Family Therapy in Outdoor Behavioral Healthcare: Current Practices and Future Possibilities

Contemporary Family TherapyPublished in the Journal of Contemporary Family Therapy, an article about the role of family therapy in wilderness therapy.  Troy really enjoyed writing with Dr. Widmer on this project.  It shows the forward thinking and role that Legacy shows in helping shape the conversation about treatment in experiential treatment settings.

Abstract

This paper highlights the role of the family in the treatment of youth who attend Outdoor Behavioral Healthcare (OBH) programs. It discusses the history of OBH, provides a critical overview of the research on the impact of OBH programs on family functioning, and discusses the importance of increased intentional integration of family therapy into OBH settings. To show this integration, this study presents a case study that highlights the role of the family, as well as the home family therapist throughout the phase of OBH treatment. Areas for future research are provided as well as suggestions for the increased utilization of adventure activities with families.

Keywords

Outdoor behavioral healthcare Wilderness therapy Adventure therapy Family therapy


Research on Outdoor Behavioral Healthcare (OBH)

Outdoor Behavioral Healthcare Council

Over the last 20 years, research in wilderness therapy (often referred to as Outdoor Behavioral Healthcare, or OBH) has grown considerably in numbers and professionalism. While a number of programs and institutions have contributed to this promising research base, the Outdoor Behavioral Healthcare Council (OBHC), formed in 1997, has been a driving force for research and evaluation. PROGRAM joined the OBH Council in YEAR.

The OBH Council works with Outdoor Behavioral Healthcare Research Cooperative (OBHRC), whose purpose is to carry out comprehensive independent research and provide credible, objective information to the field. OBHRC has grown to include 12 full and affiliate research scientists with over 200 studies conducted in the field about the behavioral healthcare. Below is a summary of a few of OBHRC’s specific research areas. Follow the links to learn more about the research and work of the OBHC and the OBHRC.

The actual safety of participants in OBH Programs

Public perception of outdoor behavioral healthcare programs often misconstrues “wilderness therapy” as potentially dangerous and unsafe. This perception can often be linked to a lack of knowledge regarding this innovative method of treatment, unfamiliarity with the extensive risk management techniques used in such programs, the inappropriate practices of less developed yet seemingly similar programs, and the vulnerable and problematic states of many clients.

While no treatment can guarantee the total safety of any child, adolescents participating in OBHC programs are actually at less risk than adolescents not participating in these programs. In 2012, the average American adolescent was two times more likely to visit an emergency room than their counterparts in OBH programs.

Continue reading at: OBH is Safer than Being at Home for the Average Teen or OBHRC Risk Management

Effectiveness of OBH

Recent research produced by the Outdoor Behavioral Healthcare Research Cooperative (OBHRC) supports that OBH is effective at improving overall functioning of youth, reducing the use of abusive substances, and engaging resistant clients. A few outcomes with demonstrated statistical, clinical, and practical significance in the research are highlighted below.

  • Clients enter OBH programs with high clinical dysfunction.
  • Clients make dramatic improvements in emotional and behavioral functioning while in OBH treatment.
  • Clients maintain improvements up to six and 12 months post-OBH treatment.

Ongoing research of OBH’s impact on youth well-being affirms these findings and is discovering more about how and why OBH works. For more information, read more on the OBHC research page here, or on the OBHRC page here.

Accreditation

In partnership with the Association of Experiential Education (AEE), OBH Council is engaged in the most stringent accreditation process in the field. This accreditation program helps to identify programs of high quality. AEE has 25 years of experience in adventure-program accreditation and has invested over $1 million in refining the process. Programs holding OBH Accreditation have been rigorously evaluated by an independent review body and have successfully demonstrated that they maintain the industry’s highest standards of quality, safety and effectiveness. More information can be found here in the coming months.

