Atlas›Domain X · Body, movement, breath & physical›Guide 198
Guide X-198

Heliotherapy (Rollier) and Rikli's air-and-light baths

Arnold Rikli, Auguste Rollier, Oskar Bernhard1855Veldes (Bled), Slovenia; Leysin, Switzerland
A 28 · L 61 · M 1112 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the historical cures as Swiss, German and Slovenian historians describe them. These are Arnold Rikli's "atmospheric cure" with light-and-air baths at Veldes (Bled), from 1855, and the alpine heliotherapy of Auguste Rollier (Leysin, from 1903) and Oskar Bernhard (Samedan and St. Moritz). Current sun-safety guidance follows WHO. Everything about how a psychotherapist works with this material today is marked [synthesis].

What it is. This entry is a historical family of nature cures, not a current psychotherapy. Nobody delivers it today as a recognised treatment, and it is not presented here as a treatment for tuberculosis, cancer or any other physical disease.

  • Rikli's air-and-light baths. Arnold Rikli (1823–1906) was a Swiss dyer turned lay nature healer. In 1855 he founded the cure establishment "Mallnerbrunn" at Veldes, now Bled in Slovenia. There he introduced bathing in light, air and sun as a nature-cure treatment, and he called his method the atmosphärische Kur ("atmospheric cure"; translation mine). [source: Deutsche Biographie/NDB-online, Rindlisbacher 2024]
  • Rollier's heliotherapy. Auguste Rollier (1874–1954) was a Swiss physician who trained under the surgeon Theodor Kocher. From 1903 at Leysin he combined high-altitude air with sunbaths. He used this "Sonnenkur" (sun cure) mainly for tuberculosis outside the lungs, especially bone tuberculosis. [source: HLS, Barras 2009/2012]
  • Bernhard's work. Oskar Bernhard (1861–1939) in the Engadine helped win recognition for high-altitude sun treatment of joint and bone tuberculosis. [source: HLS, Wieser 1998/2009]

Core idea of change, as its proponents held it (attributed, not established).

  • Rikli taught that natural forces of air and above all light strengthen the body. His advertising slogan was "Wasser tut's freilich, höher jedoch steht die Luft und am höchsten das Licht". In English: "Water does it, certainly; but air ranks higher, and light highest" (translation mine). [source: Deutsche Biographie/NDB-online]
  • Rollier held that alpine air and sun invigorate the whole body. He also held that recovery must extend into social and moral well-being, which he called "moral orthopaedics" (HLS term, translated from German). [source: HLS, Barras]

Historians place these cures within the 19th-century nature-cure and life-reform (Lebensreform) movements. The same milieu fed naturism and, in some currents, racial-hygiene ideas. [source: HLS, Weibel, "Freikörperkultur"]

Heliotherapy lost importance after 1945. [source: HLS, Barras] Swiss public broadcaster SRF notes that sun treatment brought many tuberculosis patients relief but rarely a cure, and that antibiotics became a more effective weapon against tuberculosis in the 1940s. [source: SRF Wissen, Bernard 2016, translated from German]

Why it matters to a psychotherapist [synthesis]

  • Clients meet these ideas today in wellness tourism. Some hotels in Bled offer therapies based on Rikli's methods [source: RTV SLO, Bartolj 2015], and researchers have proposed Rikli-based preventive wellness programmes [source: Grafenauer & Kužnik 2021].
  • Clients also meet them in naturism, in "sun cure" and vitamin D claims online, and in their own wish to spend more time outdoors.
  • The psychotherapist's job has four parts:
    • give accurate history;
    • keep health claims honest;
    • route sun and skin questions to medical care;
    • use outdoor daylight and nature in sun-safe, non-prescriptive ways, such as behavioural activation and social connection.
  • Medical light therapy for seasonal or other depression is a separate, device-based method. See light therapy in Domain IX. For nature-based practices, see Domain XV.

