Wilderness therapy is a complementary therapy model which stimulates behavioral and mental changes in adolescents with certain mental illnesses by exposing them to natural challenges in a non-critical natural environment – the wilderness.
Wilderness Therapy: What is It?
Wilderness therapy, also known as outdoor behavioral healthcare, is a form of therapy which uses expeditions into the wilderness or another strange environment, free of negative influences, to help address an individual’s psychological and behavioral disorders. This model of psychological therapy combines elements of experiential learning with individual and group therapy in an outdoor location. While this form of treatment may be used for patients across all age groups, it is primarily used for at-risk adolescents and young adults.
Wilderness therapy is a subdivision of adventure therapy, however, both of these forms of therapy have different approaches. In wilderness therapy, individuals learn healthier behavioral patterns and achieve improvement in their symptoms through the use of primitive skills in the wilderness. The activities engaged in this form of therapy usually do not pose any risk to the clients. Adventure therapy, on the other hand, involves using psychologically and physically challenging outdoor activities which are often risky.
The concept of using expeditions to strange places to treat mental illnesses began in the early 1900s when 40 patients in psychiatric wards at the Manhattan State Hospital were relocated to the lawns of the facility after they contracted tuberculosis. After this event, the patients showed dramatic improvements in their mental as well as their physical health. This improvement in their symptoms was ascribed to their new outdoor location.
Five years later, in 1906, an earthquake occurred near the San Francisco Agnew Asylum causing serious damage. In this event, the doctors and nurses noticed that residents who were relocated outdoors as a result of the earthquake reported sharp improvements in their symptoms almost immediately. Now, there are more than 100 wilderness therapy programs engaging more than 10,000 clients every year.
Wilderness Therapy Theory
The concept of wilderness therapy is based on a theory that exposing patients to their behavioral problems with therapy activities in an unfamiliar setting encourages the development of social skills and a healthy self-esteem. Exposing patients to familiar interpersonal problems in an unfamiliar setting may provide deeper insight into the patient’s problems and by overcoming these challenges in the wilderness, patients may develop skills and courage to face similar real-world issues.
Wilderness therapy employs various techniques to achieve behavioral modification in clients. These include assertiveness training, open communication between therapist and patients, and group therapy. Wilderness therapy avoids negative influences such as confrontation, blame, and force which impede improvement in patients.
How does Wilderness Therapy suggest the Mind Works?
Wilderness therapy employs principles of exposing patients to a series of increasingly difficult tasks to help them learn coping skills and develop a healthy self-esteem from overcoming those simulated challenges.
These activities engage patients on cognitive, behavioral, and affective levels, stimulating them. Therefore, outdoor behavioral therapy is based on the concept that the mind develops itself upon exposure to challenges. Another principle on which wilderness therapy is based is the positive effect physical health and nature has on an individual’s mental health.
How Does Wilderness Therapy Cause Change?
Wilderness therapy provides clients with a secure, supportive, and criticism-free environment for self-expression and self-discovery. Through the challenging activities in the wilderness, clients gain insight into the maladaptive behavioral patterns that led to their negative life experiences and help them learn coping skills to overcome them. The wilderness expeditions will also help the patients challenge disruptive beliefs and engage in team-building activities.
The challenges provided in wilderness therapy simulate the real-world challenges in the family and other social settings but present them in a non-critical environment. The clients work in teams to help them complete the tasks. Through the individual and group therapies offered in this outdoor setting, as well as the physical activities they engage in, the clients learn how to build healthy social relationships, create personal boundaries, and develop their sense of self and purpose.
What Happens in a Wilderness Therapy Session?
The first step in a wilderness therapy session is the stage of opening up/assessment. In this stage, therapists conduct a vigorous evaluation of the client’s cognitive, affective, and behavioral states. Clients also open up about their internal struggles, past negative life experiences, and emotional states to enable the therapist to gain insight into the cause of the problem. Once the patients have been thoroughly evaluated, they are assigned into various groups and the therapy is tailored to the nature and degree of their concerns.
