Atlas›Domain XV · Nature, philosophy, social & rites of passage›Guide 028
Guide XV-028

Norwegian friluftsliv-based therapy

Norway
A 35 · L 46 · M 1924 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Friluftsterapi ("therapy in the open air"), the outpatient group programme of the Department of Child and Adolescent Mental Health (ABUP), Sørlandet Hospital, as described by Fernee, Gabrielsen, Andersen and Mesel (2015) and University of Agder reporting on Fernee's 2019 doctoral work; supplemented by the Friluftssykehuset (Outdoor Hospital) practice at Oslo University Hospital (Johnsen, Lindheim and Hauge 2022) and Gabrielsen and Harper's (2018) brief nature-based "micro-interventions". [source: Fernee et al. 2015; ScienceNorway/UiA; Johnsen et al. 2022; Gabrielsen & Harper 2018]

Friluftsliv, usually translated "life in the open air", is the Scandinavian outdoor-life tradition; Gelter describes it as a philosophical lifestyle grounded in experiences of freedom in nature (as quoted by Fernee et al. 2015). It is a cultural tradition and a legal setting (the public right of access, allemannsretten, under the Outdoor Recreation Act, friluftsloven), not a psychotherapy. "Friluftsliv-based therapy" is therefore a family of Norwegian and Nordic adaptations rather than one manualised treatment: the Sørlandet Friluftsterapi™ group programme for 16–18-year-olds; Utmarksterapi for families at the Sámi National Centre in Karasjok; wilderness therapy for adults with personality disorders at Modum Bad; and Villmarksterapi for young people offered by Norsk Mestring (all as listed by Fernee et al. 2015, who note the lack of networking and systematic research across them). [source: Fernee et al. 2015] The Outdoor Recreation Act's year of enactment (1957) is [uncertain: not verified].

Core idea of change: Fernee et al. (2015) summarise a four-factor model shared across wilderness programmes: (1) the wilderness as a restorative environment; (2) basic outdoor life with sequenced, intentional tasks and challenges; (3) individualised, structured therapeutic work; (4) a supportive peer group and group therapy. The approach is strength-focused, turning attention from dysfunction towards abilities and resources. The Norwegian version is much shorter than many North American programmes and frames nature as a place for rest and reflection rather than conquest (ScienceNorway reporting on Fernee). Therapists share camp life, carrying packs and sharing weather and fatigue, which the authors argue builds alliance. Concepts such as nature's restorative quality are attributed to these authors and the environmental-psychology literature they cite, not stated as fact. Evidence status in one line: the 2019 mixed-methods evaluation of Friluftsterapi (International Journal of Adolescence and Youth) found little average change from pre- to post-treatment but general improvement at 12-month follow-up (effect sizes around 0.5), with participants needing several months to process the experience. [source: DOAJ record of the 2019 evaluation]

2. Framework

This is a programme framework; the phases below are the Sørlandet sequence as publicly reported, not a published manual. No published manual gives session counts, and the order of the preparatory sessions is [uncertain: not verified]. [source: ScienceNorway/UiA]

Phase 0: Referral and assessment. Goal: decide whether outdoor group treatment suits this young person. Referral targets reported: depression, anxiety, adjustment disorder, withdrawal, low self-efficacy, and relational or behavioural problems in 16–18-year-olds already in specialist child and adolescent mental health care. An initial clinical assessment and tentative diagnostic formulation precede group work. Move on when: the formulation supports it, the young person has chosen it, and risks are judged manageable. Fernee stresses it is "not for everyone" and that young people should be able to choose their treatment. [source: Fernee et al. 2015; ScienceNorway]

Phase 1: Preparation. Goal: group familiarity, trust and practical readiness. Format reported: weekly day-sessions outdoors and a weekend trip before the expedition. Move on when: the group can function together, each member has negotiated an individual challenge level, and equipment, medical and family arrangements are in place [synthesis for the last criterion]. [source: ScienceNorway; Fernee et al. 2015]