 

 

 

 


Five Gremlins, and Something Somewhat Meaningful

Recovery in the red rocks of Utah

Before the Spanish conquistador Coronado lead his soldiers into the southwest of what is now the United States. Before Columbus sailed for the New World. Before the Anasazi built the huge multistory structures in the canyons of the western desert, there were groups of peaceful people living here in the mountains and deserts of central Utah. Formerly referred to as the “Fremont” now more correctly known as “ Ancestral Puebloan” These people lived in pit houses, and in what we call “overhangs” or “alcoves” Great arched shallow caves which face the south thereby catching the suns warmth. They farmed, raising the three sisters -  corn, squash and beans. They hunted deer and other game. Their tools were made from the flint-like chert stone found here – atlatl spear points, and knife blades. They built with timber and mortar. All that is left is what is made of stone, the land, and the views. We went to experience all three.

I didn’t know the area we were going to this week, but my fellow guide Jack, knew it well. It is an area on the east side of Boulder Mountain. Several creeks run into this area. It is below the cold of the mountain, and above the heat of the desert. It’s where a lot of ancient people liked to live.

We started the adventure by camping at the head of Sulfur creek canyon. There had been a lot of rain, and camping spots were not plentiful. In fact I don’t believe we had a 24 hour period this week without rain. We found a spot at last, and as we looked around the area, found stone circles, remnants of ancient homes. There were also two shallow overhangs that gave shelter from the rain. Some of us slept in those. The hike the next day was about 6 miles on the map. Having not been there, I didn’t appreciate until later how many turns and twists the canyon had that were not shown on the map. By the time we reached our destination by the side of Pleasant creek, we were absolutely beat. The hike had kicked our butts, and that doesn’t happen all that often to me.  About 15 minutes before reaching our camp site, tempers were flaring, and conflict began. After dinner and a warm fire, issues were processed, and everyone was happy again. This was a pattern for the rest of the week.

It wasn’t comfortable.

It wasn’t really fun.

It really brought out the issues that each client very much needed to face, and deal with.

It was very good.

We found many flakes of chert. We found quite a few broken stone knives. We found many broken spear and arrow heads, and Jack found some whole, unbroken arrow heads. All of these we left on the land where we found them. We toured the alcoves where the ancient people lived. We looked at and felt with our hands the grinding stones they used for preparing corn. We found pieces of ancient corn cobs. We saw the petroglyph writing they left in the dark patina coated sandstone walls.

One day as we climbed up out of a canyon, within a mile of our destination and without any warning, lightening struck overhead. It was closer than I have ever felt it before, and closer than I ever want to feel it again. After picking myself up from the ground where I dove during the flash. I yelled out to the young men to run to medium sized trees, and crouch under them, with lots of space between each other. I have never seen our clients comply with a request so quickly, and without discussion. Backpacks were dropped right where they had been standing, and they literally ran to do as I’d asked. A few more cracks of lightening, and the rain came down in a deluge that lasted about 20 minutes during which time we kept in contact by voice. We were soaked, we were cold, we were shook up, and we were alive. Some of our clients got pretty cranky after that, (nothing new for the week), some got shaken into good moods, and one young man said he felt as if his life had been taken and handed back to him.

It was an emotionally charged, and trying week. So much good came out of it. So much progress was made, and so many breakthroughs for these amazing young men.

We ended the week as a much stronger and coherent group. With deep respect and understanding of each other.

I want to thank you parents again for the privilege of working with your sons. They are becoming good men.

Michael

 

PS. The clients named this adventure.


The Healing Wilderness: The Legacy Outdoor Adventures Course Area

Fishing Drug and Alcohol RehabLegacy’s course area is comprised of over 2500 square miles of public land administered by the US Forest Service, the Bureau of Land Management, and the State of Utah School and Institutional Trust Lands Administration.  The lower elevation desert country to the east of Capitol Reef National Park is warmer and dryer than the higher, more mountainous areas in the western part of our course area.

We use the San Rafael and Henry Mountain desert areas more in the winter due to the warmer temperatures and less snow.  It is a great area for canyoneering, hiking, exploring, and observing wild horses and desert bighorn sheep.

