Beyond the Therapy Room: Nature, Safety and Mental Health

As a psychodynamic psychotherapist and counsellor, I currently see most of my clients in consulting rooms in Milan’s Porta Romana area, as well as international students at Bocconi University and IES Abroad Milano. But during my last years working in the psychotherapy department of the National Health Service (NHS) in Bristol, UK, part of my work took place outdoors. I was working with people for whom, for specific clinical reasons such as complex trauma, a conventional indoor therapy room was not always accessible or appropriate.

What I noticed then has stayed with me. For some people, the outdoors felt safer and less restrictive than four walls and a closed door. There was more space, more autonomy, and a different sense of psychological safety. For some, that difference made therapy possible at all.

“Nature is good for you” has become a wellness slogan. The research behind it is more specific, and more interesting, than the slogan suggests.

What the Research Is Finding

1. How Much Nature Is Enough?

The most cited figure comes from a study of 19,806 adults in England, published in Scientific Reports in 2019. White and colleagues found that people who spent at least 120 minutes a week in natural environments were significantly more likely to report good health and high wellbeing than those who spent none. It did not matter whether the two hours came in one visit or several. The data are self-reported and observational, so they show an association rather than proof of cause.

Source: Scientific Reports (2019)

2. What Happens in the Mind

Why would it work? One clue comes from Stanford. In a 2015 study in PNAS, Bratman and colleagues found that a 90-minute walk in a natural setting, unlike the same walk along an urban road, reduced rumination (the repetitive, self-focused negative thinking linked to depression) and activity in a brain region associated with it.

Source: Proceedings of the National Academy of Sciences (2015)

3. Healing Beyond Formal Therapy

Contact with nature can support healing through many kinds of activity, not only psychotherapy. A 2021 systematic review and meta-analysis of 50 studies in SSM – Population Health (Coventry et al.) found that structured outdoor activities, including gardening, green exercise and nature-based therapies such as forest bathing, improved mood and reduced anxiety in adults, including people with existing mental health problems. The most effective programmes ran for 8 to 12 weeks, with sessions of 20 to 90 minutes.

Water is part of the picture too. Reporting for The Guardian in July 2026, Tamara Davison describes the rise of “blue-space” therapy: sailing programmes for veterans living with trauma, surf therapy for people recovering from addiction, even freediving. According to the co-founder of one surf therapy programme, the number of such schemes worldwide has grown from around 50 in 2022 to more than 100. The geographer Catherine Kelly, quoted in the piece, adds a useful caution: research on blue space is only now being funded, because for years attention went to green space.

In Italy, the National Research Council (CNR) and the Club Alpino Italiano have published Terapia Forestale, which reviews three decades of international evidence and reports on structured forest sessions led by professional psychologists.

Source: SSM – Population Health (2021); The Guardian (2026); CNR – Club Alpino Italiano (2020)

Expert Opinion: When the Room Is Too Much

The therapeutic setting is never neutral. A small room and a closed door reassure most people; for someone who has experienced trauma, or lives with intense anxiety or depression, the same frame can at times feel overwhelming. Winnicott wrote about the “holding environment”: the conditions that allow a person to feel safe enough to be themselves. For most clients, the consulting room provides it. For some, at some moments, it does not.

Research on outdoor therapy reflects what I saw in practice. A 2020 meta-synthesis in Clinical Psychology Review (Cooley and colleagues) brought together 38 studies involving 322 practitioners and 163 clients. Both groups described a greater sense of mutuality, a reduced power imbalance between therapist and client, more freedom of expression, and the benefit of moving the body while talking. The same shift comes up in the blue-space programmes described by The Guardian: in wetsuits, one surf therapy co-founder says, clients “get to see me more as a human walking alongside them on this journey, versus telling them what to do.” The same review is honest about the limits: confidentiality in public spaces, unpredictable weather, and the difficulty of holding therapeutic boundaries all need careful thought, and practitioners managed them through individual assessment, informed consent and clear agreements.

Outdoor work is not a better setting for everyone; it is a different one, suited to some people at some moments. What interests me most is the broader idea behind it: that natural environments can offer a context in which emotional regulation, a sense of connection and belonging become more available, and in which rumination loosens its grip enough for a different kind of thinking to begin. Nature does not resolve what lies underneath. It can make it easier to approach.

For this reason, in Milan I am able to offer outdoor therapy when, following an initial discussion, the clinical rationale and practical considerations make this an appropriate setting.

What Institutions Are Saying

The World Health Organization’s European office reviewed the evidence in Urban green spaces and health (2016). It concluded that parks and residential greenery can support mental and physical health through stress relief, social cohesion and physical activity, and by reducing exposure to pollution, noise and heat. As the European Environment Agency notes, WHO recommends that everyone live within 300 metres of a green space.

Access is not equal. The same EEA briefing (2022) shows that cities in southern and eastern Europe tend to have less green space than those in the north and west, and that poorer neighbourhoods generally have less of it, and of lower quality. Globally, UN Sustainable Development Goal target 11.7 commits countries to universal access to safe, inclusive green and public spaces by 2030. (For European data on depression and for green space in Italian cities, see the FAQ below.)

