Beruflich Dokumente
Kultur Dokumente
Katherine Hodgson
D. Tufford
Stenberg College
Abstract
Adventure-based group therapy has been considered a viable treatment option for hard to treat
psychiatric service users, especially at-risk-youth. Based on traditional models of group development,
facilitation and therapeutic factors, adventure-based therapy takes group work out of the office and into
evidence-based work of Yalom (2005) and his model of interpersonal group psychotherapy, the efficacy
of adventure therapy is strengthened. Personal experience of the writer as an outdoor educator is drawn
from to provide examples of situational processes in adventure therapy groups. Three essential qualities
of group work are explored in light of Yalom's (2005) research; the social microcosm, group cohesion,
and selection of group participants. Due to the physical and emotional challenges of a wilderness
setting it is suggested that therapeutic factors are enhanced. Wilderness therapy plays an important role
treatment.
Standing at the top of a mountain with nine other youth participants. Together we are recovering
drug addicts, we are rape victims, we are delinquents. We are also mountaineers, we are ice climbers,
we are back-country cooks. Adventure-based therapy groups provides participants with the journey to
become something they never thought possible. Based on theories of traditional group psychotherapy
and experiential education, adventure-based therapy uses the wilderness as a tool-kit and group
interaction as the catalyst for change (Bandoroff & Newes, 2003). Over the past two decades
wilderness therapy has emerged as a treatment modality to engage hard to treat clients due to the effects
of the “out of the office” experience and it's ability to maximize spontaneous interaction between
clients and client self-disclosure (Hill, 2007). This essay aims to emphasize the value of adventure-
based therapy groups by comparing academic literature on wilderness therapy and personal experience
in the outdoor adventure industry with Yalom's (2005) evidence-based work on the efficacy of group
therapy processes. Specific therapeutic factors will be explored including the social microcosm, group
cohesion, and selection of group participants as well as implications for wilderness group therapy in
mental health.
Adventure-based group therapy has been increasingly used by social workers, mental health
professionals and counsellors for the purpose of promoting communication, problem solving and group
co-operation in adolescent and adult populations through the use of experiential and risk-taking
activities (Tucker, 2009). Adventure therapy, also known as wilderness therapy is a form of group
psychotherapy in that it is action orientated, it involves attention to clients personal goals, provides
immediate feedback from other participants and therapists and emphasizes personal responsibility
(Davis-Berman & Berman, 2008). The wilderness setting is believed to magnify therapeutic outcomes
through more intense group interaction, dependency on team members for survival and the perceived
Adventure-Therapy Groups4
risk of adventure based activities such as rock climbing, kayaking, mountaineering and spelunking.
The writer has been closely involved with three adventure-based organizations; Power to Be
from Victoria, British Columbia, Salt Spring Adventure and kayak from Salt Spring Island, British
Columbia and Outward Bound Pacific Rim School from Redmond, Oregon. For the purposes of this
essay, personal experience will be reflected upon from groups of Power to Be and Outward Bound.
Power to Be was founded in 1998 with the aim of enhancing the quality of life for youth and families
of special needs. The program consists of 15 days over six months including two days of outdoor skills
training, a five day sea kayak expedition and an aftercare program reuniting group participants for other
outdoor experiential activities. Youth are taught wilderness travel and survival skills, problem solving,
conflict resolution, emotional management through group work and group development.
