Tag Archives: youth

Parent-child relationship problems: Treatment tools for rectification counseling

By Monika Logan December 8, 2015

As counselors, we come in contact with clients who are angry or heartbroken and oftentimes feel defeated. This sense of pain and loss is frequently realized in the forensic setting in which I work with parents who are desperate to rebuild a parent-child relationship that is severely damaged or estranged. I also work with children who assert that they never want to see or speak with one of their parents again.

SadKidThese are not parents who have abused or neglected their children. They are parents who previously had what would be characterized as a good relationship with their children — until the time of a separation or divorce. I have worked with families in which the conflict has continued for longer than 10 years prior to therapy.

It should be noted that many people in the helping professions refer to this troubled parent-child relationship as “parental alienation.” Through the years, various nomenclatures have been applied in an attempt to give this pathological post-divorce phenomenon a name. But even as we settle on what to call it, we must help these children and the counselors who work with them.

Most counselors working with children or families have witnessed this dynamic to varying degrees. There are ample articles on child alienation, yet many counselors remain conflicted about how to effectively treat these troubled parent-child relationships.

I’ll provide a case example. “Sarah” contacted me and said she had been divorced for 15 years. She told me she had been happily remarried for five years, held a doctorate degree in mathematics and was employed as a full-time professor. But she indicated she had a damaged relationship with her 15-year-old daughter, “Julie.”

In chronicling her story in my office, Sarah vacillated between sobbing and seething with anger. She said that when Julie spent time with her biological father, “Michael,” that he undermined Sarah’s parenting boundaries, spoiled Julie and used every opportunity to denigrate Sarah. Sarah went on to say that she was worried because Julie was disregarding curfews and skipping classes, had been in trouble with the juvenile court system and had recently been caught smoking marijuana.

When I contacted Michael, he presented with a jovial disposition. He stated he was engaged to be married and was employed as a plumber. He initially appeared supportive of his daughter. Although he said he didn’t see any reason that Julie might need therapy, he indicated that he wasn’t opposed.

When Julie’s therapy sessions began, she insisted that she loathed her mother because Sarah was unreasonable. Julie stated that her mother grounded her for “trivial” reasons such as skipping school and smoking marijuana. When discussing her father’s approach to parenting, Julie described Michael as a superb parent because he did not stoop to “ruining” her life. In addition, Julie mentioned that her father was planning on buying her a car. She stated that her father would talk with her and not carry out “ridiculous, over-the-top consequences for trivial, normal teenage mishaps.”

 

Treatment tips

Step one: The first step is to ask yourself if you possess the skills and advanced training to work with families engaged in transition and ongoing conflict. If not, that is OK. This is a good time to seek referrals from colleagues who are comfortable with court-connected work.

Step two: When working with parents who are separated, divorced or are in the middle of a child-custody evaluation, counselors should request a copy of the court orders prior to starting treatment with their children. Counselors should be aware that some parents “therapist shop” and are actively looking for a counselor who will tell them what they want to hear, not necessarily what is helpful. Some potential clients are searching for a counselor to align with them and join in with them about how awful their ex-spouse is. Counselors should keep in mind that failure to contact the child’s other parent may introduce a host of issues (for example, board complaints), especially if the parent seeking treatment for the child does not have the right to do so per court order. Also make certain to obtain all necessary releases before conversing with any previous counselors who have worked with the family members.

Step three: Counselors working with parents who are irrationally rejected by their children need to be well-versed in the literature. Failing to recognize and treat alienated children and their parents prolongs emotional damage for the child and can harm the entire family system.

Step four: As a counselor, you must know who the client is. Are you working with the child, the child and the parent(s), or one/both of the parents? It is vital to understand how the client ended up in your office. Additionally, your role must be clear. Are you working as a court-appointed counselor or a court-involved counselor? Recognize that in cases of child alienation, other parties — such as other counselors, attorneys or parenting coordinators — are often involved.

Step five: Know your definitions, but do not diminish your clients by labeling them. When conversing with other professionals, it is acceptable to refer to the parent to whom the child aligns as the “favored” parent. The “rejected” parent (or “target” parent) is the parent whom the child rejects or refuses to spend time with. When working with the courts, and depending on their jurisdiction, counselors may want to use behavioral descriptions, not diagnostic labels.

Counselors should remember to focus on behaviors that can be described. Although it is acceptable to discuss the concept of triangulation, gatekeeping, pathological alignment or irrational alienation with your colleagues, it is not helpful to use these terms with clients.

Step six: Do not diagnose if you have not actually met the client or witnessed the parent-child interactions. For instance, if one parent seeks your services and reports that the other parent is alienating the child and is a narcissist and/or borderline, you cannot diagnose that other parent as borderline because you have not met with or witnessed that parent.

 

Therapeutic fallacies

Richard Warshak is a world-renowned expert on parental alienation. He has written countless peer-reviewed publications on custody disputes, divorce, alienated children and stepfamilies, and has developed educational materials. Warshak recently provided strategies that can guide counselors in working with this difficult parent-child dynamic. According to a study he published earlier this year (see http://psycnet.apa.org/psycinfo/2015-27699-001/), several fallacies can compromise the therapeutic process.

  • Children never unreasonably reject the parent with whom they spend the most time. The first fallacy counselors should recognize is that more time does not necessarily equal quality time. Using rapid clinical judgment, it is easy to conclude that a child identifies with the parent whom he or she sees the most. If counselors do not recognize this fallacy, they may determine that the parent must have done something that warranted poor treatment by the child. This line of thinking contributes to additional emotional distress. In turn, under this assumption, counselors can go on the lookout for flaws within the rejected parent to substantiate their beliefs. Counselors should be aware that when a child spends time with the nonresidential parent, that parent could be using that limited time to teach the child to disrespect and disobey the custodial parent. To offset this fallacy, counselors must stop thinking in unidimensional terms.
  • Children never unreasonably reject mothers. According to Warshak’s study, “Those who believe mothers cannot be the victims of their children’s irrational rejection are predisposed to believe that children who reject their mothers have good reason for doing so.” He advises that counselors should keep an open mind about both parents and consider that mothers may be rejected without good reason.
  • Each parent contributes equally to a child’s alienation. Counselors should not generalize that both parents are always equally at fault for a child’s alienation. Counselors would not place equal blame for intimate partner violence on the victim. Likewise, it is not helpful to equally blame both parents for a child’s unwarranted rejection when one parent may be instigating the child’s actions and attitudes.

One bias that comes into play is repetition bias. Those working in the field are permeated with the term “high conflict” and may deem that parental alienation is synonymous with that term. As described by Warshak, the term high conflict “implies joint responsibility for generating conflict.”