Phase 2: Expedition. Goal: shared outdoor life as the therapeutic medium. Format reported: a multi-day hiking and paddling journey (reported as six days, from Evje to Kristiansand) with the group and three therapists; campfire gatherings, group time, individual and group therapeutic work, quiet time. Participants reportedly felt safe in the group first and grew closer to the therapists later. [source: ScienceNorway; Fernee et al. 2015]

Phase 3: Closure. Goal: mark the end and make the experience shareable. A formal closure ceremony at which pictures and experiences are shared; family and other involved parties are invited. [source: ScienceNorway]

Phase 4: Follow-up and reincorporation. Goal: transfer into daily life. Individual follow-up sessions; an ongoing open weekly outdoor day-session run by ABUP's outdoor therapy team; the Scandinavian health system's facilitated aftercare when needed. The 2019 evaluation suggests gains may appear over months rather than at programme end, so judge outcome at follow-up, not on the last day. Bell (2003) argues that outdoor programmes resemble the first two of van Gennep's three stages but often fail at the third, the return; this is the phase to plan most carefully. [source: ScienceNorway; Fernee et al. 2015; DOAJ 2019; Bell 2003 abstract]

Integrated (non-expedition) formats. Nature can also be woven into ordinary treatment: sessions in a cabin in near-nature on hospital grounds (Friluftssykehuset, Oslo University Hospital, opened 2018 with the Friluftssykehuset foundation and architects Snøhetta), where children and families alternate between talk, looking out at the forest, and play indoors or outdoors. [source: Johnsen et al. 2022]

3. Guiding principles

  • No therapy room is neutral. The setting is part of the treatment; choose and discuss it deliberately. [source: Johnsen et al. 2022]
  • Rest and reflection, not conquest. Pitch nature as a calming place, not an ordeal to survive; severe initiations are known to raise group liking and conformity (Aronson and Mills 1959, as summarised by the BPS), which is a reason to avoid hardship as a lever. [source: ScienceNorway; BPS 2015]
  • Strength focus. Look for and name abilities and resources, not only symptoms. [source: Fernee et al. 2015]
  • Individually negotiated challenge. Each young person agrees their own challenge level with a therapist; perceived risk is assessed person by person. [source: Fernee et al. 2015]
  • Choice. Outdoor therapy suits some people, not all; offer it as one option, never as a condition. [source: ScienceNorway]
  • Shared conditions. Therapists live the same camp life as the group; alliance grows from shared effort. [source: ScienceNorway; Fernee et al. 2015]
  • Here and now. Work with behaviours and concerns as they arise in camp rather than saving them for later. [source: Fernee et al. 2015]
  • Integrative frame. Hold affect, behaviour, cognition and relationships (ABC-R, Gass et al., as cited by Fernee et al. 2015) in view together. [source: Fernee et al. 2015]
  • Nature can frighten. Some reactions to nature are evolutionarily prepared and a child who finds it threatening will not be helped by it; check each person's relationship with the outdoors. [source: Johnsen et al. 2022]
  • Processing takes time. Expect integration over months; schedule follow-up accordingly. [source: DOAJ 2019]
  • Plan the return. Reincorporation is where rite-of-passage-style programmes most often fail. [source: Bell 2003 abstract]
  • Legal and considerate access. Use land under allemannsretten with consideration (hensyn) and caution (aktsomhet); note it does not by itself cover organised activities. [source: Miljødirektoratet]
  • Boundaries travel with you. Confidentiality and professional boundaries are harder outside the clinic and must be contracted explicitly. [source: Becker 2010 as cited by Fernee et al. 2015]
  • Competence on two fronts. Clinical competence and outdoor leadership competence are both needed; whether one person should hold both is debated. [source: Fernee et al. 2015]

4. Intervention inventory

The published Norwegian sources describe the programme's components but not step-by-step procedures. The components below are named in those sources; the steps that make them usable in session, and the therapist-side procedures (evaluation, consent, contracting, family work, debriefing) are marked [synthesis] where they go beyond the sources. Example language throughout is illustrative.

