Wilderness therapy

Wilderness therapy (also known as outdoor behavioral healthcare) is an 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]

Backpackers at a wilderness therapy program

Overview

Wilderness therapy has had many definitions, typically involving the use of traditional therapy techniques mixed with group therapy out in a wilderness setting, approached with therapeutic intent. Wilderness therapy has been described as "challenge courses", "adventure-based therapy", and "wilderness experience programs".[3] A variety of theoretical orientations are used in wilderness therapy,[4] including mindfulness-based therapy and cognitive behavior therapy. According to Russell 2003, Wilderness Therapy is a program for individuals who have not had success in psychiatric hospitals, rehabilitation programs, and out-patient treatment.

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.[5]

Interventions may consist of individual, group, or family therapy sessions, and can also include individualized treatment plans, medication management, and milieu-based care. Participants are encouraged to create reflections that make them in tune with themselves and nature.

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.[2] 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]

History

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.[5] The New York Asylum and the San Francisco Agnew Asylum played an early role in the development of wilderness therapy.[6]

Controversy

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.[7] Given the proliferation of such programs, lax 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.[8]

Some programs which advertise as "wilderness therapy" are actually boot camps similar in style to military recruit training 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 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.[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

In October 2007 and April 2008, the United States Government Accountability Office convened hearings to address reports of widespread and systemic abuse. In connection to 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

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.[20]

gollark: It isn't really self-aware.
gollark: What? I did ages ago.
gollark: In case of my death, control of my github account goes to a GPT finetuned on my code and Discord messages.
gollark: I actually once won a chess game.
gollark: Fine, submerge the entire room in superglue.

See also

References
  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. 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 requires |journal= (help)CS1 maint: multiple names: authors list (link)
  3. Russell, KC. "What is wilderness therapy?". Journal of Experiential Education. 24 (2): 70–79.
  4. Gass, Michael A. (2012-04-27). Adventure Therapy. doi:10.4324/9780203136768. ISBN 9780203136768.
  5. 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. Williams, Bryant (2000). "The Treatment of Adolescent Populations: An Institutional vs. a Wilderness Setting". Journal of Child and Adolescent Group Therapy. 10: 47–56. doi:10.1023/A:1009456511437.
  7. ASTART. "Dangers of Wilderness Programs". Retrieved 5 August 2013.
  8. 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". All Theses and Dissertations. 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 2019-08-01.
  14. "The Problem". 2013. Archived from the original on 2013-11-23. Retrieved 2013-11-23.
  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. 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.
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