This chapter of the dissertation contains sections on each of the five most frequently mentioned factors that inhibited practitioners from practicing ecotherapy, as identified in Wolsko and Hoyt’s (2012) study. These five categories were: (1) lack of time and money; (2) boundary, confidentiality, and legal concerns; (3) poor location; (4) that ecotherapy was considered to be irrelevant to treatment goals; and (5) a lack of awareness or confidence in implementing ecotherapy. In each section, I have outlined the perceived obstacle, reviewed relevant literature on the topic, and where possible, provided possible approaches to overcoming or diminishing the obstacle. I have also included my interpretations and responses to the literature in keeping with the hermeneutic methodology. The amount and quality of literature that I found varied significantly across these categories, and in some cases, such as the section on financial and time constraints, there was virtually no relevant literature available.
Lack of Time and Money
In Wolsko and Hoyt’s (2012) survey, the most prevalent factor that inhibited ecotherapy practice, mentioned at a frequency of 56.4%, was regarding limits of time and money. “Clients could not afford to pay for the amount of time necessary” and “[b]ack to back appointments, needing to change clothes to accommodate outside sessions” (Wolsko & Hoyt, 2012, p. 19) were a few responses participants offered to explain their concern. To an extent, this concern parallels the challenges of access; if the therapist does not practice near a suitable greenspace, then they might have to spend valuable session time travelling to it. This also raises concerns of the financial and environment costs of driving a car, especially if public transport is not a viable option.
According to Sarah Conn (1995) who practices ecotherapy in the United States, insurance companies in general are limiting access to therapy, based on economic reasons, as they prefer to offer funding to mainstream treatments such as medication or short-term behavioural interventions. This results in beneficial alternative therapies becoming less financially accessible, which reduces the client base to the wealthy or those eligible for public funded programmes. Although Conn described this dynamic in an American context, I imagine there are similarities in New Zealand. For instance, internationally, the first line of response to depression is anti-depressants (Moncrieff & Kirsch, 2005), and New Zealand is no exception, with 10% of the adult population currently being prescribed anti-depressant medication (Exeter, Robinson, & Wheeler, 2009). “[H]igh rates of antidepressant prescription in New Zealand may be more a result of a lack of availability of alternatives rather than the efficacy or tolerability of these drugs” (Mental Health Foundation of New Zealand, 2012, p. 11).
Another opportunity to address therapists’ concerns about lack of money could lie with the psychotherapy profession as a whole, in particular its low public profile and lack of cohesive image (Gaudiano, 2013; Orenstein, 2013; Schofield, 2008). In New Zealand and Australia, psychotherapists have room for improvement in communicating to the public, employers, insurance companies, and policy makers what psychotherapy is, how it works, and what the benefits are (Gaudiano, 2013; Orenstein, 2013; Schofield, 2008). Also, psychotherapy is declining in the US and UK, and possibly other countries, and according to American Clinical Psychologist, Brandon Gaudiano (2013), “psychotherapy needs to overhaul its image, more aggressively embracing, formalizing and promoting its empirically supported methods” (para 6). Increasing the awareness of the evidence of psychotherapy’s effectiveness would surely be positive for the profession and practitioners, and would increase the number of clients specifically seeking psychotherapy (Gaudiano, 2013), as well as the rate of referrals from general practitioners (Schofield, 2008). Some progress was made when mandatory professional registration for psychotherapists in New Zealand began (in 2003) which increased the number of job opportunities for psychotherapists at district health boards, although the chances of getting a psychotherapy job are still average, “as the role still has limited recognition and funding in the public sector” (CareersNZ, 2014, para. 2).
Just as psychotherapists may need to develop a cohesive imagine, communicate efficacy backed up by evidence, and use clear and convincing language for potential clients to promote their profession, ecotherapists may need do these same things, and more besides (as it is even more fringe than psychotherapy). Essentially, ecotherapists need to communicate and self-promote more effectively, in order to have any genuine effect on our environment and psychological theory and practice. In addition, if these changes did occur, ecotherapists could see an increase in their financial returns as this may increase the number of clients seeking ecotherapy. This would make it more financially viable to lower fees to ensure that ecotherapy is affordable for everybody.
Another example of ineffective self-promotion contributing to financial constraints, is the impersonal web-presence of therapists in private practice, this is probably due to wanting to be non-self-disclosing and to appear neutral. This reveals very little to the potential client that would help them to make an informed decision about whom to see, and to believe that therapy will actually help them. In my experience, this makes it harder for people who may already be ambivalent about therapy. For example, I did a brief online search (google.co.nz) for psychotherapists in Auckland, I found a number of therapists websites used technical words that the public would not understand. For instance, listing theories such as attachment theory or psychodynamic psychotherapy; or not giving more details on how the therapist would work with depression, anxiety, or trauma; and not providing information on how their treatment would help the potential client. In addition, my colleagues and I have discussed the intangible nature of our training, and the subtle (difficult to measure) nature of therapy; I wonder if this makes it harder to value our work, and perhaps charge more money.
Looking at this from another angle, people often become therapists out of a desire to make a positive difference in people’s lives, and perhaps therapists with this motivation accept that psychotherapy is not (in my opinion) a particularly lucrative job. As an example, my mother was in the healing profession and found it hard to turn people away who could not pay for her treatment. Sometimes they would trade services, but often she saw people with not a lot of money, because they were in pain and she felt she could help. It did not matter (to her) that they could not pay her. Having seen the impact this had on my father at times, I want to make sure that I follow her compassionate example, whilst not disregarding the financial necessities of life. To extrapolate this point, the altruistic motivations of many therapists may lead to them not being financially comfortable due to undercharging for their services (although I personally think that therapists are morally obligated to provide some lost cost services). This financial insecurity could make therapists feel cautious about investing further time and money in the training and experimentation required to begin practicing ecotherapy.
