BENEFITS AND PRACTICES OF ADVENTURE THERAPY FOR ADULTS By MICAELA KLUTZ A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF BACHELOR OF INTERDISCIPLINARY STUDIES We accept this thesis as conforming to the required standards: _________________________________________ Craig Campbell (MA), Thesis Supervisor, Dept. Adventure Studies _________________________________________ Jeffrey More (MSW), Dept. School of Social Work __________________________________________ Jay Goddard (M.Ed.), Dept. School of Human Services __________________________________________ Annette Dominik (Ph.D.), Co-ordinator, Interdisciplinary Studies Dated this 20th day of April 2020, in Kamloops, British Columbia, Canada i ABSTRACT How does a secure wilderness environment, where one feels safe and all needs are met, affect one's mental state? Building on this topic, what are some effective practices used to achieve a positive impact on one's mental state? Through further understanding of this topic, we can better design effective programs for facilitating therapy within a wilderness setting that would most benefit the participants. There are many benefits of adventure therapy including the presence of a wilderness environment and the use of adventure activities. These factors help to increase the effectiveness of the therapy sessions given in these programs. Currently, there is very little research available as to what are the most effective practices for adventure therapy programs. To gain a better understanding of the practices and techniques that are currently being used, a short questionnaire was sent out to Canadian adventure therapy companies. Data from this questionnaire and the literature showed that hiking is the most effective activity to use in adventure therapy programming. As well, the ideal length of a trip can vary for markets but ranges from 1 to 10 days. The ideal group size also varies with the market and can be anywhere from 4-10 participants with a ratio of 2:1 participants to instructor or higher for more independent markets. Overall, there are many different markets that can benefit from adventure therapy and the exact programming will shift to best suit each market. Thesis Supervisor: Craig Campbell ii ACKNOWLEDGEMENTS I wish to thank all the people whose assistance was a milestone in the completion of this project. First off, my supervisor, Craig Campbell, who originally gave me the idea for this project and has continued to support me throughout the entire process. As well, I appreciate the individuals and companies that took the time to participate in my study and provide me with valuable information. I would also like to thank my family and friends who showed continued encouragement and faith. Without these people, I would not have been able to complete this project. iii TABLE OF CONTENTS ABSTRACT ii ACKNOWLEDGEMENTS iii TABLE OF CONTENTS iv LIST OF TABLES vii 1.0 INTRODUCTION 1 2.0 LITERATURE REVIEW 5 2.1 BENEFITS OF ADVENTURE THERAPY 5 2.1.1 Benefits of the Wilderness Environment 6 2.1.2 Benefits of Adventure Activities 11 2.1.3 Conclusion 16 2.2 PRACTICES OF ADVENTURE THERAPY 17 2.3 ADULT PROGRAMMING COMPARED TO YOUTH PROGRAMMING 23 3.0 ANALYSIS OF CURRENT PRACTICES UTILIZED IN CANADIAN ADVENTURE THERAPY PROGRAMMING FOR ADULTS 26 3.1 INTRODUCTION 27 3.2 METHOD 27 3.2.1 Participants 27 3.2.2 Procedure 28 3.3 RESULTS 3.3.1 Question 1: What market do you run trips for? 29 29 iv 3.3.2 Question 2: What adventure activities have you found to be most effective to facilitate on your trips? For example, hiking or canoeing. 30 3.3.3 Question 3: What do you find is the ideal length for trips? 31 3.3.4 Question 4: What is the ideal group size of participants on your trips?31 3.3.5 Question 5: What is the ideal ratio of participants to leaders? 32 3.3.6 Question 6: How many touch points with participants are needed to make progress? 33 3.3.7 Question 7 & 8: What’s one thing that you think really makes a difference on your trips? What other strategies do you find make your program successful? 34 4.0 DISCUSSION 37 4.1 MARKET 37 4.2 ACTIVITIES 39 4.3 TRIP LENGTH 42 4.4 GROUP SIZE 43 4.5 RATIO OF PARTICIPANTS TO LEADERS 44 4.6 TOUCHPOINTS 45 4.7 STRATGIES FOR FACILITATING PROGRAMMING 46 5.0 CONCLUSION 48 REFERENCES 51 APPENDIX 54 CONSENT FORM AND QUESTIONNAIRE USED FOR RESEARCH 54 ETHICS APPROVAL 57 v GLOSSARY OF TERMS 58 vi LIST OF TABLES Table 1 Adventure Activities used by Canadian Adventure Therapy Companies in Adult Programming 29 Table 2 Length of Trips Offered by Canadian Adventure Therapy Companies for Adult Programming 30 Table 3 Ideal Group Size Used by Canadian Adventure Therapy Companies for Adult Programming 31 Table 4 Ratio of Participants to Leaders Used by Canadian Adventure Therapy Companies for Adult 32 vii 1.0 INTRODUCTION In the literature, many different terms are used to describe adventure therapy programming. Terms such as wilderness therapy, therapeutic adventure, adventure-based counselling, and various others are used to refer to the same type and style of program. Within the literature, the name of the program used appears to differ between countries. For example, Australia often uses bush adventure therapy and the United States often uses outdoor behavioural health care or wilderness therapy (Ritchie, Patrick, Corbould, Harper, & Oddson, 2016). All of these terms refer to the same type and style of program. This paper will refer to this field of practice as adventure therapy. It is important to note that this paper was written without technical knowledge in counselling or social work. The focus is from a wilderness guide perspective. Research was done on adventure therapy specifically without delving to deeply into the vast topic of counselling and therapy. Michael Gass defines adventure therapy as “the prescriptive use of adventure experiences provided by mental health professionals, often conducted in natural settings that kinaesthetically engage clients on cognitive, affective, and behavioural levels” (Gass, 2012). Adventure therapy is a type of therapy that is conducted in the wilderness environment and incorporates adventure activities. It involves a group of participants that desire guidance and assistance in managing personal issues. 1 The overall goal of adventure therapy is to provide the participant with the tools and skills to address underlying concerns or trauma (Ritchie, et al. 2016). It can be used for individuals, groups, and families and can assist in reaching goals such as fostering personal development. It is also used for more intense therapeutic situations such as managing addictions, PTSD, trauma, or other personal struggles. The programming focuses on establishing an opportunity for the participant to adjust their current and future functional behaviour (Gass, 2012). This is achieved through the use of a strong ethic of care and maintaining support throughout the therapeutic experience (Gass, 2012). A strong ethic of care is particularly important due to the use of unfamiliar experiences in adventure therapy. This form of therapy utilizes a positive influence of nature in the therapeutic healing process (Gass, 2012). Adventure therapy provides the active and direct use of client participation and responsibility in their therapeutic process (Gass, 2012). This program uses physical activity and group work to help communicate the therapy sessions. The environment used allows for the participants to connect genuinely to the therapy sessions. This technique provides the opportunity for the information given in the therapy sessions to resonate deeply with the clients. In this type of programming participants are also given the opportunity to implement new skills or techniques immediately after learning them. Adventure therapy program can be utilized by various target markets. Overall, these programs can benefit anyone. However, these programs are aimed towards people who have experienced some sort of trauma or those in need of psychological assistance. This vulnerable population may include military veterans, people with substance addictions, childhood trauma 2 victims, survivors of sexual abuse or domestic violence, or anyone seeking therapy. As well, adventure therapy is not only for those who are physically fit or have experience operating in the outdoors. Previous experience is not necessary to participate in this type of program. When working with vulnerable populations it is important to establish a critical theory orientation to address any type of systemic oppression or discrimination. Having proper training and expertise is essential when instructing an adventure therapy program with marginalized individuals. There are many benefits to adventure therapy programming. Using adventure activities within a wilderness environment effectively incorporates a positive use of stress through the presence of risk (Gass, 2012). The intent is to place the participant in an unfamiliar environment and assist them in adopting different perspectives. Their involvement in adventure experiences is very meaningful for the participant, particularly in terms of natural consequences (Gass, 2012). They are provided with the opportunity to receive immediate feedback for their actions. As well, the presence of a wilderness environment contributes to the healing process in a positive way. Currently in Canada, there is no governing body for adventure therapy (Ritchie, et al. 2016). Despite this, adventure therapy is increasing in popularity and may start to receive more attention and regulation. Right now, each company establishes programming based off of the small amount of literature available on this topic, their own research, and past experiences of trial and error. There is an organization called International Adventure Therapy that offers information on the practices and values being used in adventure therapy around the world. This is not a government body but is a valuable resource and an international standard of practice (Adventure Therapy International Committee, 2020). 