Wilderness Therapy: Description, Types, and Benefits

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Wilderness Therapy: Description, Types, and Benefits

THC Editorial Team April 3, 2022
St. Jerome in the Wilderness mid-16th century Attributed to Nicolò Boldrini (article on Wilderness therapy)
St. Jerome in the Wilderness mid-16th century Attributed to Nicolò Boldrini

Contents

Wilderness therapy has grown in popularity since the first wilderness therapy program was founded in 1988. This program was called the Aspen Achievement Academy and was located in Loa, Utah.1 This type of therapy is conducted outdoors and has been widely used with adolescents and young adults deemed “troubled”; many adolescents who attend wilderness therapy programs are referred from juvenile courts or have emotional and behavioral issues.2

What Is Wilderness Therapy?

Wilderness therapy, also referred to as outdoor behavioral healthcare, combines psychotherapy sessions and wilderness experiences. In wilderness therapy, program escorts take participants to remote areas, where they live in tents for several weeks or months while also receiving group therapy and participating in outdoor activities.3

There are many different wilderness therapy programs in the United States; they utilize a range of therapeutic modalities and are staffed by people with varying levels of education and experience. Because of the variety of programs and practices, it is difficult to use a single definition for this form of therapy.2 The concept of wilderness therapy broadly includes terminology like challenge courses, adventure-based therapy, wilderness experience programs, nature therapy, therapeutic camping, recreation therapy, outdoor therapy, and open-air therapy.4 The lack of cohesion likely contributes to the varied perspectives available in wilderness therapy research.2

Although these terms are generally used interchangeably, different sects of wilderness therapy typically vary in their approach. For instance, adventure therapy programs include physically and emotionally challenging activities and come with a level of risk.5 Therapists who work in these programs view risk as a beneficial clinical tool to help change problematic behaviors.5,6 Wilderness experience programs also offer camping experiences in the wilderness and group activities. However, they are a bit more informal and less based on psychotherapeutic theory—they are generally not overseen by licensed clinical psychologists or state agencies and usually don’t offer individual and group counseling sessions.5

A well-structured wilderness therapy program can include different therapeutic interventions, like group counseling, cognitive behavioral therapy (CBT), and the natural environment to help participants develop relationships, improve self-esteem and self-concept, and address maladaptive behaviors.2,7 Wilderness therapy is most frequently used for youths at risk for emotional disorders; the programs within wilderness environments are designed to give them the coping skills to manage the challenges they face in normal social circumstances.7,8

How Does Wilderness Therapy Work?

Wilderness therapy uses an outdoor milieu that is structured to provide a safe environment for clients to develop necessary coping skills. The therapists and clients’ caregivers often set goals for treatment, such as “better communication with parents,” to address maladaptive behaviors that cause problems in their lives.8 Depending on the intervention, the therapists might lead participants on expeditions and teach them “primitive” survival skills to challenge disruptive behaviors or beliefs to achieve transformative change.7

Wilderness therapy programs often also include individual and group counseling sessions. The counseling helps clients learn how to apply what they’ve learned in the wilderness to their communities, families, and day-to-day lives.8 Therapists teach participants relationship-building skills and how to respect boundaries. Clients also learn how to process and accept feedback from others while developing greater self-awareness and inner strength. Participants learn how to cooperate to achieve goals, which helps to build trust.5

Wilderness therapy can include group expeditions to facilitate teamwork and improve participants’ cooperation and trust. It also sometimes involves games to build the participants’ confidence and self-esteem. Adventurous activities, including hiking or rock climbing, might be incorporated along with multiple types of outdoor recreational activities.5

Phases of Wilderness Therapy

Wilderness therapy typically involves three distinct phases of treatment: a cleansing phase, a personal and social responsibility phase, and a transition and aftercare phase.8

Cleansing Phase

In the first phase of wilderness therapy, the client is removed from their home environment. This helps them break away from the environment that enabled their maladaptive behaviors. The program first “cleanses” with healthy meals, physical exercise, and basic survival and self-care skills. It strips away cultural stimuli like trendy clothing and music to allow the clients to learn essential lessons required for living in the wilderness.8

Wilderness therapists believe that the wilderness plays the most considerable role in this phase of treatment. It is an entirely new environment and evokes feelings of vulnerability and intimidation. The clients’ survival skills are limited, and they are without the comforts of home—or even typical society. Wilderness therapists posit that this is a compelling experience for clients.8

Personal and Social Responsibility Phase

Next, wilderness therapy harnesses interactions between clients and natural consequences to teach clients responsibility. Wilderness therapists do not enact punishments for failed tasks and missed lessons; they instead let nature provide a consequence. For instance, if a client refuses to learn how to set up a tarp properly, they will be unable to stay dry when it rains. Nature provides prompt consequences that help clients apply the same cause-and-effect thinking to their everyday lives. Just as they may not have listened when told to set up a tarp to avoid rain, clients may have balked at a counselor telling them the importance of staying in school so that they can more easily find employment. This consequence was too long-term for them to see easily. In the context of wilderness therapy, the consequence is quick and straightforward.8

