Adventure Activities: Expeditions

Expeditionary activities involve outdoor experiences, both land or water based, aimed at utilizing natural environmental factors to support desired client change. These activities facilitate the initiation and integration of emotional or behavioral action toward achieving therapeutic goals. Existing in a community in the natural environment is a central component of the intervention, as well as reflection, solitude, and contemplation. Clients are removed from everyday distractions and are able to focus on basic needs, receiving feedback from the natural environment, peers and practitioners about their choices and the positive or negative consequences of those choices. Using the natural consequences and feedback from the environment are key components of using expedition activities as a therapeutic intervention.

In expedition activities, programs utilize wilderness expeditions in remote settings and treatment lasts anywhere from 7-60 days (Newes & Bandoroff, 2004). Program models vary greatly in length of program, structure and activities. Russell and Hendee (2000) identified four types of Outdoor Behavioral Health program models, including contained expedition programs, continuous flow expedition programs, base camp expedition programs and residential expedition programs. These interventions are believed to provide intensive treatment and produce dramatic change in a short period of time. They typically employ the teaching and practicing of wilderness skills as an important aspect of the intervention (Newes & Bandoroff, 2004) in addition to using the natural environment.

Reasons for Using Expedition Activities
It is important to be clear that this discussion is related to expedition activities utilized for the express purpose of changing dysfunctional problem behaviors in clients through clinically supervised interventions based on a quality assessment and developed treatment plan. The clinical goals addressed through expedition activities are varied, but frequently interconnected. For example, the interdependence required for survival and comfort on an expedition lends itself to encouraging develop effective problem solving and conflict resolution in order for the group to move forward in the expedition. Improved coping skills paired with increased self-efficacy provide a strong foundation for addressing treatment issues. The goals will often be similar to those of natural environment or high adventure activities, as these activities are often incorporated into expedition programming. The distinction of an expedition activity is the intensity and duration of the intervention, allowing for a different level of removal from mainstream society and resulting opportunities for contemplation and reflection.

Responsibility
The interdependence of the community in a wilderness setting highlights the importance of responsibility to one another. One way this is accomplished is the use of natural consequences. In an outdoor context, the results of choices become quite tangible. For example, if a client is responsible for setting up a personal shelter and chooses to do this well, then in the event that it rains, the client is rewarded for these efforts. Also, the community itself is an avenue for feedback, support and accountability as the group makes decisions together and must work through challenges together.

Self-Awareness
Clients are able to become more self-aware of the results of their own choices when the outdoor environment or activity provides feedback related to these choices. Clients are able to see the impacts of their behavior on themselves, others, and the environment. Clients are provided the opportunity to practice healthy functioning such as taking care of others and taking care of their own needs. Additionally, the environment does not include the distractions available in a client's daily life and can allow clients different opportunities for reflection than are found outside of the natural environment. The wilderness environment lends itself to reflection, contemplation and solitude as well as an enhanced connection to nature.

Self-Efficacy
In an outdoor context, skills mastery takes on a stronger sense of urgency as it relates to survival and management of the challenges of the environment. Learning new skills takes on increased importance in coping with the new setting. As clients are able to develop a level of mastery over these skills, they can experience increased feelings of pride and belief in their ability to achieve and to confront the issues that face them in their treatment process.

Coping Skills
Clients can become more aware of their manner of coping with challenges, evaluate the effectiveness of this coping based on feedback from the activity or environment, and practice functional methods of coping with challenges. The outdoor environment is one that cannot be controlled but can be managed effectively with training and experience. Practitioners provide a structure for operating within the environment that allow clients to learn how to respond. Practitioners do this by modeling with their own responses to challenges encountered and by empowering clients to make choices and experience the results of their choices. Practitioners provide the safety net while allowing clients to manage their environment in an effective way.

Relationship Building and Cooperation
Participating in expedition activities with another person creates a unique shared experience that can be given positive meaning attributions and enhance relationship development. Whoever participates typically must cooperate and trust one another in some manner as they create an interdependent group. This is an opportunity for clients and practitioners to apply and reinforce the behavioral expectations of the treatment environment and to practice social skills. Clients are involved in a community that must make decisions together, which fosters a sense of mutual aid. Sharing the challenges of the natural environment with practitioners can allow clients to engage in the therapeutic relationship in a less guarded manner.

