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Treatment Program Comparison: Outward Bound vs. Wilderness Therapy

From the popular forest bathing in the 1980s in Japan to the growing body of research that says 2 hours a week in the wilderness – simply being outside – can improve your mental health and now, in Scotland, General Practitioners now regularly prescribe walks in the woods for their patients.  Enter Wilderness Therapy and the Outdoor Behavioral Healthcare Council. Outdoor Behavioral Healthcare has begun outcomes-based research.

Wilderness Therapy programs have been influenced directly, or indirectly, by Kurt Hahn’s Outward Bound program. According to Dr. Will White, author of Stories from the Field: A History of Wilderness Therapy shared that, “Outward Bound arrived in the United States in 1962 and many of the early Outward Bound instructors and students went on to start wilderness therapy programs in the later 60’s, 70’s and 80’s.” There are many different models to wilderness therapy and White explained, “One of those instructors included the originator of the primitive skills model of wilderness therapy, Larry Dean Olsen, who was inspired by his summer working at Outward Bound in Colorado. He took what he learned at Outward Bound and added primitive skills to help struggling students at Brigham Young University in 1968. This would spark the movement of wilderness therapy programs in the west. Most wilderness therapy programs still include segments that were first seen at Outward Bound including solos (time on one’s own in the wilderness) as well as an endurance challenge. It has had a tremendous influence on wilderness therapy.

Outward Bound Intercept program was specifically designed for struggling teens. Although Wilderness Therapy programs have similar roots to Outward Bound, they evolved into very different models, with one foundational distinction being licensed clinicians as part of each treatment team and how programs are state-regulated for struggling teens (if offered) and that most are nationally accredited by Association of Experiential Education. Wilderness therapy programs work with the whole family system from enrollment through discharge.

The goal of this blog is to point out the 6 key areas of difference between the two different populations of “troubled teens” or young adults who are struggling.

  1. The Client: Struggling Teen | Young Adult 

    Wilderness Therapy programs (sometimes referred to as adventure therapy) are accredited by state and/or national organizations and enroll students who could be struggling with a particular diagnosis (or diagnoses), acting out behaviorally, and have not found success at home, school and/or with friends. Wilderness Therapy programs rarely are the first intervention in a teen or young adult’s life. The child may have been to outpatient, family, or group therapy, struggled in school, been hospitalized, attended a partial hospitalization program (PHP) or Intensive Outpatient Program (IOP) expelled from school, arrested, is struggling or failing in school or is a puzzle in terms of the clinical piece or behavior. Wilderness Therapy for a teen or young adult might be an assessment/stabilization/treatment step.   Several Wilderness Therapy programs specialized groups for a specific diagnosis (neurodivergent/autism spectrum disorder (ASD) or substance/recovery.

    Outward Bound Intercept program students have a level of insight and it is the students’ choice to enroll.

  2. Enrollment | Length of Stay

    Wilderness Therapy accepts new students on a rolling admissions basis, and the length of stay varies up to 3 months. They have an extensive application that includes a psychosocial assessment. The enrollment fee to a wilderness therapy program pays for all the outdoor gear that is required for the treatment program. Families do not have to shop for gear for their child, this allows a client to enroll in an emergency. Some wilderness therapy programs will allow a client to enroll with a teen transport; others will focus on assisted transport and yet many clients enroll willingly.

    Outward Bound Intercept programis either 28 days or 50 days and has a particular start date and end date; in other words, the group starts and finishes as one group expedition.

  3. Group of young adults participating in a Wilderness Therapy session

    Staffing

    Wilderness therapy programs hire college graduates who go through 40-plus hours of training before going out with students in the field and ongoing training. The title of the staff varies wilderness program to wilderness program but the intense training requirements weed out those who are not capable in terms of outdoor wilderness survival or adventure skills (“hard skills”) and their emotional intelligence/communication (and sometimes, de-escalation).  Field Staff are a vital component of a teen’s treatment at a wilderness therapy program. Field staff shifts vary, working 8 days on and then 6 days off to 15 days on to 13 days off. All of the wilderness therapy programs start pay at $120+/day. After a certain period, there are healthcare benefits and more. Therapeutic staff develop soft skills, along with expedition leadership; their job includes being an extension of the clinical team, assessing and intervening with their assigned “caseload” of students.

    Outward Bound staff do help participants recognize and modify their behaviors but almost entirely in relation to a group-orientation, and group goals. Staff training is something to speak to OB about.

  4. Clinical Goals

    Wilderness Therapy Nationally accredited and/or state-accredited wilderness therapy programs have licensed masters or Ph.D. level clinicians creating and supervising the treatment plan for the student. In simple terms, the goals for the struggling teen or young adult treatment and strategies to achieve them are in this document, and it is updated consistently during enrollment in the program.  A licensed therapist will do individual and group therapy sessions during their field time. Each Wilderness therapy program has a different schedule for the day(s) the therapist is in the group.  Another regular aspect of the course includes groups and individualized counseling by the field instructors/staff, who are a critical part of the treatment team.

    Outward Bound Intercept does not have treatment plans or clinical oversight during the student’s enrollment. Struggling Teens who enroll in the Outward Bound program are not there to receive individual treatment; instead, all of their therapeutic experience is from group processing that is not run by a clinician.

  5. Clinical Assessment vs. Experiential Education

    Wilderness Therapy programs have deep-rooted clinical underpinnings, where the goal, according to Outdoor Behavioral Healthcare accreditation, is “ the prescriptive use of wilderness experiences by licensed mental health professionals to meet the therapeutic needs of clients’ The nuance of how a particular company implements this is part of the nuance of how they differ. There are different wilderness therapy models that focus on stabilization, assessment and varying types of treatment. Wilderness Therapy programs use small group dynamics, backcountry simplified living, community interaction and intensive observation and psychotherapy to engage clients in healthier interdependence.

    Outward Bound, founded by the British military in 1930 with the mission of developing group loyalty and team orientation, uses expedition, physical hardship, skills development, and group success over gradually more difficult goals to create pride and confidence in each contributor. While individuals develop self-efficacy and initiative, the focus is not on individual “issues” or personal triumphs.

  6. Family 

    Wilderness Therapy programs work with families before their teen or young adult’s enrollment and during their enrollment. Generally, it begins with admissions helping the family detach from unhealthy excuses or co-dependence, and in treatment, becomes letter writing, weekly phone calls with the clinician updating on the assessment and treatment goals, and possibly phone and field visits with the son or daughter (except during COVID restrictions). Many Wilderness programs now have a parallel process of treatment or course work that that families must go through,  a family workshop during or at the end of a teen or young adult’s programming, or a dedicated clinician for that family, or a parent coach.   One piece that has changed with Wilderness Therapy since its inception ~ the entire family has therapeutic work while the child, teen, or young adult is enrolled. 

    Outward Bound reveals on its website that it serves families and students who are ready or open to change.  They have partnered with parent coaches to assist with family work after the student completes the course.

Wilderness Therapy (Adventure Therapy) ~ aka Outdoor Behavioral Healthcare and Outward Bound have changed and are changing.  This is because family systems are now more engaged in their child’s therapeutic process and are inquiring and wanting more skills as parents.  This change in parents/families has revealed a more invested family (this is true of all levels of treatment) and parents are available to do family work and their own clinical work too.  They want new communication skills.  It is exciting to see these changes, all levels of care and types of interventions are engaging with families differently.    Be sure to ask questions above and beyond what you believe you need to because you – the parent – are going through the therapeutic process now too.

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