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Wilderness Therapy: An Alternative Treatment for Adolescents
Stacy B. Shaw University of California, Los Angeles
Abstract Clinical research has overwhelmingly suggested that wilderness therapy may be used to successfully treat adolescents for a variety of psychological and behavioral problems. Researchers do not known definitively which aspects of wilderness therapy are fueling such success compared to traditional treatment programs. Potentially positive aspects include: close relationships between participants and therapists and/or counselors, a small group living environment, physical and emotional challenges, the use of experiential education, solos, and the wilderness itself. More research needs to be conducted to determine if the presumed benefits of these features are consistently successful across programs, what other unidentified features are beneficial and/or essential for success, and how these aspects could be integrated into standard adolescent treatment in a standard clinical setting. Wilderness Therapy: An Alternative Treatment for Adolescents Wilderness therapy is a popular and compelling method of treatment for adolescents with a variety of psychological and behavioral problems. This form of treatment has been used as an alternative to traditional psychotherapy and/or institutionalization. Also referred to as adventure therapy, wilderness therapy is defined by the use of therapy in a wilderness environment, recreation, and experiential education in the psychological treatment of patients. Research has overwhelmingly confirmed that wilderness therapy is a successful treatment for adolescent clinical populations and may be more successful than traditional treatment programs (Cason & Gillis, 1994; Hans, 2000; Hattie, Marsh, Neill, Richards, & Garry, 1997; Sveen and Denholm, 1997; Williams, 2000). Researchers have only just begun to examine which aspects of wilderness therapy are fueling such success. Additionally, further study is needed to determine how wilderness programs can be structured to best serve patients and how traditional therapy can utilize successful methods used in wilderness programs. History of Wilderness Therapy In the United States, the emergence of wilderness therapy in 1901 was nothing more than an accident. Due to overcrowding, the New York Asylum for the Insane was forced to set up tents on its lawn to house the overflow of psychiatric patients. Five years later, overflow patients of San Francisco’s Agnew Asylum were also pushed into outdoor tents. Patients in both “tent therapy” sites benefited from the fresh air, small groups interaction, and greater staff to patient ratios and subsequently showed unprecedented rapid improvement (Caplan, 1974). Unfortunately, the newfound improvements were short lived as the asylums’ overcrowding was addressed and patients were moved back inside. It was not until the 1940s that wilderness therapy reappeared. At that time, Kurt Hahn founded Outward Bound, a program based on experiential education and outdoor recreation as a means of building self-esteem and positive group interactions (Hans, 2000). Participants continually reported that their experience with Outward Bound brought about noticeable emotional and psychological benefits. Soon after, formal wilderness treatment programs for clinical populations emerged. Today,
multiple wilderness therapy programs exist but vary in duration of
treatment and types of therapy techniques.
This review will focus on long-term residential wilderness programs
for adolescents that include psychotherapy by licensed clinicians.
In such programs, participants engage in physical activities such
as backpacking, rock-climbing, or kayaking while living with a small group
of other adolescent patients and instructors in a wilderness setting.
Instructors facilitate group processes and activities and licensed
therapists, who either live with the group or come to the field
periodically, offer individual and group psychotherapy. Literature
Review The Effectiveness of Wilderness Therapy Currently,
structured therapeutic programs target adolescents with depression,
conduct problems, substance abuse, and defiance of authority.
Such programs have shown marked success in treating these problems
as compared to traditional treatment (Williams, 2000). Researchers have “Regularly claimed that adventure therapy
in a wilderness setting is a more effective option when compared to
treatment provided in institutional settings” (Williams, 2000, p. 51).
Hans (2000) recently conducted a meta-analysis to measure the
effectiveness of wilderness therapy programs.
Specifically, he measured patient’s Internal-External Locus of
Control, which gauges how much control a person attributes to internal or
external forces. Hans (2000)
found that wilderness therapy programs increase internalization of control
in participants. Similarly,
Sveen and Denholm (1997) found that participation in a wilderness-based
program increased self-esteem and self-actualization in participants
compared to a control group. Cason
& Gillis (1994) and Hattie, Marsh, Neill, and Richards (1997) also
conducted meta-analyses of preexisting research and concluded that
adolescent participants in adventure therapy showed marked improvement on
various behavioral and emotional scales.