Often, adolescents who display disruptive behavior lack social skills. Their antisocial behavior can often prevent them from forming relationships, which only causes and reinforces more antisocial behaviors. The wilderness therapy social system usually contains only six clients and three staff members. They are forced to communicate and interact to ensure safety from the various elements. The clients must learn appropriate social skills and cooperation for survival, which can translate back into their home environments.8

Unlike in the first phase, where the stark environment fostered an appreciation for the comforts of home and cultural items, the clients begin to miss and appreciate their family and friends during the second phase. The scarcity also promotes self-reflection in this phase, as there is little distraction.8

Transition and Aftercare Phase

As the program approaches its end, the clients learn to apply the skills they’ve acquired to their home environments. The therapists and clients reconsider their goals for treatment and use both one-on-one and group counseling sessions to develop plans and strategies for achieving them outside of wilderness therapy. For example, if a goal was to abstain from drugs or alcohol, the client’s plan might include attending weekly Alcoholics Anonymous (AA) meetings and individual counseling. Most wilderness therapy programs recommend placements in long-term programs like residential mental health facilities or emotional growth boarding schools following wilderness therapy.8

In this final phase, the clients feel physically stronger and healthier due to the intense physical activity, nutritious meals, and abstinence from addictive substances. They finally begin to appreciate the fresh air and simple life of the wilderness and find peace in nature. Their emotional health has also improved from professional guidance and the tendency toward reflection.8

Potential Benefits of Wilderness Therapy

Wilderness therapy can be used to treat people with a variety of different conditions and behavioral problems, including:

  • low self-esteem2
  • anxiety2
  • depression2
  • stress2
  • substance abuse8
  • anger issues7
  • poor emotional communication7
  • inability to cooperate with others7
  • inability to process interpersonal issues7

Wilderness therapy can help participants build healthy relationships and strengthen their relationships with their family members and friends.8 It can also help participants build self-confidence and increase their self-awareness and personal and social responsibility feelings.5,8 Participants in wilderness therapy programs learn new coping skills that can translate into other areas of their lives when they return from their programs.8

Effectiveness of Wilderness Therapy

The effectiveness of wilderness therapy programs varies; often, it is contingent upon program structure, therapy administration, and staff qualification. Well-structured, evidence-based wilderness therapy programs have shown efficacy in treating adolescents.

A 2016 meta-analysis by researchers from the University of Utah and Georgia College examined outcomes reported for wilderness therapy with 2,399 private-pay clients. They found statistically significant, medium-sized improvements in self-esteem, interpersonal and clinical measures, personal effectiveness, locus of control, and behavior.9

A 2012 study conducted by Keith Russell, a leading wilderness therapy researcher, and researchers from the University of Utah involved 189 adolescents with substance use disorders in wilderness therapy programs. They used questionnaires including the Youth Outcome Questionnaire Self-Report and the Adolescent Relapse Coping Questionnaire to find that wilderness therapy can be effective even when clients don’t want to change their behaviors at the start of treatment.10

Another study conducted in 2013 by researchers from Second Nature Wilderness Programs, a wilderness therapy program located in Santa Clara, Utah, examined the efficacy of wilderness therapy for 297 young adults. The researchers used data including responses to the discharge Outcome Questionnaire and found that, between the time of client intake and discharge, the participants showed statistically and clinically significant improvements in life effectiveness, motivation for therapy, therapeutic alliance, and attitude.11

Wilderness Therapy Criticism and Controversy

Despite its theoretical merit, the implementation of wilderness therapy programs has often been flawed. Some research touts the method’s effectiveness, but the research itself is lacking. The Outdoor Behavioral Healthcare Industry Council (OBHIC), formed in 1997 to share practices within the wilderness therapy industry, has spearheaded most of the research regarding wilderness therapy. Of the approximately 65 programs included in OBHIC, only about eight to 14% have participated in studies. These programs have demonstrated best-practice industry standards, but little information about the other OBHIC programs is available.2

In many wilderness programs, the wilderness or field staff far outnumber the clinical team, comprising trained mental health counselors. The field staff is often young, inexperienced, and given little training—and therefore unable to provide the therapeutic care that programs boast.2,12 Those who have attended wilderness therapy programs say they had little time with trained therapists and spent most of their time with the field staff.13

A lack of proper governmental oversight has allowed for some lapses in the treatment protocol. For example, a North Carolina wilderness therapy program called Trails Carolina earned citations in 2021 from the North Carolina Department of Health and Human Services. Although the facility is supposed to be inspected yearly, it had been over two years since this program was inspected. The program was cited for improperly administering medications, making physical improvements without state permission, and disallowing participants to call their parents. This program had been cited several times before, including for the mishandling of medications.13 Even when these facilities are inspected regularly, underlying issues can go unchecked. A 2018 inspection of Red Rock Canyon School in Utah noted some minor issues but missed the conditions that led to a riot just four months later.14