Outward Bound was founded by Kurt Hahn in 1941. Since then it has become an international
community of interdisciplinary professionals from health, mental health, corrections, social work, and
wilderness education (Tucker, 2009). Value was found in Outward Bound from an early study which
documented a lower re-offence rate from a group of juvenile delinquents who were selected to
participate in a wilderness group therapy setting compared to a control group of traditional outpatient
group therapy (Davis-Berman & Berman, 2008). The belief behind Outward Bound is that by
bolstering physically and psychologically demanding components in a group setting, participants will
learn skills to be better prepared for coping with demanding situations in life (Davis-Berman &
Berman, 2008). Unlike Power to Be, Outward Bound is a long-term residential outdoor program in
which group members and therapists live in camps for up to 60 days at a time. Outward Bound
provides a variety of adventure activities depending on terrain and location such as river rafting, rock
Drawing from Yalom's (2005) evidence-based theory of interpersonal group psychotherapy the
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following will compare adventure-based groups with Yalom's work in an attempt to provide evidence
for wilderness therapy as a beneficial mode to group work. Yalom (2005) suggests that interpersonal
learning is a complex therapeutic factor to group therapy and is unique to the group setting. This factor
has become an integral part of psychiatry due to the fact that “people need people” for survival,
socialization and the pursuit of satisfaction (Yalom, 2005). For those with mental health issues it may
modify distorted interpersonal behaviours/beliefs. Adventure-based groups provides the opportunity for
The social microcosm theory suggests that over time individuals in a group setting will
automatically and inevitably display their maladaptive interpersonal behaviours during therapy sessions
(Bandoroff & Newes, 2003). Group context provides an environment for the enactment of individual
pathology and the problem solving that will be associated to reactions of other group members. For
many clients, the ability to self-report interpersonal characteristics is largely inaccurate. As group
members act out maladaptive behaviours the group acts as an immediate feedback mechanism and lays
ground for learning new behaviours that receive positive reactions from the group. Adventure-based
therapy groups are incubators for the social microcosm. Yalom (2005) makes note that the more
spontaneous interaction there is, the more rapid and genuine development will be of the social
microcosm. Spontaneous interaction is essential to complete tasks in an adventure group setting. For
example, when a group is caught up in environmental elements such as a blizzard or a rain storm
quitting is not an option. All participants must work through challenges and play a role in order to
succeed. When a participant chooses not to play the role that the rest of the group depends on (i.e.
cook), the entire group suffers and ultimately goes hungry. It is demanding circumstances such as these
that cause individuals to let their guards down and act in an unselfconscious manner that will recreate
past learned maladaptive interpersonal behaviours. These past behaviours continue to exist until
Adventure-Therapy Groups6
realized in an adventure-group setting because, people in their past have not communicated reasons for
rejecting poor behaviour (Yalom, 2005). The adventure-based group setting forms norms for participant
feedback in scheduled times such as after dinner during group reflection which allows other group
members to say what about their behaviour was ineffective as well as individual self-observation
through “solo” time. Solo time usually occurs after a physically demanding task such as a few hundred
foot rappel from the top of a rock spire. At this time group members are experiencing emotions they
have never felt; the have achieved something they never thought possible and have engaged all sensory
systems which enhances the learning and change process. Here interpersonal learning and self-
reflection occurs. Hill (2007) reiterates the effects of wilderness therapy on learning by stating that,
“effective wilderness therapy groups involve challenge and stress. Challenge and stress are powerful
(Hill, 2007). Group cohesion is the sense of “we-ness”. It is the extent that group members will stand
up for the norms and values of the group and the amount of pride they feel for being members of the
group (Yalom, 2005). Members of a cohesive group feel warmth, belonging and a sense of
unconditional positive regard from other group members (Yalom, 2005). Cohesion is so important
because without it other therapeutic factors may not be facilitated and for many group participants this
may be the first time they have felt valued and as an integral part to a group's development (Yalom,
2005). Adventure-based groups offer increased opportunities for group decision making, problem-
solving and depending on each other for physical trust (Tucker, 2009; Hill, 2007). Working together in
attempts to reach physical goals brings the group together and develops skills in interpersonal
communication and leadership roles. Yalom (2005) implies that when success occurs in group tasks this
strengthens emotional bonds within the group which will lead to greater integration of therapeutic
factors. Wilderness therapy offers a variety of initiatives in order to accomplish goals of improved
Adventure-Therapy Groups7
communication, increased problem solving and enhanced leadership. Physical trust that is unique to
adventure-therapy activities promotes interpersonal trust among group members (Tucker, 2009).
Physical trust can be seen as a less threatening way to become emotionally connected to other group
members then verbally sharing emotional experiences such as in traditional group therapy. Rock
climbing is an example of a physical trust activity; the climber depends on the belayer for their ability
to safely climb and descend great heights. Hill (2007) found that the use of these kinds of activities
establishes a willingness to communicate openly and honestly and feel connected to each other.