4.1 Evaluating a programme before referral

  • Purpose: Decide whether a friluftsliv-based or wilderness programme is safe and suitable before you refer. Use for any external programme, Norwegian or abroad. [synthesis]
  • Steps: (1) Establish whether it sits inside public specialist mental health care (e.g. a hospital department such as ABUP) or is private. (2) For programmes in North America, ask for accreditation: the Association for Experiential Education (AEE) accredits outdoor behavioural healthcare (OBH) programmes, and OBH accreditation is required of all OBH Council member programmes within two years of joining; its manual covers ethical, risk-management and treatment matters, including an infectious-disease standard (2020) [source: AEE]. (3) Ask in writing for: licensing, who the licensed clinicians are and how often they see the young person, staff qualifications and staff-to-client ratios, medical screening and emergency procedures, weather and evacuation plans, restraint and transport policies (ask whether these are used at all, and get the policy), contact rules with family, complaints routes, and aftercare. (4) Check public regulators, courts and major news for complaints. (5) Prefer short, voluntary, outpatient, clinic-embedded formats like the Norwegian model over long residential programmes using escort transport [synthesis]. Cross-refer guide 025 (harm account for coercive programmes).
  • Example language (illustrative): "Before I recommend anything, I'd like the programme to tell us in writing who the therapist is, how families stay in contact, and what happens if your son wants to stop."
  • Watch for: refusal to share policies; limits on family contact; claims that restraint or escort transport is routine; no named licensed clinician; no aftercare plan. Working: you can describe the programme's safety system to the family in plain words.

4.2 Clinical assessment and tentative formulation

  • Purpose: Establish fit before group work; the Norwegian programme starts with an initial clinical assessment and tentative diagnostic formulation. [source: Fernee et al. 2015]
  • Steps: (1) Complete your usual assessment, including risk to self and others. (2) Note the reported referral targets (depression, anxiety, adjustment disorder, withdrawal, low self-efficacy, relational or behavioural problems). (3) Add a nature history: experience outdoors, fears (water, dark, insects, heights, animals), traumatic events outdoors, body image and changing in front of others. (4) Medical and physical screening is the medical team's task: ask about conditions, allergies, medicines and mobility, and route questions to the young person's physician [synthesis]. (5) Write a formulation that states what the outdoor setting is expected to add (e.g. less pressure than office talk for a socially anxious young person). [synthesis for 3–5]
  • Example language (illustrative): "Tell me about the last time you were out in the forest or on the water. What was that like?"
  • Watch for: active suicidality, psychosis, severe eating difficulties or substance withdrawal that need a different level of care first; a young person agreeing to please parents. Working: you can say why this person, why outdoors, why now.

4.3 Informed consent, assent and real choice

  • Purpose: Ensure participation is chosen. Fernee stresses that outdoor therapy is not for everyone and young people should be able to choose their treatment. [source: ScienceNorway]
  • Steps: (1) Describe the programme concretely: settings, nights away, who is there, what is optional. (2) Give alternatives of equal standing. (3) Obtain consent according to the young person's age and local law; at 16–18, the young person's own consent is central in Norway [uncertain: legal detail not verified], with parents informed as the young person agrees. (4) Make the right to decline any activity explicit. (5) Record that the choice was free. [synthesis for steps]
  • Example language (illustrative): "This is one option, not a test. If you choose office sessions instead, your treatment carries on just the same."
  • Watch for: pressure from school, parents or services; agreement given flatly. Working: the young person asks questions and names what they will and will not do.

