Volume 22 Number 2
If I Conduct Outdoor Pursuits with Clinical Populations, Am I An Adventure Therapist?
In the recent posting on the Internet noted above, a colleague used this story as a metaphor for how adventure therapy was about individuals shaping themselves from the inside and how that new "shape" was enhanced by group members from the outside to produce pottery that had life. In one view of this metaphor, the individual client (apprentice potter), with several group members (other apprentices) and a therapist (master potter), help identify most of the principle players in adventure therapy. Missing are (1) those who theorize on how to teach master potters and (2) the public which evaluates the pottery.
This paper is an attempt to examine the current shape of adventure therapy as it relates to the players identified above. To this author, the field is being molded by more than one of these players (some of whom are even 'master potters') who wish to shape the course of 'adventure' therapy. The demand from parents, health care providers, judges, and governments (those in the public who evaluate the work of the'potters') already exists for valid and cost effective ways to change behavior; especially behavior of unruly adolescents (apprentice potters).
What does the field of adventure therapy offer with regards to a theoretical base, an agreed upon way to practice, and a method for evaluating the results? What are the current trends in the field and which questions does the field need to answer in order to meet the future with the type of professional preparation which would parallel the logistical preparation of beginning an expedition into the wilderness or facilitating a day on a ropes course? Does this field know what shape it is in or where it is going?
For this feature article, I define adventure therapy as an active approach to psychotherapy for people seeking behavioral change, either voluntarily or through some court ordered coercion, that utilizes adventure activities, be they group games and initiatives or wilderness expeditions (with some form of real and or perceived risk), as the primary therapeutic medium to bring about such change.
Let it be known that the experiential field of therapeutic intent suffers from serious semantic confusion (Roland, Keene, Dubois & Lentini, 1988). Novice and experienced readers of the literature are faced with various terms such as adventure therapy (e.g., Gass, 1991; Stich & Senior, 1984), adventure-based counseling (Maizell, 1988; Schoel, Prouty, & Radcliffe, 1988), experiential-challenge (Roland, Summers, Freidman, Barton, & McCarthy, 1987), outdoor-adventure pursuits (Ewert, 1989), therapeutic adventure programs (Wichmann, 1991), therapeutic camping (Rice, 1988; Walton, 1985), wilderness therapy (e.g., Bacon & Kimball, 1989; German & Davis-Berman, 1993; Levitt, 1982), and wilderness-adventure therapy (e.g., Bandoroff, 1990). Do all these terms refer to similar or different method and setting of operation?
Defining adventure therapy by just the adventure activity, setting, or only by client population is too simplistic. Just conducting activities with clinical populations does not an adventure therapist make! There must be a depth of understanding regarding theory and research that informs practice for an adventure therapist to be truly competent.
Defining A Theory Base In Adventure Therapy
No one theory from the field of psychotherapy appears to be adequate to explain the cognitive, affective, and behavioral changes that can take place in adventure experiences. Psychoanalytically based theories (Gillis & Bonney, 1989) and family systems theories (Lass, 1993) coupled with cognitive behavioral theories (Griffin, 1991) and Ericksonianbased solution therapies (Itin, 1994) each offer pieces of the puzzle as to how adventure therapy integrates into the larger psychotherapy profession.
The Scope Of Practice In Adventure Therapy
Priest and Gass (1993) have identified five generations of facilitated learning techniques for adventure therapists. These have evolved from a 'just do it' approach, through reflection after an activity (called a debriefing discussion), to introducing or framing the activities beforehand in metaphoric stories (called isomorphic framing). Their fifth generation of isomorphic framing has it roots in the psychotherapy work of Milton Erickson (1980). Bacon (1983, 1988) and Gass (1991) have advanced the use of isomorphs in the presentation of adventure activities in therapeutic contexts.
One of the principles tools of adventure therapy practice, beyond the activities and settings, is the use of metaphoric stories. A metaphor is a symbolic way of experiencing reality, where one thing (an adventure experience) is conceived as representing another (a situation in a client's or group's actual lives (reality)). Every metaphor is composed of several isomorphic linkages: elements with a parallel form that are common to both metaphor and reality. The short story at the start of this article is a metaphor, while each of its connecting components are isomorphs: the master potter (therapist), the apprentice potter (client), the other apprentices (group members), the adventure therapy process (shaping pottery).