3 The overall process of adventure therapy programming is to have each activity slowly increase in difficulty, ending with a final task that incorporates skills the participants gained in the previous activities. Adventure therapy can also be offered in, or as, different sections (Reintegration Through Sport, 2018). These sections of programming can be offered in one program where they are all integrated together, or these sections can be offered as separate programs or trips. One section of this programming is focused on prevention, where the participants build skills to keep themselves healthy. Activities can involve learning basic skills such as cooking or establishing strategies to avoid drugs or alcohol. The next section is early intervention where the participant is placed in the program before a disorder or dysfunction has developed. This is done in an act of prevention. The next section is treatment. This programming is designed for those struggling with their mental well-being and are in need of assistance and treatment. The last section is continued care. This programming occurs after treatment and is designed to assist the participants with maintaining their health and positive habits (Reintegration Through Sport, 2018). More research is emerging on the topic of Adventure therapy but currently, the research picture is not as well developed as compared to other forms of therapy. To gain a better understanding of the practices and techniques Canadian adventure therapy companies are currently using, a short questionnaire was sent out. This questionnaire was then completed by the program manager at various companies that offer programs for adults. This research aims to 4 determine a general set of effective practices based around group size, activities used, length of trip, and how many trips are the most beneficial to the participants. Establishing an understanding of what practices are the most effective in adventure therapy programming will allow for the construction of programs that will provide the most benefit to the participant. So how does a secure wilderness environment, where one feels safe and all needs are met, affect one's mental state? Building on this topic, what are some effective practices used to achieve a positive impact on one's mental state? Through further understanding of this topic, we can better design effective programs for facilitating therapy within a wilderness setting that would most benefit the participants. 2.0 LITERATURE REVIEW 2.1 BENEFITS OF ADVENTURE THERAPY There are many aspects of adventure therapy that make it a beneficial experience for the participants. Especially through the integration of both the wilderness environment and adventure activities. These aspects create a unique and complex environment that allow the participants to fully experience the therapeutic process. One unique aspect of the wilderness is that it helps to create an uncomfortable and new environment for the participant. It can remove them from their everyday life and introduces them 5 to new experiences and perspectives where they develop skills and confidence. In some ways this can be similar with other types of therapy as every participant has a different version of normal. This environment helps to effectively deliver therapy sessions. The wilderness, which is a state of nature, also plays a significant role in the healing process. Along with disrupting the participants daily routine, it provides an ideal environment for personal reflection. This environment and structure allow the participant the opportunity to contemplate their life and the challenges they are facing in a safe setting (Russell, Gillis, & Kivlighan, 2017). An adventure activity involves an element of risk, physical activity, and participation from the client. Some common adventure activities include hiking, canoeing, kayaking, snowshoeing, skiing, and camping. By involving the element of risk, they receive immediate feedback with every action they take. The experience becomes real for the participant and the skills developed can be applied to other life events. As well, adventure activities often involve group work and the need to operate as a team in order to successfully complete the task. This helps to build common life skills such as communication. These activities provide an interactive approach to delivering therapy sessions and teaching valuable skills that could be used in their daily life (Gass, 2012). 2.1.1 Benefits of the Wilderness Environment A secure wilderness environment involves a location outdoors, away from most urban developments, where the participant feels safe, and all their basic needs are met. This can be anywhere from a half hour drive out of the city, to a seven-day hike into the backcountry. The 6 location of the wilderness used for programming also depends on what is available. For example, Canada tends to use expedition style trips, where the participants journey into the backcountry, due to the vast amount of wilderness available (Ritchie, et al. 2016). The natural environment used for the program does not need to be absent of all amenities. Often for adventure therapy programs designed for youth, they are taken into the backcountry on self-sufficient trips where there are no roads, running water, or electricity. For adults, depending on the market, it can be more constructive to have some basic comforts such as a cabin with a bathroom, kitchen, and bed. One main factor, for both youth and adults, however, is that these environments involve minimal technology. This means no Wi-Fi, cell service, or television. These products provide distraction, connection to their life outside the program, and, more often than not, they create stress. Research has shown that excessive screen time can cause depressive symptoms, poor sleep quality, ADHD-related behaviour, antisocial behaviour, and multiple other negative psychological symptoms (Lissak, 2018). Providing an environment away from these devices allows the participant to experience a break from these symptoms. Without these symptoms and the distractions related to technology, the participant is able to build psychological resilience and other useful skills to manage personal stress and challenges (Lissak, 2018). It is also important that the participant feels a sense of security within the environment. If they are continually stressed about their safety and security, they will not be able to absorb the therapy sessions. To ensure the participant is able to function easily within this new environment, the instructors facilitate education sessions around what to wear, how to pack, and any other task 7 that is different than in everyday life. The aim of this specific environment is to create a connection between the participant and nature, disrupt the day-to-day routine of the participants, and take them outside of their comfort zone. The strict parameters of this environment allow them to fully experience the adventure therapy program and receive the most benefit (Gass, 2012). This intentionally therapeutic environment often places participants outside their comfort zone. Therefore, this environment creates an atmosphere where, in most cases, the participant puts trust into the instructor to keep them safe and looked after. Whereas if the participants were within their comfort zone, they would more likely feel confident in their ability to look after themselves. Ultimately, they may have less motivation to listen to, engage with, and trust their instructors. A trusting relationship where participants listen to their instructor provides an excellent platform to discuss more sensitive topics such as mental health, bad habits, or temperament (Johnson, 2018). If a participant has a traumatic interpersonal history, where is it difficult for them to trust others, this environment may not increase the trust between the participant and instructor. However, it will still place the participant outside of their comfort zone provoking a situation where they must work with others is a constructive way. One benefit of having the participant in an unfamiliar environment is that they are more likely to try something new, such as adopting a new perspective on their issues or engage in a challenging activity. In the wilderness, people have little control over the environment around them. This encourages them to relax and experience the world in a different way. (Reintegration Through Sport, 2018). If the whole situation is new to them, it is less intimidating. Being in an 8 unfamiliar environment also helps them let go of the things they cannot control in their everyday life. As they discover they can function in an environment where they are unable to control what they may wish they could control and develop new skills. Overall, this helps to reduce the stress and anxiety levels in the participant and gives them a new perspective to utilize when they finish the program. This feeling of little control that is involved in adventure therapy programming encourages the participants to focus on what they can control. This includes their emotions and perspectives. Learning how to control one’s emotions and thought processes are effective coping skills for many other issues in life. By having participants in an unfamiliar environment, there is a higher chance that they will cease old habitats and become more able to adopt new, healthier habits and perspectives (Bastemur, 2019). There is increased difficulty to make changes to one’s habits when there is a routine that is followed. Adventure therapy provides an opportunity to disrupt an unhealthy routine and offer the opportunity to form new, healthy practices. There is always a chance that once the participants finish the program and return to their routine, that they will return to their previous unhealthy practices. Therefore, it is important to provide the participant with tools they can utilize on their own, connect the participant with local resources, and, if possible, to check in with the participant periodically. As well, having a community that will support and encourage them will increase the chance of the participant continuing with healthy practices and actions. The wilderness environment eliminates many of the social obligations that are a large part of most people’s everyday lives. There is often a lot of social pressure to look or act a certain way. In the wilderness, this pressure is significantly reduced, if present at all. Clothes are 9 chosen for their function rather than their looks and there is a limited number of people you can interact with. This environment is also new to all participants creating more equal social status within the group and effectively eliminating yet another distraction from moving forward with therapy. Nature also plays a role in making adventure therapy programs beneficial to participants. Having the location of the program away from urbanization decreases distractions such as the internet, advertisements, and the general public (Jeffery and Wilson, 2017). The natural environment slows things down in contrary to day to day life in westernized cities. It is restorative for mentally fatigued individuals, this refers to those who experience prolonged stress, work for long hours, and/or they get very little sleep (Gass, 2012). The wilderness also provides an environment with the ability to focus without competing stimuli. This allows participants to fully invest themselves in the program resulting in the participant receiving the full benefits of the therapy (Gass, 2012). Participants will interact with the natural environment on a personal level and receive immediate feedback (Bastemur, 