4.4 Negotiating an individual challenge level

  • Purpose: Keep each young person emotionally and physically safe; individual assessment of perceived risk is central and each adolescent discusses the appropriate challenge level with a therapist. [source: Fernee et al. 2015]
  • Steps: (1) Before each phase, ask the young person to rate how much challenge they want and fear. (2) Agree a level for each activity type (e.g. paddling, sleeping out, speaking in the group). (3) Agree a signal for "step back". (4) Revisit after each activity. [synthesis for steps]
  • Example language (illustrative): "Where's the line between stretching and too much for you on the water? Let's mark it now so you don't have to decide in the moment."
  • Watch for: bravado, or the group pushing someone past their line. Working: the young person uses the signal without shame.

4.5 Contracting confidentiality and boundaries outdoors

  • Purpose: Outdoors, confidentiality and boundaries are harder to keep (Becker 2010, as cited by Fernee et al. 2015). [source: Fernee et al. 2015]
  • Steps: (1) Agree what you will do if you meet walkers or someone known to the client. (2) Agree that group material stays in the group. (3) Contract touch: only for safety or practical help, asked first, with the right to say no; never sexual. (4) Agree photo rules before any pictures are taken (photos are used at closure). (5) Agree sleeping, changing and toilet arrangements and staff conduct around them. (6) Agree how phones and social media are handled. [synthesis]
  • Example language (illustrative): "If we meet someone on the path, we'll just say hello and walk on. You never have to explain who we are."
  • Watch for: blurred roles in shared camp life (staff as friends); private messaging between staff and young people. Working: young people know the rules and staff follow them visibly.

4.6 Preparation day-sessions and a weekend trip

  • Purpose: Build group familiarity before the expedition; the Sørlandet programme runs day-sessions and a weekend trip first. [source: ScienceNorway]
  • Steps: (1) Start with short, low-demand outings near home. (2) Teach equipment, clothing and camp routines. (3) Introduce group norms and the challenge-level system. (4) Use the weekend trip to test sleep-out arrangements and identify who needs more support. [synthesis for steps]
  • Example language (illustrative): "Today is just about getting to know the place and each other. Nothing to prove."
  • Watch for: absence from preparation sessions, which predicts difficulty on the expedition [synthesis]. Working: members begin speaking to each other, not only to staff.

4.7 Weather, terrain, allergies, ticks and hydration (risk management)

  • Purpose: Physical safety, described qualitatively and routed to the programme's own safety procedures. [synthesis]
  • Steps: (1) Ensure the programme has written plans for weather, terrain, water, evacuation and communication, and that you know them. (2) Before each outing, check the forecast with the outdoor lead and agree a turn-back point. (3) Confirm allergies, medicines and emergency medication with the medical team. (4) Brief participants on ticks and checks as the programme's guidance states. (5) Check accessibility: routes, toilets, sleeping. (6) Observe fire law: under allemannsretten, fire in or near forest is banned in a summer season without municipal permission (Miljødirektoratet). [source: Miljødirektoratet for 6; synthesis for 1–5]
  • Example language (illustrative): "If the wind picks up on the lake, we go ashore. That's the plan, not a failure."
  • Watch for: staff pressing on to keep the schedule; cold, wet young people too ashamed to say so. Working: changes of plan are calm and routine. No water temperatures, swim or immersion guidance belongs here; refer to the programme's safety lead and national lifesaving bodies, and see Domain X 196 for cold water.

4.8 Shared camp life (therapist as participant)

  • Purpose: Build alliance; therapists join the hike, carry backpacks and share weather and fatigue. [source: ScienceNorway; Fernee et al. 2015]
  • Steps: (1) Carry your share and do camp chores alongside the group. (2) Let the young people see you cope with discomfort ordinarily. (3) Keep your professional role clear while sharing tasks (see 4.5). [synthesis for 2–3]
  • Example language (illustrative): "I'm soaked too. Let's get the tarp up and then have something warm."
  • Watch for: over-disclosure by staff; staff exhaustion reducing judgement. Working: young people approach staff informally with real concerns.

