Wilderness therapy

wilderness therapy, outdoor therapy

Wilderness therapy is a form of experiential therapy that involves participants spending time in a natural outdoor environment, often for an extended period of time, while receiving therapeutic interventions. This form of therapy typically takes place in a wilderness setting, such as a national park, forest, or another remote area, and may involve participants living in tents or other temporary shelters.

The goal of wilderness therapy is to help individuals overcome emotional, behavioral, and mental health issues through a combination of physical activity, group therapy, and nature immersion. Participants are usually guided by trained therapists and outdoor experts who provide guidance and support throughout the program.

What is involved in wilderness therapy can vary depending on the specific program, but they often include hiking, camping, rock climbing, kayaking, and other outdoor activities. These activities are designed to challenge participants physically and mentally and to help them develop new skills, build confidence, and develop a sense of self-reliance.

Types of Wilderness Therapy programs

There are several types of wilderness therapy, each with its own unique approach and focus.

Some of the most common types of wilderness therapy include:
  • Adventure-based therapy: This offshoot of wilderness therapy involves outdoor activities that are designed to challenge participants physically and mentally, such as rock climbing, backpacking, and white-water rafting. The focus is on developing teamwork, communication, and problem-solving skills.

  • Equine-assisted therapy involves working with horses as a way to promote emotional and mental healing. Participants may learn to ride and care for horses, and develop a sense of trust and communication with the animals.

  • Horticultural therapy involves working with plants and gardens as a way to promote emotional and mental healing. Participants may learn to cultivate and care for plants, and develop a sense of connection with nature.

  • Experiential therapy: This style of wilderness therapy involves using the wilderness environment as a way to promote personal growth and self-awareness. Participants may engage in activities such as solo hikes or meditation, and have opportunities for reflection and introspection.

  • Residential wilderness therapy: Also known as wilderness expedition therapy, the individual lives in a wilderness setting for an extended period of time, typically several weeks to several months. Participants may engage in a variety of therapeutic activities and receive counseling and support from trained professionals.

  • Outward Bound: This type of wilderness therapy is a structured outdoor program that aims to promote personal growth and self-discovery through challenging physical and mental activities such as rock climbing, canoeing, and mountaineering. It often includes a focus on leadership and teamwork skills.

Difference between Wilderness Therapy and Adventure Therapy

Wilderness therapy and adventure therapy are both forms of therapeutic interventions that involve outdoor experiences, but they differ in their focus and approach.

Wilderness therapy involves using the natural environment as a therapeutic tool for individuals who are struggling with emotional, behavioral, or mental health issues. The stated goal of wilderness therapy is to promote personal growth, self-awareness, and emotional healing through the challenges and experiences of living and surviving in the wilderness. 

This therapy is typically guided by trained professionals who use a combination of individual and group counseling, experiential learning, and physical activities such as hiking, camping, and survival skills to help participants develop self-esteem, trust, communication skills, and problem-solving abilities.

Alternately, adventure therapy is a larger umbrella term that encompasses a variety of outdoor activities such as rock climbing, rafting, backpacking, and other outdoor activities. The focus of adventure therapy is to use these activities as a means of promoting personal growth and development, team-building, and self-discovery. Adventure therapy is typically more structured than wilderness therapy, with specific goals and objectives that are designed to help individuals develop skills such as leadership, communication, and teamwork.

Overall, the main difference between wilderness therapy and adventure therapy is that wilderness therapy uses the wilderness environment as the primary tool for therapy, while adventure therapy uses a variety of outdoor activities as a way to promote personal growth and development.

Development of Wilderness Therapy 

Wilderness therapy can be traced back to the mid-twentieth century, when outdoor experiences were first recognized as having therapeutic benefits for individuals with emotional and behavioral problems. The first formal wilderness therapy program, Outward Bound, was developed in the 1940s in England by Kurt Hahn and Lawrence Holt. Hahn was a German educator and founder of the Salem School, which was based on the philosophy of experiential education, while Holt was a teacher and sailor.

The first Outward Bound program was designed to help sailors who had been torpedoed during World War II, but the program soon expanded to include young people who were struggling with personal challenges such as lack of direction, low self-esteem, and behavioral problems. The program was based on the idea that challenging outdoor experiences could help individuals develop resilience, confidence, and problem-solving skills, which would translate into improved functioning in other areas of their lives.

Since then, wilderness therapy has evolved to cover a wide range of programs and interventions, each with its own unique approach and focus. Today, wilderness therapy programs are used to treat a variety of emotional and behavioral problems, including addiction, depression, anxiety, and trauma. They are designed to provide individuals with a safe and supportive environment in which to learn new skills, develop self-awareness, and practice healthy behaviors.

Therapy techniques

Wilderness therapy takes place in natural settings such as forests, mountains, and deserts. The goal of wilderness therapy is to use nature as a tool to facilitate personal growth, self-awareness, and positive change.

Here are some of the techniques commonly used in wilderness therapy:
  • Outdoor activities: Wilderness therapy often involves activities such as hiking, camping, rock climbing, and canoeing. These activities provide opportunities for individuals to challenge themselves, build resilience, and develop confidence.

  • Group therapy: Participants in wilderness therapy often participate in group therapy sessions with a trained therapist. Group therapy can provide opportunities for individuals to connect with others, share their experiences, and receive support.

  • Individual therapy: In addition to group therapy, individuals may also receive one-on-one therapy sessions with a therapist. These sessions can provide a safe and supportive space for individuals to explore their feelings, thoughts, and behaviors.

  • Mindfulness practices: Wilderness therapy often incorporates mindfulness practices such as meditation and yoga. These practices can help individuals develop greater self-awareness, reduce stress and anxiety, and improve their overall well-being.

