Forest4Youth Practice Guide

Welcome

Who is this for?

Choose the perspective that fits your current need. You can switch at any time using the toggle in the corner.

Exploring FBT

I'm exploring forest-based therapy

Plain-language information about what FBT is, how sessions work, and whether it might be useful for your situation or someone you care about.

Participant · carer · referrer · curious person
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Practising FBT

I'm a practitioner

Clinical reference, session tools, pocket guide to activities, indications and contraindications, integration with other modalities, and reflection prompts.

Therapist · facilitator · educator · researcher
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Welcome

What brings you here today?

Select a pathway to access resources tailored to your current need.

Learn More

Understand the theoretical basis of forest-based therapy, the evidence, and the key principles behind it.

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Implement in Practice

Session planning tools, a pocket guide to activities, pre/post checklists, and safety considerations.

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Reflect & Evaluate

Post-session reflection prompts, outcome tracking, and practitioner self-assessment tools.

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Clinical Reference

Indications, contraindications, population-specific guidance, dosage reference, and integration with other modalities.

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Companion Guide

The full Forest4Youth practitioner handbook. Theory, practice, clinical application, and professional context across 14 chapters.

Browse chapters →
Welcome

What would be helpful today?

Plain information about forest-based therapy — what it is, what a session looks like, whether it might fit your situation, and how to prepare.

What is FBT?

A plain explanation — what forest-based therapy is, what it isn't, and how it differs from forest bathing.

Read →

What happens in a session?

A walk through a typical 60–90 minute session — what your practitioner does, what you might feel.

See the timeline →

Is it for me?

Experience-based guidance — what the research suggests for situations like yours, and what a realistic engagement looks like.

Explore →

Before your first session

What to share with your practitioner, what's normal to feel, signs it may be helping, and questions you can ask.

Prepare →
Exploring

What forest-based therapy is

A plain-language introduction. No jargon — just what it is, what it isn't, and what it might do.

A plain definition
What it is
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Forest-based therapy (FBT) is a way of doing therapy where the forest is part of the work. A trained practitioner guides you through activities in a natural setting — walking, sitting, noticing, sometimes making something, sometimes talking. The forest isn't a backdrop. It's part of how the therapy works.

Not a replacement for clinical care

FBT is a therapeutic approach that can stand alone for some situations and complement other treatment for others. It is not a substitute for medication, crisis care, or treatment of serious clinical conditions. A good practitioner will be clear with you about what FBT can and can't do in your case.

Research behind this

Guided, not self-help

You are not being sent into the woods to figure things out. The practitioner holds a structure: they choose the site, the activity, the timing, and they stay with you through it. The structure is usually light — but it is there.

Not only for "outdoor people"

You don't need to be fit, experienced outdoors, or comfortable in nature for FBT to work. In fact, some of the best therapeutic material emerges from discomfort — the forest not feeling safe, getting cold, noticing resistance. Tell your practitioner honestly about your relationship with nature.

FBT vs. forest bathing
Often confused
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Forest bathing (shinrin-yoku)

A practice from Japan. Usually non-clinical, often in groups, focused on sensory immersion. Benefits are real but general — reduced stress, improved mood, lower blood pressure. There is no therapeutic contract, no clinical goal, no practitioner competency requirement.

Forest-based therapy

A clinical or therapeutic engagement. A trained practitioner works with you toward specific goals, often across several sessions. Activities are chosen for your situation. The relationship is structured: informed consent, confidentiality, supervision, evaluation.

Both are valuable — for different things

Forest bathing is an excellent preventive practice and wellbeing habit. FBT is a therapeutic intervention for a specific situation or goal. If you're looking for general wellbeing, forest bathing may be enough. If you're working through something specific, FBT is the right tool.

What the research suggests
In plain terms
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Stress and anxiety reduce

Across many studies, people who spend structured therapeutic time in forests show lower cortisol (a stress hormone), slower heart rates, and less self-reported anxiety than when equivalent work is done indoors. The effect isn't just "being outside" — structured attention matters.

Strong evidence

Attention and concentration improve

Natural environments restore a type of attention that gets depleted by screens, work, and urban life. After time in a forest, people perform better on tasks that require sustained focus — often for several hours afterward.

Strong evidence

Mood lifts, but gradually

For depression, FBT shows promising results but usually works best alongside other treatment. Expect gradual shifts across several sessions, not a single transformative experience. One session rarely changes anything lasting — a sequence of sessions can.