In my practice, I developed a nuanced view. There are times when both parents contribute to and could benefit from parenting education or family therapy. However, in the case of Sarah and Michael, Michael openly defied the court’s orders, ultimately refusing to let Sarah spend time with their daughter. He also denigrated Sarah in front of the child. I would not be practicing the concept of “non-maleficence” when working with Sarah if I were to suggest that she was at fault. Demanding more of Sarah and blaming her only adds insult to injury.

As Warshak points out, “When the rejected parent’s behavior is inaccurately assumed to be a major factor in the children’s alienation, therapy proceeds in unproductive directions.” At this point, counselors may wonder, “What am I to do?” A counselor should remain neutral and avoid making unwarranted assumptions.

  • Alienation is a child’s transient, short-lived response to the parents’ separation. This fallacy is damaging because child alienation may be deemed to be a normal byproduct of divorce that will resolve on its own. Prior to going into private practice, I co-led a support group for adults who had lost all contact with their children. These cases were not due to a background of abuse or neglect; instead, many involved a contentious divorce.

Unfortunately, some counselors espouse the notion that the child should decide when to see the rejected parent and suggest that over time, the child will come around. In some cases, the child may re-establish a relationship with the parent. However, not all children reconnect. And even if they do, parents cannot reclaim lost time.

Counselors understand that they should practice within the scope of their license. In many states, counselors are prohibited from making access or possession determinations. Counselors do not have the right to supersede a court order and tell an alienated child that he or she does not have to spend time with the rejected parent. Again, it is necessary to obtain a copy of the client’s current court orders prior to starting counseling.

Another practice tip is that counselors should encourage the parent who is the target of unwarranted rejection to remain in constant contact with his or her children. Counselors can also aid parents in knowing and understanding the stages of development and helping parents to formulate proper responses to a child’s verbal insults.

  • Rejecting a parent is a healthy short-term coping mechanism. Counselors can identify this fallacy by reflecting on common biases, many which are covered in counseling programs. Counselors must be cautious about the bias of wishful thinking because it provides a false hope to clients. As Warshak (2015) explains, “Counselors who believe that rejection of a parent is a healthy adaptation encourage parents to accept the children’s negativity until the children feel ready to discard it.” He goes on to say that “this is especially true when therapists assume that the alienation is destined to be short-lived.” Although we have specialized training as counselors, it is important to remember that we cannot predict future outcomes.

Another way to think about parental rejection is to consider whether the parents would ignore their child refusing to speak to one of the parents if the whole family still resided together. Understandably, most would find this unacceptable.

  • Alienated adolescents’ stated preferences should dominate decisions. This fallacy can be offset by using analytical thinking and a basic understanding of brain development. Many adolescents know more about adult matters than we would want them to know. Regardless, adolescents are not adults and should not make adult decisions. Adolescents are prone to peer pressure and are in the process of discovering their identity. Most adults cannot imagine asking if an adolescent would like to attend school. As Warshak writes, “Adolescents’ vulnerability to external influence is why parents are wise to worry about the company their teenagers keep.”

Counselors can help rejected parents to not personalize it when a teenager has a soccer game and prefers to forego parent-child time. Or when working with a favored parent who claims the child does not enjoy time with the target parent, counselors can point out that some adolescents do not enjoy their homework, but they are expected to do it anyway.

 

Treatment goals and tips

When working with the child:

  • Promote a healthy relationship with both parents.
  • Help the child to correct cognitive distortions.
  • Work with the child to maintain a balanced view of both parents.
  • Improve the child’s critical thinking skills.
  • Recognize when a child’s behavior is incongruent from one setting to the next.
  • Augment the child’s coping skills.

When working with the rejected parent:

  • Recognize that the parent may feel misunderstood.
  • Work with the parent not to counter-reject the child.
  • Be aware of avoidance and passivity; the parent may want to escape the poor treatment of the ex-spouse and the child by avoiding the problem altogether.

When working with the favored parent:

  • Recognize there may be a role reversal. The child may be meeting the emotional needs of the parent. Help the parent recognize his or her role as a parent and encourage the parent to engage in adult relationships to find emotional support.
  • Keep an eye open for enmeshment. What might initially appear as a healthy parent-child relationship could be extremely unhealthy. For instance, there may be a lack of community or family support.
  • Recognize that children generally benefit from the involvement of parents, absence abuse or neglect. Realize that some rejected parents may have personality disorders and continue to instigate court hearings or defy court orders.

 

The do’s and don’ts

• Do not recommend a change in custody if one parent is behaving badly. Custody reversal may be necessary in some cases, but it is not the role of the counselor to make that determination.

• Do not align with one parent over the other.

• Do cooperate with parenting coordinators and the courts.

• Do recognize that parents in litigation are likely to be working toward an adult-oriented outcome — namely to prevail in court.

• Do consider a variety of explanations when working with a child or teenager who irrationally rejects a parent.

• Do not discard information that is inconsistent with the counselor’s viewpoint.

 

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Monika Logan is a licensed professional counselor living in Dallas who specializes in troubled parent-child relationships and sexual behavior problems. In addition to maintaining a private practice and doing court-connected work, she recently developed a program to help youth in the criminal justice system maintain boundaries both offline and online and stay connected with their families. Contact her at mlogan@texaspcs.org.

 

Behind the Book: Solution-Focused Counseling in Schools

By Bethany Bray November 2, 2015

One of the many reasons solution-focused counseling is a good fit for school settings is because it’s a client-directed approach, says John Murphy, a longtime school psychologist and author of Solution-Focused Counseling in Schools.

School counselors often find the bulk of their time consumed with noncounseling tasks. When they Branding-Box-Solutionare able to meet with a student, using a solution-focused approach provides a customizable way to forge a therapeutic bond with the young person in a short amount of time.

“The simple and practical premise of solution-focused counseling – find what works and do more of it – is one of its most appealing features for school practitioners,” Murphy writes in the book’s conclusion. “This does not mean, however, that it is easy to do. Solution-focused work requires careful attention to language, client feedback, relationship building and other therapeutic nuances and skills. Mastery of these skills requires patience and practice. If your experience is anything like mine, however, it is well worth the effort.”

Solution-Focused Counseling in Schools was originally released in 1997; the American Counseling Association published a third edition of Murphy’s book earlier this year.

 

Q+A: John Murphy on Solution-Focused Counseling in Schools

In the book’s introduction, you write “schools are not set up to accommodate counseling.” Can you elaborate on what you mean by that?

This is not a criticism, merely an observation that the main purpose of schools is to teach reading, writing, math and other important academic skills. Unlike mental health centers and private practice settings where counseling is the main focus and the physical setting reflects that focus, school settings present some unique challenges for counselors.

