Out of the Office and Into the Woods: Lessons from the Field of Wilderness Therapy

Posted by Dr. Brad Reedy, Founding Partner on April 02, 2014

reedyNearly two decades ago when I was looking for a job, a mentor suggested I apply at a wilderness therapy program. I left several introductory phone calls with the clinical director to inquire about a potential job opening, but my attempts went unanswered. So I decided to make the three-hour drive to their base camp office in Loa, Utah. I arrived with my resume in hand, a flannel-lined sleeping bag in my duffel, and the confidence that I was right for the position.

Lucky for me, the program was anxious to fill the job opening because the previous therapist had quit after his first attempt to find his group some forty-five miles into the desert. His trek ended with him frustrated and forty-five miles off course. After my impromptu introduction to the clinical director, I was invited to attend the staff meeting. When the director was asked, “Who will be the therapist for group three?” she gestured to me. Suffice it to say, I felt really good about my chances at the interview later that day. I was offered and accepted a position to start immediately as a wilderness therapist. I had almost no idea what wilderness therapy was and I tried to learn about the milieu while waiting to head out to the field area (wilderness area of operation). However, I received very little instruction before heading out with the staff to meet my clients, or “students,” as they are called.

I drove along with the incoming shift of Wilderness Instructors to my group on one dusty road after another, through the picturesque landscape of Capital Reef National Park and Southern Utah. I took the opportunity the long drive afforded me to try to learn more about wilderness therapy. “What exactly is it?” “Why do we do therapy in the wilderness?” Clay, a nature enthusiastic, dread-headed, kind and gentle instructor responded to my questions with the following imagery. “You see Brad, most people are living two miles off the planet. Out here, we are teaching kids to live on the ground. That is where you will meet your students.” Later another instructor said it this way. “Nature has a healing power. It is magic and hard to explain, but there is a healing that occurs as these kids live outdoors, in the simple majesty of nature. The kids have a powerful spiritual experience, develop a strong sense of gratitude, and some even find God here.”

While I appreciated their passion and agree with their answers, it wasn’t good enough. I think it is incumbent on us as therapists to understand the “why” of wilderness therapy. Often when I ask people to describe the effectiveness of wilderness treatment, they will launch into a poetic answer about the healing effects of beauty, outdoors, and nature. I believe there is truth underlying their intuitive responses, and without taking the magic out of it, I still feel a responsibility to understand and explain how and why it works. So what are the mechanisms of this therapeutic delivery method? The answer to this question may offer our clients and families some insight into aspects of the intervention that can lead to greater generalizations post-treatment.

The Influencing Theory in Wilderness Therapy

My early observations of children and young adults participating in wilderness therapy led me to reflect on a course I took as an undergraduate titled Temporal Work and Relationships in the Home. The professor was Dr. Kathleen Bahr. It was a course on how many of the modern advances in our culture were taking families in a dangerous direction. The class began by viewing two documentaries. The first followed a day-in-the-life of “The Utah Mother of the Year.” The second was about a primitive African tribe. The Utah mother was very impressive, with her planned, set schedule. One scene, which we later realized supported the thesis of the course, showed the mother interrupting some spontaneous rambunctiousness to follow the lesson plan and have the children do “calisthenics.” Her lesson plan was well scheduled and she kept the house spotless, cleaning the morning mess while the children took their afternoon naps. The documentary of the primitive tribe showed family members engaged in the daily task of life and survival. There was a division of labor, with the mothers working and watching all the younger children around their simple homes, while the fathers took the young men into the woods to hunt and gather food. Throughout the day, and then highlighted during the evening around a fire circle, the parents shared stories and lessons with their children. The stories were both religious and practical, and wove life lessons into a mythical narrative. At night they sang songs and talked about how their God had blessed them and about how they were able to survive. The line between their religion and the struggle to survive was nonexistent. It was in the context of their struggle that they passed on their values and life lessons. What it meant to be a member of the tribe and to be a person was integrated into and inherent in their every day lives.

Parents in Western culture often contrive and stretch to create teaching moments like the Mother of the Year, while primitive cultures rely on oral tradition and modeling to pass on values. Their chores require the help of several family members and create connection rather than the isolation that is sometimes created in more modern social structures. Lessons about life are woven together in their religion and in their daily traditions and rituals. One of the challenges, when all of the creature comforts are offered too readily to our children, is to create lessons and opportunities for lessons for our children. In such instances, the lessons appear contrived—that is, the message seems to be about the parent and not about life. An example may be as simple as the old adage, “what you reap is what you sow.” This saying is self-evident for the child who grows up on a farm. By contrast, a child raised by attorneys may have trouble seeing the value of high-school trigonometry and the impact it will have on her life.

