How does wilderness therapy work? Using Yalom’s principles of group therapy to provide clarity

Posted by Matt Hoag on March 28, 2023

When people ask me how wilderness therapy works, many different answers come to mind. I think of the outcome research that has been done in wilderness therapy using valid measures of tracking progress. I think of the thousands of young people I have worked with personally over the last 25 years. I think of the many stories I have heard from families of how their child responded in the wilderness. I think of the importance of the guides and the work they do with young people day after day. There are so many great answers to consider. Today, I wanted to share about some of the underlying principles that contribute to this success.

Irvin Yalom is a psychiatrist who taught at Stanford and has written many fantastic books on existential psychotherapy as well as books exploring what is effective in group psychotherapy. Yalom¹ identified eleven factors that contribute to healthy functioning in group therapy, which can be considered as we explore what works in wilderness therapy. Day to day life in the wilderness is often akin to group therapy, as guides and participants take steps to form a functioning group process. Application of these 11 principles of group therapy to the wilderness therapy experience provides an understanding of the effectiveness of this treatment intervention.

Group Cohesiveness: Groups form and develop through day-to-day activities by working through challenges together. Difficult hikes, dealing with the challenges of weather, cooking as a group, and initiative activities all lend themselves to strengthening the group dynamic. They provide common experiences that all group members share. Common experiences help to build a sense of solidarity and togetherness as group members have a goal to work towards and share some of the same challenges.

Universality: Wilderness therapy utilizes peer mentors (other participants in the program) to reinforce the shared experience and build empathy. These mentors teach new clients necessary backcountry living skills. The mentor validates the feelings of new clients and often shares ^their own experiences about her first days in the wilderness. By observing and relating to the experiences of new clients, other clients validate their own early experiences in the wilderness and reflect upon the progress that they have made. This not only generates empathy with new, often resistant, clients, it also provides hope for new clients that change can occur, and that wilderness can be a positive experience.

Interpersonal Learning: The social microcosm in wilderness is quite real, because clients not only participate in group therapy together; they hike, cook, sleep, and work through challenges together as well. This provides opportunities to observe and offer feedback on how they cope with stressful situations. Relationships in wilderness are built through cooperative work, empathic communication, and conflict resolution. Also, participants that are resistant to emotional exploration may be more open to starting with feedback on seemingly simple tasks like cooking. Successes, such as learning how to make fire from another group member or guide, provide corrective emotional experiences. Participants then have a positive emotional experience of success that can be related to challenging emotional work.

Instillation of Hope: The open-ended format of wilderness groups provides for the development of leadership, modeling through successful outcomes, and peer support wherein older, more established group members facilitate the improvement of younger members. The open-ended group thus provides a built-in social mechanism, which pushes the adolescents and adults to become more engaged in the process with each other. Other clients, guides, and therapists provide support and encouragement, which increases hope and engagement.

Imparting Information: In the wilderness, imparting information often involves wilderness living skills and emotional expression tools. Often, participants are resistant to engaging these skills, resist the structure, and provide barriers similar to what they might in a group therapy session. Often, other clients, staff, and therapists play a part in shifting this dynamic. Direct advice occurs early in groups, especially when groups are still forming and prior to developing a therapeutic process. Advice giving is seen as helpful because the client believes if they just tell their peer what to do, then they will do it.

Corrective Recapitulation of the Primary Family Group: This is one of my favorite ones as it parallels life at home. Field guides and therapists often take on roles as parents or other authority figures within the participant’s world, while group members take on roles of siblings. Issues that occur in life in a wilderness program are issues that occur in the family, and provide an opportunity to work through them. Guides relate struggles in wilderness treatment to difficulties at home. Resistance to program expectations, rules, or assignments, are manifestations of the difficulties with school, respect for parents, or similar processes prior to treatment. Trust issues can also be worked through within the wilderness therapy group.

Catharsis: Much of the wilderness is designed to assist with accessing cathartic experiences, through ‘busting’, hiking, or some other ‘hard skill.’ The intensity of the outside world, including weather or dealing with the elements, creates experiences which are often uncomfortable and lead to emotions; which likely relate to some repressed or ignored event.

Altruism
Within the wilderness environment, the group functions as a cohesive unit on a daily basis. Group members must learn to take care of each other and offer assistance when needed in order for the group to manage effectively. This is actually necessary in order for the group to achieve the goals needed for the day. Wilderness therapy encourages participants to move beyond themselves and work together in a variety of ways, improving self-worth, value, and effectiveness.

Development of Socializing Techniques
Many young people who attend wilderness programs have had difficulty establishing and/or maintaining meaningful or healthy relationships. Some participants present as very isolated and lonely, while others have been managing to make friendships through substance abuse or other unhealthy means. These relationships are oftentimes quite superficial and lack in healthy reciprocation. One of the strongest components of the social learning factors described by Yalom that can be utilized in wilderness therapy is through healthy interaction and basic “here and now” coaching and feedback about the interpersonal process. The “social microcosm” described by Yalom occurs as members live with the group 24 hours per day for a number of weeks. Processing social interaction through feedback in the moment can aid in understanding how members affect each other interpersonally.

Imitative Behavior
Imitative behavior is effective in wilderness therapy, particularly when a client is first enrolled. Participants are assigned a mentor in order to help them move along and feel a part of the group quickly. These mentors utilize the altruistic therapeutic factor and also aid the client in learning the group culture and expectations faster. Guides and group members utilize common strategies and language within groups in order to aid in conceptualization of difficulties and means in which to better work through issues.

Existentialism
Wilderness can aid clients in feeling more responsible for themselves and empowered to cope with the environment around them. Participants in wilderness therapy are encouraged to take personal accountability for self-care and come to view themselves more clearly through the therapeutic process. Recognizing personal strength and developing a connectedness with who they are and the environment is a powerful process which is unique to wilderness therapy.

¹Irvin Yalom, M.D. is a psychiatrist and writer whose first book, The Theory and Practice of Group Psychotherapy, is a seminal writing and has been used to train therapists in the practice group psychotherapy over the last 40 years. He has also written a number of books on the practice of existential psychotherapy.