Nevin J. Harper and Keith C. Russell
Wilderness vs. residential treatment
Key factors are shared to assist in distinguishing wilderness treatment from conventional residential treatment. Additionally, wilderness treatment defined by a recently developed industry council to establish best-practice, assists in attempting to differentiate ethical and effective wilderness treatment programmes and practices from other 'wilderness programmes'. It is important for this comparison of practice to remind readers that residential treatment and wilderness treatment programmes serve similar populations; adolescents with serious emotional, behavioural and substance use issues. Adolescents entering wilderness treatment have not generally experienced success in previous outpatient, community-based or residential treatment settings. Wilderness treatment programmes then place adolescent's in remote and challenging outdoor environments (Russell, 2001) adding to the real, and perceived, risk of managing the therapeutic process while benefiting from the theorised advantage of being in nature, free of modern distractions (see Maller, Townsend, Pryor, Brown, & St. Leger, 2005).
Wilderness treatment programmes, although variations exist, are generally comprised of administrative and therapeutic practices similar to those of licensed residential treatment programmes. They do, however, have one obvious and significant differentiating feature, treatment occurs in wilderness or outdoor environments and not in a residential facility. Wilderness camps and outdoor programming have been widely used in North America and abroad in reaching educational and therapeutic objectives for more than 40 years. Positive gains in child and adolescent social and emotional well-being, increased resiliency, self-competence and locus of control have been identified as intentionally achieved outcomes common to outdoor and adventure-based interventions (Durkin, 1988; Hattie, Marsh, Neill and Richards, 1998; Russell, 2003; Ungar, 2005). Three key distinctions theorised between residential and wilderness treatment settings by Williams (2000) are helpful in further delineating the two modalities. Distinctions include (a) more effective use of transference issues, (b) the creation of a social microcosm, and (c) differences in type of group activities. Wilderness treatment environments allow for transference issues to be magnified, and subsequently worked through as the group, including staff, live and travel together while completing challenging outdoor activities and adjusting to the rigours of outdoor life. He suggests that transference is less likely to be successfully explored and resolved in a service-delivery model of shift-working staff (i.e., in residential facilities) where adolescents do not have the same opportunities to fully explore and work through those issues. The second distinction, a social microcosm, which Yalom (1995) described as intensive group formation occurs in wilderness treatment where individual behaviours are more easily identified and modified as individual actions constantly affect group dynamic and success. This is because peers live together 24/7 for weeks on expeditions, and the environment provides constant feedback and motivation for positive behaviour. Outdoor group living and travel does not allow for adolescents to 'opt' out of programming, or be elsewhere, such as their room or a common hall. The group spends almost every hour of every day, with the exception of sleeping and the solo experience, in close contact. The last aspect differentiating wilderness from residential treatment, different activities, may be the most critical in understanding adolescent adherence to treatment and explain alternate paths to exploring adolescent issues and problem behaviours. The types of activities in wilderness treatment are multi-faceted. They include physically challenging outdoor travel and living which increases in difficulty and building on previously learned skills; success determined by individual contributions to group success; reflective and solitary in natural settings; simplistic in routine to pare down daily concerns; intensive group living as a metaphoric family in which issues will arise and need to be worked through for the group to proceed.
A number of wilderness treatment programmes in the US have collectively formed a professional research and standards cooperative called the outdoor behavioral healthcare research cooperative (OBHRC). This movement toward a distinguishable professional group serves two main functions: (a) to identify and implement best-practice in wilderness treatment through research and evaluation, and (b) to establish recognisable standards of practice in professional literature to inform adolescent treatment providers who may utilise wilderness practices.
Harper, N.J. and Russell, K.C.
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