While we appreciate technology and modern efficiency, when it comes to raising children and passing on the important lessons of life, they may distract or short-circuit natural routes for educating our children. Dr. Bahr challenged the common American ideal, illustrated by Abraham Maslow’s hierarchy of needs, that the most basic task in life is to meet our visceral needs. This model posits that if we are struggling to survive, then we are prohibited from focusing on higher level needs. Yet, what is even more obvious today than back in the mid-1990s when I first started as a wilderness therapist, is that many of our modern conveniences, intended at assisting us in living, are not necessarily advancing our humanity. In fact, it is often in the struggle to survive that we both learn for ourselves and pass on the most critical values to our children—through our rituals, our work, and our suffering. Life lessons are intrinsic in living. As the quote by Arnold H. Glasgow goes, “Telling a teenager the facts of life is like giving a fish a bath.”

In a lecture, Dr. Bahr used ice cream as a simple illustration of how modern conveniences might be hurting the processes in family. She explained, “Years ago, ice cream might be made by the whole family. Each would have their turn at the hand crank, the ice maintenance and the salt. The ingredients were mixed and frozen and the activity might take hours. The family was engaged in the same goal and at the end they enjoyed the ice cream. Today, we buy a half-gallon of ice cream in order to save time. Time for what? Usually to watch TV or go our separate ways.”

Consider the following observation from Harvard Anthropology Professor Dorothy Lee in 1959:

When my first child was two or three, I used to shell peas with her. Nowadays, I buy my peas already shelled and packaged. This saves time; and the peas are fresher… But was this all that happened when I shelled peas with my daughter: Did I merely get a dish of peas? It was a total process; and if I am going to see to it that the totality of the important aspects are retained, I shall have to find out what they were and then find the media through which they can continue to be expressed.

If modern life was creating some obstacles for parents in the 1950s and in the 1990s when I started in wilderness therapy, imagine the impact of our modern and technological wonders on today’s family.

Many children of the current generation are suffering and baring the symptoms in an age where information is abundant and connection is stunted. Students are enrolled in a therapeutic wilderness program with a variety of presenting issues such as depression, anxiety, substance abuse and addiction disorders, behavioral problems, school problems, family conflict, learning disabilities with associated problems in functioning, and autism spectrum disorders. Wilderness therapy programs are a short term, primary care setting and offer families an interruption and stabilization in a crisis. Assessment, both formal and through natural observation, prepare individuals and families for follow-up care settings which may include outpatient therapy at home, residential programs or some form of transitional living. Therapeutic gains in wilderness therapy are often very dynamic and research has demonstrated very high levels of retention and generalization.

The Practice of Wilderness Therapy

The version of wilderness therapy I practice is a nomadic, primitive, small-group living model. That is a technical way of saying we hike around in the wilderness, in groups of eight to ten students, with three to four staff members and a therapist, setting up camp each day in a new area. Other versions of wilderness therapy incorporate adventure activities or utilize base camps (residential-living) during a significant portion of the clients’ time in treatment. The curriculum in a primitive model is the tasks and chores associated with hiking and camping in small communal living. I prefer the way that simple, primitive living creates a microcosm for clients—a small, manageable world that recreates the larger, infinitely complex universe outside the program. This microcosm recreates dynamics and reveals the issues without relying on self-report. Wilderness therapy also provides space for incorporating new solutions to challenges that can generalize to life after treatment. Licensed therapists meet with the students each week in individual and group therapy and establish treatment plans with the wilderness instructors.

The treatment plans are based on traditional therapeutic models and will include aspects of experiential therapy in the outdoor setting. Therapy with the wilderness staff occurs throughout the course of each day and may relate to the issues that brought the student to the program. Just as common, the topic of the therapy may focus on the here-and-now of group living, with the student being asked to make a connection between his current circumstances and the issues that he was struggling with at home before entering the program.

