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August 18, 2011

PERIPATETIC PSYCHOTHERAPY

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?
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"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".                                ______________________

8 comments:

  1. Anonymous6:53 PM

    I think this type of therapy sounds cool. Will allow more hyper converations? And more exercise and a realistic personable experience. As someone may find the hike more stressfull than the therapy lol

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  2. Anonymous7:05 PM

    Also what if the therapy session turns into another in office session where the patient adapts to the new atmosphere and relations will resume normally? However I think the dynamic will stimulate more conversations:))

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  3. Anonymous11:46 AM

    N'ayant jamais été particulièrement confortable avec l'ambiance froide et non propice aux échanges naturels qui règne lors d'une séance de consultation traditionnelle, j'avoue que cette nouvelle approche me plaît énormément. J'ose espérer avoir la chance d'en faire l'essai!

    P.S.: Thank you for this very inspiring blog!

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  4. Betty2:33 AM

    Darrell, I have been in receipt of great benefits resulting from therapy. Although I've never had you as a therapist and putting aside any therapy needed as a result of knowing you, [...A Little humour(^_^)] I have spent much time considering the therapeutic process. Specific things that made a difference to me. The idea of going for a walk is a very appealing idea to me. I would opt for it given the chance. However my Doctor would have so called me on it. I think I would have been distracted and would have recognized on some level, an opportunity to escape issues that could only have been really looked at in a different milieu. I'm just saying that therapy is a process and at specific points of that process, changing up the venue may well be a catalyst for furthering the process. The criteria shouldn't necessarily be just a clients consent. I think I would have consented to my detriment. Part of the process, should very much be about walking side by side with your therapist and experiencing the comfort and fresh air from a casual excursion. ( Part of the process might also be, giving your therapist a good kick now and then but that' a different discussion) I'm interested to see how this works out.
    Betty
    P. S. For a runner it might be hard to appreciate how hard it actually is to walk and talk at the same time so hopefully you'll find places folks might sit comfortably while out.

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  5. Betty2:38 AM

    Ha............. it says comments will be visible after approval..... well shit......I'm going to cuss here and be rude so you'll have something to not approve (^_^) Darrel I didn't want to just blog this but... I love that you are such an optimist.... you referred to yourself as reaching the mid point of life........... honey that ships' sailed!........... but I like, that you expect to live to be a hundred...................... ha ha ha ha ha ha
    (^_^) have a good day... now delete this

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  6. @Betty, thanks for your insightful comments on the therapeutic process. At the very least, if we *must* sit in my office, my client and I, I try to change where I sit from time to time in order to not get too quickly stuck in one way of seeing things.

    (And from the other side of the couch, I can attest to the fact that therapists may also fantasize about giving that “good kick”, from time to time, to certain of our esteemed clients! ;-)

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  7. Really nice like it.....

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  8. what a great idea, like it.

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