Sometimes a pineapple is just a pineapple.
But on a January day, the rough edges of the cone — and the lone feather protruding from it — meant something different to Rachel Oppenheimer, 25, a counselor at the Chesapeake Mental Health Collaborative in Towson, Maryland.
"Growing up, I had some problems," Oppenheimer said, referring to his thorny teenage past, "some struggles with managing my emotions
.
"
But her grandmother, who died four years ago, was soft as a feather and gave her an unconditional love that reminded Oppenheimer how important it was to treat herself with
"reassuring tenderness
," especially when she became self-critical.
Oppenheimer and her clinical supervisor, Heidi Schreiber-Pan, were visiting Talmar, a nonprofit farm that offers therapeutic programs and vocational training, a short drive from the busy highway and nondescript shopping centers near her office.
On the farm, the only sounds that could be heard were that of a stream, birds chirping, and several inches of snow crunching underfoot.
Ms. Oppenheimer and Heidi Schreiber-Pan set up chairs outside, where they conducted a nature-based therapy training session.
Photo Rosem Morton for The New York Times
It was the perfect place to teach Oppenheimer therapeutic techniques that take advantage of the natural world.
During the session, they set up camping chairs under a bright blue sky – a makeshift office without walls – and discussed how to create a circular design called a mandala.
Next, they placed objects that Oppenheimer found on the floor, each of which symbolized the complex feelings derived from mourning his grandmother.
Schreiber-Pan is one of a growing number of therapists who are taking their
therapy sessions outdoors
and, in some cases, training other counselors to do the same.
They say combining traditional therapy with nature and movement can help clients feel more open, find new perspectives and express their feelings, while helping them connect with the outside world.
"It's a sense of belonging to something bigger, and I think that's a really powerful moment for a lot of people," Schreiber-Pan says.
He added that as humans evolved, they spent much of their time outdoors, but our modern lives are mostly spent indoors, looking at digital devices.
Outdoor therapy is included in ecotherapy, a broad and nebulous term that includes activities as varied as equine therapy and going outdoors or adventure therapy.
During the pandemic, while many therapists went online, others held sessions outdoors, seeking a safer way to meet in person.
But the concept has been around for much longer.
Decades ago, psychiatrist Dr. Thaddeus Kostrubala, author of the 1976 book
"The Joy of Running,"
was
known for running alongside his patients.
This practice never caught on, in part because most therapists were trained to meet with their clients in closed, controlled settings, in order to maintain confidentiality and strict boundaries.
Now, however, some centers, such as Lewis and Clark College in Oregon and Prescott College in Arizona, provide training in ecotherapy.
And some therapists, like Schreiber-Pan, are creating their own curricula.
In 2020, she founded the Center for Nature Informed Therapy, which offers certification and continuing education credits to any certified social worker or counselor who completes the program.
So far, more than 100 people have graduated.
Outdoor sessions are not one-size-fits-all.
For example, not all customers want to walk through the snow.
Schreiber-Pan and other therapists also offer clients the chance to explore nature indoors, starting with a collection of shells, stones, sticks and spiked rubber balls.
And there is no special license for this therapy, nor any established best practices that dictate what exercises or activities therapists should use when meeting with their clients outdoors.
Some professionals are suspicious of this emerging discipline.
Petros Levounis, president of the American Psychiatric Association, was a little "skeptical" about taking a patient to the park.
"In psychotherapy there is a formality: tested parameters," he says.
"You sit in front of them; there's the 45-minute session. And I don't know exactly what would happen outside. It starts to rain. What do you do with the patient?"
Psychiatrists have to think more carefully, he added, and consider special training "before signing
such novel
interventions on the dotted line . "
Still, he added, several studies have found that being immersed in nature can be beneficial for mental health.
A 2023 analysis of the effects of "
forest bathing
," the Japanese practice of taking a relaxing walk in the forest, suggested that it can significantly reduce symptoms of depression and anxiety.
And staying physically active is associated with a lower risk of depression.
A review of several studies concluded that "physical activity should be a fundamental approach" in the treatment of psychological distress.
It connects me with the human being
Outdoor or nature-based therapy has become a big draw especially for men and people under 40, according to Schreiber-Pan and other therapists.
Chase Brockett, 36, who lives in Portland, Oregon, started
hiking therapy
in 2022 and continued for a year and a half, despite having to pay for the sessions out of pocket.
"It connects me with being human, with being alive," he said.
"Not to be subject to the world, but to be part of it."
During his sessions, he and his therapist, Aimee Frazier, would go outside in
all kinds of weather conditions
, including rain.
"You have to be uncomfortable and just accept that that's what's happening," he said, a lesson that became an analogy for his anxiety.
"I think a lot of anxiety comes from A) seeing anxiety as a bad thing and B) trying to escape it at all times."
Therapists also see other benefits:
more receptive and relaxed customers.
"I think for some young people, therapy feels very prescribed," said Andrew Tepper, founder of Boda Therapy, who often works with teens and young adults in New York City and the Catskill Mountains.
"It's a lane. Let's sit down. Let's talk and maybe play a board game. And with that, I think, comes some resistance."
Tepper, a psychotherapist, guides his clients toward outdoor movement, such as hiking or skiing, if they are receptive.
During a retreat in early February, he took three clients snowshoeing, on long walks and cooking lunch over a campfire.
"I think therapy can be fun, and part of that is assessing in advance what clients like to do," she says.
I started to feel like the withered plant in my office.
Therapists are realizing that a nature-based practice can improve their own well-being and help them avoid professional burnout.
Years ago, when Frazier completed a clinical internship in a dimly lit, windowless office, she realized she needed a
"more life-giving environment
," for her clients and for herself.
"I started to feel like the withered plant I had in a dark corner of my office," he says.
"I longed to be out in the sun and rain, surrounded by the calming presence of nature."
In 2021, she began offering hiking therapy to clients under the supervision of Thomas Doherty, a Portland psychologist who founded Lewis and Clark College's ecotherapy certification program.
For some clients, she said, the environment makes therapy feel more accessible and less intimidating.
Maria Nazarian, a clinical psychologist in Santa Monica, California, does not rent a consultation.
He serves his clients only virtually or while strolling along the beach, which he describes as his "happy place."
And, she says, her clients have benefited from getting off the couch.
Walking side by side encourages collaboration, Nazarian said, and being on the shore often provokes moments of awe and admiration, all of which helps create "connection and trust."
winter has to pass
Amy Fuggi, 63, has been going to Schreiber-Pan on and off for six years to overcome her grief over her mother's death.
"You want to push it away, you want to bury it, you want to ignore it," he says.
"But that doesn't work too well."
When he's away, he says, he feels a "great connection" with his mother, who loved the outdoors and often planned camping trips for Fuggi and his siblings.
"I feel like he's walking with me," Fuggi says.
On a recent sunny Monday, she and Schreiber-Pan waded through the snow to visit the campus of a nearby college and wandered onto a tree-lined trail near a small pond, where they played with the concept of wintering:
the ability to peer into the dark moments of our lives.
"They have a purpose, you know, just like winter has to pass for us to enjoy spring," Schreiber-Pan said.
After the session, Fuggi said she felt lighter.
"When you walk, you breathe fresh air and you feel open," she said.
"It's very easy to relax and talk about things."
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