Adventure therapy

Adventure Therapy as a distinct and separate form of therapeutic process has only been prominent for less than 40 years. Influences from a variety of learning and psychological theories have contributed to the complex theoretical combination within adventure therapy (AT). The underlying philosophy largely refers to experiential education. Existing research in adventure therapy reports positive outcomes in effectively improving self concept and self esteem, help seeking behavior, increased mutual aid, pro-social behavior, trust behavior and more. Even with research reporting positive outcomes it appears that there are many disagreements about the underlying process that creates these positive outcomes (Berman & Davis-Berman, 1995; Gass, 1993; Parker, 1992).

Definition
Adventure therapy is the creation of opportunities to explore the unknown in a safe environment through adventure activities. Often adventure therapy is conducted in a group or family context, though increasingly adventure therapy is being used with individuals (Parker, 1992; Ziven, 1988). Adventure therapy approaches psychological treatment through experience and action within cooperative games, Trust activities, Problem Solving Initiatives, High adventure, outdoor pursuits, and wilderness expeditions. Some believe that in adventure therapy there must be a real or perceived psychological and or physical risk generating a level of challenge or perceived risk. Challenge can be viewed as significant in eliciting desired behavioral changes. Positive behavior changes, which are synonymous with psychological healing, can occur through isomorphic connections. An isomorphic connection is transferring learning from a specific experience to other life experiences. Isomorphic connections occur through the structure of framing and activity (Bacon, 1983; Gillis, 2000; Parker, 1992). Framing is the creation of a metaphoric theme for a given activity or a series of activities that relates to a targeted treatment issue. Debriefing or processing the experience is a discussion during or after the activity that is related to the frontload, individual, and group treatment issues designed to facilitate isomorphic connections (Weinberg, 2002).

Adventure therapy encompasses varying techniques and environments to elicit change. These include cooperative games, problem solving initiatives, trust building activities,high adventure (rock climbing/rappelling, ropes courses, peak ascents); and wilderness expeditions (backpacking, canoeing, dog sledding, sailing, etc.) (Gass, 1993; Itin, 1995). Wilderness therapy, adventure based therapy, and long term residential camping are the most common forms of adventure therapy (Gass, 1993).

History
The use of adventure as a part of healing process can be traced back in history to many cultures including Native American, Jewish and Christian traditions (Parker, 1992). Tent therapy, emerged in the early 1900s. This therapy brought certain psychiatric patients out of hospital buildings and into tents on the hospital’s lawn. Many patients showed improvement during this treatment that prompted a series of studies, which failed to present enough evidence to support efficacy. Literature on this therapy lasted approximately 20 years and then dropped off completely (Berman & Davis-Berman, 1995).

In the late 1930s this approach reappeared mainly as camping programs designed for troubled youth. This era influenced the present day use and extent of adventure therapy programs with adolescents. The format for these programs utilized observation, diagnosis and psychotherapy. One of the first of these programs was Salesmanship Club Camp based in Dallas, Texas and founded by Campbell Loughmiller in 1946. His philosophy of adventure in therapy included the theory that the “…perception of danger and immediate natural consequences for [a] lack of cooperation on the part of [participants]…[after confronting danger] built self-esteem, [while] suffering natural consequences taught the real need for cooperation” (Berman & Davis-Berman, 1995, p. 3). These ideas informed some adventure therapy programs

This period also saw the creation of Outward Bound (OB) in the 1940s by Kurt Hahn (Aghazarian 1996; Blanchard, 1993; Dickens 1999; Glass, 1999; Parker 1992; Ziven 1988). Outward Bound was a direct response to Lawrence Holt, part owner of the Blue Funnel Shipping Company, [who] was looking for a training program for young sailors who seemed to have lost the tenacity and fortitude needed to survive the rigors of war and shipwreck, unlike older sailors who, because of their formative experiences on sailing ships, were more likely to survive (http://www.outwardbound.net/about/history/ob-birth.html). In this way Outward Bound was engaging in a form of adventure therapy - intervening in the lack of tenacity through the use of challenging adventure training.

