Wilderness therapy

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Wilderness therapy, also known as outdoor behavioral healthcare, is a controversial treatment option for behavioral, substance, and mental health issues in adolescents.[1] Patients spend time living outdoors with peers. Most participants attend involuntarily. Reports of abuse, deaths, and lack of research into efficacy have led to controversy.


Backpackers at a wilderness therapy program

Wilderness therapy has been described as "challenge courses", "adventure-based therapy", and "wilderness experience programs".[2] A variety of theoretical orientations are used in wilderness therapy,[3] including mindfulness-based therapy and cognitive behavioral therapy. However, in the majority of wilderness therapy programs, teens spend most of their time living in tents in the woods with a group of eight to twelve peers.[4][5] Participants are accompanied by three staff members who are not trained as therapists and work for minimum wage, who are responsible for their day-to-day activities.[4]

About half of wilderness therapy participants attend involuntarily and are transported by services specialized for “uncooperative” youth.[1]

Madolyn Liebing first proposed combining clinical therapy with wilderness programming.[5]

Generally, therapeutic wilderness programs cost upwards of $30,000 or more for a child’s three-month stay.[4] Few clients receive financial assistance from medical insurance.[6] Insurance companies have long refused to pay for wilderness therapy, contending that the programs are not covered by insurance policies because they take place outdoors.[7]


Allegations of abuse, deaths, and lawsuits[edit]

Abusive situations have been reported and several children have died in wilderness therapy programs. Many participants also say that they are left with lifelong trauma from the experience.[8]

In Utah, two teens died in 1990 while enrolled in wilderness therapy programs.[9] Both of their deaths were related to heatstroke on hikes.[9] Aaron Bacon, age 16, died in 1994, while enrolled in a wilderness program in Utah. He was three weeks into a 63-day wilderness trek when he died of peritonitis and a perforated ulcer.[9] Several staffers were charged with felony neglect and abuse of a disabled child.[9]

In 2001, a teen at the Catherine Freer Wilderness Therapy program died of heatstroke and dehydration while on a hike the day after she had arrived.[10] Another fourteen-year-old in the Catherine Freer Wilderness Therapy program died in 2003 when a tree fell on the tent that he was sleeping in.[10]

Maia Szalavitz, author of the 2006 book Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, has concluded that many of the tactics that wilderness-therapy programs use are no different than those used at Guantanamo Bay.[10] Szalavitz has documented cases of emotional and physical abuse, and the withholding of food, water, and sleep.[10]

In October 2007 and April 2008, the United States Government Accountability Office convened hearings to address reports of widespread and systemic abuse in adolescent treatment facilities. In connection to the hearing, they issued a report about the wilderness therapy industry.[11][12] The Federal Trade Commission has published a list of questions for parents to ask when considering a wilderness program.[13]

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.[14]

Staff qualifications[edit]

Most wilderness programs advertise themselves to be therapeutic.[citation needed] In some programs, licensed mental health personnel are not employed to work directly with participants,[15] with programs instead hiring licensed mental health personnel as consultants or in other roles.[15]

To be licensed in the counseling field, one must possess at least a master’s degree in counseling, but much of the time these counselors are individuals without even a bachelor’s degree. Some programs report having no licensed mental health professionals on staff.[16] As a result, mental health emergencies and other related issues can become more serious.[citation needed] Some have argued that it is unethical for programs serving “high-risk” youth to deliver therapeutic services using less than professionally trained and credentialed mental health staff.[15]

Some researchers have argued that national standards should be created with respect to the training, formal education, and licensure in therapeutic wilderness programs.[15] Wilderness programs are not required to employ licensed workers,[citation needed] and so the counselors may be unqualified to help adolescents in the programs to create therapeutic change.[15]

Limited and biased research[edit]

Although the wilderness therapy industry has tried for several decades to fill research gaps to bolster its case of effectiveness and reduce the need for legislative intervention, science still does not support wilderness therapy.[17]

Independent researchers have called into question the wilderness therapy industry's claims, expressing ethical concerns and criticizing its use of "bad science" due to methodological flaws in the research.[18] Given the proliferation of such programs, relaxed regulation, and absence of research setting uniform standards of care across programs, advocates have called for increased accountability to ensure programs are capable of providing care that is consistent with their marketing claims.[11]

Some programs which advertise as "wilderness therapy" are actually boot camps similar in style to military recruit training in a wilderness environment.[19] These can sometimes be distinguished from other wilderness therapy by such programs promising behavior modification for troubled teens.[20]

One of the major differences between military style 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). Incidents of alleged and confirmed abuse and deaths of youths have been widely reported across many wilderness programs, despite claims that these programs provide a less coercive environment than that of boot camps.[21]

Therapeutic wilderness programs have no outcome data to support the effectiveness of these programs,[15] and particularly the long-term effects of these interventions.[citation needed] One review concluded that until data demonstrates that therapeutic wilderness programs are safe and effective, these programs should not be a suggested treatment model for those struggling with their mental health.[22]

