PERSPECTIVES

Climate Change for Clinicians

Gioia Jacobson, MA

There is growing awareness in the popular culture of both climate change and its impacts on mental health. Two out of three Americans (66%) report they are “somewhat worried” about global warming, and 30% are “very worried,” a nearly threefold increase since 2014 (Leiserowitz et al., 2019).

In 2020, it is now possible to enroll in an undergraduate course on Environmental Grief and Anxiety: Building Hope in the Age of Climate Consequences. The Good Grief Network, established in 2016, exists as a support group to address climate anxiety. Mainstream media, including miniseries and music, have also begun to normalize the issue of climate anxiety for a broad audience. A 2017 report from the American Psychological Association (APA) entitled Mental Health and Our Changing Climate: Impacts, Implications, and Guidance highlights psychological responses to climate change, including tendencies toward “conflict avoidance, fatalism, fear, helplessness, and resignation” (Clayton, Manning, Krygsman, & Speiser, 2017, p. 4).

Certainly, it is completely natural and normal to want to withdraw from a potential stressor in order to avoid overwhelming fear, hopelessness, and despair. This reluctance can be understood compassionately from a clinical perspective. It can perhaps be understood as ambivalence from a motivational interviewing perspective. It can perhaps be understood as a lack of willingness to admit that there is a problem from a 12-step perspective. It can perhaps be understood as dissociation from a trauma perspective, or denial as a stage of grief in the Kübler-Ross model (2014).

In their APA report, Clayton et al. (2017) recognized health professionals as being “uniquely positioned to foster new levels of support for climate solutions” and urged clinicians to consider their abilities to

Become a mental health-related climate-literate professional
Engage fellow public and mental health professionals
Be vocal, model leaders within your communities
Support national and international climate-mental health solutions (p. 8)

I am not a climate scientist—but as a mental health professional, I am called and charged with becoming climate literate and practicing with that literacy in mind. As a marriage and family therapist (MFT) specifically, my scope of practice is relational. It became important to me to understand how this profession could serve the mounting impact of climate change in that capacity. Certainly, I am qualified to address anxiety, but what about addressing the underlying issues? What about looking at this crisis systemically? I was challenged to think about which elements of a relational dynamic are present between myself and nature; an entity which I cannot communicate with in the traditional sense of that word. Ecopsychology provides a perspective from which I feel equipped to approach this pertinent question, as well as a viable way into addressing climate change as an MFT.

The APA (2020) gives the following definition of ecopsychology:
Ecopsychology explores humans’ psychological interdependence with the rest of nature and the implications for identity, health, and well-being. Ecopsychology topics include emotional responses to nature; the impacts of environmental issues, such as natural disasters and global climate change; and the transpersonal dimensions of environmental identity and concern.

Research and practice examples:

Integrating outdoor activities into therapy
Preventing burnout and despair regarding environmental issues
Understanding transcendent experiences in nature

From a more theoretical perspective, Theodore Roszak, noted scholar who coined the term ecopsychology, said:
If ecopsychology has anything to add to the Socratic-Freudian project of self-knowledge, it is to remind us of what our ancestors took to be common knowledge: there is more to know about the self, or rather more self to know, than our personal history reveals. (2001, p. 319)

It may seem somewhat radical to think of relationship to nature as being one of our primary relationships, or of the broader context of the natural world being intimately tied to our personal context—but one only needs to take in the next breath to be met with a visceral understanding of this relationship and its primacy. In the words of Carolyn Raffensperger, Executive Director of the Science and Environmental Health Network:

We have thought about disease and healing as completely separate from the natural world. . . . [But] our bodies are not a boundary that excludes the natural world. Every time I take in a breath, I am engaged in a process with the tree outside my window. Every inhalation of mine is an exhalation of the tree, and every exhalation of mine is an inhalation of that tree. (as cited in Scully, 2004, p. 72)

Marriage and family therapy as a field has acknowledged the intrinsic importance of the family system and the way in which the connection to nuclear family profoundly impacts the individual. Ecopsychology asks for an expansion of systemic thinking to include the ecosystem as a meaningful system, which impacts the individual and within which the individual is housed.