Marx (1988) even claims that, “Traditional treatment techniques
and settings often are inappropriate for the needs of adolescent” (p.
517). Collective research
suggests that wilderness therapy is an effective treatment for a wide
adolescent clinical population, and researchers have identified some
specific benefits. Although
hypotheses will be reviewed, the question of why wilderness therapy is
more successful than standard clinical treatment is still largely
unanswered. Successful
Features of Wilderness Therapy Close
Relationships between Participants and Therapists and/or Instructors.
The relationship between patient and therapist is important to
any therapeutic outcome. Russell & Phillips-Miller (2002) hypothesize that the
intense bond formed between instructor, therapist and student is one of
the reasons for wilderness therapy’s success compared to traditional
treatment. Wilderness program
staffs differ in several fundamental ways from institutional staffs.
First, wilderness therapy instructors live with participants
twenty-four hours a day, whereas traditional/institutional therapists
generally do not live with patients.
This allows for participants to work through transference issues
faster and allows counselors to observe participant behavior in a
continuous manner (Marx, 1988). Constant
interactions between participant and counselor permit counselors to
address problems and solutions more immediately than in an institutional
setting (Harris, Fried & Arana, 1995).
Furthermore, counselors become more approachable as participants
have the opportunity to observe staff members in a variety of
“real-life” settings and a symbiotic relationship can develop (Gillis
& Gass, 1993). Gary
Ferguson (1999), who wrote about his experience as an instructor for the
Aspen Achievement Academy, explained that the success of one particular
therapist was due to, “Her willingness to huddle under the tarp in a
downpour, or dine with the kids on a few bites of burned beans at ten
o’clock at night” (p. 67). Consequently,
“Even those who say they hate therapists… trust her” (p. 67).
Longer-term relationships and frequent interactions provide a solid
basis from which trust can be built and maintained. Small Group Living Environment. Intense small group interactions also contribute to the success of wilderness therapy (Gillis & Gass, 1993; Russell & Phillips-Miller, 2002). Participants must work together with their peers and instructors to accomplish group goals (Williams, 2000). Good working relations need to exist between participants in order for group activities to run smoothly. Working together at a common task toward a common goal helps break down barriers so that group members can work through important interpersonal problems without the burden of facades. Although the reason is unknown, Russell & Phillips-Miller (2002) noted that in wilderness treatment, students spent less time telling “war stories” and more time dealing with their issues. Another
important factor for success is that patients cannot escape the group with
which they live. Adolescents
who participate in wilderness therapy programs, like most adolescents in
general, find it easy to avoid people and problems in the complex modern
society in which they live. Parents
are at work all day and when they are at home, it is easy to escape to
another room, a friend’s house or even just into the TV or Internet.
On the trail, the small group to which a participant belongs is
literally in his or her face twenty-four hours a day.
It is much harder to run away from issues or people (Ferguson,
1999). “Kids who’d come
to lean on some rather lame coping skills- hiding from people they
didn’t like, distracting themselves from important issues- ended up for
the first time in their lives having to come up with alternatives”
(Ferguson, 1999, p.88). Everyday
problems are not the same in the front and backcountry, but patients still
bring fundamental issues that underlie these problems to the wilderness.
Therapists note that problems generally surface in the backcountry
in a much more tangible and visible form and a lot more quickly than in an
institutional setting (Ferguson, 1999). Physical and Emotional Challenges. Wilderness therapy programs boost adolescents’ self-esteem by creating challenging environments in which participants can find success (Williams, 2000). Challenging activities such as backpacking or making a bow drill fire, besides being physically difficult, are mentally taxing and force participants to face fears and self-made limitations. Successful completion of an activity that at first seems impossible is inherently rewarding, especially for adolescents who value independence and self-reliance (Williams, 2000). Additionally, adolescence is a time of experimentation, testing the limits of oneself and one’s environment. Unfortunately, in the home environment, these risks include such things as drugs, sex, or violence (Williams, 2000). In the backcountry, staff can provide adolescents with safer and healthier but still exciting and challenging alternatives. Because outdoor environments are often unpredictable, participants must acquire adaptive skills in order to succeed. As patients experience novel environments and situations more frequently, these situations become less threatening. In addition, participants learn new problem solving strategies and coping skills by observing how their instructors deal with the same circumstances. As participants learn to adapt to their environment, they also learn that they can change certain aspects of their environment and themselves to better cope with life’s challenges (Russell & Miller, 2002). On
the whole, challenges and their solutions are often used as metaphors in
wilderness therapy (Russell & Miller, 2002).
