By Dr Simon Crisp MAPS
Clinical Psychologist Faculty of Education Monash University
You can learn more about a person in an hour of play than in a year of conversation - Plato
Clinically, adolescents with mental health issues can be very difficult to work with due to the distinct developmental issues associated with this population. Nonetheless, and despite important differences, adolescent therapists have tended to persist with one-to-one psychotherapeutic approaches developed for adults. While we have produced developmentally appropriate therapies for children using play as therapy, it could be argued that an equivalent of play therapy for adolescents is adventure. This perfectly suits the developmental imperatives of adolescence: learning to take appropriate risks, mastery of real world problems that have tangible consequences, and refining one's judgment of one's own and other's capabilities and limits.
Estimates of compliance with adolescent treatments suggest that only one in two adolescents referred for therapy actually follow through or stay engaged with a professional for more than the first few sessions (Kazdin, 1995). Regardless of how effective treatments might be, if adolescents won't attend, then questions of efficacy are irrelevant. Adolescent treatments need to not only work, but must also be engaging - including not being detrimental in unintended ways, such as being stigmatising, or creating doubt about the benefits of psychological assistance.
Group adventure therapy
Wilderness Adventure Therapy (WAT) is a multi-systemic, group therapy intervention established in 1992 as a component of Australia's first clinical adolescent day-program at the Austin Health, Child & Adolescent Mental Health Service (Crisp & O'Donnell, 1998). Over the last five years it has also been implemented as an outpatient treatment, in sexual assault and substance abuse counselling services, and as an early intervention in schools. The intervention is a manualised, ten-week, part-time program where participants are clinically assessed prior to inclusion. The WAT practitioner accreditation scheme ensures that a team, comprising psychologists and qualified outdoor leaders, facilitate all components competently and ethically. A thoughtfully selected sequence of various adventure activities such as bushwalking, caving, rock climbing, abseiling, ropes course, cross country skiing, and white water rafting are combined with a 3-day and a 5-7 day bushwalking, ski-touring and snow camping or white water rafting expedition.
The selection and sequencing of activities aims to (a) maximise benefits from social interactions that occur at different group stages, and (b) target intra-personal therapeutic changes that arise in the different social-task contexts. For instance, during activities such as caving or rock climbing, group social support as well as cognitive anxiety management strategies are commonly the focus. Parents, teachers and support workers also participate in weekly in-door adventurous problem-solving activities incorporated within group therapy sessions. Simultaneous intervention in key domains of the adolescents' social environment ensures the generalisation and maintenance of therapeutic benefit in school and family contexts. The program concludes with a day of white-water rafting (or similar activity) where family-teacher-adolescent teams crew their own raft.
Research indicates wide-ranging benefits continuing for up to two years for a variety of mental health and behavioural disorders (Crisp & Hinch, 2004; Davis-Berman & Berman, 1994). In particular, when benchmarked against trials of cognitive behavioural therapy combined with anti-depressant medication (SSRIs) in adults with depression, WAT produces an equivalent rate and degree of symptom reduction in severely depressed adolescents (Crisp & Hinch, 2004). Further, results show many additional benefits that other therapies do not. For example, promotion of more effective coping, improved self-esteem, increased social connection to, and trust in others, and increased help-seeking and self-efficacy. Data also suggest the beneficial processes underlying WAT occur because the context allows for therapeutic social interactions and peer feedback to occur. Opportunities to help others, social inclusion and personal and group achievement are the reasons most often reported as to why WAT has been therapeutic (Crisp & Hinch, 2004).
WAT may appear to be daunting to implement, but this novel treatment brings great rewards, not least, witnessing the rapid way it can so positively and broadly impact upon the lives of very needy young people and their families.
For further information, contact the author on Simon.Crisp@education.monash.edu.au.
Crisp, S.J.R. & Hinch, C. (2004). Treatment Effectiveness of Wilderness AdventureTherapy: Summary Findings, Neo Psychology, Melbourne.
Crisp, S.J.R. & O'Donnell, M. (1998). Wilderness Adventure Therapy in developmental psychiatry. The Australian Journal of Outdoor Education, 3(1), 47-57.
Davis-Berman, J. & Berman, D.S. (1994). Two-year follow-up for the wilderness therapy program, Journal of Experiential Education, 17(1), 48-50.
Kazdin, A.E. (1995). Bridging child, adolescent and adult psychotherapy: Directions for research. Psychotherapy Research, 5(3), 258-277.