To link this directly back into ecotherapy, perhaps therapists who want to protect and care for the environment are passionate, and to some degree, idealistic. This idealisation can turn nature into a pristine and pure place (Brooke & Cantor, 2000; Elworthy, 2007; Kaufmann, 2012), which brings with it a devaluation of the human world, as if we are impure. If this is the case, this could lead to a cutting off, or denial of human desires (and needs) as these have led to destruction of our environment. Furthermore, as we tend to deny the reality of death (Bregman, 1999; Howarth, 2007; Kastenbaum, 2000), we could too be denying that we need a healthy planet to sustain our lives; a denial of human environmental limits (Kassiola, 2003). This denial would include the cutting off of financial desires that could be seen as tainting the good work the ecotherapist is doing (or thinks they are doing) regarding healing our planet. For instance, I have heard environmental leaders criticising people who are working in sustainability and want to make a profit. This dynamic of people needing to be passionate about our planet and not financially motivated, creates a polarity as well as separating nature from humans, as if we are not a part of it (Kovel, 2007). This might be a split or polarity within individuals, it also could reflect a split in the field between green-capitalism on the one hand, and anti-capitalist influenced therapists or clients on the other (Michael Apàthy, personal communication, June 26, 2014)
I did not find ecotherapy literature that directly addressed the concern about a lack of time; however, the following are some possible remedies.
· Extending total session time to include travel (which has contractual and financial implications) and if necessary, reducing the frequency of sessions (which changes the consistency of therapeutic relationship), or meeting less frequently but for a longer period (Jan Edl, personal communication, May 14, 2013).
· Clustering all outdoor sessions with clients together, i.e., all on the same day and asking if the client can meet the therapist there. This option might be more convenient for the therapist but not the client, or vice versa, depending on the location.
· Holding workshops or group sessions.
· If practical, a therapist could move to a location that is more suitable, or find an agency that offers better access to nature in terms of location and support.
· Holding sessions indoors and where necessary redesigning the space to reflect the ecotherapy practice, through decorations that reveal the therapists personality, and including elements from nature. This is normal practice whereby therapists create and change their rooms to reflect their practice modality, for instance, a child therapist creates a space appropriate for play with toys, art materials, and colourful images.
· If employees in agencies voice their concerns about wanting to practice outdoors to management, in conjunction with providing educational material illustrating the benefits of ecotherapy, they could create change in their work environment enabling them to have the time and opportunity for outdoor therapy.
Boundary, Confidentiality, and Legal Concerns
Therapy changes when it moves outside, the frame and the relationship in particular alters, this is what 43.2% of the responses from participants mentioned as a concern about practicing ecotherapy (Wolsko & Hoyt, 2012). This category covered boundaries, confidentiality, and legality. Some comments from the participants were “[l]oss of objectivity. I would become a part of their life rather than being an observer” and “[b]lurs boundaries between myself and my clients” (Wolsko & Hoyt, 2012, p. 19). Further concerns included the lack of control and containment offered outside, along with the perception that mental health policies impose strict limits on how therapy can be practiced. Due to the scope of each of the concerns within this category, they were covered individually in three separate sections.
Boundaries: power and the frame.
The frame relates to the professional and ethical conduct of the psychotherapist and enhances the safety of the therapy for both client and therapist (Jordan & Marshall, 2010). There are two aspects of the frame: the environmental frame that provides a safe and creative space (physically, emotionally, and interpersonally), and the contractual frame that supports the development of the therapeutic alliance. Moving outside extends the environmental frame and it becomes more dynamic, “the boundaries between mutuality and the asymmetry of the relationship we feel become more magnified” (Jordan & Marshall, 2010, p. 357). The frame becomes flexible, and the concern for some is that this negatively affects clients, the relationship, treatment, and a therapist’s privacy. The relationship also expands to include nature (as living therapist), client, and human therapist, which transforms into a multi-directional relational style. This “two-person-plus psychology”, which is expanded from the relational two-person psychology “acknowledges the social, cultural, and environmental context” (Tudor, 2011, p. 53). Another way of describing it is that ecotherapy attaches importance to what is between, and beyond the therapist and client (Jordan & Marshall, 2010). Depending on the client’s needs, the ecotherapist can choose between being more active and directive; the human therapist holds the central position and nature is the container, or the human therapist is an unobtrusive witness and nature has the central relationship with the client (Berger & McLeod, 2006; Berger & Tiry, 2012). According to pioneering Nature Therapist Ronen Berger (2009a), having nature as a partner in the therapy process, provides more support to the ecotherapist (and in my opinion, helps to reduce burnout) as the client develops a relationship with nature as well as the human therapist.
Depending on the background, inclination, and training of the therapist, the frame is either an aspect of the therapeutic environment (Casement, 2013) or it is what makes therapy therapeutic (Milton, 1993). In essence, the holding environment could be the therapist, the space, or a combination of both. If a therapist believes to some extent that the space is part of the holding environment, then they might tend to always practice in the same room with a client. In addition, changing the frame changes the boundaries between client and therapist. A boundary is a concept for space, to have a space that belongs to the therapist and a clear, separate space for the client and this space should not be traversed, according to Psychologist Gary Hermansson (1997). For some clients well-defined and almost rigid boundaries are essential to keep the client held. In other instances, a more fluid boundary is vital. Hermansson (1997) argued that it is potentially abusive to hold rigid boundaries, which can appear to the client as aloofness or arrogance. Totton (2011) encourages therapists to hold the frame in a way that reflects the client’s needs, to “dance outside the frame” (p. 135) with clients who hold overly rigid boundaries, and to act within a well-defined frame for clients who often break rules. Totton (2011) is also in favour of therapists practicing and role-modelling undefensiveness, practicing without goal or trying to change the client, letting go of trying to be a good therapist, and recognising the illusion of control, as clients symptoms commonly arise from the illusory belief of control.
