Tag Archives: wilderness therapy

The ‘storm and stress’ of adolescence and young adulthood

By Laurie Meyers October 25, 2018

For much of human history, the idea of adolescence being a distinct life stage was nonexistent. True, in the Middle Ages, children were recognized not merely as “mini” adults but as distinct beings with different needs. However, the years from ages 13 to 19 were not considered part of childhood until the turn of the 19th century. Instead, the “teen years” were the time when one began to assume adult responsibilities such as making a living and starting a family.

During the late 1800s, changes in child labor laws and the push for universal education for those under the age of 16 began to influence society’s perspective on when adulthood began. G. Stanley Hall, the first president of the American Psychological Association (APA), is credited with the modern “discovery” of adolescence, defining it in a 1904 book as a new developmental stage — created by societal changes — in which children grow into adults. Hall described adolescence as a time of “storm and stress” and, unlike later researchers, ascribed this life stage as lasting from ages 14-24 (rather than today’s generally accepted range of 13-19).

Although adolescence is still considered to be synonymous with the teen years, Hall’s instinct to single out the early 20s as different from later “adult” years was prescient. In the past decade, neurological research has discovered that the brain does not fully mature until one’s mid-to-late 20s. This revelation has spurred many researchers, particularly in mental health fields, to call for a separate developmental stage that is generally referred to as “young” or “emerging” adulthood.

Adding more than a soupçon of complication to both the recognition of emerging adulthood and the established research on adolescence is the reality that being a teen or 20-something in the information age is, in many ways, significantly different — and arguably more difficult — than it was for previous generations.

Stressed and depressed

An abundance of research indicates that teens and young adults are experiencing increased levels of stress and depression. In recent years, APA’s annual “Stress in America” survey has gathered data only on adults. However, in the survey released in 2014, “Stress in America: Are Teens Adopting Adults’ Stress Habits?” young people ages 13-17 were also included.

Survey respondents reported that during the school year, they had a stress level of 5.8 on a 10-point scale. During the summer break, teens reported a slight decrease in stress levels — 4.6 on a 10-point scale. Furthermore, 31 percent of survey respondents said that their stress levels had increased over the past year. In response to their high levels of stress, 40 percent of respondents reported feeling irritable or angry, 36 percent reported feeling nervous or anxious, 36 percent reported feeling fatigued or tired, and 31 percent reported feeling overwhelmed.

Depression is another significant concern among adolescents. According to the National Institute of Mental Health, in 2016 (the most recent year for which statistics are available), an estimated 3.1 million adolescents ages 12-17 experienced at least one major depressive episode. That number represented 12.8 percent of the U.S. population in that age bracket.

Although most mental health surveys do not specifically target “young” or developing adults, data are available relating to college students. Among the more than 31,000 college students who completed the 2017 American College Health Association National College Health Assessment, 39.3 percent reported being so depressed that they found it hard to function at some point during the previous 12 months. Anxiety levels among respondents were even higher: 60.9 percent reported feeling overwhelming anxiety at some point during the prior year.

The high levels of anxiety and depression indicated in these studies are part of a national pattern of significantly increasing distress. A national poll published in May by the American Psychiatric Association noted a sharp increase in American anxiety levels over the past year. On a scale of 0-100, this year’s “national anxiety score” was a 51 — a five-point jump since 2017. A study published in the June 2018 issue of the journal Psychological Medicine found that rates of depression rose across all age brackets of Americans for those 12 and over from 2005 to 2015. Most significantly, among those ages 12-17, depression rates increased from 8.7 percent in 2005 to 12.7 percent in 2015.

Under pressure

Some researchers are eager to blame technology — particularly social media — for the increase of depression and anxiety among teenagers and young adults. The reality is more complex and involves myriad factors.

It is undeniable that some people do find their lives lacking when compared with what they see on social media. Carefully curated Facebook feeds can suggest to them that their friends are happier and more successful than they are. Celebrity photos on Instagram — most of which are professionally produced and heavily filtered — can encourage unrealistic expectations about body image and personal appearance. However, when one considers the role that social media plays in the quest for perfection, it may be something of a chicken-and-egg scenario.

A 2017 study on perfectionism that appeared in the journal Psychological Bulletin found that beginning in the 1980s, a culture of “competitive individualism” in the United States, Canada and the United Kingdom steadily increased the quest for personal perfection. So, is what we see on social media pushing us toward unattainable standards of perfection, or is it a reflection of the pressure we put on ourselves? At this point in time, we may be caught in a reinforcing loop. The study found that current generations not only feel intense societal pressure to be perfect but also expect perfection from themselves and others. The study’s authors also believe that this rise in perfectionism may be linked to an increase in myriad psychological problems.

Today’s teenagers and young adults are unquestionably subject to high expectations and demands. Licensed mental health counselor David Flack, who has worked with adolescents and young adults for 20 years, says he has seen a significant increase in anxiety related to academic performance among his clients.

“It is not uncommon for teens I meet with to have three, four or even more hours of homework most days,” he says. This reality creates significant pressure and is particularly stressful for students who are predisposed to anxiety. Flack, a member of the American Counseling Association, also believes that such heavy academic workloads are interfering with important social and developmental processes because many teenagers may be spending more time doing homework than socializing and engaging in extracurricular or other age-appropriate activities.