2019). Just being in the presence of nature can increase one’s mental well-being (Mental Health Benefits of Nature, 2020). The wilderness contains many healing effects such as lowering heart rate and clearing the mind which results in it greatly contributing to the therapy process (Emami, Amini, & Motalebi, 2018) A positive mindset has many beneficial impacts on one’s life (Johnson, 2018). The wilderness environment boosts self-esteem and mood, as well as reduces anger and improves general psychological well-being (Whitehead, 2020). The wilderness therefore fosters a healthy mindset where participants will be more open to accept the program, engage in the activities and 10 benefit from the therapy. If people are in a positive mood, they are more likely to have a positive experience (Baron & Branscombe, 2019). Researchers have claimed that nature is, in fact, the main therapeutic factor of adventure therapy (Gass, 2012). Facilitators simply use adventure activities or therapy exercises to engage and enhance the healing power of the wilderness. The wilderness in itself is very peaceful which creates the ideal environment (Emami, Amini, & Motalebi, 2018). Through reflection paired with these activities and practices, the client begins to question themselves to understand themselves better. This increases their ability to connect to the environment, other people, and themselves on a deeper level (Bastemur, 2019). This is also achieved through reflection in a natural space. By interacting with nature, people are connecting to themselves (Gass, 2012). The wilderness environment provokes 'soft fascination', when involuntary attention is engaged but does not require direct attention (Gass, 2012). For example, clouds, sunsets, and moving water capture attention and allows for cognitive reflection as one is engaged in something fascinating and stimulating. Sitting by a river, stream, or the ocean and watching the water creates an ideal atmosphere to contemplate issues and create revelations. This can also be done on a mountain peak overlooking a valley or anywhere with a captivating, calming, natural view. The majority of adventure therapy programs allow for a solitary or group reflection using soft fascination. 2.1.2 Benefits of Adventure Activities 11 Activities with an element of adventure can provide an effective transition into therapy sessions. Adventure activities are activities that involve an element of risk. These activities also create a challenge that the participant then overcomes. The act of overcoming a challenge provides many benefits to the individual, such as building skills that can be used in their everyday lives. As well, these activities usually involve some sort of teamwork or need to interact with others which further builds communication and cooperation skills. The skills developed through adventure activities can assist the participant in finding solutions to problems and managing their reactions when they return to their regular day to day lives (Keene, 2017). Another benefit that adventure activities provide is an opportunity for reflection. After the task is accomplished, participants have the chance to consider what was just experienced as well as contemplate other aspects of their lives. This ignition to reflect allows the participant to be more open to the therapy session at hand. These activities can also function as a metaphor for other situations the participant has encountered (Straus, 2018). Therefore, these activities can be the perfect catalyst to address other, more prominent, issues that affect the members involved. The nature of adventure activities allows for reflection and self-improvement. Immersion in the wilderness allows one’s thoughts to expand with the landscape (All & Balzar, 2017). Long hikes or periods of solitude in the wilderness encourage the mind to wonder. This time of reflection is an important part of the therapy process. Adventure activities such as hiking almost force the participants to use this time for reflection as there are no other distractions available to hold their attention. In these situations, the mind automatically turns to a state of reflection. 12 The majority of adventure activities involve some sort of physical activity where participants are moving around and increasing their heart rate. There are many health benefits of physical activity. It helps to boost one's mood and release positive endorphins (Reintegration Through Sport, 2018). Improving a participant's mood through adventure activities allows them to be more receptive to the therapy sessions that usually follow. It can put participants in a better state of mind to be able to reflect constructively. Physical activity also offers a release of tension from everyday life (Reintegration Through Sport, 2018). It allows people to physically let go of the stress that they have been holding and be present in the moment. Physical activity also improves participants' personal fitness (Reintegration Through Sport, 2018). Integrating physical activity into the therapy process helps to address both the health of the body as well as the health of the mind. Creating a well-rounded program. It prepares participants to be able to accept the therapy sessions and utilize them to their fullest potential. The act of engaging in an exercise can also build emotional strength and intelligence. The completion of an activity develops greater self-awareness and self-sufficiency (Keene, 2017). Building self-esteem and confidence further contributes to the health and healing of the individual. Another benefit of this concept is that engaging in enjoyable activities offers the immediate reward of experiencing oneself laughing and playing (Straus, 2018). Adventure activities are designed to be fun and engaging. A big part of healing mentally for the individual is experiencing the release of endorphins when they are enjoying themselves. The risk involved with adventure activities plays an important role in the impact of the activity on the participant. There are different kinds of risk including real risk and perceived risk 13 (Wolff, Larsen, & Ogaard, 2019). Real risk is risk that poses a real threat where activity can result in very real injury or harm to the participant. Perceived risk is where the participant feels that there is a high real risk when in actuality there is a low risk of harm involved. The ideal type of risk to utilize in adventure therapy programming is perceived risk (Gass, 2012). There is real risk in everything we do, so risk is never eliminated. However, having the participants feel as though there is higher risk than there is creates a balance where the participants receive all the benefit of participating in a risky activity without actually putting themselves in harm's way. This is beneficial for the participants, the instructors, and the company. By effectively managing the risk during the activity as well as the cooperation of the group, participants are able to gain valuable life skills and behavioural management tools (Keene, 2017) The role of risk in adventure activities incorporates a positive use of stress (Gass, 2012). Thus, with the inclusion of risk, participants are gaining the necessary skills and knowledge that can be utilized in healing. The presence of risk further puts the participant outside their comfort zone. The environment outside of the participants comfort zone creates an ideal atmosphere to learn. It provides just enough fear to motivate the participant, but not enough to intimidate them. The element of risk also helps the participants to gain control (Braunsberger & Trocchia, 2011), it gives them motivation to complete the activity correctly and work with the instructor and other team members. Many interpersonal bonds are formed through participation in adventure activities due to the risk involved. There are many difficult decisions to be made within adventure activities and in most cases, these decisions have an effect on others in the group. In the adventure activity of white-water kayaking, a form of trust is created when each paddler is confident in the decision making made by each other (Scharlock, 2014). It comes down to the 14 fact that when participating in the sport, if one person in the group takes a higher risk and ends up in a tough situation, it is the other members of the group that will be performing the rescue. This creates a relationship of trust between members of the group. This relationship further allows participants to talk freely with each other. If they trust each other with their safety, then they are more likely to trust them with their personal thoughts. Along with the positive use of risk and the integration of physical activity, adventure activities also provide a hands-on experience. Participants are directly involved with the activity which allows the participant to experience success due to their actions. This also boosts selfesteem and releases positive endorphins which is an added positive impact (Reintegration Through Sport, 2018). Along with adventure activities, experiential activities can have similar effects. Experiential activities involve games and group work and engage the participant in the activity. Adventure and experiential activities are often intertwined or used in conjunction in adventure therapy programs. There is an importance of physical activity and participation by the participant as it has a greater impact on the participant (Jeffery & Wilson, 2017). It helps to show the participant what they are capable of. For example, if a participant that does not have a lot of experience with the outdoors or physical activity reaches the top of a rock climb, it shows them that they can succeed in something new. They prove to themselves that they can accomplish difficult tasks. This newfound confidence can then be used for other activities such as adopting a new perspective or trying out new skills. The participant overcoming a challenge in an activity can serve as a metaphor for other challenges in their life (Gass, 2012). In the rock climbing example, the 15 instructor can help the participant see that the resiliency and strength used to finish the climb can be used to combat other challenges they face. Once they accomplish a task, they did not think they would be able to, taking on other challenges can be less intimidating. The participant is able to learn new skills and lessons through activities. This results in the new information or skills to be easily accepted by the participant and create a longer lasting impact as they have a chance to use it themselves (Gass, 2012). Adventure activities can also be used to build important life skills such as communication, teamwork, and problem solving (Gass, 2012). The formation of these skills assists the participant in living more comfortably outside of the program. The use of fun to facilitate therapy creates a positive atmosphere and encourages participants to be involved. It also provides an easier opportunity for the participant to adopt a new perspective on themselves and their issues (Straus, 2018). Fun activities help participants to take a step back from their current situation to better see their present issues and form strategies to address them. This significantly helps with reflection and healing. 