A major goal for participants is to seek solutions to the
challenges they confront in the wilderness and to use their newfound
problem-solving skills to deal with challenges they confront at home. Experiential Education.Wilderness therapy is based on an experiential learning process (Ferguson, 1999). Experiential education adopts a philosophy that people learn better by being actively involved in the learning process. Instead of reading a book or listening to a lecture about a subject, students acquire hands on experience in experientially based programs. By engaging more than visual or auditory senses, educators hope to enhance the learning experience. Such techniques have proved successful in all forms of education, including wilderness therapy. The adage, "Tell me, and I will forget. Show me, and I may remember. Involve me and I will understand," sums up the educational philosophy of wilderness therapy programs. In many therapeutic settings, counselors teach participants coping and problem-solving skills. In traditional therapeutic settings, participants are often expected to learn skills in therapy and then change their behavior outside of therapy. In wilderness therapy settings, on the other hand, participants can use their newly acquired skills immediately and under the observation and guidance of the instructors (Ferguson, 1999). Furthermore, skills taught and methods of teaching can be tailored to the specific needs of the participants. It seems then that wilderness therapy instructors and clinicians may have a more holistic view of each participant and, therefore, may have more information with which to develop therapeutic strategies. Solos. Participants
of many wilderness therapy programs are required to complete a “solo”.
A “solo” is an extended period of solitary time, sometimes
lasting for multiple days, in which each participant remains in one
location and cares solely for his or her own basic needs.
During this period, participants are encouraged to reflect on both
their physical and emotional lives. The
adolescents interviewed by Russell & Phillips-Miller (2002) reported
that solos were an important and beneficial part of their therapeutic
experience. One of the
participants said, “On the solo, I had, you know, me and 20 square feet
or whatever and that was all I had was my problems, so I faced them, dealt
with them” (p.427). The Wilderness
Itself. The
reasons for the success of wilderness therapy noted above are consistent
with accepted psychological theory, but there is more to wilderness
therapy than psychological and social forces.
It is hard to explain why people feel an uncanny sense of ease in
sharing stories, problems, or mysteries around a campfire.
Or why, “On one particularly rainy morning… a desert phlox, the
sound of a morning dove, would bring a kid to tears.
Why a stray comment made on the side of a mountain can change a
life” (Ferguson, 1999, p. 91). As
Williams (2000) notes, just being outside has a powerful therapeutic
effect, possibly because adolescents are not constantly reminded that they
are in therapy. Nature has humbling and insightful forces that can be used
as an effective therapeutic tool. Conclusion Wilderness
therapy programs have important societal implications and could
potentially help thousands of troubled teens that have been in and out of
traditional therapy, therapeutic boarding schools, and jail.
In fact, the number of adolescents who could benefit from
wilderness therapy is staggering. It
is estimated that one out of every five young persons has a mental health
problem, two-thirds of whom are not receiving effective treatment, and as
many as one out of every 33 adolescents is suffering from clinical
depression (Conner, 2000). Furthermore,
juvenile detention centers in the United States are filled with
adolescents who have been unsuccessfully treated in conventional treatment
programs, wasting valuable taxpayer dollars.
Wilderness therapy may provide a more effective treatment for
adolescents. Even
though participants and staff members of wilderness therapeutic programs
could list many reasons why wilderness therapy is effective, anecdotes do
not suffice. Further studies
need to be done on wilderness therapy, including a more rigorous
investigation of specific program components (including those discussed
above) that make wilderness therapy successful.
Results of such studies could facilitate the development of
improvements on current wilderness therapy programs, as well as provide a
solid basis for integrating successful features of wilderness therapy into
more traditional clinical treatment programs.
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