Weekly sessions with the therapist reference both daily living and the historical difficulties the student experienced prior to entering the program. The fabric of the therapy is both “here and now” and “then and there.” A colleague explained it like this, “Wilderness therapy is the delivery method, but the therapies utilized are empirically based and found in many offices.” The therapist dispenses traditional therapies, such as DBT, CBT, Twelve Step groups, and Family Therapy all in the sublime backdrop of experiential, wilderness therapy. The sessions help students to see the connections with their daily challenges, the challenges they are having with staff and peers, and similarities to the challenges they experienced at home. The focus becomes truly about the student. For example, when some issue creeps up during a trust exercise while crossing a river on a hike in the woods, students are more likely to own it as their own rather than reject it as their “parents’ issue.”

Similar to the primitive fathers teaching their sons during the hunt, senior students in wilderness therapy mentor newer kids in campcraft or “hard” skills,—cooking, fire-making, site selection, bear-proofing, gear maintenance, etc.—group organization and most valuably, the students learn, role-model, and eventually promote the “soft skills” of accountability, communication and conflict-resolution, seeking emotional support, containing another.

This is not an adventure therapy program with rappelling, mountain biking or white-water rafting. While that might play well to parents who are saddled with guilt for sending their child to a therapeutic program, it comes with some disadvantages. In their book Nurture Shock, Bronson and Merryman (2009) address the pitfall of an increasing trend where parents are replacing hard work with recreation. This trend, they suggest, works because everyone is happy. Parents feel less stress, guilt, or personal discomfort and with kids entertained and distracted, parents survive to fight another day. Any parent can relate to those motives.

In the primitive living milieu, or “camping therapy,” inherent challenges of nature and group living foster community, problem solving, healthy communication, and resiliency. It is not punitive or deprivational, but rather it is natural. The therapeutic staff utilize the challenges nature intrinsically provides to create the treatment plan. Rain, wind, and the elements become the antagonist and in facing those challenges, the wilderness student thrives. This use of nature truly underscores the message that it is the “journey and not the destination” that matter.

What Works in Wilderness Therapy?

I have heard wilderness therapy living referred to as a metaphor for life, but I find this a strange concept. That is, how can living in the natural world be the “metaphor” and living in the modern world with virtual realities be the “real” world? Primitive living is actually less contrived than other forms of therapy and as Dr. William White (personal communication, 2009) quotes a pioneer in the therapeutic primitive living model, “‘Whenever we adopted what we have come to call contrived experiences, the overall impact diminished for the participants.’ I like to explain to the clients, neither that neither we, nor your parents, are playing the role of God. We are more like Isaac Newton. We didn’t invent gravity, we are just showing you how it works.” I know of no better way to show a child how the world works than to expose them to it through small group living in the wilderness.

Nothing can be taken for granted in the wilderness. Everything comes with work, sacrifice, and often requires compromise, problem solving, and healthy communication in order for an individual to experience success personally and in the group. Students increase their self-reliance and develop a healthy sense of interdependence. Not listening to the staff might lead to a faulty shelter technique, which would lead to a very wet night—no lecture is needed on such an occasion. Students hike, camp, cook, set up shelter, sleep, eat, clean, and carry everything they need in their backpack. Fresh food and water are delivered as needed, but the daily task of living is without most of the modern conveniences and creature comforts that we enjoy in our culture. The intentionality in this environment allows therapeutic staff to amplify and underscore the important skills and principles the treatment plan lays out, using a comprehensive integrated experiential framework.

Over the years, our newer staff members have asked me, during the winter’s short days, or the rainy season of early spring, “How can we do therapy when we are spending so much of the day helping keep the children safe and warm?” My response is, “That IS the therapy. What better way to teach children the importance of patience, responsibility, self-worth, listening, trust, gratification delay, and frustration tolerance than by nurturing, caring for them, and teaching them to care for themselves? It relates to everything their parents want them to learn, only you use camping to teach it. The genius of the model is that the lesson is coming in through the back door, in a way that students don’t recognize you as ‘their parents,’ so their urge to rebel is less likely to be triggered.” Dealing with the elements posits the student against nature and removes the need to struggle for a separate identity by rejecting parental values that so often occurs as children navigate the tasks of adolescence.

As this process unfolds for their children in the middle of the Utah Desert or in the Blue Ridge Mountains, parents learn principles such as healthy detachment. “Letting go of the outcome,” and “trusting the process” are principles reinforced as the parent enrolls their child in a wilderness program. Rather than lectures, parents learn the value of teaching with healthy boundaries and experience. A parent explained to me, “The most important lesson I have learned by our participation in wilderness therapy is that children often change from the outside-in, not the inside out. I have been engaged in lecturing and verbally teaching my son, and I realize that I have not reached him. He isn’t struggling with something rational, and your program has taught me to shut up and understand that he is a child and needs to learn from his experiences.” This doesn’t relegate the parent to a bystander, but rather encourages them to create experiences and limits that do the teaching in the way that children learn. They are often not insight-oriented creatures, with their developing frontal lobes, but rather irrational and driven by unconscious needs and social influences.