2.1.3 Conclusion There are many benefits of adventure therapy that are different from other therapy styles. The use of the wilderness environment and adventure activities provides a unique experience for the clients. Adventure therapy programs aim to execute a program that will provide the participant with the necessary skills and mindset to face the challenges in their life. As well, for 16 adult specific programs, adventure therapy companies also aim to provide an opportunity to relax and release the stress that the clients have been holding. This allows them to be able to face other challenges in the future. 2.2 PRACTICES OF ADVENTURE THERAPY There is currently no governing body for adventure therapy in Canada (Ritchie, et al. 2016). This means that there are no set rules or regulations as to what can be offered for an adventure therapy program. This literature discusses what has been found to be effective in adventure therapy programming for adults. There are different styles of adventure therapy programming, therefore, there is no one right way to design a program. For example, the United States tends to use a more medical approach in their programming whereas Canada uses a more holistic, well-being technique to deliver the therapy sessions (Ritchie, et al. 2016). Both techniques are effective and beneficial to the clients. This is a very general outlook; every program will be a bit different as each target market is different. A program for clients with addiction will be tailored slightly different than a program for sexual assault survivals, or war veterans. However, there are a couple of general key factors that make up an adventure therapy program. This includes the tactics that are used such as debriefing and time for reflection, the types of activities used, and the development of new life skills and resiliency. 17 Overall, the program must be matched to the client’s needs and goals. This can change between target groups. This can also change within participants on a trip. Every person experiences therapy differently, therefore, the programming and techniques used to deliver the programming must be flexible to adapt to the needs of every participant. The three factors that need to be taken into account when establishing a program are the physical ability, social ability, and cognitive ability of the group (Gass & Gillis, 2010). Having a program that is above the ability of the participants can be more discouraging than constructive. For example, if the group of participants struggle with severe social anxiety having an activity that involves a lot of group communication and problem solving can be traumatic. Or having a group of participants that have limited physical fitness embark on an intense multi-day hike can result in frustration and prevent the participants from effectively experiencing the therapy part of the program. Due to the physical, social, and cognitive abilities being different for every group, the programming will also be different to accommodate. While delivering the programming there are different tactics that have been found to be effective. One is to have each stage of the program or activity increase in difficulty. Eventually, it will end with a master task that combines all the new skills the participants have learned in the previous tasks (Bastemur, 2019). After each task or activity is completed, having a debrief helps to solidify the learning from the experience. This debrief should include the questions: What? So what? And now what? (Reupert & Maybery, 2002) The first question, what, forces the participant to review what happened during the activity to ensure they fully understand the events. The second question, so what, allows the participant to consider why those events 18 occurred and why they reacted as they did. This helps to show the importance of their reactions and how it contributes to the events. The last question, now what, has the participant consider the next step. If they did not like how they reacted during this activity, how will they adjust their perspective to act differently next time? If they were satisfied with the outcome of the activity, how will they work towards continuing this trend? As well, what did they learn from this activity that they can use in their everyday lives? The debrief also allows for reflection. Through reflection, the participant has the opportunity to consider what skills they have gained from the activity and how that can help them in other challenges they face. This helps to carry the skills learned in the program to their everyday life when the program is finished. Without a debrief, there is an increased chance that the lessons experienced will be forgotten faster or the participant may leave with unanswered questions. The benefits of adventure activities were discussed earlier, however, in terms of the practices, what activities are found to be ideal in facilitating the programming? Basically, the most effective adventure activities to use are ones that pose a challenge and include an element of risk. In terms of risk, the real risk should be low, but the perceived risk should be great (Bastemur, 2019). This creates the ideal environment where the participants receive all the benefits of feeling that there is a great amount of risk involved but where there is little chance that they will be harmed. Putting people outside of their comfort zone by using the element of risk can help them develop a sense of identity (Scharlock, 2014). 19 Camping is an ideal activity as it breaks the routine of the participant’s normal life. This allows for new thinking patterns to form and the opportunity to break old, unhealthy habits (Whitehead, 2020). Using activities in combination creates a well-rounded experience involving multiple factors and opportunities for growth. For example, using a hiking trip with camping provides the disruption of routine and removal from one’s comfort zone with camping, and introduces the element of risk and a challenge with hiking. Using one adventure activity on its own in the programming is effective, but the impact can be increased if multiple activities are used. However, having too many activities may be overwhelming for the participant. The most effective amount and variety of activities will depend on the market the program is intended for. Consider again the physical, social, and cognitive ability of the participants (Reintegration Through Sport, 2018). In adventure therapy programming there is a significant importance to building life skills (Reintegration Through Sport, 2018). This can include decision making, problem solving, selfawareness, communication skills, and general coping skills. These skills assist the participant in facing challenges once the program has ended. Many different activities can be used to build these skills. Any task done as a group, working towards a main goal, helps to form problem solving and communication skills. As well, facing challenges and succeeding, such as paddling a canoe without getting wet, creates skills based around self-confidence and ability. Skills are formed through most activities, however, the process of debriefing the activity helps to solidify these skills. This is particularly effective for soft skills. By discussing the skills used and created, the participant becomes more aware of these new skills. This increases the chance that they will use these new skills in future situations. These life skills help the participant to manage their life 20 in a healthier way upon leaving the program. It also equips them with the ability to better manage the demands of life. Another important trait to build through adventure therapy programming is resiliency. Resiliency is the ability to cope with adverse events and bounce back easily. Protective factors help to build resiliency and consist of three stages; individual, family, and community (Werner, 1989). Adventure therapy focuses on building individual protective factors by building selfconfidence and establishing a sense of self-worth. It also helps to change negative thought patterns through counselling or group discussions. Along with building a healthier mindset, it is important to provide the participants with the resources to be able to build family and community protective factors. This can be educating the participants about the community resources available to them outside of the adventure therapy program. It can also include making a plan with the participant to create their own social support system. A personal support system is a very valuable protective factor against any adverse event (Werner, 1989). By having group therapy sessions during the program, it allows participants to provide support to each other and have the opportunity to relate to one another. This also helps them establish skills to build their own system after the program has been completed. The adventure therapy trip can start the process of building resilience and healing and give them the tools to be able to continue to build it once they have left the program. One technique that has been found to be effective in counselling practices is to focus on the positive aspects that that individual is currently utilizing and then build off of those (Walsh, 21 2002). For example, instead of focusing on all the things the client is doing wrong, focus on what they are doing right and what techniques are working for them. By focusing on these, the instructor can determine what skills they have that can be utilized in a different way for different challenges. It also helps to boost the client's self-esteem and increase positivity. The client may then feel that they are capable and have the ability to tackle the challenges that they face. The use of nature in the therapy process is one of the factors that defines adventure therapy. Simply being in a wilderness environment has a positive impact on the participants, as discussed earlier. Therefore, spending as much time as possible in the wilderness will increase the benefit of the program. As well, certain activities can increase the positive effects of nature. Having participants spend time on their own in nature to reflect can help to solve personal issues, come to personal revelations, or address challenges in a positive environment (Emami, Amini, & Motalebi, 2018). The use of the natural environment, group work, and adventure activities are