Moderate evidence

For young people, especially

Adolescents often engage more openly outdoors than in a consulting room. There's less pressure to make eye contact, less feeling of being examined. For many young people this lowers the threshold for meaningful therapeutic work.

Emerging evidence
Exploring

A typical session, phase by phase

Most sessions run 60 to 90 minutes and follow a rough structure. Your practitioner adjusts it for you — but the shape usually looks like this.

1
Arrival & grounding
10–15 min
What your practitioner might do
Welcome you at the site. Brief check-in — how you are, how the journey was, anything that changed since last contact. Walk with you for a few minutes at an easy pace. Help you orient to the place without an immediate agenda.
What you might feel
A bit awkward at first. Unsure what you're supposed to do. That's normal — the first ten minutes in any forest session tend to feel uncomfortable. Your body is still in "city mode". Give it time. By the end of this phase, most people notice their breathing has already slowed.
2
Core activity
30–45 min
What your practitioner might do
Introduce an activity chosen for your situation — sitting quietly in one spot, walking a defined route, making something from what you find, working with a specific tree, or something else. Explain it briefly, then step back. They stay close enough to be available but far enough to give you space.
What you might feel
Unexpected things often surface here. Boredom, restlessness, then a shift. Sometimes a memory or emotion you weren't expecting. Sometimes nothing dramatic — just a quieting. All of these are useful. You don't need to make something happen. Your practitioner will ask you about it afterwards.
3
Reflection & integration
10–15 min
What your practitioner might do
Sit with you somewhere quiet. Ask open questions: what did you notice, what surprised you, what stayed with you. They won't try to interpret everything — holding the space matters more than analysing it. They may make a brief note, with your knowledge, for continuity between sessions.
What you might feel
Sometimes words come easily here. Sometimes you'll feel that whatever happened resists being put into words — that's also information. You don't have to perform insight. Saying "I don't know yet what that was" is a complete answer.
4
Transition back
5–10 min
What your practitioner might do
Walk you back toward the edge of the site. Mark a clear end point — sometimes a small gesture, sometimes just standing still and breathing once together. Agree on the next step. Check whether you have a safe return journey.
What you might feel
A slight reluctance to leave is common and usually a good sign. You might feel unexpectedly tired afterwards — the session works through the body as well as the mind. Some people feel more present for hours or days after. Others feel things stirring up before they settle. Both are part of it.
Exploring

Is this for you?

These are experiences, not diagnoses. Pick whichever is closest to what you're living with. None of these say "yes, definitely" or "no, never" — they describe what FBT tends to look like in each situation.

Feeling anxious or overwhelmed
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What research shows
For generalised anxiety and chronic stress, forest-based therapy has some of the strongest evidence. Most people report meaningful reduction in anxiety symptoms within 4–6 sessions. The effect is not just psychological — measurable changes in the nervous system (heart rate variability, cortisol) occur alongside.
What a typical engagement looks like
Usually individual sessions, weekly or fortnightly, across 6–10 sessions. Early sessions emphasise grounding, breathing, and sensory attention — giving your nervous system a chance to settle before doing harder work. Later sessions often explore what feeds the anxiety and build tolerance for uncertainty.
Realistic expectations
You will probably feel some relief early — this is real but partial. Lasting change takes longer. Some sessions will feel more productive than others; that is normal. If you are currently taking medication for anxiety, FBT complements rather than replaces it. Tell your practitioner about any medication.
Exhaustion and disconnection
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What research shows
For burnout and exhaustion — the kind that doesn't lift after a weekend off — FBT has consistent results. The combination of reduced sensory load, sustained attention to something outside yourself, and permission to do very little in early sessions seems to be what helps.
What a typical engagement looks like
Individual sessions, slower pace. Early work often involves almost no activity — just being present in the forest. Resist the urge to make sessions productive. Over time, sessions may explore what led to the exhaustion and what a sustainable rhythm could look like.
Realistic expectations
Recovery from real burnout is slow. Expect months, not weeks. Sessions that feel "like nothing happened" are often the most useful ones early on. If you are still in the situation that caused the exhaustion, FBT can help but will not override chronic overwork.
Going through a big change
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What research shows
For life transitions — a relationship ending, a job change, a move, an identity shift, a new chapter of life — FBT is particularly well suited. The forest gives change a physical scale: thresholds, paths, clearings, seasons. Many people find it easier to work with change when it has somewhere to exist outside their own head.
What a typical engagement looks like
A shorter engagement is often enough — 4–8 sessions. Many practitioners use walking, threshold metaphors, and work with trees as a structural reference. The work is less about fixing something and more about orienting: where have I come from, where am I, where am I going.
Realistic expectations
Expect more clarity, not fewer difficult feelings. The transition itself will still be hard. What FBT can do is help you meet it more consciously, with less reactivity and more sense of where you stand.
My child is struggling
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What research shows
For young people — especially adolescents — FBT often works when indoor talking therapy hasn't. The outdoor setting reduces the pressure of being examined, the walking makes silence feel less awkward, and many young people find it easier to talk about difficult things side by side than face to face. Evidence is emerging but consistent.
What a typical engagement looks like
Individual or small-group work. Sessions often involve movement, making, or specific activities rather than long conversations. A practitioner working with a young person will communicate clearly with the carer about safeguarding, boundaries, and what can and cannot be shared.
Realistic expectations
Change in young people is often not linear — they may seem worse before they seem better, because sessions can bring feelings to the surface. Trust the practitioner's process. Resist the urge to ask your child for session updates — what stays private to the session is part of what makes it work.
Dealing with loss
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What research shows
For grief — especially once the acute phase has passed and you are beginning to rebuild — forests can offer something that rooms cannot: the visible presence of cycles. Decay as habitat. Seasons returning. Nothing of this removes loss. But many people find it easier to grieve in a setting that acknowledges, structurally, that endings are part of living systems.
What a typical engagement looks like
Individual sessions. Timing matters — if your loss is very recent and you are still in acute grief, a gentler setting may be better first. When ready, FBT often involves working with specific places or objects (a tree, a piece of dead wood, a path), walking as a way of holding difficult emotion, and space for silence.
Realistic expectations
Grief does not resolve — it metabolises. FBT does not make loss smaller. It can make it more bearable to carry, and it can help grief find a form. Sessions may bring waves of sadness; this is the work. Choose a practitioner with specific training in grief.
Exploring