Licensed professional counselor (LPC) Sean Roberts, an ACA member who specializes in working with young adults, says he has witnessed a precipitous increase in anxiety among clients. He thinks this is strongly, though not solely, linked to teenagers and young adults feeling increased pressure to succeed.

Not coincidentally, the anxiety they experience makes it only more difficult for them to achieve. “Anxiety has a neurological effect,” explains ACA member Amy Gaesser, an assistant professor of counselor education at the State University of New York at Brockport whose research focuses on the social and emotional well-being of students in school. “The survival part of the brain activates and shuts off or interferes with the parts of the brain that help us think clearly.”

This can have a significant effect on academic performance, says Gaesser, a certified school counselor in New York who gives presentations and offers private consultations with parents. For example, some students can study extensively and be fully prepared for a test, but because of their anxiety, can have trouble accessing that information while taking the test. Anxiety can also interfere with the ability to take in and synthesize information, Gaesser says. Students become frustrated with their seeming inability to “get it,” which affects their feelings of self-efficacy and can even make them question their level of intelligence. Once a pattern of academic difficulty tied to anxiety is established, the problem can become self-perpetuating.

Disrupting the cycle is vital, says Gaesser, who recommends the emotional freedom technique (EFT) as an effective method of interrupting the stress response and downregulating the brain. In EFT, participants respond to stressful thoughts or situations by visualizing an alternative outcome while taking their hands and tapping acupuncture points on the body that have been linked to stress reduction. Students can go through the whole sequence of body points or just use the areas they find work best for them, she says.

Gaesser also recommends the “4-7-8” breathing method as a quick way to interrupt the stress response. This involves breathing in for four seconds, holding the breath for seven seconds and then breathing out for eight seconds. Students can practice this method themselves, but Gaesser thinks that teachers should also use it in their classrooms as a way to begin class.

Peter Allen, an LPC based in Oregon who specializes in counseling young adults and adolescents, used to work with teenagers in a wilderness therapy setting. Most of his clients were struggling with a variety of issues, including substance abuse, conduct problems (although not usually at the conduct disorder level) and mood disorders, principally depression and anxiety. In most cases, Allen says, the core elements of the wilderness setting were effective in helping these clients address their various presenting issues.

In part, he believes that’s because the pressures of school, family and social life were stripped away, leaving these teenage clients to focus on the basics, such as securing food and shelter. Surviving in the wilderness also required working together and building a community, which helped teach clients new communication skills. Participants also got daily exercise, ate healthy meals and were required to follow a regular sleep schedule, all of which had a calming and stabilizing effect. “Once diet, sleep and exercise have been regulated, about half of the problems disappear right away,” Allen says.

Many wilderness therapy clients also benefit from what Allen calls “expanding the size of their world. … If you are a 15-year-old kid and doing bad at school, arguing with your parents, your world is tiny.” The wilderness program not only provided literal wide-open spaces, but also introduced clients to people from different places and adults who didn’t have the same expectations as the teenagers’ parents or teachers did.

The wilderness can also serve as a mirror for clients, says Roberts, who has also worked in wilderness therapy, or, as he says it is becoming more commonly known, outdoor behavioral health care. For instance, when clients who struggle with executive function and organization encounter bad weather for which they are not prepared, the experience can be a vivid demonstration of the importance of working on those problem areas. Another example: Someone who is struggling with distress tolerance will need to get used to having to build a fire after hiking all day.

Information overload?

Although none of the counselors interviewed for this article view social media or technology as inherently negative, they agree that living in the information age is complicated. The current generation of teens and young adults is awash in an unprecedented flood of information, asserts Roberts, clinical director at Cascade Crest Transitions, a program that provides support to young adults struggling to launch their independence by attending college or obtaining a job. He maintains that this technological bombardment not only is difficult to assimilate but also can encourage the tendency to “get stuck” in one’s own head.

Allen adds that in the age of the internet, children and adolescents are exposed to a lot of information and knowledge at an earlier age than previous generations were. In certain cases, it is information that they may not have the maturity to handle. For example, most children and adolescents who grew up in the latter half of the 20th century had to somehow get their hands on a copy of Playboy or another adult magazine to satisfy their sexual curiosity. Today’s children and teens are exposed online to myriad genres of easy-to-access pornography, which not only present unrealistic ideals of sexuality but also can include disturbing practices such as bestiality and pedophilia. Children and young adolescents today are also more likely to be exposed to media coverage of frightening or horrific events before they have the ability to contextualize all that they are taking in, Allen says. He believes this early exposure is contributing to a kind of “nonspecific existential dread” that he says he commonly sees in his clients.

Roberts says that technology offers many positive benefits, but it also sometimes provides adolescents and young adults with a means to avoid their problems. He stresses the need for counselors to learn more about the draw of technology so that they can help clients evaluate whether they are using it in positive or negative ways. Roberts gives gaming as an example. For those who know little about it, gaming may seem like an excuse to “do nothing.” In reality, he says, it is a legitimate hobby that can provide enjoyment, stress release and even a sense of community while boosting problem-solving skills. However, like any other activity, when gaming gets in the way of schoolwork, chores or getting out of the house, it becomes a problem to be addressed, he says.

