Risks and Benefits of Wilderness Therapy
Wilderness therapy combines rigorous clinical work with an experiential component in a way that is qualitatively different from both outpatient psychotherapy and other types of residential therapy. It is an evidence-based treatment backed by over 20 years of research. And despite how they are portrayed on social media and in the newspapers, wilderness therapy programs have been shown to be safe and non-punitive.
What is Wilderness Therapy?
Wilderness therapy is a clinical intervention for both adolescents and young adults. It can be used to address not just behavioral difficulties and substance abuse, but social, emotional and relational difficulties as well. Most wilderness therapies may include any or all of the following:
Extended backcountry travel and wilderness living
Continuous group living and regular formal group therapy sessions to foster teamwork and social interactions.
Individual therapy sessions, which may be supported by family therapy session.
Adventure experiences which help students to develop confidence and resilience by allowing them to move out of their comfort zones in a safe and supportive environment.
The use of nature both in reality and metaphor within the therapeutic process.
A strong ethic of care, support, and safety throughout the therapeutic experience.
Wilderness treatment can be thought of as an extended group backpacking and camping trip, with licensed clinicians. It allows the clinicians to see patterns and behaviors as they come up organically, and to be able to address them experientially in the moment, in addition to processing them verbally. Additionally, it is an evidence based treatment. It is supported by a considerable amount of research published in peer reviewed journals. It has been shown to improve participants’ self-esteem, their feelings of being more in control of their lives, and more confident. Further, it appears that the gains made in wilderness may last 6-18 months after students complete a program.
Risks
Regardless of the model, wilderness programs typically involve some participation in somewhat challenging and risky activities and helping students move out of their comfort zone. While doing so, programs necessarily have a responsibility to keep their students safe. “However, making physical and emotional safety paramount in outdoor recreation, education, and therapy does not negate the need for, or even the value of positive risk taking as a mechanism of personal growth” (Norton, 2021). Interestingly, data collected from wilderness programs show that despite the risks that are inherent in some of these activities they are actually quite safe. In fact, students enrolled in therapeutic wilderness programs were three times less likely to go to a medical emergency room than adolescents living at home. Further, teenagers were 140 times more likely to be injured playing high school football than participating in a wilderness program. In terms of therapy, “The average adolescent in US inpatient mental health services was about four and a half times as likely to be restrained as (a wilderness therapy) client in 2010” (Gass et al. 2012).
Continued Improvement in the Field
As is the case for most areas of medical and psychiatric care, wilderness therapy needs to improve as the field continues to develop. Towards this end, just this year the National Association of Therapeutic Schools and Programs (NATSAP) has submitted legislation to congress that outlines federal guidelines intended to improve both the safety and effectiveness of residential therapeutic programs including therapeutic wilderness programs. This proposed legislation includes:
Child abuse and neglect shall be prohibited, including any acts of physical, emotional or mental abuse:
All parts of the covered program must ensure the safety of the children in their care:
Adequate furnishings at the covered program shall be provided for each child in their care:
The covered program must maintain and environment that ensures safety for program staff and children in care for the following safety areas-(I) Food service risk and assessment, (II) Drinking water or wastewater assessment; and (III) Hazardous material management, including handling and storage…
The covered program must obtain all private health record information referred to in this Act in a manner that complies with federal law and applicable regulations.
The covered program must have policies and procedures that cover all prescription and non-prescription medication …
staff at the covered program must be provided with orientation training prior to or within 30 days of hire. The orientation must include training on the following – (I) Discipline and behavior management protocols including de-escalation skills training, crisis prevention skills, positive behavior management, and discipline techniques that are non-punitive in nature and are focused on helping children in care build positive personal relationships and self-control; and (II) Training may not include any emotional, mental or abusive protocols.
ratios of staff to children in care must be established and maintained that will provide adequate supervision, safety and protection for children in care.
Outdoor therapy has been used to help teenagers and young adults for decades. It has been shown to be a useful and effective treatment when other modalities have not been successful. Is it 100% effective? No. Is an extended backpacking trip (whether as part of a wilderness therapy program or just for recreation) sometimes uncomfortable? Absolutely. Do backpackers sometimes find themselves cold or hungry or dirty? Yes. Has it been shown to be safe? A review of the literature confirms that these programs are, in fact, quite safe. Were/are there some poor quality programs out there? Unfortunately, yes. Did the industry need to grow, develop, improve and tighten up its procedures over the past 25 years? Yes. Have surgical procedures, chemotherapy and most other medical procedures grown and improved over this same time span? Of course. Is wilderness therapy a panacea? No. But it can be an extremely good and useful option when it is a good fit and other treatments have not been successful.
References
Bettmann, J. E., Gillis, H. L., Speelman, E. A., Parry, K. J., & Case, J. M. (2016). A Meta-analysis of Wilderness Therapy Outcomes for private pay clients. Journal of Child and Family Studies, 25(9), 2659-2673.
Bettmann, J. E., Martinez-Gutierrez, N., Esrig, R., Blumenthan, E., & Mills, L. (2023). Who declines and who improves in wilderness therapy. Child & Youth Care Forum. Advanced Online Publication.
Combs, K. M., Hoag, M., Javorski, S., & Roberts, S. (2016). Adolescent self-assessment of an Outdoor Behavioral Health program: longitudinal outcomes and trajectories of change. Journal of Child and Family Studies.
DeMille, S., Tucker, A. R., Gass, M. A., Javorski, S., VanKanegan, C., Talbot, B., & Karoff, M. (2018). The effectiveness of Outdoor Behavioral Healthcare with struggling adolescents: A comparison group study. Child and Youth Service Review, 88, 241-248.
DeMille, S. (2012). Is Wilderness Therapy Safe? www.redcliffascent.com/wilderness-therapy-program/wilderness-therapy-safe/
Gass, M.A. (2012). Accident Rates/Trends in Outdoor Behavioral Healthcare Industry Council (OBHIC) programs. Journal of Therapeutic School and Programs.
Gregg, Charles (2021). Legal Principles: The Law Says “Yes” to Risk. In S. Smith (Ed.), Beneficial risks: The evolution of risk management for outdoor and experiential education programs: Theories, research, and lessons learned through experience (pp. 81-91). Sagamore-Venture.
NATSAP’s Therapeutic Legislation. (2024) Proposed federal bill submitted to congress.
Norton, C. L. (2021). Excerpt: Trauma-informed risk management in Chapter 8 Inclusive risk management practices. In S. Smith (Ed.), Beneficial risks: The evolution of risk management for outdoor and experiential education programs: Theories, research, and lessons learned through experience (pp. 65-80). Sagamore-Venture.