Before your first session

A short guide for the first meeting — what to share, what is normal to feel, and what you can ask.

What to share with your practitioner
Practical information
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Your practitioner needs an accurate picture to make good decisions about the site, the activities, and the pace. Everything you share is confidential within the limits your practitioner explains at the start.

Allergies

Pollen, insect stings, plant contact, specific trees. Bring any medication you carry (antihistamines, epinephrine auto-injector). Tell your practitioner where to find it and how to use it.

Mobility and physical capacity

Walking distance, balance, joint issues, recent surgery, any condition affected by cold or heat. Be specific — your practitioner will choose a site and activity that fits.

Difficult experiences in nature

If you have had traumatic, frightening, or unsafe experiences in natural settings — being lost as a child, a serious accident outdoors, violence — say so. The forest is not neutral for everyone. Your practitioner can adapt.

Medications

Both psychiatric (antidepressants, anxiolytics, mood stabilisers, ADHD medication) and other medications, because some affect thermoregulation, alertness, or sun sensitivity. Bring a written list if you take several.

Clinical history

Previous or current mental health care. Diagnoses, if any. Past hospitalisations. Current treatment team. A responsible practitioner will want to coordinate, not work in isolation.

What's normal to feel
In the first sessions
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Resistance in the first ten minutes

A voice saying "this is silly" or "I don't see how this will help." Almost everyone experiences this. It usually fades once the body starts to settle. Name it if you want — it's useful material.

Unexpected emotion

Tears, unease, laughter, anger, or sudden memories of people or places. This is not a sign something is wrong. The forest setting bypasses some of the filters we use indoors. Your practitioner is not surprised by any of it.

Feeling exposed

Especially in groups, or if you are used to indoor therapy. A sense of being visible, awkward, or "not doing it right." Your practitioner will not be judging you against a correct version. There isn't one.

Fatigue afterwards

Sessions can leave you surprisingly tired. Plan gently after a session — not a meeting, not a difficult conversation. Hydrate. Rest if you can.

Signs it may be helping
What to watch for
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Between sessions, not just during

A session you barely remember can still have an effect. Watch what happens in the days between sessions — better sleep, less reactivity, noticing more, unexpected moments of ease.

Small, not dramatic

Progress rarely looks like a breakthrough. It looks like being slightly less snagged on something, responding instead of reacting, having a bit more room.

Noticing the forest outside sessions

Many people find themselves paying attention to trees, light, weather, small natural details in ordinary places. This is part of the work doing its job.

Things to bring back to your practitioner
Between sessions
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Anything that felt unsafe

Physical (the site, the weather, a moment you felt at risk) or emotional (a feeling that surprised you in a difficult way, something you couldn't place). Don't hold it until next session if it matters.