Ecopsychologist Sarah Conn (1995) believes ecotherapists should soften their boundaries and reveal themselves (more than is common in psychotherapy) in order to create a more relational, ecological experience. This could be uncomfortable for therapists who are not used to, or disagree with, revealing too much of themselves to clients, preferring to keep a distance and be an observer or witness for the client. I believe that doing therapy outdoors reveals more of a therapist. This requires a higher level of comfort with feeling exposed (and being closer), and trust that it will be beneficial for the client. Totton (2011) offers, “there is no possibility of, nor would there be any point in, our standing outside and observing in expert fashion” (p. 188). To be the observer implies that one can be objective, that there is an external reality, and that we can put aside subjectivity (Totton, 2011). This is arguably unfeasible as nothing is external or separate from anything else; therefore, there is no “external” reality (Cox & Forshaw, 2012). We are all part of each other’s relational field even if we live on the other side of the planet (Jordan & Marshall, 2010).
In any modality of therapy, boundaries need to be actively managed and attended to; this is a fluid and dynamic process requiring judgment from the therapist. This “living frame” insists on a present focus, and according to Jordan and Marshall (2010), is a good fit for relationally oriented therapists. Outside, therapy is altered as the client is invited to co-construct the frame, radically reconceiving it (Totton, 2012). This flattens power dynamics and therapy becomes more mutual, although not equal as the client still is the focus (Berger & McLeod, 2006; Jordan & Marshall, 2010). “One of the challenges in working outdoors then is how to hold the important, inherent, asymmetry of the therapeutic relationship whilst promoting mutuality in a natural environment that is more neutral” (Jordan & Marshall, 2010, p. 351), this mutuality has the potential to be supportive and comforting for clients. However, with greater mutuality the therapist is revealed as a real person in the world, rather than solely as a therapist, increasing the potential for unhelpful boundary crossing. This highlights the importance of supervision, and the need for the therapist to have good awareness of these possibilities (Jordan & Marshall, 2010). This is topic is also covered in detail in the section on outdoor therapy (see chapter 6).
Theory informs how we view and maintain boundaries, and in my opinion so do senior and esteemed colleagues. What do they do? What is currently the “accepted” frame? If they do work outside, it is more likely for other therapists, especially less experienced therapists, to feel comfortable doing the same as we often work within the confines of what we think others are doing. I have heard therapists whisper quietly to colleagues about holding a walking session with their client for fear of other colleagues judging them to have behaved unprofessionally, or acted out. Psychoanalyst Sebastiano Santostefano (2008) has acknowledged this potential discomfort and fear of working in different environments, and yet he maintains that a therapist needs to learn who and what she or he is in different spaces, and whether they can, when appropriate, be more therapeutically effective interacting in environments other than the office. On the other hand, there is a risk that going outside is moving away from something in the therapy, for instance it might feel stuck inside, and the outdoors might beckon in an attempt to free up the work (see: Jordan and Marshall, 2010). Once outdoors, the therapy could shift or stay stuck, reflecting the client’s process in relationship with the therapist. If moving outside is the therapist enacting something, then this is not necessarily problematic as long as the therapist alone, with peers, or supervision, can reflect upon it.
Boundaries also affect the transference, Psychoanalyst Harold Searles (1960) thought that we need to consider humans transference to the non-human world, and to take into account the total environment in psychology. Transference as originally conceived, relates to people, the unconscious assignment of significant early childhood figures, their feelings, attitudes, and so forth, onto other people (Gabbard, 2005). Ecotherapy could significantly expand transference to incorporate other animals, places, trees, or rivers, developing new theories and practice models. Jordan (2009) explores our ambivalent attachment to nature and considers that our internal working models can be applied to our relationship with nature, “[i]f complicated dependency issues are set up in infancy with the primary caregiver, these cannot help but become manifest in our relationship to the planet and nature” (p. 28). For ecotherapy to be integrated with therapies that utilise ideas of transference, it would be helpful for ecopsychology to have a developed view on transference and how it changes in relation to outdoor therapy and our environment.
Ecotherapists injecting their environmental concerns into the therapeutic work could be, or could be viewed as, a boundary issue, for instance, the risk of the therapist violating boundaries (or being seen to do so) by bringing their own green agenda to the therapy. An example of this happened with a client of Mary Jayne Rust’s (2008), after Rust shared her association on deforestation with her client, (who was linking her dream on the destruction of the rainforest to early abandonment and her eating problem), the client responded by commenting that Rust was inserting her “green agenda” into the therapy. This example illustrates the importance of ecotherapists being comfortable with, and thoughtful about, how they bring nature into the therapy. Perhaps it would be helpful to discuss this explicitly with new clients, particularly if the client is not aware that their therapist practices ecotherapy.