The power of adventure therapy lies in the metaphoric associations people are able to make that enhances their ability to transfer the lessons learned in the experience into behavioral or attitudinal changes in their life. For example, a person who learns to deal with their fear of failure while climbing a difficult rock face, may be able to cope with their fear of failure regarding an addiction. The key to applying coping strategies on the return home, lies with visualizing and finding meaning from the parallels between the adventure and home life (reality). The greater the metaphoric connection, due to the presence of multiple isomorphic linkages, the better the chances of transferring those strategies.
From reading of this these level of goals and generations of experiential learning, it may appear that isomorphic work is considered by some as the pinnacle of good adventure therapy,. However, the question remains for this author: What conditions or group characteristics are best suited for each generation of facilitated learning?
Handley (1992) partially answers this question with a description of how metaphor works in therapeutic programs. He speaks to the tension created by metaphors from adventure experiences that are never 'explained' or discussed with the group. He also agrees with the necessity for adventure activities to have similar structures or be isomorphic with therapeutic issues that are the focus of the experience. Handley supports Bacon's contention that discussion (or reflecting upon) an isomorphic adventure experience can lessen the depth of the metaphor's meaning for some clients.
Handley sights three reasons for his thinking. First, he believes isomorphic experiences are more individually based and meet the needs of individual group members, while debriefing sessions often have the leader's goal of gaining some feedback about the program or the experience. Second, he feels many participants, especially adolescents, are unable to resolve the tension created by the metaphorical experience (and find meaning from) a therapeutic adventure. They must, according to Handley, have analogous experiences in their daily lives in order for debriefing to make sense. Third, he feels the language necessary to describe a metaphorical experience is often unavailable or beyond some participants. In Handley's experience, group members 'learn' to tell the leaders what the leader wish to hear in order to "please them" or "get them off our backs." Handley's opinion is that such a debrief can threaten or even lose the metaphor in the experience. Such thoughts challenge much of what is discussed in typical adventure therapy debriefs as well as how it is discussed and finally points to whose goal or need the debrief fills: participant or leader?
Pinkard (1995) adds to the debate about whether there is a need for prescriptive metaphors  in adventure therapy in order to facilitate the transfer of learning in the adventure experience "back to the real world or back home." He describes three strategies for facilitating transfer of learning. The first strategy is a metaphoric debriefing whereby the leader employs an opened ended or non-prescriptive approach that allows participants to draw upon their own experience of the activity and discuss metaphoric links they have made (Handley might wonder if this might be possible or if one person's revelation might ruin the metaphor for others). The second approach Pinkard speaks of is isomorphic framing that 'prescribes' a predetermined framework for the activity based upon the therapist's goals. Such a prescribed method is (by nature) influenced by the leader's goals. These goals may not match the group's. There is much potential for damage to occur when the leader insist that a group follow the prescription of goal that does not match the goal of the client group or the funding source for the adventure experience.
Pinkard calls the third method 'custom mapping'. This method describes a collaborative (or co-created) approach between leader and group that allows the group to creatively adjust an adventure activity to fit with the way they see the world. The leader begins to present an activity with some direction towards a therapeutic idea or group issue but allows the group to find their own meaning through discussion, reflection, and interpretation. Pinkard notes that therapists in such collaborative activities must have the skill to present an adventure activity that has adequate structure and boundaries for the group (e.g., "This is an activity about drug use and abuse), but which allows much room for exploration within those boundaries (e.g., "I'm not sure how participation in the activity may relate to your own experience with drugs). He feels such an approach is much less prescriptive and much more effective at bringing change since the meaning is created with the participants.