Another complicated aspect of online life is social media. For all the potential benefits, social media feeds have made it so that virtually no part of life is private anymore, Allen says. Many adolescents may not fully understand that by making everything public, the internet is, in essence, “forever” or grasp the potential ramifications of that reality, he says. In addition, he notes, social media feeds can encourage social contagion.

ACA member Amanda LaGuardia, a former private practitioner whose research focuses on self-harm, agrees. Much of the social media content targeted to young girls is focused on body image, says LaGuardia, a licensed professional counselor supervisor in Texas and a licensed professional clinical counselor supervisor in Ohio. Many of her former clients talked about the images they saw on Instagram, such as already-thin celebrities discussing “thigh gap” (as part of a supposedly “perfect” body, women and girls must have thighs that don’t touch each other) and other unrealistic physical standards. Such posts are usually popular, garnering a large number of likes and admiring comments, which gives girls the impression that this is what their bodies should look like, she says.

However, such standards are unrealistic for most females and are simply unachievable for girls with developing bodies, continues LaGuardia, an assistant professor at the University of Cincinnati. Regardless, these images are presented as the feminine ideal, presuming to highlight all of the elements that will make women attractive to men. At the same time, girls are often subject to sexual harassment at school and too often told by those in authority “that’s just how boys are” (boys will be boys) and that girls just need to find a way to deal with it, she says.

All of these messages about how girls should look and act and what they should accept come at a time when they are already struggling to figure out who they are. It is overwhelming, and self-injury is becoming a more common way to cope with the distress. Self-harm used to be most common in the eating disorder population, but according to LaGuardia, social media has introduced it to a wider audience. It isn’t necessarily that self-injury is presented as a positive behavior online. Most people who talk about it on social media are seeking support, she says. However, the widespread nature of the discussion has created social contagion.

The best thing counselors can do to help is listen and affirm, LaGuardia emphasizes. When adolescents talk about their experiences, some counselors focus on helping them feel better about themselves, but that is not what they need most, she asserts. Instead, adolescents need to express what they are going through and to process their confusion verbally. Counselors should respond, she suggests, by saying things such as, “That sounds really difficult” and “I’m here and I’m listening.”

“So many of the messages they [adolescents] are receiving are controlling,” LaGuardia explains. “They need to feel in control.”

As these clients become more comfortable, they will begin to talk about how they are coping with their turmoil. LaGuardia explains that these clients view self-injury as a means of surviving what they are currently experiencing, not a solution. “I ask clients, ‘Is this something you see working for you for the rest of your life?’ I’ve never had anyone say yes.”

Usually, LaGuardia notes, clients will say that they hope not to engage in self-harm forever, but at the current time, they don’t know what else to do. At that point, counselors can ask whether this coping method is something the client is ready to change. LaGuardia says the first step is finding out what the client needs help coping with and then exploring ways that will allow the client to cope without self-harm.

The most common underlying problem for clients who self-harm is conflict with a parent or sibling, LaGuardia says. In such cases, she works with the whole family on communication skills. She starts with the adolescent clients, teaching them how to express their needs without self-injury. She asks the adolescents to think about their most stressful conflicts and what they would like their parents to know. Then, through role-play, LaGuardia helps these clients practice asking for what they need.

Often, LaGuardia will also bring in the parents and have the adolescent express the source of conflict. As the parents and adolescent talk, things can get heated, so LaGuardia is there to help redirect the conversation. She also tries to educate parents about what adolescents need, which includes being treated as independent young adults and given space to grow, while at the same time knowing that their parents are always there to listen to them regardless of
the circumstances.

Adult transitions

Allen is the program director at College Excel, a residential, coaching-based college support program. The program’s clients are typically young adults who are coming out of high school and looking for extra support to succeed in college or those who previously attended college but dropped out because of a mental health issue or learning disability.

Many of the students have some level of anxiety and depression and often struggle with executive function deficits. College Excel provides the students with mental health support and coaching on life and study habits. Allen says he tries to run the program through the lens of good mental health practices. Calling on his background in wilderness therapy, he also encourages students to eat well, follow a consistent sleep schedule and get regular exercise. College Excel staff do not live on-site, but the program does provide students with housing, which helps them establish a sense of community and support — elements that are common among those who successfully adjust to college life, Allen points out.

Allen says that many of the program’s clients struggle with attention-deficit disorder and organization. College Excel staff teach students basic organizational skills such as using their attention strategically. For example, with students who struggle with memory and retaining information, Google Calendar can be a particularly useful tool. It can tell students where they need to be at any given moment, freeing up their attention and memory for other tasks.

Allen also talks with students about the importance of a clean workspace and provides them with practical tips on organization. For example, he says, students who constantly misplace things can save time and frustration by designating a space for pens, papers and other basics so that they will always know where to find them.

Students also work on developing good study habits. For example, rather than growing frustrated with their struggles to focus on what they’re reading for long periods of time, clients learn to study in 15- to 20-minute chunks, with five-minute breaks in between.

Roberts’ program is geared toward young adults who are coming from inpatient treatment and are ready to enter college or find a job. In addition to receiving ongoing mental health treatment, these clients take classes that focus on interpersonal skills, stress regulation, goal setting, time management and money management. They are also encouraged to exercise, and all students are matched with a case manager who helps them focus on sleep hygiene, peer interaction, health and nutrition, and, in some cases, dating.