When working indoors, issues of confidentiality relate to how the therapist holds the clients material in confidence, and in general, being overheard is not a consideration. Although ecotherapy can take place in many different spaces including inside, working outside no doubt affects confidentiality uniquely. Jordan and Marshall (2010) discuss this topic at the beginning of therapy with a new client. If sessions take place outside in a public space, therapist and client can hypothesise and explore a range of possible scenarios, such as “what would you like to happen if a stranger comes nearby or walks past us?” to see what the client might prefer. These questions could be deepened “what about if you are feeling distressed at the time, do you imagine you would like the same thing or something different to happen?” In this situation, this asks more of clients than normal at the start of therapy, which may be overwhelming, or forgotten in the anxiety of a new therapeutic relationship. Therefore it is probably better suited for higher functioning clients (raising the question of how can a therapist know so quickly), or at least after the early stages of the development of the therapeutic alliance. This discussion empowers the client to be self-directive by expressing their imagined needs (Jordan & Marshall, 2010), they are also gaining self-awareness if this process is new to them, and in my experience, developing responsibility for my thoughts, feelings, and actions helps me to feel more positive, empowered, and capable. Another option is for the therapist to offer to guide the client in the beginning, until the client feels more able to know, and express, what they prefer. This may be the central work of the therapy, for the client to begin to feel in touch with their feelings, and perhaps to be able to share or assert him or herself with the therapist. Throughout therapy, these issues will evolve, requiring ongoing contracting between therapist and client.
Some therapists, such as Rust (2009) chose to use a private garden to minimise concerns of confidentiality and boundaries. Another therapist prefers to have an outdoor space that has qualities of being inside, such as sitting underneath a willow tree, enclosed inside its hanging branches, with a sign nearby asking people to not come near (Jordan & Marshall, 2010). This willow tree provides a natural container for the therapy offering a degree of privacy, and could offer protection from the elements by being covered. In this example, the therapist has taken the lead, which is similar to traditional indoor therapy where the space is in the domain of the therapist. This compromise suits some therapists and clients by reducing potential anxiety about feeling exposed or uncontained in an unpredictable environment (Jordan & Marshall, 2010).
Legal concerns: safety and ethics.
The final part of this category is regarding legal concerns. As the law varies from country to country and requires specialist knowledge to decipher, it is not within the scope of this dissertation to review this topic in depth. In Aotearoa New Zealand, practitioners would need to read books such as Counselling and the Law: A New Zealand Guide (Ludbrook & Counsellors, 2012) to understand the legal components of therapy in context. Subsequently, instead of reviewing legal concerns, this section predominately covers safety and ethical concerns relevant to ecotherapy, as this is a subcategory of the legal field.
The ethical codes relevant to each practitioner’s field determine the parameters (or rules) of practice, specifically the therapist’s legal responsibility of safety towards clients. The New Zealand Association of Psychotherapists’ (NZAP) Code of Ethics (NZAP, 2008) states,
[p]ractise safely. Psychotherapists shall take reasonable steps to ensure that clients, whether in individual, family, or group settings, suffer neither physical nor psychological harm during the conduct of psychotherapy, accepting that considerable distress may be an inevitable part of the process. (NZAP, 2008, sec. 1.14)
For ecotherapy practice, the above could edited to “accepting that considerable distress and/or minor injury may be an inevitable part of the process.” This inclusion is an honest representation of the uncontrollable nature of therapy, particularly when holding session outside; that despite a therapist’s best effort, a client might incur injury such as a sprained ankle. Although ecotherapists have a responsibility to hold adequate training in emergency response and care depending on where they practice (for guidelines see: Buzzell, 2012), the risks of working outside should not stifle where practice occurs by reducing access to the benefits of working in various greenspaces.
Ecopsychologist John Scull (2009) offers guidelines for nature therapy as: safety first, get appropriate training, learn about nature, leave home, work in a variety of natural areas, and let nature do the therapy. This order of learning, placing safety first seems overly cautious. How can therapists learn about safety when they do not yet know how to practice ecotherapy, or primarily, how to relate to, and be in, nature? I believe that being excessively cautious around safety can restrict ecotherapy practice, and therapy in general, as this limits the therapist’s range of possible interventions. Safety is very important, yet it is possible to promote safety whilst also being flexible and creative in therapy in order to do what is beneficial for the client.
Another example of ethical concerns was raised by Berger (2008) in his article on developing an ethical code, wherein he raised some interesting questions that he felt were yet to be answered in ecopsychology theory, “[d]oes Nature Therapy inevitably involve the modeling (by the therapist) of respect for nature, or maybe even directly teaching participants to respect nature?” (p. 58). Berger (2008) asks what it means to say that nature is a partner in the therapy process and if ecotherapists are obligated to educate clients about the environment, such as how to protect or heal nature. Berger’s questions require a deepening of ecopsychology theory that, in my opinion, seems particularly valuable, and I hope that experienced ecotherapists will respond to these questions by designing an ethical code for ecotherapy.
One particular concern that survey participants (Wolsko & Hoyt, 2012) raised, is whether their insurance covers them comprehensively whilst practicing therapy outside. Although this seems inappropriate in a New Zealand context, there are some parallels. New Zealand Psychotherapist John O’Connor (personal communication, October 7, 2012) mentioned that doing anything outside of the norm (not conservative) as a therapist in New Zealand, makes you more vulnerable to being negatively judged by your peers and other professionals. For instance, if a client makes a complaint about you, the people assessing the complaint might view you less favourably if you were practicing outside. American Psychologist, Ofer Zur (2001), who stated that “insurance companies, ethics committees, licensing boards, and attorneys have been advising therapists to ‘practice defensively’ and to employ ‘risk management techniques’” (p. 96) echoes this view (Bennett, Bricklin, & VandeCreek, 1994; Koocher, 1998; Pope & Vasquez, 2011; Strasburger, 1992). This is one example that could result in a therapist (or an agency) thinking that it is too risky to be unconventional by holding therapy sessions outdoors. At this stage, this point appears to relate specifically to the US and Canada, whereas New Zealand is more straightforward, because it is rare that psychotherapists are paid by their client’s insurance provider. However, the issue of their own indemnity insurance remains – though this is probably not a complex issue to resolve, and it is important to check about the implications of outdoor therapy on insurance and liability coverage (Corey, Corey, & Callanan, 2010).
