The Journey of a Walking/Running Therapist2 Comments July 6, 2009 / Posted in Mindful Running
“SOLVITUR AMBULANDO: The problem will walk itself out.” ––Latin Proverb.
The Journey of a Running Therapist
A Sometimes Mindful Runner
©1997, 2009 Austin’Ozzie’ Gontang, Ph.D.
The issue will always be, “When was your last run?” Not what you did last month or last year or ten years ago. The sojourn, however, is often of interest to fellow travelers on the road of running and marathoning. What I have to share is only possible because others have allowed me to run and walk with them. During those walking/running moments together they shared their perspectives and I mine.
Those that came seeking a cure were only promised the one guarantee which I continue to make before we start: “When we finish, you’ll have burned 300 to 700 calories of energy. I don’t know how you’ll feel, but I know you’ll be able to tell me what your thinking body feels. And even if you can’t put it into words, those feelings are yours and no one can take them away from you. Some of the feelings that you don’t want, we can leave out ‘there’ on our walk. And any time you want to get them back, they’ll be there waiting at whichever spot we decide to deposit them.”
Here are some general questions asked by a writer doing an article on walking and running therapy and my answers. You can interchange running with walking as it was for a walking magazine article.
1. How long have you been walking with your clients and how did you start to do so?
In 1974, Dr. Tad Kostrubala, MD, the chief of Psychiatry at Mercy Hospital in San Diego orchestrated a research study with graduate students and faculty of the Rehabilitation Counseling Department at San Diego State University. It measured the psychological and physiological benefits of endurance exercise i.e. running. Using target heart rates which were determined by an extensive physical work up and an exercise stress test using a bicycle ergometer, approximately 20 of us started a walk/jog program for an hour followed by an hour of group therapy. This regimen was carried out 3 times a week from October 1974 to May 1975.
From 1975 until 1980, I worked and studied under Dr. Kostrubala. I was the first individual he trained as a “Running Therapist.” I would walk and run with individual patients of his and also conducted several therapy groups based on the model of walk/run an hour followed by an hour of group therapy. In 1976, he wrote the book The Joy of Running, in which he described the Running Therapist. From the very beginning, individual patients had the choice of doing therapy sitting, walking or running. The people who participated in the group therapy knew that they would be involved in an hour of walking/running followed by the hour of group therapy.
Over the past 30+ years, I would say that 75% of the people I have seen for therapy have chosen to walk or run as we explore the issues confronting them. Nearly all of those individuals who chose to do therapy on the move started by walking and talking. I would say that close to half of those who walked with me at the start chose to remain walkers and for many reasons were not interested in running.
2. What is it about walking that you feel is effective in therapy. Basically, how does it work?
With people who suffer from depression or other job, family or psychological stressors, walking has all the following physiological benefits:
o Reduced heart rate
o Resting blood pressure reduced
o Reduced potential for platelet obstruction
o Increased muscle metabolic capacity & enzyme activities
o Increased lipid utilization
o Increased HDL
o Decreased LDL/HDL Ratio
o Increased insulin receptor sensitivity and glucose tolerance
o Reduced depression/anxiety/tension
o Increased feelings of well-being
o Improved control of daily stressors
o Higher tolerance to daily stressors
o Improved self-image
o Increased sense of vigor.
3. How does it work?
1. The therapist and patient are doing something together. They are moving in the same direction. They are looking in the same direction. Anxiety, blocked thoughts give way as the adrenaline is metabolized through exercise.
2. The dialogue while walking with the therapist often are recalled while the patient is walking alone or with others. The Walking Therapist is trained to pick up verbal and non-verbal cues during the walking session. e.g. an increase in pace as the patient talks about an emotional issue; change in the breathing pattern; postural changes.
3. The physical feelings of exercise, exertion and discomfort are experienced. Often these people have shut down and are completely out of touch or lack any awareness of their feelings.
4. The therapist may see the patient only once a week but the contract is for the patient to walk at least two and preferably 3 or 4 more times during the week. This can be done alone at least one of those times but again preferably with a friend or some walking group that meets regularly.
5. The experience of two people going for a walk and discussing/talking about personal issues. The experience of doing something that is non-threatening, total involvement of mind and body.
6. The use of the environment to enhance or reinforce a point: Walking next to the vastness of the ocean, hearing its power, knowing it has been there for millions of years, the metaphor of the waves like breath or feelings, they come and they go. There’s silence, there’s the crashing sounds of waves breaking, ebb and flow, ebb and flow. As far as the eye can see, the vastness of ocean. Even doing the same walk each week, one sees all the changes due to the weather, it’s the same but it’s different. Through parks, through wooded areas, through canyons, through desert, through a mall. All these visual, aural and often olfactory experiences help one remember that one is experiencing life, their own life. It brings people into the present as one becomes a part of nature or one in a sea of shopping humans and not just a passive observer sitting in a chair
7. The therapist is not doing something to you. He’s not fixing you or treating you. He is sharing time and space. He is sharing an experience. He is active in helping the patient alter perceptions, look at life differently, experience thoughts through a different filter, a different view, or the same view from a different vantage point.
8. Should the therapist and patient meet someone known by either of them, they may stop and say hello or say hello as they continue on their way. They are introduced as friends if they stop. If they continue past, it is two people, two friends, two acquaintances out for a stroll and some conversation.
9. The therapist is a role model. He/She gets the patient back into life, back into relationships, back into experiencing the present, back into observing and quieting the mind as it observes what is.