key characteristics of adventure therapy programming. When designing programs it is important to take into consideration the physical, social, and cognitive ability of the group in order to create the most effective program (Gass & Gillis, 2010). This ability can change with every group and programming may even need to be adjusted while it is in progress. As well, each stage of the program should increase in difficulty to end with a final task that summarizes the program. This final task should also allow an opportunity for the participants to practice the new skills they learned throughout the previous tasks. The ideal activities to use in adventure therapy programming include activities that disrupt the routine of the participants and introduce a 22 challenge. A balance needs to be established between having enough activities to impose new challenges and not overwhelming participants with too many activities or challenges. This balance will be different for every group. For example, a group of war veterans may benefit more from a trip including hiking, camping, and canoeing, but this same trip may overwhelm a group of people who’ve worked desk jobs their whole lives. In adventure therapy programming it is important to build life skills for the participant to be able to cope with challenges after the program is completed. As well, it is effective to build resiliency through forming an external support system and focusing on the things that the client is doing right in the situation to address what is not going right. This further prepares the participants to manage after the program is completed. Lastly, utilizing nature in the programing creates a beneficial experience for the participant. 2.3 ADULT PROGRAMMING COMPARED TO YOUTH PROGRAMMING Adult adventure therapy programs are significantly less popular than youth programs. This is due to many factors such as the fact that adult programs receive less funding from the government or other agencies. This can make these programs less accessible due to the availability of finances from the participants. As well, adults feel that their time is quite precious and are careful about how they spend it. This results in fewer adults choosing to participate in adventure therapy programs as they choose to spend their time elsewhere. They also differ slightly in programming to accommodate the different markets. 23 The adventure activities used are similar in adult and youth programs. Hiking, camping, canoeing, etc. are effective activities for both markets. One aspect of the activities that may differ is the number of games or small activities to fill time. For youth programs, it is important to keep the participants entertained and occupied throughout the trip. This is usually done through games. For adults, however, they are able to entertain themselves more easily or may enjoy the downtime to themselves. There is less of a need to facilitate extra games and activities to keep the participants occupied. The main adventure activities, however, remain consistent. The ideal length of a trip is the same for youth and adult programs. The longer the better. However, realistic trip lengths differ. Youth trips are often longer than adult trips. Youth participants are more available for longer trips as they have minimal prior commitments. Most adults have jobs and families they are obligated to manage. These factors create a challenge to participate in longer adventure therapy programs. As well, the government or other health organizations tend to give funding to youth programs over adults. This can decrease the accessibility for some adults in terms of cost. Without funding to subsidize the cost, fewer adults may be able to afford to participate in the programs. The group size for youth and adult trips are similar. The factors that influence group sizes such as availability of resources and group experience are the same. The ideal group size will be dependent on the market the trip is designed for, but this is not due to the age of the participant but rather their need from the program. 24 The ratio between participants and leaders for adults can be slightly larger than for youth trips. Meaning there can be more participants per instructor. This is because adult participants are more independent than youth participants. For youth, there is an increased need to monitor the participants. This need decreases with adults. As well, the chances that adults will need significant instructor interception is less as compared to the youth. These factors result in the ideal ratio of participants to leaders to be larger for adult programs than for youth programs. Ideally the more touchpoints the better. This is the same for youth and adult programs. However, due to factors such as availability and lower cost, it is more realistic for youth to participate in multiple programs. There are many differences in adult adventure therapy programming as compared to youth programming, which is more popular at this point in time. For adults it is important to maintain the independence of the participants while guiding them. There is a need to create a balance where the participants still feel they have freedom within the programming, but they can still benefit from structured programming. For youth, there is more authority and supervision needed from the instructors or guides as the participants are minors and therefore the instructors are ultimately responsible for them. As well, in some cases the youth may not have chosen to be there and, if given the option to make their own decision, it could result in a negative outcome or the participant leaving the program. For adults, the participants choose to be in the programming and are looking to get the most out of it, therefore the instructor is there to give them all the tools and opportunities to achieve this without fully telling them what to do. 25 Unlike in youth programming, participants cannot be forced to participate. For example, if an adult participant decides they do not want to participate in an activity one day the instructors cannot force them. They can explain the importance of participating, but ultimately it is up to the participant to make that decision. However, if a youth participant decided they did not want to participate, more drastic measures, such as inflicting consequences, will be taken by the instructors to ensure the participant is participating. This is ultimately due to the fact that the instructors are responsible for the youth, whereas, for the adults, they are simply there to provide an experience and therapy session. As well, with adults, the participants can interact more with the programming than for youth. For youth, there is a strict program that is decided by program managers and instructors. With adults, they can have more of an input with the programming as the program progresses, as long as it is still beneficial to all participants and the goals of the program are met. This allows for flexibility and the opportunity for the participants to optimate their experience. Overall, youth and adult adventure therapy programs are very similar. They differ in the fact that adult programming is less structured and allows more freedom to the participant. The adults are able to have input in the programming and how they participate, to an extent. 3.0 ANALYSIS OF CURRENT ADVENUTRE THERAPY PRACTICES UTILIZED IN CANADIAN PROGRAMMING FOR ADULTS 26 3.1 INTRODUCTION The purpose of this study was to establish what practices and programing current adventure therapy companies are utilizing. This will further establish what some effective practices are for adventure therapy programs for adults. The literature on this topic helps to establish the ideal programming in theory. However, once the availability of finances, staffing, participants, and resources are established, these practices may not be attainable. Therefore, this study was done to establish a realistic set of basic effective practices in regard to group size, instructor to participant ratios, activities used, length of the trip, and ideal number of touchpoints. 3.2 METHOD 3.2.1 Participants The participants for this study involved Canadian adventure therapy companies that offer programs for adults. Due to the scarcity of businesses that offer these programs, the locations were distributed across Canada, with responses from companies in Ontario, Quebec, Alberta, and British Columbia. In total, twelve companies were contacted with response from 5. The program director or manager was contacted to answer the questionnaire as they would have the best understanding of the programming being used and why it is in use. All participants will remain anonymous in this study as revealing their identity would not be constructive to the research. In this study, each company will be referred to by a letter. The companies will be referred to as A, B, C, D, and E. 27 3.2.2 Procedure A questionnaire was used to gather information on the programming that is currently being used by each company (appendix 1). Each company was contacted by email with a request to complete the questionnaire via a couple of options. The first option was for them to fill out the questionnaire and email it back. The second option was to set up a phone call, or an in-person interview to discuss the questions. Multiple options were given to gather this data to accommodate the participants' preferences and increase the number of responses. The targeted participants are busy people so extra effort was given to help to accommodate schedules or preferences. Overall, 3 responses were completed by email and 2 were completed by phone interviews. Although the data was collected in different ways the questions remained the same. After receiving the first completed survey, adjustments were made to one of the questions. Due to the response, it was discovered that the question did not clearly communicate what it was intended to. The question was then reviewed to ensure that correct inquiries were being communicated effectively. The adjusted survey was then used for the rest of the participants. Through this process, it was discovered that the interviews completed over the phone were more effective as the participant was able to give a longer, more thought out answer. The phone interviews also prevented any misinterpretations of the questions. The interview was able to be shaped in order to acquire the data needed. For example, on a survey completed through 28 email, a participant left a question blank as they thought that it was repeating the previous question. However, even though phone interviews allow for the collection of more data at a higher quality, participants can be less willing to complete the questionnaire in this style. One drawback is that it includes an extra step of setting up a time for the interview, whereas participants are able to complete the questionnaire in their own time if emailing it. Overall, the use of both styles was found to be effective in collecting as much data as possible. 