Wilderness Therapy is a primary treatment provider involving safely intervening, clinically assessing and creating an environment for teens and young adults to self-examine and for real treatment to begin. These outdoor therapeutic interventions (insight-based therapy or experiential therapy) are modeled for students depending on the age and experience of the participant. Wilderness Therapy Programs use the natural environment as a major part of the therapeutic milieu to create conversation and evoke change; the adventure or unfamiliar aspects provide fertile dialogue about relationships and intentions and generally focus on group dynamics, individual improvements and safety. As evidence to how far wilderness therapy has evolved from a Boy Scouting trip or a weekend in the woods, this blog will attempt to explain the generalities and then the specific branches of what is commonly referred to as “wilderness therapy”.
Wilderness therapy has developed on top of the philosophies of educator Kurt Hahn’s Expeditionary Learning (now world-renowned as the “Outward Bound model”), where staged learning occurs by virtue of group participation, working through challenge and hardship and the omnipresence of the corporeal world. And because wilderness therapy takes place in the “backcountry”, life has fewer but more logical distractions and potentially more visceral consequences; participants are away from the comforts, distractions and the coping mechanisms of choice - peers, electronics, school, substance(s). So, in contrast to expeditionary learning, how did wilderness therapy develop its popularity and what are the present variations?
A major distinction lies in programs’ intentions to provide psychotherapeutic treatment; wilderness therapy borrows as much as practical from the Expeditionary model, but adding professional therapists and a treatment team responsible for attending to participants’ treatment plans. In more explicit terms, Dr. Keith Russell’s brilliant 1999 dissertation defined wilderness therapy as including “a sense of adversity and challenge confronting the client; the use of natural reward and punishment allowing authority figures to step back from the role of the provider of consequences; a peer mentoring process; a feeling of group development; physical exercise from hiking and wilderness living; time for reflection; an emphasis on self care and personal responsibility; skill mastery, particularly primitive skills and the making of fire, and a strong therapeutic relationship between the client and staff.” While argument continues in the professional research of what precisely does or does not constitute “wilderness therapy”, individual programs and the industry’s associations now seek to prove which experiences, lengths of immersion, models, specific diagnoses, etc., are the critical aspects that generate the proven “efficacy” of wilderness therapy.
Wilderness Therapy Programs provide a comprehensive clinical treatment plan and a discharge summary and recommendations. Many programs host “niche” groups, reinforced with fitting therapists’ specializations (analogous to outpatient therapist practices) and attract a very focused membership (trauma-informed, Learning Differences, Eating Disorder, Social Anxiety, as well as substance abuse treatment, pre-adolescents, and primary interventions for “failure to launch” young adults. (Field groups are primarily single-gender for adolescents and coed for young adults and pre-teens).
Nomadic means that a group intends to remain self-sufficient, works toward group accomplishments and that the student will be responsible for packing his/her own equipment in a fitted backpack for the duration of the wilderness experience. Hygiene occurs in the field. Food (and nowadays, often “city” water) is resupplied periodically for the group; unless a medical emergency comes up, the student is immersed in as complete a “wilderness experience” (24/7 for the entire enrollment) as the program can manage.
The therapist for the student drives out to the field for formal weekly group and individual therapy sessions. The therapist may or may not stay overnight with the group. The model and training matter, however, when the therapist leaves, as much of the therapeutic tension and purposeful challenges occur outside of therapy days - during the experiential aspects, and beyond the direct observation of the therapist. For this reason, the instructors/field staff act as critical contributors in the treatment team.
Nomadic wilderness therapy programs might have adventure therapy aspects (ropes course, rappelling, mountaineering, whitewater rafting experiences) built in as brief interventions or as part of the natural progression hiking from one location to another but use the routine and friction that naturally develops in small-group-living to enhance a challenging, safe therapeutic milieu.
Ocean-based sailing wilderness programs qualify as nomadic courses, despite the obvious differences in programming. Students live a remote, therapeutically-moderated small-group lifestyle, with regular group and instructor feedback, psychotherapeutic sessions and restricted communication with the “outside world”.
In a base camp model, the adolescent or young adult will return weekly to a base camp, for a shower, to meet with the therapist, and to replenish food supplies. This is a place for the student and the group to refuel, metaphorically and literally. The base camp usually has plumbed water (including toilets, showers) and rudimentary beds - and often a location-specific programming. Base camps provide time and logistical convenience for written work, and is often the locale for visits from parents and other professionals (e.g., psychological evaluators).
There are three subtypes of Base Camp wilderness: Adventure Therapy, Backpacking and Horticulture Therapy. All three of these different models use the wilderness in different ways to effect change. Many base camp programs provide excitement via peak experiences to invite self-reflection. Adventure therapy might involve different experiences where the student will be in a car getting from point A to point B to have the mountain biking, skiing, hiking, or climbing experience. Most base camp backpacking programs will hike the students back to the base camp for hygiene and programming that is tied to the basecamp specifically, though pre-teen programs may transport to basecamps. And finally Horticulture Therapy allows the participant to experience and see change using a sustainability and botanical parallel. In this model, students practice stewardship, develop practical skills focused very clearly on a community’s future benefit and do not move out of the camp for the duration. Horticulture Therapy also provides students real-world consequences for their labors, in that the students are nourished from their own gardens.
Several programs report that their base camp model becomes a “home” like experience for the adolescents and young adults, meaning their maladaptive behaviors from home emerge and become overt at the base camp.
A lesser-discussed model of Wilderness Therapy includes programs that incorporate wilderness as the first phase of their model. There are not a lot of those out there but it is an option to consider for clients who may not transition well or just need less time in the interventional wilderness therapy program to effect necessary changes (it is always hard, before the intervention, to predict the length of time needed). Programs that have wilderness can always place the student back into the wilderness therapy portion of the program if they need a “tune-up” during their process.
It has become common for students enrolled in wilderness treatment to have an independent psychological evaluation while enrolled, assessing the student academically and revealing any concealed emotional conflicts through psychological projective testing. Typically, the diagnoses revealed from the standardized testing corroborate the clinical impressions and diagnosis of the clinician and field staff in the group, but can add layers of nuance regarding treatment recommendations.
Therapeutic consultants understand the nuance and differences between these models in general; the expertise comes in constantly assessing the therapist and model specialization in regards to their client’s need. Consultants must stay informed about the new wilderness diversity available for treating autism spectrum disorder, sensitively helping with trauma assessment, programs designed and working with whole family systems or clinically complex clients, and those trained to confront substance abuse and assessment. Knowing how to tease out what is needed for the client and family and speak about why a model (therapist & program) are being recommended is the expertise that therapeutic consultants bring to an initially confusing and complex dynamic. It is exciting to see change happen with a model as much as it does with the therapist and staff.