Why Wilderness Therapy Works

The prescriptive use of adventure.

Posted Dec 01, 2017

By Patrick M. Burns

In 1994, when I was fourteen years old, my parents, with considerable reluctance, accepted the recommendation of an educational consultant and sent me to an outdoor therapeutic program in Oregon. Apprehensive that the program was a “scared straight” boot camp, they nonetheless concluded that, given my emotional and behavioral issues and my lack of progress with outpatient “talk therapy,” wilderness was worth a shot.

Flobrant/Unsplash
Source: Flobrant/Unsplash

Since then, wilderness therapy, defined as the prescriptive use of adventure experiences provided by mental health professionals, “that kinetically engage clients on cognitive, affective, and behavioral levels,” has come a long way. More than 100 Outdoor Behavioral Healthcare programs in the United States serve more than 10,000 clients and their families each year. Professional organizations in this field (affiliated with the umbrella organization, the Outdoor Behavioral Healthcare Council) are now committed to, accreditation, increasing access through third party payers, best practices, effective treatment, evidence based research and monitoring risk management.

Most important, there is considerable anecdotal and empirical evidence that wilderness programs work. 

Parents are frequently concerned that sending their son or daughter to an outdoor behavioral health program will compromise his or her safety. However, recent studies demonstrate that the average injury rate in an outdoor behavioral health program is 1.12 per 1,000 participants. 

While no setting can guarantee safety, adolescents participating in OBHC programs are actually at less risk than other adolescents. In fact, the average American adolescent is two times more likely to visit an emergency room than an OBHC program participant.

The OBHC has also conducted studies on the emotional and behavioral outcomes of clients from participating programs. They have found that significant improvements were made during wilderness program treatment and that clients maintained these positive changes 1 year after discharge. Interviews with a random selection of participants revealed that 83 percent reported to be doing better, 58 percent said they were doing well or very well, 81 percent rated OBH treatment as effective and 17 percent were still struggling.

A recent meta-analysis, reviewing 197 studies related to adventure therapy (inclusive of wilderness therapy), reports that the short-term effect of adventure therapy is greater than that of alternative and no treatment comparison groups. Follow up studies indicate that for a substantial percentage of “graduates” of wilderness programs, including those with clinically significant levels of emotional and behavioral dysfunction (including substance abuse) the short-term growth is maintained.

These empirical studies, most of which, to be sure, were commissioned by the OBHC and conducted by “in house” researchers, are consistent with my own experiences, those of the vast majority of my clients, and conversations I have had with other educational consultants.

Wilderness therapy does three things very well: assess the issues, help the young person develop coping strategies, and emerge with a more positive sense of self and hope for the future.

Opening Up/Assessment:

The first step in the “treatment process” should include a rigorous assessment of “the problems.” Families frequently acknowledge a lack of in-depth knowledge (beyond the obvious manifestations of anger, anxiety or depression) about what is going on beneath the surface with their son or daughter. At times, they are uncertain about the diagnoses offered by professionals. Medications may or may not have helped. They wonder whether spending two months in the woods can really address core issues and fear that sending their son or daughter away will only exacerbate already frayed relationships.

Although once a week therapy can be very helpful, adolescents are not always motivated to cooperate by offering relevant information. Many therapists agree that wilderness programs, comprised of several students, field staff, and mental health professionals, provide an environment conducive to self-disclosure. Students in each group are often of the same age and share similar issues.

I started to open up because everyone around me was opening up. When I heard my contemporaries talk about something I could relate to, but had never shared, I joined the discussion. As the days and weeks passed I developed trust, and began to thrive on the positive feedback I received from sharing intimate details of my experiences. These disclosures were explored in greater depth in individual therapy sessions and during hikes with field guides.

In many cases, moreover, parents receive clinical information about their child, often for the first time, typically through weekly calls in which the therapist discusses observations, reports on progress and relays assignments for the upcoming weeks.

The Development of Coping Strategies:

When a young person attends a wilderness therapy program, he or she is observed by staff at all times. With in-the-moment therapy, professionals constantly assess how young people are managing their experiences—and intervening when appropriate. They talk through issues in real time and help the student develop strategies to self-soothe more productively—and move on when appropriate. Many young people learn to rely more and more on themselves as well as seek out appropriate help from peers and adults.

Identity/Self-esteem:

As several researchers have noted, wilderness therapy programs help build success-oriented identities for clients by increasing self-concept, hope, internal locus of control, self-confidence, and improved interpersonal relationships and social skills.

My wilderness experience, I will confess, was not easy and my progress was not always linear. That said, I take pride in my participation in the self-discovery process and the skills acquired by “living primitively.”

More important, I left with a much greater understanding of who I was, how I connected with my family, where I fit into the world, and how, when and with whom I could discuss my feelings.

To be sure, wilderness programs have limitations. The groups tend to be pretty homogenous, lacking both socioeconomic and ethnic diversity. And, of course, not everyone “takes” to them, or is an appropriate candidate for one. And more often than not, wilderness therapy should be considered a component of a larger—and oftentimes—longer process.

I have experienced a variety of treatment options, but none were as memorable or enduring as my experience in wilderness. I still have the journal we were asked to keep and I remember, in vivid detail, the night we sat around the campfire and the conversation that provoked my first “aha moment.” And of course, I remember the first time I saw my parents, with whom I had been so angry, after being apart from them for a long period of time. They and I had literally, and figuratively, come a long way. Like many of my clients, I had ups and downs after wilderness, but I look back with gratitude at what turned out to be a defining experience. 

Patrick M. Burns is a therapeutic and educational placement specialist at the consulting firm, ECS.