Things that emerged afterwards

Dreams, thoughts, emotions that came up days later. Often the most useful material comes hours or days after a session, not during it. A note in your phone is enough.

If something isn't working

A practitioner can only adjust what they know about. If the pace feels wrong, an activity didn't land, you want more or less structure — say so. This is not criticism; it is part of the work.

Questions you can ask at a first meeting
Eight starting points
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A good practitioner welcomes these questions. If any of them are brushed off, that is itself useful information.

  • What is your training specifically in forest-based therapy? How long have you been practising it?
  • Do you have clinical supervision for this work? With whom?
  • Given what I've shared, do you think FBT is the right approach for my situation — or might something else be a better fit?
  • What does a typical engagement with you look like? How many sessions, how often, how do we decide when to end?
  • How do you handle confidentiality — and what are the exceptions?
  • What happens if I'm in distress during or after a session?
  • How do you coordinate with other practitioners (GP, therapist, psychiatrist) if I'm working with them too?
  • What should I do if something isn't working, or if I want to stop?
Companion Guide

Forest-Based Therapy · Practitioner's Handbook

The companion guide to this tool. Where this tool gives you reference at a glance, the guide provides theoretical grounding, case material, and sustained discussion of each topic.

About this edition

This handbook is a working companion to the practitioner tool. It is written for clinicians, facilitators, and educators delivering forest-based therapy. It assumes baseline clinical training and builds FBT-specific competence from there.

108 pages · 14 chapters across 4 parts · Prototype edition · 2026

Open full PDF (link coming soon)
I
Foundations

Theoretical grounding, historical lineage, and the evidence base.

1
What forest-based therapy is pp. 3–10
Definitional boundaries. Distinguishing FBT from forest bathing, wilderness therapy, and general outdoor work. The therapeutic contract in a natural setting.
2
Theoretical foundations pp. 11–19
Attention Restoration Theory, Stress Recovery Theory, biophilia, phytoncides. What the mechanisms imply for practice.
3
Evidence base pp. 20–28
Synthesis of current research. Forest4Youth findings. What the evidence supports, what it doesn't, and where it's emerging.
II
Practice

The work itself — site selection, session structure, activities, and facilitation.

4
Site selection and safety pp. 29–36
Choosing a therapeutic site. Terrain, acoustic characteristics, seasonal considerations, accessibility. Risk assessment and emergency planning.
5
Session architecture pp. 37–44
Arrival, grounding, core activity, integration, transition. How each phase works, what it does, how to hold it.
6
Facilitating the core activities pp. 45–58
Notes on each of the 12 pocket-guide activities. What they do clinically, when to choose each, common variations and pitfalls.
7
Group and dyadic work pp. 59–64
Dispersion, holding attention across space, managing divergent responses, circle versus dispersed formats.
III
Clinical application

Working with specific presentations and populations.

8
Anxiety, burnout, and stress pp. 65–70
Primary indications. Session trajectories, activity pairings, common patterns in early and later sessions.
9
Depression and withdrawal pp. 71–75
Activation through natural environment. Assessment of motivation. Pairing with other treatment.
10
Working with adolescents pp. 76–82
Developmental considerations. Reducing the clinical gaze. Parent and carer communication. Safeguarding in outdoor contexts.
11
Grief and life transitions pp. 83–89
Nature-as-witness. Seasonal and decay metaphors. Timing relative to acute phase. Threshold structures.
12
Trauma: boundaries and adjunctive use pp. 90–96
When FBT supports trauma work and when it doesn't. Post-stabilisation integration. Managing activation in outdoor settings.
IV
Professional context

Ethics, supervision, and continuing development.

13
Ethics and informed consent pp. 97–102
Specific ethical considerations for outdoor therapy. Consent processes. Confidentiality in shared natural space. Scope of practice.
14
Supervision and practitioner development pp. 103–108
Why FBT supervision differs. Finding supervision. Self-reflection practices. Pathways for continuing development.
Reference

Clinical reference

Indications, contraindications, population-specific guidance, dosage framing, and integration with other modalities. Evidence-informed starting points — not protocols. Clinical judgement governs all applications.

Clinical indications
Three tiers · evidence level · recommended format
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Tier 1 · Primary indications — FBT may be first-line

Generalised anxiety and chronic stress Strong

Consistent effects on self-reported anxiety and autonomic markers (HRV, cortisol). Outdoor setting directly addresses sensory over-stimulation that commonly maintains anxiety.

