Environmental Context of Treatment

Diverse applications and settings for the use of adventure therapy are utilized within the United States (Gass, 1993; Newes & Bandoroff, 2004; Russell, 2002). This section explores environmental contexts through which AT may be applied. These contexts range from offering individual counseling in an office to spending 2 months on a wilderness expedition. The context selected will vary depending upon the initial and on-going assessment of the client. Environmental contexts are explored in this section to help the reader understand the venues through which AT may be used (Berman & Davis-Berman, 1994; Berman & Davis-Berman, unknown; Newes, 2000; Russell & Hendee, 2000; Gass, 1993; Gillis & Ringer, 1999).

Practitioners are required to observe state and national regulations related to their environmental contexts. Individual practitioners are expected to maintain state certification or licensure in their area of training. A practitioner providing mental health treatment is expected to be appropriately trained and licensed according to state requirements for the services being rendered.

It is important to note that this list is not exhaustive in terms of the wide range of environmental contexts used in adventure therapy. Home-based services, group homes, or more long-term care facilities are examples of contexts not described in detail but in which AT applications are being utilized. The intent is to demonstrate a variety of treatment contexts in which AT applications are found.

Schools

Numerous types of educational settings exist that utilize AT approaches to working with clients. Examples include traditional schools, day treatment programs, or therapeutic boarding schools. Applying AT in a school setting allows practitioners to address client issues in an environment clients are in on an almost daily basis. Clients are accessible in this environment and practitioners also have access to other important figures in the client's world, such as teachers, coaches, or peer groups.

Outpatient Treatment

Outpatient therapy is the treatment of an individual who does not reside in the setting where they are receiving treatment. The client is engaged in treatment sessions and then returns to his or her home system to test the skills learned within the outpatient context. This return to system allows the client to integrate treatment progress immediately into the home setting. Outpatient contexts are excellent venues for AT because the participant can return to the outpatient context and identify successes and failures of AT with his or her clinician. An advantage of AT is the richness of the parallel process that is possible between the action in the outpatient context and what occurs in the participant’s real life (systemic context) (Lung, Stauffer & Alvarez, 2008).

Inpatient Treatment

A client in inpatient treatment remains in a closed controlled system and receives services under the direction of a physician for at least 24 hours. This is often an intensive process whereby the participants are immersed in their treatment or recovery process. It is important to note that inpatient treatment is often focused on managing acute issues and is therefore a shorter process where the clients concentrate on stabilization. This is important because AT can support the clients in identifying acute stage issues and heighten awareness that are germane to their treatment. Due to the fact that inpatient work occurs in a closed controlled system, a therapeutic milieu can be developed with the potential to become a primary agent of change. AT can aid in the development and use of this milieu (Berman & Anton, 1988; Stich & Senior, 1984; Voight, 1988 in Gillis, 1992; Doherty, 1996; Gass, 1993)

Residential Treatment

Residential treatment is a structured out of home placement for clients experiencing behavioral and or emotional problems. Residential treatment facilities provide 24-hour care with trained staff offering mentorship, counseling and therapy. A client may need residential treatment for their own safety or the safety of others. As opposed to inpatient treatment, this environmental context generally provides a lower level of confinement and longer term of stay. Similar to inpatient treatment, AT is often used to develop the treatment milieu as a primary agent of change.

Residential treatment as an environmental context for AT can allow the practitioner to develop a deeper, longer term relationship with participants through the therapeutic milieu and extended stay. This structure allows for greater control of the treatment environment, which can enhance desired results. AT applications exist in residential facilities and in residential wilderness programs.

Wilderness Treatment

Wilderness treatment refers to using the outdoors and outdoor activities as an important context in the treatment process. This context is used within residential treatment programs, outpatient programs, schools, and stand-alone wilderness treatment settings. Clients may be traveling and immersed in the wilderness context or may be involved in a more base-camp focused experience. There are diverse program structures for using wilderness or the outdoors, but a key distinguishing factor for this context is that the outdoors or outdoor activity are specifically used to support the desired client change and that interventions are based on sound mental health practices. In wilderness treatment, work with clients is done in compliance with ethical standards and is not designed to be punitive in nature. The outdoor environment is utilized in creating a place for healing and healthy change (Miles, 1987).

The term "outdoor behavioral healthcare" has been used to describe wilderness treatment programs that are committed to upholding standards common to established mental health practice (Newes & Bandoroff, 2004; Russell, 2003). Outdoor behavioral health programs are designed to help participants change destructive, dysfunctional or problem behaviors through clinically supervised individual and group therapy, and an established program of educational and therapeutic activities in outdoor settings (Russell & Hendee, 2000). These programs utilize elements of wilderness treatment to focus client behavioral assessment and intervention by immersing participants in an outdoor environment involving group living, along with the above mentioned clinical oversight. They are designed to address problem behaviors by fostering personal and social responsibility and emotional growth (Russell, Hendee & Phillips-Miller, 2000). Although this setting has primarily been used with groups, there are also practitioners using this context for working with individuals and families (Bandoroff, 2005; Russell, 2000; Russell & Hendee, 2000; Russell, Hendee & Phillips-Miller, 2000; Newes, 2000; Friese, Hendee & Kinzinger, 1998; Rozak, 1992; Rozak, Gomes & Kanner, 1995).