After the initial period of evaluation, the therapists are matched with a group of adolescents with similar issues, and the clients engage in group discussions where they discuss their experiences, emotional struggles, and their journey to recovery. Patients also undergo individual therapy where the therapist learns about their treatment progress and gains a deeper insight into the clients’ learning process. Some adolescent groups may comprise persons of the same gender, while others combine both male and female clients. These young adults remain in each group, living together, and tackling their tasks together throughout the duration of the therapy. The average duration of wilderness therapy is eight to 12 weeks.
Therapy using this model may be in an individual or group setting. Individual therapy helps build trust with the therapists, to promote honesty and a free flow of communication. Individual therapy sessions also provide therapists with a deeper understanding of their internal struggles, as well as the negative personal or family dynamics which may be promoting such dysfunctional patterns. In group sessions, therapists educate the group about such topics as emotional control, healthy communication, self-esteem, wisdom, and a positive outlook on life. Group therapy helps the clients feel safe in themselves, receive and give support to other team members, and develop healthy interpersonal relationships.
Generally, these adolescents pass through (i) an avoidance stage where they tend to avoid discussions with others or attempts at completing tasks, (ii) a learning stage where they begin to develop new social skills which, in turn, build their self-esteem, and (iii) a final stage where they fortify newly-formed healthy thought and behavioral patterns.
Therapists say that the longer the duration of stay in wilderness therapy, the greater the level of improvement in the client’s symptoms. This is because of the absence of distractions and escape hatches, such as video games or hiding in the room, in the wilderness. A long duration of wilderness therapy provides ample time to break down the client’s defensive barriers and help them fortify their newly developed healthy relationships and behavioral patterns.
The physical locations used for wilderness therapy are often safe, with enabling factors including exposure to adequate natural light, provision of healthy food, and an environment which promotes adequate sleep.
Some therapists may involve families, couples, and adults in wilderness therapy sessions to prevent relapses which some young adults may develop after successfully completing the program. This is essential to eliminate the negative family dynamics which may impair further progress of the client or stifle the client’s new mental and behavioral patterns.
Techniques Used in Wilderness Therapy
Techniques used to achieve behavioral and mental changes in clients on wilderness therapy include certain activities such as expeditions, high adventure activities, problem-solving games, team building, outdoor education, structured daily activities, academic activities, and facing natural challenges. High adventure activities in wilderness therapy include rock climbing, rope courses, hiking, and zip line courses. These activities are designed to instill confidence in the clients by having them overcome these physical challenges. Expeditions include survival expeditions and discovery expeditions which, like problem-solving games, require teamwork and communication. These activities foster interpersonal communication and trust between the team members.
The staffs are also trained in communicating effectively with the patients to identify problems and provide appropriate solutions. They also conduct in-the-moment assessment of each client’s progress. The therapists measure their clients’ progress using a level system. The levels measure clients’ “soft skill” and “hard skill” performance. Hard skills are adaptive skills required to achieve personal and interpersonal well-being. Such skills include the ability to build a backpack, set up a campfire, or cook. Soft skills involve more cognitive skills such as leadership, self-knowledge, self-control, and respect for other people. Therapists assess their clients’ progress by how much of these skills they have learned and developed.
Does Wilderness Therapy Work?
Wilderness therapy, as a complementary form of psychological therapy, is very successful in helping an individual achieve a healthier emotional and mental well-being. The techniques of wilderness therapy help patients develop goals, build healthy self-esteem, build healthy relationships, and develop deep insight into their emotions, thoughts, and values. The key to the success of wilderness therapy is for the client to translate the strengths they develop during wilderness therapy to dealing with their everyday life experiences.
Reports on the effectiveness of wilderness therapy have been largely positive. These reports show that adolescents with mental health problems reported significant improvement in their symptoms when wilderness therapy was combined with conventional models of therapy such as cognitive behavioral therapy.
Some studies show that adolescents participating in wilderness therapy programs are less likely to engage in risky behaviors than adolescents who are not. In fact, studies reveal that the average American adolescent is twice as likely to visit an emergency room as an adolescent participating in a wilderness therapy program.