Today, around 55% of the human population lives in urban areas, and that number is only expected to increase—to almost 70% by the year 2050 (United Nations, 2019). It is clear that anxiety disorders and depression are positively correlated with living in cities and urban environments, and that, conversely, contact with nature and green spaces, is linked with improved mental and physical health (Keniger, Gaston, Irvine, & Fuller, 2013; Maas et al., 2009; Shanahan, Fuller, Bush, Lin, & Gaston, 2015). Twenty or thirty years ago, this lack of proximity or contact may have constituted the heart of the conversation. Today, the issue, or rather, the relationship, has become somewhat more complex and dynamic as climate change, climate thresholds, and resulting climate fear come into play. The data suggest a distant and dysfunctional relationship, with significant problems and stressors involved. Damage has been done and trauma sustained. From a therapeutic perspective, neither guilt nor denial in and of themselves are likely to improve the relationship moving forward.

Rupture and repair are a vital dynamic to grasp within the context of healthy relationships, and individual and collective relationships to climate change are no exception. As Zach Brittle, a certified Gottman therapist put it, “In Dr. Gottman’s research, the consistent failure of repair attempts is a sign of an unhappy future.” To take the metaphor one step further and apply it to current apocalyptic fears, he indicated that a relationship “can survive The Four Horsemen of the Apocalypse, but only if partners learn to repair effectively” (Brittle, 2014). The executive summary of the 2017 APA (Clayton et al., 2017) report also speaks to some of the reparative actions that can be taken and indicate that the feedback loop of individual well-being and climate engagement holds true on a larger scale as well. The authors stated:

Climate solutions are available now, are widespread, and support psychological health. Increasing adoption of active commuting, public transportation, green spaces, and clean energy are all solutions that people can choose to support and integrate into their daily lives. These climate solutions, among others, can help to curb the stress, anxiety, and other mental illnesses incurred from the decline of economies, infrastructure, and social identity that comes from damage to the climate. (p. 7)

Similarly, they note that “individuals who have higher perceived environmental self-efficacy, or the sense of being able to positively contribute, are more motivated to act on climate solutions (Clayton et al., 2017). The executive summary of this report concludes with the following recommendations for individuals:

Build belief in one’s own resilience
Foster optimism
Cultivate active coping and self-regulation skills
Maintain practices that help to provide a sense of meaning
Promote connectedness to family, place, culture, and community. (Clayton, 2017, p.7)

If we, too, are nature, and can positively impact our resiliency reciprocally, then this list represents a very practical way forward toward addressing mental health concerns around climate change as well as impacting some of the underlying factors contributing to climate change. Viewed this way, the conversation becomes a broader one about the strengths and supports we have, internally and externally, which allow us to adapt well and maintain our resilience. The following are some of the ways in which ecotherapy, and development of a more functional or more connected relationship with nature, might be supportive of these goals:

Positive mental health effects can be seen as a result of viewing nature, sitting in nature, walking in nature, and even conservation-based activities (Keniger et al., 2013)
Small changes, or even simply witnessing or observing nature can improve an individual’s sense of well-being. This could mean planting a tree or spending more time at a nearby park (Shanahan et al., 2015)
Exposure to nature is correlated to reduced depression (Maas et al., 2009) as well as reduced psychological and physiological stress (Keniger et al., 2013)
Experiences that generate an appreciation of and connection with nature are likely to be the most beneficial for psychological well-being (Wolsko & Lindberg, 2013)

In spite of these clear benefits, clinicians have historically been hesitant to bring nature-based or nature-facilitated techniques into practice. When researchers Wolsko & Hoyt (2012) polled 231 mental health practitioners, they found that only 26% of the sample could recall learning anything about the influence of the physical environment on mental health during their graduate education. Almost one-third (29.5%) of respondents reported that they thought nature-facilitated techniques would be ineffective or irrelevant to the healing process. Conversely, nearly half (48.5%) of practitioners indicated that they intentionally used a nature-themed environmental logo to advertise their businesses. Admittedly, there are some ethical considerations to be faced when thinking about the possibility of taking the confidential therapeutic dyad outdoors. On the other hand, bringing nature into the consulting room seems extraordinarily possible. Implementing ecopsychological interventions in practice might look many ways, but without ever stepping foot outside one could consider:

Exploring an individual’s existing relationship to nature—including both beneficial and strained aspects of that relationship
Making metaphorical connections to natural elements, particularly those which exemplify resiliency
Increasing levels of contact with natural world (Keniger et al., 2013)
Improving sense of efficacy via participating in conservancy measures, such as clicking to save the rainforest daily for free via websites such as www.greatergood.com
Assigning ecotherapy related homework if indicated, such as forest bathing, planting a tree, gardening, community gardening, or meditating outdoors
Bibliotherapy assignments of texts which normalize and address eco-grief themes

That being said, the single most impactful change to the therapeutic landscape may be the shift in a therapist’s perspective, which allows observation and contextualization of an individual’s relationship to nature as a vital part of that person’s mental health. All signs point to connectedness, a central element of strong relationships, as being key to finding a way forward that includes both healthy people and a healthy planet. It is my hope that, as MFTs, we can utilize our expertise with this familiar and central goal of our work to address the current climate crisis in an effective and meaningful way.

Gioia Jacobson, MA, LMFT, is an AAMFT Clinical Fellow, a clinician in private practice, and serves as director of research in the MA Counseling Program at Pacifica Graduate Institute.

REFERENCES

American Psychological Association. (2020). Ecopsychology. APA division 34: Society for environmental, population and conservation psychology. Retrieved from http://www.apadivisions.org/division-34/interests/ecopsychology/index.aspx

Brittle, Z. (2014, September 3). R is for repair. The Gottman Institute: A research-based approach to relationships. Retrieved from https://www.gottman.com/blog/r-is-for-repair

Clayton, S. C., Manning, C. M., Krygsman, K., & Speiser, M. (2017). Mental health and our changing climate: Impacts, implications, and guidance. American Psychological Association and ecoAmerica. Retrieved from https://www.apa.org/images/mental-health-climate_tcm7-215704.pdf

Keniger, L. E., Gaston, K. J., Irvine, K.N., & Fuller, R. A. (2013). What are the benefits of interacting with nature? International Journal of Environmental Research and Public Health, 10, 913-935.

Kübler-Ross, E., & Kessler, D. (2014). On grief and grieving: Finding the meaning of grief through the five stages of loss. New York: Scribner.

Leiserowitz, A., Maibach, E., Rosenthal, S., Kotcher, J., Bergquist, P., Ballew, M., Goldberg, M., & Gustafson, A. (2019). Climate change in the American mind: November 2019. Yale University and George Mason University. New Haven, CT: Yale Program on Climate Change Communication.

Maas, J., Verheij R. A., de Vries S., Spreeuwenberg, P., Schellevis, F.G., & Gorenewegen, P. P. (2009). Morbidity is related to a green living environment. Journal of Epidemiology & Community Health, 63, 967-973.

Roszak, T. (2001). The voice of the earth: An exploration of ecopsychology (2nd ed.). Grand Rapids, MI: Phanes Press.

Scully, J. M. (2004). To heal from without: Exposure to nature may be just what the doctor ordered. Orion Magazine, 23(1), 72-73.

Shanahan, D. F., Fuller, R. A., Bush, R., Lin, B. B., & Gaston, K. J. (2015). The health benefits of urban nature: How much do we need? Bioscience Washington, 65(5), 476-485.

United Nations, Department of Economic and Social Affairs, Population Division (2019). World urbanization prospects: The 2018 revision (ST/ESA/SER.A/420). New York: United Nations.

Wolsko, C. & Hoyt, K. (2012). Employing the restorative capacity of nature: Pathways to practicing ecotherapy among mental health professionals. Ecopsychology. 4(1), 10-24.

Wolsko, C. & Lindberg, K. (2013). Experiencing connection with nature: The matrix of psychological well-being, mindfulness, and outdoor recreation. Ecopsychology. 5(2), 80-91.

Climate Change for Clinicians

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