Format: Individual, weekly or fortnightly, 6–10 sessions before reassessment.
Pocket guide activities: Sit spot, forest breathing, sensory mapping.
Combines with: CBT (behavioural experiments with graded exposure); somatic approaches for interoceptive work.
Guide ch. 8, pp. 65–70

Burnout and occupational exhaustion Strong

Particularly strong results where exhaustion is accompanied by depletion of directed attention. Low-demand early sessions that permit rest counter the productivity bias sustaining the condition.

Format: Individual, fortnightly, 8–12 sessions; longer timeframe than anxiety work.
Pocket guide activities: Sit spot, silent paired walk, weather dialogue.
Combines with: ACT for values clarification; narrative work on occupational identity.
Guide ch. 8, pp. 65–70

Mild-to-moderate depression (non-psychotic) Moderate

Evidence strongest for depression with behavioural withdrawal and anhedonia components. Movement through natural environments supports activation without the demand characteristic of structured exercise prescriptions.

Format: Individual, weekly, 8–12 sessions. Assess motivation for outdoor engagement before committing.
Pocket guide activities: Threshold walk, roots & branches, bark rubbing & texture journal.
Combines with: Behavioural activation; medication management; narrative therapy for meaning-making.
Guide ch. 9, pp. 71–75

Adolescent emotional and behavioural difficulties (non-acute) Moderate

Outdoor context lowers resistance typical of adolescent presentations: reduces face-to-face pressure, normalises movement and silence, side-by-side dialogue feels less clinical. Group formats leverage peer-relational dynamics.

Format: Individual or small group (4–6), weekly, 8–12 sessions. Parent/carer communication protocol agreed in advance.
Pocket guide activities: Threshold walk, tracking & noticing, forest mandala.
Combines with: CBT-adapted approaches; systemic family work; school liaison where indicated.
Guide ch. 10, pp. 76–82

Attention difficulties (ADHD profile) Emerging

Attention Restoration Theory predicts direct benefit; emerging evidence supports this for both adults and children. Particularly useful as adjunct to stimulant treatment for non-pharmacological skill development.

Format: Individual or group, shorter sessions (45–60 min), weekly, 6–10 sessions. Pharmacological treatment continues unchanged.
Pocket guide activities: Tracking & noticing, sit spot, forest breathing.
Combines with: Ongoing ADHD pharmacotherapy; executive function coaching.

Grief and bereavement (post-acute phase) Moderate

Not for acute grief. For post-acute grief work — typically 3+ months after loss — nature provides structural metaphors (cycles, decay as generative, seasons) that complement narrative reconstruction of the bereaved's relationship with the deceased.

Format: Individual, fortnightly, 6–10 sessions. Longer if complicated grief.
Pocket guide activities: Dead wood dialogue, threshold walk, tree council.
Combines with: Continuing-bonds frameworks; narrative therapy; meaning reconstruction approaches.
Guide ch. 11, pp. 83–89
Tier 2 · Adjunctive — FBT as complement to primary treatment

Trauma recovery (post-stabilisation only)

FBT may support integration work once trauma has been stabilised through trauma-specific approaches (EMDR, CPT, phased trauma therapy). Never a primary trauma treatment. Requires specific training in trauma-informed practice.

Required before use: Stabilisation phase complete; participant's window of tolerance mapped; trauma-informed practitioner competency; clear containment protocol if activation occurs outdoors.
Guide ch. 12, pp. 90–96

Attachment and relational work

Paired and small-group formats can surface relational patterns with less defensive structure than indoor settings. Silent paired walks, tree council work, and shared-task activities generate relational material.

Required before use: Formulation of relational difficulty; established therapeutic relationship; competence in working with enactments.

Identity and life-stage transitions

Strong fit for transitions where orientation rather than symptom reduction is the goal. Threshold metaphors, walking structures, and tree-as-structure work are directly generative. Less symptom burden usually means shorter engagements.

Required before use: Clinical formulation distinguishing transition work from underlying mood, anxiety, or personality disorder presentations.

Family and couples work

Outdoor setting disrupts entrenched interaction patterns. Activities requiring cooperation or shared attention externalise relational dynamics in ways that room-based work often cannot.

Required before use: Systemic/couples therapy training; clear contracting around confidentiality between partners; safeguarding screen (IPV, child protection).
Tier 3 · Specialist competency required — flags, not contraindications

Dissociative presentations

Natural environments can both ground and trigger dissociation. Outcomes depend critically on the practitioner's competence in working with dissociation, not on the setting. Without that competence, FBT is contraindicated for this presentation.

