Despite occasional anecdotal reports, the process of conducting psychotherapy while both client and therapist are exercising has received little systematic attention. Through a case study, an initial attempt is made to delineate the specific, predictable, and salient characteristics and issues which may inhere to this type of therapy. Client variables and therapist attributes need to be addressed. Significant interpersonal issues include changes in the therapeutic bound, competition, and body awareness. Characteristics of running therapy include changes in thinking patterns, the use of symbolism and metaphor, and nonverbal communication. The positive effects of aerobic exercise in the context of psychotherapy may lead to a more profound and beneficial experience of psychotherapy. Further understanding of this form of therapy is useful both to those interested in the relationship between exercise and mental health and those studying varieties of psychotherapeutic experience.