Blue care, wild and open-water swimming

Domain XV · Nature, philosophy, social & rites of passage · Wallace J. Nichols · 2014

What it is

Blue care is not a psychotherapy and has no treatment manual. It is an umbrella for health-promoting contact with outdoor water ("blue space": sea, lakes, rivers), whether being near, on or in it. Wild or open-water swimming is one form; community groups such as Mental Health Swims offer…

Format

• No source gives a session count, phase structure or format for blue care within psychotherapy; the stages below are. Do not set a number of sessions or swims.
• Contracting and safety planning. Goal: agree what the therapist will and will not do (in-room only, shoreline sessions, or neither), and the client's own safety plan (supervised venue, never alone, visibility, conditions check, exit plan, how to call for help). Move on when both are written down or…

Who practises it, and how they are trained or regulated

• Medical and safety screening. Goal: the client consults their GP or prescriber about any heart condition, seizures or epilepsy, pregnancy, diabetes, respiratory problems or medicines that affect alertness, balance or heat regulation, and reads the published safety guidance. Lifesaving Society Canada's standard advises people with serious medical conditions such as seizures or heart conditions to consult a doctor…

Evidence status, as the guide reports it

• Blue care is not a psychotherapy and has no treatment manual. It is an umbrella for health-promoting contact with outdoor water ("blue space": sea, lakes, rivers), whether being near, on or in it. Wild or open-water swimming is one form; community groups such as Mental Health Swims offer…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• comments about weight, "earning" food or punishing the body. Working: the client participates with less avoidance and less self-criticism.
• the group becoming the client's only support, or conflicts in the group. Working: the client reports new relationships and less isolation.
• secrecy, social media escalation, ignoring safety rules. Working: the client can skip a session without distress and keeps to the safety plan.
• all-or-nothing scheduling, or mood depending on a single activity. Working: activity and mood ratings improve across several activities, not just swims.
• hopelessness spreading to other areas of life, or eco-distress masking depression. Working: the client holds the concern while staying engaged with life.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.