Katie Steele’s mind is never clearer than when she’s working out — running, doing yoga, whatever it may be.

“I do the majority of my processing when I’m moving,” said Steele, a certified marriage and family therapist in Bend.

While working toward her graduate degree, she started to wonder why counseling and physical activity weren’t combined. To her, the mind and body are connected, and working on them at the same time provides the ultimate emotional release.

“The thought of having someone who can be there with you to intentionally process what you’re experiencing makes so much sense to me,” she said. “Rather than just being with it and noticing it … to have somebody who’s there with you to say, ‘OK, what are we going to do with this?’”

Steele is among a small faction of counselors who incorporate movement, primarily walking, into their therapy sessions, a practice that’s been coined “walk and talk therapy.” Advocates say clients tend to be more forthcoming with their thoughts when their blood is flowing and endorphins are being released.

Other counselors aren’t sold on those benefits, however, and cite a number of concerns, primarily the lack of client confidentiality, an assurance that’s foundational to traditional psychotherapy sessions.

Esther Lerman Freeman, a psychologist at Oregon Health & Science University, said if she were to walk with a client around the medical school she works at, it would be similar to doing so in a small town in that there would be no privacy.

“People see somebody walking with me, they know that that person is my patient,” she said. “If they don’t know that person is my patient, they could come up and start talking to us in the middle of a session.”

While an overwhelming number of studies have solidified the health benefits of exercise, no major research to date has looked at the effectiveness of walk and talk therapy.

For Joy Wilson, who owns Hope Rising Counseling in Bend, the changes she sees in her clients when they get out in the fresh air and hit the trails is all the proof she needs.

“People will actually share a lot more when they’re relaxed that way and not staring straight eye-to-eye with a therapist,” she said. “It’s very comforting, I think, being more side by side.”

‘More bang for your buck’

Steele, who also works part-time as a therapist for St. Charles Health System, is so confident in her theory she recently moved to Bend from Eugene and started her own business, Thrive Bend.

Clients can choose the type of movement they prefer for their 50- to 60-minute sessions, whether that be using free weights, going for a hike or doing yoga, said Steele, who is also a registered yoga teacher through Yoga Alliance, a nonprofit that sets standards and certifies yoga studios and instructors. Currently, Thrive Bend is located within Recharge, a business that provides sports recovery services, nutrition counseling and massage. The two businesses are in the process of securing new space nearby the Industrial Way strip mall they’re located in. Eventually, Steele said, she plans to have her own office.

Steele first dabbled with mixing exercise and therapy after earning her master’s degree in couples and family therapy from the University of Oregon in 2011. While working part-time as a therapist for a community-based mental health program in Eugene, she secured gym memberships for her clients and started taking them to the gym. While they exercised, she said, she noticed they opened up more than when they were back in the office. They told her they could think more clearly.

“I found that it was actually a pretty effective treatment modality,” she said.

People tend to hold emotions in their bodies, and when their blood starts pumping, they generate new ideas and gain clarity, Steele said.

“When we get moving, we’re empowered and alive and active,” she said, “and that’s what we all want is to feel more of that energy.”

Wilson, of Hope Rising, said endless research supports the benefits of exercise. Combining that with processing depression, anxiety and trauma is just an added bonus.

“To be purposeful about the conversation and processing while they’re already getting the benefits of breathing and the grounding and the mindfulness of exercise, I just think you get more bang for your buck that way,” she said.

Wilson’s hourlong walk and talk therapy sessions generally begin outside. Most clients prefer to walk on the Deschutes River Trail, but they also walk by the Old Mill District and through residential neighborhoods. Then the latter half of the sessions are spent in Wilson’s office for more intense processing and private topics the client didn’t want to bring up outside.

Teenagers and children tend to benefit the most from walk and talk therapy, as they’re the most uncomfortable sitting in a chair making eye contact with a therapist, Wilson said. Shooting hoops, however, helps them relax, she said.

And the client is always in control, Wilson said.

“If they say, ‘Gosh, this is getting to be too much. I feel like crying,’ we’ll head back to the office at that time,” she said.

Outdoor distractions

Robert Erard’s counseling office in Bloomfield Hills, Mich. is located in a charming area full of 19th-century buildings. When the weather is nice, some clients — especially children — find it helpful to walk down by the old cider mill nearby.

“It seems to really help them open up,” said Erard, a counselor with the Psychological Institutes of Michigan. “Sometimes, patients who just don’t respond very well to the formality of the therapeutic settings seem to relax once they start walking around.”

Overall, Erard said, he’s open to the practice if patients are uncomfortable with being in an office, but said it raises significant privacy and boundary issues.

Most walk and talk therapists have their clients sign waivers that say they understand the risks associated with having a therapy session outside, but Erard said that doesn’t cover everything. People could still run into somebody they didn’t expect to see, such as a family member or a boss. If that person is within earshot, it’s possible they could do something inappropriate with the information, he said.

Wilson’s clients sign a waiver, but she said she and her clients don’t stand out on the River Trail, where lots of people already are running side by side with friends talking about their problems.

“There’s not a sign above our heads that says, ‘Currently in a counseling session,’” Wilson said. “It isn’t obvious. It just isn’t.”

Likewise, Steele, of Thrive Bend, said clients can choose whether or not a situation is uncomfortable.

If they run into someone they know, she suggests clients say, “‘This is Katie. I’m going to keep going,’” she said. “It’s not like you have to stop and explain and give a bunch of information about what is happening.”

OHSU’s Freeman questions whether walking provides the right conditions for effective psychotherapy, which is intense and requires focus.

“I think that there’s a lot to distract you when you’re outside,” she said. “I think that looking at the person and them having your complete interest and attention is part of what the healing process is about. It’s the one time they don’t have to be anything, do anything to be accepted, to get support.”

It’s not that Freeman doesn’t believe in exercise. In fact, in her 30 years of practice, exercise is the one thing whose list of known benefits just keeps growing longer as research progresses. She said she’d love to walk with her patients who have severe depression and health problems like diabetes, but that would be to help with a separate behavioral issue, such as a fear of exercise, rather than psychotherapy.

Erard said he’s also concerned about clients’ ability to get walk and talk sessions covered by insurance companies, which use codes for whether the session happened in a hospital or a home, for example. He said it’s unclear whether there’s currently a definition that fits walking around.

There’s also the issue of maintaining professional boundaries between a therapist and his or her client, which may be more difficult when they’re outside walking together, Erard said.

But Steele said she likes how walk and talk therapy offsets the power imbalance between a therapist and client. After all, the client knows more about his or her life than anyone.

“I’m a tool who can help them on that journey to get to their best them, but they know what they need,” she said. “I’m here to help them with that.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com