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August 18, 2011


And now for something completely different ... Dear Reader, I'd appreciate your feedback on the following, a form which I would (should my professional order accept it) present to my clients the first time we meet. So what do you think? A crazy idea ... or would you go for it?

"Therapy has typically been done with both/ all parties talking face to face while sitting together in an office. (This is of course not to mention the traditional psychoanalytic approach where the patient lies on a therapy coach and the analyst sits invisibly behind him or her). The present note is to present you with a further possibility: simply stated, that all or some sessions or parts of sessions consist of the two of us talking as we walk together outside the office rather than as we sit together in the office. (At the present time, due to issues of complexity, only individual therapy will be offered in this mode).

The two following issues make this approach somewhat controversial:

1) Confidentiality: the possibility of running into someone you might know. (We will discuss how you would feel about this and if and how you would want to introduce me to your acquaintance should this occur).
2) Boundaries: a less-clearly defined therapeutic space. Obviously, leaving the formal setting of the office behind might create a new dynamic which would be less traditional, structured or predictable. (We will talk about such issues if they occur).

An additional issue for me would be note-taking: in order to allow 5 minutes for this activity at the end of our time, walking sessions will be 45 rather than 50 minutes.

Why then consider this new approach to therapy? What are the potential benefits for you?

1) Physical activity component: in particular, in therapeutic situations involving depression or anxiety I have always discussed the importance of physical activity and movement in beginning to feel better - partly because of the benefits of increased serotonin production and partly because of an increased sense of self-efficacy, that is, your perceived ability to take charge and make concrete changes in your life. (Because of solid research on the psychological benefits of physical activity - cf. the Duke University study of 2000 - I have sometimes felt more like a coach than a psychologist!) In the walking approach to therapy, we would actually build in some physical activity even as we discuss other aspects of your situation.

2) Real-world generalization: a key challenge in therapy has always been the integration of therapeutic progress in the office into real life outside the office. Some of my family therapy colleagues tap into generalization effects by actually meeting with the family in their own home. I believe that walking outside the office might similarly encourage the generalization of therapeutic effects to other settings

3) Easier flow of discussion and ideas: personally, in discussing important matters in my own life with friends or confidants, I have always found it easier and more natural to talk as we walk side by side rather than as we sit face to face. It is my contention that some clients might find it easier and more 'natural' to talk about the journey of their lives while we are making a symbolic walking journey together.

[If I am to be honest, I might mention a personal benefit to myself of this approach as well: therapy is a decidedly sedentary type of work, and the occasional walk will change the pace for me as well and potentially increase my own energy level! (cf. Montreal Gazette article of Thurs. Aug. 18, "Watching too much TV could take years off your life: Prolonged sitting is just as detrimental for mortality as obesity or inactivity")]

The beginning and ending point of walking sessions will be my office. Walks will occur within the 45 minutes of therapy, either for the entire time or for part of the time. Payment will occur in my office, either before we leave or when we return from walking. Walks will be as leisurely or as rigorous as you choose, on the quieter back streets near my office or even on the trails going up Mount Royal.

Even if you should decide to try this approach, no pressure will ever be put on you to walk, and you will decide before each session whether you would prefer to walk or to remain seated in my office for that session. The choice will be yours.

I declare that I have read this document and understand its content".                                ______________________