Abstract
Wilderness therapy is a growing treatment modality for adolescents presenting with a variety of clinical concerns, and wilderness therapy clinicians and referring mental health professionals must carefully consider the ethical issues that are unique to this modality. Following an overview of wilderness therapy as a mental health treatment, relevant ethical issues for mental health professionals are described and discussed, including the distinction between therapy and therapeutic experiences, the use of efficacious treatment, consent and confidentiality, therapeutic boundaries, a continuum of care and family involvement, and aftercare. A thorough reflection of the unique ethical issues faced by wilderness therapists is not only necessary, but will also assist in moving the field of wilderness therapy and outdoor behavioral healthcare forward in its establishment as both a recognizable and ethical treatment option.
Similar content being viewed by others
References
(2007). When ‘tough love’ is too tough. The New York Times, Editorial.
(2008). Stop Child Abuse in Residential Programs for Teens Act of 2008, H.R. 6358, 110th Congress, 2d Sess.
Outdoor Behavioral Healthcare Industry Council. (2009). Outdoor Behavioral Healthcare Industry Council—OBHIC. Retrieved 17 April 2009, from http://www.obhic.com (n.d.).
Becker, S. P., & Conway, J. (2009). The Family Journey: An Experiential Approach for Multi-Family Group Treatment. Pre-conference Learning Institute presented at the 2009 American Counseling Association (ACA) Conference and Exposition, Charlotte, NC.
Behar, L., Friedman, R., Pinto, A., Katz-Leavy, J., & Jones, W. G. (2007). Protecting youth placed in unlicensed, unregulated residential "treatment" facilities. Family Court Review, 45(3), 399–413.
Berman, D. S., & Davis-Berman, J. L. (1989). Wilderness therapy: A therapeutic adventure for adolescents. Journal of Independent Social Work, 3(3), 65–77.
Bettmann, J. E., & Jasperson, R. A. (2009). Adolescents in residential and inpatient treatment: A review of the outcome literature. Child & Youth Care Forum, 38(4), 161–183.
Bickman, L. (1996). A continuum of care: More is not always better. American Psychologist, 51(7), 689–701.
Bohart, A. C. (2005). Evidence-based psychotherapy means evidence-informed, not evidence-driven. Journal of Contemporary Psychotherapy, 35(1), 39–53.
Borys, D. (1994). Maintaining therapeutic boundaries: The motive is therapeutic effectiveness, not defensive practice. Ethics and Behavior, 4(3), 267–274.
Brand, D. (2001). A longitudinal study of the effects of a wilderness-enhanced program on behavior-disordered-adolescents. Australian Journal of Outdoor Education, 13(6), 38–47.
Cason, D. R., & Gillis, H. L. (1993). A meta-analysis of adventure programming with adolescents. Journal of Experiential Education, 17, 40–47.
Clark, J. P., Marmol, L. M., Cooley, R., & Gathercoal, K. (2004). The effects of wilderness therapy on the clinical concerns (on Axes I, II, and IV) of troubled adolescents. Journal of Experiential Education, 27(2), 213–232.
Davis-Berman, J., & Berman, D. S. (1994). Wilderness therapy: Foundations, theory, and research. Dubuque, IA: Kendall/Hunt.
Davis-Berman, J., & Berman, D. (2008). The promise of wilderness therapy. Boulder, CO: Association for Experiential Education.
Frensch, K. M., & Cameron, G. (2002). Treatment of choice or a last resort? A review of residential mental health placements for children and youth. Child & Youth Care Forum, 31(5), 307–339.
Friedman, R. M., Pinto, A., Behar, L., Bush, N., Chirolla, A., Epstein, M., et al. (2006). Unlicensed residential programs: The next challenge in protecting youth. American Journal of Orthopsychiatry, 76(3), 295–303.
Gass, M. A. (1993). Foundations of adventure therapy. In M. A. Gass (Ed.), Adventure therapy: Therapeutic applications of adventure programming (pp. 3–10). Dubuque, IA: Kendall/Hunt.
