Research update: the wilderness therapy trail: wilderness therapy can help provide personal growth and physical health benefits.

"The only real antidote is inside ... It is the skill and humor and courage within, the ability to build your own tires and find your own peace. On a solo trip you may discover these, or try to build them, and life becomes simple and deeply satisfying. The confidence and strength remain and are brought back and applied to the rest of your life" (Sutherland, p. 265).

As suggested in Sutherland's writing, individuals who seek inner strength, confidence or an antidote to the problems they face often turn to the wilderness as a place to receive therapy. Wilderness settings are an effective medium for therapy because they take people out of their everyday environment and place them in an unfamiliar setting where there is opportunity for reflection and the development of supportive relationships (Russell, 2000). Wilderness environments promote healing and personal growth because they serve as a place where individuals can learn and practice physical and emotional survival skills as they struggle to exist in this new environment (Friese, Hendee & Kinziger, 1998).

What is Wilderness Therapy?

Wilderness programs generally focus on providing experiences that lead to personal growth, therapy, rehabilitation, education, leadership or organizational development (Friese, Hendee & Kinziger, 1998). Wilderness therapy is distinguishable from general wilderness programs in that those focus on general therapeutic modes as a way to serve clients in need (Russell, 2001). Wilderness therapists employ a process whereby clients undergo an assessment to determine their specific needs, create a treatment plan outlining goals and objectives for each individual and conduct comprehensive evaluation of service outcomes (Russell, 2001).

Who is Being Served?

It is estimated that about 10,000 adolescents between the ages of 12 and 17 receive wilderness therapy each year (Cooley, 1998). The adolescents are provided services collectively on about 330,000 user days that generate about $60 million in annual revenue (Cooley, 1998). Adolescents are the most frequent participants in wilderness therapy programs because of the dramatic increase in emotional disorders and mental health issues experienced by this group (U.S. Department of Health and Human Services, 1999).

The adolescents who commonly engage in wilderness therapy include youth with psychological, emotional, behavioral, learning of substance abuse problems (Conner, 2005). Although it was once considered a "last-ditch" effort for individuals in need of treatment, wilderness therapy is now available at any time in the treatment process.

How are Programs Structured?

According to the Wilderness Therapy Treatment Network (Conner, 2005), there are about 56 programs in the U.S. that provide wilderness therapy. The programs are located throughout the country with a disproportionately large number located in the West and Southwest. Wilderness therapy programs use a number of natural areas including public and private land.

The administrative framework of programs also varies. Some programs are affiliated with a large corporation that operates multiple programs (Conner, 2005). For example, The Aspen Education Group, a corporation with headquarters in Cerritos, Calif., oversees the operation of eight programs located in five states. Other providers include state governments and independently owned businesses.

Wilderness therapy programs vary in the number and types of employees they hire. The professional preparation of employees also ranges considerably. Some staff, such as outdoor instructors, posses a bachelor's degree while clinically trained psychologists hold a doctoral degree. In a recent Research Update, Rosol (2000) concluded that wilderness therapists require a variety of competencies and skills including technical skills, (e.g., map and compass, belay systems), soft skills (e.g., interpersonal helping and leadership skills) and advanced skills (e.g., crisis intervention, transference techniques, psychotherapy and counseling).

While there is no one prescribed or set program format, wilderness therapy programs generally have several things in common. Programs are often long in duration, typically lasting a minimum of 30 days. The groups are intentionally small with a 2:7 or 3:8 staff-to-camper ratio.

Additionally, most program staff work with clients to develop treatment goals, and then teach the skills needed to independently facilitate recovery, and be less reliant upon staff. Most programs also rely upon the metaphors inherent to wilderness settings, and foster transference of the lessons learned during the program to life situations experienced at home (Bacon, 1983).

There are also frequent variances that exist in wilderness programs. Only a handful of states have legislation that establishes minimum standards of practice designed to ensure the physical and emotional safety of participants. Legislation governs a number of key areas including: staff qualifications, housing requirements, safety guidelines and meals. For example, in Utah, all campers must be provided with clean clothing on a weekly basis as well as a way to bathe at least twice a week (Division of Administrative Rules, 2001).

Unfortunately, it is difficult to determine which states have legislation impacting wilderness therapy programs because of variables in the language used to define such programs. Some legislation governs "outdoor youth programs" while others are under the umbrella of "residential child care."

Another variance involves whether contact with other individuals (e.g. family and friends) is allowed during the program. Some programs require and encourage parent and family interactions throughout the program while others do not. Lastly, programs vary in the amount of contact campers have with a licensed counselor or psychologist--interactions can range from once a week to daily.

