All learning is experience-based. Whether we hear a lecture, read a book or watch a video, our learning is based on those experiences. Most people remember 20 percent of what they hear, 50 percent of what they see, and 80 percent of what they do (Gass, 1993).

For treating adolescents with emotional, behavioral, and substance abuse disorders, experiential or adventure-based psychotherapy, with its hands-on approach, can be an effective treatment choice. The method focuses on creating personal change through learning by doing. It presents opportunities for trust and personal growth to help teens experience feelings of self-worth, to assume responsibility for their own actions, and to internalize new coping skills. The use of the outdoors as a mental health treatment setting began as early as 1901 with a tent therapy program for state hospital patients during summer months. The program was effective but gains were short-lived, as patients were returned to hospital units with the onset of colder weather (Davis-Berman & Berman, 1994).

By the mid-1940s, programs placed more emphasis on camping as therapy. These camp programs provided insights still relevant today, including the importance of the natural environment as a place for participants and staff to relate to one another in a physically active way, so the focus is not solely on talk; the use of group process to facilitate change; the stability of change over time; and the establishment of training models for counselors. The 1960s and 1970s saw the growth of Outward Bound, with an outdoors activities-based learning focus that effectively paralleled the therapeutic objectives of more traditional mental health providers (Davis-Berman & Berman, 1994).

Currently, three prominent designations are used to refer to activity-based therapy. All of them subscribe to the philosophy of hands-on learning, but can vary in activities (the second two listed are slight variations of the first):

• Experiential therapy is founded learning through active doing. Experience-based learning (action alone) becomes experiential therapy by adding an examination of the experience’s process (reflection); when change obtained in the process is recognized in another situation (transfer); and when time, resources and additional opportunities permit individuals to maintain or continue changing (support). Experiential therapies include music, art, psychodrama, and outdoor activities (Gass, 1993).
  
• Adventure therapy is a subset of experiential therapy where the outcome of the experience is uncertain and may contain physical, emotional, and social risks. Direct participation requires participants to use their competence to face their fears of the risks and to resolve the uncertainties of the outcomes. In dealing with these challenges and by turning perceived limitations into abilities, participants learn about their relationships with others and themselves. Adventure therapy focuses on activities such as initiative games, ropes courses, hiking, backpacking, rock climbing, canoeing, rafting, and journal writing. It is important to note that not all of the activities practiced must be high risk. Also, when a perceived risk is called for, the difference between perceived and actual risk can be great if proper safety measures are taken (i.e., proper use of a ropes course) (Gass, 1993).
  
• Outdoor behavioral health (OBH) uses a wilderness challenge model in which the participants spend an extended time in a camping environment while participating in adventure therapy. While the activities basically follow the adventure therapy model, it is the extended outdoor stay that is significant. OBH is regarded more as a type of treatment, such as outpatient treatment or residential treatment, rather than a treatment approach, and includes Outward Bound programs (Russell, 2003).

It is important to note that none of these three include the boot-camp approach that follows a military model. Boot camps break down individuals through aggressive physical and emotional confrontation, then build them back up to be more compliant (Mitchell, MacKenzie, Gover & Styve, 1999). Recent research has shown that, while the military structure of boot camps sometimes can build acceptance of rules and routine, boot camps are not effective in treating adolescents with behavioral and substance abuse disorders (Pearson & Lipton, 1999).
Whatever the title of the program, the field of experiential/adventure treatment has recognized the importance of formal regulation of such programs. Currently, three primary organizations oversee the industry, providing guidelines, certification, and outcome studies: the Association for Experiential Education (www.aee.org); the Wilderness Education Association (www.weainfo.org); and the Outdoor Behavioral Healthcare Industry Council (www.obhic.com).

Why this approach?
A growing body of research points to positive results from incorporating experiential/adventure activities into psychotherapy treatment. In fact, this approach can help overcome challenges posed by at least three aspects of traditional therapy. First, verbal exchanges between therapist and client require cognitive, verbal, and symbolic channels. This is not always an effective way of reaching all types of people, especially adolescents who may still be developing verbal skills or do not communicate well with adults. Also, adolescents with attention deficit disorder (ADD) can have difficulty focusing on verbal stimuli and may not respond well to traditional therapy (American Psychiatric Association, 1994). Second, traditional therapy usually occurs within the confines of an office for a set amount of time of about 45-50 minutes. It is not unusual for patients to drop a bombshell on their way out the door, leaving no immediate opportunity for response or follow-up. The third limitation is deinstitutionalization. While fewer people are hospitalized today in state hospitals, admissions have increased in general and private psychiatric hospitals (Keisler and Sibulkin, 1987). However, medical insurance plans have reduced the length of stay for psychiatric admissions, creating a need for effective alternatives to traditional health care, particularly for adolescents.
In contrast to traditional therapy, experiential/adventure programs focus on action events that involve the individual in doing rather than talking. These action events are grouped into four types of programs:

1. Recreational — designed to change how people feel (to entertain, re-energize, relax, socialize, teach and learn new skills)

2. Educational — intended to change how people feel and think (to gain awareness of needs, add knowledge of new concepts, understand new ways to view old or familiar concepts)

3. Developmental — designed to change the way people feel, think, and behave (by increasing positive functional behavior, improving interpersonal and intrapersonal relationships)