Poor Location: Inadequate Access to Nature
In Wolsko and Hoyt’s (2012) study, 33% of participants responses revealed that practicing in a poor location is considered to be an obstacle to practicing ecotherapy. Statements ranged from being unable to decorate therapy rooms or having small, windowless rooms that offer limited room for improvement. Lack of access to greenspace near the workplace with suitable levels of privacy and quiet was another limiting factor. Therapists working in higher density urban areas are likely to face this obstacle (Wolsko & Hoyt, 2012), and for urban therapists interested in practicing ecotherapy, or integrating it into current practice, poor location seems to be a significant hurdle. Although consideration of the space where therapy occurs is essential, it is just as important how that space is acknowledged and spent time in, for instance there is the risk of simply moving outside, without changing the frame or the scope of practice from the indoor model of therapy (Totton, 2011).
For therapists wanting to integrate ecotherapy into their practice, with limited or no access to nature, it is essential to personalise the therapy room by decorating it to reflect the natural world and their interests, such as bringing in the natural world with smells, images, and sounds of nature such as fresh air, sunlight, greenery, flowers, framed poetry, and rocks. All these elements serve as reminders of nature for client and therapist, and it creates a space for the client to express their relationship with the earth (Harris, 2009). Cahalan (1995) would talk to clients upfront about how the natural world is part of the scope of therapy, and he has designed a room where the nature is apparent using some of the aforementioned techniques.
The benefits of paying attention to the therapy room by creating a space that reflects the natural world, and in general, creating a beautiful room, have been demonstrated in studies by Abraham Maslow and Norbett Mintz (1956). In their study, participants who spent time in a beautiful room, defined as harmoniously decorated with sculptures, soft couches, a wooden desk and bookcase, paintings, soft indirect lighting, and two large windows, self-reported having more energy and overall well-being, compared to time spent in an average or ugly room. Mintz (1956) furthered this study and found that people want to spend longer in beautiful room and participants reported feelings of comfort, pleasure, importance, energy, and a desire to continue their activity. Whereas in the ugly room there were reports of fatigue, monotony, headaches, drowsiness, discontent, irritability, hostility, and a desire to avoid the space. The ugly room had grey walls, austere metal furniture, naked light bulbs, and two small windows with torn shades. Although the above example is extreme, I recall practicing in therapy rooms that felt industrial and sterile, and feeling uncomfortable in this space, and embarrassed to bring clients there. I felt that the room did not represent the importance, sensitivity, and respect that I had for clients who were willing to engage in therapy. Other research has focused more specifically on the natural world, such as the value of having a window overlooking greenspace. Researchers (Pretty et al., 2005) found that people in workplaces with views of nature have fewer illness, feel less frustrated, and express greater enthusiasm for their work. Given the high rate of burnout the mental health profession has (Wessells et al., 2013), working in pleasant spaces could clearly offer some immense benefits for therapists and clients.
Creating an indoor environment that is healthy with clean and fresh air (air purifiers, de/humidifiers, or purifying plants); natural and healthy lighting, especially not fluorescent, which is unhealthy (Stigliani, 1995); with windows or images of nature; and a room that is suitably spacious (Clinebell, 1996), could be too expensive for agencies or individual therapists. In addition, some therapists might rightly believe that expressing a desire to see their client’s outdoors could result in conflict with authority, a situation requiring courage, support, energy, and knowledge to engage in. They also might lack the support of their colleagues and feel they are “on their own”. This raises the question of how can therapists talk about working outdoors to colleagues or managers. In general, a good approach is to determine what your boss or organisation needs, and what role you (or a peer leader) could have in providing it (Baldoni, 2010). There is plenty of literature available on how to create change and have a challenging conversation in your workplace (Baldoni, 2010; Bridges, 1999; Dutton, 2003; Geuss, 1981).
Adapting the room by integrating nature and making the space more pleasant might be a better alternative for therapists who are unable to practice therapy outdoors due to poor location. Additionally, some clients prefer to be seen indoors, either initially, or throughout the duration of therapy. Reasons for this preference could be, feeling too exposed outside, they are used to indoor therapy and are uncomfortable with change, or they need the containment of a room and the predictability that comes with this (i.e. not affected by temperature and weather fluctuations). The section below, “Benefits of Ecotherapy” covers this detail.
Ecotherapy and Treatment Goals
Wolsko and Hoyt (2012) found that 29.5% of participants comments expressed the belief that ecotherapy was either ineffective or irrelevant to the healing process. Some of their comments highlighted a theme, that some practitioners believed that the client’s internal space is the central focus of (their modality of) therapy and that ecotherapy would be an unhelpful distraction. “Do not think it is relevant to everyone. This type of approach assumes that everyone is a tree hugger when they are not” (Wolsko & Hoyt, 2012, p. 19). This type of thinking embodies the splitting that tends to occur around nature or the environment, and the belief that only certain types of people can and should take care of our planet. Whether we are passionate environmentalists or not, we are all reliant on our environment to stay alive. Environmental activists tend to be on the receiving end of the split-off collective guilt about environmental damage, becoming the objects of ridicule “tree-hugging hippies”, and effectively the collective guilt is neutralised (for more details see: Randall, 2005). I find this dynamic particularly upsetting, as we are all responsible for our lives and the effect that they have, not one particular, marginalised group.
