Revision happening now. Wording might change while you are reading.
Wilderness therapy is one of the most effective forms of intervention with many young people, especially older adolescents and young adults. When we hear "wilderness" we tend to think of the short term programming, usually six to twelve weeks, that is often the starting point for therapeutic intervention with older children, adolescents, and young adults. The typical short term therapeutic wilderness program can be the most effective way we know with many young people to (1) improve motivation and (2) provide an excellent assessment so families can better plan for the long term, although medication reviews are not possible in most wilderness settings. (Some variations of the wilderness theme will also be discussed) The value of Wilderness for many young people simply cannot be overstated.
Variations on this theme are trending. Some programs, like Discovery Schools of Virginia and Eckerd operate with some aspects of wilderness in a long term setting and have been doing so for many years. The goals there are different from the short term wilderness programs. Base camp models (see below); bells and whistles found in other programming, such as equine therapy, medication reviews (Aspiro), ropes courses, etc. occur in some venues. Most provide in-depth psychological testing. Some school work to continue (Summit Achievement and Trails Carolina, for example).
Short term wilderness has two primary values: It enhances motivation for most teens and it provides a great opportunity for evaluation. The one limitation is that most wilderness programs do not do medication trials and adjustments. You will find exceptions; ask the programs. Aspiro is one. Look at our search function.
To understand how wilderness works, we recommend reading the book Shouting at the Sky by Gary Ferguson. As you read this keep in mind that this was written in the 1990s and today's wilderness programs tend to have many add-ons not considered then. It does give an excellent account of the basics of what happens in most wilderness programs and why they are effective. In our opinion it also offers some insight into why wilderness is not the best choice for everyone. Since this book was written, most wilderness programs have added a very strong clinical component that the program described did not offer then, but later added. (That program has since closed) More recently some programs have become base camp model programs; their participants return to a permanent camp or building(s) at regular intervals, which location may have modern conveniences . Some have added ropes courses and artificial climbing walls. Some have added Equine therapy. Some have added an academic component.
In addition to that, many therapeutic boarding schools, Residential Treatment Programs, and Young Adult Programs have added wilderness-like experiences their own programming.
Like most powerful medicines -- and wilderness is a powerful medicine -- it has powerful benefits and has risks and side effects. Families considering wilderness need to learn both the benefits and liabilities of wilderness as they really are before making a decision. We get very frustrated by the wrong information in circulation about wilderness both pro and con. Parents influenced by those bits of wrong information are very likely to make a bad decision. Some examples of very bad information:
- "Wilderness should be used for a punishment." Wilderness should never be used as a punishment as such. It might in some cases reasonably be a consequence of a young person's choice. For example, if parents are considering wilderness for the reasons wilderness can be a constructive modality, and they inform their son or daughter "if you choose to do X, we will understand you are telling us that you need wilderness" then X occurs, and wilderness is the consequence, that is OK. But deciding on wilderness in the heat of anger about a young person's behavior is never a good idea.
- "Wilderness is like a boot camp." NOT!! We are accustomed to parents equating Wilderness with Boot Camps. Actually there is hardly any similarity between a well run therapeutic wilderness program and a boot camp. If you read what we say about Wilderness and what we say about Boot Camps, the differences should become clear.
- "Any child or young adult with any kind of behavioral problems should go to wilderness." NOT (We are particularly concerned when we hear this attributed to educational consultants). Wilderness should be used very selectively, just as any powerful medicine must be used selectively. While we don't say "never use wilderness" in any of the situations referenced, we believe caution should especially be used in any of the following situations:
- Young people who are extremely anxious. Wilderness works in part because it introduces an unfamiliar environment that produces a certain amount of anxiety that, used constructively with many teens, can break through resistance to change. But before sending a young person to wilderness, parents and professionals need to consider the question, "Will the anxiety this environment produces be constructive in this situation? In some situations, even for a person with an anxiety disorder, the answer will be "yes." But in that case a clinician expert in treatment of anxiety disorders and also very familiar with the wilderness environment should be supporting the strategy.
- Young people showing symptoms suggesting autism spectrum issues. Note we did not restrict the caution notice to people with a formal diagnosis on the spectrum. But we are also not ruling this out absolutely. The Vantage Point Program at Aspiro is specifically designed for people on the autism spectrum. We believe they do as good a job as can be done with that population. With many they have a very positive effect. But if the decision on using even Vantage Point for a specific person is a one that needs to be made by someone who understands Vantage Point, understands the autism spectrum, and understands the person you are considering sending there. (Since writing this, a number of other wilderness programs have initiated specific programming for this population)
- Children who are pre-puberty and/or very early adolescents. Again, this is not an absolute rule-out. We have used wilderness with some very young clients with good results. For example the Second Nature Footsteps program has an age appropriate environment for early teens and pre-teens, headed by a very capable therapist, and does a fine job, with the young people admitted. We are far from convinced, however, that wilderness is the optimal environment for many of the young people sent there.
- Young people with strong indications of attachment issues (early childhood trauma; early childhood in foreign orphanages) are all situations where wilderness is sometimes appropriate but in many cases wilderness would be counter productive. We do not question that certain wilderness programs are staffed with attachment informed staff including therapists. However, an essential aspect of attachment treatment is forming a relationship with a therapist and perhaps other mentors who will form consistent, lasting relationships with the young person. Since wilderness tends to be short term, that is not compatible. We do understand that there are some exceptions where wilderness will have a benefit for a person with serious attachment issues. Frankly we think these exceptions are extremely rare. We urge that wilderness not be used with people with serious attachment issues unless an independent clinician who is expert in attachment fully supports the decision. Too many referral people look a negative behavior and think "Wilderness" as a response to the behavior. But this should never happen unless a well qualified attachment expert confirms that this is the legitimate rare exception.
- "Any young person being dismissed from a therapeutic school or treatment program should automatically go to wilderness, especially if it is due to behavior." That is often appropriate, but should not be done automatically. In cases like that, one question to be asked and answered before committing to wilderness in this circumstance is "What happens after?" Will the school accept the student back, if the student is successful in wilderness? If he or she does not do well, then what? In many cases this is an appropriate use of wilderness, but it needs to be part of a larger plan as to what happens in response the dismissal or suspension. Parents: get the whole plan before committing to wilderness.
- "Enroll your son or daughter in wilderness just for the summer and she/he will come home and be the kid you always wanted." Wrong! With the rare exception of the teen who without pressure and with full knowledge of what she/he is getting into volunteers to go to wilderness, NO ONE SHOULD EVER BE SENT TO WILDERNESS WITH ASSURANCE OF RETURN HOME WHEN THE WILDERNESS TIME IS COMPLETE. Families should never consider wilderness for a resistant teenager unless fully prepared emotionally and financially to continue with long term residential placement after wilderness. (A completely willing and fully engaged teenager is a different story) That is, a long term placement to which the young person will go directly from wilderness without stopping home. To use wilderness without being open to that possibility may cause more harm than good. And this warning has no exceptions.
To be clear, sometimes young people going wilderness will be ready to come home after their wilderness experience. When we say "no exceptions" we are concerned with what is promised at the front end, not what we may learn during the wilderness experience. The problem is, we do not know which kids will be able to return home safely and appropriately immediately after wilderness until we know what impact wilderness is having on the kid and the parents. The increasing availability of transition services like Vive and Homeward Bound does make successful return home after wilderness more likely to be an appropriate possibility. But you still must be open to the possibility that a longer term structured setting may be necessary. Again, those kids who go to wilderness fully voluntarily, knowing what it will be like, present a different situation and may be appropriate for wilderness with no committed plans for after wilderness.
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September 16, 2016