Mother Nature’s Medicine — Wilderness Therapy
By Dan Orzech
Social Work Today
Vol. 6 No. 4 P. 14

Exploring the wilderness isn’t a cure, but sharing the vast beauty and solace of nature with others can absorb a lot of anger and give kids a place to start healing.

Dwarfed by towering, 11,000-foot–high, snow-covered peaks, eight teenagers and three adults kick up dust with their hiking boots as they make their way toward a pristine alpine meadow in a wilderness area just north of Yellowstone National Park.

The adults are staff members of Three Rivers Montana, a wilderness therapy program based in Belgrade, MT; the kids, most of whom will spend six weeks or more in the backcountry, have been referred to the program for a variety of issues, including substance abuse, trouble in school, and harming themselves.

There are roughly 150 wilderness therapy programs in the United States; together, they will treat roughly 15,000 kids this year. The programs can be rigorous. Typically, the kids will be hiking for days at a time, cooking their own meals and setting up their own campsites, as well as learning wilderness survival skills such as how to make a fire with a bow-drill. In many programs, kids spend anywhere from a few hours to a few days in the wild by themselves, in an Outward Bound-type solo.

They’re also meeting with therapists—sometimes while walking side by side on the trail—doing interpersonal group work in the evenings, and completing written assignments or art projects. At Three Rivers, which is accredited as a high school, they may also be earning up to six high school semester credits in areas such as environmental science, applied English—they write four essays during their stay—and interpersonal psychology.

That doesn’t mean it’s all work. “We think it’s important that kids have fun,” says Marylis Filipovich, LCSW, executive director and cofounder of Three Rivers. “We play games, and the kids learn to make things from what’s available in the wilderness. In the summer, sometimes they’ll have fresh salad out of what they’ve been able to gather, or make pies out of wild huckleberries.”

Drugs … and Depression
While wilderness therapy programs date back to the 1940s, the field experienced a boom in the late 1980s and early 1990s, following on the heels of the success of programs such as Outward Bound and a growing nationwide interest in activities such as backpacking and rock climbing. Since then, the industry has grown steadily, according to Keith Russell, a professor at the University of Minnesota who studies the field.

Most kids in wilderness therapy programs are there, at least in part, because of drugs or alcohol. Substance abuse is the primary diagnosis for approximately one half of the kids in wilderness therapy programs, says Russell, and in roughly one half of those, it has become a significant problem or full-blown addiction. Another 25% of clients are also using substances in some fashion, but they are issues primarily for problems stemming from things such as attention-deficit/hyperactivity disorder, bipolar disorder, or social adjustment difficulties.

But that doesn’t mean the programs make substance abuse the main focus of their work. Three Rivers, for example, has a licensed addiction counselor on staff but does not bill itself as a substance abuse treatment center, says Filipovich.

At the Catherine Freer Wilderness Therapy program in Albany, OR, the staff views substance abuse mostly “as a co-occurring issue,” says Paul Smith, MS, program director. “Most kids don’t start using just to start using; there’s some other deficit or some trauma they’re trying to medicate. So we believe if we don’t work with both things, we’re missing the boat.”

That may be less true in adult treatment, Smith says, “where if you don’t deal with the addiction first, you’re not going to get to the underlying emotional pieces. But with kids, sometimes it’s clear that if you don’t deal with their depression, for example, or with the abandonment or grief they felt from a parent dying, then you’re not going to impact the substance abuse. But if you attack the problem the other way and help them understand their grief or [its] impact on their life, they might be able to stop using.”

For parents of a child with a drug or alcohol problem, wilderness therapy may be both less expensive and carry less stigma than a traditional drug and alcohol treatment program, says Russell. Wilderness therapy programs are expensive, averaging between $300 and $500 per day, but that’s far less than a residential rehab program, which could run as much as $800 per day.

Wilderness Therapy or Boot Camp?
The term wilderness therapy is actually a broad brush that paints a wide variety of different types of programs. There are programs such as Three Rivers, where the kids spend five days of each week hiking in the backcountry and two days in a base camp, resting, restocking their backpacks with food and equipment, and meeting with therapists. Other programs use an expedition model. Oregon’s Catherine Freer—which was named after a pioneering woman mountain climber—takes kids out into the wilderness for treks that last 21 or 51 days at a time. There are also residential programs, such as Red Top Meadows, a private nonprofit treatment program in Wyoming’s Jackson Hole area which specializes in adolescent sex offenders. There, the kids typically stay for 14 to 16 months, during which time they will make several backcountry expeditions, including a 28-day trek in the summer, a week of trail work in the fall, and snow camping trips in the winter.