Whether a therapist believes that ecotherapy is relevant to treatment goals, to some degree, depends on their understanding of human development. If they do not believe that our environment (and all that we interact with) affects a person’s development, then it is more likely that they will deem ecotherapy, or any therapy modality that addresses the environment, to be irrelevant to therapy treatment. Personally, I think that for ecotherapy (and similar modalities) to actually be irrelevant to therapy treatment, there needs to be strong evidence that our relationship with this planet is irrelevant to our lives, and therefore to therapy, evidence that I find hard to imagine existing. Spaces and personal relationships dialectically co-create each other (Santostefano, 2008); we are changed by our location as we are embedded in (not separate from) our physical environment, if the space is changed, then so is the person (Stevens, 2010). I have experienced this dynamic recently when I travelled to India and stayed in areas where rubbish and dirt was everywhere, and the constant noise was inescapable. I felt very stressed and grubby, and I desperately wanted to find some peace and quiet. When I reached the hill stations and stayed in a hotel surrounded by greenery and minimal noise, I felt like a completely different person, far more relaxed and happy.
Additionally, memories are tied to our state of consciousness and our physical location (Nevid, 2012; Rubin, 1999), this means that it is much easier to remember something if either of these elements are reproduced. This could be quite useful therapeutically, especially if the therapist is flexible to hold therapy in a contextual environment that helps the client to process and heal past trauma. Given the effect our environment has on our whole being, I believe that it would be consistent for therapists to be very thoughtful about where we practice, as well as how our environment affects health, for instance including in the assessment questions about the client’s physical environment. I believe that integrating the environment into therapy, alongside therapists modelling respect and care for our environment, would expand the range of healing that therapy can offer, for clients, therapists, and our planet.
One related application of ecotherapy is to work with peoples’ lifestyle choices in relation to the environment, a treatment goal of harmonising our lives with the ecosystem, such as decreasing our carbon footprint. In New Zealand, our relationship with nature, often, does not match our values. According to Carl Rogers (1989) from a person centred perspective, incongruence, which is a dissonance between our self-concept and our lived experience, is a source of human distress. Furthermore, Terrance O’Connor (1995) has argued that we need to gain insight into our ecological incongruence as there is a disconnect between how we feel about the environment and how we relate with it. For example, New Zealanders love to spend time outdoors in nature. In a New Zealand household sustainability survey (Research New Zealand, 2008) 83% of respondents stated that they believe we are all responsible for caring for the environment. This survey also revealed that two thirds of people with access to a motor vehicle drove to work without passengers, and of this number, a third described themselves as unwilling to change their behaviour, such as using public transport, carsharing, walking, or cycling. This illustrates this misalignment of environmental values and related behaviour; this incongruence is common, and I am aware that I too have ecological incongruences. This is not inherently a problem unless I am unwilling to be aware of my behaviour, and reflect on how it relates to my values. Ecotherapy is about attending to this ecological incongruence which can creative positive changes, aiding us to face into, and take care of, our current environmental crisis (Buzzell & Chalquist, 2009a).
Ecotherapy: Lack of Awareness or Confidence to Implement
The category with the lowest reported occurrence by participants in Wolsko and Hoyt’s (2012) survey was 9.6%. In this category, the mental health practitioners felt as though they lacked sufficient awareness or confidence to incorporate nature into their therapy practice. “I think fear of stepping outside the box is a big factor. (Gasp, I am startled at my timidity.) I often, often, often think how therapeutic it would be to conduct a session while walking on a nearby bike path” (Wolsko & Hoyt, 2012, p. 19). This comment is an example of how hard it can be to really trust and act on our intuition, especially if the idea is unconventional. Often, practitioners do not know about ecotherapy, or if they do have some knowledge, they might feel unsure how to apply it. I imagine that this lack of awareness contributes the attitudes of the 29.5% of participants who mentioned their belief that ecotherapy was irrelevant to therapy. Consequently, this section aims to increase awareness and understanding of ecotherapy by focusing on some of the main benefits and limitations.
Benefits of Ecotherapy.
Nature’s restorative properties have been widely researched, studies show that nature restores depleted physical and psychological states and alleviates dysfunction (Antonioli & Reveley, 2005; Fuller et al., 2007; Gidlöf-Gunnarsson & Öhrström, 2007; Hartig et al., 2003; Kaplan, 1995; Kuo & Sullivan, 2001; Maas et al., 2009; Ulrich, 1984; Vries et al., 2003). When being outside in nature is not possible, indoor plants (Bringslimark, Hartig, & Patil, 2009; Park & Mattson, 2009) and images of nature offer some of these stress reduction benefits, the larger and more immersive the image, the greater the benefit (de Kort, Meijnders, Sponselee, & IJsselsteijn, 2006). As ecotherapy acknowledges and knows the importance of the space and place that therapy occurs, and as it is often located in the natural world, ecotherapy is a field with distinct advantages to traditional indoor therapy. Why not utilise spaces that people naturally tend towards for restoration (Ulrich et al., 1991) as a part of therapy?
Ecotherapy facilitates people to get in touch with their larger self (to experience an expansion of the mind-body), and explore dimensions beyond the intrapersonal and interpersonal (Berger & McLeod, 2006). This expansion decreases people’s sense of isolation as they sense that they belong to something larger than themselves. There is a range of literature available for therapists on the self as interdependent and extending beyond our skin (Berger & McLeod, 2006; L. Conn & Conn, 2009; S. Conn, 1995; S. Harper, 1995; Hillman & Ventura, 1993; O’Connor, 1995; Rust, 2009, 2009; Sabini, 2002). Greenspace increases creativity and play, and develops the instinctual (animal) self, which is creative, spontaneous, capable of strong emotions, and deep insight (Berger & McLeod, 2006; S. Harper, 1995). Also, flexibility develops due to being immersed in an environment that is palpably uncontrollable, along with fostering feelings of acceptance and completion (Berger & McLeod, 2006). These benefits are similar to those of mindfulness meditation practices (Greenberg, Reiner, & Meiran, 2012), this similarity may be due to the common ground between mindfulness practices and ecotherapy; both cultivate awareness and compassion (Buzzell, 2009b; Clinebell, 1996).