Participants in wilderness therapy become the “hero” in their own journey through their experiences associated with hikes, making it though a storm, braving cold temperatures, participating in communal living, and cooking a tasty meal over an open flame that you made yourself. All these experiences create a sense of accomplishment and efficacy. These successes give birth to a greater sense of confidence. The students feel positive about themselves, not because they receives praise, but because of their accomplishments and increased sense of self-efficacy. Group therapy sessions occur throughout the day, highlighted by a group around a fire circle at night—the same fire where their dinner was cooked. The fire was created by a student using the meticulous bow-drill technique of rubbing sticks together. The fire circle is a perfect example of the integration of living and learning.

The first thing I learned about children, while working in wilderness therapy, is that they are much more resilient than they or their parents believed they were. Wilderness therapy is hard, challenging, and safe. It is a good place to practice living in relationship to others and to the self. The children develop such an affinity that they regularly promise to come back to work in a wilderness program. While all of them don’t follow through on this promise, our ratios show that about 25 percent of our front line staff are former clients.

Wilderness living is free of the usual distractions or hiding places that home offered. Without these distractions, the student learns how to feel, how to assertively express their feelings, and how to practice healthy coping strategies. The experiential aspect of wilderness therapy also speaks the language of children’s developing brain. Rather than verbal therapy, the student is engaged through the context of daily activities related to living. Our brain stores our memories in cell assemblies; these are groups of associated cells that code information. Accessing our issues through the medium of verbal or oral therapy alone may limit our ability to deal with and correct the challenges we face in mental health and addiction treatment. Our pain or trauma may be stored in the parts of the brain where language doesn’t exist or was stored in the brain before we had language to name it. As a result, experiential therapies may be most effective at accessing trauma and creating a reparative experience for the participant in a way that talk therapy cannot touch.

The use of story, metaphor, and experience commonly utilized by the wilderness staff also do well to bypass resistance. The change of context students experience as they move out of the city and into the woods creates a certain rawness or vulnerability. Students suddenly become exposed to themselves and to others. Since the lessons don’t often walk through the front door and announce themselves like in a therapist office or the home, the student’s resistance is less likely to be engaged. Practical living, rituals, ceremonies, and rites of passage become the mediums of the expression and healing in wilderness therapy.

One of the most common changes in wilderness therapy living for the student is the shift from an external to an internal locus of control. This transformation refers to a change from “happiness and success are determined by the things that happen to me,” to “I am the one that determines my happiness and success.” Happiness doesn’t come when we take our kids to Disneyland—any parent who has made the journey to the Magic Kingdom can attest to that—but rather it comes when we connect to ourselves, work through something, and find nurturing in our relationships. What better place to find and spend time with ourselves than nature?

It is important to note that play and fun occur in primitive living models also. A certain innocence is restored as students learn to create their fun through simple camp games. Participants learn that happiness and fun does not come externally through material things or from substances; they learn to create their own fun. Fun and play are an essential aspect of a child or young persons’ development. In the book Child-Centered Play Therapy, the authors explain the therapists “aim is to provide developmentally relevant treatment in a child’s own ‘language,’ that of play.” As Plato reportedly observed, “You can discover more about a person in an hour of play than in a year of conversation.” The difference between a true wilderness therapy model and the adventure therapy model is that life includes play in our model, and the adventure therapy model puts fun and play and excitement as the center of the treatment model (VanFleet, Sywulak, & Caparosa-Sniscak, 2010).

Wilderness as An Intervention for the Entire Family

The earlier versions of wilderness therapy did not address or support the family. In fact, I was told as a new wilderness therapist to ignore the parents and the family dynamics. “They were beyond help,” I was told. I was encouraged to avoid family coaching and parent education, and to refer the family to a therapist in their home community. This lack of parent support was one of the principal changes that ultimately led to me leaving my first wilderness program and creating a family therapy based wilderness program. Trained in family therapy and systems theory, I was able to see that addressing family dynamics didn’t necessarily imply that the parents were the cause of the problem, but that by changing some of the dynamics we could improve outcomes and retain the change in our clients substantially.