These challenges include working around students’ and teachers’ busy class schedules, safeguarding client confidentiality and conducting “counseling sessions” whenever and wherever you can — in the lunchroom, on the playground, talking with a parent by phone or walking alongside a student or teacher in the hallway. This requires a lot of flexibility on the part of school practitioners.

But let’s not forget that there are advantages to school-based counseling as well. In addition to offering instant access to students and teachers, schools provide a natural and familiar setting for students and parents who might otherwise have to leave their community and travel long distances to receive services. For these reasons, and the fact that we know more than we ever have about helping people change, I ended the new edition of Solution-Focused Counseling in Schools by stating that there has never been a better time to be a school-based counselor.

 

From your perspective, what makes a solution-focused approach effective in helping elementary through high school students? How is it a “good fit”?

For starters, solution-focused counseling (SFC) is a clear and practical approach that makes sense to students, caregivers and counselors. Research tells us that people are more likely to benefit from counseling approaches that make sense to them, that respect their input and goals, and that customize counseling to them rather than requiring them to conform to the counselor’s preferred methods. SFC meets all of these criteria, which explains why it is effective with students of all ages.

Although solution-focused counselors validate problem-related experiences and struggles, they gently invite students to take action instead of spending a lot of time analyzing the problem. The “less talk, more action” nature of SFC seems to appeal to students as well as school counselors, who have very little time to do counseling in the first place.

Another reason SFC works with students is because it grabs their attention as “something different” rather than more of the same. Most students with school problems are well accustomed to problem-focused conversations with adults. These well-intentioned conversations emphasize what is wrong with students, with little or no attention to what they are doing well, which may include coping with a problem or preventing it from getting worse. In contrast, solution-focused conversations seek out students’ strengths and resources and explore how these assets could be applied toward solutions. In my experience, conversations that recognize and build on what is right and working with students engage their participation more effectively than “more of the same,” problem-saturated discussions.

The solution-focused approach fits with school counselors as well. In teaching classes and workshops throughout the U.S. and overseas, counselors often tell me that the solution-focused emphasis on “doing what works” as quickly as possible is more practical than cumbersome, time-consuming approaches that don’t fit well for schools and school problems. Building on students’ strengths also appeals to counselors’ desire to empower, energize and encourage people. The fact that solution-focused counseling accommodates a variety of cultural backgrounds and life experiences is another important feature in today’s increasingly diverse world. Most people, including myself, signed up for this business to lift people up, and SFC fits nicely with this goal.

 

What prompted you to do a third edition of this book? What’s new and different in this edition?

Though many of the basic ideas and techniques of SFC have been carried over from previous editions, several aspects of my approach to SFC have changed since the previously published second edition in 2008. Research continues to clarify specific elements of effective counseling, all of which are incorporated into the new edition of Solution-Focused Counseling in Schools. These elements include the importance of building a strong counselor-client alliance and of collecting ongoing client feedback.

The third edition has new chapters on topics such as the restrictive influence of problems and practical strategies for developing “goals that matter,” as well as additional practice exercises at the end of each chapter and a widely expanded chapter on innovative ways to use solution-focused strategies in group counseling, classroom teaching, peer helping programs, parent education, consultation with parents and teachers, systems-level change and referral forms. I also included new appendices with examples of solution-focused checklists and referral forms, therapeutic letters to students of all ages, scripts for introducing client feedback tools and handy crib sheets for conducting SFC sessions.

 

What is a main takeaway you want counselors of all types, including nonschool counselors, to know about the importance of solution-focused counseling in school settings?

The main takeaway is that the ideas and techniques in this book are “value added.” A value-added technique adds value and impact to whatever it is combined with, making everything else you do with clients more effective. Examples of value-added techniques include obtaining client feedback, giving compliments, validating students’ experiences and exploring exceptions to the problem.

The beauty of these techniques is that there are no risks or downsides to using them. The worst thing that can happen is that the person does not respond and nothing changes, at which point you simply move on to something else. Even then, value-added techniques can enhance the alliance by conveying respect for people’s input, wisdom and capability. The bottom line is this: You can use the techniques in this book regardless of your theoretical orientation and regardless of whether or not you consider yourself a solution-focused practitioner.

 

You were a public school teacher and school psychologist for many years. How have you seen the role of school counselor/psychologist change since then?

I haven’t seen much of a change in the roles of most school counselors or school psychologists, especially when it comes to the small amount of time they spend in intervention-related activities such as individual and group counseling, parent/teacher consultation and schoolwide prevention/intervention programs. I am not criticizing the professionals who fill these roles, many of whom would like to spend more time on such activities. School counselors and psychologists often tell me that they are pulled in so many different directions and saddled with certain responsibilities that leave little time for counseling and other intervention-related services. Unfortunately, the situation will not change in a big way if schools continue to rely exclusively on outside professionals and agencies to provide the bulk of school-based counseling and intervention services.

 

What advice would you give to a new professional who is starting a career as a school counselor?

Find ways to stay active, involved and hopeful about your profession and the people you serve. Effective practitioners are continually engaged in professional learning and development. They also find ways to sustain their hope in the midst of the ongoing problems and challenges they face on a daily basis. I would also advise them to make sure that their job description and role includes sufficient time for counseling and intervention activities.

 

Besides your book, what resources would you recommend for school counselors who would like to learn more about solution-focused counseling?

There are many more resources on solution-focused counseling with young people and schools than there were when I wrote the book’s first edition almost 25 years ago. An Internet search of “solution-focused counseling in schools” will yield various articles and chapters. The Solution-Focused Brief Therapy Association’s website (sfbta.org) contains general information about SFBT. I also maintain a website on solution-focused and strengths-based practices in schools that has a variety of links and additional information about solution-focused practice in schools, workshop offerings on the topic and other related topics (drjohnmurphy.com).

 

 

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Solution-Focused Counseling in Schools is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222

 

For more insights from Murphy, see these downloadable VISTAS articles from ACA:

Solution-Focused Counseling in Schools

Building School Solutions From Students Natural Resources

Student-Driven Interviewing Practical Strategies for Involving Students in School Solutions

 

Also, see ACA’s podcast with Murphy on solution-focused school counseling: bit.ly/1OSO26v

 

 

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About the author

John J. Murphy is a licensed psychologist and professor of psychology and counseling at the University of Central Arkansas. Previously, he was a public school teacher and school psychologist.

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

 

 

Assessing ‘ideal’ versus ‘real’ family characteristics with adolescents

By Brandon S. Ballantyne April 13, 2015

When working with adolescents in a group setting, it is important to provide opportunities to explore, evaluate and process the dynamics that occur within their homes. After all, eventually they will be faced with the dilemma of figuring out how to apply what they have learned in therapy to situations at home.