Clients are required to attend one individual and one group counseling session per week. Counselors are also on-site five days a week, which allows them to give feedback outside of sessions. For example, a counselor might say to a student, “You say that you want to socialize, but you’re constantly retreating to your room or on the phone.” This opens up a discussion about why the student isn’t following through on counseling goals and allows the counselor and client to work on solutions together, Roberts says.

The students are usually enrolled in college or working when they start Roberts’ program. The coaching and classes take place around the students’ schedules, and staff members are available to help clients through whatever challenges they are facing in school or at work. Clients typically remain in the program about nine to 12 months. During the last six months, they move out of program housing and into their own apartments or college dorms.

Allen closes by noting that today’s adolescents and young adults — the oft-discussed millennials — are very much aware that older generations generally view them in a negative light. He believes this widespread maligning carries a psychic weight for this generation and can contribute to limiting their self-efficacy and sense of options.

Because this negative image of adolescents and young adults is so prevalent, Allen believes that even counselors may fall prey to it. “You can’t hold them in contempt and do good work,” he emphasizes. “The best thing we could be doing for them is stoking the fire of creativity.”

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books and DVDs (counseling.org/publications/bookstore)

  • Youth at Risk, sixth edition, edited by David Capuzzi and Douglas R. Gross
  • A Contemporary Approach to Substance Use Disorders, second edition, by Ford Brooks and Bill McHenry
  • Active Interventions for Kids and Teens, by Jeffrey S. Ashby, Terry Kottman and Don DeGraaf
  • Suicide Assessment and Prevention, DVD, presented by John S. Westefeld

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources)

  • Suicide Prevention
  • Substance Use Disorders and Addiction
  • LGBTQ Resources

Webinars (aca.digitellinc.com/aca/pages/events)

  • “Depression/Bipolar” with Carmen S. Gill (CPA22120)
  • “Trauma/OCD/Anxiety” with Victoria E. Kress (CPA22118)
  • “Substance Abuse/Disruptive Impulse Control/Conduct Disorder” with Shannon Karl (CPA22116)
  • “Counseling Students Who Have Experienced Trauma: Practical Recommendations at the Elementary, Secondary and College Levels” with Richard Joseph Behun, Julie A. Cerrito and Eric W. Owens (CPA24339)

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Ask your doctor if nature is right for you

By Bethany Bray January 3, 2017

Happy-looking people take a walk in the woods as small-print disclosures scroll across the bottom of the TV screen and a soothing voiceover explains possible side effects. As the scene closes, one of the actors looks squarely into the camera and says, “Ask your doctor if nature is right for you.”

The tongue-in-cheek NatureRx video campaign has the look and feel of the prescription drug commercials that inundate television in the U.S. The difference, however, is that they are “selling” something that is widely available and has proved to benefit mental health and overall well-being — without prescription drugs.

NatureRx is the brainchild of Justin Bogardus, a filmmaker and licensed professional counselor candidate in Boulder, Colorado. Everything seems to have a marketing campaign in this modern age, he says, so why not nature?

Rather than relying on a heavy-handed “you should” directive, the films use humor and a witty message to emphasize the benefits of getting outside, Bogardus explains.

“As a trained counselor myself [but primarily a filmmaker now],” he says, “I really wanted to create a message like NatureRx because I resonated with it so much personally. … I think people really resonate with the message and the humor because it’s fun, funny and inspiring to remember the little things that were always there, but sometimes we forgot about them, like nature and getting outdoors.”

NatureRx “commercials” have been screened at film festivals and shared widely online since the

Justin Bogardus, NatureRx filmmaker (Courtesy photo)

first video was released in the summer of 2015.

Bogardus has a film degree from Vassar College and has worked as an editor, writer and producer for several documentaries on wrongful conviction/incarceration. In 2013, he completed a master’s degree in Buddhist psychology and contemplative psychotherapy from Naropa University in Boulder. Although he primarily devotes his time to independent filmmaking and speaking engagements, he does occasionally see clients, lead group therapy and teach Buddhist psychology at Naropa.

 

 

Is NatureRx right for you? CT Online contacted Bogardus to learn more about the campaign and its connection to counseling and mental health.

 

The holiday season can be especially tough for people with anxiety and other mental health issues. At the same time, the weather is getting colder and the days are shorter and darker. Do you have suggestions on how to find “NatureRx” throughout the winter?

Research shows [that] as little as 10 minutes outdoors can reset the nervous system, especially if you can be mindful and present with nature for those 10 minutes. … Taking a walk and tasting the cold brisk air makes a big difference even in small doses.

I get asked about winter a lot in regards to NatureRx, and I love that question. I love winter. The outdoors seems particularly tranquil and quiet to me in the winter. There are no studies about this, but I actually think the positive impact of nature on our minds happens faster in winter. Something about a little temperature change and a change of scenery from the indoors in winter really resets my mind and body pretty quickly. Yes, it can be a little harder to motivate putting on jackets and boots when it’s cold and the sun sets so much earlier, but the colder air is more refreshing, I think. I also like to remember that our bodies were built for the outdoors, including the cold weather.