We spend most of the summer months in the mountains.  Fishlake, Thousand Lake, and Boulder mountains have over 75 square miles of area at elevations over 11,000 feet.  There are hundreds of small lakes and vast expanses of forest.  Boulder and Thousand Lake are plateaus with rolling hills, patches of timber, and meadows resembling arctic tundra.  Wildlife includes mule deer, elk, and antelope as well as coyotes, bobcats, and even a few bear and mountain lion.  The mountains are great for hiking, fishing, and climbing peaks.

Native Americans have lived in this area for nearly 10,000 years.  Archeological studies have found human artifacts intermingled with the bones of wooly mammoths and extinct camels and horses in desert caves in the area.  There are many locations where we can observe ancient rock art in the form of petroglyphs and pictographs.  It is not unusual to find artifacts when hiking.  Arrowheads, scrapers, pottery shards, and grindstones are reminders that others were here first and had found a way to live in harmony with this amazing land.  When early settlers first arrived in the area in the 1860’s, Native Americans were still practicing a nomadic lifestyle as they had for millennia.

There is power and healing to be found in the wilderness.  A young man seeking refuge from the ravages of substance abuse or addiction can find peace.  Coupled with comprehensive therapy from a master’s level clinician, the wilderness affords space to slow down and re-connect with what really matters in life.  We facilitate weekly adventures such as canyoneering, summiting mountain peaks, fishing, and wildlife viewing.  These fun and engaging activities offer a great deal of support for people trying to make change in their lives.

Mountain Biking for RecoverySeveral of us who work here at Legacy grew up in this area.  These mountains, deserts and canyons shaped us as we matured from the boys that we were then, to men that we are now.  To be able to facilitate a condensed version of that journey for the young men who come to Legacy to work with us is deeply meaningful.  Whether standing on a mountaintop or exiting a challenging canyon that tested us to the core, we find ourselves surrounded by great things that make us feel small and at the same time, small things that make us feel great. We can all benefit from an experience like that.

 

 

 

 

 


Legacy Spoon Ceremony

Welcoming struggling teens to wilderness therapyIn 2001 I worked as a wilderness guide in a wilderness recovery program in Utah. There I saw my first hand-carved wooden spoon. It was a beautiful piece of woodwork being used by a fellow guide named Becky. She had been given the spoon as a gift from another guide where she had previously worked. I was an experienced cabinet maker, and had seen and done some nice wood working, but I had never seen a hand carved wooden spoon before. It was made of aromatic red cedar, was elegant, smooth, and oiled to a dark red finish. It was love at first sight.

I began experimenting with my own spoon making abilities, and soon found that my years as a professional cabinet maker were helpful in becoming an expert spoon carver. I quickly found that instead of burning out the bowl of the spoon with hot coals, I could use a gouge from my wood carving set. That instead of smoothing the wood with a stone, I could use a small square of sandpaper, and in place of oiling the wood with peanut butter from the camp supply, a small amount of vegetable oil gave a nice, no mess finish.

I experimented with Red Cedar, which is a nice wood for carving, then moved to dry fallen branches of Quaking Aspen. Utah Juniper was pretty but more challenging.  Then I took a leap to Sage, which is more challenging still, but the amazing color and grain of the wood made the effort worthwhile.

The clients I guided liked the spoons. I taught them how to make their own. Without years of experience and training as professional wood workers, the clients’ spoons were often more utilitarian than elegant. Finding my spoons admired, I began giving them away as gifts to the graduating clients. I would write some personalized encouraging message on the handle, and give them the spoon as they departed the wilderness.

At Legacy, I met Derek, our field director, and saw a new angle on gifting spoons. Derek made a spoon for our first client, with the instruction, “I made this one for you, now you make a spoon for the next guy who comes in.”

And so began the tradition of clients who have already received a spoon themselves make spoons to give new clients upon their arrival in the group. But it didn’t stop there.  Derek then introduced the spoon ceremony. When the team of clients is aware of the imminent arrival of a newcomer, a spoon is carved, usually by one of the senior members of the team. Then within a day of the new arrival, a group is held, always in a circle. The new spoon is displayed, and then passed around the circle, while each team member holds the spoon in turn and tells of his own spoon ceremony and relates the fears he experienced, the concerns he had when he was new in the program, how he might have felt lost, or afraid he would not fit in, or might not be accepted.  He also speaks of the good wishes he has for the new guy, and symbolically puts those into the spoon. The spoon is passed to the next team member, who does the same, and so it progresses around the circle to the newest member of the team who receives his spoon with all the good wishes and welcome messages of his team mates.