2. Framework

2a. The historical cures (description only, not instructions).

  • Rikli's establishment at Veldes, 1855 to about 1918.
    • Daily regimen as a journalistic history describes it [source: RTV SLO, Bartolj 2015]:
      • early-morning walks;
      • much of the day spent in baths, alternating steam baths with cold mineral-water baths;
      • nude sunbathing, which many contemporaries found shocking;
      • a ban on alcohol and smoking, and mostly vegetarian meals.
    • Rikli called the method "helio-hydrotherapy" [source: RTV SLO].
    • His followers bathed "leicht bekleidet in Licht und Luft" ("lightly clothed in light and air"; translation mine) [source: NDB-online].
    • He published a house rulebook (Cur- und Hausordnung, 1886) and books on the method, including Die atmosphärische Cur oder das Lichtluftbad und das Sonnenbad (1894) [source: Deutsche Biographie]. No procedure from these books is given here [uncertain].
    • His son Oskar ran the establishment until 1918 [source: NDB-online]. The press history says the First World War ended the sanatorium [source: RTV SLO].
    • Dates differ between sources. The press history says Rikli came to Bled in 1852; the NDB gives 1855 as the founding of the institute [uncertain].
  • Rollier's Leysin clinics, 1903 to about 1945.
    • He started with a children's clinic, "Le Chalet". By 1940 he oversaw 18 clinics with nearly 1,500 tuberculosis patients, including orthopaedic treatment [source: HLS, Barras].
    • A Swiss news history gives 36 clinics and more than 1,000 beds at his peak [source: swissinfo, Dawson 2004]. These figures conflict [uncertain].
    • The cure had two kinds of element:
      • physical: graded sunbathing in the alpine climate, with early-morning sun and a nutritious diet favoured [source: swissinfo];
      • psychosocial: physical exercise, patient choirs, a library, scouting and open-air schools. In 1930 he opened a "Clinique manufacture" where patients did manual work [source: HLS, Barras].
    • Rollier's own exposure procedure is in his books, for example Die Heliotherapie der Tuberkulose (1913), as cited in the NDB literature list. It is deliberately not reproduced here.
  • Bernhard at Samedan and St. Moritz.
    • He co-founded the Samedan district hospital and led it from 1895 to 1907. He opened his own clinic in St. Moritz in 1911 and published Die Sonnenlichtbehandlung in der Chirurgie (1917; 2nd edition 1923).
    • His teacher Kocher was initially reserved about the approach [source: HLS, Wieser].
  • Who delivered these cures. Physicians delivered heliotherapy (Rollier and Bernhard were both surgically trained), assisted by clinic staff. Rikli was a lay nature healer who came into conflict with academic medicine [source: HLS; NDB-online].

2b. How the psychotherapist works with this material today [synthesis]

This is not a stand-alone course. It is a thread inside ongoing therapy, usually one to three sessions of focused work and then occasional check-ins. Phases:

  1. Orientation.
    • Goal: find out what drew the client to the topic, for example a spa stay in Bled, naturism, a wish for more daylight, a health belief or seasonal low mood.
    • Move on when the therapist knows the client's aims and beliefs.
  2. Accurate information and claims check.
    • Goal: share history and evidence status, and separate wellbeing aims from disease-treatment claims.
    • Move on when the client can say what outdoor time can and cannot be expected to do.
  3. Safety and medical routing.
    • Goal: go through the WHO risk groups and sun-protection principles together.
    • Refer to the GP, dermatologist or prescriber for skin, medicine or vitamin D questions.
    • Move on when red flags are cleared or a referral is in place.
  4. Planning outdoor engagement.
    • Goal: weave outdoor daylight, nature contact and social activity into behavioural activation, within sun-safe habits.
    • The therapist gives no exposure schedule.
    • Move on when the client has a plan they chose themselves.
  5. Integration and review.
    • Goal: link experiences to mood, body image and meaning, and check for adverse effects.
    • Close the thread, or refer on, for example to light therapy (Domain IX) or a nature-based programme (Domain XV).