With a family-therapy-based wilderness program, families are offered a plethora of services for support. Weekly parent coaching via telephone, family workshops, and parent groups are all a part of the experience. Family visits to the field during the middle and at the end of the course are encouraged. Cell and satellite phone therapy sessions are provided as student and parents begin to utilize new skills and insights developed in the weekly letter-writing process. The goal of wilderness therapy, like other therapies, is to treat the identified patients and all those effected by and embedded in their struggles. The primary tool in this model is the weekly phone call between the wilderness therapist and the parents. Updates, assessment, prognosis, and recommendations are offered each week during the family call.

Therapists review the written letters each week that are exchanged between the parents and their child. This letter-writing tool is a powerful version of family therapy and generates tremendous insight for families and the student. The deliberate form of family therapy, letter-writing therapy has also offered me a unique vantage point to treat the relationships between parents and their children. Coaching, communication skills training, and the restructuring of the relationship through letter-writing therapy is particularly clear because they occur in letter format. Because of the distance created by this unique intervention, the author of a letter has to wait days for a response, refocusing the individual on self, rather than focusing on the reaction of the other. The natural distance this process creates reduces reactivity, manipulation and codependency. This structure, inherent in wilderness therapy, is a fantastic guide rule encouraging healthy differentiation.

Concluding Thoughts

Wilderness therapy is safe, both physically and emotionally. One student said to me in tears, after hearing from his mother he had to complete the objectives on his treatment plan, “You have taken away all of my freedom,” then he paused and continued, “except my choices.” Another child told his parents after hearing he was going home, “I have never felt so safe and free in my life as I have felt here.” This was coming from a young man who initially threatened to hurt himself unless his parents let him come home after one week.

Wilderness therapy is a sophisticated and compassionate version of therapy for adolescents and young adults. The practice of wilderness therapy has grown considerably in the twenty years I have been practicing with outcome research* replicating our early findings of efficacy (Hoag, Burlingame, Reedy, Parsons, & Hallows, 1999) and the development of standards and definitions about this unique treatment approach, which has come to be identified as Outdoor Behavioral Healthcare. Additionally, researchers have identified some of the factors that promote healing and health in wilderness therapy. Small group living, promotion of self-efficacy through task accomplishment, and nature’s facilitative influence on mindfulness are identified as key factors in promoting therapeutic change (Hoag, Massey, Roberts, Logan, & Poppleton, 2011; Russell, 2007). There is a powerful bond and quality created as therapeutic staff care for and work closely with students in this challenging and raw environment. It is emotionally rehabilitating. It is a rich, dynamic, spiritual, and even magical intervention. Perhaps the best way I can explain it is by using the language I used to explain it to my own children when they were young, “I work in the mountains to help the sad boys and girls feel better.” That is basically what we do. We put backpacks on their backs, hike, live, teach them how to feel, and how to feel better. Going back to nature may be more important than ever in our digitally drenched world. Like many of our students and their parents suggest after participation in wilderness therapy, “Everyone should have to do this!”

References

Bronson, P., & Merryman, A. (2009). NurtureShock: New thinking about children. New York, NY: Twelve.

Hoag, M. J., Burlingame, G. M., Reedy, B., Parsons, P., & Hallows, G. (1999). The efficacy of wilderness therapy: Analysis of change using the Y-OQ. Poster presentation at the annual meeting of the Western Psychological Association, Irvine, CA.

Hoag, M. J., Massey, K. E., Roberts, S., Logan, P., & Poppleton, L. (2011). What changes in wilderness therapy: Moving beyond outcome. Paper presented at the meeting of the Utah Regional National Association of Therapeutic Schools and Journals, Provo, UT.

Lee, D. (1959). The joy of work as participation. In D. Lee (Ed.), Freedom and culture, (pp. 27-38). Prospect Heights, IL: Waveland.

Russell, K. C. (2007). Summary of research in the Outdoor Behavioral Healthcare Research Cooperative from 1999-2006. Retrieved from http://natsap.org/wp-content/uploads/2011/07/Research_1999-2006.pdf

Van Fleet, R., Sywulak, A. E., & Caparosa-Sniscak, C. (2010). Child-centered play therapy. New York, NY: Guilford Press.

See more at: http://www.counselormagazine.com/2014/Mar-Apr/Out_of_the_Office/#sthash.B7zsYjRN.dpuf

Comments

Be the first to comment on this page:

Post your comment