A study commissioned by Mind (2007), a mental health organisation in the United Kingdom, and implemented by the University of Essex, found remarkable benefits of outdoor walking in natural spaces: 90% felt an improvement in self-esteem, 71% felt an improvement in depression, and 71% felt a reduction of tension. Only 5% felt their self-esteem decline, with 6% feeling more depressed after an outdoor walk, this is compared to 44% and 22% respectively, in an indoor walk (Mind, 2007). This simple intervention holds good potential for the reduction of depressive and anxiety symptoms; it is also cheap and could be effective in combination with psychological, physiological, and neurological interventions. Mind (2007) recommended that the primary intervention for people with mild to moderate depression is green exercise, or if this is not realistic, simply spending time in green environments. I personally have utilised green exercise for reducing anxiety and stress, I find that even a short walk in nature can help to reduce anxiety and increase my sense of wellbeing.
Another benefit of ecotherapy is that for some clients, working outside feels safer, more appealing, and spacious. Clients with a history of sexual abuse, and who feel afraid to be in a room with only one person, are likely to feel more able to engage and establish a therapeutic alliance outside, due to decreased anxiety (Totton, 2011). I also imagine that being outside helps, by putting less pressure on the relationship as being outside broadens the focus out from the dyad to include the surroundings. Also, the natural world can provide a sense of stability in its complexity and reliability at being unpredictable, and it is very engaging – it is hard to ignore nature when you are caught in a thunderstorm (Holifield, 2010). For some, being outdoors is a safer entry point as it assists people who have suffered by the actions of humans, such as torture survivors who engage with the soil and the cycles of birth and death through planting gardens (Rust, 2005). Practicing ecotherapy outside expands a therapist’s treatment options by allowing for clients who prefer (or are more suited) to outdoor sessions.
An aim of ecotherapy is to assist in healing for all forms of life on earth. Thus, the crucial benefit of ecotherapy could be enabling humans to live more sustainably, by caring for, and valuing ourselves, and all the creatures who we share this earth with. One method to accomplish this, according to psychological authors (Macy, 1995; Rust, 2008; Totton, 2011) on climate change, is that we each need support to face into our (often repressed) collective apathy, rage, guilt, despair, grief, denial, and dissociation about the state of our environment. Macy (1995) has found that sharing these potentially overwhelming emotions with the support of experienced facilitators in a group, is empowering and opens people up to the possibilities, rather than feeling helpless and stuck. For therapists who are interested in taking therapy outdoors, it is important that they too have moved through feeling stuck and helplessness about environmental issues, so that they are able, by feeling freer psychologically, to do the required thinking and preparation for adjusting the frame and space of therapy.
Another benefit is that people who feel more connected to nature have higher life satisfaction, and it is probable that they are more likely to engage in eco-friendly behaviour (Mayer & Frantz, 2004), although further research is needed to prove this link. How to enhance this connection to nature is one of the questions that ecotherapy and ecopsychology endeavour to answer; by deepening our connection within ourselves, becoming more aware of our body-mind, and feeling more at ease within ourselves, we are also deepening our connection with nature.
Limitations of Ecotherapy.
Ecotherapy is a young field, and according to Berger (2009b), there is plenty of room for constructive critiques on its limitations; it is beyond the scope of this dissertation to review them all. Ecotherapy modalities include a wide range of philosophies, and in my opinion, this diversity is a limitation, as ecotherapy does not have a clear, coherent message. In addition, ecotherapy has a limited amount of in-depth case studies available, making it hard for ecotherapists to gain practical knowledge; there is a need for more in-depth ecotherapy literature that covers the applied end of the spectrum, rather than the theoretical. This lack hinders a valuable source of learning for therapists interested in ecotherapy practice.
Psychologist Robert Greenway (1995) has spent nearly 30 years leading wilderness excursions and he collected responses from participants about the effects of the experience, 90% of participants reported an increased sense of aliveness, energy, and well-being upon returning home after time spent in the wilderness. These gains were short lived, with 52% describing themselves as feeling “depressed” a few days later (Greenway, 1995). This decline in positive affect illustrates the importance of integrating wilderness excursions, that may have felt transformative, into the participant’s everyday life. Although these experiences offer benefits, such as enlivening the senses through expanding modes of perceptions and opening up or expanding our sense of self (S. Harper, 1995), interventions that intermingle with our daily lives offer more chance of long-term gains. Short-term intensives can be very effective, but there needs to be some sort of sustained follow up, otherwise the gains will be lost (Bassman, 1998; Seed, Macy, & Fleming, 2007).
Berger (2009b) has offered valuable contributions by identifying some of the limitations of ecotherapy. He raises the issue of how hard ecotherapy is to define as it is predicated on uniqueness and creativity. Generally, defining a therapy modality has the potential to limit the therapist’s creativity and flexibility as they may feel, either consciously or unconsciously, that their practice should look something like the definition. To lose creativity and flexibility is to lose the vital element of therapy according to Irvin Yalom (2002). However, defining ecotherapy does not necessarily require a rigid or uncreative practice and there are advantages to having a more developed definition. If ecotherapy became simpler to describe and understand, it would help by raising awareness and perhaps, its popularity; this is also a challenge that psychotherapy faces. In my experience, there is a tendency to emphasise the individual, subtle, and unique, aspects of the work (either ecotherapeutic or psychodynamic) and, it seems, a fear that candid communication with other professions and the public, along with a clear definition, could somehow damage the work. This attitude stands in strong contrast to research oriented psychologists, and the more technical modalities, such as cognitive behavioural therapy (CBT). I wonder why more psychotherapists and ecotherapists have not shared their techniques and successes; are we afraid of robust critical thinking that is such a part of research and CBT? or do we feel that this is not our strength, as we are relationally focussed, and thus we miss the value of research and clearly articulating our therapeutic style.