3. Guiding principles

  • History is not prescription. Describe Rikli's and Rollier's regimens as past practice, and never turn them into exposure plans. [synthesis]
  • Attribute every claim. "Rikli taught…" or "Rollier held…", never "sunlight heals…". Mark evidence status, and do not present heliotherapy as a treatment for tuberculosis, cancer or any physical disease. [synthesis]
  • UV is a known carcinogen. In IARC's evaluation, "Solar radiation is carcinogenic to humans (Group 1)." [source: IARC Vol. 55 summary] WHO states that skin cancers are mainly caused by UV radiation from the sun or from sunbeds [source: WHO 2022]. In practice, every outdoor-time conversation includes sun protection.
  • Benefits are modest and specific. WHO notes that small amounts of UV are needed for vitamin D, but recommends against artificial tanning as a way to get it, and suggests supplements for people with very low sun exposure as a medical decision [source: WHO 2022]. NICE adds that there is no safe or healthy way to get a tan from sunlight, that burning or tanning adds little benefit, and that people with darker skin living in the UK are at higher risk of low vitamin D and should get advice on supplements [source: NICE NG34]. In practice, vitamin D questions go to the GP.
  • Protection follows WHO, consistent with dermatology and national guidance.
    • Use sun protection when the UV Index reaches 3 or above.
    • Seek shade and limit time in the midday sun.
    • Wear protective clothing, a broad-brimmed hat and UV-blocking wraparound sunglasses.
    • Use broad-spectrum sunscreen on uncovered skin, and do not use sunscreen to extend time in the sun.
    • Avoid sunbeds. [source: WHO 2022] In practice, the therapist passes these principles on and does not invent personal exposure limits.
    • Dermatology and national guidance say the same: the American Academy of Dermatology advises shade around midday, protective clothing with a wide-brimmed hat and UV-blocking sunglasses, broad-spectrum water-resistant sunscreen of SPF 30 or higher reapplied after swimming or sweating, extra care near water, snow and sand, and avoiding tanning beds; it adds that any tan signals skin damage. NICE says sunscreen does not replace clothing and shade. [source: AAD; NICE NG34]
  • Know the higher-risk groups. WHO lists children and adolescents, fair-skinned people, people with many moles, people taking photosensitising medicines, people with a family history of skin cancer, and outdoor workers. It adds that darker-skinned people can also develop skin cancer [source: WHO 2022]. NICE adds people with very fair skin, fair or red hair or freckles who burn quickly [source: NICE NG34]. In practice, ask about these and route medicine questions to the prescriber or pharmacist; never advise on medicines.
  • Stay in your lane. Medical UV treatment and light-therapy devices are for medically supervised services. The psychotherapist's role is referral and collaboration. [synthesis; see Domain IX]
  • Separate wellbeing from cure. Outdoor daylight, movement and nature can serve behavioural activation and connection. They are not treatments for physical illness. [synthesis]
  • Respect bodies and modesty. The historical cures involved nude or lightly clothed exposure [source: RTV SLO; NDB-online]. In practice, the therapist never suggests undressing, and treats nudity, body image, gender identity, religious modesty and trauma as the client's own territory. [synthesis]
  • Be cautious with diets in cure packages. Rikli's regimen included dietary rules and abstinence [source: RTV SLO]. In practice, screen for eating-disorder history before endorsing any "cure" diet, and route fasting or dietary cures to medical supervision. For harms of historical cures, see Domain XVI. [synthesis]
  • Hold the history critically. The life-reform milieu that produced these cures also carried exclusionary ideologies in some currents [source: HLS, Weibel]. In practice, the therapist can name this if a client idealises "natural living" movements. [synthesis]
  • The client chooses. Any outdoor plan is the client's own, built on their values, and the therapist does not prescribe it. [synthesis]

4. Intervention inventory

None of the sources describes psychotherapist procedures for this topic. Every intervention below is therefore [synthesis] built on the historical and safety facts cited above. No sun-exposure times, intensities or schedules are given anywhere.

