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What Else Changes in Wilderness? Moving Beyond Outcome

Posted by Matt Hoag, Ph.D., Owner, Clinical Director and Therapist at Entrada on March 07, 2016

1matt resizedA cairn is a pile of stones or rocks, often used as a trail marker, landmark, or memorial. We use cairns in the field to mark where the group is so we can find it when we go to the field. Wilderness participants also look forward to cairns, as they mark where camp is and represent the end of a hike. On a solo, the cairn represents where staff will come to deliver water, food, or other needs while the young man or woman is reflecting and considering things. Over the course of a stay in Wilderness Therapy, the young person will see and build many cairns which represent a variety of things: starting and ending points, art in general, part of a sculpture of some kind, something done in group while they listen to others, and steps along the journey of their experience. In many ways, research in outdoor behavioral healthcare is like cairns, marking the way, representing steps as we investigate and evaluate this innovative therapeutic intervention.

IMG 4559Evoke Therapy Programs has been monitoring outcome with participants in wilderness programs for almost 10 years. We are committed to research as a way to demonstrate that our treatment approach works, and also as a way to further understanding of the efficacy of wilderness therapy. Our program contributes to the research base in outdoor behavioral healthcare and is nationally well known for our research expertise.

This year at the annual meeting of the National Therapeutic Schools and Programs (NATSAP) a group of researchers from a variety of programs presented during the panel discussion entitled: “Big Ideas, Backstories, and Bold Directions”. Panel presentations covered the impact of outdoor behavioral healthcare on family functioning, developing practice standards within NATSAP, the importance of post-discharge data, and examining what else changes with participants while they are in wilderness programs. Researchers from University of New Hampshire, Westminster College, an adult residential program, wilderness programs, and several different adolescent residential programs presented.

My presentation discussed an article that we published in the most recent issue of Journal of Therapeutic Schools and Programs. It is entitled “Pushing Beyond Outcome: What Else Changes in Wilderness Therapy?” Many wilderness programs (including ours) provide outcome data examining whether change takes place in wilderness, and our study sought to push beyond those outcomes to see what else was impacted by participation in our wilderness program. We decided to look further at hope, life effectiveness, and treatment expectancy and credibility to see how they were impacted by the wilderness experience.

Adolescents indicated significant improvement in their hopefulness about life and feeling more effective with general life skills. Interestingly, they did not report significant change in their hopefulness or beliefs about the effectiveness of their coping skills until later in the treatment process. Life effectiveness and hope increased only slightly in the first five weeks of treatment yet made more dramatic changes during the second half of treatment. This may be attributed to the need for the client to stabilize, take inventory of their situation, and begin to build confidence in their ability to heal and move forward in a healthier manner. This finding demonstrates the value in using an open-ended length of stay to allow for internalization of changes and to ensure that young people have sufficient time to experience increased hopefulness and belief in the effectiveness of their coping skills.

Improvement in therapeutic alliance and treatment expectancy was also apparent with the young people in our program. In contrast to the above findings regarding hope and life effectiveness, treatment expectancy and credibility increased nearly as much during the first three weeks as it did over the remaining weeks of treatment. Research on outcome in therapy has long indicated that the relationship is a vital part of outcome, and our findings suggest that participants improved their alliance with their therapist and found more credibility in this treatment approach over the course of the program. This likely contributed to the positive outcomes noted above.

Our research also demonstrated that adolescents in our program were significantly improved over the course of the program, both from the perspective of the young person who attended the program as well as the perspective of their parents. Clinical change was apparent based on the characteristics of the outcome measure we used (Y-OQ®). Like other studies of outcome in the wilderness, this research indicates that adolescents in wilderness therapy undergo positive changes while in the wilderness.

Another interesting finding of this study was that parents and their teens saw the issues (or symptoms) that contributed to treatment much differently at the beginning of the program; yet portrayed them similarly at the end of treatment. Parents are often in a state of crisis upon their son or daughter’s admission to wilderness. Conversely, the young person is often in denial and externalizing fault for struggles or discord. This tension may account for the divergent perceptions early in treatment (as measured by the Y-OQ®). Similarly, it is possible that, as parents move out of their heightened emotional state and young people begin to see their process more clearly, scores on these measures more closely align at discharge. This reflects the movement to a more objective and unified family system, something that is anticipated and suggested as a goal in wilderness treatment.

These findings are interesting and relevant to understanding wilderness therapy. Outdoor behavioral healthcare has regularly demonstrated effectiveness in outcome, typically measured by measures of symptom reduction, and has recently began to examine other factors that are impacted by the experience. We see this research as adding another cairn along the pathway of evaluating this treatment intervention. We appreciate the opportunity to contribute to the growing body of research that supports wilderness therapy as a treatment intervention for young people.

Burlingame, G.M., Mosier, J.I., Wells, G., Atkin, Q.G., Lambert, M.J., Whoolery, M., & Latkowski, M. (2001). Tracking the influence of mental health treatment: The development of the Youth Outcome Questionnaire. Clinical Psychology and Psychotherapy, 8, 361-379.
Hoag, M.J., Combs, K.M., Roberts, S., & Logan, P. (2015). Pushing Beyond Outcome: What Else Changes in Wilderness Therapy. Journal of Therapeutic Schools and Programs, 8, 46-56.

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