Wilderness therapy and outdoor behavioural healthcare

Domain XV · Nature, philosophy, social & rites of passage

What it is

Wilderness therapy, also called outdoor behavioural healthcare or adventure therapy in the literature, is a programme, not a single psychotherapy. WSIPP describes it as programmes that "combine therapeutic elements with outdoor activities in a natural setting", with components such as CBT,…

Format

• The cited sources describe no fixed phase model, session count or length of stay; programmes vary, and any figures a programme quotes should be checked against its own documents. WSIPP reports that therapists often create treatment and aftercare plans and monitor progress; that some programmes…
• Phase A, Question the placement. Goal: decide whether an out-of-home wilderness placement is needed, or whether community-based care can meet the need. Move on only if there is a documented clinical reason that less restrictive options cannot address, and the young person's views have been heard.

Who practises it, and how they are trained or regulated

• Phase B, Evaluate the programme. Goal: verify state licence, AEE/OBH accreditation, staff qualifications, restraint, seclusion and transport policies, communication access, complaints and violation history. Move on only when every item is verified from an independent source, not from marketing.
• Version followed: outdoor behavioural healthcare (OBH) as accredited under the Association for Experiential Education (AEE) and Outdoor Behavioral Healthcare Council Manual of Accreditation Standards for OBH Programs (edition and date); programme components as described in the Washington State Institute for Public Policy (WSIPP) 2022 systematic review; harms as documented by the US Government Accountability Office…
• Wilderness therapy, also called outdoor behavioural healthcare or adventure therapy in the literature, is a programme, not a single psychotherapy. WSIPP describes it as programmes that "combine therapeutic elements with outdoor activities in a natural setting", with components such as CBT, individual and group therapy, reflection, emotional regulation and goal setting; WSIPP separates it from adventure programmes,…

Evidence status, as the guide reports it

• Phase C, Consent, assent and preparation. Goal: informed consent from those with legal authority, the young person's assent or documented dissent, medical screening and a shared safety and communication plan. Move on when consent is informed and no one has been told the programme is "a perfect fit"…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• identity fused with the programme; shame. Working: a balanced, self-authored narrative.
• parents told to cut contact or disbelieve complaints. Working: parents engaged in their own change.
• your own reluctance to contradict a consultant or family. Working: the family has a safe alternative.
• the return treated as the end of treatment; old roles reimposed. Working: new behaviours seen in daily life.
• suspensions, conditions on licences, changes of ownership or name. Working: dated verification in the record.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.