The spoon is then used for eating meals, and also as a pattern for making his own spoons, with his own style and flair. It’s a beautiful tradition, and one that I am glad we have at Legacy.


Relapse Prevention in the Canyons: Training ourselves to be aware of and deal with Triggers

Relapes Prevention - Dealing with TriggersRelapse prevention is an important topic in substance abuse treatment. At Legacy Outdoor Adventures one topic of relapse prevention we focus on is education, awareness of, and how to deal with triggers.

What are triggers? Triggers are things that induce an emotional response in us that can lead to obsessive thought or behavior around drugs and alcohol. A trigger could be a smell that we associate with using. A trigger could also be seeing someone who we associate with using or going to a place we used to use. It could be hearing a song we have listened to while using. Triggers often appeal to the senses. There are also emotional triggers. Something that creates stress, anxiety, anger, or depresses us can be a trigger. When using drugs or alcohol all the time, all of these things can create a conditioned response that makes an addict obsess and crave drugs and alcohol.

This week at Legacy we worked on creating awareness around the things that trigger us and tools to help deal with them. We incorporated this with a canyoneering adventure. Canyoneering is descending technical slot canyons by hiking, down climbing, and rappelling through the canyon. It requires teamwork and good communication to navigate and descend the canyon safely and efficiently. After gathering all the equipment we needed to descend the canyon we began our approach hike from the trailhead. The first half mile of the hike was flat and did not offer much of a challenge. Then we came to a trail that lead straight up hill where we would gain 700 feet in elevation over the course of ¾ mile. At this point we sat down and took our packs off and had a discussion about triggers. We defined what triggers are, what experiences people have had being triggered, and what specific things trigger us. We then talked about specific tools we use to fight triggers. Then we introduced the idea of a trigger buster. A trigger buster is a tool to interrupt the internal response that the trigger causes and reconnects us with our purpose in living a life of meaningful recovery. The trigger buster starts with awareness that we are being triggered. Then we take a deep breath to calm ourselves and slow down our thoughts. Then we have a mantra that we tell ourselves that connects us to our purpose. After explaining what a trigger buster was we all took a few minutes in silent meditation to think about our trigger buster and develop a personal mantra or saying that we would tell ourselves when things got tough that would connect us back to our purpose. Everyone shared their saying out loud and we began the hike up hill. When the hike got tough we encouraged each other to take a deep breath and say your mantra. “Be Strong” “God, grant me the serenity.” I have the freedom to choose to be me.” “I am capable of dealing with hard times in positive ways.” “I want to make my Grandpa and family proud.” These were some of the mantras the members of the group shared.

The most fear, stress, and anxiety inducing thing encountered canyoneering is often the rappels and because of this response that it creates we wanted to use the rappels to practice our trigger busters. When each member was half way down the rappel his partner below would take him on belay so he could let go of the rope with both hands. With both hands free of the rope each member practiced taking a deep breath and saying their mantra. One group member stated that he realized the purpose of this exercise and saw the value in it. “If I can learn, practice, and condition myself to practice a trigger buster while hanging off the side of a cliff on a rope I will be able to do it when I am tempted by something in my regular life. But I know I have to practice it so it becomes my natural response to dealing with stuff when it comes up.”

This canyoneering adventure proved to be a successful one. Not only did we have a great time hiking, exploring, rappelling, climbing and celebrating recovery but we also learned about addiction, triggers, and how we deal with triggers.  The canyon helped create a meaningful setting for us to teach and talk about relapse prevention and having meaningful recovery.