4.1 Exploring the client's interest and beliefs

  • Purpose: find out why the client has raised sunbathing, air baths, a Bled or alpine cure, or naturism. Possible reasons include wellbeing, low mood in winter, body confidence, a health belief, or curiosity about a family history of tuberculosis or sanatorium stays. Use this when the topic first comes up.
  • Steps:
    1. Ask open questions about where the interest came from: a trip, a book, online claims, a hotel programme.
    2. Ask what the client hopes it will do for them, and write down each hoped-for effect.
    3. Sort the hopes into three groups: mood, energy and routine; body image; and physical-disease claims.
    4. Ask about current health conditions, medicines and skin history, using the screening in 4.4.
    5. Summarise the client's aims back to them and agree whether to explore the topic further.
  • Example language (illustrative): "What first got you interested in Rikli's light-and-air baths? And what would you notice in your life if spending time outdoors was going well for you?"
  • Watch for:
    • beliefs that sunlight will cure a physical illness, or replace medical treatment;
    • interest driven by body dissatisfaction or tanning;
    • over-valued health ideas.
  • Working if: the aims have been named and sorted, and the client has agreed which ones to pursue.

4.2 Historical psychoeducation

  • Purpose: give an accurate, attributed account so the client can judge modern marketing. Use this when the client cites "Rikli", "Rollier" or "the sun cure".
  • Steps:
    1. Explain that Rikli was a lay nature healer at Veldes from 1855. He promoted his "atmospheric cure" of light, air and sun in a strict regimen of walks, baths, a mostly vegetarian diet and abstinence, and he clashed with academic medicine. [source: NDB-online; RTV SLO]
    2. Explain that Rollier and Bernhard were physicians who used alpine sunbathing mainly for bone and joint tuberculosis in the pre-antibiotic era. Rollier added exercise, choirs, schooling and work. [source: HLS]
    3. Point out that heliotherapy lost importance after 1945 [source: HLS] and that tuberculosis is now treated medically.
    4. Note that UV is classed as carcinogenic today [source: IARC; WHO].
    5. Invite the client's reactions.
  • Example language (illustrative): "Rollier was treating children with bone tuberculosis before there were antibiotics. Sun and mountain air were part of what he had. Today we know sunlight also causes skin cancer, so the useful part for you is probably time outdoors and in company, not the tan."
  • Watch for:
    • the client feeling lectured or corrected; keep it brief and collaborative;
    • idealising "natural living". If it fits, mention that the wider life-reform movement also had exclusionary strands [source: HLS, Weibel].
  • Working if: the client can retell the history in their own words and draw the distinction between then and now.

4.3 Claims check and evidence status

  • Purpose: separate attributed historical claims from current evidence. Use this when a programme, website or friend makes health promises.
  • Steps:
    1. Write out the claim exactly as it was made.
    2. Ask who makes it and what their interest is: commercial, ideological or medical.
    3. Say plainly that no source here supports sunbathing or air baths as a treatment for any physical disease.
    4. Refer any disease claim to the client's physician.
    5. Reframe the client's aim in wellbeing terms they can test, such as mood, routine or connection.
  • Example language (illustrative): "This hotel page says the Rikli programme 'strengthens immunity'. That's their claim. What would you want to check with your doctor before relying on it?"
  • Watch for:
    • delaying or abandoning medical treatment;
    • escalating spending on cures;
    • distress when the client's beliefs are questioned.
  • Working if: the client weighs claims critically and keeps up their medical care.

