Medicine:Wilderness therapy

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Short description: Wilderness therapy for teens, in the United States

Wilderness therapy, also known as outdoor behavioral healthcare, is a controversial treatment option for behavioral, substance, and mental health issues in adolescents.[1]

Overview

Backpackers at a wilderness therapy program

Wilderness therapy has been described as "challenge courses", "adventure-based therapy", and "wilderness experience programs".[2] A variety of theoretical orientations are used in wilderness therapy,[3] including mindfulness-based therapy and cognitive behavioral therapy. However, in the majority of wilderness therapy programs, teens spend most of their time living in tents in the woods with a group of eight to 12 peers.[4][5] Participants are accompanied by three staff members who are not trained as therapists and work for minimum wage, who are responsible for their day-to-day activities.[4]

About half of wilderness therapy participants attend involuntarily and are transported by services specialized for “uncooperative” youth.[1]

Generally, therapeutic wilderness programs cost upwards of $30,000 or more for a child’s three-month stay.[4] Few clients receive financial assistance from medical insurance.[6] Insurance companies have long refused to pay for wilderness therapy, contending that the programs are not covered by insurance policies because they take place outdoors.[7]

History

Madolyn M. Liebing, Ph.D. (of Aspen Achievement Academy then, and currently of Juniper Canyon Recovery) was the first clinical psychologist to integrate clinical therapy with wilderness programming.[5]

Controversy

Allegations of abuse, deaths, and lawsuits

Abusive situations have been reported and several children have died in wilderness therapy programs. Many participants also say that they are left with lifelong trauma from the experience.[8]

In 2014, a 17-year-old missing from the North Carolina Trails Carolina wilderness therapy program was found dead in a stream.[9] The teen wandered away from the group he was with, broke his hip and was unable to move, and died of hypothermia when he was not found.[9] The North Carolina Department of Health and Human Services (DHHS) report investigating his death shows a deputy sheriff said staff at Trails Carolina waited five hours before calling for help.[4]

Maia Szalavitz, author of the 2006 book Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, has concluded that many of the tactics that wilderness-therapy programs use are no different than those used at Guantanamo Bay.[10] Szalavitz has documented cases of emotional and physical abuse, and the withholding of food, water, and sleep.[10]

A fourteen-year-old in the Catherine Freer Wilderness Therapy program died in 2003 when a tree fell on the tent that he was sleeping in.[10]

In 2001, another teen at the Catherine Freer Wilderness Therapy program died of heatstroke and dehydration while on a hike the day after she had arrived.[10]

Aaron Bacon, age 16, died in 1994, while enrolled in a wilderness program in Utah. He was three weeks into a 63-day wilderness trek when he died of peritonitis and a perforated ulcer.[11] Several staffers were charged with felony neglect and abuse of a disabled child.[11]

Also in Utah, two teens died in 1990 while enrolled in wilderness therapy programs.[11] Both of their deaths were related to heatstroke on hikes.[11]

Due to the trauma and alleged harm reported by former wilderness program residents who have been forcibly escorted into placement, psychologists have heavily criticized this approach as inappropriate, and grossly inconsistent with establishing the necessary trust required for building a therapeutic relationship between youth and providers.[12]

Limited and biased research

Although the wilderness therapy industry has tried for several decades to fill research gaps to bolster its case of effectiveness and reduce the need for legislative intervention, critics say that science still does not support wilderness therapy.[13]

Independent researchers have called into question the wilderness therapy industry's claims, expressing ethical concerns and criticizing its use of "bad science" due to methodological flaws in the research.[14] Given the proliferation of such programs, relaxed regulation, and absence of research setting uniform standards of care across programs, advocates have called for increased accountability to ensure programs are capable of providing care that is consistent with their marketing claims.[15]

Some programs which advertise as "wilderness therapy" are actually boot camps similar in style to military recruit training in a wilderness environment.[16] These can sometimes be distinguished from other wilderness therapy by such programs promising behavior modification for troubled teens, but it is hard to tell just from the ads.[17]

One of the major differences between military style boot camps and wilderness therapy is the underlying philosophical assumptions (wilderness therapy being driven by the philosophy of experiential education and theories of psychology, and boot camps being informed by a military model). Incidents of alleged and confirmed abuse and deaths of youths have been widely reported across many wilderness programs, despite claims that these programs provide a less coercive environment than that of boot camps.[18]

Accountability

In October 2007 and April 2008, the United States Government Accountability Office convened hearings to address reports of widespread and systemic abuse in adolescent treatment facilities. In connection to the hearing, they issued a report about the wilderness therapy industry.[15][19] The Federal Trade Commission has published a list of questions for parents to ask when considering a wilderness program.[20]

Programs seeking additional accreditation and certification often pursue partnerships and memberships with non-profit membership and accreditation organizations.

