds a valuable modality to their toolkit, allowing for a greater flexibility and the ability to cater to a wider range of client preferences.

A few more things about walk and talk therapy that can be an excellent fit for diverse range of clients, but it’s not suitable for everyone. So it is suitable for individuals who find traditional office settings that can be intimidating. Clients experiencing anxiety, stress, or mild to moderate depression. Those who appreciate physical activity and enjoy being outdoors. Clients processing difficult emotions or trauma. And adolescents and young adults who may find the less formal environment, more approachable.

However, it may not be a best fit for clients with significant mobility issues or physical limitations. Those who require absolute privacy for highly sensitive topics or individuals in an acute crisis needing a highly contained and immediate safe environment.

It’s also less suitable for modalities that require specific office-based tools like EMDR or art therapy. Ultimately the decision to engage in walk-in talk therapy should be a collaborative one between the client and clinician, ensuring that it aligns with the client’s needs, comfort level, and therapeutic goals.

Kayla: I love that. Now, I know that some therapists worry that conducting therapy outside of the therapy room will cause some confidentiality issues or potential breaches. What are the limits of confidentiality when providing walk and talk therapy or even therapy in nature?

Julie: Kayla, you’ve addressed a really important and crucial ethical consideration for offering therapy outside of a traditional office. While walk-in talks, therapy and therapy in nature offers significant benefits, the public setting introduces unique challenges that we must thoroughly address.

So the most obvious and unavoidable limit to confidentiality in outdoor therapy is the risk of people walking by and overhearing our conversations. When sessions take place in a public park or on trails, there’s always a chance that others might overhear parts of our conversation. While therapists can choose less busy trails or lower their voices to minimize this risk, it can never be entirely eliminated.

So clients need to be really fully aware of this inherent possibility. Closely related is another potential for accidental encounters with acquaintances, right? You or your client might encounter friends, family, colleagues, or even other clients during a session. It’s essential to pre-plan with your clients on how to handle these situations. Establish whether the therapist should acknowledge the client or maintain a professional distance and giving the client the autonomy to choose how they wish to proceed.

The conversation itself might need to be temporarily paused or shift to a more general topic if someone approaches or is with an earshot.

However, beyond social interactions, the lack of a controlled environment presents another challenge. Unlike an office, you can’t control the outdoor setting, meaning that unexpected interruptions like loud noises, sudden events, or unpredictable weather can disrupt the session’s flow and impact privacy.

While not a confidentiality issue, directly discussing on how to manage these environmental factors, including the option to reschedule or return to an indoor space, should be part of the informed consent.

It’s also important to consider the limited ability to document privately during an outdoor session. Clinicians won’t be taking notes in the same way that they might in an office. We are requiring strong recall and a system for prompt private documentation after the session.

Finally, it’s important to remember that all legal and ethical obligations regarding confidentiality still apply even in an outdoor setting, and these can override privacy in specific situations. So given these unique limitations, a robust and specific informed consent process for the walk-in talk therapy or therapy in nature is absolutely paramount. This discussion should happen before the first outdoor session, ideally in a private setting and to thoroughly cover all potential risks and how they will be managed, ensuring that the client is fully informed and comfortable with the nature of therapy.

Kayla: I love that you took this another step, not just talking about confidentiality, because I think you touched on a lot of important considerations. So having that open dialogue about, was this helpful for you? Was this not helpful for you? How can we improve this in the future? It may be that some clients love it and want to continue, and it may be that some clients may not.

So having that collaboration I can see is so important as well as the informed consent prior to, and then the planning of, what if I see someone in the park. So these are all really good considerations that, sometimes we might forget.

Julie: Absolutely. You’re a hundred percent right.

Kayla: So how can a therapist prepare for a therapy session in nature? Are there specific considerations beyond confidentiality that listeners should consider?

Julie: Absolutely. So preparing for a therapy session in nature requires a comprehensive approach to ensure the safety, effectiveness and ethical integrity of the therapeutic process for both the client and the clinician.