4.9 Sequenced outdoor tasks

  • Purpose: Basic outdoor life with sequenced, intentional tasks builds mastery; tasks named include building shelters, making campfires, rappelling and navigating to campsites. [source: Fernee et al. 2015]
  • Steps: (1) Order tasks from simple to demanding. (2) Give each young person a task they can succeed at early. (3) Assign shared tasks that require cooperation. (4) Briefly review each task: what went well, what helped. (5) Activities needing technical skill (e.g. rappelling, paddling) are led by qualified outdoor staff under the programme's procedures. [synthesis for steps]
  • Example language (illustrative): "You got the fire going in the rain. What did you do that made the difference?"
  • Watch for: tasks becoming tests of worth; one member always taking over. Working: self-efficacy statements appear ("I can do that").

4.10 Quiet time / alone time

  • Purpose: Facilitated reflection; named by Fernee et al. (2015) and by Gabrielsen and Harper (2018) as a micro-intervention. [source: Fernee et al. 2015; Gabrielsen & Harper 2018]
  • Steps: (1) Agree with each young person whether quiet time will be alone or near others, always within staff sight or reach. (2) Give a simple focus (sounds, a view, a question). (3) Agree a signal to end early. (4) Debrief briefly afterwards. This is not a solo fast or survival exercise; set the length to the person and the programme's supervision rules. [synthesis for steps]
  • Example language (illustrative): "Find a spot where you can still see the tent. Just notice what you hear. Come back whenever you're ready."
  • Watch for: rumination, dissociation, panic, or self-harm risk when alone; reduce or drop for those at risk. Working: the young person reports calm or a new thought.

4.11 In vivo counselling

  • Purpose: Work with behaviours or concerns as they arise in camp. [source: Fernee et al. 2015]
  • Steps: (1) Notice the moment (a withdrawal, a conflict, a refusal). (2) Step aside with the young person if needed for privacy. (3) Name what you saw, ask about it, link it to their goals. (4) Agree one thing to try next. [synthesis for steps]
  • Example language (illustrative): "I noticed you went quiet when the plan changed. Is that like what happens at school?"
  • Watch for: shaming in front of peers. Working: the young person connects camp behaviour to life at home.

4.12 Group sessions and here-and-now problem solving

  • Purpose: A supportive peer group is one of the four factors; problems are brought into the group for active problem solving; campfire gatherings and group time are reported. [source: Fernee et al. 2015; ScienceNorway]
  • Steps: (1) Hold a regular group round at a set point in the day (e.g. at the campfire). (2) Open with a check-in on the day. (3) Invite one live problem from camp life (a quarrel, a fear, a plan). (4) Ask the group for ideas and help the member choose one. (5) Close by naming each person's contribution. [synthesis for steps]
  • Example language (illustrative): "Something got hard today on the portage. Who wants to bring it to the fire, and what would help?"
  • Watch for: scapegoating, alliances against one member, disclosure beyond what a member will be comfortable with later. Working: members offer each other help unprompted.

4.13 ABC-R integrative framing

  • Purpose: Fernee et al. (2015) cite the ABC-R triangle (Gass et al.), combining affect, behaviour and cognition with relational work involving peers, therapists and family, as an integrative framework. [source: Fernee et al. 2015]
  • Steps: (1) After a significant event, ask in turn what the young person felt, did and thought. (2) Ask who else was involved and how the relationship was affected. (3) Link the pattern to home or school. (4) Note it in the individual plan. [synthesis for steps; the ABC-R model's own procedures are in Gass, Gillis and Russell's text, [uncertain: not verified]]
  • Example language (illustrative): "When the canoe tipped, what went through your head, what did you feel, what did you do, and how did the others react?"
  • Watch for: turning every event into analysis. Working: the young person spontaneously links feeling, action and relationship.