3.3 RESULTS The company’s responses to the questionnaire varied largely due to differences in target demographic, location, or availability of resources. Overall, they provide an overview of what practices adventure therapy companies are currently using in adult programming. 3.3.1 Question 1: What market do you run trips for? The results to this question are diverse and may depend on multiple factors such as the market the program is used for and the location of operation. Company A runs trips for people with mental health issues that are struggling to function in society. Company B runs trips for cancer survivors and those in treatment. Company C runs trips for young men who are recovering from substance addiction. Company D runs trips for a demographic that face barriers to accessing nature. Lastly, company E runs trips for young male offenders. 29 3.3.2 Question 2: What adventure activities have you found to be most effective to facilitate on your trips? For example, hiking or canoeing. Table 1 Adventure Activities used by Canadian Adventure Therapy Companies in Adult Programming A B Companies C D E Winter Nordic Hiking Canoeing camping Snowshoeing Kayaking Camping Skiing Activities Shading indicates the activities used by each company. All 5 companies stated that they utilized hiking in their programming. Canoeing and snowshoeing were also popular activities. Some of the other activities may be less popular as they depend on location or season. Not all of the companies may offer winter programs. As well, location plays a role in what activities can be offered dependant on what environments are accessible. For example, a company located in Saskatchewan, Canada would not offer sea kayaking as they do not have access to the ocean. Overall, hiking was the most popular activity in this study. 30 3.3.3 Question 3: What do you find is the ideal length for trips? Table 2 Length of Trips Offered by Canadian Adventure Therapy Companies for Adult Programming A B Companies C D E 1 2-4 Day Days 8-10 Days 20-30 6 Day Weeks Length of Trip Shading indicates the trip length offered by each company. The most popular option for this question is tied with 3 companies stating 1-day trips were ideal, 3 companies stating 2 to 4-day trips, and 3 companies stating 8 to 10-day trips were ideal. These companies mention that the ideal trip length is the longer the better, however, shorter trips may be utilized due to restricting factors such as participant or resource availability. 3.3.4 Question 4: What is the ideal group size of participants on your trips? 31 Table 3 Ideal Group Size Used by Canadian Adventure Therapy Companies for Adult Programming A B Companies C D E 4 to 6 8 to 10 Number of Participants Shading indicates the group size used by each company. The results for this question were split equally between 4 to 6 participants or 8 to 10 participants on the trip. However, every company expressed that the smaller trips are more ideal as they provide a more intimate experience. This ultimately increases the participants experience. However, this is not always as realistic goal due to resources availability and a need for revenue. 3.3.5 Question 5: What is the ideal ratio of participants to leaders? Table 4 Ratio of Participants to Leaders Used by Canadian Adventure Therapy Companies for Adult Programming 32 A B Companies C D E 2:1 4:1 The ratio of participants to instructors Shading indicates the ratio used by each company. The most popular ratio in this study is 2 participants to 1 leader. A ratio of 4:1 was also a popular vote with one less vote than a ratio of 2:1. Overall, these ratios are quite small. This allows for more interactions to occur between instructors and participants. This question is similar to the previous question in that smaller is better as it increases the quality of the participant's experience. 3.3.6 Question 6: How many touchpoints with participants are needed to make progress? There seemed to be some confusion with this question as only two companies answered this question. They also happened to be the questionnaires that were completed over the phone. The concept of ‘touchpoints’ was not as widely used as anticipated. A touchpoint is an 33 interaction between the participant and the company or program. As well, the question was not worded very clearly. The intended meaning of the question was to gather how many trips were ideal for the participants to attend. The results of this study showed that as many touchpoints as possible are ideal. One of the companies that answered this question runs a mentorship program where the returning participants are put into a mentorship role to mentor the first-time participants. This was found to be very effective. It helps to build valuable life skills for the returning participant and give their trip a different feel. As well, it gives the first-time participant someone they can relate to and help them thoroughly enjoy the experience. The other company that answered this question only allows first time participants on their trips unless they have extra room and are looking to fill the trip. This is done in order to give as many people as possible this wonderful experience. They expressed that it would be ideal to have these participants on as many adventure therapy trips as possible as you can always learn more and benefit from the experience. However, there is a high demand for these trips and not enough resources to be able to make this a reality. Instead, this company focuses on providing a positive adventure therapy experience to as many participants as possible. 3.3.7 Questions 7 & 8: What's one thing that you think really makes a difference on your trips? What other strategies do you find make your program successful? 34 The last two questions in the questionnaire ask the participant to expand on some other tactics in their programming that they find provide a successful experience. Company A expresses that the role of nature is significant. It really helps to utilize reflection to overcome adversity. This can be through personal reflection, journaling, or group talk. There is also an advantage of being secluded with the same group. Participants wake up in the morning with the same people and the same expectations. This creates an ideal environment for a longer period of time to really allow the participant the opportunity to utilize new strategies and have more time for reflection. As well, the seclusion from the rest of society is beneficial. It established an ideal environment for personal reflection as there are very few distractions. Company B focused on utilizing group work to build life skills and create positive connections between participants. Creating empowerment is also a significant factor that provides a positive experience and helps the participants to gain self-confidence. This will further assist in their ability to adopt new skills and mentally healthy habits. Company C talks about the importance of being self-reliant within a team while navigating the elements. As well as being resourced by the surrounding beauty and wild space in the wilderness. Another effective strategy in programming is utilizing intention setting. Intention setting is where the participants set clear goals for themselves and establish the proper skills to achieve these goals. This is a structured part of their program that supports participants when they return from the trip and are faced with the challenges they had felt behind and begin to 35 return to old patterns of behaviour. This practice helps to prevent the participant from returning to their old habits and maintaining the new skills they establish while in the program. Company D uses a participant-centered program where they take participants who live in the city into the wilderness. They believe that the participants want to be in nature but do not have the opportunity or skill set to comfortably experience the wilderness on their own. This program helps these participants access places they may not be able to access, allowing them to see the world from a different perspective. This company really focuses on utilizing the healing effects of nature and being in a wild environment. Company E's programming takes into consideration the individual and the group needs of the participants and seeks to balance both through prescribed activities. One way they ensure individualization is through providing ongoing formal feedback. This is provided by the staff to clients about their progress in the program. This feedback allows for open communication between the client and staff and keeps the clients connected to the programming. This company also expresses that adventure therapy provides an immersive experience that facilitates deep and meaningful therapeutic relationships and alliances that can be difficult to establish through other forms of therapy. However, they also mention that adventure therapy is not for everyone. Program designs are not universally well suited for broad cultural, ethnic, or racial backgrounds. They are designed for a specific market and would not be as beneficial to a client outside of that market. 36 4.0 DISCUSSION The data collected from this research is similar to three studies found in the literature. The first one was conducted on a group of men that embarked on a therapy focused, multiday backpacking trip (Scheinfeld, Rochlen, & Buser, 2011). The second study involved college students that came from dysfunctional families and participated in an 8-week program (Wood & Carlson-Bancroft, 1991). The third study was done with war veterans and involved sailing as a way to combat post-traumatic stress disorder (Gelkopf, Hasson-Ohayon, Bikman, & Kravetz, 2013). By combining and comparing these sets of data, a further understanding of the current research is established. 4.1 MARKET The market of the first study consisted of adult men who were already participating in individual, office style therapy. These men were all seeing the same therapist who invited them on this trip as a part of his study. The group in this study consisted of only men. This tactic of maintaining a similar demographic has a positive impact on the participants as they found it easy to identify with each other. This ultimately made them feel closer as a group. There is benefit in having the participants be similar in age, gender, religious beliefs, or other characteristics. Participants that relate to each other will have an easier time revealing things that they would not reveal to just anyone. This increases the effectiveness of the therapy sessions if the participants are more willing to participate (Scheinfeld, Rochlen, & Buser, 2011). 