SEPTEMBER 2013 • MONITOR ON PSYCHOLOGY 59
sexuality implicitly arise,” says Hays. Male therapists and clients
may feel pressed to compete with one another, for instance,
while female clients may negatively compare their athletic
abilities or appearance with that of the therapist.
Defuse possible discomfort by strongly establishing the
framework as psychotherapy first and foremost, essentially by
making it explicit, recommends Hays. She writes about this
issue in the third edition of “Exploring Sport and Exercise
Psychology,” edited by Judy L. Van Raalte, PhD, and Britton
W. Brewer, PhD, due out this year. “Discuss with your client
the idea that you are still doing psychotherapy; you’re just
changing the medium in which it occurs,” she suggests.
• Share the good news. Keep current about the benefits of
exercise and the outdoors and share that information with
clients, says Lager. “It helps to be well-versed about the benefits
of exposure to natural light, the mood benefits of moderate
exercise and the fact that we’re not built to be sedentary,” she
says. A growing body of research shows that even a regular
exercise schedule may not be enough to counteract the effects of
too much “couch potato” behavior, for instance — so the more
movement, the better.
In surveys she’s conducted with her walking groups, Lager
has found that her clients’ moods improve after the walks.
What’s more, she found that group walks sparked some clients
— most of whom hadn’t exercised much before — to walk on
other days by themselves.
• Get creative. When Asmus walks with clients on the
trails near her office, she finds ways to use the natural world
metaphorically, symbolically and therapeutically. For instance,
she may instruct clients to wander off alone for a few minutes
and find an object that represents an issue they’re working on
— a rock that symbolizes the need for more groundedness, for
instance, or a feather signifying the need to let go of a harmful
habit or person. Object in hand, the two then discuss ways it
can serve as a metaphor to provide insight or guide their work
in that area.
In a related vein, the natural world produces amazing
instances of synchronicity, Asmus says. On one walk, a client
was talking about a dream that included three horses. The next
minute, three horses and their riders appeared around a bend in
“Things like that happen so often in the natural world,”
Asmus says. “Animals show up and can mirror what is
happening with people, either directly or more metaphorically.
It helps people open up their perspectives and see their issues in
• Respect the client’s preferences. Don’t push walking or
exercise on a client, and be flexible about how the session goes,
Joshua says. “Some people like to motor it, and others just
shuffle,” she says. “If they come in and say, ‘I’m tired,’ then we’re
• Keep it simple. Asmus suggests starting with small things,
like bringing natural objects into the therapy room, or walking
into the backyard or park for a few minutes. If therapists seek
deeper or greater skills, there are plenty of training options
available (see page 51).
“You don’t have to be a backpacking instructor to
incorporate the natural world into therapy,” she says.
• Monitor the conversation. Be aware that exercising outside
with your client may alter the type of communication you have.
That can be good when it sparks creativity, both in the client
and the therapist, says Hays. “There is potential for much more
openness and disclosure, capacity for insight, the ‘aha’ moments
that we know are facilitated by physical activity,” she says.
For other clients, though, going outside may promote
avoidance, cautions Lager.
“While walking may be distracting in a good way for
someone who gets hyperaroused, it could keep others from
going as deep as they might,” she says. In that case, make sure to
address it with your client.
“There may be clients for whom the office environment is
a better fit, and others who do well with a combination of the
two,” she adds. “As with any therapy, one size does not fit all.”
• Monitor yourself, too. In a related vein, check with yourself
about whether you think you’re accomplishing treatment
goals in this format, says APA’s Assistant Executive Director for
Practice Research and Policy Lynn Bufka, PhD.
“Integrating psychotherapy with exercise is likely a new
approach for many clinicians, so it’s important to be honest
with yourself about treatment progress,” she says. Check in
periodically with your client to assess how things are going, she
Psychologists who combine exercise and therapy are believers
in its benefits. However, Hays says more research is needed on
how the two operate synergistically. Other areas ripe for study
include examining which aspects of therapy are best facilitated
by exercise — insight or catharsis, for example; whether certain
types of people benefit more from exercise-talk therapy than
others; and what kinds of exercise other than walking might be
useful adjuncts to therapy. In her 2010 survey, for instance, Hays
found that 80 percent of therapists who exercised with clients
did so via walking, but 10 percent also ran with clients and 40
percent played noncompetitive sports, such as shooting baskets
or throwing a softball.
Scant data notwithstanding, it’s apparent that combining
exercise and therapy accomplishes at least one important goal:
helping people do two healthy things they might otherwise put
“With exercise, you often hear excuses like, ‘I don’t have
enough time.’” says Joshua. “A lot of times, people don’t want to
take the time to do therapy either. When you combine the two,
it makes it easier to do both.” n
Tori DeAngelis is a writer in Syracuse, N. Y.