4.14 Walk and talk

  • Purpose: One of Gabrielsen and Harper's (2018) four brief micro-interventions; side-by-side talking can feel less pressured. [source: Gabrielsen & Harper 2018]
  • Steps: (1) Agree route, privacy plan and turn-back point (4.5, 4.7). (2) Walk at the client's pace. (3) Let silence happen; use the path, view or terrain as openings. (4) Stop or sit for difficult material. [synthesis for steps] Exercise as treatment is not the aim; no exercise prescription belongs here (behavioural-activation framing, Domain II 040).
  • Example language (illustrative): "We can just walk for a bit. Say whatever comes up, or nothing."
  • Watch for: avoidance through walking; breathlessness limiting talk. Working: the client raises material they had avoided in the office.

4.15 Nature metaphors

  • Purpose: Gabrielsen and Harper (2018) list the use of metaphors; at Friluftssykehuset therapists use seasons, growth and small creatures as images, e.g. a worm that hides when scared and comes out when it feels safe (anxiety work), or an ant that gets help carrying a large seed. [source: Gabrielsen & Harper 2018; Johnsen et al. 2022]
  • Steps: (1) Notice what the client is already attending to. (2) Offer a metaphor tentatively, or invite theirs. (3) Let the client extend or reject it. (4) Return to it later as shared shorthand. [synthesis for steps]
  • Example language (illustrative): "That worm went under the leaf when we came close. Do you ever feel like that? What helps it come back out?"
  • Watch for: imposing a meaning. Working: the client uses the metaphor themselves in later sessions.

4.16 Risk and challenge through experiential activity

  • Purpose: Gabrielsen and Harper (2018) list risk and challenge through experiential activity as a micro-intervention; mastery of a chosen challenge supports self-efficacy (ScienceNorway). [source: Gabrielsen & Harper 2018; ScienceNorway]
  • Steps: (1) Use only challenges agreed at the young person's level (4.4). (2) Prepare the young person for the feelings likely to arise. (3) Stay close during the activity. (4) Debrief: what they feared, what happened, what they learned about themselves. [synthesis for steps] Technical risk is managed by qualified outdoor staff.
  • Example language (illustrative): "You said your stomach would be in knots on the ridge. It was. And you still did it. What does that tell you?"
  • Watch for: challenge used as ordeal or punishment; hardship that bonds the group but reduces dissent (see Principles). Working: the young person attributes success to their own effort.

4.17 Closure ceremony

  • Purpose: Mark the end; at Sørlandet pictures and experiences are shared collectively and family and other involved parties are invited. [source: ScienceNorway]
  • Steps: (1) Plan with the group what will be shown and said; each person chooses their own photos (with consent from anyone pictured). (2) Invite family and professionals as each young person wishes. (3) Give each person a chance to say what they take with them. (4) Avoid making it a performance of success. [synthesis for steps] For ritual design, keep the young person as the author.
  • Example language (illustrative): "Pick two photos that say something about your trip. You decide what you tell your family about them."
  • Watch for: a young person with no one to invite; pressure to show only positives. Working: young people explain the trip in their own words to family.

4.18 Individual follow-up and slow processing

  • Purpose: Individual follow-up runs alongside group work; participants needed several months to process the experience and apply it. [source: ScienceNorway; DOAJ 2019]
  • Steps: (1) Schedule individual sessions after the expedition, not only before. (2) Ask what has stayed with them and what has faded. (3) Link specific moments to current challenges. (4) Review goals at follow-up rather than at the last day. [synthesis for steps]
  • Example language (illustrative): "It's been a few weeks since the trip. Which moment comes back to you most?"
  • Watch for: post-trip low mood or a sense of loss. Working: references to the trip used to solve present problems.