37 The market of the second study consisted of college students, age 20-23, that came from dysfunctional families. These students were seeking therapy on campus to assist them in managing trust issues, the fear of abandonment, feelings of shame, and managing perfectionism. This group contained a mixture of individuals who have experienced office style therapy and those who had not experience any form of therapy. This market can be more vulnerable and impressionable than others as these young adults are encountering many new perspectives and experiences due to leaving home for the first time (Wood & Carlson-Bancroft, 1991). The third study involved war veterans that were struggling with a mental disorder called post-traumatic stress disorder. This disorder originated from the time they spent while active in the military. This disorder can create many challenges within their day to day life. It can be difficult to function for these individuals. Some participants sought out this program to assist them in healing while others agreed to it simply out of boredom or an excuse to leave the house (Gelkopf, Hasson-Ohayon, Bikman, & Kravetz, 2013). Adventure therapy can be used for almost any vulnerable population. As well as the markets previously mentioned, adventure therapy can be beneficial for veterans, sexual assault survivors, domestic violence survivors, those who simply seek assistance in working through some personal issues. It is also targeted towards people suffering from mental disorders such as post-traumatic stress disorder, depression, or anxiety (Gass, 2012). These are just a few markets, there are many more. Utilizing a critical theory approach and acknowledging intersectionality is important when working with these vulnerable groups. There is a large variety of demographics involved, therefore, there will be a large variety of adventure therapy programs. These programs 38 have many beneficial aspects and by slightly adjusting the programming, it can be tailored to different markets. 4.2 ACTIVITIES The activities in the study by Scheinfeld et al. (2011) include a 4-day backpacking trip. They hiked, cooked and camped together. Each day involved 2-3 hours of structured therapy sessions lead by specialists. Along with these sessions, while hiking or cooking, the men were able to converse informally. They usually talked about whatever was on their mind. This provided an opportunity for the participants to open up about what they were feeling. These chats were usually discussed further in the therapy sessions (Scheinfeld, Rochlen, & Buser, 2011). One benefit of hiking is that it allows the participants to converse while performing the activity. The calmness and ability of the mind to wander while hiking creates an atmosphere for clients to open up. The long trekking also provides the opportunity for the participant to share their thoughts when they are ready (Scheinfeld, Rochlen, & Buser, 2011). They are not faced with a time limit and are able to contemplate and share when they feel is the right time for them. The participants in this study also stated that the wilderness environment and the use of activities increased their desire to participate in the therapy sessions (Scheinfeld, Rochlen, & Buser, 2011). These aspects were also used to gain new perspectives. These new perspectives assisted the participants in addressing their issues. 39 The activities in the second study involved a rope works course (Wood & CarlsonBancroft, 1991). The program was designed with multiple sessions. A couple therapy sessions occurred first, then the rope course activity was conducted, followed by a few more therapy sessions in conclusion. This tactic prepared participants for the activity as well as thoroughly debriefed it afterwards. This technique helped to build and solidify new skills and perspectives. As well, the rope course introduced a beneficial amount of risk and challenge to assist in facilitating the therapy sessions. The third study by Gelkopf et al. (2013) utilized sailing as a therapy activity. This activity was used to increase familiarity with social and nautical environments. This tactic builds soft skills such as effective communication and compassion as well as hard skills such as rope work and navigation. These skills may increase the function of these individuals in their day to day lives. The seclusion that comes with a wilderness environment and the teamwork aspect of the adventure activities helped to create trust between the group (Scheinfeld, Rochlen, & Buser, 2011). This involved trust between participants and between participants and the specialists. In the study by Wood and Carlson-Bancroft (1991), trust was also formed through the rope course activity as the participants had to work together and trust each other in order to complete the task. This trust allowed for deeper sharing in the therapy sessions. It helps to break down the feeling of insecurity or embarrassment. These aspects increase the effectiveness of the therapy sessions as the participant has increased motivation to participate, has adopted new perspectives, and is comfortable in opening up to the group and specialists. 40 The current research that was conducted for this paper displayed that hiking was the most popular activity to use for adventure therapy programming. This can be due to the ease of facilitating and the many beneficial aspects it holds. This was reflected in one out of the three studies observed. This difference could be due to the markets involved and the time available. The two studies that did not support the research held multiple shorter sessions rather than one longer session. This could be why alternate activities were utilized. Overall, through the majority of the literature and the research conducted, hiking is the best adventure activity to use in adventure therapy programming. Season and location of the operation plays a role in the adventure activities that are used. Often hiking and canoeing are utilized in the summer, hiking is used in the fall and spring, and snowshoeing and winter camping are used in the winter months. The majority of the companies that operate in Ontario, Canada offer canoeing as there is a large opportunity for access to lakes and rivers. Companies that operate by the coast may offer sea kayaking instead as they have a large access to the ocean. As well, companies that operate in the Canadian Rocky Mountains tend to focus more on hiking and backpacking due to the vast availability of trails. One reason that hiking is the most popular activity in adventure therapy may be that it is very accessible and little to no training is needed to participate in this activity. As well, there is less cost for equipment associated with this activity as compared to other activities such as canoeing or rock climbing. Some companies used other activities such as kayaking and Nordic skiing. Participants expressed that each activity brings unique value and are all extremely 41 effective for varying reasons. Kayaking involves more risk than hiking and therefore allows for more development involving the role of risk as discussed earlier. Hiking, on the other hand, involves less risk, but provides more of an opportunity for personal reflection. 4.3 TRIP LENGTH The length of the trip in the study conducted by Scheinfeld et al. (2011) was 4 days. They used this length as it was long enough to fully experience the wilderness while not taking them away from their work and family life for too long (Scheinfeld, Rochlen, & Buser, 2011). The length of the program in the study by Wood and Carlson-Bancroft (1991) was 24 hours spread over 8 weeks with one 8-hour day to conduct the rope course activity. This structure was formed to accommodate the schedules of the college students as they were all full time students. The study by Gelkopf et al. (2013) was 1 year in length with weekly 3-hour sessions. Not all the participants attended all the sessions, but the majority made it to at least 40. The results of the current research showed that most companies offer short trips, single day trips, 2 to 4 day trips, and up to a week-long trip. This is a wide array of ideal trip lengths. There are many reasons as to why the trips offered are shorter even though ideally, they would be longer. This can be due to the availability of the client. People have jobs and family lives that they can be hesitant or unable to leave for longer periods of time. This is shown in the study by Wood and Carlson-Bancroft (1991). As well, for the company in the current research that offers trips for cancer patients in treatment, the trip length has to be short enough to accommodate those treatments. Overall, the most beneficial trip lengths vary depending on the 42 market. For example, for a market that is struggling with substance abuse, a longer trip may be more beneficial to increase the time without access to those substances. However, for a market that has an active job, a short trip may be more ideal in order to minimize the amount of time taken off of work. Another reason companies may offer shorter trips is the availability of resources, in order to make trips longer, it will increase the cost for the client. Shorter trips can be more finically accessible to participants. The length of the trip is also dependant on the season. Trips that operate in the winter months are usually shorter than in the summer months due to weather. The effectiveness of the therapy sessions will decrease if the clients are miserable and unable to keep warm. Not all companies run programs in the winter due to this reason. 4.4 GROUP SIZE The group size for the first study was 11 participants with 2 specialists (Scheinfeld, Rochlen, & Buser, 2011) and the second study consisted of 5 participants with 2 instructors (Wood & Carlson-Bancroft, 1991). The third study had about 73 participants in total however each session had 6 to 10 participants with 4 instructors (Gelkopf, Hasson-Ohayon, Bikman, & Kravetz, 2013). The results from the current study showed that the ideal group size was either 46 participants or 8-10 participants. This is supported by all three studies. This size again depends on the market the program is for and how independent that market is. A more independent market, a group that is high functioning in society, can be bigger than a more dependant market, a group that struggles to function normally in society. The first study involved a group that was 43 very independent, therefore, the group size was slightly larger than the ideal group size from the research. There are many reasons as to why companies run larger trips. Although trips with fewer participants are more ideal for the client's experience, it provides experiences to fewer people. By increasing the number of participants more people have the opportunity to enjoy and utilize these programs. Companies work towards maintaining a balance between creating an opportunity for more people to participate in the program and keeping the quality of the experience for each participant. As well, the companies still need to make sure that they are making a profit in order to continue running future trips. 