Author: Ann Thompson

By Sami Petty, MSN, APRN, PMHNP-BC, Consulting Nurse Practitioner

We treat young adults as if they are fully formed adults. Developmentally, they are not, and that misunderstanding can derail mental health residential treatment before it even begins.

Language Matters

Clarifying the difference between “young adults” and “emerging adults” is an important foundation. Young adulthood, generally ages 18–29, is a stage of life when people are taking on new social roles, jobs, education, relationships, and independent living, while still developing the emotional regulation, identity clarity, and life skills needed to manage those transitions. Emerging adulthood, a term introduced by developmental psychologist Jeffrey Arnett, describes a distinct stage between adolescence and full adulthood. It is characterized by identity exploration, instability, self‑focus, and ongoing transition. Emerging adulthood offers a lens that highlights a psychological and developmental process, not just an age range.

Developmental Context

From 2019 to 2023, the percentage of adults receiving mental health treatment increased from 19.2% to 23.9%, with a similar upward trend among adults aged 18–44, the core young adult population (CDC). This matters because these individuals are our future professionals, tradespeople, and leaders. Investing in their well-being is a wise investment and being fully informed before forming opinions helps us see beyond assumptions that they are unmotivated, they have potential that deserves attention and understanding.

Development provides the context that makes treatment effective, or, if ignored, can cause it to fail. When treatment overlooks developmental factors, it risks misreading symptoms, mislabeling behaviors, and misjudging readiness. Conditions such as depression, anxiety, trauma, and substance use often manifest as avoidance, withdrawal, impulsivity, identity confusion, and relational instability. These behaviors are not merely “symptoms”; they are developmental signals. Recognizing this layer allows families, clinicians, and program staff to interpret behavior more accurately and respond in ways that truly support growth and recovery.

What Now?

Emerging adulthood is a critical period of identity formation, brain maturation, and growing independence. Mental health challenges during this stage can disrupt these developmental tasks, making timely and developmentally informed interventions essential. The brain is still maturing, identity is still forming, and independence is uneven, which intensifies the impact of mental health struggles.

Many young adults in residential treatment exhibit stalled identity development, poor emotional regulation, limited life skills, disrupted attachment patterns, and difficulty tolerating stress or uncertainty. Instead of asking, “What’s wrong with them?” the more productive question becomes, “Which developmental needs have not been met yet?” Residential treatment can address these needs by providing structure, relational consistency, skill building, opportunities for autonomy, and real-time feedback, the very conditions that foster developmental growth.

When programs fail to meet emerging adults where they are developmentally, treating 18-year-olds like 30-year-olds, the results are predictable: poor engagement, early dropout, relapse, family conflict, and stalled progress. Conversely, residential treatment that intentionally supports development can be transformative, helping young adults not only stabilize but grow, learn, and thrive.

What You Can Do

Young adults are not fully formed – they are emerging adults. Their brains, identities, and coping systems are still developing, shaping how they experience symptoms and respond to treatment. Many mental health struggles are driven by developmental gaps; what looks like resistance, avoidance, or instability often reflects unfinished developmental tasks rather than a lack of motivation. Residential treatment is most effective when it supports development, not just symptoms. Programs that combine structure, autonomy building, and relational consistency foster deeper, more sustainable recovery.

If you are supporting a young adult, remember development isn’t separate from mental health, it drives it. By shifting our perspective to meet emerging adults where they are, we can transform challenges into growth and change outcomes for the better.

 

Article written by Maggie Penman, Washington Post.  Published by the Cleveland Plain Dealer on Sunday, April 12, 2026

Jennifer Udler has been a practicing therapist for 25 years. A little over a decade ago, she started training for a marathon, running with a group near her home in Montgomery County, Maryland.

“I noticed that people were more comfortable, less inhibited, opening up and talking during our group training runs,” Udler said. “And I started to wonder if there was a way to do a practice where people are moving.”

Udler sees children and adolescents as well as adults, and she suspected that her younger clients especially might feel more comfortable talking while walking on a nature trail rather than sitting in a therapist’s office. She decided to try it with one of her young clients with his mom’s permission.

“We met at a park, and we walked around, and he was a different kid,” Udler said. “He was running around, and he was showing me stuff in nature. And he talked.” She said they made more progress in one session outside than they had in two years meeting in her office.

“That was in the snow in February,” she added. “So I was like, it’s only going to get better.”

Udler started reading more about outdoor therapy, which is also known as walk-and-talk or nature-informed therapy. At that time she couldn’t find any formal training or certification programs, but she did learn that other therapists had tried it and found many of the same benefits she had.

“You’ve got the movement, you’ve got nature, which is extremely grounding and stabilizing for people, and you have the co-regulation, walking side-by-side,” Udler said. For her younger clients or anyone uncomfortable with therapy, it also helped to be walking while talking about difficult topics because they didn’t always have to make eye contact with her.

She wrote her own informed consent for her clients, establishing the additional risks of outdoor therapy and how confidentiality would work in a public park. She started a practice called Positive Strides, specializing in walk-and-talk therapy sessions outdoors in nature.