10. Even if the patient is verbally and mentally locked in the thought of not being able to go on, by the time they have finished, even should the thought remain; they have gone on for 2 to 5 miles. I once walked with a patient who had attempted suicide. We walked around Mission Bay, a distance of 8 miles. For five of those miles, the patient and I chanted in mantra style, “I can’t go on! I can’t go on?” We stopped four or five times to deal with the tears and emotions but we covered the distance. We acknowledged his feelings of not being able to go on and even verbalized those feelings and thoughts. When we reached our starting point on the circular route, I pointed out the path we had taken proved that his feelings of not being able to go on were not physically true.
11. One becomes resocialized in the process of walking and talking with the therapist.
12. Walking Therapists often become extremely good coaches in walking form and style. They can assist the patient in feeling balanced and centered. They can teach the patient how to walk gracefully. The therapist makes sure she never takes their old style away. She just shows them the difference between their style and another style. She assists them in discriminating the fine differences and allows them to experience both. The metaphor of going from old style walking to new, often helps overcome the fear of change.
Yes, I have seen many people recover from their depression, their anxiety, their confusion, their problems as we walked and talked. Critics years ago said that it was the walking or running and not the therapy that was the secret of this form of therapy. Another criticism leveled back in the late seventies was that Kostrubala and the therapists he trained were excellent therapists and used walking and running as a hook to hang onto people.
In 30+ years I have walked with a good number of people who were mildly to severely depressed or suffered from other psychological problems. All I know is that they get better. Is it the walking? Is it the therapist? Is it a combination of the two? Is it just the passage of time? People who return months or years later after we have finished our therapeutic journey do so to check in and to problem solve so they won’t regress back to where they once were. A large percentage of those who I see again for another bout of depression or other psychological problems have stopped walking, running, stopped exercising and have stopped taking control of their lives.
The metamessage is: “Only you can take the first step. No one can take it for you. The therapist is there to help you take the first steps, but it will always be you taking the next step. Or deciding not to take the step.”
5. Walking vs. Walking Therapy vs. other forms of aerobic and non-aerobic therapy
Walking Therapy teaches patients to take care of themselves physically while dealing with issues or problems surrounding their mental health. While there are beneficial side effects from other exercise therapies, my experience is that the individual needs someone as a reality check. It is that dialogue coupled with the exercise which, I believe, increases the chances of a quicker therapeutic healing. Patients must accept more responsibility in their therapy. They also take a more active role in their own improvement. Walking is a tool by which patients can self-regulate to control depression. This process of walking can help generalize beyond the therapy session which has been a problem in traditional therapy.
One of the benefits of walking therapy is that the therapist benefits at the same time. Such an approach such as walking therapy may help therapists reduce their own burnout and job-related psychopathology.
Today with customer service a big issue, walking therapy is a healthy outlet for the therapist’s often chaotic and hectic schedule. What better way to take care of your customer/patient while actively and responsibly being a role model of mental and physical fitness. If you decide to sit in a therapy session, my fees are $175 an hour as opposed to $150 an hour for a therapy session while we walk. As we have so often heard: “Walk Your Talk!”
6. Other psychologists who walk with their clients.
Psychologist Ray Fowler, former CEO of the American Psychological Association. Mark Shipman, MD psychiatrist, who died several years ago, was medical director of the San Diego Center for Children for 30 years. Mark has done some extremely good research on the benefits of walking and running (especially running) on emotionally disturbed children. It greatly lowered or did away with the need for medications. Rosalie Chapman, Ph.D., adjunct professor of Psychiatry, UCSD had walked with many of her patients. Jim Hornsby who has conducted running groups for recovering alcoholics. Isaac McLemore, LCSW has conducted walking and running groups for polydrug users and recovering alcoholics. Ron Lawrence, MD founder of the American Medical Athletics Association (formerly the American Medical Joggers Association). John Griest, MD. psychiatrist. John was one of the early researchers back in the late 70’s who did research on the effects of running on depression. Again, all of these individuals used walking and running with their patients or groups. All of us have been or were involved for years in marathoning. That’s another article for you.
7. FITNESS FORMULA (Physical)
o Frequency (F) = 4X/Week minimum
o Intensity (I) = Comfortable (best pace to become fit)
o Time (T) = 30 minutes of muscular activity. Sixty minutes preferred.
Mode: Use large muscle groups: Walking, Swimming, Cycling, Jogging Dancing, Racquet Sports, Body Machines
Some observations of George Sheehan about the Fitness Formula:
o Normal aging occurs at approx. 5%/decade.
o Gender is not a factor in determining results
o Terms needing to be changed to reflect these concepts:
i) Physical work capacity NOT Max. oxygen uptake
ii) Aerobic metabolism NOT Aerobic Exercise
iii) Muscular endurance NOT cardiopulmonary endurance
iv) Perceived exertion NOT target heart rate.
The key to starting a fitness program is to find your play. Find a place and people with whom to play.
Some advantages are:
o Accountability in psychotherapy can be more carefully monitored
o Easily learned and no special skills or coordination required.
o Health benefits reinforce the physician’s motto: “Do No Harm.”
o Increased cardiovascular endurance,
o Increased respiratory efficiency
o Improved muscle tone, digestion, and blood volume
o Increased fat loss
o Increased energy
o Decreased anxiety
o Improved sleep
o Enhanced body awareness and image
o Greater sense of well-being
In closing some of the best running and walking therapists who I have met, don’t even know they are running and walking therapists. We simply call them: my running group, my walking partner, my running buddy, the Saturday morning bunch. These therapists have walked and/or run sometimes hundreds or thousands of miles with you…and you trust your souls to each other. And in that trust you and they have healed each other and other fellow travelers many times over…and more often than not, never even knew it.