Much of the about metaphors in adventure therapy points to two questions for adventure therapists working with clients. What developmental, intellectual, emotional, or cognitive skills are needed by client groups to be able to 'get the meaning' of the metaphor - at any level whether it be today, tomorrow, next week, month or year? A more difficult question is how to assess the group's skill level so that one can know which method of facilitated learning (Priest & Gass, 1993) and which prescriptive or non-prescriptive method (Pinkard, 1995) to use with this particular client group? Lastly, has research and evaluation in adventure therapy offered any guidance for the practitioner?
Research Methods And Evaluation Results In Adventure Therapy
Bandoroff (1990), Burton, (1981), Ewert (1987, 1989), Levitt (1982), and Shore (1977) have reviewed a substantial amount of information on research into adventure programming that includes references to therapeutic populations. The writings of Bacon (1983, 1987, 1988; Bacon & Kimball, 1989), Chase (1981), Gass, (1991), Kimball (1983, 1991), Haussman (1984), Roland, (Roland, et al., 1987), Schoel, Prouty, & Radcliffe, 1988; Stich (Stich, 1983; Stich & Gaylor, 1983), and Witman (1989) have also contributed significantly to this field. These reviews agree with the findings of Cason & Gillis that globally measured self esteem has been found to increase following participation in adventure programming, although the longevity of such change and its transfer to other settings has not been empirically validated. The reviews also support the fact that recidivism for adjudicated adolescents has been positively impacted by adventure programming. Additional dependent variables have been studied including self reported changes in locus of control and problem solving, staff observations of behavioral change, and other measures such as grade point average and attendance. Results of changes on these measures have been less conclusive.
There is still no one clearly defined and researched method of conducting therapy with adventure activities; thus the practitioner is left with little guidance for what type of adventure activity or setting is most effective with which client group. An increasing problem is that the literature is confusing. Researched programs utilize different adventure activities (wilderness expeditions versus ropes courses) and methods (educational, adjunctive, and primary), making comparisons among programs very difficult. More troublesome is that the majority of research studies are not specific enough in their methodology (what they actually did that was considered therapeutic) so that readers can determine if program findings can be compared. There is no way to measure integrity of adventure therapy at this point in time. The need for specificity regarding method used as well as an accurate description of the techniques employed or protocol being followed is long overdue in the field of adventure therapy.
With regard to methodology and definition, even practitioners from different programs, in conversations or presentations, will use terms like "adventure therapy or "wilderness therapy interchangeably often times without clarifying what each means. The term used is not nearly as important as the methodology described, including how activities are sequenced, introduced and discussed. The descriptions, which can take the form of the well ingrained case study method or even a daily schedule of specific activities along with topics discussed, might do more to inform the field than pre and post test scores on a self report measurement. The 'mystery' needs to be taken out of the method!
To gain respect in the research field, and also to provide adventure practitioners with "how-to-guides," adventure therapy needs to develop protocols that spell out exactly what is done in the field. Such guides will allow for replication of adventure therapy with numerous populations and can be assessed quantitatively for effectiveness. In addition, qualitative evaluation (done with small frequency in the adventure therapy field) has the potential to offer an understanding of how adventure therapy programs work with various homogeneous diagnostic populations (e.g., alcohol and drug groups, delinquent groups, physically challenged groups). If such training protocols are developed for adventure therapy, they will need checks and balances to insure treatment integrity (perhaps through supervision and video-taped sessions as suggested for psychotherapy by Kazdin, 1991). Such specificity, coupled with research, may be able to (1) revitalize the experiential tradition of psychotherapy, which according to Goldfried, Greenberg, and Marmar (1990) is "either in danger of becoming extinct, or.(of) being absorbed by other approaches" (p. 666), (2) gain more recognition and respect among traditional psychotherapy researchers and practitioners, and (3) contribute significantly to the advancement and integration of this field with more traditional forms of psychotherapy.
Randomized (at best) and nonrandomized groupings (at worst and as the norm in adventure therapy) that compare treatment and control groups or alternative treatments on outcome measures have dominated traditional psychotherapy research and adventure therapy research as well. Such research has continued to be controversial due to "nodifference" findings which may be related to a lack of statistical power (from small sample sizes and weak assessment instruments as suggested by Kazdin, 1991). For traditional psychotherapy, the use of regression techniques for targeting treatment-relevant participant attributes instead of analysis-of-variance research designs is suggested to move beyond the "no-differences" outcomes. Adventure therapy has tremendous potential for field based research that can be clinically relevant and statistically significant if it were to look to the psychotherapy research field for guidance in what not to do; more regression research is needed to understand who does well in different types of adventure therapy programs.