4.4 Sun-safety and medical-screening conversation

  • Purpose: make sure any plan for outdoor time follows public-health guidance, and that medical questions reach clinicians. Use this before any outdoor plan, and again whenever health or medicines change.
  • Steps:
    1. Ask about the risk factors WHO lists: fair skin, many moles, a personal or family history of skin cancer, photosensitising medicines and outdoor work. For a child or adolescent client, involve the parent or guardian. [source: WHO 2022]
    2. Share WHO's protection principles and the UV Index guidance (protect at 3 or above): shade, limiting midday sun, clothing, a hat, sunglasses and sunscreen, which is not a licence for longer exposure; and no sunbeds. [source: WHO 2022] Dermatology and UK guidance give the same message: broad-spectrum sunscreen of SPF 30 or higher alongside, not instead of, clothing and shade, and no tanning beds. [source: AAD; NICE NG34]
    3. Route questions to the right clinician:
      • medicines and sun sensitivity to the prescriber or pharmacist;
      • changing moles or skin lesions to the GP or dermatologist (dermatology and UK guidance advise regular skin checks and a medical review of any new spot or one that changes, itches or bleeds [source: AAD; NICE NG34]);
      • vitamin D to the GP. Never advise on medicines or supplements yourself.
    4. Ask about heat tolerance, cardiac conditions, pregnancy and alcohol use if the plan involves hot outdoor settings or spa programmes. Recommend medical clearance where any of these apply. [synthesis; no specific heat-risk list is cited for this entry: uncertain]
    5. Record the conversation and any referrals.
  • Example language (illustrative): "Before we plan more time outside, can we go through a few sun-safety basics from the WHO? And would you be willing to ask your pharmacist whether any of your medicines make your skin more sensitive to sun?"
  • Watch for:
    • minimising sunburn or past skin problems;
    • wanting to tan "for health";
    • using sunbeds;
    • eye symptoms after bright sun. WHO lists acute inflammation of the cornea and conjunctiva, and cataract as a chronic effect. [source: WHO 2022]
  • Working if: the client uses sun protection on their own initiative, and referrals have been made where they were needed.

4.5 Outdoor daylight within behavioural activation

  • Purpose: use the useful core of the old cures, which is time outdoors, movement and routine, as part of behavioural activation for low mood, without a light dose. Use this for depression, withdrawal or loss of routine.
  • Steps:
    1. Look together at the client's current activity and mood record.
    2. Choose valued outdoor activities: a walk with a friend, gardening, a café terrace in the shade, a park bench at lunch.
    3. Build sun-safe habits into each activity, such as shade, a hat and avoiding the midday sun (see 4.4).
    4. Let the client set how often and how long, based on their values and their medical advice.
    5. Review mood and activity links at the next session and adjust.
  • Example language (illustrative): "Rather than 'sunbathing', what's one thing outside you'd actually enjoy this week, maybe in the morning or in the shade? How would you make it sun-safe?"
  • Watch for:
    • all-or-nothing plans;
    • activity driven by guilt;
    • fatigue from medical illness;
    • sunburn or heat discomfort.
  • Working if: the activity is happening, mood ratings show links with it, and no adverse effects have been reported.

4.6 Meaningful activity and community scaffolding

  • Purpose: translate Rollier's "moral orthopaedics" into modern support. He paired the cure with exercise, choirs, a library, scouting, open-air schooling and manual work [source: HLS, Barras]; the modern version is meaningful occupation and belonging during long illness or recovery. Use this with clients facing chronic illness, long convalescence or isolation.
  • Steps:
    1. Map the client's current roles and sources of meaning.
    2. Identify one social or creative activity the client can manage, such as a choir, a reading group, a volunteer role or adapted work.
    3. Problem-solve access around health limits, together with the client's clinicians.
    4. Review the effect on mood, identity and hope.
  • Example language (illustrative): "Long cures a century ago weren't only about the sun; patients sang in choirs and went to school. What could give your days that kind of shape and company now?"
  • Watch for:
    • overload;
    • activity used to avoid grief about illness;
    • medical limits that need clearance.
  • Working if: the client reports more structure, contact and sense of purpose.

