wilderness therapy

As many of you know I am drawn to alternative approaches to counseling and drug and alcohol rehabilitation. A very popular approach for “young people” is wilderness therapy. I believe the expansion of this modality could benefit many people; regardless of their age.

I am recycling a research paper from grad school in effort to stimulate some reflection on the utility of “wilderness therapy”. This paper will focus on wilderness and adventure based experiential therapy.

On the surface this appears to be a very broad topic area.  There are many descriptions and definitions of this type of experience.  Russell (2001) uses challenge courses, adventure based therapy, wilderness experience programs, and wilderness therapy as examples of a process where activity and experience are utilized to affect positive change in individuals.

One could broaden this even further and include wilderness base camping under this umbrella.  It is necessary to acknowledge all these titles in order to provide a comprehensive exposition.  At the same time, it seems appropriate to narrow my focus on a unifying description or name of the approach I will be exploring.

To this end I will utilize “adventure therapy” (Berman & Davis-Berman, 2001) as the base that guides this exploration.  I will seek to establish a clear definition of adventure therapy.

It is important that this delineation takes into consideration “the considerable debate” (Itin, 2001) that exists related to adventure therapy.  This requires an examination of the historical foundations of wilderness programming so that a framework for the debate can be established.  I will include an investigation into the qualities of staff and programs which employ adventure therapy as a means of more fully illuminating adventure therapy.

An important aspect of this essay includes a thorough review of the theoretical underpinnings of adventure therapy.  In addition, I will explore counseling theories and approaches which are applicable to adventure therapy.  Finally, I will use this forum as an opportunity to explore my reactions and position where adventure therapy is concerned.  I intend to propose a framework appropriate to adventure therapy that did not appear in the literature (stages of change theory).

“The use of adventure experiences as a programming tool formally began in the 1940s” (Priest & Gass, 2005).  Furthermore, the importance of experience in the arena of learning and human growth can be traced to the philosophy of Plato and Aristotle who championed experience as the answer to the question, “How can we best learn or teach?” (Kraft & Sakoss, 1985).

Therefore, we can see that the concept of experience, mentoring and on the job learning has existed within human culture for centuries.  However, experiential programming as it is known today finds its roots in the 1930’s and 1940’s with the development and promotion of the “Hahnian approach” which ultimately resulted in the establishment of Outward Bound.

Kurt Hahn became interested in the “social diseases or declines that he believed were causing individuals within society to lose certain positive attributes” (Nicholas, 2008).  Nicholas (2008) enumerates these societal ills along the following lines: a decline in physical fitness due to modern methods of transportation, a decline in initiative or enterprise due to a social tendency towards being a spectator rather than a participator, a decline in the individual’s memory and imagination because of confusion and restlessness in modern life, a decline in skills and care because traditions of craftsmanship had diminished, a decline in self-discipline from an over-reliance on ubiquitous stimulants and tranquilizers, and a decline in human compassion because of the hurried lifestyle inherent to a modern lifestyle.

In response to this Hahn began Outward Bound as a program for youth, many of whom were destined for the armed services (Priest & Gass, 2005).  Hahn and his colleagues designed physically and mentally challenging courses that encouraged the youth involved to push themselves and work together toward identified goals.

Original Outward Bound courses included orienteering, search and rescue training, athletics, small-boat sailing, ocean and mountain expeditions, obstacle-course training and service to the local communities (Miner as cited in Priest & Gass, 2005).

Today’s Outward Bound programming has become even more varied and includes “long wilderness courses, urban education programs, short intense challenge training’s, or even custom courses designed to the needs of the client” (Nicholas, 2008).

Outward Bound does not equal adventure therapy, however, it has been widely accepted as the foundation of the movement that has lead to adventure therapy’s growth.  In addition, much of the philosophical foundation of Outward Bound can be generalized to adventure therapy and wilderness experience programs.

It is clear that Hahn felt that the in the moment experience associated with challenging outdoor activities could provide a way to overcome many of the ills of society.  Although he did not articulate this in a systematic clinical manner it is evident that his position is very similar to the foundations which exist today regarding the experiential framework of adventure therapy.