I have formulated a creative, psychoeducational task that allows adolescents to assess and explore the similarities and differences between their “ideals” and what really occurs within their unique and, at times, chaotic family relationships. I have broken this down into three simple categories. I ask the housedrawing_1adolescents to draw an illustration of a house. Inside the house are to be three distinct rooms with boundaries, because boundaries are healthy no matter how you slice that pie. The adolescents usually laugh at that analogy. Utilizing that humor, I then invite them to talk more about the boundaries at home.

I next ask them to label each of the three distinct rooms in the house. One section is labeled “Think,” another section is labeled “Do” and the last section is labeled “Say.”

I ask them to title their paper “Family Shoulds.” As a group, we discuss what the word “should” refers to. Typically, one group member will mention his or her impression of the word “should” as a reflection of a demand, expectation or wish. All of those definitions are acceptable for this task.

The idea is to have each group member write a list of three items for each category inside the house: three things they believe a family “should think,” three things they believe a family “should do” and three things they believe a family “should say.”

I have found that when I simplify group tasks in terms of “threes,” that the group flows more smoothly. For example, three rooms in the house and a list of three items for each of the three categories. I think this provides the task a sense of organization and predictability, thus increasing the group members’ level of trust and safety. This creates a less intimidating environment for each group member to talk about his or her family issues or other issues that may come up.

It is important to invite each group member to ask questions about the assignment. For example, I usually receive questions such as “What do you mean by things a family should say?” You might encourage the adolescents to write down specific things they believe a family should say to one another and then apply this to the other categories as well. For example, you might encourage the adolescents to write down three things they believe a family “should do together.” Or encourage them to write down a list of three things they believe a family “should think about one another.”

In the second component to this task, you instruct each group member to draw another outline of a house with the same three categories: think, say and do. Except this time, you ask the adolescents to write down their beliefs about their “Family Reals.” It is important to have a discussion about what you mean by the term “reals.” Usually, one group member will suggest that “reals” refers to facts or reality.

As the counselor, you can then take the focus of the group and place it on sharing ideas of “what actually goes on” from day to day in their families. Discuss how this is similar to or different from their beliefs about what a family “should” be doing, thinking, or saying.

This invites conversation about specific issues within their families that the adolescents want to address. You can also have a discussion about what “shoulds” are healthy versus what “should” are unhealthy. Finally, you can discuss which “shoulds” are realistic to address, identifying achievable, measurable steps to work toward at home.

As the adolescents listen to the other group members speaking about their family issues, they beginhousedrawing_2 to feel a sense of validation and belongingness. They cultivate a belief that “I am not alone.” As anyone who has studied Irvin Yalom likely knows, these three components are critical to the progress of individuals in group settings.

This task can also be used as a tool in family therapy sessions, serving as a less intimidating way to open the door to communication. It can be used to explore and address each family member’s expectations for others in the family unit.

It can be emotionally difficult for adolescents to talk directly about family issues. But as a counselor, I believe that if you can access adolescents’ creativity and provide a level of predictability, organization and safety, it will open the door to communication between you and your client. This can then be transferred to work with the family as a whole.

I believe this task creates opportunities for individual growth within the therapeutic relationship and opportunities for growth within the family system by reinforcing the difference between realistic and unrealistic expectations, discussion of problem-solving and implementation of communication skills.

 

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Brandon S. Ballantyne is a licensed professional counselor, national certified counselor and certified clinical mental health counselor. Contact him at ballantynebrandon@yahoo.com.

 

 

Empowering youth victimized by cyberbullying

By Janet Froeschle Hicks February 25, 2015

JF_HicksTechnology has changed the way adolescents bully one another. What once happened during an eight-hour school day now happens online within the home environment. This form of bullying is inescapable and occurs at all hours of the day and night. For victims, the consequences of being targeted by this behavior can range from lowered academic achievement to mental health issues such as anxiety, depression and even suicide. When assisting victims of cyberbullying, I find a combination of principles from Rudolf Dreikurs’ mistaken goals, Betty Lou Bettner and Amy Lew’s Crucial C’s, Alfred Adler’s social interest and Steve de Shazer’s solution-focused brief therapy to be helpful.

Dreikurs contended that children mistakenly seek out attention, power, revenge and inadequacy in lieu of healthy personal goals. This might explain some of the behavior associated with cyberbullying. For example, adolescents might bully one another to gain attention or power from others. The victim may then choose to perpetuate the behavior by seeking revenge or choosing a stance of inadequacy and hopelessness.

Fortunately, Bettner and Lew describe four Crucial C’s that I find helpful to positively displace a youth’s mistaken goals. These Crucial C’s consist of feeling connected, feeling courageous, feeling capable and feeling that you count (or are important). In my opinion, shifting the focus from Dreikurs’ mistaken goals of revenge, power, attention and inadequacy to those of courage, capability, connectedness and importance may change the outcome of cyberbullying from victimization to empowerment. This change of focus could alter the cycle of cyberbullying so that victims do not choose revenge and therefore avoid becoming perpetrators themselves. Additionally, victims become focused on improving internal characteristics and, in turn, enhance mental health.

Adler’s social interest may be used to further reinforce these Crucial C’s. Victimized youth who become involved in helping others demonstrate courage as part of initial engagement and experience connectedness as a result of their community involvement. Furthermore, I believe they experience a sense of counting or importance as a result of their contributions, as well as self-evidenced proof of their capabilities. As youth victimized by cyberbullying experience these Crucial C’s firsthand, they become empowered and feel more in control of their feelings and reactions. Self-efficacy and self-esteem begin to replace anxiety, depression and hopelessness.

The theoretical principles mentioned above become even more productive when combined with de Shazer’s solution-focused brief therapy techniques to assist victims of cyberbullying. Complimenting youth when they avoid mistaken goals and demonstrate positive attributes and behaviors builds a foundation on which courage can thrive. Instead of exhibiting retaliatory behaviors, the victim of cyberbullying may exhibit developmentally appropriate coping skills. According to de Shazer, complimenting involves pointing out a person’s strengths so that self-efficacy is instilled and recognized. Exception questions allow victimized youth to uncover times when they responded to difficult times without negative behaviors or emotions. This encourages a focus on what works rather than replicating self-defeating mistaken goals and behaviors. Solution-focused brief therapy feedback allows the counselor to reinforce the client’s strengths at the end of a session, connect ideas by agreeing with the client’s stance and suggest a task for the client to undertake.

In short, a synthesis of Dreikurs’ mistaken goals, Bettner and Lew’s Crucial C’s and Adler’s social interest with de Shazer’s solution-focused brief therapy techniques may empower victims of cyberbullying and improve their mental health. The case of “Elizabeth” that follows illustrates how I specifically combine these elements within a counseling session.