  • Experiential learning: Wilderness therapy often involves experiential learning, where individuals learn through hands-on experiences. For example, participants may learn about teamwork and communication while navigating a challenging hiking trail.

  • Reflection and journaling: Participants may be asked to reflect on their experiences in nature and journal their thoughts and feelings. Reflection and journaling can help individuals process their experiences and gain greater insight into themselves.

Effectiveness of Wilderness Therapy

Wilderness therapy has been found to be effective for treating adolescent substance abuse. A systematic review of 13 studies found that wilderness therapy was associated with reduced substance use and improved mental health outcomes in adolescents with substance use disorders.

Additionally, it has been found to be effective for reducing symptoms of anxiety and depression. A study of 53 adults with anxiety and depression found that wilderness therapy was associated with significant reductions in anxiety and depression symptoms. In general wilderness therapy has been found to be effective for improving social skills and interpersonal relationships. A study of 45 adolescents with behavioral problems found that wilderness therapy was associated with significant improvements in social skills and relationships with family members.

Wilderness therapy has been found to be effective for improving self-esteem and self-efficacy. A study of 117 adolescents with behavioral problems found that participating in wilderness therapy was associated with significant improvements in self-esteem and self-efficacy.

Downsides of Wilderness Therapy

While wilderness therapy can be an effective approach for some individuals, there are also some limitations to consider.

Here are a few potential limitations of wilderness therapy:
  • Limited generalizability: The skills and insights gained through wilderness therapy may not always generalize well to everyday life. Individuals may struggle to apply what they have learned in the wilderness to their daily lives and may require additional support or therapy to transfer these skills to other contexts.

  • Lack of diversity: Wilderness therapy programs may not be accessible or culturally appropriate for all individuals. Some people may not have the physical ability or financial resources to participate in outdoor activities, and some cultural groups may not have a tradition of outdoor recreation.

  • Safety concerns: Wilderness therapy involves inherent risks associated with outdoor activities, such as exposure to inclement weather, accidents, and injuries. It is important for wilderness therapy programs to have safety protocols in place and to ensure that participants are physically and mentally prepared for the challenges of the wilderness.

  • Limited research: While there is some evidence to suggest that wilderness therapy can be effective, there is still relatively limited research on the topic. More studies are needed to fully understand the potential benefits and limitations of wilderness therapy.

  • Limited regulation: Wilderness therapy is not regulated in the same way that traditional therapy is, which can make it difficult for individuals to determine the quality and safety of different programs. It is important to research and select a reputable and accredited program.

Wilderness Therapist training

Wilderness therapy combines traditional talk therapy with outdoor activities and wilderness expeditions. To become a wilderness therapist, individuals typically need to have a background in mental health counseling, psychology, social work, or a related field. In addition, specialized training and experience in wilderness therapy are essential.

Here are some of the specific training and qualifications a therapist may need to become a wilderness therapist:
  • Wilderness training: Wilderness therapy typically involves activities such as camping, hiking, rock climbing, and other outdoor adventures. As such, a therapist must have experience and training in wilderness safety, navigation, and survival skills. Wilderness First Responder (WFR) certification may also be required.

  • Therapeutic training: A wilderness therapist should have a strong foundation in traditional counseling or psychotherapy. This includes a graduate degree in a related field, such as psychology or social work, and experience providing therapy to clients.

  • Specific certifications: Many wilderness therapy programs require therapists to have specialized certifications, such as Certified Outdoor Therapist (COT), Wilderness Therapy Field Guide (WTFC), or Certified Adventure Therapist (CAT). Different programs may have different requirements so it is best to do some research into what you are looking for prior to seeking out certifications. 

  • Experience working with youth and families: Wilderness therapy often involves working with adolescents and their families. While some wilderness programs are for older adults, this is generally not the case. A therapist should have experience working with these populations and be comfortable managing challenging behaviors and emotional issues.

  • Understanding of ethical and legal considerations: As with any therapy, a wilderness therapist must adhere to ethical guidelines and laws. Individuals seeking to be a wilderness therapist should have an understanding of these considerations and be able to navigate them effectively.

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Billing for Wilderness Therapy 

Wilderness therapy encompasses a wide range of activities, some of which may be covered by insurance and some of which may not be. Wilderness therapy programs often charge a flat fee that covers the cost of the program. This fee may cover expenses such as transportation, food, lodging, and therapeutic services. Insurance may cover some aspects and leave others to be paid out of pocket by the individual receiving services. 

While there is no specific CPT code for wilderness therapy, services provided during wilderness therapy may be billed using several different codes depending on the specific services provided.

For example, if a therapist provides individual or group therapy during a wilderness therapy session, the CPT code for the appropriate psychotherapy may be used (90832 for a 30-minute session or 90834 for a 45-minute session). Additionally, if the program includes medication management services, the CPT codes for evaluation and management services (99201-99499) may be used.

It is important to note that billing for wilderness therapy can be complex, and it is recommended that you work closely with the program and your insurance provider to understand the costs and billing process. Additionally, it may be helpful to consult with a financial advisor or therapist who specializes in wilderness therapy to help you navigate the financial aspects of the program.


Outdoor Behavioral Healthcare Council (OBH): The OBH is a professional association that represents the wilderness therapy industry. Their website provides information on industry standards, research, and best practices for wilderness therapy programs.

Association for Experiential Education (AEE): The AEE is a non-profit organization that promotes experiential learning and education. They have resources on adventure therapy, outdoor education, and other experiential learning programs.

National Association of Therapeutic Schools and Programs (NATSAP): NATSAP is an organization that represents therapeutic schools, programs, and services. Their website includes information on wilderness therapy programs and resources for families seeking treatment. Additionally, there is a wealth of information for therapists seeking certifications or additional knowledge. 

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