Over time Outward Bound expanded and other outdoor based programs took root.  These programs included the National Outdoor Leadership School (NOLS) established in 1965, Project Adventure established in 1971, and the Wilderness Education Association established in 1977 (Nicholas, 2008).

Nicholas (2008) reports that there were over 190 adventure based programs in the United States by the mid nineteen seventies.  These programs were established to provide various services including “therapy, recreation, and education” (Attariran as cited in Nicholas, 2008).  Despite the diversity of the mission there remained the underlying principle of outdoor, experiential based interventions as a means of initiating positive change.

Another noteworthy development in the wilderness programming realm was the development and formalization of wilderness base camping as a means of helping at risk youth.  Again, the challenge and intensity of the experience is the focal point of the process.  However, wilderness base camping involves the added dimension of daily residential life in a wilderness setting.

This provides incredible opportunity for activity intensive experiences, ranging from construction of living facilities to recreational activities and educational responsibilities.  This is accomplished through an intimate and intense group process: “The heart of wilderness camping is the structure of small groups process in the out-of-doors” (WRTCA).

Wilderness base camping provides a ready example of the processes deemed helpful in the area of outdoor programming.  In addition to the here and now experience, examples of these benefits include increase in self-worth, improved problem-solving, improved social judgment and interpersonal skills, and increased assertiveness and leadership skills which can be generalized to resisting negative peer influences.

Although wilderness experience programs cannot be distilled merely to Outward Bound and Wilderness Base Camping models alone, these paradigms provide a useful framework for understanding wilderness experience programs in general.

As previously mentioned, the experience is a fundamental and essential aspect of all wilderness experience programs.  It seems appropriate to discuss this aspect of the process in more depth.  The concept of experience is not unique to wilderness programming.

Many therapeutic and educational approaches promote the power of the experience.  In the case of education this is seen as a pragmatic and productive manner of working with students.  The idea of experiential education can be traced back to John Dewey who proposed that “subject matter should not be learned in isolation and that education should begin with student experience and should be contextual” (Breunig as cited in Nicholas, 2008).

Related to clinical underpinnings one need look no further than Fritz Perls and gestalt therapy to see the centrality of the experience in the therapeutic process.  Wagner-Moore (2004) describes the “processes underlying gestalt” as the “experience/contact cycle”.  The gestalt therapist provides a setting where the client is challenged to confront “unfinished business” with the intent of creating a here and now experience that is then processed by the therapist (Wagner-Moore, 2004).

The result is increased awareness and insight.  What is important for the gestalt therapist is processing what is happening right now rather than discussing what may have happened in the past.  This is very similar to the goal of the adventure therapist.  Different techniques (ie…physically and emotionally challenging outdoor programming) are utilized to create “client disequilibrium” (Fletcher & Hinkle, 2002).

This disequilibrium can be thought of as “a state of dissonance (which) is crucial for client change” (Fletcher & Hinkle, 2002).  A common term associated with this eventuality is “taking a client out of his or her comfort zone” (Fletcher & Hinkle, 2002).  Many times this situation provides an opportunity for the adventure therapist to use the here and now experience to encourage increased awareness, insight and possible change.

In addition to gestalt theory there are other clinical applications that should be discussed related to adventure therapy.  On its most basic level adventure therapy involves both individual and group sessions.  Individual sessions involved one-to-one interaction centering on the task at hand and the associated issues.  The adventure therapist needs to be able to develop trust to facilitate a productive therapeutic relationship much the way a traditional therapist does.

However, it should be noted that there are unique aspects associated with the therapeutic relationship.  For example, the amount of time and intensity of experience challenges the traditional view of professional boundaries (Fletcher & Hinkle, 2002).  “The primary individual counseling theories are cognitive, rational emotive, and reality” (Fletcher & Hinkle, 2002).

