Tag Archives: Ecotherapy

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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Girls daring greatly

By Sabrina Marie Hadeed November 24, 2014

When discussing the idea of girls in the wilderness, the topic of vulnerability comes up often. Typically it is in the context of how girls are vulnerable in fragile ways that we should protect or shelter. However, having been a teenage girl myself, and now having worked as an adolescent WildernessGirlsmental health therapist for nine years, I can confidently say that vulnerability among girls in the wilderness has more to do with courage and resilience than anything else.

Brené Brown is one of the world’s leading researchers on the study of vulnerability and shame. In her most recent book, Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent and Lead, she highlights relevant themes such as learning to embrace imperfections, letting the people we love struggle and other elements of healing our shame. The book’s title was inspired by Theodore Roosevelt’s “Citizenship in a Republic” speech (1910), in which he said, “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

I have witnessed countless examples of girls daring greatly in the arena of my adolescent therapeutic wilderness group in Bend, Oregon. As we drive out to our remote wilderness use area, my thoughts are filled with a review of the clinical conceptualization of each client. I systematically picture the face of each girl and review the presenting concerns, clinical assessment and other data relevant to the case. Anxiety, depression, history of self-harm and suicide attempts, defiance, drug and alcohol abuse, trauma, history of being bullied or bullying, and tumultuous family relationships are among the most common clinical features represented in my group at any given time. I also consider the strengths and innate potential that each girl possesses, wondering what has stood in the way of the maturity and expression of those strengths. My mind then wanders to the awe of watching nature (the wilderness) help each girl peel back the layers of unnatural overstimulation resulting from daily technology immersion and the false faces of social media relationships.

My teenage years took place before the era of Facebook and cell phones. I am astounded by the resilience that today’s adolescents must possess in order to survive the fast-paced, often cruel and technologically advanced world in which we now live. Many of the adolescent girls with whom I work have spent precious little time connecting with nature or disconnecting from their phones, televisions, computers and social media sites. Few have ever slept under the stars or stopped to listen to the wind whispering through the trees. In fact, most of the teenage girls I work with initially find it very uncomfortable to be in the remote wilderness. I commonly hear “I’m not good at being alone with my thoughts!” or “I can’t possibly be expected to sit and reflect; it’s too hard for me!” and “I need counseling, not sitting in the middle of nowhere!” These protests are understandable because these girls never learned how to sit by themselves and connect with nature. Instead they are used to being surrounded by any number of distractions that encourage disconnection from nature and the here and now.

One day, I arrived after my long reflective drive to the remote site where my group was camping. With my trusty, nature-loving golden retriever by my side, I exited our burly off-road vehicle, took a deep breath of the warm Cascades air and hiked up the barely visible dirt trail. Taking a final step over the gnarled volcanic rock, I could see the group of girls in the distance. Instantly, I was struck not by what I saw but by what I heard.

My ears and heart were suddenly being serenaded by six harmonizing girls. They were standing in a circle, all eyes focused on the group-appointed 17-year-old pseudo choir director. Their bodies stood like gracefully poised trees as they gently sang out. But they weren’t singing a song by any artist WildernessHikecommonly attached to their generation, such as Lady Gaga or Miley Cyrus. Instead they were harmonizing so beautifully to “Rose Red,” a ballad from the Elizabethan era.

There was a disorienting two-second lapse of time where I had to remind myself where I was standing. For one lovely moment that day, we were no longer in the Oregon desert in a therapeutic wilderness program defined by mental health struggles and adolescent angst. Instead we were transported to a magical place where teenage girls put their pain aside to learn a song together, letting their voices sing out and dance along the juniper tree-spotted hills of the Cascades.

It was beyond any brilliant counseling technique I could have applied. The moment was made possible through the influence of a connection to nature, a disconnection from the distractions of cell phones and social media sites, a positive group culture, the ongoing collaborative support of the entire treatment team and, of course, the courage of six teenage girls. The girls had been able to develop emotional safety within the group and increase their self-confidence, which gave them the courage to “dare greatly.” I believe the power of vulnerability and daring greatly can be linked to reconnecting with one’s self through nature and disconnecting from the conveniences of our technologically smothered first-world lives.

In 2011, Brené Brown wrote, “I define connection as the energy that exists between people when they feel seen, heard and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.”

Among the circle of singing girls there were no perfect vocalists, no dominating ego, no cyberbullies, no gestures of self-harm, no competing debutants. There was only honest harmonized courage and the presence of emerging self-acceptance and genuine connection. Moments like that remind me how the influence of nature can transform and why the power of vulnerability is born from the courage to dare greatly.

 

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Sabrina Marie Hadeed is a licensed professional counselor, national certified counselor and approved clinical supervisor. She is a primary therapist at Second Nature Cascades and a doctoral candidate at Oregon State University. Contact her at sabrinamariecounseling@gmail.com.

 

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Wilderness therapy: A closer look

See the January issue of Counseling Today for an in-depth feature article on wilderness therapy (to which Hadeed contributed).