So therapists must cultivate personal competence and training in outdoor safety, risk management, and how to generally integrate natural elements into the therapeutic intervention. Moving beyond just walking while talking. This includes conducting a thorough pre-session environmental assessment of the chosen location, checking for hazards like uneven terrain or noisy areas, identifying private spots, and knowing the availability of restrooms or shelters.

A therapist must also check the weather forecast and have a clear contingency plan for adverse conditions, advising clients on appropriate attire and ensuring that they are also prepared for the outdoor environment.

Beyond confidentiality, there are several other important factors to consider.

One is that physical safety and risk management are non-negotiable. Therapists must have a clear emergency plan, including a charged phone and knowledge of local emergency services. It’s also essential to screen clients for physical limitations or health conditions to ensure the outdoor activity is safe and comfortable for them, and always allowing the clients to dictate the pace of the walk.

Another thing is that professional boundaries and role clarity must be discussed because the outdoor settings can sometimes blur the lines of the therapeutic relationship.

An informed consent process for outdoor therapy needs to be more extensive, covering not only confidentiality, but also unique physical and environmental risks, emergency procedures, contingency plans for weather or discomfort and logistics like appropriate clothing.

Something else that a therapist must also consider is that the accessibility and inclusivity is paramount, right? Understanding that outdoor therapy may not be suitable for every client especially for clients who have certain physical disabilities, sensory sensitivities, or cultural backgrounds. And they have to be prepared to offer suitable alternatives.

Finally, therapists should also assess the adaptability of their therapeutic modality to the dynamic outdoor environment and prioritize their own wellbeing and safety by informing someone of their whereabouts and having a personal safety plan, especially if working in more secluded areas.

Kayla: I love that. And one other consideration that I would think about as well is, also having insurance that covers walk and talk therapy or out of organization therapy because not all insurances may cover, out of office. So just double checking to ensure you have that or add it on if that is a possibility for your coverage.

So do you have any additional advice, insights, or tips for listeners for maintaining confidentiality when providing walk-and-talk therapy or therapy in nature?

Julie: Of course, I have lots of ideas, thoughts, and advice for clinicians and clients. So first of all. Therapists need to plan strategic location selections, right? So choose wisely of the location where you want to walk. Finding wide pathways with less foot traffic and natural barriers. Avoid overly populated areas, especially during peak hours, right? So vary the roots if you can. If you do want to use the same park, try to find a different path or a different route, or even finding another trail in your community that could be suitable.

So scouting ahead it’s probably one of my favorite part of the nature-based therapy is that I get to explore other areas of other natural areas in my community that could be beneficial for clients.

There also needs to be some proximity to a public space, right? So be mindful of how close you are to playgrounds, dog parks, main road where conversations can most likely be overheard.

Another thing to think about is your voice modulation and pacing, right? So if you’re close to encountering people on the trail with you, you may want to lower your voice a bit but also consider that you want the client to lead the pace as well as the conversation.

You also have to think about the visual cues and body language. So obviously walk-and-talk therapy means that the therapist and a client are walking side by side. So you know, you may not be able to see clearly the facial expressions that you would normally have in an office setting. Side by side there is some advantages but you have to be aware of your surroundings as well.

And there’s also non-verbal communication that, is important to consider. Because, there are some non-verbal cues such as nodes and gestures that could be important to integrate into the walk and talk therapy, especially when you’re passing others.

Something that I often integrate into my therapy and nature program is that there’s a no acknowledged rule, right? It’s a default. So the standard practice is for the therapist to not to initiate contact or acknowledge the client if an acquaintance is encountered just to protect the client’s privacy.

And it’s also the client’s choice what they want to do, if they want to acknowledge people that they encounter on the trail or to have a discussion, a predetermined strategy to create a generic response if someone directly asks us about our relationship or asks us what we’re doing.

Another thing to think about is documentation practices. Obviously you’re walking outdoors. You don’t have a pen and paper or a tablet at hand to take notes. You’re also not allowed to use electronic devices to record the session outdoors. So it’s really important to have good recall memory. And then when you do come back to a private secure space, that you can write down your notes.