Fletcher and Hinkle (2002) explore the details of these theories as they play out in adventure therapy: cognitive theory use the adventure experience to highlight cognitive processes and the resultant feelings and behaviors which manifest themselves through interactions and self-talk; rational emotive theory takes center stage related to apparent danger associated with the experiential activity which can be used to challenge the client regarding existing perceptions of real versus perceived risk; reality therapy capitalizes on the natural and logical consequences which are ever-present in the adventure based activity.

At is core, however, adventure therapy relies on the experience in itself as the catalyst to raise awareness and insight and influence change. In most cases the modality of service delivery is group sessions.  The group is central to the experience.

The adventure therapist usually leads a group through the expedition or trek and typical group issues are magnified through the out-door setting.  Groups typically progress through clear stages which have been identified in a variety of ways.

One of the most useful has been developed by Tuckman and Jensen in 1977 (Priest & Gass, 2005).  Tuckman and Jansen used the following to describe group development:  forming is characterized by the discomforts, concerns, feelings, and doubts group members experience in a new group.

This is the initial stage of group formation; storming follows and occurs when members begin to question the group process and authority of the group.  There is growing comfort but overall the group remains unstable and potentially volatile; norming involves the establishment of appropriate and necessary standards for the group.

There is a greater sense of order and the members are generally comfortable with each other; performing arises when the group is focused on the task at hand.  Members concentrate on mutual support and the group is becoming very productive; adjourning involves closure and the end of the group.

Adjourning is also a period where the group can become restless as they struggle with appropriately closing relationships (Priest & Gass, 2005).  The experiential group provides extensive content and process opportunities for the effective facilitator.

At the same time the challenge inherent in the expeditionary aspect of adventure therapy requires a facilitator who can address and utilize the inevitable crisis states that may arise.  “Catching members in the act breaks the cycle of behavior, thoughts, and feelings by increasing awareness.  Awareness is the necessary precursor to change.  Awareness and insight are the goals attributed to group counseling experiences” (Corey as cited in Hill, 2007).

The wilderness experience and the associated stress and challenges provides innumerate situations that allow important issues to be highlighted: (1) here is what your behavior is, (2) here is how your behavior makes others feel, (3) here is how your behavior influences others’ perceptions of you, and (4) are you satisfied with the world you have created (Corey as cited in Hill, 2007).

The therapeutic factors that have been identified with group counseling include universality, altruism, group cohesiveness, and interpersonal and vicarious learning (Yalom, 1985).  It is clear how these elements can be translated to adventure therapy.

For example, during a trek everyone is equally involved in the expedition.  All share the same goal and responsibilities.  Everyone is truly in the experience together; it equals the playing field.  Another example, this one related to altruism, concerns the multitude of opportunities to assist other members.  One member may offer to share his or her water or assist in carrying a pack up a steep incline.

An effective adventure therapist will highlight all these occurrences as they arise.  Family counseling models have also been applied to adventure therapy (Fletcher & Hinkle, 2002).  Structural (Minuchin, 1974), strategic (Haley, 1987; Madenes, 1978), and systemic (Bowen, 1978) all have aspects that can be integrated into adventure therapy.

Structural theory drives assessment and restructuring the group’s transactional patterns, systems perspectives recognize that the individual’s actions influences the larger group or system, and strategic theory informs the use of intentional and planned activities to address presenting issues and concerns in the group process (Fletcher & Hinkle, 2002).

In addition to the clinical foundation an effective adventure therapist must have hard or “technical” skills (Priest & Gass, 2005).  This refers to the ability to manage the group in the wilderness and ensure the safety of all involved.  Priest and Gass (2005) conceptualize these technical skills on the generic and meta-skill level and clarify that the hard skills must be distilled down to the details related to each specific adventure activity.

For example, issues of risk management that apply to all adventure activities include weather interpretation, first aid, trip planning, physical fitness and mental awareness (Priest & Gass, 2005).   An adventure therapist must also have good leadership, problem-solving, decision making, ethical behavior, effective communication skills and experience based judgment (Priest & Gass, 2005).

