Wilderness First Responder training and certification typically involves 60 hours of Emergency Medical Response [urban skills education] training, often focusing on pre-teen through adulthood emergency care (and specifically not considering infant, gerontological or "advanced" care), with the additional hours spent practicing these skills in a wilderness context, with wilderness-relevant equipment.
WFR training courses therefore train its students to prevent further injury, stabilize patients (improvising as necessary), to communicate authoritatively to front-country medical care and to evacuate the patient to definitive medical treatment as soon as practicable.
Dr. Keith Russell’s opening sentence in his seminal 1999 dissertation bemoaned the lack of specificity regarding the terms “Wilderness Therapy” and so he compiled the similarities of existing programs into this defining group of characteristics: must include sense of adversity, immersion into an unfamiliar environment, natural peer conflict and problem-solving, parental involvement, individual and group therapy and “primitive living” skills, including bowdrill and hiking. In the decades since, the field of therapeutic interventions has expanded and left his original stipulations behind.
While many of the components remain integral, wilderness therapy no longer only refers to nomadic, backpacking groups, but also incorporates basecamp models, expedition programs that occur on ocean-going sailing ships and recently, adventure therapy programs have emerged inside the umbrella of “wilderness therapy”.
The Outdoor Behaviorial Health Council has recently developed an accreditation seeking to update the definition Dr. Russell's early attempt. This is an evolving field.
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Wilderness Therapy is a primary treatment provider. It involves safely intervening, clinically assessing and creating an environment for teens and young adults to self-examine and for treatment to begin. Therapeutic interventions work with students for insight based therapy or experiential therapy 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 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 therapist's’ 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 Model 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 student's therapist 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”.
Base Camp 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.
Integrated 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 Experts, which are sometimes referred to as Therapeutic Placement Consultants or Interventionists or an Education Consultant 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.
Women for Sobriety, founded by Dr. Jean Kirkpatrick in 1976, is another alternative to the 12 Steps. A non-profit organization dedicated to helping women overcome alcoholism and other addictions, Women for Sobriety’s "New Life Program” is designed to help women achieve sobriety and sustain ongoing recovery. They have 13 acceptance statements designed specifically for women.
World Professional Association for Transgender Health (WPATH) is a 501c3 organization of professionals, students and other supporting members working to promote “evidence based care, education, research, advocacy, public policy, and respect in transgender health.” They provide training and Standards of Care for working with this population around the world.