Unfortunately, these faulty inspections allow for abuse and neglect in many wilderness therapy programs. From the start, transportation to the program usually means that participants are taken from their beds in the middle of the night to “avoid resistance,” and sometimes placed in restraints, handcuffs, or electric shockers.1 They are denied access to basic hygiene—one former participant in the Trails Carolina program said they were once not allowed to shower for 17 days. Another, when denied access to a toilet, defecated in his pants and was forced to continue wearing the pants for two weeks.13 Security cameras at the Red Rock Canyon School showed teenage participants choked, thrown across a room, and pinned down for over 30 minutes by staff members.14 In a 17-year span, five adolescents died in wilderness therapy programs in Utah alone.1

Summary/Key Takeaways

Although there is some evidence that wilderness therapy helps adolescents with emotional and behavioral issues, there are considerable variations in treatment. Poorly executed wilderness therapy can cause trauma and even death. The theoretical basis of wilderness therapy has merit; research shows that it can be a helpful resource when executed properly and humanely, especially when followed by other mental health treatments. Increased oversight, training, and professional mental health staff are necessary for a safe experience.

References

  1. Monneron, E. (2021, August 28). Wilderness therapy. Breaking code silence. Retrieved February 12, 2022, from
    https://www.breakingcodesilence.org/wilderness-therapy/
  2. Becker, S. (2012). Wilderness therapy. In R. J. R. Levesque (Ed.), Encyclopedia of adolescence (pp. 3067–3074). Springer.
    https://doi.org/10.1007/978-1-4419-1695-2_387
  3. Harper, N. J., Magnuson, D., & Dobud, W. W. (2021). A closer look at involuntary treatment and the use of transport services in outdoor behavioral healthcare (wilderness therapy). Child & Youth Services, 42(2), 200–219.
    https://doi.org/10.1080/0145935X.2021.1938526
  4. Jong, M., Jong, M. C., Lown, A., Otto, H. R., & Schats, W. (2019). Mapping the concept, content and outcome of wilderness therapy for childhood cancer survivors: Protocol for a scoping review. BMJ Open, 9(8).
    https://doi.org/10.1136/bmjopen-2019-030544
  5. GoodTherapy Staff. (2016, January 3). Wilderness therapy. Good therapy. Retrieved February 15, 2022, from
    https://www.goodtherapy.org/learn-about-therapy/types/wilderness-therapy
  6. Fernee, C. R., Gabrielsen, L. E., Andersen, A. J., & Mesel, T. (2017). Unpacking the black box of wilderness therapy: A realist synthesis. Qualitative Health Research, 27(1), 114–129.
    https://doi.org/10.1177/1049732316655776
  7. Russell, K. C. (2001). What is wilderness therapy? Journal of Experiential Education, 24(2), 70–79.
    https://doi.org/10.1177/105382590102400203
  8. Hendee, J. C., Phillips-Miller, D., & Russell, K. C. (1999). How wilderness therapy works: An Examination of the wilderness therapy process to treat adolescents with behavioral problems and addiction. In W. T. Borrie, D. N. Cole, S. F. McCool, & J. O’Loughlin (Eds.), Wilderness science in a time of change conference (pp. 207–217). United States Department of Agriculture.
  9. Bettmann, J. E., Gillis, H. L., Speelman, E. A., Parry, K. J., & Case, J. M. (2016). A meta-analysis of wilderness therapy outcomes for private pay clients. Journal of Child and Family Studies, 25(9), 2659–2673.
    https://doi.org/10.1007/s10826-016-0439-0
  10. Bettmann, J. E., Russell, K. C., & Parry, K. J. (2013). How substance abuse recovery skills, readiness to change, and symptom reduction impact change processes in wilderness therapy participants. Journal of Child and Family Studies, 22(8), 1039–1050.
    https://doi.org/10.1007/s10826-012-9665-2
  11. Hoag, M. J., Massey, K. E., Roberts, S. D., & Logan, P. (2013). Efficacy of wilderness therapy for young adults: A first look. Residential Treatment for Children & Youth, 30(4), 294–305.
    https://doi.org/10.1080/0886571X.2013.852452
  12. Ochsner, N. (2021, May 24). ‘It’s beyond cruel’: Inside an N.C. wilderness therapy program for teens. WBTV Charlotte. Retrieved February 16, 2022, from
    https://www.wbtv.com/2021/05/24/its-beyond-cruel-inside-nc-wilderness-therapy-program-teens/
  13. Ochsner, N. (2021, August 30). New inspection finds more problems at wilderness therapy camp for kids, teens. WBTV Charlotte. Retrieved February 16, 2022, from
    https://www.msn.com/en-us/news/us/new-inspection-finds-more-problems-at-wilderness-therapy-camp-for-kids-teens/ar-AANUJV8
  14. Miller, J. (2020, November 22). Utah faces criticism for its light oversight of ‘troubled teen’ treatment centers. The Salt Lake Tribune.
    https://www.sltrib.com/news/2020/11/22/utahs-troubled-teen/

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