What are the Outcomes of Services?

Research regarding the effects of wilderness therapy has generally found positive outcomes such as improved physical health, improved social skills and decreased antisocial behavior, and increased interpersonal adjustment (e.g., social skills, self control, self-esteem and school adjustments) (Russell, 1999; Wilson & Lipsey, 2000). There is concern, however, that the lack of methodology precludes our ability to clearly articulate the outcomes of services (Wilson & Lipsey, 2000). Nevertheless, research largely supports a trend toward positive effects from wilderness therapy.

In programs that use licensed medical guidance, there is a strong likelihood that wilderness therapy promotes increased strength, endurance and cardiovascular output, as well as a decrease in weight, anxiety, stress and sleep disturbances (Ewert, McCormick & Voight, 2001). There is even preliminary evidence to suggest that programs with intense physical components are more effective than less physically intense programs, and have a more long-lasting impact on overall quality of life (Wilson & Lipsey, 2000).

The physical demands of wilderness programs, when combined with nightly group therapy sessions and individual counseling, encourage positive social outcomes (Ewert, et al., 2001; Wilson & Lipsey, 2000; Russell, 2000). In programs that allow interaction with family members, clients experience an affirming change in communication because of their improved expression of opinions, listening and decision-making with group members (Ewert, et al., 2001).

Participants gain additional social value as they take advantage of leadership opportunities and act as an integral part of the group. Thus, by improving a participant's social skills, encouraging critical thinking and refining personality issues, wilderness therapy has the combined effect of reducing antisocial and delinquent behavior (Wilson & Lipsey, 2000).

In combination with improved social skills and improved relations with others, participants often experience an improved relationship with self. Russell (2000) contends that improved self-image stems from the vast amount of self-reflection available and time spent alone in wilderness settings. This solitude provides opportunities for individuals to evaluate and improve their self-concept and to develop a more realistic, positive perception of life events (Cason & Gillis, 1993).

The numerous challenges faced alone and with others, as well as the personal achievements experienced, promote the development of coping mechanisms that lead to increased self-efficacy and positive regard for self (Ewert, et al., 2001). Finally, individuals develop an overall appreciation for the environment and awareness of nature that encourages personal reflection and the development of a connection with ecology and natural processes (Russell, 2000).

Programming Implications

Practitioners interested in offering wilderness therapy programs to the community are encouraged to be mindful of several important variables. Since wilderness therapy often works with vulnerable populations engaged in high-risk activity, professionals must stay abreast of current standards and laws affecting service delivery, be aware of best practices in programming and staff training and stay current on research regarding outcomes.

All wilderness therapy practitioners must be knowledgeable of and adhere to state laws governing the provision of services that may fall under the auspices of counseling, therapy or adolescent development. Practitioners should also use a broad range of key words when searching for applicable standards and not simply focus on "wilderness therapy" as the only solution.

Additionally, practitioners should follow standards of practice adopted by applicable professional associations. Although no single set of guidelines exist, organizations such as the Association of Experiential Education, the National Association of Therapeutic Schools and Programs, and National Association of Therapeutic Wilderness Camps have guidelines specifying desired professional conduct.

In addition to understanding and following state law and standards of practice as a way to manage risks, practitioners must also develop their judgment skills. This may be best accomplished by gaining knowledge and experience in the field and critically reflecting upon those experiences (Hogan, 2002). Particularly in light of the sensitive, and often exhausting nature of the clientele served, specific attention to staff training and development is essential. Staff must possess the skills to promote growth and development and, above all, to do no harm to clients.

Staff trainings must focus on several key factors including: knowledge of psychological illness and symptom management, effective intervention techniques, leadership and group dynamics, technical skills required to thrive in wilderness environments and numerous counseling techniques. (Rosol, 2000).

Finally, practitioners are encouraged to promote the development of the field by reading and conducting efficacy research that attempts to document the outcomes of services. As noted by Rosol five years ago, wilderness therapy is still an evolving field and therefore practitioners must conduct research aimed at understanding why wilderness therapy works and what outcomes we can expect from programs.

Several areas of study have been identified such as understanding the physical and emotional intensity of treatment needed to yield the desired results, finding the desired program duration, documenting impacts of programs on various minority populations and young girls, determining whether wilderness programs can prevent delinquent behavior, researching the long-term effects of participation, and pinpointing which therapeutic components work best under what circumstances (Wilson & Lipsey, 2000). Regardless of the subject of investigation, methodologically rigorous studies must be completed in order to further solidify the use of wilderness therapy as an effective intervention for youth at risk.