These attributes apply across all the various experiential activities.  Examples of skills that apply to specific experiences include understanding and negotiating river crossings during back-packing outings, understanding movement techniques, chimneying, and counterforce belaying in top-rope climbing, and knowing snow climbing techniques for mountaineering (Priest & Gass, 2005).

What then constitutes a comprehensive and efficacious definition of adventure therapy?  This is a difficult question to answer as so much falls under the purview of adventure therapy.   The most effective manner of defining adventure involves a three level exploration.

On one level I will evaluate adventure therapy in comparison to other “wilderness experience programs” (Russell, 2001).  Secondly, I will explore adventure therapy as it relates to identified clients, approaches utilized, and intended outcomes (Itin, 2001).  Finally, I will address the characteristics of therapists and programs and associated issues such as degree held, certification and accreditation as a means of further differentiating adventure therapy from other outdoor experiences (Priest & Gass, 2005).

Adventure therapy can be understood when taken in context with other wilderness  experience programs (WEPs). These WEPs range from Outward Bound experiences to boot camps (Russell, 2001) and provide an opportunity to examine the differences across clearly defined domains.  Among these domains, Russell (2001) includes key components and wilderness dependency.  “Key components” refers to the elements that are required for a program to be considered adventure therapy.

“Wilderness dependency” is related to where the intervention must be delivered (Russell, 2001).  In the end there is a level of subjectivity associated with establishing a definition of adventure therapy.  At a certain point one must choose between the different positions in each domain.

Adventure therapy differs from other WEPs in many ways.  Key components of adventure therapy include the use of planned expeditions with the intention of challenging small groups as they move from place to place in a self-sufficient manner.  Examples of expeditions include back-packing, canoeing, rock climbing and caving (Crisp as cited in Russell, 2001).

Adventure therapy utilizes clinical assessment in the process of selecting candidates for involvement, treatment planning is part of the programming, and the provision of group facilitation is conducted by qualified professionals (Davis-Berman & Berman as cited in Russell, 2001).  Russell (2001) also cites the following unique aspects of adventure therapy.

Adventure therapy programs are licensed when appropriate and possible and the program is supervised by licensed practitioners.  The clients have contact with licensed therapists in group and/or individual sessions.  The adventure therapy program has staff which specialize in clinical areas (for example substance abuse counselors) and staff which are trained in managing the specific population they serve.  It is not necessary that all staff are trained and certified clinically but the program must be managed by such staff.  The appropriate degree and certification depends on the clientele being served.

The adventure therapy profession has not defined specific degrees required for service delivery.  The existing requirements for credentialing in the behavioral fields should be generalized to adventure therapy.  For example, if the adventure therapist is working with substance abuse clients in the state of Pennsylvania he or she should hold a degree and certification consistent with the regulations of the Pennsylvania Department of Health Bureau of Drug and Alcohol Program Licensure staffing requirements.

Wilderness dependency is an interesting question.  For purposes of my definition adventure therapy must take place in the outdoors.  The naturally occurring events involved with being in the wilderness provide the bedrock of adventure therapy.  Clientele appropriate for involvement in adventure therapy vary widely.

The most common group targeted for adventure therapy is “at risk youth” or adolescents with emotional and behavioral problems.  However, the Association for Experiential Education (1998) in the publication Exploring the Boundaries of Adventure Therapy: International Perspectives provides a more comprehensive account of clientele appropriate for involvement in adventure therapy.  These include “offenders and sexual perpetrators, mental health concerns, and families” (Association for Experiential Education, 1998).

Substance abusing clients and victims of abuse, trauma and disease have also been identified as appropriate for adventure therapy (Fletcher & Hinkle, 2002).

It is easy to see that defining adventure therapy is a difficult task.  However, I will boil it down to the following elements.  Adventure therapy must include a clinical component, at the very least at the level of supervision, preferably at the level of direct practitioner.

Adventure therapy must operate within an articulated framework and the experiences must intentionally target a desired goal and change.  This necessitates assessment and treatment planning.  Adventure therapy is appropriate for a variety of clients whom would typically be served in traditional settings.

