What Makes Backcountry Therapy Different?

Posted by Ellyn Zografi, MS, LMFT, Therapist at Entrada on September 27, 2017

EllynPerspective from the Frontcountry

Several weeks ago I began a new job as a Wilderness Therapist at Evoke. Previous to my start date, I had been working as a psychotherapist in Madison, Wisconsin, working with individuals, couples, and families; all with issues and challenges not unlike the ones that present with clients coming to wilderness programs. How I came to Evoke and wilderness therapy is a story in itself, and relates directly to the amazing process wilderness therapy provides for hundreds of adolescents and young adults attending these programs year after year, with, from what I read in the research, high levels of success.

A year ago, I ventured into uncharted territory for myself by going on a 15-day white-water rafting trip along the Colorado River. It was there, deep in the canyon, far from home, that I was awakened to the therapeutic benefits of being removed from my usual distractions, daily routines, and comforts and plunged into a space of discomfort, relentlessness and uncertainty. Shortly after finishing the trip, I was in conversation with a friend of a friend and relayed my wonder of how I felt I received “4 years of therapy in 15 days”. It was in that moment that it was disclosed to me that there was a whole industry built around providing clinical therapy in a wilderness setting. I never looked back as I began my journey of pursuing and then transferring my own clinical work from four walled offices to the open air of the mountainous desert. In my first three weeks of shadowing other therapists as part of my training process, I immediately could see differences between “frontcountry” and “backcountry” treatment. Beyond the obvious difference that my previous clients came to an office setting and sat on a comfortable chair, while Evoke clients sit on folded foam pads and have to earn the privilege of a camping chair, I noticed other differences that spoke significantly to the healing powers and empowerment potential of receiving treatment in a wilderness setting. Here is what I discovered in just my first four weeks:

In frontcountry therapy, I helped my clients identify their ‘distractions of choice’; the ones that help them to cope with their core issues; challenges that are more uncomfortable to face than others. Obvious distractions are drinking, taking drugs, smoking, over working, eating, etc. Another less obvious distraction is something we seek and have accessible to us every day: comfort. When we are hungry, we eat. When we are thirsty, we drink. When we are tired, we sleep and when our muscles hurt, we sit down. However something interesting happens to us mentally when we are NOT able to relieve our physical discomfort on demand. We have to face ourselves in a different way. We have to push what we think are our limitations, and discover levels of strength and flexibility we don’t think we have. Even more interesting and exciting is what happens when we discover we had more in us than we thought. It raises our confidence, lessens our fears, and removes chronic roadblocks for desired change. It changes “I can’t” into “I can”. In the frontcountry therapy office, a therapist certainly can guide their clients to this positive feedback loop of leaving comfort zones and pushing them to an awareness of capacity that leads to a desire to want to push into even more areas of discomfort, challenge, self agency and potential. However, the frontcountry therapist cannot always be assured between sessions that their client will actually venture into this “discomfort” zone or sustain it long enough between sessions for it to reap the benefit. A prolonged experience in the wilderness, however, just by its very nature, is uncomfortable for most. Being outside, day after day, in all weather conditions without the comfort of a bed to sleep on, hot food whenever you want, a cold soda when you just need a “pick me up” forces an individual to go deeper in themselves to find solace. There is no choice but to search for coping strategies that go beyond external gratifications to minimize uncomfortable feelings, both physical and mental. The backcountry therapist will unlikely have to push their clients to go out of their comfort zone, because their clients are already there. That being said, the backcountry therapist, along with field guides, must help the clients to sit with that discomfort, not resist it and discover the subsequent potential that is being afforded them by simply being out in the wilderness. This lack of comfort in the wilderness is a therapeutic tool a therapist can’t fabricate fully in any other setting, and it is nothing short of a gift for both client and clinician.

When I came back from the river trip I was full of river analogies to pass along to my clients. Being “stuck in an eddy” or “If you fall out of the boat, get back in the boat” or how you “can’t push a river”. But the one that came in most handy was “don’t be worrying about future rapids, when you have one right in front of you”. Future Information (FI) is something I learned early on in my training at Evoke that most clients yearn for, and don’t get. Along with discomfort, the coupling of uncertainty and relentlessness are two more therapeutic tools naturally found in wilderness therapy. In front country therapy, a client can pretty much be guaranteed their session week to week will be over in 50-60 minutes. They have a choice whether to stay in therapeutic mode or not when leaving their therapist’s office. They can work the “homework” most therapists provide upon departure or blow it off with little to no consequences to their regular daily life. For a backcountry client, their therapy “session” is on average 8-10 weeks straight. And I mean straight. For 24 hours a day, seven days a week, a backcountry client is engaged in their therapeutic process. They can’t step out when the therapist isn’t around, because there are skilled field guides maintaining and pushing each client’s treatment process whether they are in active conversation, taking a hike, or washing dishes, etc. There is no separation between “going to therapy” and daily life for a client in a wilderness therapy program. Every action is an opportunity to look at themselves and see how their role in the group is a reflection of their role back home with their families, friends and other community members. In other words, you can’t escape yourself and your process, which I believe is the true path to healing chronic wounds and breaking patterns that keep you stuck. As I mentioned, one of the most challenging parts of my river trip, was not knowing what lay ahead – what rapids I needed to fear. For a backcountry client, they don’t know when their therapy will be done. They don’t know if they are going home when their time is done at Evoke, or will be sent to an aftercare program. They, too, don’t know what “rapid” they should fear. There is no set schedule for every client and it is up to them to work their individualized program and be done, when they are done. This uncertainty is tough, but yet acts as another significant therapy tool that is difficult to fabricate in other therapeutic settings. When we can’t attach to the future and what lies ahead, we have to open our senses to what is right in front of us, and what is around us – and most importantly, for true healing to begin, what lies within us.

It’s an honor to be joining a therapeutic field that takes all the metaphors we use every day to describe life, and makes them literal. This is probably the biggest difference, in sum, I see so far between front and backcountry therapy. We often call a therapeutic process for a client a “journey”. A journey where there will be ‘rocks in the road’ or “deep ravines to cross” or “loads to carry”. When these things are actually happening, and not just in our imagination or as a descriptive comparison, it pushes our potential and healing process in ways, ironically, I cannot find a metaphor to describe. Wilderness therapy just is what it is – a natural, wise and powerful tool for helping clients reach their mental health goals and potential.

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