In the 1960s OB came to the United States through the OB school in Colorado (Parker 1992; see Outward Bound USA). Outward Bound programs in Colorado and other schools quickly began to use Outward bound as an adjunctive experience work with adjudicated youth and adults (one of the first programs in 1964 offered recently released prisoners a job at Coors Brewery if they completed a 23 day course). In the late 70's Colorado Outward Bound developed the Mental Health Project. Courses were offered to adults dealing with substance abuse, mental illness, being a survivor of sexual assault and other issues. In 1980 Stephen Bacon wrote the seminal text in Adventure Therapy "The Conscious Use of Metaphor in Outward Bound" which linked the work of Milton Erickson and Carl Jung to the process of Outward Bound.

Project Adventure, adopted the OB philosophy in a school environment and brought the ropes course developed at the Colorado Outward Bound School into use at schools. Project Adventure staff including Karl Rohnke are credited with developing many of the cooperative games, problem solving initiatives, trust activities, low elements, and high elements. PA first emerged in Hamilton-Wenham High School in Massachusetts in 1972 with a principle named Jerry Peih, son of Robert Pieh founder of the Minnesota OB School. Jerry Peih wanted to bring the concepts behind the Outward Bound schools, developing self-esteem and self-confidence through mentally and physically straining and stressful situations, to classrooms (Aghazarian 1996; Blanchard, 1993; Dickens, 1999; Gillis & Simpson, 1992; Glass, 1999; Maizell 1988; Parker 1992; Schoel, Prouty, & Radcliffe, 1988; Ziven 1988). PA programs were often used at part of the health curriculum in PE programs.

Eventually Paul Radcliffe, a PA trained facilitator and school psychologist, Mary Smithy a PA staff member along with a social worker from Addison Gilbert Hospital, started a 2 hour weekly outpatient group. Eventually this model was incorporated into school psychological services and was called the Learning Activities Group (Schoel, Prouty, & Radcliffe, 1988). This later grew into Adventure-Based Counseling (ABC), a project adventure term that reflects the therapeutic use of adventure activities (Gillis & Simpson, 1992).

Theory
Adventure therapy theory draws from a mixture of learning and psychological theories. The learning theories include contributions from Albert Bandura, John Dewey, Kurt Hahn, and Kurt Lewin. These theorists also have been credited with contributing to the main theories comprising experiential education. Moote and Woodarski (1997), Blanchard (1993) and Davis, Berman, and Capone (1994) all report that experiential education is a theoretical component of adventure therapy. The ideas and thinking of Alfred Adler, Albert Ellis, Milton Erickson, William Glasser, Carl Jung, Abraham Maslow, Jean Piaget, Carl Rogers, B.F. Skinner, Fritz Perls, and Viktor Frankl all appear to have contributed to the thinking in adventure therapy. Adventure therapy is a cognitive-behavioral-affective approach which utilizes a humanistic existential base to strategically enact change through direct experience through challeng (Calver 1996; Gass 1993; Gillis and Thomsen, 1996; Itin, 1995; Kimball and Bacon, 1993; Nadler, 1993; Schoel, Prouty, and Radcliffe, 1988; Schoel and Maizell, 2002; West-Smith, 1997).

This theory, though, has been questioned extensively. These questions cover many issues. Blanchard (1993) states that with all the importance that is placed upon adventure therapy as a therapeutic intervention, the research is restricted to cooperation and trust, and even less research examines therapeutic techniques with adventure therapy and outcomes on pathology. The adventure therapy research field is having difficulty answering the basic questions of how, what, when, where and who. Further research on the standards, requirements, education, and training for individuals conducting adventure therapy is required (Blanchard, 1993). Ziven (1988) stated that the research is based upon the examination of self-concept and social adjustments. Cason & Gillis (1994) conducted a meta-analysis to statistically integrate all the available empirical research on adventure therapy. In total, 99 studies were located covering a 25 year span of research. Out of 99 studies located, only 43 studies fit the criteria for analysis. Many of the studies excluded were dissertations and the authors stated that dissertation studies did not accurately represent the field of adventure programming. The 43 studies used varied in design, methods, and treatment goals. They report that the limited amount of studies for their meta-analysis is proof of the limitations in the research in adventure programming.

