Wilderness therapy

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Backpackers at a wilderness therapy program

Wilderness therapy (also known as outdoor behavioral healthcare) is a controversial adventure-based therapy treatment modality for behavior modification and interpersonal self-improvement, combining experiential education, individual and group therapy in a wilderness setting. The success of the Outward Bound outdoor education program in the 1940s inspired the approach taken by many current-day wilderness therapy programs, though some adopted a survivalist methodology.[1] Young individuals aged 12-17 are the most frequent clients.[2] Wilderness Therapy, according to Russell 2003, is a program for individuals who have no had success in psychiatric hospitals, rehabilitation programs, and out-patient treatment.

Overview[edit]

Wilderness Therapy is defined by taking traditional therapy techniques and mixing it with group therapy out in the wilderness setting that is approached with therapeutic intent, Powch, 2004). Through this form of therapy, participants are encouraged to create reflections that make them in tune with themselves and nature. WT has been defined and characterized in many ways. Rehabilitative outdoor-based approaches such as "challenge courses", "adventure-based therapy", "or wilderness experience programs(WEPs)", are often used interchangeably to describe "Wilderness therapy (Russell 2001)." These programs typically consist of 8-12 members that run on a 7-8-week schedule where licensed mental health professionals take clients out into the wilderness.[3]

In WT therapist use a varied amount of theoretical orientations.[4] These orientations include mindfulness-based therapy and cognitive behavior therapy. These therapies often use the come common therapeutic intervention approach. These interventions are individual, group, or family therapy. Finally, the last type of therapy that therapist may use is the common approaches. The common approaches are individualized treatment plans, medication management, and milieu-based care.

The price of a wilderness therapy program is expensive, sometimes averaging $325 dollars per day with only 40 percent of clients receiving financial assistance from medical insurance.[5] More clients may receive co-pay assistance in the future if Wilderness Therapy programs receive accreditation from national agencies and then receive recognition from insurance companies.[2]

Pioneers in the Industry[edit]

The pioneers in the field of wilderness therapy include Larry D. Olsen and Ezekiel C. Sanchez at Brigham Young University; Nelson Chase, Steven Bacon, and others at the Colorado Outward Bound School; Rocky Kimball at Santa Fe Mountain Center. Madolyn M. Liebing, Ph.D. (of Aspen Achievement then, and currently of Journey Wilderness) was the first clinical psychologist to integrate clinical therapy with wilderness programming.[3] The New York Asylum and the San Francisco Agnew Asylum played an early role in the development of wilderness therapy.[6]


The CHANGES AND GRABBS model[edit]

Before entering the wilderness, therapist use assessments to understand each individuals needs and to figure out how to make WT beneficial to them. They also use these models to give a baseline to the therapist on if these programs are meeting the individual or group’s needs, goals, and self-efficacy. These models also give the therapist ideas on what activities to have the group complete to be able to build their teamwork, trust, communication, and more. The first model used by therapist is called the CHANGES model (Gass & Gillis, 1995), which leads to the experiential wave model of Alvarez and Schaeffer (2001). Then after these models comes the GRABBS model (Schoel, Prouty, and Radcliffe, 1988).

The CHANGES model[edit]

The CHANGES model is a "helpful way to organize interactive steps to acquire information and reflect upon it to enable the development of functional client change [7] In this process there are seven steps which are: Context, Hypothesis, Action, Novelty, Generating, Evaluation, and Solution. In an adventure therapy assessment there are three elements which are Diagnosis, Design, and Delivery.

In the first step of the CHANGES model the therapist figures on the context by acquiring all of the background information of the client groups. They focus on figuring out the groups strength, goals, drug/alcohol history, what their experiences are, and how long they have been in the WT programs. This stage will be able to help therapist focus on meeting the groups needs and to figure out how to beneficially help the group.

The next stage in the model is the hypothesis and this is when the therapist makes plans based on what the expected behavior of the group might be. These are test through engagement in adventure experiences. "The Wampum experience was used to see if the group could maintain their Composure with an activity that involved hitting one another[7] These experiences will be test out within the Residential Treatment center. Therapist ask many questions in this model which include; what kind of past experiences from the therapist do they bring to the group, and what questions do they want to test out.