4.19 Reincorporation and transfer planning

  • Purpose: Bell (2003) argues outdoor programmes resemble the first two stages of van Gennep's rites of passage but often fail at the third, the return; ABUP offers an open weekly outdoor day-session, and a year later several participants were still going into nature. [source: Bell 2003 abstract; ScienceNorway]
  • Steps: (1) Before the expedition ends, ask each young person what they want to carry home. (2) Name who at home, school or in services will know about it. (3) Identify an ongoing outdoor or social link (e.g. an open outdoor session, a club, a nearby trail) at a level they can keep up. (4) Plan for the first difficult week back. (5) Share with the young person's consent what the referring team needs to know. [synthesis for steps]
  • Example language (illustrative): "Out here you got good at asking for help. Who at home could you ask, and how?"
  • Watch for: the change "staying in the forest"; families not ready for a changed young person. Working: specific new behaviours appear at home or school.

4.20 Mastery stories and positive memories

  • Purpose: At Friluftssykehuset therapists later ask children to recall good experiences as resources and highlight them to build "thicker" mastery stories (drawing on White and Epston); an anonymised example is a child who became more optimistic after catching a trout. [source: Johnsen et al. 2022]
  • Steps: (1) Notice and name a moment of mastery as it happens. (2) Later, ask the client to retell it in detail. (3) Ask what it says about them. (4) Connect it to a current challenge. [synthesis for steps]
  • Example language (illustrative): "Tell me again about the day you caught the fish. What does the person who did that know about not giving up?"
  • Watch for: the client discounting the success. Working: the client retells it unprompted.

4.21 Moving between settings (near-nature integrated work)

  • Purpose: In the Friluftssykehuset cabin, children can alternate between talking, looking out at the forest, and playing indoors or outdoors, which helps them stay with emotionally difficult topics longer; a shared interest in something in the forest can open spontaneous talk. [source: Johnsen et al. 2022]
  • Steps: (1) Offer the client choice of indoors or outdoors. (2) Allow movement between the two when talk gets heavy. (3) Use a shared object of attention (a bird, the stream). (4) Return to the theme once the client is settled. [synthesis for steps]
  • Example language (illustrative): "We can sit by the window or go and look at the stream. Let's go where it's easiest to talk."
  • Watch for: constant movement as avoidance; hazards (water, weather) near the site. Working: the client stays with difficult topics longer than in the office.

4.22 Family involvement

  • Purpose: The Sørlandet programme invites families to closure; the Sámi National Centre's Utmarksterapi includes families; ABC-R includes family in relational work. [source: ScienceNorway; Fernee et al. 2015]
  • Steps: (1) With the young person's consent, brief parents on the programme, safety and contact arrangements. (2) Agree what will be shared with them. (3) Offer a family session before and after the expedition. (4) Help parents receive changes without testing them. [synthesis for steps]
  • Example language (illustrative): "Your daughter may come home tired and quiet. That's normal. Let her tell you about it in her own time."
  • Watch for: parents seeking the programme as a solution for the family's own conflict. Working: parents describe the young person's strengths more.

4.23 Dual roles, competence and insurance

  • Purpose: Fernee et al. (2015) note debate over whether therapists should also be trained in outdoor education. A therapist who is also outdoor leader holds two roles. [source: Fernee et al. 2015]
  • Steps: (1) Hold outdoor competence appropriate to the activity, as relevant certifying bodies require, or work alongside qualified outdoor staff. (2) Clarify who holds safety authority in the field. (3) Confirm professional indemnity and the programme's liability cover extend to outdoor and overnight work. (4) Manage the multiple relationship in line with APA Ethics Code Standard 3.05 (Multiple Relationships) and local codes. [source: APA Ethics Code for 4; synthesis for 1–3]
  • Example language (illustrative): "On the water, Kari is in charge of safety. I'm here as your therapist."
  • Watch for: the therapist making safety calls beyond their training. Working: clear role split known to all.