I also love this thing from Denmark called hygge (pronounced hoo-ga). Everyone knows how cold and dark winters in Denmark are, and the Danes have come up with a great word and lifestyle to make the most of it. It’s basically the idea of cultivating coziness, slowing down and taking in simple pleasures. It’s like NatureRx for the indoors.

I like that with the idea of hygge, you bring an overall sense of coziness to the winter and holiday season, which you bring with you both outdoors and inside. A 10-minute walk in the cold air, all bundled up in all the scarves, mittens, hats, puffy coats — whatever makes being outside a slowing down and cozy experience too. How great is a warm fire and hot cup of tea after a short dose of outdoors? How cozy and relaxing is that? So yes, back and forth with outdoors and the family, back and forth with getting warm and then getting refreshed outside with an overall sense of hygge. That’s a perfect recipe for the holiday season I think.

During holiday get-togethers, people and families can go stir crazy if no one is getting outside. Togetherness is great, but too much togetherness in an enclosed space is well … cue the commercial … “are you feeling tired, irritable [and] stressed out?” Who isn’t feeling tired, irritable and stressed out at some point during the holiday season? That’s the cue for a dose of nature, even a microdose. It really works and so does hygge.

NatureRx has been a lifesaver for me during the holidays. Now it’s fun because as I get outdoors for short breaks during each holiday season, the rest of my family has started doing it too. … Maybe they saw how happy and relaxed I was after a little time outside.

 

What do you want professional counselors to know about nature’s connection to wellness and mental health?

I like to remind even the most self-described “I would rather do anything besides camping” indoor people that it’s all about discovering the dose of nature that works for you. [Moving] more plants inside or gardening, or having a great view of the outdoors from a window, whatever brings nature into your life in a way you like, I think, can support our well-being [and] slowing down, which is incredibly helpful, especially in [the] busy, screen-time, information-overload, never-stop-world so many of us are meeting these days.

I once met this great group counselor in New York City — a real expert and guru of counseling. I was telling him how I like to get outside and to meditate. He told me, “Getting outside and meditation are like rocket fuel for healing in therapy.” I think that’s the best way to put it. NatureRx helps on its own and in conjunction with all the others things we need for rich, healthy lives.

Yes, there’s a new big study from big-name institutions almost every week it seems about the positive impacts of the outdoors and nature on all kinds of well-being metrics, especially mental health for all kinds of symptoms and challenges [and] for healthy development of kids. But really I think NatureRx got millions of views and has made such a splash because on a deep intuitive level, we already know this. The healing impact of nature is a story as old as humanity itself.

Being outside in nature supports our well-being. Of course it’s not a panacea. It’s not a cure-all. But who knows? For some people it might be. I think it’s like good rest. It’s something we all know on some level is needed and super helpful for whatever life throws at us. And like good rest, you don’t want to overdo it or go outside with too much of an agenda, expecting nature to fix everything. Nature doesn’t work that way, but if you can hang back a little in nature, let its beneficial impact come to you more and more … it works! I could go on and on. The magic always happens eventually.

Since the dawn of human civilization, we [have] lived increasingly in busier spaces. Every culture and every civilization from every time period has countless stories about the need for nature — a respite and restorative space to not only heal, but find your truer and deeper voice in. NatureRx is that same story, updated for our times. I think nature is a timeless space, a great place to discover your authenticity and who we really are — outside the din and distraction of culture and civilization.

 

Do you have suggestions for how counselors can bring nature into their work with clients?

Well, first have clients watch the NatureRx commercial. Self-promotion? Maybe, but really it’s true. First-time viewers love the humor and then love sharing the videos with other folks — it just resonates with so many people. That was certainly part of the goal with NatureRx and the humor behind it. I didn’t want to prescribe nature and getting outside as a “should.” I wanted to playfully invite people to look at getting outside and nature from a fresh perspective, and of course spoofing a prescription commercial was the way to do that.

So for counselors of all kinds, I say … find ways to invite people into thinking about nature and getting outdoors as a fun, healing space rather than imposing the idea on them in subtle or not so subtle ways. I think [it’s] always good to start with some curiosity, asking people questions about nature, [such as] plants or places they may like. It seems almost everyone has some memory or some animal or plant or some outdoor smell or nature activity they already remember or enjoy. I think that’s a great starting point. Later on, it can also be good to offer some of the evidence-based information about getting outdoors, which some people like to know because it can increase their time outdoors and their perceived benefit from nature. But some folks don’t even need that didactic information.

I’m amazed how many folks already have some NatureRx practice in their life without even realizing they’re intuitively getting benefit from nature — even smokers I meet. Many smokers talk about enjoying the break outdoors as part of their smoking habit. It’s interesting how many, when they quit, still like to get outside, but this time just for a short walk or to sip a cup of tea or something. What they didn’t think about was how smoking was a tool to take a break outside, even in the cold. Without the cigarette, they still get to benefit from getting outside with a lot more enjoyment.