Case study

Elizabeth is a 14-year-old high school freshman. Her teacher referred her to the school counselor because her grades are falling and she is skipping classes. Not surprisingly, Elizabeth reveals that she is spending most of her nonschool time communicating with others through social media. It doesn’t take long for the counselor to discover that another girl is cyberbullying Elizabeth. Elizabeth indicates that her self-esteem has fallen, and she thinks about the social fallout constantly.

Because Elizabeth’s self-esteem and grades have declined, she needs to believe that she is capable of succeeding and that she has value (or that she counts). At the same time, she requires the courage to overcome feelings of inadequacy, thoughts of revenge and a desire for power and attention. The connectedness she already possesses with friends and family may help Elizabeth overcome some of the negative feelings associated with being cyberbullied.

To accomplish this in the counseling session, I use a five-step model:

1) Build rapport

2) Identify and express emotions

3) Integrate feelings and experiences

4) Develop coping strategies

5) Administer feedback

The initial use of solution-focused brief therapy may be effective in building rapport with Elizabeth and changing the overall tone of the session from a focus on the negative to a more positive position. Elizabeth needs to be genuinely complimented so that she minimizes feelings of inadequacy and refocuses on her personal strengths. Asking Elizabeth exception questions helps her to focus on instances when she has been successful. When followed by solution-focused complimenting, this also helps her to reframe the situation and begin to feel empowered.

Next, Elizabeth must identify and express the emotions she feels at home, at school and online. To accomplish this, I ask Elizabeth to describe how she feels in each setting and to associate a color with each feeling. Next, I have her draw a line using a different colored marker for each emotion on three separate pages (school, home and online). Each colored mark is labeled and discussed as a representation of an emotion she feels within that particular setting. I then use solution-focused brief therapy complimenting and exception questioning techniques to demonstrate ways in which Elizabeth is positively handling these emotions. Pointing out times when Elizabeth has handled similar emotions adequately ensures a focus on her strengths and a repetition of the Crucial C’s as demonstrated in her response behaviors.

To integrate feelings and experiences and to expand on ways that Elizabeth is demonstrating the Crucial C’s, I find it helpful to assist her with associating mistaken goals and the Crucial C’s. When shown separate index cards, each containing a written mistaken goal, Elizabeth reads the word and describes a time when she experienced each feeling. For example, Elizabeth might read the word inadequacy and say, “I feel inadequate every time that girl posts something about me.” Or Elizabeth might say, “The word revenge reminds me of the time I got even with her by telling lies about her to others.”

After Elizabeth elaborates and finishes the story, I ask her to tell me which of the Crucial C’s she needed to improve the situation. She then retells the story using the selected Crucial C. For example, Elizabeth might retell the story about revenge with a new focus on courage and connectedness. For instance, “That girl said I was ugly, but instead of making up lies about her, I logged off and texted my best friend. We talked about other things until I forgot all about it. It took courage not to get even, but because I have other friends, I was able to do it.”

Finally, I ask Elizabeth to generate short-term and long-term coping mechanisms. Exception questions help Elizabeth recognize and generate this list of ways she has previously coped in similar situations. These strategies may include creating art, journaling, playing video games, playing with pets, exercising or participating in sports, playing or listening to music, doing guided imagery, visiting with friends, talking to parents and numerous other ideas. To strengthen her long-term coping strategies, I ask Elizabeth to find a social interest activity. Suggested activities include mentoring younger children affected by cyberbullying, creating safety tips for children who surf the Internet, reading empowerment stories to younger children, reading to or visiting elderly adults, volunteering to work in community agencies and countless other possibilities. I then ask Elizabeth to contemplate these ideas, generate a list of both short-term and long-term coping strategies to use during the next week and return to the next session with social interest ideas.

At the end of the session, I incorporate de Shazer’s solution-focused brief therapy feedback technique. I compliment Elizabeth once again so her strengths are evident to her as she leaves the session. For example, I might say, “I recognize the courage it took to share all of this with me this week. I think that shows you have strengths to help you get through this.” Then I might add, “I agree that you need to feel better about yourself. Over the next week, I suggest using the short- and long-term coping strategies you listed as well as finding a project to help others while helping yourself.” To conclude, I ask Elizabeth to report on her success at the next session.

Subsequent sessions focus on self-reported improvement and implementing social interest activities. There is also continued focus on implementing the Crucial C’s in lieu of mistaken goals. Solution-focused brief therapy techniques, including complimenting, exception questions and feedback, are used throughout all sessions to continue reinforcing Elizabeth’s strengths. Finally, I incorporate Internet and online safety and social media trainings for Elizabeth and educate her parents on what Elizabeth is experiencing all day, every day online.

Why include parents?

Parents are included in future sessions for several reasons. First, upon hearing about cyberbullying, many parents fear the Internet and insist that their children avoid all technology. Although this may be an effective short-term solution, I do not believe it helps long term. Eventually, youth find themselves required or tempted to use the Internet for employment, homework or socialization.

As a result, I teach Internet and online safety skills both to parents and youth. These safety tips provide education about privacy and restraint when posting online, decrease fear and allow youth to continue using the Internet provided that their parents are involved in Internet communications. Youth and parents must understand the importance of keeping specific personal information private as it relates to the long-term and worldwide reach of the Internet. Once parents understand how to use social media appropriately, they have an opportunity to become role models for the proper use of technology. Learning strategies to avoid harm while using the Internet may be an important mechanism for personal empowerment for both victims of cyberbullying and their parents.

Another reason counselors should involve parents is related to the mistaken goals discussed earlier. Initially, parents often respond to their child’s victimization with inappropriate feelings of attention, Branding-Box-Cyberbullyrevenge, inadequacy and power. These feelings could result in parental behaviors that perpetuate bullying rather than improving the situation. For example, some parents initially respond to knowledge that their child is being cyberbullied with feelings of revenge. These parents may confront the bully or the bully’s parents and unknowingly increase, rather than decrease, their child’s victimization.

I teach parents to first empathize and communicate with their child. It is important that any parental response to bullying first be discussed with the child. If nurtured, the bond between parent and child may become the greatest protective element for youth who have been cyberbullied.

Conclusion

As Elizabeth experiences the Crucial C’s firsthand through social interest, feels secure in the bond with her parents and focuses on her strengths, she begins to feel empowered rather than victimized. Internet safety tips that illustrate the importance of privacy and restraint when posting online further demonstrate to Elizabeth that she possesses courage and has control over life events. Eventually, Elizabeth is able to focus on her own value rather than on the unhealthy stigma perpetuated by others.