Gillen, M. C., & Balkin, R. S. (2006). Adventure counseling as an adjunct to group counseling in hospital and clinical settings. The Journal for Specialists in Group Work, 31(2), 153–164.
Gillis, H. L., Gass, M. A., & Russell, K. C. (2008). The effectiveness of Project Adventure’s behavior management programs for male offenders in residential treatment. Residential Treatment of Children and Youth, 25(3), 227–247.
Gillis, H. L., & Thomsen, D. (1996). A research update of adventure therapy (1992-1995): Challenge activities and ropes courses, wilderness expeditions, and residential camping programs. Invited presentation for the Coalition for Education in the Outdoors Symposium. Bradford Woods, IN.
Glass, J. S., & Myers, J. E. (2001). Combining the old and the new to help adolescents: Individual psychology and adventure-based counseling. Journal of Mental Health Counseling, 23(2), 104–114.
Government Accountability Office. (2007). Residential treatment programs: Concerns regarding abuse and death in Certain programs for troubled youth (GAO-08–146T). Washington DC: Author.
Government Accountability Office. (2008). Residential programs: Selected cases of death, abuse, and deceptive marketing, (GAO-08–713T). Washington DC: Author.
Hoyer, S. (2004). Effective wilderness therapy: Theory-informed practice. In S. Banderoff & S. Newes (Eds.), Coming of age: The evolving field of adventure therapy (pp. 56–72). Boulder, CO: Association for Experiential Education.
Itin, C. (1993). A common understanding: Therapy vs. therapeutic. Insight, 1(2), 2.
Jones, C. D., Lowe, L. A., & Risler, E. A. (2004). The effectiveness of wilderness adventure therapy programs for young people involved in the juvenile justice system. Residential Treatment for Children and Youth, 22(2), 53–67.
Kaczmarek, P. (2000). Ethical and legal complexities inherent in professional roles with children and adolescent clients. Counseling and Human Development, 33(1), 1–21.
Kimball, R. O., & Bacon, S. B. (1993). The wilderness challenge model. In M. A. Gass (Ed.), Adventure therapy: Therapeutic applications of adventure programming (pp. 11–41). Dubuque, IA: Kendall/Hunt.
Kiselica, M. S. (2003). Transforming psychotherapy in order to succeed with adolescent boys: Male-friendly practices. Journal of Clinical Psychology, 59(11), 1225–1236.
Koocher, G. P. (2003). Ethical issues in psychotherapy with adolescents. Journal of Clinical Psychology: In Session, 59(11), 1247–1256.
Koocher, G. P. (2008). Ethical challenges in mental health services to children and families. Journal of Clinical Psychology: In Session, 64(5), 601–612.
Krakauer, J. (1995). Loving them to death. Outside, 72–82, 142–143.
Lambie, I., Hickling, L., Seymour, F., Simmonds, L., Robson, M., & Houlahan, C. (2000). Using wilderness therapy in treating adolescent sexual offenders. The Journal of Sexual Aggression, 5(2), 99–117.
Lazarus, A. A. (1994). How certain boundaries and ethics diminish therapeutic effectiveness. Ethics and Behavior, 4(3), 255–261.
Levine, D. (1994). Breaking through barriers: Wilderness therapy for sexual assault survivors. Women and Therapy, 15(3/4), 175–184.
Louv, R. (2005). Last child in the woods: Saving our children from nature-deficit disorder. Chapel Hill, NC: Algonquin Books.
Meyer, L. (2007). Dangerous discipline. Monitor on Psychology, 38(11), 16–17.
Miles, J. (1993). Wilderness as healing place. In M. A. Gass (Ed.), Adventure therapy: Therapeutic applications of adventure programming (pp. 43–55). Dubuque, IA: Kendall/Hunt.
Newes, S., & Bandoroff, S. (2004). What is adventure therapy? In S. Bandoroff & S. Newes (Eds.), Coming of age: The evolving field of adventure therapy (pp. 1–30). Boulder, CO: Association for Experiential Education.