The action stage is next in the CHANGES model. "Much of the material used for constructing change is obtained from the actions of the group members as they involve themselves in adventure experiences"[7] The idea of a never-fail kind of materials is used in this stage so participants can show their strengths and weaknesses without feeling discouraged. Some activities that can be used during this stage is mood ball and group juggle. In this model therapist might be thinking "Are Clients' actions congruent or in congruent with your hypothesis? Does initial hypothesis confirm, adapt, revise, or reject your thoughts? Can you engage clients in their motivation areas, not your own?[7]"

In the Novelty stage therapist try to find the true behavior of the participants by using spontaneity. By using spontaneity, therapists are able to identify the true issues of the group instead of the “Social Proper” ones. Therapist will also use projection with the client groups.

In the generating stage of the CHANGES model therapist observe many actions that the group present. They can identify functional and dysfunctional behaviors as well as concrete, abstract, distorted, or critical thinking patters. Also, therapist can determine the group’s appropriate or inappropriate affect. Many questions come into place in this stage like the groups beliefs, behavior patterns, how the behaviors make sense, and many more.

Next is the evaluation portion of this model. During this stage the hypothesis is brought back into play and is compared on how the group behaved overall. Also, during this stage feedback is given to the clients.

Finally, the last stage is the solutions. This is when the therapist evaluates the total group behavior and they are able to design solutions. They will find solutions that fit best to help the group’s needs, individual goals, and more.

To break this model down a little more, the context and hypothesis stage of the CHANGES model is when the therapist are diagnosing the problem/s. Then in the Actions, Novelty, and Generating stage the therapist is delivering this information. In the evaluating and solution stage, therapist is debriefing & departing.

Controversy[edit]

Given the proliferation of such programs, lax regulation, and absence of research setting uniform standards of care across programs, advocates have called on increased accountability to ensure programs are capable of providing care that is consistent with their marketing claims.[8]

Some programs which advertise as "wilderness therapy" are actually boot camps in a wilderness environment.[9] These can sometimes be distinguished from other wilderness therapy by such programs promising behavior modification for troubled teens, but it is hard to tell just from the ads.[10]

One of the major differences between boot camps and wilderness therapy is the underlying philosophical assumptions (wilderness therapy being driven by the philosophy of experiential education and theories of psychology and boot camps being informed by a military model). Additionally, most wilderness therapy programs have highly trained clinical staff either on the expedition or in active and ongoing consultation with the team. Boot camps may have no clinically trained staff working in the programs. Some staff members are from a correctional or military background. Nevertheless, incidents of alleged and confirmed abuse and death of youth, have been widely reported across many wilderness programs claiming to provide a less coercive environment than that of boot camps.[11]

Abusive situations have been reported and accidental deaths have taken place in some of these programs. The industry reports that deaths are extremely rare compared with similar outdoor adventure activities. These assertions cannot be independently verified due to inadequate regulation, poor monitoring, and a pattern of unreported deaths and state failure to prosecute offenders.[12][13][14][15][16]

There is also controversy over whether parents should be allowed to make their child attend a wilderness therapy program by force, as is often the case. Apart from the thousands spent on the actual program (around $500/day), some parents pay a teen escort company thousands to ensure their child gets to the program by any means necessary, without the child's consent or foreknowledge. Generally the "transfer" occurs at night, when children are disoriented. Due to the trauma and alleged harm reported by former wilderness program residents who have been forcibly escorted into placement, psychologists have heavily criticized this approach as inappropriate, and grossly inconsistent with establishing the necessary trust required for building a therapeutic relationship between youth and providers.[17]

Accountability[edit]

In October 2007 and April 2008, the United States Government Accountability Office convened hearings to address report of widespread and systemic abuse. In relationship with the hearing, they issued a report about the wilderness therapy industry.[8][18] The Federal Trade Commission has published a list of questions for parents to ask when considering a wilderness program.[19]

Programs seeking additional accreditation and certification often pursue partnerships and memberships with associations such as;

After the program[edit]

Independent researchers have called into questions industry claims, criticizing the industry's use of 'bad science' due to methodological flaws in the research and ethical concerns.[20]