After the program

After a wilderness therapy program, clients may return home or may be transferred to a therapeutic boarding school, young adult program, or intensive residential treatment center. Some estimate that 40% of children enrolled in wilderness programs are later sent to long-term residential behavioral care facilities.[21]Template:Outdated inline

See also

References

  1. ↑ 1.0 1.1 Dobud, Will (2021-06-14). "A Closer Look at Involuntary Treatment and the Use of Transport Service in Outdoor Behavioral Healthcare (Wilderness Therapy)". Child & Youth Services: 1–20. https://scholar.google.com/citations?view_op=view_citation&hl=en&user=X8oycZ4AAAAJ&citation_for_view=X8oycZ4AAAAJ:_FxGoFyzp5QC. Retrieved July 27, 2021. 
  2. ↑ Russell, KC (2001). "What is wilderness therapy?". Journal of Experiential Education 24 (2): 70–79. doi:10.1177/105382590102400203. 
  3. ↑ Gass, Michael A. (2012-04-27). Adventure Therapy. doi:10.4324/9780203136768. ISBN 9780203136768. 
  4. ↑ 4.0 4.1 4.2 4.3 Ochsner, Nick (May 24, 2021). "'It's beyond cruel': Inside an N.C. wilderness therapy program for teens". WBTV. https://www.wbtv.com/2021/05/24/its-beyond-cruel-inside-nc-wilderness-therapy-program-teens/. 
  5. ↑ 5.0 5.1 White, W. (2012). "Chapter 2: "A History of Adventure Therapy"". in Gass, M; Gillis, L.; Russell, K.. Adventure Therapy: Theory, Practice, and Research. Routledge/Bruner-Mazel Press.. 
  6. ↑ C. Russell, C. Hendee, Phillips-Miller, Keith, John, Dianne (November 29, 1999). How Wilderness Therapy Works: An Examination of the Wilderness Therapy Process to Treat Adolescents with Behavioral Problems and Addictions. pp. 26. https://www.fs.fed.us/rm/pubs/rmrs_p015_3/rmrs_p015_3_207_217.pdf. 
  7. ↑ Berr, Jonathan (June 27, 2017). "Should insurers cover wilderness therapy programs?". CBS News. https://www.cbsnews.com/news/health-insurers-sued-over-wilderness-therapy/. 
  8. ↑ Bastian, Jonathan (July 30, 2021). "'Almost everyone is left with trauma': The impact of American's unregulated wilderness teen therapy industry". KCRW. https://www.kcrw.com/culture/shows/life-examined/tough-love-wilderness-behavioral-therapy/kenneth-rosen-troubled-teen-outdoor-boot-camps. 
  9. ↑ 9.0 9.1 Golgowski, Nina (November 26, 2014). "Teen missing from North Carolina wilderness therapy camp found dead after breaking his hip in stream: autopsy". New York Daily News. https://www.nydailynews.com/news/national/teen-missing-n-therapy-camp-found-dead-article-1.2025238. 
  10. ↑ 10.0 10.1 10.2 10.3 Silverman, Amy (November 5, 2009). "Losing Erica: Cynthia Clark Harvey Doesn't Want Anyone Else's Child to Die in a Wilderness-Therapy Program". Phoenix New Times. https://www.phoenixnewtimes.com/news/losing-erica-cynthia-clark-harvey-doesnt-want-anyone-elses-child-to-die-in-a-wilderness-therapy-program-6431310?showFullText=true. 
  11. ↑ 11.0 11.1 11.2 11.3 August, Ian (July 13, 2003). "Utah wilderness therapy deaths". Salt Lake Tribune. https://archive.sltrib.com/story.php?ref=/news/ci_7139316. 
  12. ↑ Pinto, Dr Alison. "Congressional Testimony: Hearings on Residential Treatment Programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth". Committee on Education and Labor, House of Representatives. https://www.youtube.com/watch?v=i3ye8YB109M&list=PL92FE4010DF42541C&index=3. 
  13. ↑ Bauer, Ethan (July 12, 2021). "Can the $300 million 'troubled teen' therapy sector be reformed by legislation and public pressure?". Deseret News. https://www.deseret.com/2021/7/12/22565911/can-the-300-million-teen-therapy-sector-be-reformed-by-legislation-and-public-pressure-paris-hilton. 
  14. ↑ ASTART. "Dangers of Wilderness Programs". http://astartforteens.org/dangers-of-teen-wilderness-programs. 
  15. ↑ 15.0 15.1 GAO (2007). "Residential Treatment Programs - Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth, Statement of Gregory D. Kutz, Managing Director Forensic Audits and Special Investigations and Andy O'Connell, Assistant Director Forensic Audits and Specials Investigations, October 10". http://www.gao.gov/new.items/d08146t.pdf. 
  16. ↑ Conner, Michael. "Wilderness Therapy Programs and Boot Camps: Is there a Difference?". www.wildernesstherapy.org. http://www.wildernesstherapy.org/Wilderness/WildernessVsBoot.htm. 
  17. ↑ Jeppson, Mayer (2008). "Characterization and Comparative Analysis of Adolescents Admitted to Therapeutic Wilderness Programs and More Traditional Treatment Settings". All Theses and Dissertations. http://scholarsarchive.byu.edu/etd/1509/. Retrieved 2009-04-12. 
  18. ↑ Smith, Christopher (1998-06-10). "The rise and fall of Steve Cartisano". High Country News. http://www.hcn.org/issues/61/1913. 
  19. ↑ "Congressional Hearings on Child Abuse and Deceptive Marketing by Residential Programs for Teens". Committee on Education and Labor, House of Representatives. 2008. https://www.youtube.com/playlist?list=PLEE758B17681E3F1F. 
  20. ↑ "FTC". 2009. http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens. 
  21. ↑ Russell, Keith C.. "Summary of Research from 1999 – 2006 and Update to 2000 Survey of Outdoor Behavioral Healthcare Programs in North America Outdoor Behavioral Healthcare Research Cooperative". ASTART. http://astartforteens.org/dangers-of-teen-wilderness-programs. 

Further reading

  • Kenneth R. Rosen (2021). Troubled: The Failed Promise of America's Behavioral Treatment Programs. Little A. ISBN 978-1542007887. 

External links




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