Source: WHO Regional Office for Europe (2016); European Environment Agency (2022); United Nations

What This Means for You

1. Small, Regular Doses Count

You do not need a forest or a coastline. The research includes city parks, and around two hours a week, even split into shorter visits, is associated with better wellbeing.

2. Notice Where You Feel Safe

If a conventional setting has ever felt like too much, that is not a failure on your part. It is information, and it is worth taking seriously, including when you look for support.

3. Know Where the Line Is

Time in nature complements care; it does not replace it. If what you are carrying feels heavy, it deserves to be talked through with someone. If you are in acute crisis, contact emergency services: in Italy, call 112.

Our relationship with the natural world is not only a source of restoration. For a growing number of people, it is also a source of worry and grief. I explore that side, climate anxiety and the psychological weight of environmental change, in a companion article, Climate Anxiety: A Sane Response to a Real Threat. In the meantime, the free Ecopsychology and Climate Psychology Glossary, which I co-authored with a group of Italian mental health professionals, introduces key terms such as biophilia, eco-anxiety, solastalgia and outdoor therapy.

Frequently Asked Questions

What is outdoor therapy?

Outdoor therapy is talking therapy that takes place in natural spaces such as parks or woodland, rather than in a consulting room. A 2020 review of 38 studies found that clients and therapists often described a greater sense of equality, freedom and movement in these sessions.

Who can benefit from therapy outdoors?

It can help some people for whom an indoor room feels restrictive or overwhelming, including some people affected by trauma, anxiety or depression. It is not right for everyone, and its suitability should be assessed individually.

How much time in nature do you need to feel the benefits?

A 2019 study of nearly 20,000 adults in England found that people who spent at least 120 minutes a week in nature were more likely to report good health and wellbeing. The time could be split across several shorter visits.

Does a city park count as nature?

Yes. The research includes urban parks and green spaces, not only forests or countryside. The World Health Organization recommends that everyone live within 300 metres of a green space.

Can time in nature replace therapy?

No. Nature-based activities can improve mood and reduce anxiety, but they complement professional support rather than replace it when someone is struggling.

How common is depression in Europe?

According to Eurostat, 7.2% of people aged 15 and over in the EU reported chronic depression in the 12 months before the 2019 European Health Interview Survey: 8.7% of women and 5.5% of men.

How much green space do Italian cities have?

According to ISTAT’s Ambiente urbano report (data for 2024, published September 2026), provincial and metropolitan capitals had an average of 33.7 m² of urban green space per resident, up 5% since 2015. Twelve capitals, however, were still below the legal minimum of 9 m². Milan has been improving: an Openpolis analysis of ISTAT data shows it was the capital where the share of land covered by urban green grew most between 2011 and 2021, from 12% to 13.8%.

The First Step Is Just a Conversation

Finding the right setting for therapy, and the right person, is not always easy, particularly if you live far from home or would rather speak in a language other than Italian.

If you are in Milan, I see clients in person in Porta Romana. If you are in Puglia or Bari, or elsewhere in Italy, I work online. Whether you are an expat, an international, LGBTQIA+, or simply someone who thinks more clearly in English, I offer an initial consultation so we can see together whether working with me feels right.

You do not need a crisis to begin. We can start with a conversation.

Get in contact

Official Resources & References

Primary sources:

• WHO Regional Office for Europe: Urban green spaces and health — a review of evidence (2016)
• European Environment Agency: Who benefits from nature in cities? Social inequalities in access to urban green and blue spaces across Europe (2022)
• United Nations: Sustainable Development Goal 11, target 11.7
• Eurostat: Mental well-being and social support statistics (EHIS 2019)
• ISTAT: Ambiente urbano — Anno 2024 (September 2026)
• CNR – Club Alpino Italiano: Terapia Forestale (2020)

Supporting research:

• White et al.: Spending at least 120 minutes a week in nature is associated with good health and wellbeing — Scientific Reports (2019)
• Bratman et al.: Nature experience reduces rumination and subgenual prefrontal cortex activation — PNAS (2015)
• Coventry et al.: Nature-based outdoor activities for mental and physical health: systematic review and meta-analysis — SSM – Population Health (2021)
• Cooley et al.: ‘Into the Wild’: a meta-synthesis of talking therapy in natural outdoor spaces — Clinical Psychology Review (2020)
• Davison, T.: The rise of blue-space therapy: how the sea is helping people deal with trauma, anxiety and addiction — The Guardian (8 July 2026)
• Openpolis: La disponibilità di verde pubblico nelle città italiane (2023, ISTAT data)

Psychodynamic and relational perspectives:

• Winnicott, D. W. (1965). The Maturational Processes and the Facilitating Environment. London: Hogarth Press and the Institute of Psycho-Analysis.

Further reading:

• Gamba, C., Tecuta, L. (eds.), Danzi, A. et al.: Glossario di Ecopsicologia e Psicologia Climatica (2026) — free PDF, in Italian

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Antonio Danzi is a psychodynamic psychotherapist and counsellor trained at the Tavistock and Portman NHS Foundation Trust in London. He works in person in Milan (Porta Romana) and online across Italy and internationally, and is a registered member of the British Psychoanalytic Council and of AssoCounseling. Get in touch.