The major theme of these questions about adventure therapy is effectiveness. A group has emerged arguing that before any other question in adventure therapy can be answered the question what are the properties that influence the effectiveness of adventure therapy must be answered. This group argues that theory driven research instead of outcome driven research will answer this question. Outcome driven research means that outcomes are the source of explanations for AT theoretical structure (Baldwin, Persing, and Magnuson, 2004). Outcome driven research has generated many conflicting findings that confuse theoretical structure and explanations of effectiveness (Baldwin, Persing, and Magnuson, 2004; Ringer & Gillis, 1996). The outcomes in adventure therapy research are linked to existing psychological theories of change to explain, modify, or validate AT theory. Ringer and Gillis (1996) refer to the theories of change as upwards of 400 forms of therapy and related practices that have emerged from a conglomeration of psychological theories. When outcomes are tied to existing psychological theories within the 400 forms of therapy it is impossible to understand the underlying influences of AT.

Baldwin, Persing, and Magnuson (2004) report that with all the research to date and the numerous reports of positive outcomes there is still little understanding of the underlying processes influencing these positive outcomes. This has caused extensive discussion concerning why adventure therapy appears effective in treating a multitude of DSM related mental disorders in children, adolescents, and adults (Blanchard, 1993; Gass, 1993, Gillis, 2000). Blanchard (1993), Davis, Berman, and Capone (1994), Gass (1993), Gillis (without year; 2000), Gillis and Thomsen (1996), Gillis and Mcleod (1992), Hatala (1992), Maizell (1988), Moote and Woodarski (1997), and Ziven (1988) have attempted to explain the underlying process to adventure therapy. Gillis (2000) describes adventure therapy as non-traditional therapy allowing for the pre-therapeutic adolescent to experience their mental health issues. Gillis (et al.) describes the following theoretical aspects of adventure therapy: 1) it is a physical augmentation to traditional therapy for the purpose of a shared history with the participants and the therapist, 2) there is a sense of natural and logical consequences in the activities, 3) environment should be structured into the activities, 4) a participant perceives risk, stress, and anxiety so the they can problem solve and generate their own sense of community for feedback and behavior modeling, 5) participants will transfer their present attitudes and behaviors into the activities, 6) works with a small group of participants, and 7) requires a facilitator that models appropriate behaviors and guides the group towards adaptive self regulation that is based upon appropriate behaviors.  Maizell (1988) focused on adventure therapy’s normalizing effects on deficits in delinquent adolescent’s developmental process. Maizell (1988) and Gillis and Mcleod (1992) report these normalizing effects as the process of moving into formal operational thinking which is achieved through the experiential learning theories in adventure therapy. Maizell (1988) further reports that a therapist holds the skills to make the adventure experience a therapy. Moote and Woodarski (1997), Blanchard (1993) and Davis, Berman, and Capone (1994) state the theoretical basis of adventure therapy describes the participant as a learning being who achieves their greatest learning outside the classroom, through challenge and perceived risk, promoting social skills through experiencing a group challenge mixed with affect, cognition, psychomotor activity and formal operational thinking generated through metaphor. Hatala (1992) states that experiential learning becomes adventure therapy when the activities are planned and implemented as vehicles for patients to address individual treatment goals. Hatala (1992) also theorized that adventure experiences molded into a more therapeutic group model ran by the therapist could have a more significant effect than the one day intervention run by counselors. Ziven (1988) describes the importance of having the clinician as an integral part of the adventure therapy process so that there can be a strong transference of the adventure experience to other aspects of the therapeutic process. Baldwin, Persing, and Magnuson (2004), though, report that many of these explanations are “…folk pedagogies…” that lack thorough empirical evidence (p. 172). Hattie, Marsh, Neill, and Richards (1997) report that adventure therapy research has focused on outcomes without exploring theoretical structure. They report that the focus of AT research needs to concentrate on testing and validating theoretical structure. Baldwin, Persing, and Magnuson (2004) further report that adventure therapy’s theoretical structure must be studied and documented. After a theoretical structure is validated then a discussion on outcomes can occur (Hattie, Marsh, Neill, and Richards, 1997).

