There's no couch. In fact, there aren't even any chairs.

When Minneapolis therapist Tammie Rosenbloom meets her clients for a session, they go for a walk around a lake. If it's too cold out, they head into the downtown skyways or even a shopping mall.

Rosenbloom is among a small contingent of counselors who practice what they call "walk and talk therapy." Adding movement to traditional therapy, advocates say, is a catalyst for getting clients to talk more openly about their emotions. They also point out that walking releases endorphins, which can elevate moods, and that for some clients, a lake or a mall is less intimidating than an office setting.

"I was working with a guy who has Asperger's and he had a really difficult time with eye contact," Rosenbloom said. "He Googled me and said, 'I've never been able to go to a therapist and sit on the couch because it's so overwhelming to have to do the eye contact.' So we met [outside] and it was wonderful and it worked really well."

Some psychologists, however, see glaring privacy concerns with counseling clients in public and are concerned that such an informal setting blurs the line between client and therapist.

"Protecting a client's privacy is of paramount importance," said Christopher Vye, chairman of the University of St. Thomas's Graduate School of Professional Psychology. "It's an ethical duty of a therapist. And it's difficult to do outside of an office, particularly in a public, crowded environment."

Proponents like Rosenbloom acknowledge that walk and talk therapy isn't for everyone, but they say the benefits outweigh the concerns. And while she's one of the few such practitioners in the Twin Cities, the approach has been steadily growing on the coasts.

"It started out as an idea to set myself apart, but what I came to find out is it really was more effective," said Clay Cockrell, a New York City therapist who's often cited as a pioneer in the field. "A lot of people think better on their feet."

Wandering mind

Seven years ago, Cockrell started taking his sessions outside after his experiences with a busy Wall Street executive who struggled to keep his therapy appointments. To make it more convenient, Cockrell would meet the executive at a nearby park, strolling as they talked. Soon, Cockrell began offering walking appointments to other clients.

"It just kind of took over my practice," he said. "Everybody wanted to be outside."

Cockrell admits that the practice has inherent hazards: There's no way to guarantee that a client won't run into a familiar face or that others won't overhear the conversation. (His clients must sign a waiver acknowledging that they understand the risks.)

On the other side of the country, Megan Brown has offered walk and talk therapy sessions in Los Angeles since 2007, and has even written a book about it ("Walk and Talk Therapy: A Therapist's Guide"). A licensed family and marriage therapist, she takes her clients along a three-mile loop at the Rose Bowl arena.

Therapy can be intense, and Brown said she has had clients cry while walking. She carries tissues with her and if someone gets emotional while walking, she finds a place to stop and sit down for a bit. "It usually works out fine," she said. One client chose to wear sunglasses during her walking sessions just in case she became teary-eyed, Brown said.

When it comes to emotional expression, every client is different. Rosenbloom opened her business last summer, and has since learned that a person's pace can reveal how they're feeling. For instance, clients who are wound up will often walk faster.

"Sometimes I slow people down when they seem like they're getting anxious," she said.

Too close for comfort?

St. Thomas' Vye remains a skeptic about the practice, primarily because there has been no scholarly research on it.

"What I've noticed is that people extrapolate from very general research [findings] — such as walking as a form of physical exercise is associated with enhanced well-being," he said. "That's an idea that's supported in the research literature. But that doesn't necessarily translate into a counseling practice."

As an avid hiker and trail runner, he said he appreciates the idea that there are mental benefits from being active, especially in the outdoors. "Movement and exercise and how that relates to health is an active area of study," he said. "So it makes sense that people are starting to look at ideas about how to promote a mind-body connection in the context of psychotherapy."

Still, he said, the walk-talk approach also calls into question the psychotherapy relationship. Therapists and clients aren't friends, he explained.

"Professional boundaries are very important," he said, "and there can be enhanced risks of blurred boundaries if one works with clients outside of the office environment."

Walking therapists say they strive to maintain clear boundaries during their sessions. Rosenbloom said she would never walk to a coffee shop with a client for refreshments after the session. Cockrell is upfront about telling his clients that they are not hanging out — they are there to work.

That work goes on even after the walk is over, Rosenbloom said, but adding a walk to the traditional talk often leaves clients with a feeling of accomplishment.

"Even if they're feeling stuck, they've done something about it," she said. "They've gotten up and they've actually moved."

Allie Shah • 612-673-4488