Staff facilitating the experience should meet staffing requirements consistent with the realm in which the program operates.  Finding qualified adventure therapists is a challenge.  The ideal candidate has the education, training, and qualifications to provide clinical services and wilderness experience that ensures the safety of all involved.  This is an uncommon combination.  It represents an ideal and programs should work toward this ideal.

Choosing adventure therapy as a topic for my paper was not a difficult decision.  Due to my professional experiences I have come to embrace adventure therapy.

I am the director of an inpatient drug and alcohol rehabilitation center for court ordered youth.  I am responsible for the on campus delivery of services.  However, these clients also participate in expeditions while they are in the program.

This element of the program is supervised by another director who has a background as an adventure therapist.  He meets all of the expectations described above and is very accomplished in the area of adventure therapy.  My involvement in the process includes selection of candidates for the expeditions, clinical supervision of the wilderness addiction counselors, establishment and review of goals pre-trip, and review of progress/concerns post-trip.

I have participated in tripping (expeditions) on a very limited scale.  However, I am very supportive of the experiential part of the program.  I have seen the positive results of adventure therapy in many clients.  Examining the topic of adventure therapy in more detail has only reinforced my position.  Along with course content, writing this paper has opened my eyes to aspects of adventure therapy that I was unaware of.

For example, an understanding of the theoretical orientations and foundations of adventure therapy has been very helpful.  At best the uninformed believe that adventure activities are positive and beneficial to those involved; at worst they equate it with boot camps and view adventure therapy as a punitive way of dealing with problematic youth.  Rarely is adventure therapy viewed as a true clinical intervention.

Having the ability to cite the ways in which well established therapeutic theory applies to adventure therapy helps in clarifying these claims.  As I dug into the existing research and literature the same counseling theories came to the surface; cognitive approaches, behavioral/reinforcement, rational emotive, reality therapy, family systems, and gestalt theory.

These theories are widely accepted in the therapeutic world and bring legitimacy to the practice of adventure therapy.  Researching this topic provides me with the basics for articulating the clinical benefits of adventure therapy.

At this point I would like to discuss a theoretical orientation that did not appear in the literature.  However, it provides a structure that seems to fit well with adventure therapy.  Stages of change theory (SOC), as developed by Prochaska and DiClemente appeared in prominence in the early 1980’s (Connors, Donovan, DiClemente, 2004).

Although the details of SOC are beyond the scope of this paper I will describe the fundamentals.  SOC holds that, when it comes to changing a problem behavior, people go through identifiable stages.  Furthermore, there are interventions and approaches that are more or less appropriate dependent of the assessed stage of change.

By maximize the use of appropriate interventions the clinician can help move a person through these stages toward a lasting behavior change.  Connors, Donovan, and DiClemente (2005) identify these stages as pre-contemplation, contemplation, preparation, action and maintenance.  Within each of these stages there are change processes that are either behavioral in nature, experiential in nature, or contain both behavioral and experiential elements.  This is where the application of SOC is most appropriate.

Behavioral processes involve things that a client can do to develop and support change.  For example, a client can attend 12-step meetings to support long term recovery and this falls under the behavioral process of “helping relationships” (Connors et al., 2005).  Experiential processes describe events or experiences that precipitate and promote the change.  For example, a client may receive feedback from peers during a group that forces him to take a honest look at his past behavior leading to a revelation that increases desire to change.  This experience falls under the experiential process of “self re-evaluation” (Connors et al., 2005).

The behavioral processes are as follows (Prochaska as cited in Connors, et al, 2005): stimulus control, helping relationships, counter conditioning, reinforcement management, and self liberation.  Adventure therapy could be viewed through this lens.  For example, for a chemically dependent client participation in the activity or expedition could access the behavioral process of counter conditioning as the client experiences a substitute activity that does not involve the use of substances.