4.7 Preparing a client for a spa, wellness or "Rikli" programme

  • Purpose: help a client who plans to join a programme get ready for it, for example a Bled hotel offering Rikli-based therapies [source: RTV SLO] or an alpine wellness stay. Use this before the stay and again after it.
  • Steps:
    1. Ask the client to get the programme's written description: its components, the staff and their qualifications, and its health screening.
    2. Check whether the programme includes sauna, cold baths, fasting or dietary rules, or nude areas. If so, apply the relevant safety guidance and medical clearance. For heat and cold, see the other entries in this family; for diets, see Domain XVI on historical cures. [synthesis]
    3. Rehearse how the client will decline any component or stop at any point, and how they will raise any concern with staff.
    4. Agree a short debrief after the stay.
  • Example language (illustrative): "You can say no to any part of the programme, including the cold baths or the diet. Shall we practise how you'd tell the staff?"
  • Watch for:
    • pressure to complete the programme "properly";
    • restrictive eating;
    • mixing alcohol with heat treatments;
    • discomfort with nudity or touch. Consent before and during any touch, the right to stop, and never sexual touch are non-negotiable.
  • Working if: the client goes in informed, uses their right to opt out where they need it, and comes back able to reflect on the experience.

4.8 Body image, nudity and naturism

  • Purpose: explore the client's feelings about exposing their body. Rikli's guests sunbathed nude [source: RTV SLO], and naturism grew out of the same reform milieu [source: HLS, Weibel]. Use this when the client raises naturism, body shame, or wanting to tan to feel attractive.
  • Steps:
    1. Explore the client's values, including religious, cultural, gender-identity and trauma considerations.
    2. Separate the client's own wish from social pressure.
    3. Work on body image with the therapist's usual methods. Never suggest undressing in or for therapy.
    4. If the client chooses a naturist setting, discuss the published etiquette there, privacy, consent and safeguarding, and sun protection.
  • Example language (illustrative): "What would it mean for you to feel more at ease in your body? Is being outdoors with less clothing part of that, or is something else pulling you towards it?"
  • Watch for:
    • trauma reactivation;
    • compulsive tanning or checking;
    • exploitation risks in unregulated groups;
    • safeguarding concerns involving minors.
  • Working if: the client makes choices from their own values and reports less shame.

4.9 Seasonal pattern screening and referral to light therapy

  • Purpose: recognise when a client's interest in "more sun" reflects seasonal depression that may warrant assessment for medical light therapy. That is a separate method; see light therapy in Domain IX. Use this when mood follows the seasons or worsens in winter.
  • Steps:
    1. Ask about the timing of mood changes across the seasons.
    2. Use the therapist's usual depression assessment.
    3. Explain that bright-light therapy uses devices and needs clinical assessment and supervision, and that it is different from sunbathing.
    4. Refer to the GP or psychiatrist, and keep risk assessment current.
  • Example language (illustrative): "You've noticed your mood drops every November. There's a specific treatment, light therapy, that a doctor can assess you for. It's different from sunbathing and doesn't involve UV tanning."
  • Watch for:
    • bipolar history: light therapy needs psychiatric oversight [uncertain; see Domain IX];
    • eye conditions;
    • self-treatment with tanning beds, which WHO advises against [source: WHO 2022].
  • Working if: a referral has been made and the client understands the difference between light therapy and sunbathing.