A focus on significant change events in adventure therapy and a data base for collecting results of therapy across different adventure therapists is currently seen as a more fruitful avenue for (psychotherapy) researchers to contribute to practitioners (Goldfried, Greenberg, & Marmar, 1990). Adventure therapist must inform practice through research that is clinically relevant; not just statistically accurate. We must familiarize each other with our methods (through case studies and qualitative analysis) if we are to advance the art and science of adventure therapy practice. We must develop specific case books for specific diagnostic categories if we are to move forward into the future.
What Does The Future Hold?
Issues surrounding training of adventure therapist with the requisite skills and knowledge to 'do no harm' with such powerful methodology is fundamental to the field having a professional and legitimate identity. We have a responsibility to our clients for being competent and not allowing our own goals or needs as therapists to interfere with their treatment. We must have a knowledge of group dynamics, traditional group psychotherapy methods, ethical principles and guidelines as well as good assessment and referral practices. The knowledge of physical and emotionally safety issues by people calling themselves adventure therapists is paramount to the future of adventure therapy.
However, none of these 'therapy' skills is any more important than the responsibility to competently conduct 'safe' adventure practices. This is a field that utilizes powerful techniques that are often perceived as risky and can be dangerous. The cold hard reality is that people can die in this approach to therapy. We cannot afford to lose one life nor can those who entrust us be fearful of our practices.
What level of education and how much experience does it take to call oneself an adventure therapist? How many research studies must you cite and how much theory should you know to be able to practice competently and responsibly? Who judges the minimally acceptable level of skills needed to conduct adventure therapy work with adjudicate youth, with physically challenged persons, with persons labeled mentally ill? Do you just need to be able to sell yourself to enough parents who want to let you work with their children or find a job working with clinical or 'challenged' populations to be an adventure therapist? Is being employed by a program claiming to be adventure-based or reporting to practice wilderness therapy enough to call oneself an adventure therapist? Although the Therapeutic Adventure Professional Group of the Association of Experiential Education has adopted a set of ethical guidelines that attempt to answer some of these questions (Gass, 1992), a jury has yet to be called to answer such questions. But who is likely to serve on that jury: peers who review one another's programs and provide feedback and guidance or state or federal legislators who are not as familiar with the standard practices but feel the heat from concerned constituents wanting to protect their children?
"Getting back to nature" or offering the 'reality therapy' of natural consequences is pushing for the seemingly rapid construction of more and more ways of changing behavior that fall under the name of 'adventure therapy'. Does the adventure therapy field and those who align themselves with this powerful way of working with people need to stand upon the potter's wheel and have the clay of federal legislation and state regulation thrust upon them? Or might there be some formation from inside the field that:
This article has been an attempt to assess the current shape of theory, practice and research in adventure therapy. The field is in dynamic flux feeling pressure from (1) traditional fields to know how and why it is promoting behavioral change, from (2) funding agencies to justify itself and from (3) practitioners who wish to be informed of more effective ways of working. Relatively few are willing to shape the field from within, at least by the paucity of writing about what is done with whom under what conditions.
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* Lee Gillis is an associate professor of psychology at Georgia College in Milledgeville, Georgia, USA. He coordinates the master of science track in adventure therapy. Lee also serves as the therapeutic strand manager for Project Adventure, Inc. and works as a licensed psychologist for Project Adventure's Covington Ga (USA) Cooperative Treatment Program (COOP), a residential, adventure-based substance abuse treatment program for adjudicated youth.
1. Prescriptive metaphors by definition would state or imply a method of solving an adventure activity that would lead to a particular solution. The implication is that the facilitator'knows' what is best for the group and prescribes such with the briefing to the adventure activity.
Other articles from this issue:
Sharing Program Ideas
Adventure Therapy and the Addictive Process
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