Lack of professional oversight[edit]

There is no governing body tasked with enforcing laws and regulating services provided by wilderness therapy programs.[citation needed] There are no national standards or state laws that regulate these programs.[23] Mental health standards are not enforced.[citation needed][clarification needed] This lack of oversight and responsibility puts these program participants in danger.[15]

After the program[edit]

After a wilderness therapy program, clients may return home or may be transferred to a therapeutic boarding school, young adult program, or intensive residential treatment center. Some estimate that 40% of children enrolled in wilderness programs are later sent to long-term residential behavioral care facilities.[24][needs update]

See also[edit]


  1. ^ a b Dobud, Will (2021-06-14). "A Closer Look at Involuntary Treatment and the Use of Transport Service in Outdoor Behavioral Healthcare (Wilderness Therapy)". Child & Youth Services: 1–20. Retrieved July 27, 2021.
  2. ^ Russell, KC (2001). "What is wilderness therapy?". Journal of Experiential Education. 24 (2): 70–79. doi:10.1177/105382590102400203. S2CID 144845914.
  3. ^ Gass, Michael A. (2012-04-27). Adventure Therapy. doi:10.4324/9780203136768. ISBN 9780203136768.
  4. ^ a b c Ochsner, Nick (May 24, 2021). "'It's beyond cruel': Inside an N.C. wilderness therapy program for teens". WBTV. Retrieved 31 July 2021.
  5. ^ 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.
  6. ^ 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. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)
  7. ^ Berr, Jonathan (June 27, 2017). "Should insurers cover wilderness therapy programs?". CBS News. Retrieved 31 July 2021.
  8. ^ Bastian, Jonathan (July 30, 2021). "'Almost everyone is left with trauma': The impact of American's unregulated wilderness teen therapy industry". KCRW. Retrieved 31 July 2021.
  9. ^ a b c d August, Ian (July 13, 2003). "Utah wilderness therapy deaths". Salt Lake Tribune. Retrieved 31 July 2021.
  10. ^ a b c d Silverman, Amy (November 5, 2009). "Losing Erica: Cynthia Clark Harvey Doesn't Want Anyone Else's Child to Die in a Wilderness-Therapy Program". Phoenix New Times. Retrieved 31 July 2021.
  11. ^ 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).
  12. ^ "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.
  13. ^ "FTC". 2009. Retrieved 2013-08-15.
  14. ^ 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. Archived from the original on 2021-12-21. Retrieved 2013-08-15.
  15. ^ a b c d e f g Davis-Berman, Jennifer; Berman, Dene S. (1993). "Therapeutic wilderness programs: Issues of professionalization in an emerging field". Journal of Contemporary Psychotherapy. 23 (2): 127–134. doi:10.1007/BF00952173. ISSN 0022-0116.
  16. ^ Russell, Keith; Gillis, H. Lee; Lewis, T. Grant (August 2008). "A Five-Year Follow-Up of a Survey of North American Outdoor Behavioral Healthcare Programs". Journal of Experiential Education. 31 (1): 55–77. doi:10.1177/105382590803100106. ISSN 1053-8259.
  17. ^ Bauer, Ethan (July 12, 2021). "Can the $300 million 'troubled teen' therapy sector be reformed by legislation and public pressure?". Deseret News. Retrieved 31 July 2021.
  18. ^ ASTART. "Dangers of Wilderness Programs". Retrieved 5 August 2013.
  19. ^ Conner, Michael. "Wilderness Therapy Programs and Boot Camps: Is there a Difference?". www.wildernesstherapy.org. Retrieved 2009-04-12.
  20. ^ Jeppson, Mayer (2008). "Characterization and Comparative Analysis of Adolescents Admitted to Therapeutic Wilderness Programs and More Traditional Treatment Settings". All Theses and Dissertations. Retrieved 2009-04-12.
  21. ^ Smith, Christopher (1998-06-10). "The rise and fall of Steve Cartisano". High Country News. Retrieved 2009-04-12.
  22. ^ Durr, Leila I. (March 2009). "Optimal Challenge: The Impact of Adventure Experiences on Subjective Well-Being". Journal of Experiential Education. 31 (3): 451–455. doi:10.1177/105382590803100319. ISSN 1053-8259.
  23. ^ Somervell, Julia; Lambie, Ian (2009-07-01). "Wilderness therapy within an adolescent sexual offender treatment programme: A qualitative study". Journal of Sexual Aggression. 15 (2): 161–177. doi:10.1080/13552600902823055. ISSN 1355-2600.
  24. ^ Russell, 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 2013-08-05.

Further reading[edit]

  • Kenneth R. Rosen (2021). Troubled: The Failed Promise of America's Behavioral Treatment Programs. Little A. ISBN 978-1542007887.