After a wilderness therapy program, students may return home or may be transferred to a therapeutic boarding school, young adult program or an intensive residential treatment center. Some estimate that 40% of children enrolled in wilderness programs are later sent to long-term residential behavioral care facilities.[21]

See also[edit]

Notes[edit]

  1. ^ Davis-Berman, Jennifer; Berman, Dene S. (1 January 1993). "Therapeutic wilderness programs: Issues of professionalization in an emerging field". Journal of Contemporary Psychotherapy. 23 (2): 127–134. doi:10.1007/BF00952173.
  2. ^ a b C. Russell, C. Hendee, Phillips-Miller, Keith, John, Dianne (November 29, 1999). "How Wilderness Therapy Works: An Examination of the Wilderness Therapy Process to Treat Adolescents with behavioral problems and Addictions" (PDF): 26.CS1 maint: Multiple names: authors list (link)
  3. ^ a b White, W. (2012). "Chapter 2: "A History of Adventure Therapy"". In Gass, M; Gillis, L.; Russell, K. (eds.). Adventure Therapy: Theory, Practice, and Research. Routledge/Bruner-Mazel Press.
  4. ^ Gass, Michael A. (2012-04-27). "Adventure Therapy". doi:10.4324/9780203136768.
  5. ^ C. Russell, C. Hendee, Phillips-Miller, Keith, John, Dianne (November 29, 1999). "How Wilderness Therapy Works: An Examination of the Wilderness Therapy Process to Treat Adolescents with behavioral problems and Addictions" (PDF): 26.CS1 maint: Multiple names: authors list (link)
  6. ^ Williams, Bryant (2000). Journal of Child and Adolescent Group Therapy. 10: 47–56. doi:10.1023/A:1009456511437. Missing or empty |title= (help)
  7. ^ a b c d Cite error: The named reference :3 was invoked but never defined (see the help page).
  8. ^ a b GAO (2007). "Residential Treatment Programs - Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth, Statement of Gregory D. Kutz, Managing Director Forensic Audits and Special Investigations and Andy O'Connell, Assistant Director Forensic Audits and Specials Investigations, October 10" (PDF).
  9. ^ Conner, Michael. "Wilderness Therapy Programs and Boot Camps: Is there a Difference?". www.wildernesstherapy.org. Retrieved 2009-04-12.
  10. ^ Jeppson, Mayer (2008). "Characterization and Comparative Analysis of Adolescents Admitted to Therapeutic Wilderness Programs and More Traditional Treatment Settings". Retrieved 2009-04-12.
  11. ^ Smith, Christopher (1998-06-10). "The rise and fall of Steve Cartisano". High Country News. Retrieved 2009-04-12.
  12. ^ "Wilderness School Counselor Charged in Death of Camper". The Oregonian. 2000. Retrieved 2013-08-15.
  13. ^ "Loving Them to Death". Outside Magazine. 1995. Retrieved 2013-08-15.
  14. ^ "The Problem". 2013. Retrieved 2013-08-15.
  15. ^ Szalavitz, Maia (2008). "Under the Radar". Mother Jones. Retrieved 2013-08-15.
  16. ^ "Investigation Suggests Boy's Death a Homicide". KATU. 2009. Retrieved 2013-08-15.
  17. ^ Pinto, Dr Alison. "Congressional Testimony: Hearings on Residential Treatment Programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth". Committee on Education and Labor, House of Representatives. Retrieved 2013-08-15.
  18. ^ "Congressional Hearings on Child Abuse and Deceptive Marketing by Residential Programs for Teens". Committee on Education and Labor, House of Representatives. 2008. Retrieved 2013-08-15.
  19. ^ "FTC". 2009. Retrieved 2013-08-15.
  20. ^ ASTART. "Dangers of Wilderness Programs". Retrieved 5 August 2013.
  21. ^ Russell, Ph.D, Keith C. "Summary of Research from 1999 – 2006 and Update to 2000 Survey of Outdoor Behavioral Healthcare Programs in North America Outdoor Behavioral Healthcare Research Cooperative". ASTART. Retrieved 5 August 2013.

External links[edit]