4.10 Nature contact and outdoor sessions

  • Purpose: offer nature contact as a modern descendant of the open-air cures. This means time in green or blue space as a wellbeing practice; see nature-based practices in Domain XV. Use this when the client values nature or feels confined indoors.
  • Steps:
    1. Explore what nature settings the client can reach and what draws them.
    2. Choose between client-led practice between sessions and a referral to a nature-based programme.
    3. If the therapist offers outdoor sessions, agree in writing beforehand on confidentiality limits, the route, the weather and sun plan, physical-safety limits and what to do in an emergency.
    4. Review.
  • Example language (illustrative): "Would you like to try one of our next sessions outside? We'd agree beforehand where we walk, what happens if we meet someone you know, and we'd keep to shade."
  • Watch for:
    • loss of privacy;
    • mobility or heat limits;
    • the boundary shift involved in walking side by side.
  • Working if: the client engages, feels safe, and outdoor time carries over between sessions.

4.11 Integrating outdoor and cure experiences

  • Purpose: link what the client experiences outdoors, or at a spa, with the goals of therapy. Use this after outdoor activity or a stay.
  • Steps:
    1. Invite a description of what the client did, and what they noticed in body, mood and thoughts.
    2. Explore the meaning, for example rest, a sense of permission, contact with others, or memories such as a family history of tuberculosis or sanatoria.
    3. Connect the experience to the treatment goals.
    4. Decide whether to keep, change or drop the activity.
  • Example language (illustrative): "When you were sitting by the lake, what did you notice in your body? What would you like to bring back into ordinary weeks?"
  • Watch for:
    • over-attributing improvement to the "cure";
    • grief about family illness histories;
    • disappointment when the effects are modest.
  • Working if: the client draws realistic, usable links between the experience and their goals.

4.12 Recognising and passing on adverse effects

  • Purpose: notice harms and route them to medical care. Use this at every review.
  • Steps:
    1. Ask about sunburn, eye pain, changing moles, heat discomfort or fainting, restrictive eating, and any distress or pressure experienced in programmes.
    2. For any physical symptom, advise the client to see their GP, dermatologist or optometrist, as appropriate. Urgent symptoms go to emergency services.
    3. Encourage the client to report any harm to the programme provider. Record it, and consult your supervisor.
  • Example language (illustrative): "That mole you mentioned has changed. I'm not able to judge skin changes, so please book with your GP soon. Can we agree you'll do that this week?"
  • Watch for:
    • minimising;
    • shame about "overdoing it";
    • avoidance of medical contact.
  • Working if: the client follows through on referrals and adjusts their plans.

5. Handling problems

All guidance in this section is [synthesis] unless a source is tagged.