Complex PTSD with possible nature-related triggers

Trauma history involving nature (outdoor assault, disaster, childhood neglect involving being left outside) requires specific assessment. The forest is not neutral. Screen explicitly before proceeding.

Recent suicidal ideation (stabilised)

FBT is not contraindicated in recent (not current) suicidality if stabilisation is established. However, remote-setting risk considerations (access to means, phone signal, extraction time) require explicit planning and shared with the participant.

Severe personality disorder presentations

Particularly for presentations with intense transference/counter-transference dynamics. The informality of outdoor settings can blur frames in ways that destabilise therapeutic boundaries. Requires supervision specifically competent in this work.

Contraindications
Absolute · relative · competency-based
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Absolute — do not proceed without specialist consultation

Acute or recent psychosis

Active psychotic symptoms or psychosis within a period too recent for stability (judgement of treating team). Perceptual ambiguity of forest environments can compound symptoms. Specialist psychiatric consultation required before any consideration.

Active suicidal crisis without stabilisation

Current plan, intent, or recent attempt without adequate safety planning and clinical stabilisation. Outdoor setting complicates crisis response time and may introduce means. Crisis care takes precedence.

Severe untreated agoraphobia or specific nature-related phobia

Where the forest setting itself would constitute an untreated phobic exposure without gradient and without specific therapeutic framing. Phobia treatment with graded exposure must precede or be the explicit frame of the work.

Conditions requiring continuous clinical monitoring

Acute eating disorder below safe weight, brittle diabetes, unstable epilepsy, severe cardiac conditions, or any condition where the distance from emergency response exceeds safe intervention time.

Relative — protocol adaptation required

PTSD with possible nature triggers

Assess history before proceeding. Specific sensory modalities (certain sounds, light conditions, smells, enclosure/exposure) may trigger. Co-design the session with explicit trigger map and exit protocol.

Significant mobility impairment

Adapt site and activity selection. Accessible trails, reduced distance, stationary activities. Not a contraindication — an activity selection constraint. Consult with the participant on capability and preference.

Severe pollen or insect allergy

Seasonal scheduling, pharmacological management (antihistamines, epinephrine auto-injector accessible), site selection (avoid known allergen concentrations). Written protocol agreed with participant and practitioner.

Extreme thermoregulatory sensitivity

Certain medications, menopause, cardiovascular conditions, MS. Adjust clothing requirements, session length, time of day, seasonal timing. Not a barrier — a scheduling constraint.

Sensory processing profiles requiring modified sensory load

Autism spectrum profiles, post-concussion syndrome, migraine disorders. Choose sites by sensory characteristics (reduced acoustic variation, predictable light, known routes). Pre-session site briefing reduces startle load.

Practitioner competency contraindications

When clinical complexity exceeds practitioner training

If the presenting complexity exceeds the practitioner's clinical training, FBT is contraindicated for that practitioner with that participant — regardless of how well the indication fits the approach. Refer, consult, or decline. This is a matter of clinical responsibility, not of willingness.

When FBT-specific training is absent

Holding a clinical qualification without FBT-specific training is not sufficient for FBT practice. The setting introduces factors (safety, group dynamics outdoors, transference shifts in informal space) that require specific preparation.

Population-specific guidance
Developmental · situational · systemic
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Adolescents

Outdoor settings reduce the clinical gaze

Guide ch. 10, pp. 76–82
that many adolescents find intolerable indoors. Side-by-side dialogue (while walking, while working with bark, while making something) feels less confrontational than face-to-face. Peer-relational dynamics in group formats can be productively used but require active facilitation. Safeguarding considerations: clear contact protocols, supervision ratio, terrain safety, mobile phone policy, and explicit protocol for what is and is not shared with parents or carers. Parent/carer communication should be agreed with the young person at the outset and revisited.

Burnout

A recognisable trajectory:

Guide ch. 8, pp. 65–70
recognition of depletion → permission to rest without guilt → gradual reconnection with interest and capacity → reorientation toward a sustainable rhythm. Early sessions should demand almost nothing. Resist the participant's frequent wish to make sessions productive. The guilt response to stillness is the clinical material. Expect the engagement to be longer than for anxiety — burnout recovers on a slower timescale and cannot be compressed.