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Janet Froeschle Hicks is an associate professor of counselor education and chair of the Educational Psychology & Leadership Department at Texas Tech University. She is both a licensed professional counselor and a certified school counselor in Texas. Contact her at janet.froeschle@ttu.edu.

Charles R. Crews, associate professor of counselor education at Texas Tech University, also contributed to this article.

Letters to the editor: ct@counseling.org

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Going wild

By Bethany Bray December 23, 2014

In a matter of months, 16-year-old “David” had gone from being a successful student to spending 12 or more hours per day playing video games. He lost his scholarship to a private school, then dropped Branding-Box-Utah-streamout of school altogether, refusing to leave the couch, even to bathe.

He also stopped communicating with his family. His parents, with whom David had previously been affectionate and close, were afraid he was shutting down.

Diagnosed with depression, David saw four different mental health professionals without making much progress. What finally reached David was wilderness therapy, a unique treatment model that brings clients to natural settings for intensive therapy with a counselor (or other mental health professional) and peer group.

David spent 12 weeks in a program in the high desert plateaus of southern Utah. Although initially resistant to the program, the wilderness setting and peer group eventually prompted him to become social again and work through his struggles. David and his parents exchanged letters while he was away, helping to repair the relationship.

Now back at home, David is again close with his family and flourishing at school. In fact, he was recently elected student body president, says Steven DeMille, an American Counseling Association member who was David’s counselor at Redcliff Ascent, a wilderness therapy program in Utah.

In a post-therapy case study, DeMille, a licensed clinical mental health counselor who is a clinician and director of research at Redcliff Ascent, wrote, “The wilderness provided David with a challenging, straightforward and neutral environment to reflect on old behaviors and try out new options. … David realized that he no longer needed to defeat the structure through disengagement to meet his personal needs. He could meet his needs through following rules and meeting social and family expectations.”

Redcliff Ascent is one of a growing number of programs across the United States that specialize in wilderness therapy. Although models vary from program to program, the majority involve taking groups of clients — most commonly youth or young adults — out into the wilderness for an extended period of time. Participants, including program staff, typically sleep outside, pitch tents, hike and cook food over an open fire.

Therapy occurs in both group and one-on-one sessions. But it also takes place “in the moment,” such as when a client’s anxiety flares when struggling to start a fire or self-doubt kicks in when tasked with leading a hike by compass, says Sean Roberts, a clinical mental health counselor who has worked in wilderness therapy for almost a decade.

“The wilderness is such a powerful intervention because it’s unpredictable,” adds Sabrina Marie Hadeed, an ACA member and licensed professional counselor at Second Nature Cascades, a wilderness therapy program in Oregon.

In one case, a client of Hadeed’s was struggling to set up the tarp for her sleep shelter during an unexpected rainstorm. Frustrated to the point of tears, she gave up and sat down in the rain. The situation served as a chance for Hadeed to talk with the client about coping when circumstances were out of her control and how to ask others for help, both of which were hard for the young woman.

“There’s equal balance in the wilderness of challenge and nurturing, structure and safety, and really learning what’s inside and outside of your control,” says Hadeed, who is finishing her doctorate in counselor education and supervision at Oregon State University. “It’s challenging [for clients] to lean into the discomfort of their difficult feelings rather than turn from them. As long as it’s safe, we’ll encourage them to do that [and they] will increase tolerance for those feelings. In a traditional setting, you meet with a therapist for an hour, even if it’s twice a week. You leave that space and you don’t have to practice what you’ve practiced in the session. In the wilderness, you have to practice all the time — how to give feedback, express frustration, interact with peers.”

Simply put, wilderness therapy is evidence-based therapy — including traditional methods such as Adlerian therapy, cognitive behavior therapy and others — that is done outdoors, say Roberts and DeMille, who presented together on the topic at the 2014 ACA Conference & Expo in Honolulu.

The wilderness therapy model is intensive in many ways, from the group dynamics and 24/7 interaction with program staff to the often breathtaking scenery and natural challenges confronting the clients. Practitioners in the field say wilderness therapy has been proved to have positive outcomes for clients, from better management of behavioral disorders, anxiety, addictions and other struggles to boosts in self-confidence and overall health, including nutrition and sleep patterns.

“The therapy is much more challenging than anything physical,” says Roberts, an ACA member who just began a position as clinical director at Cascade Crest Transitions, a residential program for young adults in Bend, Oregon. “It creates a very powerful milieu. … It’s an incredibly rich and fertile environment for therapy [and] a strengths-based approach to healing.”

Outdoor behavioral health care

DeMille prefers to use the term outdoor behavioral health care rather than wilderness therapy because he says the latter is a nebulous, unregulated term that many nonprofessionals use. He recommends that counselors looking to refer clients search for programs that adhere to the outdoor behavioral health care model, which is a regulated industry with set standards (see sidebar on the Outdoor Behavioral Healthcare Council below).

“There are going to be programs out there that say they’re wilderness therapy, but that’s not necessarily outdoor behavioral health care,” DeMille says.

Outdoor behavioral health care is light years away from the “boot camp” image that many people still associate with wilderness therapy programs, where participants are “broken down” in order to build them back up, Roberts and DeMille say. In fact, outdoor behavioral health care is the opposite, says DeMille.

Regulated programs, including all of the programs for which the counselors interviewed for this article work, have field guides with small groups of clients around the clock. Although the guides are not counselors or mental health professionals, they are given extensive training in wilderness living and serve as adult mentors to clients. Client groups range in size from a few individuals to a dozen people.

Clients meet regularly with a counselor or other licensed mental health professional from the program’s support staff. These counselors work closely with the field guides to get feedback and check in on the client’s progress concerning the treatment plan or goals.

Counselors lead group and individual therapy sessions, work on outreach to families and provide case management. As a clinical director, Roberts says he will also join a group at least once per session for an overnight trip outdoors. He remains on call whenever he isn’t with the group.

“There’s so much more to work with than when I’ve done outpatient work and so many more ways to gather [client] data,” Roberts says.

Clients enter outdoor behavioral health care programs for a number of reasons, including treatment for a variety of mental health diagnoses, behavioral problems, substance abuse issues, problems with school or relationships and trauma recovery. Client stays are usually open-ended; they leave the program only when they are ready, Roberts says. An average stay at DeMille’s program is 70 days, whereas the average at Hadeed’s program is eight to 10 weeks. Programs have rolling admissions, with clients joining and leaving the group intermittently.

Parents of youth clients stay involved with the program and visit their sons or daughters in the wilderness, even sleeping overnight. Hadeed’s program maintains a website for clients’ families where they can post photos and updates and exchange messages while their teenager is out in the wilderness.