And then there are the boot camps, which achieved wide recognition—some would say notoriety—from recent media coverage. Many of the licensed therapists at more clinically oriented wilderness therapy programs are cautious about the boot camp approach.

Boot camps tend to be strictly behavioral and were “the flavor of the day in the 1980s, mostly to deal with an adjudicated population,” says Smith. They tend to lean towards uniforms for the kids, and lots of “PT,” or physical training, such as push-ups, sit-ups, and marching.

Filipovich draws the dividing line between boot camps and more clinically oriented programs around the issue of fear. At Three Rivers and similar programs, she says, the goal is to help kids get at what’s underneath their behaviors and teach them to meet their needs in ways that are not destructive to themselves or others. “With boot camps,” she says, “you’re achieving change through fear. As long as you’re there to provide the fear, you’re probably going to get really good results. When you’re not there to provide the fear, you’re probably not.”

There’s also a fringe element of wilderness programs, often faith-based and found in Idaho or Utah, that has some therapists deeply concerned. William Shryer, DCSW, LCSW, the clinical director of Diablo Behavioral Health Care in Danville, CA, has seen four or five psychologically vulnerable young people “who’ve been mistreated terribly” in these programs over the past few years. One teenager, he says, was put into a wooden box that was then put into a hole in the ground. “They acted as if they were burying him,” he says. “They wanted to have a funeral for his bad self and a rebirth of his good self.”

Some programs operate overseas, where it can be difficult for parents to find out exactly what is going on with their children—or retrieve them if there are problems. After reports of problems emerged, the U.S. State Department issued an advisory in 2004 strongly recommending that parents visit overseas programs before enrolling their children.

For parents seeking help for their kids, finding a good program, unsurprisingly, can be a nerve-racking process. “I get literally 10 e-mails a week from parents who’ve tracked me down and want to know if a particular program is any good,” says Russell.

That’s not a question that Russell, who studies the industry as a whole, can answer. He does, however, make some suggestions for parents or others trying to locate a good program: Look for programs that belong to the Outdoor Behavioral Healthcare Industry Council (www.obhic.com), the National Association of Therapeutic Schools and Programs, or the Association for Experiential Education (www.aee.org), and that have licensed therapists on staff. They should also be nationally accredited by the Joint Commission on Accreditation of Healthcare Organizations or the Council on Accreditation (www.coanet.org).

Ideally, programs should also be licensed by the state where they operate, Russell says. But while state licensing is becoming more widespread—Colorado, Oregon, and Idaho all began licensing programs in the past few years—there are also a number of good programs that operate in states such as Minnesota that do not yet license wilderness programs.

Authority Figures
Wilderness programs appear to succeed from a combination of two things: the power of the wilderness itself and the close therapeutic bonds that kids form with program staff.

Wilderness programs, says Smith, “can take the therapeutic relationship to a different level because of the intensity and the closeness and the shared experience. The staff has different skills and competencies than the kids, but if it’s raining, everyone’s getting rained on.”

For kids—especially ones who may be wrestling with their own growing independence in the world and challenging authority—the staff’s experience in the wilderness makes it rapidly apparent who the authority figures are—and why.

In the 1970s, educator John Holt wrote about “natural authority,” the notion that authority is based on trust, respect, and an awareness of another person’s greater competence in a specific act or field. For Holt, that authority had nothing to do with age or college degrees but emerged out of competence.

In the wilderness, that authority flows naturally from the staff’s skills in navigating terrain, knowing how to keep warm and dry and avoid bugs, sunburn, and bears—and being able to help kids with their own emotional issues as well as challenges in group dynamics.

The biggest natural authority in the wilderness, however, is the environment itself, which provides feedback that is often very concrete. “If you set up a poor shelter and it rains,” Smith says, “you get wet. That’s instant feedback in a way that most of us are pretty buffered from.”

The feedback isn’t always negative. Catherine Freer expeditions typically involve hiking up mountain peaks or other activities that give the kids a chance to develop a sense of mastery based on their own efforts. Reaching the top, Smith says, “the kids realize that they are there because they expended the effort to take the hundreds and hundreds of steps needed to get them there. It may have been difficult and they felt challenged, but once they get to the top, they see the view below them, and they realize they really did get from there to here, and they did that on their own.”

Wilderness programs are also structured to help kids learn to take responsibility for themselves. “Our clients,” says Smith, “are mostly cooking their own food. If you burn your meal, it’s not as though you can blame it on someone else. That feedback loop is really helpful.”