I met a woman I’ll never forget who liked to check the weather for the sunset time. She rarely ever watched the sunset. She just found herself always checking in on what time the sun would set. She didn’t care too much for camping or the outdoors; she would never describe herself as a nature person. I worked with her some, and we talked about what she liked about the sunset and knowing the rhythms of the sunrise and sunset from season to season. Before long, she told me she had started to actually take the time, even if it was just five minutes toward the end of the workday, to not only check the sunset time, but take some time outside to really enjoy watching the sunset. Simple. Relaxing. Restorative. I’m pretty sure she still does that today and loves it.

 

Who is your target audience for the NatureRx campaign?

When first creating the NatureRx commercials and the NatureRx movement online, I intended to target millennials with the humor and the particular disconnection millennials might feel around nature. It’s the first generation that may not have been exposed to the outdoors readily as kids and, consequently, that millennial generation — which I’m a part of, but on the older side — may feel that lack of nature more acutely.

I grew up in the city myself. I was lucky to have a father who took the time to take us to national parks and [go] hiking. That’s probably how I first fell in love with nature. But I had a lot of city friends who didn’t get those experiences growing up, and I always imagined those lifelong friends and what might appeal to them when crafting this message and writing NatureRx content. The millennial generation is so used to getting tons of information on their laptops and phones all the time, so certainly it was an important goal of mine in creating NatureRx to craft a fun-filled message that could connect with them in short form and on social media in a way that they could really enjoy and consider.

It’s food for thought for any age — even kids love our G rated versions of the commercials. It’s something we can all relate to.

 

Do you think medical and mental health professionals sometimes overlook nature and its therapeutic benefits?

Yes and no. I think the medical and mental health professions as a whole have some real ambivalence about nature and the outdoors. [But] I think a lot of that’s changing now as we see the alternative — being inside, disconnected and sequestered, and how that is having terrible health and well-being impacts on our bodies and minds. I think there’s a big shift in medical and mental health professionals around embracing the benefits of nature and getting outdoors because of this.

I think all this research coming out about the benefits of getting outdoors reveals this movement and paradigm shift. For the last few decades in medicine, culture and in parenting, the view was [that] getting outside and in nature is how you get sick or hurt. I think lots of folks are seeing now how wrong that view is.

 

In a nutshell, what inspired you to start the NatureRx campaign?

Nutshell? I love nutshells. That was a big inspiration. That and climate change. I wondered, how could I speak about the human relationship to nature in a way that connected with people personally, whether they believe in human-caused climate change or not? I don’t say anything about climate change in the commercials, but I think it’s in there nonetheless.

I was inspired by how nature is something I need in my personal life. It’s helped me in countless ways, and nature is something we all need as a valuable space for all earthly inhabitants. I hoped the message and humor would convey that — both the personal and universal value of nature. It was a way of giving back for me.

 

What do you want professional counselors to know about why your campaign is needed?

As a trained counselor myself, I like this phrase: “Of all the paths you take in life, make sure some of them are dirt.” For professional counselors, I think NatureRx is needed because there are many paths to healing and recovery for clients. I think it’s also true to make sure some of those paths are made of dirt. A dirt path in the woods is the real-life metaphor we can experience at anytime. It’s a great ready-at-hand place where we can see that natural healing isn’t like a manicured superhighway to health. There are twists and turns.

Getting outside reminds me of my most human qualities. It reminds me that I have a body that likes to be in nature, to look at nature and be healthy. It reminds me to take time to just be. I think that’s the energizing trail mix we all need on whatever path we’re taking in life. That’s the need I hope NatureRx fills. It’s an empowering message about how you can take back your life at any point by simply stepping outdoors. I think healing and counseling works well when people feel empowered with real solutions, and getting outdoors is most certainly one of those solutions.

 

 

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Find out more about NatureRx and watch Bogardus’ TED Talk at Nature-Rx.org

The NatureRx “commercials” are available there as well as on the YouTube channel: bit.ly/2h1MCZp

 

 

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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 at facebook.com/CounselingToday.

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

The Counseling Connoisseur: Nature-informed counseling for children

By Cheryl Fisher October 13, 2016

“Once there was a tree … and she loved a little boy” — from The Giving Tree by Shel Silverstein

 

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I recently returned from a wonderful week in Nova Scotia featuring painted clapboard cottages against blue skies and a seascape of majestic hills and swirling tides. With a history rich in forts, fur trades and complex propriety, Nova Scotia also affords miles of pristine trails for the avid (and not so avid) hiker.

On one such hike, I ventured up Cape Split, which offered a spectacular view of the Bay of Fundy following a two-hour uphill jaunt. The inland path was lush with evergreen and paved in centuries-old rocks. Snarled roots from ancient maples protruded from the narrow trail, and patches of mud provided slippery terrain. At times the trail seemed endless and unforgiving. However, just at that moment when body and morale were failing, the forest opened to a grassy knoll that blanketed the age-old rock formation overlooking the (now) returning six-foot tides of the Bay of Fundy.

Damp with perspiration from navigating the trail, we sat down and unloaded our backpacks, laying out a feast before us of lobster rolls and blueberry lemonade. The cool breeze from the bay mingled with the warmth from the sun. In that moment, I was sure there was nothing sweeter than communion with nature and the physical and emotional exertion and spiritual nourishment it afforded.