References

Bacon, S. (1983). The conscious use of metaphor in Outward Bound. Denver: CO: Colorado Outward Bound School.

Berman, D., & Davis-Berman, 3. (2001). Critical and emerging issues for therapeutic adventure. The Journal of Experiential Education, 24(2), 68-69.

Cason, D. R., & Gillis, H. L. (1993). A meta analysis of adventure programming with adolescents. Journal of Experiential Education, 4, 25-27.

Cooley, R. (1998). Wilderness therapy can help troubled teens. International Journal of Wilderness, 4(3), 18-20.

Conner, M. (2005, February 11). An overview of wilderness therapy programs Retrieved February 24, 2005 from www.wilderness-therapy.org/Wilderness/WildemessProgramOverview, htm.

Division of Administrative Rules. (2001). Outdoor youth program rules (Rule R501-8). Retrieved from www.utah.gov/government/agencylist.html.

Ewert, A. W., McCormick, B., & Voight, A. E. (2001). Outdoor Experiential Therapies: Implications for TR Practice. Therapeutic Outdoor Journal, 35(2), 107-122

Friese, G., Hendee, J. C., & Kinziger, M. (1998). The wilderness experience program industry in the United States: Characteristics and dynamics. Journal of Experiential Education, 21(1), 40-45.

Hogan, R. (2002). The crux of risk management in outdoor programs--Minimising the possibility of death and disabling injury. Australian Journal of Outdoor Education, 6(2), 71-79.

Outdoor Safety Institute (2005). Self assessment checklist for best practice: Safety management for adventure recreation providers. Retrieved August 22, 2005 from www.risk.net.nz/index2.htmL

Rosol, M. (2000). Wilderness therapy for youth-at-risk. Parks and Recreation, 35(9), 42-60.

Russell, K. (1999). Theoretical basis, process, and reported outcomes of wilderness therapy as an intervention and treatment for problem behaviors in adolescents. Unpublished doctoral dissertation, University of Idaho.

Russell, K. (2000). Exploring how the wilderness therapy process relates to outcomes. The Journal of Experiential Education, 23(3), 170-176.

Russell, K. (2001). What is wilderness therapy? The Journal of Experiential Education, 24(2), 70-79.

Sutherland, A. (1987). Building your own fires. In 3. Niemi and B. Wieser (eds.), Rivers running free: Stories of adventurous women. Bergamot Books: Minneapolis.

U.S. Department of Health and Human Services (1999). Mental health: A report of the Surgeon General Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Notional Institutes of Health, and National Institute of Mental Health.

Wilson, S., & Lipsey, M. (2000). Wilderness challenge programs for delinquent youth: A meta-analysis of outcome evaluations. Evaluation and Program Planning, 23, 1-12.

RELATED ARTICLE: Research into action: managing wildness therapy programs.

Wilderness therapy has the potential to promote positive growth and development in a range of populations but most notably youth at risk. As an accepted but complex intervention, practitioners must take steps to ensure that programs are delivered in a sale and effective manner. When managing wilderness therapy programs, attention should be given to the following:

* Prior to developing a program, become acutely familiar with all state laws that may impact service delivery. Hiring a professional consultant familiar with your business goals and state laws may be a worthwhile investment.

* Hire qualified therapists and field staff that have the skills needed to deliver effective programs.

* Complete on-going staff training to ensure that staff remains current on advances in technical, soft and advanced skills.

* Complete an in-depth assessment of safety practices. See the Outdoor Safety Institute for an online self-assessment tool (www.risk.net.nz/ index2.html).

* Design programs so that they have the amount of daily physical challenges and demands required to produce positive health benefits.

* Create opportunities to develop trusting relationships with others so that individuals can develop the social skills needed to succeed in life.

* Foster the development of self-reflection and resilience by offering ample opportunities for solitude and reflection.

* Develop a wilderness curriculum that uses extended metaphors as a way to promote transfer of learning upon completion of the program.

* Continue to conduct research using rigorous methods so that the outcomes of wilderness therapy may continue to be explored.

* To find more information on wilderness therapy, visit www.wilderness-therapy.org.

Paige Werhan is a recent graduate of the University of North Carolina at Chapel Hill. While at school, she was an expedition instructor for Carolina Adventures, UNC's Outdoor Education Center and active in the Carolina Leadership Development Program. Diane Groff is an assistant professor of Recreation and Leisure in the Department of Exercise and Sport Science at the University of North Carolina at Chapel Hill. Her research interests include the effects of sport and physical activity on individuals with cancer and individuals with physical disabilities.