Like everyone, I’ve learned to go without a lot of things these past two years — group workouts, restaurant meals, grandparent visits without testing beforehand. I’ve held fast, however, to my weekly therapy sessions. Though I’ve been working with Eli, my therapist, for eight years, we haven’t seen each other, either in person or on a screen, since March 5, 2020. That’s because we’ve moved from in-person talk therapy to a practice I call “walk therapy” — a phone call while I amble through the nearest park along the same packed-dirt riverbank in sun or deep snow or chilly rain.
I didn’t intend for walk therapy to become a permanent practice. In the first weeks of the pandemic, suddenly at home with my spouse and two children, I just sought an escape, a place to speak freely about my growing panic over this new, strange situation.
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Eli had guided me through a lot in our previous work together: postpartum rage and despair; the peaks and valleys of parenting, partnership, and career; depression and the right medication to help lift me out of it. She helped me rebuild a version of myself when I felt effaced by marriage and motherhood. Our weekly in-person sessions brought me clarity and strength. By early 2020, we were talking more about my successes than about my frustrations and perceived failures.
When COVID struck, relationships that she and I had carefully examined suffered under new strain. The sense of self and independence I’d gained slipped. The atmosphere in my house felt full to bursting with fear and worry. I cried stormily and often, as I had in the early days of motherhood.
I can’t remember what we discussed during my first walk therapy session, but I do recall the bliss of leaving the pressure cooker where my home and work and family lives simmered uncomfortably together.
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As I unburden myself to Eli each week, I also free myself from my surroundings — I leave behind my computer and the distracting chimes of new messages. I don’t think, however fleetingly, about the laundry or the unemptied dishwasher. These sessions have helped me navigate one of the most trying times in my life.
Before the pandemic, neither Eli nor I would have predicted that this could work. Which is not to say that we have not both wondered what, if anything, is being lost. Our pre-pandemic sessions relied on physical proximity. In the confines of Eli’s office, she could observe my set jaw or crossed arms and address what my body language was saying that I wasn’t.
I once asked Eli what she thought we were missing by not meeting face to face. “The power dynamic has changed,” she said bluntly. “In my office, you’re on my turf. Now, I’m along on your walk, and you can start and stop the conversation.”
It’s true. Now I choose when it is time to talk about something hard, rather than allowing it to emerge at will or with Eli’s coaxing. This is a key issue in teletherapy, says Dr. John Markowitz, a professor of clinical psychiatry at Columbia University and lead author of “Psychotherapy at a Distance,” which appeared in the American Journal of Psychiatry in September 2020. Without the intense one-on-one dynamic of in-person therapy, Markowitz says, it’s far easier for patients to avoid confronting what’s really bothering them.
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“People are uncomfortable with closeness and often with strong feelings. And one of the things that’s probably effective about psychotherapy in an office is that you can’t escape, right?” he says. “And in fact, you can tolerate the intensity that tends to come with good therapy. Some of that gets diffused with any kind of teletherapy, and if you are avoidant to begin with, [teletherapy] is a good way to avoid a little further.”
As for the topics I might be avoiding or the insights that Eli might gain by seeing my face, she is philosophical; she doesn’t believe we can know what we might have been missing until our walk therapy is a memory.
She takes the ambient distractions that can interrupt our conversations in stride, too. Eli has joked that she’s going to use our experience to create a line of outerwear specifically designed for walk therapy. Perhaps, she says, she will make a playlist of the background noises — hammering construction, playground laughter, helicopter blades chopping the air above nearby hospitals — that come through my earbuds and sometimes drown out my voice as we talk.
So now that my children are back in their classrooms and quiet at home is restored, why have I continued to walk and talk with Eli? I could consider a return to in-person sessions or carve out a quiet hour on the couch at home for my remote therapy sessions. But now, the walk and what it represents are as much a part of the therapy as our conversation is.
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So in January, I bundled up. In July, I will apply sunscreen. And for the foreseeable future, I will continue to push myself out into the world and the fresh air and to move my body and examine the path that I still, two years later, find myself walking.
Jessica Ullian is a Boston-based writer and editor. Follow her on Twitter at @jessicau.