Bereavement

Timing matters. Acute grief

Guide ch. 11, pp. 83–89
(weeks to a few months) is usually better served by gentler, more contained settings; forest sessions at that stage can feel exposed. In post-acute grief, nature-as-witness framing is particularly generative: the forest does not try to console, does not look away, continues its own processes. Dead wood, seasonal change, and threshold metaphors offer structural support for mourning work. Build explicit closure protocols for sessions where grief activates strongly.

Groups

Group facilitation outdoors has distinct dynamics

Guide ch. 7, pp. 59–64
from individual work and from indoor groups. Dispersion (participants at different spots during an activity) requires attention-holding across space. Divergent responses in a shared setting — one person finding a quality of peace, another finding discomfort — are the norm, not a problem; manage them in the integration phase rather than suppressing them. Decide in advance between circle formats (tighter containment) and dispersed formats (greater autonomy, more complex facilitation). Ideal group size is usually 6–10, with clear sightlines.

Session dosage reference
Starting points · not protocols
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Evidence-informed starting points for session format, frequency, and minimum duration before reassessment. These are reference values, not prescriptions — clinical judgement, supervision, and the participant's response govern all decisions.

Condition
Format
Frequency
Before reassessment
Generalised anxiety / chronic stress
Individual
Weekly
6–10 sessions
Burnout / exhaustion
Individual
Fortnightly
8–12 sessions
Mild-to-moderate depression
Individual
Weekly
8–12 sessions
Adolescent difficulties (non-acute)
Individual or group (4–6)
Weekly
8–12 sessions
Attention difficulties (ADHD)
Individual or group
Weekly (shorter sessions)
6–10 sessions
Grief (post-acute)
Individual
Fortnightly
6–10 sessions
Life-stage transitions
Individual
Fortnightly
4–8 sessions
Trauma integration (post-stabilisation)
Individual
Weekly or fortnightly
Open-ended, reassess at 12
Couples / family work
Dyadic or family
Fortnightly
6–10 sessions

Session length 60–90 min is the common range. Shorter sessions are appropriate for ADHD work and some adolescent contexts. Longer sessions (up to 120 min) may be appropriate for specific group formats.

Integration with other modalities
Theoretical connection · in practice · pocket-guide pairings
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CBT — forest observations as behavioural experiments

Cognitive-behavioural work benefits from concrete contexts for testing predictions. The forest provides unpredictable, real-world material for behavioural experiments: predicting one's own response, testing avoidance patterns against actual tolerance, graded exposure to externally-imposed discomfort (cold, unfamiliar terrain, uncertainty).

Pairs with: sit spot, tracking & noticing, threshold walk.
Guide ch. 6, pp. 45–58

ACT — values clarification through nature metaphor

The forest offers rich metaphor for values work: what directions does this tree grow toward, what has it had to adapt around, where does it give way. Many ACT practitioners find values clarification substantially easier with a concrete referent than with abstract worksheets.

Pairs with: roots & branches, tree council, weather dialogue.
Guide ch. 6, pp. 45–58

Somatic and body-based approaches — interoceptive attention

Somatic work depends on sustained interoceptive attention, which is easily disrupted by indoor sensory saturation. The forest provides a lower-noise environment where subtle body signals become available. Movement becomes part of processing rather than an interruption of it.

Pairs with: forest breathing, bark rubbing & texture journal, silent paired walk.

Narrative therapy — externalisation and re-authoring

The threshold walk is a re-authoring structure in physical form — moving from one version of the story to another through a marked middle. Tree council externalises voices and positions. The forest provides spatial scaffolding for narrative moves that would otherwise be imagined.

Pairs with: threshold walk, tree council, sensory mapping.
Learn More

Understanding Forest-Based Therapy

A grounding in the theory, evidence base, and mechanisms behind FBT before entering practice.

What is FBT?
Foundations
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Definition

Forest-Based Therapy (FBT) is a structured therapeutic approach that uses natural forest environments as the primary setting for psychological and physical health interventions. It is distinct from recreational forest use — the therapeutic relationship, intentional framing, and evidence-based activities are central.

Distinction from Forest Bathing

Shinrin-yoku (forest bathing) is passive immersion. FBT is practitioner-guided, goal-oriented, and often combines somatic, creative, and relational elements within a clinical or semi-clinical framework.

Core mechanisms

Attention Restoration Theory (ART), Stress Recovery Theory (SRT), biophilia hypothesis, and the role of phytoncides and reduced cortisol load in forest environments.