And, the use of technology is also important to consider, right? So you have to have a phone in case for emergencies, not to receive calls or text messages during a session, just like any other in office setting. If ever there is unexpected weather that changes the plans for the outdoor session. It’s always important to offer a virtual backup, so having a session in office or virtually on the computer is always another option for clients.

One other thing that therapists have to consider is the ongoing consent and check-ins with your clients, right? So you have to regularly review your client’s comfort level with confidentiality in an outdoor setting, right? But their comfort level might change over time or depending on the session’s content, right?

And you wanna encourage empowerment. Continually empower the client to voice their concerns, request a change of location or pace or decide to move the session indoors at any point.

So a few more things to consider for clients. For people who are interested in doing walk and talk therapy or therapy outdoors in nature be prepared to discuss it openly with your therapist. So have a thorough discussion about confidentiality, its limits in an outdoor setting, and ask questions until you feel completely comfortable with the idea.

It is also important to know your comfort level. So reflect honestly on how comfortable you are with the possibility of being overheard or seen by others outdoor in nature.

Try to communicate your needs. So if you feel uncomfortable during a session tell your therapist immediately. They are here to adjust your needs. Understand the role of engagement. Be clear on how you and your therapist will handle accidental encounters with people that you might know.

You have to dress appropriately for the weather. really important. So you should know ahead of time what the weather forecast should look like. So dress appropriately have water bottles at hand, good footwear to ensure a smooth transition, into outdoor therapy.

And you have to trust the process and your therapist. So while risks exist, therapists who offer this modality are trained to minimize that. So trust in their judgment and your collaborative relationship.

Kayla: I love that. And actually one other thing is it might be helpful for the therapist to also take a small first aid kit with them. As you were talking about the proper footwear, I’m thinking I’m always wearing flats. If I were to go walking, I’m definitely going to get a blister. So just having a band aid would be helpful. So maybe for the therapist to think, but taking a little tiny first aid kit just in case.

Julie: Yes, always. Absolutely necessary.

Kayla: Julie, you provide therapy-in-nature services. Can you tell us what it is and how it can support listeners and where listeners can access this service if they’re interested?

Julie: Absolutely. So our group practice is proud to offer nature-based therapy as a unique and enriching service for our clients who are seeking to explore the profound benefits of doing therapy outdoors.

This specialized approach leverages the healing power of the natural world, moving beyond the traditional office setting to support wellbeing and personal growth. In our therapy and nature program, clients engage with the therapeutic process while immersed in Ottawa’s beautiful green spaces.

This can include walk and talk therapy where the rhythmic movement of walking facilitates deeper processing and reduces the intensity of traditional face-to-face sessions. Often leading to increased openness and clarity. But beyond walking, our therapists may incorporate mindfulness exercises in nature sensory awareness activities, and the use of natural metaphors to help clients connect with their inner experiences, reduce stress, manage anxiety, improve mood, and foster a stronger sense of grounding and self-awareness.

We view nature as a co-therapist and we actively integrate its calming and restorative effects into our evidence-based therapeutic approaches. So clients in Ottawa can access our services from specific conservation areas near our office’s green space that offers accessible walking trails and serene natural areas.

During the initial consultation, which is typically held virtually or in our office to ensure privacy for sensitive discussions and we collaboratively determine the client’s needs, physical capabilities, and therapeutic goals.

Kayla: Amazing. So to book a free consultation with Julie for her Therapy in Nature program, head to desjardinspsychotherapy.com, or you can simply scroll down to the show notes and click on the link.

Julie, thank you so much for joining us on the podcast today to discuss maintaining confidentiality when providing walk and talk therapy and therapy in nature.

Julie: It was my pleasure. Thank you again for having me.

Kayla: Thank you everyone for tuning into today’s episode, and I hope you join me again soon on The Designer Practice Podcast.

Until next time, bye for now.

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