Outdoor professionals are trained in how to spontaneously structure and implement group initiatives,
for example one group of youth during an Outward Bound trip were in conflict. Some of them felt that
they were not strong enough to summit a peak in Oregon. They were all looking to the group
facilitators for answers and their judgement. By now the group had been together three weeks and the
facilitators knew that the participants had the ability to make the judgement call, they were merely
frustrated with conflict and being hung in their decision to prepare for summit or not. The facilitators
left the youth in the middle of the day unannounced only to come back at sunset when the groups
decision had been made. They summited at nine o'clock the next morning.
environments although very unique due to increased proximity of group members, physically
demanding activities, and increased time spent in the group under prevailing elements. In order for
group development to be successful, careful consideration of group participants must occur during a
selection process. Yalom (2005) makes note that the possibility of failure in group development may
occur if clients are unable to participate in the primary tasks of group for reasons being either logistical,
intellectual, psychological, physiological or interpersonal. Clients must have the ability and willingness
to engage in self-reflection, self-disclose and to give and receive feedback (Yalom, 2005). In wilderness
therapy clients are carefully selected by an in-depth clinical interview prior to trips (Davis-Berman &
Adventure-Therapy Groups8
Berman, 2008). Client screening explores the clients level of motivation to take physical risks, risks
related to emotional expressiveness and to self-disclose (Gillen & Balkin, 2006). During interviews
treatment goals and objectives are decided, any miss-conceptions or anxieties the client has are
addressed and pre-trip physical fitness programs are set-up. Clients are advised to quit smoking, engage
in physical activity for forty-five minutes everyday until the trip and avoid eating refined sugar and
sweets. Wilderness therapy is not beneficial for clients who are chronically psychotic, have enduring
substance abuse issues, are currently suicidal, or have anti-social personality disorder tendencies.
Physical disabilities however can be adapted to in a wilderness therapy setting. Power to Be offers
adaptive kayaking for clients who cannot use their legs or have decreased motor-skills. Booms are
attached to kayaks to offer increased balance and support. Similarly, the writer has assisted a young boy
with severe multiple sclerosis to the point where he could not use any limbs, climb at an indoor rock
gym using adaptive harnesses. Wilderness therapy values similar group selection as Yalom (2005) but
differs in that adventure-based groups welcome clients with physical disabilities even in the face of
development, nothing can truly prepare an individual for the experience of a wilderness group
expedition.
Wilderness therapy groups have some unique characteristics that are potentially beneficial for
psychiatric service users. First of all, adventure therapy groups allow therapists to observe clients in a
group setting over an extended period of time (Gillen & Balkin, 2006). Yalom (2005) refers to the
“marathon group” as group psychotherapy sessions that meet for extended periods of time with little to
no rest or sleep. It is believed that the fatigue and perseverance of clients causes social facades to
dissipate within the group as to better attend therapeutic needs of clients. Under the stress and
challenge of adventure therapy groups it is inevitable that pathological behaviour will be displayed and
Adventure-Therapy Groups9
thus able to better treat. The experiential aspect of adventure therapy offers an alternative to traditional
'talking groups'. For those individuals who find it difficult to talk about their issues, wilderness therapy
offers situations and life experiences as ways to gain insight into clients own interpersonal issues.
Although the efficacy of adventure therapy has yet to be empirically proven it has been noted to
reduce feelings of hopelessness guilt, and increase empathetic responses in psychiatric patients (Gillen
& Balkin, 2006). Mental health professionals need to be aware of adventure-therapy as a potential
treatment option for clients especially hard to treat adolescents. It has therapeutic benefits and mental
health professionals may act as advocates for individuals who would be potential candidates for an
References
Bandoroff, S. & Newes, S. (2003). Coming of Age: The Evolving Field of Adventure Therapy.
Davis-Berman, J. & Berman, D. (2008). The Promise of Wilderness Therapy. Association for
Gillen, M. & Balkin, R. (2006). Adventure counselling as an adjunct to group counselling in hospital
and clinical settings. The Journal for Specialists in Group Work,31(2), 153-164.
Doi:10.1080/01933920500493746.
Hill, N. (2007). Wilderness therapy as a treatment modality for at-risk youth: a primer for mental health
counsellors. Journal of Mental Health Counselling, 29(4), 338-349. Retrieved from CINAHL
Tucker, A. (2009). Adventure-based group therapy to promote social skills in adolescents. Social Work
Yalom, I. & Lesczc, M. (2005). The Theory and Practice of Group Psychotherapy (5th ed.). New York,