Prior to discharge, counselors spend a significant amount of time preparing clients for re-entry into home settings or social situations that previously caused them distress or with which they had difficulties. This process includes working to hone the client’s decision-making and communication skills, relapse-prevention strategies and other coping methods, DeMille says.

In addition, outdoor behavioral health care therapists often work with school staff, counselors and other helping professionals in the client’s hometown to ease the transition. “We do put a lot of energy into figuring out what will set them up for success as they leave,” Roberts says.

The right fit

Outdoor behavioral health care is often effective for clients who are “stuck or deteriorating in treatment” or not responding to traditional therapy methods, according to DeMille. It can also be a good fit for those who drop out of traditional talk therapy or end up hospitalized after a suicide attempt or overdose.

The approach is also effective, says Roberts, with clients who are struggling with a “failure to launch”: young adults who are underperforming in life or career, including failing or being kicked out of school or college.

Roberts, who is finishing his doctorate in counselor education and supervision at Oregon State University, previously worked at Second Nature Entrada, an outdoor behavioral health care program in southern Utah, near Zion National Park. He notes that many of his clients have “been through tons of talk therapy” but struggled to put what they learned into practice. Many have legal records, family systems issues, depression, a history of suicide attempts or struggles with self-medication via substance abuse. These clients are often wrestling with dysfunctional relationships, destructive life patterns or an internalized sense of hopelessness, he says.

“They need an opportunity to unplug from that [life] and course correct — shift the trajectory of where they’re heading … stabilize and gain some tools to increase their confidence,” Roberts says.

Counselors interviewed for this article agreed that outdoor behavioral health care can be a good fit for clients who struggle with:

  • Self-harm
  • Low self-esteem
  • Poor body image
  • Depression
  • Emotional, mood or anxiety disorders
  • Developmental disorders, including attention-deficit/hyperactivity disorder
  • Trauma
  • Behavioral disorders
  • Substance abuse
  • Poor school performance
  • Being disruptive, uncooperative or withdrawn
  • Having poor boundary issues with peers (such as crush obsessions or sexting)

Conversely, outdoor behavioral health care is not recommended for clients with:

  • Severe eating disorders
  • Severe forms of autism
  • Learning disabilities that cause them to become oversensitized easily
  • Psychotic disorders such as schizophrenia
  • Medical conditions that necessitate being near a hospital (for example, diabetes)

Being comfortable with the outdoors is not a client prerequisite, Hadeed emphasizes. In fact, taking clients out of their comfort zones — and away from their cell phones, friends and favorite TV shows — is often a factor in their healing and progress.

Hadeed says counselors considering whether to refer a client to an outdoor behavioral health care program should first speak with program staff to determine if the client might be a good fit. Conversely, if a counselor is working with a client who has already gone through an outdoor behavioral health care program, the counselor shouldn’t hesitate to reach out to program staff to collaborate, she says.

“Whether it has been one year or five years, the experience will still be with [the wilderness therapist], and they can talk through what works [for that client],” Hadeed says. “That collaborative piece is really important.”

A journey of self-discovery

Gil Hallows, executive director of Legacy Outdoor Adventures in Utah and chair of the Outdoor Behavioral Healthcare Council, calls the outdoor behavioral health care model a “modern-day rite of passage.” He draws comparisons with the Australian aboriginal “walkabout” and similar rites in other traditional cultures in which adolescents spend time in the wilderness to learn, grow and discover their strengths, returning to society as adults.

Similarly, outdoor behavioral health care is an “individualized journey of self-discovery,” says Hallows, who has worked in the field for two decades.

Hallows and the counselors interviewed for this article agree that numerous factors contribute to the modality’s success with clients, including:

Time away: Outdoor behavioral health care clients spend weeks away from home. In doing so, they are removed from the people, circumstances and other factors that may be contributing to their destructive behaviors and struggles with mental health, including friends, addictive substances and technology.

Hallows refers to this as “the great slowing” because clients have time to think more clearly and reflect on their life away from distractions. “It takes a young person away from everything they’re accustomed to manipulating,” from their own families to video games, he says.

In addition to long hikes, journaling time and other opportunities for self-reflection, some outdoor behavioral health care programs include a “solo” experience, in which clients spend time alone for introspection.

The time away from school cliques, name-brand clothes, cell phones and other familiarities often leads to breakthroughs in self-identity for clients, Hadeed says. In one case, a client discovered that her sense of humor and knack for performing could be a strength and a way to process and communicate her feelings rather than a means of getting her in trouble, as it had in the past.

Time away challenges clients to ask those important questions of identity, Hadeed says. “[It] highlights the strengths, gifts and natural positive qualities they have that they weren’t aware of because of the distractions of daily life, including technology,” she says.

Learning by doing: Part of the outdoor behavioral health care experience for clients is learning to take care of their own equipment, cook meals together and share in other chores such as gathering wood and building fires.

In most cases, clients are learning to do things they’ve never done before. Moments when clients struggle or get frustrated turn into opportunities for in-the-moment encouragement and guidance from program staff.

Roberts says this process leads to empowerment and taps into a host of skills that will carry over into everyday life, including dealing with frustration, sticking with a task, learning to ask for help and engaging in long-term planning.

“It’s almost unavoidable — clients will learn skills, [including] self-confidence, problem-solving, self-care and task accomplishment,” Hallows says. “It’s extremely fulfilling and rewarding to observe the transformation that takes place in a young person when they discover who they are and what they are capable of doing while on a wilderness journey.”

Roberts says he will suggest tasks for clients based on issues they are dealing with in their therapy sessions. He works with the field guides to set up interventions, such as the job of leading a hike by compass, to see how clients respond to specific challenges.

Roberts says he might also suggest that a client who is weighed down by emotional baggage (such as anger or a destructive behavior) take a walk while carrying a rock, a stick or some other object. Afterward, he will talk with the client about the metaphor of carrying something around with us constantly, why that is a challenge and how it can be overcome.

Participants in outdoor behavioral health care often gain new perspective, DeMille says. “Things that you have taken for granted [meals, for example], all of a sudden you have to work for,” he says. “It develops a sense of mastery, competency. They grow in confidence and competencies.”

The model also lends itself to learning what is and isn’t in your control, Hadeed says. “You can’t control the rain, the wind or the weather, but you have control over whether you’re going to put on a jacket or build a fire, and that can be translated to a family setting,” she says. “You can’t control what mood your dad is in when he comes home, but you can control your response to that mood.”

Group dynamic: In most cases, clients in outdoor behavioral health care programs join a group of people they’ve never met before. Over time, the client bonds with group members and staff leaders, Hallows says.