What Kinds of Concerns is Wilderness Therapy Best For?
Wilderness therapy is effective for the treatment of adolescents, teenagers, and young adults with eating disorders, anxiety disorders, obsessive-compulsive disorder, depression, substance use disorders, and addiction. It is also effective for treatment of children and adolescents with behavioral disorders such as oppositional defiant disorder, and other disorders characterized by aggression and impulsivity.
How are Wilderness Therapy Specialists Trained?
Wilderness therapy specialists are multidisciplinary experts with knowledge and skills in counseling, psychology, and experiential education. These specialists require a Bachelor of Science degree in psychology, recreational science, or other allied mental health disciplines.
To become a wilderness therapy specialist, these individuals are trained through a graduate coursework in mental health and adventure therapy, receiving licensure after completion of their training. These practitioners are trained to develop competencies and skillset which include wilderness or environmental science, interpersonal relationships, as well as some clinical knowledge. In the United States, the Association of Experiential Education (AEE) is the body responsible for establishing the standards of practice in adventure therapy.
Concerns/Limitations of Wilderness Therapy
Although wilderness therapy is a useful adjunctive therapy for several behavioral and emotional disorders, it has several limitations:
High Cost – Wilderness therapy programs are expensive, as some programs may cost as much as $500 per day for one to three months of therapy. This high cost may limit the access to these programs by potential clients who cannot afford treatment.
Age Limits – Wilderness therapy may not be suitable for the elderly and young children because of the huge physical and cognitive demands associated with this treatment approach.
Trauma – Clients who have experienced significant trauma or have trauma-related disorders, such as post-traumatic stress disorder, may not be suitable for wilderness therapy. If they participate, they must be placed under strict supervision.
Chronic Mental Health Issues – Wilderness therapy may be ineffective for treating patients with chronic mental health disorders such as schizophrenia and dementia.
Comorbidities – Clients with comorbid anxiety disorders including social anxiety or general anxiety disorder with a substance use disorder may not be suitable for wilderness therapy.
Important Practitioners in Wilderness Therapy
The pioneers in wilderness therapy include Ezekiel C. Sanchez at Brigham Young University, Steven Bacon, and Nelson Chase at Colorado Outward Bound School. However, Madolyn M. Liebing was the first clinical psychologist to incorporate wilderness programs into clinical therapy.
How to Find a Therapist
It is essential to take precautions in choosing a wilderness therapy program. Some of the factors you should consider include the cost, intensity, and schedule of the wilderness activities, duration, services offered, duration of the therapy, and follow up care. The following should also be considered in choosing a wilderness therapy program:
- Safety of the operational structure
- Available equipment and skilled staff overseen by a licensed mental health professional (LMHP)
- Licensure and training of staff.
You may seek advice from a mental health professional or check through directories of local wilderness therapy programs to choose the right one for you.
What Should I be looking for in an LMHP?
An LMHP should have the following attributes:
- Certified in wilderness therapy by the appropriate body.
- Empathy and patience in dealing with you and ensuring you move through the stages of recovery effectively.
- Knowledgeable in offering the required services for the success of your wilderness therapy.
Questions to Ask a Potential Therapist
You need answers to the following questions before registering for a wilderness therapy program:
- How will this form of therapy work for my child?
- What is the process for this therapy?
- For how long have you run this program?
- What physical conditions will students be subjected to?
- What is the average length of stay in this program?
- What and how will they be fed during their stay?
- What safety measures are in place?
- What hygiene measures are instituted for students?
- How will your clinical staff deal with students who are combative or not willing to learn?
- Is the family going to be involved?
Final Thoughts on Wilderness Therapy
Wilderness therapy is an effective therapy which is useful for the treatment of substance use disorder and several types of behavioral and emotional disorders, particularly, in teenagers and adolescents. This model of therapy aims to place these clients in a non-critical environment where they can overcome natural challenges and develop healthier self-esteem and social relationships.