Working with triggers in wilderness therapy

 


Tribute to Nita Hooker During the Annual Loa Fund Fundraiser

LOA Fund Chair of Directors, Derek Daley, started working as a wilderness therapy field instructor more than a decade ago. As a young field guide Derek was unaware of the high costs of wilderness therapy. In his naiveté he enthusiastically shared his experiences and growing confidence in the power of wilderness therapy to a group who had children or loved ones in need of treatment. His persuasive presentation brought several people to apply for treatment only to find that the high costs associated with intensive therapy in the wilderness were prohibitive.  Derek’s surprise and embarrassment sparked a determination to make a difference by finding ways to make wilderness therapy more accessible to economically disadvantaged clients.

 

After raising $120,000 and providing scholarships for wilderness therapy treatment for several clients, the LOA Fund hosted a charity and fundraising event on Thursday, April 18th in Provo, Utah. The event was well attended and participants heard personal stories from three LOA Fund recipients.

 

The audience listened attentively as each young man shared pieces of his own story. All three experienced a loss of control over their substance use that resulted in incarceration, destruction of their most valued relationships and the deep loss of personal confidence and identity. Their loved ones knew that they needed help and, without the help of the LOA fund, would have been unable to finance wilderness therapy. The Legacy Outdoor Adventure alumni explained that other rehab options hadn’t worked and that what they gained in the wilderness was what they really needed.

 

Honor was paid to Nita Hooker, wife of the late Keith Hooker who played a key role in developing risk management practices for wilderness therapy and adventure therapy since its genesis. Nita Hooker and the Hooker family continue to be strong supporters of the field of wilderness therapy, and were major contributors to the scholarships awarded to the young men who spoke at the event.

 

The final speaker of the evening, Butch Scott, shared the story of his late son Jake who lost the battle of addiction. After maintaining sobriety for 6-months and experiencing the restoration of his confidence, the speaker’s son took a fatal combination of drugs and lost his life. The tragic story grounded the good feelings of the evening with the realization that, for addicts, everyday must include the determination and commitment to holding strong to the principles of sobriety.

 

The event was catered by “Catering for the Cause” who provides job opportunities to people in recovery and also helps raise money to provide scholarships to financially challenged clients. Many of the employees of Catering for a Cause were alumni from treatment programs who attended the event. The tone and feeling of the event was reflective, optimistic, and had the feeling of a family reunion.
The event was counted as a success by Derek Daley and is the first of many to come.

 


Wilderness therapy group raises money for scholarships

PROVO — On Thursday night, Dr. Keith Hooker was honored for his 40 years of work and service in the Utah medical community at a fundraising dinner for the Legacy Outdoor Adventures Fund. Held at the Provo City Library, Derek Daley, founder of the LOA Fund, honored Hooker, who died of cancer in June, by presenting a plaque to his wife, Nita. All proceeds went to the LOA Fund, which provides scholarships for wilderness therapy for people suffering from addiction and mental illnesses.


Wilderness Therapy Programs Less Risky Than Daily Life, UNH Research Finds

March 28, 2012

Wilderness Therapy Programs Less Risky Than Daily Life, UNH Research Finds

DURHAM, N.H. – Adolescents participating in wilderness and adventure therapy programs are at significantly less risk of injury than those playing football and are three times less likely to visit the emergency room for an injury than if they were at home, a new study by University of New Hampshire researchers finds. These findings, based on an analysis of risk management data from 12 programs providing outdoor behavioral healthcare in 2011, were reported in the latest issue of the Journal of Therapeutic Schools and Programs.

“After ‘does this program work?’, the question most asked by people considering adventure therapy is ‘will my child be safe?’” says Michael Gass, professor of outdoor education in the kinesiology department at UNH, who wrote the article with lead author Stephen Javorski, a UNH doctoral student. “While no one can guarantee the unconditional safety of any child, we can now show the relative risk levels for adolescents. This study shows there is actually less risk to participants on wilderness therapy programs, when they are conducted correctly, than to adolescents in their normal everyday activities.”

Adventure therapy, described as the prescriptive use of wilderness adventure experiences to improve the mental health of clients, primarily serves adolescents and is often seen as a treatment of “last resort” for these youth, who typically present with three or more dysfunctional behaviors such as depression, substance abuse, and suicidal ideologies. Gass, a leading expert in the field, estimates that there are more than 200 such programs nationwide ranging from multimillion dollar programs to individual counselors who might informally take a group or class into the woods.