Kaplan & Kaplan, 1989 · Ulrich, 1983
Evidence Base
Research · F4Y Findings
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Mental health outcomes

FBT interventions show consistent reductions in anxiety, depression, and perceived stress across adolescent and adult populations, with moderate to strong effect sizes in controlled studies.

Kaleta et al., Frontiers in Psychology, 2025

Young people specifically

Adolescents show particular responsiveness to outdoor therapeutic contexts — lower resistance, greater emotional openness, and stronger peer-relational effects compared to indoor settings.

Limitations to acknowledge

Heterogeneous protocols, varying session lengths, and limited RCT data make direct comparison difficult. Practitioner competency and environmental quality are strong moderators.

Contraindications
Safety & Ethics
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Clinical contraindications

Acute psychosis, severe agoraphobia or nature-related phobias, recent suicidal crisis without stabilisation, and conditions requiring close clinical supervision should be carefully assessed before outdoor referral.

Environmental considerations

Severe allergies (pollen, insect), extreme weather sensitivity, or significant mobility limitations require protocol adaptation, not necessarily exclusion.

Ethical boundaries

FBT does not replace clinical treatment. Practitioners must define their role clearly — whether they are acting as guides, facilitators, or co-therapists — and work within their competency boundaries.

Implement in Practice

Session Tools & Activity Guides

Practical resources to plan, run, and reflect on forest-based sessions.

Pocketbook of Activities
5 thematic groups · session builder · run mode
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How to use this section

Activities are grouped under five themes that map onto the therapeutic arc: Getting There; Waking Up Your Senses; Discovering Yourself; Connecting with Others; and Coming Back to Yourself. Within each group, activities range from lower to higher demand. Select based on where the group is on a given day, not on where the session plan says they should be.

The principle of invitation rather than task applies throughout. No activity is mandatory, and a young person who watches rather than participates is participating.

Adapting activities for specific presentations

Suggested adjustments for the most common clinical pictures encountered in early sessions.

Pre-Session Checklist
Preparation
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Run through this before each session. Tap each item to mark it.

This checklist does not replace a full risk assessment for clinical settings.

Session Structure Guide
60–90 min format
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Opening (10–15 min)

Arrival and grounding. Brief check-in — physical and emotional. Orient participants to the space without agenda. Let the environment land before introducing any structure.

Core activity (30–45 min)

The main intervention — one of the pocket guide activities or a practitioner-designed protocol. Hold the frame lightly: nature often redirects sessions productively.

Integration (10–15 min)

Sitting debrief in the space. Open questions: what came up, what surprised, what stays. Avoid over-interpretation — hold space rather than analyse.

Transition out (5–10 min)

Conscious re-entry. Acknowledge the shift back to everyday space. A simple closing gesture (breath, touch of bark, naming one thing) supports psychological closure.

Reflect & Evaluate

Post-Session Reflection

Prompts and indicators to support practitioner reflection after each session.

Practitioner Self-Reflection
Post-session prompts
Structured questions to examine your own responses, the environment's role, and what to bring to supervision.
4 prompts
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1

What did you notice in yourself?

Were there moments you felt drawn to redirect, speed up, or fill silence? What does that tell you about your own relationship to the material or the environment?

2

What did the environment do?

Did anything in the natural space shift the session unexpectedly — weather, an animal, a sound? How did you and the participant respond? Was that response worked with or avoided?

3

What would you do differently?

Was the activity well-matched to the participant's state? Was the timing right? Where did the frame hold and where did it need flexibility?

4

What needs to be brought to supervision?

Note any countertransference, boundary moments, clinical concerns, or powerful projective material that emerged. FBT supervision should include the environmental dimension explicitly.

Observable Outcome Indicators
What to document
Non-standardised observational markers to note after each session. Use alongside formal assessment tools.
6 indicators
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Key Terms
Glossary
Core concepts from the theoretical foundations of forest-based therapy — ART, biophilia, phytoncides, and somatic awareness.
4 terms
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Attention Restoration Theory (ART)
Natural environments restore directed attention capacity by engaging involuntary fascination — the mind rests its effortful focus, reducing fatigue and improving cognitive function.
Biophilia
Wilson's hypothesis that humans have an innate affiliation with other living systems — the basis for why natural settings may uniquely support wellbeing.
Phytoncides
Volatile organic compounds released by trees, particularly conifers. Inhalation is associated with reduced cortisol, increased NK cell activity, and improved mood.
Somatic awareness
In FBT, attention to body sensation as a channel for emotional information — supported by the environmental context, which naturally directs attention outward and then back inward.
Sustained presence
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