Wilderness Therapy: Sophisticated Clinical Treatment by Getting Back to Basics

Posted by Dr. Matt Hoag on June 23, 2021

At Evoke we strive for and look to be creative; not just engaging in the "treatment as usual" approach. Often when we meet as a clinical team, we find ourselves discussing challenging cases or processes with families. Mental health is messy. It is tough. We are often working with families and young people during some of their worst moments, on some of the most challenging days of their lives. We provide support and care; often in an emergency and often quickly when people are in crisis. The importance of compassion and thoughtfulness cannot be overstated.

One of the guiding principles at Evoke is that "we are dedicated to continually innovate and grow to meet the changing needs of our participants and employees; to continually evolve, discover new approaches, and seek more effective ways for participants and their families to experience long-term change."

Many of the people we work with have been through a variety of treatment approaches as they have attempted to address clinical issues. Wilderness therapy is an opportunity to address or intervene in a way that is different, as the young person often arrives here with little to no skills in the wilderness. We provide them an opportunity to develop skills in the wilderness, an environment they have less capability in, and this creates change over time. They learn "busting" and knot tying and shelter building. They carve spoons and rings and walking sticks. They make leather pouches and fanny packs and purses. They create many things where there was nothing before.

Interpersonally, they learn to work with other young people, which often replicates or "recapitulates" their family dynamic, and over time they learn to support each other in the group. They develop coping mechanisms to deal with emotional issues, sharing "I feel" statements, providing feedback to group members and staff, and learning to communicate in an assertive manner. The "I feel" statement helps them better understand the connection between thoughts and emotions, as well as better recognize what is in and out of their control. They practice expressing themselves in writing; they do this through writing life stories, writing letters to parents and future versions of themselves, and completing a letter of awareness.

Within the family, young people are taking steps to engage their family differently, especially as the primary form of communication is through letter writing. Initially, adolescent and young adults often treat their parents the same as they did when they were home. If they were depressed and withdrawn at home, that is the pattern we see in their written communication. If they were angry or manipulative at home, they will often write angry and manipulative letters home as well. Over time these dynamics shift as the young person begins to consider other forms of communication and tries out other coping mechanisms within the family. Parents change also, as the letter writing process slows communication down, and allows for a more thoughtful or measured response to old patterns. Parents examine themselves as well, as they have an opportunity to take a step back and analyze their ways of engaging their child. As progress is made, we move to video letters, phone calls, video calls, and in-person visits as a way to take additional steps in shifting the family process. Seasoned therapists guide parents through these steps as they support the young person in their therapy and the parents in doing their work. The family work is an integral and vital part of the young person’s process in the field with Evoke.

Outdoor behavioral healthcare or wilderness therapy is at its origin an "alternative treatment." Over the last 20-plus years that I have been working in the wilderness, I have seen the approach grow from "therapy in the wilderness" to a thoughtful and sophisticated therapeutic intervention. At Evoke we continue to question why we do what we do, making sure our approach with young people and their families is fresh, has meaning, at its heart is creative, and supports the messiness that is mental health. We often question why we do things, making sure that we are doing them because they make clinical and therapeutic sense, not just because "that’s just the way it has always been done". We feel this keeps us at the cutting edge of wilderness therapy.