Wilderness therapy, also known as outdoor behavioral healthcare, is a treatment option for behavioral, substance, and mental health issues in adolescents.[1] Patients spend time living outdoors with peers. Most participants attend involuntarily. Reports of abuse, deaths, and lack of research into efficacy have led to controversy.
Overview
Wilderness therapy has been described as "adventure-based therapy", "challenge courses", and "wilderness experience programs".[2] A variety of theoretical orientations are used in wilderness therapy, [3] including mindfulness-based therapy and cognitive behavioral therapy. However, in the majority of wilderness therapy programs, teens spend most of their time living in tents in the woods with a group of eight to twelve peers.[4][5] In one program, participants are accompanied by three staff members who are not trained as therapists and work for minimum wage, who are responsible for their day-to-day activities.[4] Unlike other forms of therapy, the therapists (and other staff members) in wilderness therapy programs share their living situation with the client, which has raised some ethical concerns about transference and countertransference and maintaining appropriate boundaries between therapist and client.[6]
About half of wilderness therapy participants attend involuntarily and are transported by services specialized for “uncooperative” youth.[1]
Madolyn Liebing first proposed combining clinical therapy with wilderness programming.[5]
Generally, therapeutic wilderness programs cost upwards of $30,000 or more for a child’s three-month stay.[4] Few clients receive financial assistance from medical insurance.[7] Insurance companies have long refused to pay for wilderness therapy, contending that the programs are not covered by insurance policies because they take place outdoors.[8]
Controversy
Allegations of abuse, deaths, and lawsuits
Abusive situations have been reported and children have died in wilderness therapy programs. Many participants also say that they are left with lifelong trauma from the experience.[9]
In Utah, two teens died in 1990 while enrolled in wilderness therapy programs.[10] Both of their deaths were related to heatstroke on hikes.[10] Aaron Bacon, age 16, died in 1994, while enrolled in a wilderness program in Utah. He was three weeks into a 63-day wilderness trek when he died of peritonitis and a perforated ulcer.[10] Several staffers were charged with felony neglect and abuse of a disabled child.[10]
In 2001, a teen at the Catherine Freer Wilderness Therapy program died of heatstroke and dehydration while on a hike the day after she had arrived.[11] Another fourteen-year-old in the Catherine Freer Wilderness Therapy program died in 2003 when a tree fell on the tent that he was sleeping in.[11]
Maia Szalavitz, author of the 2006 book Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, has concluded that many of the tactics that wilderness-therapy programs use are no different than those used at Guantanamo Bay.[11] Szalavitz has documented cases of emotional and physical abuse, and the withholding of food, water, and sleep.[11]
In October 2007 and April 2008, the United States Government Accountability Office convened hearings to address reports of widespread and systemic abuse in adolescent treatment facilities. In connection to the hearing, they issued a report about the wilderness therapy industry.[12][13] The Federal Trade Commission has published a list of questions for parents to ask when considering a wilderness program.[14]
Due to the trauma and alleged harm reported by former wilderness program residents who have been forcibly escorted into placement, psychologists have heavily criticized this approach as inappropriate, and grossly inconsistent with establishing the necessary trust required for building a therapeutic relationship between youth and providers.[15]
Staff qualifications
Most wilderness programs advertise themselves to be therapeutic.[citation needed] In some programs, licensed mental health personnel are not employed to work directly with participants, [16] with programs instead hiring licensed mental health personnel as consultants or in other roles.[16]
To be licensed in the counseling field, one must possess at least a master’s degree in counseling, but much of the time these counselors are individuals without even a bachelor’s degree. Some programs report having no licensed mental health professionals on staff.[17] As a result, mental health emergencies and other related issues can become more serious.[citation needed] Some have argued that it is unethical for programs serving “high-risk” youth to deliver therapeutic services using less than professionally trained and credentialed mental health staff.[16]
Some researchers have argued that national standards should be created with respect to the training, formal education, and licensure in therapeutic wilderness programs.[16] Wilderness programs are not required to employ licensed workers, [citation needed] and so the counselors may be unqualified to help adolescents in the programs to create therapeutic change.[16]
Limited and biased research
Critics say that the effectiveness of wilderness therapy is unclear, and that further scientific studies are needed.[18]
Given the proliferation of such programs, relaxed regulation, and absence of research setting uniform standards of care across programs, advocates have called for increased accountability to ensure programs are capable of providing care that is consistent with their marketing claims.[12]
Some programs which advertise as "wilderness therapy" are actually boot camps similar in style to military recruit training in a wilderness environment.[19] These can sometimes be distinguished from other wilderness therapy by such programs promising behavior modification for troubled teens.[20]
One of the major differences between military style boot camps and wilderness therapy is the underlying philosophical assumptions (wilderness therapy being driven by the philosophy of experiential education and theories of psychology, and boot camps being informed by a military model). Incidents of alleged and confirmed abuse and deaths of youths have been widely reported across many wilderness programs, despite claims that these programs provide a less coercive environment than that of boot camps.[21]
Therapeutic wilderness programs have no outcome data to support the effectiveness of these programs,[16] and particularly the long-term effects of these interventions.[citation needed] One review concluded that until data demonstrates that therapeutic wilderness programs are safe and effective, these programs should not be a suggested treatment model for those struggling with their mental health.[22]
Lack of professional oversight
There is no governing body tasked with enforcing laws and regulating services provided by wilderness therapy programs.[citation needed] There are no national standards or state laws that regulate these programs.[23] Mental health standards are not enforced.[citation needed][clarification needed] This lack of oversight and responsibility puts these program participants in danger.[16]
After the program
After a wilderness therapy program, clients may return home or may be transferred to a therapeutic boarding school, young adult program, or intensive residential treatment center. Some estimate that 40% of children enrolled in wilderness programs are later sent to long-term residential behavioral care facilities.[24][needs update]