Another benefit of simplifying ecotherapy is that critiques that are more sophisticated could be developed and assimilated, which would probably increase ecotherapy’s robustness and efficacy. Berger (2008) proposed that the limitations of ecotherapy relate to the framework and the limitations of the therapist, such as their personality, character, training, and experience. It is the therapist doing the work, rather than the framework, according to Berger (2009b). They enliven and bring the spark to therapy through their interventions, actions, and way of being. If this correct, then the limited training, supervision, and mentorship opportunities available to aspiring ecotherapists will make it difficult for them to develop their unique, authentic practice. Although it seems that this is a limitation of any young field,
Another limitation could be the types of people who are attracted to practicing ecotherapy. It is conceivable that ecotherapy attracts practitioners who are less motivated towards consumerism, marketing, or business models, due to the philosophies underpinning ecotherapy. This raises the question of whether marketing and other capitalist enterprises are in opposition to ecotherapy values. Ecotherapy does not necessarily exclude green capitalism, the view that capitalism can be pro-environment (Wallis, 2010), but a strong critique of consumerism and capitalism is also present. I believe that ecotherapy needs to utilise consumerist activities more thoroughly, even if this is seemingly against its values. Raising ecotherapy’s (and similar modalities) profile could stimulate a deeper psychological engagement and dialogue of our environmental crisis than we are currently participating in. Should this happen then any philosophical incongruities, such as ecotherapy being anti-consumerism, could be addressed later, knowing that this transgression was for the greater good. What is more important is that we engage with the crisis, rather than being overly concerned with perfecting the ideology. Perhaps ecotherapists think that it would be inauthentic to enter into the social systems that have contributed to the state of our environment. Although I believe this question is interesting and worth investigating, it is beyond the scope of this dissertation to pursue it. However, what is relevant is that ecotherapy should be developed deliberately and coherently, creating a field that nurtures new ecotherapists through mentorship, specialist supervision, and training.
Another limitation has been raised by Snell, Simmonds, and Webster (2011) who expressed concern that ecopsychology can be misinterpreted as a new age therapy. This association diminishes its chances of gaining recognition in the academic community. The implication is that without the recognition of this community, ecotherapy will not be taken seriously enough to reach a critical mass or mainstream acceptance (if this is a goal). In response to these critiques, and in parallel with defining ecotherapy, creating a code of ethics (whether in the form of guidelines or rules) could assist in developing the identity, standards, and quality of the ecotherapy profession (Berger, 2008). As mentioned already in the section “Legal concerns: safety and ethics” Berger (2008, 2009b), in recognition of this idea, has initiated a dialogue on creating a code of ethics with ecotherapy colleagues.
Further research is required in order to develop a good understanding of who is suitable for ecotherapy; this lack of developing a clear clinical application is another limitation of ecotherapy. People with certain psychological difficulties could be at risk of overwhelm, or harm, if not adequately screened prior to treatment. Unfortunately, there are not many guides available on what this screening process looks like. Berger (2009b) notes that nature therapy, being experiential and creative, tends to require the client to be comfortable enough with connecting into child-like states, and as such is probably not appropriate for people who need clear boundaries, hierarchy, and high levels of control. Clients with difficulties in reality testing (tendency for psychosis), post-traumatic stress disorder, or who experience complex psychological issues, need ecotherapists to be aware of their condition and to adjust treatment accordingly, after a thorough assessment process (Berger, 2009b). This necessitates broad experience and good knowledge and skills (i.e., in handling flash-backs and panic attacks) of how different psychological states might interact with certain ecotherapy modalities, such as being outside, which can be unpredictable (Berger, 2009b). This raises the question of whether ecotherapy places greater demands on the therapist due to a higher degree of unpredictability in treatment. If this toll on the therapist does exist, it is another limitation of ecotherapy, making practice challenging for novice and adept ecotherapists. On the other hand, perhaps the restorative benefits of working in nature outweigh these more difficult aspects of ecotherapy.
As mentioned already, ecotherapy will not suit everyone, clients, or therapists. According to Psychotherapist and Shamanist Will Taegel (as cited in Bradley, 1997) some people’s feelings range from discomfort, to an alienated and a severely damaged relationship with nature, as a result they will be unable or unwilling to engage in ecotherapy. Scull (2009) echoes this idea and does not recommend nature therapy for these people, although he has had success in some cases by working with the clients negative responses by uncovering and understanding the underlying thoughts and feelings. People who have spent little or no time in nature will tend to feel more comfortable with therapy in an urban environment; humans are habituated – preferring people or things that we have been the most exposed to (Baumeister & Bushman, 2013; Chaiken & Trope, 1999).
Further critiques of ecotherapy come from varied lenses: feminism, social justice and poverty, ethnic diversity, and minorities. One critique is that despite recognising interdependence with all beings, ecopsychology still values (and focuses on) the human experience. The exploitation of animals, according to Eco-Feminist Pattrice Jones (2010) is not given the weight the theoretical basis compels. Environmental and Social Justice leader, Carl Anthony (1995) mentions that ecopsychology has shown some promise in addressing race and class , although there is plenty of room for further development (Kovel, 2007). For instance, Jungian Ecopsychologist David Tacey (2009) has explored the way in which the Australian people’s relationship with nature closely parallels and intertwines with their relationship with the Aboriginal people of Australia. Ecopsychology is not solely about healing our relationship with nature, it is also to heal communities that have disintegrated through racism and urban neglect. To heal these splits, stories of all life forms need to be heard, respected, and incorporated into our lives, and our therapy practice (Anthony & Soule, 1998).
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