 

Camps and communion

For many children (and their excited parents), the end of summer signifies a return to school, studies and schedules. It is a time when we bid farewell to the lackadaisical whimsy of carefree days. Summer memories of camps, cookouts and canoes fade, making way for the cooler activities of autumn. However, for many children, summer camp did not include nature hikes, bonfires or kayaking; it involved indoor activities centered around a theme such as weight management, music acquisition or computer skills.

photo-1447875372440-4037e6fae95dResearch suggests that connecting to nature can result in reduced stress, increased energy, improved sleep, reduction of chronic pain, and accelerated healing from injuries and surgery. In particular, Peter Kahn and Stephen Kellert have argued that “a child’s experience of nature exerts a crucial and irreplaceable effect on physical, cognitive and emotional development.”

Yet modern living has insulated us from the positive ionic exchange between grass, trees, river and sky, resulting in a physical, psychological and often spiritual connection from the Earth and her creatures. According to researcher and therapist Martin Jordan in his book Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces, this detachment is associated with a variety of dis-ease, including epidemic rates of obesity and depression.

Richard Louv, author and founder of the Children & Nature Network, coined the term “nature deficit disorder” in his book Last Child in the Woods to refer to a generation of children who no longer spend time outdoors hiking, camping and otherwise interacting with the natural world. Direct contact with nature appears to benefit children physically, emotionally and spiritually.

 

Physical

Interacting with natural elements provides a varied and complex terrain and physical stimulation for children. Negotiating inclining hills or slippery declines, catching and releasing tadpoles or crickets, and chasing butterflies, for example, create opportunities for skill-building in a variety of areas, including large and fine motor skills, balance and hand-eye coordination. Most people can remember the challenge of a new skill … and the thrill of successful mastery.

 

Emotional and cognitive

According to Kahn and Kellert, a child’s experience of nature “encompasses a wide variety of emotions” and an “unfailing source of stimulation.” I remember the awe and wonder I experienced when my childhood naturalist neighbors taught me how to look for the tiny green caterpillars grazing on the cabbage leaves in the garden; then observing their transformation as they ate their way to chrysalises; and the unbearable waiting and waiting until these dormant creatures emerged into beautiful white butterflies.

More recently, I ventured into raising the threatened monarch butterfly. Still with the curiosity of a child, I planted my milkweed, purchased my microscopic caterpillars and watched in amazement as larvae transformed into J’s hanging from the top of my butterfly shelter. Sadly, a virus attacked my precious guests and killed each before they could take their first flight. I experienced genuine grief over this loss.

 

Moral

Nature provides endless teaching opportunities around issues of moral conscience. Kellert identified nine values of the natural world:

  • Aesthetic: Physically appealing
  • Dominionistic: Mastery or control over nature
  • Humanistic: Emotional bonding with nature
  • Moralistic: Ethical or spiritual connection to nature
  • Naturalistic: Exploration of nature
  • Negativistic: Fear and aversion of nature
  • Scientific: Knowledge and understanding of nature
  • Symbolic: Nature as a source of language and imagination
  • Utilitarian: Nature as a source of material and physical reward These values tend to emerge in a developmental manner, generally shifting from more self-centered, egotistical values to more social and other-centered values.

 

Nature-informed counseling

Nature-informed counseling refers to a vast array of scientifically based psychological therapies that use nature in clinical practice. Among the foundational assumptions of nature-informed counseling are that we are not machines; we are human beings who are sensual, curious and creative. We are interdependent with the full ecosystem in which we reside.

Furthermore, ecotherapy is an organic model of care that tends to the whole relationship between humans and the other-than-human. Here are several ways to incorporate nature-informed methods into your counseling practice:

1) Animal-assisted therapy: I am fortunate to be able to bring my goldendoodles to my office to be co-therapists. However, in addition to dogs, there are other smaller pets that may work more easily in your practice. For example, I had a betta fish (who was named Olive by a client) that I used with clients. Or place a bird feeder outside your window (if you are fortunate enough to have a window).

2) Horticulture therapy: There are numerous ways to integrate plants in a therapeutic manner. Have clients plant seeds and tend to their care. Or keep small pots of herbs in your office, providing an opportunity to explore aromatherapy. It is a wonderful release to pinch off a bit of rosemary, mint or thyme and inhale the calming, soothing or energizing fragrance.

3) Wilderness therapy: I have used “kayak therapy” with trauma survivors with great success. However, you may not work in a community with easy water access or even know how to kayak. Therefore, your wilderness approach might be more in line with taking clients on a walk on a trail or observing wildlife with them in a nearby lake or pond.

You can also co-create homework around nature walks. For example, I was working with a couple who seemed stuck, so I asked them to go for a walk together (without talking) and collect items along the way that reminded them of their marriage. When they returned to my office, they emptied their treasures, which included a rock (“that used to be how I saw our marriage”), a feather (“we are drifting away”) and a few twigs (“we have roots still”). After a discussion centered around the items gathered, I had the couple finish the session by using the items to create a sculpture that reflected the relationship they wanted to craft.