“Sharing a common experience with a group of peers and staff, it lends itself to establishing a tight peer group that holds each other accountable,” he says. “They learn to identify and express emotion, become honest with themselves. And if they’re not, they’ll be called out by their peers.”

Clients work through anxieties and other issues alongside one another, learning as they go. The shared experience with people who are trying to overcome similar struggles is the opposite of the isolation of one-on-one therapy in an office, DeMille points out.

“The group dynamic allows [clients] to work on problems in conjunction with peers in their group,” he says.

The around-the-clock guidance from field staff is also a factor, agree DeMille and Hallows. Clients benefit from seeing adult mentor figures working alongside them, completing hikes, setting up camp

Clinical mental health counselor Sean Roberts provided this photo  of his previous “office” in the wilderness northwest of Enterprise, Utah.

Clinical mental health counselor Sean Roberts provided this photo
of his “office” in the wilderness northwest of Enterprise, Utah.

and sharing meals, chores and other tasks. These field staff work closely with the program counselors to make sure that clients are on the right track and meeting treatment goals.

Hadeed notes that many of her clients come into the program with a misconception of what therapy is or should be. She explains to them that there’s more to therapy than feeling good; therapy presents both challenges and rewards.

“[Therapy] is not always about helping you to feel happy but rather learning to tolerate very normal feelings — worry, fear, anxiety,” she says. “It’s helping you to learn how to tolerate and better express those feelings, ask for help and if you feel like crying, crying. We help them learn that these emotions they are feeling are totally normal, and the more you try and contain them, the more they’re going to come out in other ways.”

The natural setting: Lastly, the natural environment lends itself to lessons of growth and healing. Many outdoor behavioral health care programs take groups into national parks and other breathtaking locales.

“There’s something healing about being outside,” Hallows says. “A good counselor … finds the wilderness setting a huge ally. [For example], counseling a person who has survived a rainy night, kept himself dry and started a fire. Compare [those skills and victories] to his or her life before. … Imagine how impactful one can be as a counselor if you have that experience and setting as an ally. The experience of living outdoors and living in a group of peers, those are the change agents, and if you add counseling to that, you’re leveraging the experience.”

Bringing the outdoors in

The counselors interviewed for this article agree that some of the elements that make outdoor behavioral health care successful can be introduced in more traditional office settings as well. For example, group therapy and hands-on experiential exercises will be more effective at reaching certain clients, Roberts says.

In addition, instead of talking with clients about what happened yesterday, consider working through challenges “in the here and now,” he says. “Give [the client] a task to do. Put together a puzzle [or do] something that is going to create some anxiety, a chance for failure — whatever fits for the client.”

As in outdoor behavioral health care, traditional counselors can also include discussions about overall health, including exercise, nutrition and sleep habits, Roberts says. In addition, both DeMille and Roberts recommend getting outside with clients during counseling sessions when appropriate, such as by taking walks. Furthermore, they say, counselors can prescribe clients to take walks or get outside more on their own.

Parents sometimes turn to outdoor behavioral health care as a last resort, an 11th-hour option after going through multiple therapists or programs, Hadeed says. She’d love to see the opposite: wilderness therapy as a family’s first option.

When most people think of counseling, they picture an office and the iconic leather couch. Instead, what if they pictured a mountainside group therapy session or a counselor chatting with a client as they hiked or went fishing?

“That would be my dream,” Hadeed says.

Wilderness-authors

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The freedom and light heart I deserve

The following prayer was written by 19-year-old Skye Angelo Rossman, a former client at Second Nature wilderness therapy.

“In my life, I have experienced much love and much hate. I did not enjoy the severity of the extremity. From this day forth, I ask to eliminate the one that doesn’t allow me the freedom and light heart I deserve. I have been through much and will go through much more. It is my hope that I am given the respect I give you in my life. It is with eternal gratitude I pray, amen.”

— Reprinted with permission from Sean Roberts and Skye Angelo Rossman 

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The Outdoor Behavioral Healthcare Council: Collecting data, carving out a niche

In the early 1990s, what little knowledge most Americans had of wilderness therapy came via news headlines when something went wrong at a program, including, tragically, a handful of fatalities.

The decade had witnessed a marked increase in the number of programs launched, says Gil Hallows, chair of the Outdoor Behavioral Healthcare Council. However, he says, wilderness therapy programs were operating independently, without a distinct sense of mission or best practices.

With this in mind, representatives from five wilderness therapy programs came together in spring 1996 with the aim of solidifying the field of wilderness therapy. They called themselves the Outdoor Behavioral Healthcare Council. In addition to establishing best practices, the group began collecting data to document, verify and maximize the effectiveness of the wilderness therapy treatment model, Hallows says.

“It became clear that organizing would allow us to set some standards [and] allow us to better work together in educating the public on what we do and how we do it. … We wanted to focus on doing this the right way,” says Hallows, who also serves as executive director of Legacy Outdoor Adventures, a wilderness therapy program in Utah.

Most recently, the council partnered with the Association for Experiential Education to develop a set of accreditation standards specific to wilderness therapy programs. The council adopted the accreditation model in early 2014. Member programs must now become accredited within two years of joining the Outdoor Behavioral Healthcare Council.

Close to 20 years after its founding, the Outdoor Behavioral Healthcare Council has 17 member programs, plus two others currently going through the application process. The council hosts an annual symposium, held this past year in Park City, Utah, with education sessions and networking opportunities for professionals in the field.

More than 15 years’ worth of the group’s research — from statistics on program safety to client substance abuse pre- and post-participation — is available to the public through the council’s website (see OBHcouncil.com).

To become a member of the council, a program must collect data regularly for the council’s research mission. Members typically record data points about clients’ mental and overall health at intake, discharge and six months after being discharged from a program, Hallows says.

Statistics on the effectiveness of wilderness therapy, especially its cost effectiveness, are fueling the council’s campaign to improve insurance coverage of outdoor behavioral health care. Historically, insurance companies have been reluctant to reimburse clients for costs incurred for participation in wilderness therapy programs, Hallows says.

The Outdoor Behavioral Healthcare Council is reaching out to insurance companies and providing data on wilderness therapy’s effectiveness in hopes of changing that scenario. The group also provides resources to help guide clients’ families through the appeal of a claim denial, Hallows says.

“Part of this campaign is to make outdoor behavioral health care more available to average families,” he says.

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Related reading

  • Sabrina Marie Hadeed’s piece “Girls daring greatly,” a first-person perspective of how wilderness therapy can reach and help adolescent girls
  • Wilderness therapy: The question of affordability,” a look at the cost of wilderness therapy programs and the steps the Outdoor Behavioral Healthcare Council is taking to make them more affordable for average families

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editorct@counseling.org

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