4.24 Debriefing a client who attended another programme

  • Purpose: Some clients arrive after a residential wilderness programme, in Norway or abroad, with mixed or harmful experiences. [synthesis]
  • Steps: (1) Ask open questions about what happened, including transport, isolation, punishment, food, contact with family. (2) Validate both positive and harmful experiences. (3) Assess for trauma responses. (4) Follow safeguarding and reporting duties if abuse is disclosed. Cross-refer 025 and Domain XVI. [synthesis]
  • Example language (illustrative): "Some people found those programmes helpful and some found parts frightening. I'd like to hear what it was like for you."
  • Watch for: shame about having been 'sent away'. Working: the client can place the experience in their own story.

5. Handling problems

The Norwegian sources address only a few of these directly (choice, individual challenge level, confidentiality outdoors, slow processing, aftercare); the remaining guidance is [synthesis].

  • The young person does not want to go outdoors. Respect it; the programme is "not for everyone" and choice matters (ScienceNorway). Offer office-based treatment or a near-nature integrated option (4.21) instead, without framing it as a lesser path. [source: ScienceNorway; synthesis]
  • Fear of nature, water, dark or animals. Nature helps only if it does not feel threatening (Johnsen et al. 2022). Lower the challenge level, start near buildings, or treat the fear first with a standard exposure approach with consent and contraindication checks. [source: Johnsen et al. 2022; synthesis]
  • Stuck or flat after the expedition. Expect delayed processing (2019 evaluation); keep individual follow-up going and judge outcome over months, not days. Explore post-trip loss or let-down. [source: DOAJ 2019; synthesis]
  • Withdrawal or refusal in camp. Use in vivo counselling privately (4.11); revisit the challenge level; offer a role that keeps the person in the group without pressure (e.g. a camp task). [synthesis]
  • Overwhelm, panic or dissociation in the field. Stop the activity; move to shelter and a familiar staff member; use grounding; follow the programme's emergency and evacuation plan if the person cannot settle or is at risk. Reassess fitness to continue with the medical lead. [synthesis]
  • Self-harm or suicide risk on trip. Apply your service's standard risk assessment; supervision levels and quiet-time arrangements change accordingly (4.10); if risk is high, end the trip for that person with a safe return plan. No information about means beyond safe storage and removal. [synthesis]
  • Group conflict or scapegoating. Bring it to the group round (4.12) with clear norms; separate members temporarily if needed; staff model repair. [synthesis]
  • Ruptures with the therapist. Shared camp life makes ruptures visible; name them early, take your share of responsibility and repair before the group disperses for the night. [synthesis]
  • Boundary slips (being seen, touch, social media, overnight arrangements). Return to the contract (4.5); record and discuss in supervision; inform the young person and, as agreed, parents. Becker (2010, as cited by Fernee et al. 2015) flags confidentiality and boundaries as harder outdoors. [source: Fernee et al. 2015; synthesis]
  • Weather or injury forces a change of plan. Treat the change as part of the work, not failure; process frustration in the group. Safety decisions rest with the outdoor lead (4.23). [synthesis]
  • Non-attendance at preparation sessions. Reach out individually; review whether the format suits; do not take an unprepared young person on the expedition. [synthesis]
  • Families who want a 'fix'. Clarify that the programme is one component in specialist treatment; involve families in reincorporation (4.19, 4.22). [synthesis]
  • Ordeal drift. If staff begin using hardship, deprivation or punishment as levers, stop: the Norwegian model frames nature as rest and reflection, and severe initiations increase group liking and conformity (Aronson and Mills 1959, as summarised by the BPS), which can silence complaints. Cross-refer 025 harm account. [source: ScienceNorway; BPS 2015; synthesis]
  • Accessibility and cost. Disability, chronic illness or lack of equipment should not exclude a young person by default; adapt routes and kit, or use near-nature formats. [synthesis]
  • Change does not transfer home. Plan reincorporation explicitly (Bell 2003); link to an ongoing outdoor or social activity; involve school and family as agreed. [source: Bell 2003 abstract; synthesis]

Sources

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