4) Other ideas:

  • Assess your clients’ relationship with nature. Where is their “happy place”? How often does they get to visit it? Where are their favorite memories housed?
  • Invite a family with which you are working to spend the night in a tent in the backyard and reflect on this experience in session.
  • Teach cloud spotting. Teaching clients mindfulness takes on a fun twist as you lie on your back and gaze at the ever-changing cloud formations.
  • Use transitional objects. I keep a box in my office filled with seashells, sea glass and rocks lovingly collected by my own mother when she walks the beach. I use these as transitional objects when clients might benefit from imprinting an image or experience to an object that they can carry in their pockets or purses throughout the day.

 

Ethical consideration

As with all forms of practice, ethical standards must be followed to avoid harm and litigation. So what are the ethical considerations when utilizing the wisdom of nature in psychotherapy? This depends on the extent and type of nature-informed therapy you are using. For example, the ethical guidelines for hiking a trail with a client may look a bit different than the guidelines forphoto-1469440317162-d9798b137445 planting a sunflower seed and tending to it as metaphor for self-care and growth. However, in general the following issues must be addressed.

1) Do all parties feel physically and emotionally safe? Although you may thrive sitting in a field of poppies, your client may possess strong allergies to flower pollen that render therapy outdoors a physically uncomfortable experience. In addition to allergies, the client may exhibit phobias around the outdoors that need to be understood and appeased. Temperature and air quality may also be variables to consider.

2) Framing the relationship. For some therapists and clients, an office space with a designated chair arrangement signifies a professional relationship and the tasks that will ensue. A client may feel uncomfortable with the more lax and familiar atmosphere of sitting cross-legged on a hollow log while disclosing current therapeutic issues. Trading leather chair for log stump may alter the relationship in ways that prove unsettling for either the client or the therapist.

3) Is it confidentiality compliant? I have clients who love taking a walk during therapy. Some lament that it is the only time they have for physical activity. However, if we are walking in a heavily populated area, their confidentiality may be at risk. At the same time, an area that is too isolated may not be prudent should an emergency situation arise.

4) Get appropriate training. If you do not know how to kayak, taking clients on a wilderness kayak expedition probably isn’t wise. Always get training before using any modality in therapy.

5) Informed consent. It is always prudent to have clients sign an informed consent form that stipulates the possible risks and benefits of any therapy used in session. Therefore, a specific consent form that addresses the specific type of nature-informed therapy — including possible benefits and risks — needs to be explained and signed prior to taking that walk in the woods or a stroll in the garden during session.

 

Conclusion

Nature provides endless opportunities for metaphors, messages and meaning construction. Incorporating nature-informed approaches into our practices is not only creative but also clinically sound. It is as easy as taking the time to reflect on the sights, sounds, and smells just outside the door.

 

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For more information:

  • Ecotherapy: Healing With Nature in Mind by Linda Buzzell and Craig Chalquist (2009)
  • Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces by Martin Jordan (2014)
  • Children and Nature: Psychological, Sociocultural and Evolutionary Investigations by Peter H. Kahn and Stephen R. Kellert (2002)
  • Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder by Richard Louv (2008)

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Cheryl Fisher

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is currently working on a book titled Homegrown Psychotherapy: Scientifically-Based Organic Practices, of which this article is an excerpt. Contact her at cy.fisher@verizon.net.

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
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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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Wilderness therapy: The question of affordability

By Bethany Bray

Wilderness therapy is an intensive, out-of-the-box treatment modality. One of the elements that makes it so effective – multiple staff who devote focused, substantial time to clients, both individually and in group settings — drives up the price tag.

“[Wilderness therapy] is an investment, and I explain it to families as such, including the time and effort they put into it,” says Sabrina Marie Hadeed, a licensed professional counselor at Second Nature Cascades, a wilderness therapy program in Oregon.

Although models vary from program to program, wilderness therapy involves taking groups of clients WildernessHike— most commonly youth or young adults — out into the wilderness for an extended period of time. Participants, including some program staff, typically sleep outdoors, pitch tents, hike and cook food over an open fire.

Field guides are with clients around the clock; clients also see a staff therapist regularly and interact with a support crew – everyone from a wellness coordinator or other medical professional to administrators who plan and drop off water, food and supplies to groups.

“The ratio of staff and employees to clients is very large [in wilderness therapy], which means the cost per day – most of which goes to paying salaries and wages – is significant for many families,” says Gil Hallows, chair of the Outdoor Behavioral Healthcare Council.

The expense, compounded by the fact that it’s not often covered by insurance, makes wilderness therapy cost-prohibitive for some families, admits Hallows.

However, many in the field are working to change this fact.

The Outdoor Behavioral Healthcare Council, an organization formed to advocate, research and identify best practices in wilderness therapy, is spearheading a campaign to improve insurance coverage.

(Many in the field prefer the term “outdoor behavioral healthcare” to “wilderness therapy.” The former refers to a regulated industry, while wilderness therapy can be a more nebulous term.)

Historically, insurance companies have been reluctant to reimburse clients for costs incurred for participation in outdoor behavioral healthcare, says Hallows, the executive director of Legacy Outdoor Adventures, an OBH program in Utah.

The OBH 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 insurance claim denials, Hallows says.

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

At the same time, Hallows asserts that the OBH model is cost-effective, especially when compared with nonwilderness programs with similar staffing levels.

“A brick-and-mortar type of residential program, in order for them to be priced lower than a wilderness therapy program, they have to lower the staff-to-participant ratio,” he says.

 

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

 

 

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

 

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