Effectiveness
Even though there are certain arenas that question the theory of adventure therapy the practice of adventure therapy continues. The practice continues because of numerous reported positive outcomes in adventure therapy research. Davis, Ray and Sayles (1995) studied the effects adventure therapy on 266 high risk youth in rural areas. They reported lasting improvement in behavior over a six-month period. Haris, Mealy, Mathews, Lucan, and Monczygemba (1993) also report on adventure therapy effectiveness. They report that adventure therapy is effective because specifically designed activities can bring about specific outcomes. Adventure therapy is further viewed as effective because of the apparent positive effects in treating developmental issues with Juvenile offenders and adolescent offenders with drug abuse and addiction issues (Gillis & McLeod, 1992). The effectiveness of adventure therapy with offenders with drug abuse and addiction issues in mental health treatment is related to the characteristics present in addicted offenders. They “…(1) need more structure, [and] (2) they work better with an informal, tactile-kinesthetic design….” (Gillis & Mcleod, 1992, p. 151). Cason and Gillis’ (1994) findings are congruent with Gillis and Mcleod (1992) when they reported that adventure therapy as treatment was equally effective for adjudicated youth and other adolescent populations. Cason and Gillis (1994) report that 62.2% of adolescents who participated in an adventure therapy group are at an advantage for coping with adolescent issues than adolescents that did not. They also report that there is a 12.2% improvement in self concept for adolescents who participate in adventure therapy. Cason and Gillis (1994) likened their findings to a study by Smith, Glass and Miller (1980) who report that adolescents are approximately 30% better off in their ability to cope with mental health issues than those that do not participate in a psychotherapeutic treatment making the implication that adventure therapy effectiveness is comparable to the effectiveness of psychotherapeutic treatment. The reported concepts contributing to adventure therapy effectiveness are: increases in self esteem, self concept, self efficacy, self perceptions, problem solving, locus of control, behavioral and cognitive development, decreases in depression, decrease in conduct disordered behaviors, overall positive behavioral changes, improved attitude, and that adventure therapy generates a sense of individual reward. Further aspects that contribute to adventure therapy’s effectiveness are that it: increases group cohesion, aids in diagnosing conduct disorders in adolescents, improves psychosocial related difficulties, is effective in treating drug addicted and juvenile youth, treats sensation seeking behaviors, improves clinical functioning, facilitates connecting participants with their therapist and treatment issues, and increases interpersonal relatedness (Baucom, Gillis, Durden, Bloom & Thomsen, 1996; Gillis 1992; Burney 1992; Blanchard 1993; Dickens 1999; Gillis and Simpson 1992; Gillis, Simpson, Thomsen & Martin 1995; Gillis without year; Glass 1999; Moote & Woodarski 1997;  Newberry & Lindsay 2000; Parker 1992; Simpson & Gillis, without year;  Teaff & Kablach 1987; Ziven 1988). Berman & Davis-Berman (1995) compared the reduction in recidivism rates with traditional programs and programs with adventure therapy. They reported that programs using adventure therapy have lower recidivism. Lastly Blanchard (1993) and Ziven (1988) report increases in interpersonal relatedness, which they describe as the most important factor for improving mental health issues.

Conclusion
There are many agreements and disagreements within the field of adventure therapy. It does appear that there is agreement that adventure therapy is a mixture of psychological and learning theories. There are also agreements that adventure therapy is effective in treating a multitude of issues that affect an individual’s sense of self worth. There appears to be more disagreement though about how the properties within the exiting theory of adventure therapy actually influence the positive outcomes. Even with these many questions adventure therapy continues to be practiced within in many mental health arenas and viewed as an effective treatment based upon the positive outcomes reported in adventure therapy research.