For this study, Gass and Javorski looked at incident and illness data collected by the 12 adventure therapy programs that comprise the Outdoor Behavioral Health Industry Council for 2011. Analyzing injuries that required a client be removed from regular programming for more than 24 hours – including injuries treated in the field as well as those that required evacuation to a medical facility — the adventure therapy programs had an injury rate of .11 injuries per 1,000 days in 2011, or one injury for every 9,091 client-days. The estimated national average rate of injuries for adolescents treated in U.S. hospital emergency rooms was three times that rate (.38 per 1,000 days).

Adventure therapy programs boast even stronger safety records when compared to other common activities of adolescents. Injuries during high school football games are more than 140 times greater than those in adventure therapy programs, which boast lower injury rates than snowboarding, downhill skiing, mountain biking, backpacking, and football practice.

“I’m hoping that this research will counter the public perception that these programs are dangerous,” says Javorski. “Well-managed programs are not dangerous, they’re not exposing kids to undue risk, and they’re not overusing physical restraints.”

The researchers offer several reasons for the dramatic relative safety of these programs. As the field has developed, says Gass, risk management standards have improved; he notes that the programs in the OBHIC are among the leaders in the field. And our perception of risk colors how we view the risk of “everyday” activities.

“Driving a car is more dangerous than hiking in the wilderness, particularly with trained staff,” Gass says. “These programs remove adolescents from other accepted yet higher-risk situations like driving.”

What’s more, the effectiveness of these programs makes them not just safe but saviors to parents of the very troubled adolescent clients. “Many parents say, ‘this is the one thing that can save my child,’” Gass says. He and his colleagues are researching how and why adventure therapy works, but he is confident that their potency is at the intersection of adventure programming and therapy.

“The pill that we’re offering is the positive use of stress coated by appropriate levels of care and support,” says Gass, co-author of the leading academic and training text in the field, “Adventure Therapy: Theory, Research and Practice” (Routledge, 2012).

In response to the growth in the wilderness therapy field, UNH launched the nation’s first dual social work-outdoor education degree in 2009; the two-and-a-half-year program awards both a master’s in social work and a master’s in kinesiology. Graduates of the program, administered by Gass and Anita Tucker, assistant professor of social work, are all working in the expanding field of adventure therapy.

The member-programs of the Outdoor Behavioral Healthcare Industry Council that provided incident data to this study are the Anasazi Foundation (Ariz.), Mountain Homes Youth Ranch (Utah), OMNI Youth Services (Ill.), Open Sky Wilderness Therapy (Colo.), Redcliff Ascent (Utah), Second Nature Cascades (Ore.), Second Nature Entrada (Ore.), Soltreks (Minn.), Summit Achievement (Maine), Legacy Outdoor Adventures (Utah), Outback Therapeutic Expeditions (Utah), and Wendigo Lake Expeditions: REACH (Ontario). This study was funded by the Outdoor Behavioral Healthcare Industry Council (OBHIC).


Our Older Teen Program has a New Name; Legacy Protégé

In order to help differentiate its young adult program from its adolescent program, Legacy Outdoor Adventures has named its adolescent program Legacy Protégé. Beginning in the fall of 2012, Legacy Protégé has been treating 16-17 year old boys who are dealing with substance abuse and co-occurring mental health issues, using the same basic model that has proven to be effective with our young adult clients. The model includes a weekly therapeutic adventure integrated into the profound wilderness experience, the application of Motivational Interviewing techniques to invite clients to identify and address their ambivalence, daily practice and mastery of self-awareness skills, and both a substance abuse counselor and a therapist working individually with each client.
The Legacy team selected the name Protégé, which refers to one who is guided down a path by a wise, experienced mentor, because it accurately reflects the Legacy practice of assigning a seasoned, caring mentor from the guide team to walk beside and guide each protégé. Research and observation suggest that the therapeutic alliance between mentor and mentee is a powerful change agent in guiding young people over the threshold to responsible adulthood.