Prout, S., DeMartino, R. A., & Prout, H. T. (1999). Ethical and legal issues in psychological interventions with children and adolescents. In H. T. Prout & D. T. Brown (Eds.), Counseling and psychotherapy with children and adolescents: Theory and practice for school and clinical settings (3rd ed., pp. 26–48). New York: John Wiley.
Robinson, K. E., Dow, R. T., & Nicholas, P. M. (1999). Expanding a continuum of care: A report on a partial-day treatment program. Child & Youth Care Forum, 28(3), 221–228.
Russell, K. (2001). What is wilderness therapy? The Journal of Experiential Education, 24(2), 70–79.
Russell, K. (2003a). An assessment of outcomes in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 32(6), 355–381.
Russell, K. C. (2003b). A nation-wide survey of outdoor behavioral healthcare programs for adolescents with problem behaviors. The Journal of Experiential Education, 25(3), 322–331.
Russell, K. (2005). Two years later: A qualitative assessment of youth well-being and the role of aftercare in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 34(3), 209–239.
Russell, K. C. (2006a). Brat camp, boot camp, or…? Exploring wilderness therapy program theory. Journal of Adventure Education and Outdoor Learning, 6(1), 51–68.
Russell, K. C. (2006b). Examining substance use frequency and depressive symptom outcome in a sample of outdoor behavioral healthcare participants. Technical Report 1, Outdoor Behavioral Healthcare Research Cooperative, University of Minnesota, Minneapolis, MN.
Russell, K. C. (2007). Summary of research from 2000–2006 and update to 2000 survey of outdoor behavioral healthcare programs in North America. Technical Report 2, Outdoor Behavioral Healthcare Research Cooperative, University of Minnesota, Minneapolis, MN.
Russell, K. C., Gillis, H. L., & Lewis, T. G. (2008). A five-year follow-up of a nationwide survey of outdoor behavioral healthcare programs. Journal of Experiential Education, 31(1), 55–77.
Russell, K. C., & Hendee, J. C. (1999). Wilderness therapy as an intervention and treatment for adolescents with behavioral problems. In A. E. Watson, G. Aplet, & J. C. Hendee (Eds.), Personal, societal, and ecological values of wilderness: 6th World Wilderness Congress Proceedings on Research and Allocation, Vol. II. Ogden, UT: USDA Forest Service, Rocky Mountain Research Station.
Russell, K. C., & Phillips-Miller, D. (2002). Perspectives on the wilderness therapy process and its relation to outcome. Child & Youth Care Forum, 31(6), 415–437.
Smith, D., & Fitzpatrick, M. (1995). Patient-therapist boundary issues: An integrative review of theory and research. Professional Psychology: Research and Practice, 26(5), 499–506.
Strein, W., & Hershenson, D. B. (1991). Confidentiality in nondyadic counseling situations. Journal of Counseling and Development, 69(4), 312–316.
Tan, J. O. A., Passerini, G. E., & Stewart, A. (2007). Consent and confidentiality in clinical work with young people. Clinical Child Psychology and Psychiatry, 12(2), 191–210.
Taylor, S. J. (2004/1988). Caught in the continuum: A critical analysis of the principle of the least restrictive environment. Research & Practice for Persons with Severe Disabilities, 29(4), 218–230.
Thomas, S. P. (2008). From the editor—wilderness therapy under scrutiny. Issues in Mental Health Nursing, 29(5), 435–436.
Williams, M. H. (1997). Boundary violations: Do some contended standards of care fail to encompass commonplace procedures of humanistic, behavioral, and eclectic psychotherapies? Psychotherapy, 34(3), 238–249.
Williams, B. (2000). The treatment of adolescent populations: An institutional vs. a wilderness setting. Journal of Child and Adolescent Group Therapy, 10(1), 47–56.
Williams, I. (2004). Adventure therapy or therapeutic adventure? In S. Bandoroff & S. Newes (Eds.), Coming of age: The evolving field of adventure therapy (pp. 195–208). Boulder, CO: Association for Experiential Education.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Becker, S.P. Wilderness Therapy: Ethical Considerations for Mental Health Professionals. Child Youth Care Forum 39, 47–61 (2010). https://doi.org/10.1007/s10566-009-9085-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-009-9085-7