Taking It Back Home
But does the progress kids make carrying a backpack in the mountains for three weeks carry over when they leave the wilderness?

That’s the key question, says Smith. “We can do whatever we want in the field, but if it’s not transferable, it doesn’t mean anything,” he says.

Wilderness programs are increasingly focusing on what happens to their clients after they leave. The staff at Catherine Freer tells families they should be planning a year of follow-up care. That’s emphasized during the admission process and during a meeting with parents when they bring their child to the program.

“Parents need to have therapy appointments ready when their child returns,” says Smith. “You can’t wait and ride that warm and fuzzy feeling posttreatment for a month before you start aftercare. Most of our outcome research shows that the risky time period, when relapse is most likely, is three to six months posttreatment. You can help buffer that if you’re paying attention to it.”

Not all kids head directly home after a wilderness therapy program. At Three Rivers, approximately three quarters of program graduates will go on to a therapeutic boarding school. That figure is lower during the summer, says Filipovich, because the kids with less severe issues usually come during the summer.

All in the Family
A big part of having a successful transition includes getting the child’s family involved. Increasingly, wilderness therapy programs are making efforts to involve the family from the very beginning. That’s only logical, says Russell: “You can’t pluck the kid out, fix him, and drop him back into a dysfunctional system.”

Catherine Freer’s expeditions begin and end with a group session, often averaging five or more hours, with the kids and their families. The program tries to include as many of the clients’ family members as possible. “We try to get anyone who’s important either to their support or the issues they’ve developed,” says Smith. “That includes noncustodial parents, even though sometimes there’s a great deal of animosity between the parents.”

Between those sessions, while the child is on the trek, a program therapist is working with the family over the phone, usually for one hour per week, as well as supplying written reports on their child’s progress in the field, based on reports radioed in from the staff. Catherine Freer and a growing number of programs also require families to complete assignments while the child is on the trek. Catherine Freer’s assignments are online and are designed to teach communication skills and provide information on substance abuse, family roles, and similar topics.

At many programs, the parents’ assignments including writing letters to their children. For parents of teenagers at Three Rivers, the first letter they’re asked to write, says Filipovich, is a “puzzle letter,” which spells out the child’s individual strengths, the family’s strengths, and the pieces of the puzzle that resulted in the child ending up at Three Rivers. “Those might be individual factors,” Filipovich says, “like you were skipping school and flunking out, or they might be family factors, like mom and dad got divorced two years ago and things don’t seem to be going well.”

Later, Three Rivers teaches both the parents and the child about what it calls “blocks to listening,” or behavior patterns that shut down communication rather than promoting it. “We then have the kid and the parents exchange letters where they write which blocks they see themselves using with the other person and which ones they see the other person using,” Filipovich says.

Support groups for the parents are also growing in popularity. “What we see in the wilderness is that one of the most positive change agents for kids is their peers,” says Toby Mautz, MSW, a former wilderness therapist who now does consulting for various wilderness therapy programs. “That can apply to parents as well.”

Catherine Freer recently started regional parent support groups as part of its aftercare program. Mautz’s consulting group has begun offering parent support groups at its office in Princeton, NJ.

The challenge with ongoing parent support groups, of course, is that the kids on any particular wilderness therapy program may come from a half dozen or more states. Mautz would like to see different wilderness therapy programs working together to provide local support groups for parents.

The Healing Power of Wilderness
So do wilderness therapy programs work? At the University of Minnesota, Russell is in the process of finishing up a study which tracked 700 adolescents for several years after their wilderness therapy experience. In general, he says, his research shows that the outcomes from wilderness therapy programs are “fairly positive.” Kids with more serious issues, however, required a more structured aftercare environment, such as a therapeutic boarding school, to continue to do well.

For many of the therapists who work with kids in the field, there’s no doubt about the healing power of the wilderness. “Our kids’ lives are full of chaos,” says Red Top Meadows’ program director Mark Ames, CMHW. “A lot of times they come from unstructured families or unstructured environments. Their minds and their lives are chaotic and confusing and hurtful. Going out into the woods offers them some peace and space. We like to say that the woods can absorb a lot of anger, a lot of feeling. It’s an opportunity for them to take a deep breath, to relax, and maybe, rather than the seeing the world revolving narcissistically around them, to feel themselves as a part of something larger than themselves, part of the universe.”

— Dan Orzech is a Philadelphia-based freelance writer and editor of “Mindfulness Update,” a newsletter for mindfulness-based stress reduction practitioners.