“As I did the work and saw different types of people with different kinds of mental health issues, I realized how amazing it is,” Udler said.

Trading the couch for the great outdoors

In March of 2020, when many therapists moved their practices online, a smaller number brought their practices outside. The benefits were not felt only by the clients. Nature acts as a sort of “buffer against burnout,” said Heidi Schreiber-Pan, the executive director and founder of the Center for Nature Informed Therapy, where she trains clinicians in how to bring their practices outdoors.

“What we’re hearing from people is that they can see more clients when they have outdoor sessions or nature-informed sessions,” Schreiber-Pan said.

The American Psychological Association put out new guidelines this past fall for how clinicians can implement walk-and-talk therapy into their practice.

The number of therapists working outside is still small. Shreiber-Pan believes that’s in part because therapists don’t realize that nature is all around us. One of the first questions she asks in her trainings is: When you think of nature, what comes to mind?

“They talk about, like, these beautiful national parks or the mountains or the ocean,” Shreiber-Pan said. “And where is your therapy office? Not there.” She said that part of the training is helping practitioners recognize that nature is all around us — even in a city park.

Miki Moskowitz is a clinical psychologist who practices in a primary care setting, which means she sometimes sees a patient only a couple of times.

“We’re trying to make a difference, even in one single session,” she said.

For Moskowitz, practicing outside has improved her own mental health and increased her capacity, but she also sees the immediate impact for her patients.

“What I’ve seen that’s so encouraging is that sometimes just that first session we go for the walk, and patients are, like: ‘Wow, I didn’t know this trail was here. This is so beautiful. This feels so great. This is totally something I can do on my own,’” Moskowitz said. “That is so much more powerful than if we’re sitting in my office, which has no windows, just talking about the idea of going outside.”

The brain benefits of getting outside — even when it’s freezing

When Marc Berman was doing research at the University of Michigan, he helped devise a study to look at the brain benefits of time in nature. Participants did a challenging task testing their memory and attention, and then they were sent on a walk either through downtown Ann Arbor or in the area arboretum.

Those who walked in nature showed a 20% improvement in their short-term memory, while those who walked in an urban environment did not.

Berman and his colleagues did this experiment in June and January. In the winter, the nature walk was less enjoyable – but just as beneficial.

“That was pretty cool because it suggested that you didn’t have to enjoy the nature walk to get these cognitive benefits. There was something deeper going on,” Berman said.

One explanation for why nature is so good for our brains is called the attention restoration theory. The idea is that our ability to pay attention is finite, and spending time in nature can replenish our capacity. Nature is also “softly fascinating.” It captures our attention without overwhelming our senses.

“I can kind of mind-wander and think about other things when I’m looking at a waterfall,” Berman said. “I can’t really mind-wander or think about other things when I’m in Times Square.”

Berman is now a psychology professor at the University of Chicago and author of the new book “Nature and the Mind: The Science of How Nature Improves Cognitive, Physical, and Social Well-Being.”

How to make the most of time outdoors

Whether or not you are in therapy, your brain can benefit from a dose of nature, especially during the colder months when many of us are inclined to stay indoors.

Here are some science-backed tips for how to get the benefits.

› Nature can be found anywhere: You just have to look for it. Research has shown that noticing nature and paying attention to it can have positive effects even in an urban environment. Psychologists recommend noting the bird song you hear on the walk to your car, looking at the leaves on the trees and the clouds in the sky, and just taking a moment to appreciate nature’s beauty — even if it’s just a small plant poking its way through the sidewalk.

› You don’t have to like it: Nature can be an acquired taste, especially when it’s cold. But you don’t have to be a backpacker or love camping to benefit from time outside. Berman and others have found in their research that we get the brain benefits whether or not we enjoy a walk in the woods.

› Try a mindfulness exercise: Many people struggle to sit still and meditate, despite its benefits — but Moskowitz said that mindfulness practices can come more easily outside. “Just look up at the treetops and notice what you see, notice what you hear,” Moskowitz said. “Look for something that’s moving, and watch the branches sway in the breeze. Look at something close up, or look at something far away. You’re doing a mindfulness practice, and you’re tuning into your senses, and you are focusing your attention, but it’s not hard work.”

› Bring nature inside: If you aren’t able to get outside as often as you would like, you can still get some of the benefits. Put a plant in your office — even a fake one — or look at pictures of beautiful landscapes. Listen to bird songs at your desk. “It’s not as strong as the real thing, but you can get benefits from the simulated nature,” Berman said.

› Embrace the winter: When it’s cold and snowy outside, our impulse is to stay inside. But less time outside can contribute to seasonal depression. Schreiber-Pan recommends following the Scandinavian practices of “friluftsliv” — or “openair living,” getting outside no matter the weather — and hygge, or embracing the cozy indoors when you come back in. “The happiest people on this planet are the Scandinavians,” Schreiber-Pan said. “They also have the longest winters.”