4. Redirectional — intended to change the way people feel, think, behave, and resist (by decreasing negative dysfunctional behavior, reducing opposition and denial) (Priest & Gass, 1997)

A primary purpose of exper-iential/adventure therapy is to provide a psychotherapeutic approach for participants needing to change behaviors and to enable them to move beyond the emotional limits they have placed on themselves (Datillo, 2000; Gass, 1993; Luckner & Nadler, 1997; Rohnke, 1989). Also, meanings derived from such experiences must be incorporated back into the participant’s daily life (Datillo, 2000; Gass, 1993). This incorporation, or Transfer of Learning, is accomplished through a four-step learning cycle of (1) experiencing outdoor activities, personal and group challenges; (2) reviewing the experience; (3) concluding, or using models and theories to draw conclusions from past and present experiences; and (4) planning, or applying new learning from previous experiences (Gass, 1993).

Experiential/adventure programs also can be effective in helping to create a strong family component, which is key to achieving long-lasting positive behavior change in adolescents. Therapists have long been aware of the strong link between conflicted parent-adolescent relationships and adolescents evidencing higher alcohol and drug abuse, as well as depression, delinquency, sexual promiscuity, and lower school performance. In an examination of family communication, negotiation, and conflict resolution, Huff, Widmer, McCoy, and Hill (2003) found that higher levels of challenging activities provided greater opportunities for increased communication within the family. While conflicts arose between parents and adolescents during the experience, participants reported that their ability to solve family problems increased (Huff et al., 2003).

Empowering teens

The number of case studies that support the effectiveness of experiential/adventure programs is increasing. Regarding psychological empowerment, which is the process by which people create or are given opportunities to take control of their own future and influence the decisions that affect their lives (Perkins & Zimmerman, 1995), Mitten (1992) reported that female adolescents in an outdoor recreation program experienced an increase in self-esteem and gained a sense of empowerment. The girls discovered new coping skills, learned to work as a team, trusted themselves and their group members, and increased their contribution to group success.

Along with empowerment, experiential/adventure therapy can promote accountability, which is a key treatment component for maintaining lasting positive change in adolescents (and people of any age) who are dealing with mental health issues and/or addictions. A wide variety of adolescent treatment programs incorporate experiential/adventure programs. Some focus solely on substance abuse while others offer a full menu of therapy services, addressing such single or co-occurring issues as ADD, depression, anxiety, obsessive compulsive disorder, eating disorders and self-harm behaviors. To learn more about a specific credentialed adolescent programs that have been reviewed by a respected source, visit www.strugglingteens.com, a clearinghouse for adolescent treatment services.

Vicky J. Coons, MS, Certified Recreation Therapy Specialist, is an experiential therapist for the Child & Adolescent Center at Rogers Memorial Hospital in Oconomowoc, WI. For information, call 800-767-4411 ext. 309.

References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA.
Brody, G. H., Flor, D. L., Hollett-Wright, N., McCoy, J. K., & Donovan, J. (1999). Parent-child relationships, child temperament profiles and children’s alcohol use norms. Journal of Studies on Alcohol, 13, 45-51.
Datillo, J. (2000). Facilitation techniques in therapeutic recreation. State College, PA: Venture Publishing.
Davis-Berman, J., & Berman, D. S (1993). Therapeutic wilderness programs: Issue of professionalization in an emerging field. Journal of Contemporary Psychotherapy, 23, (2):127 134.
Davis-Berman, J., & Berman, D. S. (1994). Wilderness therapy: Foundations, theory and research. Dubuque, IA: Kendall/Hunt.
Gass, M.A., Ph.D. (1993). Adventure therapy: Therapeutic applications of adventure programming. Dubuque, Iowa: Kendall/Hunt Publishing Company.
Huff, C., Widmer, M., McCoy, K., and Hill, B. (2003). The Influence of Challenging Outdoor Recreation on Parent-Adolescent Communication. Therapeutic Recreation Journal, First Quarter 2003, 18-37.
Keisler, C., and Sibulkin, A. (1987). Mental hospitalization. Newbury Park, CA; Sage Publications.
Mitchell, O., MacKenzie, A. R., Gover, A. R., & Styve, G. J. (1999). The environment and working conditions in juvenile boot camps and traditional facilities. Justice Research and Policy, 1(2), 1-22.
Mitten, D. (1992). Empowering girls and women in the outdoors. Journal of Physical Education, Recreation, and Dance, 63, 56-60.
Nadler, R., & Luckner, J. (1992). Processing the adventure experience: Theory and practice. Dubuque, IA: Kendall/Hunt.
Pearson, F. S., & Lipton, D. S. (1999). A metal-analytic view of the effectiveness of corrections-based treatment for drug abuse. The Prison Journal, 79(4), 384-410.
Perkins, D. D., & Zimmerman, M. A. (1995) Empowerment theory, research and application. American Journal of Community Psychology, 23, 569-579.
Priest, S. & Gass, M.A. (1997). Effective leadership in adventure programming. Champaign, IL: Human Kinetics.
Rohnke, K. (1989). Cowstails and cobras II: A guide to games, initiatives, ropes courses, and adventure curriculum. Dubuque, IA: Kendall/Hunt Publishing.

This article is published in Counselor,The Magazine for Addiction Professionals, April 2004, v.5, n.2, pp. 42-44.

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