Reinforcement management is applicable when rewards are accented to support positive efforts toward change and these types of opportunities arise daily during expeditions.  Experiential processes are even more prevalent.  These include (Prochaska as cited in Connors et al, 2005) consciousness raising, dramatic relief, environmental re-evaluation, social liberation, and self re-evaluation.

During a typical trekking experience the client will be stressed and challenged.  The resultant state of “disequilibrium” (Fletcher & Hinkle, 2002) promotes dramatic relief which is defined as reacting emotionally and having a cathartic experience.  The intimacy of the group provides ample opportunities for social liberation which occurs when the client realizes that society may support a change in his or her behavior because the group supports the change.  One could take each individual processes of change describe by Prochaska (as cited in Connors et al, 2005) and make a case that highlights it applicability to adventure therapy.

On a personal note, I will be participating in my initial trek June 10, 2009 thru June 17, 2009.

This will be a float trip in the back country of Canada.  We will put in at Lake Ogaseanane and make our way to into the interior of the nature reserve.  The location is in western Quebec near Kippawa.

I am staying out for a week only and it is likely that the group will remain longer.  I am, after all, a beginner.

I am doing this with very seasoned staff and I am looking forwarding to gaining a greater appreciation for the intensity and dynamics of an expedition.  I have come to believe that it is necessary to have a certain hands on understanding of the process if I am to effectively evaluate who may be appropriate for trip.  This is a direct result of this course and researching this paper.

Although I will be unable to be a true adventure therapist, my hard skills are very poor, I can take advantage of opportunities to increase my knowledge base.  For me developing the technical skills is much more intimidating than developing and implementing the soft skills.  I have limited exposure to the technical aspects of being in the outdoors.

It is evident that picking an area of interest and comfort is appropriate for developing technical skills.  For example, I feel that I could make progress as it relates to back-packing.  I am in decent physical condition and it seems that the technical skills associated with hiking are less complex than the skills necessary for other disciplines such as top roping or mountaineering.  I am in no way interested in learning the skills necessary for caving.  That is left for braver individuals.  I am, however, certainly interested in expanding my abilities in the area of adventure therapy and my work place provides built in opportunities to go out and play.

References

Alvarez, A., Stauffer, G. (2001). Musings on adventure therapy. The Journal of Experiential Education, 24, 85-91.

Berman, D., Davis-Berman, J. (2001). Critical and emerging issues for therapeutic adventure. The Journal of Experiential Education, 24, 68-70.

Burg, J. (2001). Emerging issues in therapeutic adventure with families. The Journal of Experiential Education, 24, 118-122.

Connors, G., Donovan, D., DiClemente, C. (2004). Substance Abuse Treatment and the Stages of Change: Selecting and Planning Interventions. New York: Guilford Press.

Fletcher, T.B., Hinkle, J.S. (2002). Adventure based counseling: An innovation in counseling. Journal of Counseling and Development, 80, 277-285.

Hill, N. (2007). Wilderness therapy as a treatment modality for at-risk youth: A primer for mental health counselors. Journal of Mental Health Counseling, 29, 338-349.

Itin, C. (1998). Exploring the boundaries of adventure therapy, International perspectives: Proceedings of the 1^st international adventure therapy conference: Perth, Australia. Boulder, Colorado: Association for Experiential Education.

Kraft, R., Sakofs, M. (date unknown). The Theory of Experiential Education, 2^nd Edition. Boulder, Colorado: Association for Experiential Education.

Nicholas, S. (2008). Outdoor adventure education. Research Starters Education.  Great Neck Publishing.

Priest, S., Gass, M. (2005). Effective Leadership in Adventure Programming, 2^nd Edition. New Hampshire: Human Kinetics.

Russel, K. (2001). What is wilderness therapy?. The Journal of Experiential Education, 24, 70-79.

 Wagner-Moore, L. (2004). Gestalt therapy: Past, present, theory and research. Psychotherapy: Theory, Research, Practice, Training, 41, 180-189.

Wilderness Road Therapeutic Camping Association: The Wilderness Camping Program Description. Retrieved 6/4/09 from http://www.therapeuticcamping.org/WRTCA-program.html.