  • The client believes sunlight will cure a physical illness, for example cancer, an infection or an autoimmune disease.
    • Acknowledge the hope behind the belief.
    • Restate that no source supports this, and that UV is a carcinogen [source: IARC; WHO].
    • Ask the client's permission to involve their physician.
    • If the client is delaying treatment, treat this as a risk issue: discuss it in supervision, document it, and keep the alliance.
  • The client wants a tan, or uses sunbeds, "for vitamin D" or "for mood".
    • Share WHO's position: artificial tanning is not a recommended source of vitamin D, and sunbeds should be avoided [source: WHO 2022]. Vitamin D questions go to the GP.
    • Explore what the tan does for the client emotionally, such as appearance, reward or ritual, and work with that.
    • If the tanning looks compulsive, address it as a behaviour [uncertain].
  • The client asks the therapist for an exposure schedule, such as how long to sit in the sun.
    • Decline to give one, and explain why: it is outside your competence.
    • Point the client to WHO protection principles and the UV Index, and to their GP or dermatologist for personal advice.
    • Keep the focus on choosing activities, not on dose.
  • Raising sun safety feels moralising and causes a rupture.
    • Name the moment, and apologise for the tone if that fits.
    • Return to the client's own goals.
    • Offer the information once, briefly, and leave the choice with the client.
  • The client is housebound, or too depressed to go out.
    • Use graded steps: sitting by a window or a doorway, then a few steps outside.
    • Problem-solve the barriers.
    • WHO notes that people with very low sun exposure may need vitamin D supplements [source: WHO 2022]. Route this to the GP; never advise on supplements yourself.
  • The client has an eating-disorder history and is drawn to the Rikli diet or a fasting cure.
    • Screen the client's current state.
    • Discourage restrictive "cure" diets outside medical supervision.
    • Involve the eating-disorder treatment team if there is one. For historical cures and their harms, see Domain XVI.
  • The client has a history of skin cancer, many moles, or takes photosensitising medicines [source: WHO risk groups].
    • Plan outdoor activities around shade and indoor alternatives.
    • Get medical input before adding any outdoor component.
  • The client is a child or adolescent. WHO stresses that young people's skin and eyes are more vulnerable [source: WHO 2022].
    • Involve the parent or guardian, and seek the young person's assent.
    • Follow school or setting sun-safety rules.
    • Never discuss nudity-based practices with minors except as part of safeguarding.
  • The client has darker skin and dismisses sun risk. Note that WHO says darker-skinned people can also develop skin cancer [source: WHO 2022], and that eye protection matters for everyone.
  • Bipolar disorder or a mood that rises with the seasons.
    • Monitor for hypomania when the client increases light or outdoor activity [uncertain].
    • Liaise with the psychiatrist, and see Domain IX for light therapy.
  • Heat, cardiac disease, pregnancy, alcohol or medicines in hot settings.
    • Hot outdoor or spa environments can carry heat-illness risks.
    • Recommend medical clearance, and route medicine questions to the prescriber [uncertain: no specific risk list is cited for this entry; see the sauna and heat entries in this family].
  • The client idealises the life-reform past, for example "natural living was purer".
    • Explore what the client longs for.
    • Share the historians' view that the movement had problematic strands as well [source: HLS, Weibel].
  • Non-adherence to the outdoor plan.
    • Review it without blame.
    • Shrink the step, attach it to an existing routine, or swap in a social activity.
  • Overwhelm or trauma reactions to exposure, open spaces or being seen.
    • Slow down, and return to indoor stabilisation work.
    • Re-plan the activity with more privacy and control.
  • Harm in a programme, such as pressure, boundary violations or sexual misconduct.
    • Support the client.
    • Document what happened.
    • Help the client report to the provider or the relevant regulator or complaints body.
    • Follow local safeguarding duties, and consult your supervisor.

Sources

Reference sources

Further literature as listed in the reference sources

  • Rikli, A. (1869). Die Thermodiätetik. Oder das tägliche thermoelectrische Licht- und Luftbad … [as listed in Deutsche Biographie]
  • Rikli, A. (1886). Cur- und Hausordnung der Naturheilanstalt Mallnerbrunn am Veldeser See in Oberkrain. [as listed in Deutsche Biographie]
  • Rikli, A. (1894). Die atmosphärische Cur oder das Lichtluftbad und das Sonnenbad … [as listed in Deutsche Biographie]
  • Rollier, A. (1913). Die Heliotherapie der Tuberkulose. [as listed in Deutsche Biographie]
  • Bernhard, O. (1917; 2nd ed. 1923). Die Sonnenlichtbehandlung in der Chirurgie. [as listed in HLS]
  • Levental, Z. (1977). Der "Sonnendoktor" Arnold Rikli. Gesnerus 34. [as listed in Deutsche Biographie]
  • Zupanič-Slavec, Z., & Toplak, C. (1998). Water, Air and Light. Arnold Rikli (1823–1906). Gesnerus 55. [as listed in Deutsche Biographie]
  • Hobday, R. A. (1997). Work on sunlight therapy and solar architecture. [as listed in HLS; full title uncertain]
  • de Haller, R. (2004). Work on 100 years of heliotherapy for surgical tuberculosis. [as listed in HLS; full title uncertain]

Uncertain

  • Sun-safety guidance in this entry rests on WHO, IARC, the American Academy of Dermatology and NICE NG34; European dermatology bodies' own position statements are not cited [uncertain].
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