Connection to the Natural World
While we often focus on the impact of challenge and adventure on client functioning, the natural environment in which many of these adventure-based activities take place is also an important component in the therapeutic change process. A recent study showed that "being in nature" was an equally powerful therapeutic component as challenge and adventure (Norton, 2007). This study also showed that a connection to nature provided clients with time for contemplation and gave them a context in which to reflect on the challenges they faced amidst various high-adventure activities. It is clear that the two - challenge and adventure & the natural environment - work together to provide opportunities for personal growth and change (Quinn, 1997;Powch, 1994; Arnold, 1994; Angell, 1994;Levitt, 1994; Miles, 1993; Nicholls, 2004; Pryor, 2003;Beringer, 200; Louv, 2008).

Practitioner Guidelines for Expedition Activities
Expedition activities require a great deal of clinical and administrative support in order to be managed safely and effectively. Practitioner guidelines related to all adventure therapy activities still apply, but there are some additional considerations when expedition activities are intentionally used with therapeutic populations. 

  • Practitioners complete a thorough assessment and planning process prior to engaging in expedition activities. Assessment should inform the planning process of the activities and include assessment of risk, clients, staff, and environment. Treatment objectives are healing and purposeful, not punitive. 
  • Practitioners and support staff must be adequately trained to manage the environment, clients, and activities as safely as possible. This includes advanced training in the activities, medical training, and adequate clinical training to work effectively with therapeutic populations to manage the treatment process effectively (Priest & Gass, 1997; Priest, 1997a; Raiola & Sugerman, 1997). 
  • As activities become more remote, practitioners must have increased levels of intervention knowledge to manage client issues that may arise. Practitioners in the field need to have reasonable access to clinical knowledge, support and resources when needed. 
  • Practitioners must work within their scope of practice and should be clear about what their scope of practice is. 
  • Practitioners must prepare clients to cope effectively with the challenges presented by activities. Clients should be screened for appropriateness and activities should be sequenced to allow clients to participate in a manner that supports them in progressing in their treatment(Priest, 1997b; Klint, 1997). 
  • Practitioners must plan activities that are appropriate for the staff and clients who will be participating. This means activities are carefully planned to intentionally support clients in reaching established treatment goals, land use rules are considered, and the practitioner or program is adequately equipped with equipment, safety management, and emergency response systems (Horwood, 1997; Priest, 1997c; Van der Smissen & Gregg, 1997). 
  • As activities increase in technical difficulty, the required knowledge and experience required of the client is also increased. This has an impact on decision making and outcomes for clients. Practitioners need to assess this dynamic throughout these experiences and respond accordingly to support client in progress toward treatment goals (Priest & Gass, 1997; Priest, 1997b; Klint, 1997). 
  • Practitioners maintain a focus on client treatment and facilitate in a manner that assists client in connecting behavioral and emotional responses to desired treatment outcomes. 
  • Practitioners should provide regular updates with client custodial body, if the client is a minor. For minor clients, family involvement in the treatment process is encouraged for maximum therapeutic benefit (O'Connell & Kutz, 2007). 
  • Practitioners maintain an appropriate treatment environment that incorporates a focus on physical and emotional safety. When allowing clients to experience natural consequences, a practitioner continues to reinforce a therapeutic treatment environment and adheres to the tenet to "do no harm." This means practitioners do not degrade, humiliate or harm clients. Clients must not be deprived of adequate food, water, or shelter required by the environment (O'Connell & Kutz, 2007). 
  • Allow time for reflection in nature, as the environment is a key reason for utilizing these activities (Miles, 1993; Nicholls, 2004). 
  • Practitioners must remember that the natural environment, while a comfortable setting for themselves, may be a very unfamiliar and threatening environment to the client. Cultural perceptions of "wilderness" must also be considered, and meeting basic needs must always be the central focus so that other, more higher level, therapeutic needs may be addressed (Lung, Stauffer & Alvarez, 2008; Mitten, 1994).