4.5 RATIO OF PARTICIPANTS TO LEADERS The ratio of participants to leaders in the first study was 5.5:1 (Scheinfeld, Rochlen, & Buser, 2011). This is a higher ratio than the ideal ratio from the current research which is 2:1. This could be due to the fact that 2:1 participants to instructors could be the ideal ratio, but the this study did not have access to more specialists and wanted to gather as much data as possible. They could have been testing out that ratio as well to determine how effective it was. Another factor could be that the market used is very competent and does not necessarily need a smaller ratio. Whereas trips with different markets may benefit more from a smaller ratio of participants to instructors. 44 For the second study, the ratio of participants to leaders was 2.5:1 (Wood & CarlsonBancroft, 1991). This mostly supports the current research. Similar to the previous study, this ratio could be slightly higher because the participants are more independent or there are limited resources to employ more instructors. The third study had a ratio of about 2:1 participants to leaders (Gelkopf, Hasson-Ohayon, Bikman, & Kravetz, 2013). This ratio also supports the current research. The reason for this ratio being lower than others could be that that the activity involved contains a higher amount of real risk as compared to other activities such as hiking. Having a smaller ratio can also be a safety precaution especially for more vulnerable groups. If something goes wrong and a participant needs the full attention of 1-2 instructors, then that leaves 1 or more instructors to look after the rest of the group. With a larger ratio, in this situation, it would leave 1 instructor with a larger group of participants making it more difficult to manage and increase the chance that that instructor cannot manage the group adequately. Overall, the ideal ratio is dependent on the type of market in the program. 4.6 TOUCHPOINTS The number of touchpoints needed to make progress was not clearly addressed in the study by Scheinfeld et al. (2011). All the participants were previously engaged in individual, office style therapy with the therapist that joined them on the trip (Scheinfeld, Rochlen, & Buser, 2011). However, there was only one adventure therapy trip that occurred in this study. The other two studies contained multiple touchpoints. The programs were designed to operate on a weekly basis. The study with college students contained 8 touchpoints (Wood & Carlson-Bancroft, 45 1991) and the study with veterans contained about 40 (Gelkopf, Hasson-Ohayon, Bikman, & Kravetz, 2013). By having multiple touchpoints, the participants have more opportunities to take skills learned in the program and practice them within their normal lives. Using this technique allows the instructors to check in on the participants over a longer period of time. This helps to further solidify the skills learned while continually supporting the participants through this process of healing. The current research concluded that the more touchpoints with the participants the better. This is the ideal tactic, but not always realistic. An adventure therapy program can be a bigger commitment than some participants are willing to make more than once. Therefore, the ideal and realistic number of touchpoints needed to make an adventure therapy program effective is dependent on the market and situation. 4.7 STRATEGIES FOR FACILITATING PROGRAMMING The participants in the study by Scheinfeld et al. (2011) expressed some strategies that made the program successful. One strategy mentioned was the benefit of separation from their work, home, and family life (Scheinfeld, Rochlen, & Buser, 2011). This allowed the participants more time for reflection and the opportunity to address personal issues with fewer distractions. They also appreciated the formal and informal opportunities to express themselves and talk openly about whatever was on their minds (Scheinfeld, Rochlen, & Buser, 2011). This variety of opportunities provided an atmosphere where the participants were more likely to discuss things that may be difficult for them to discuss under normal circumstances. 46 The participants in the study by Wood and Carlson-Bancroft (1991) expressed the benefit of using a physical metaphor, such as the challenges overcome in the rope course, to help facilitate the therapy sessions. The rope course also helped to address trust issues, fear of abandonment, feelings of shame, and issues with perfection in real time. After the participants were able to address these issues in this adventure activity, it was easier for them to address these same issues in other aspects of their life. As well, the schedule used in this program can decrease the amount of time needed for office style therapy. Meaning that issues can be address quicker using adventure therapy than with office style therapy. This can be beneficial in regard to time and finances for the participants (Wood & Carlson-Bancroft, 1991). In the study conducted by Gelkopf et al. (2013), participants commented on the benefits of the environment this program created. These participants had a safe space where they were able to problem solve and face challenges without devastating consequences. These participants also expressed the benefit in building confidence through the adventure activity. This new confidence assists them in facing other challenges in their life (Gelkopf, Hasson-Ohayon, Bikman, & Kravetz, 2013). Overall, these three studies found in the literature on an adventure therapy program held very similar results to the current research discussed previously. This shows that there is a wide variety of markets that can benefit from adventure therapy programming and the most ideal adventure activity to use is hiking. The ideal length of a trip can vary for markets but ranges from 1 to 10 days. The ideal group size also varies with the market and can be anywhere from 4- 47 10 participants with a ratio of 2:1 or higher for more independent markets. Lastly, the more programs the participants experienced, the better, however, this is not a realistic approach. One touchpoint is also very effective and beneficial to the participant. Overall, this is a basis set of general effective practices used by adventure therapy companies. 5.0 CONCLUSION Adventure therapy holds many different benefits for the participants. Through the use of the wilderness, the participant is placed in an environment that encourages them to seek new perspectives and utilize the therapy sessions. The use of adventure activities provides an opportunity for the participant to be involved in their own healing process. It also allows them to learn new skills such as teamwork or effective communication. Participants have the ability to connect with others and themselves on a deeper level through adventure trips. This further establishes healing and growth. Certain techniques aid in the effectiveness of the programming. Having activities increase in challenge allows the participants the opportunity to build off of prior learning. It also allows them to utilize new skills that have formed. Another effective technique is the use of a debrief after activities. This helps to solidify anything that the participant has learned during the activity and provides an opportunity to answer questions. Using the healing effects of nature and working towards building resiliency also helps to increase the benefit of the adventure therapy program. 48 A general set of effective practices for adventure therapy have been established through primary research gathered through questionnaires and studies found in the literature. This includes the fact that adventure therapy can be offered for almost any vulnerable market. This can include anyone who is struggling with overcoming adversity, or who is simply seeking assistance in addressing an issue or challenge. The best and most popular adventure activity to use is hiking. This is due to its calm and relatively simple nature as well as the fact that it requires very little training and equipment. The ideal length of the trip varies depending on the market the program is for. Ideally, the longer the trip the better, but realistically trips range from 1 to 10-day. The ideal group size ranges from 4 to 10 participants. This also depends on the market; more vulnerable markets benefit from smaller group sizes. As well, if money is not an obstacle, then the smaller trips are better, however, increased group size can also mean that more people are able to have this experience. The ideal ratio for adventure therapy programs is 2:1 participants to instructors or higher for more independent markets. Lastly, the more programs or trips the participant experiences, the better, however, this is not always a realistic approach. Having only one touchpoint is also very effective and beneficial to the participant and allows others the opportunity to experience the program. This research has established a general set of effective practices for a few aspects of adventure therapy programming for adults that are currently in use in Canada. Further research should be conducted to substantiate and refine these results to create an industry standard of practices for adult adventure therapy programs. As well, it would be beneficial to further explore techniques for facilitating activities and sessions specifically for adults. 49 Adult adventure therapy programs also differ slightly from youth programs. First off, they often have different delivery methods for the therapy sessions as it is for a more mature audience. Contrary to youth, the adult participants chose to be in the program and are therefore more motivated to engage. As well the program is often less structured to allow the participants the opportunity to experience the program for themselves. Youth programs are very structured to keep the participants entertained and out of mischief. Every participant and market are different, therefore there is no one right way to facilitate a therapy program. The specific programming will change depending on the group and the market. Each program should be flexible to accommodate the needs of the participant and be able to change as those needs change as well. 50 REFERENCES Adventure Therapy International Committee. (2020). What is International Adventure Therapy? Retrieved from https://internationaladventuretherapy.org/what-is-iat/ All, J., & Balzar, J. (2017). Icefall. New York, NY: PublicAffairs. American Psychological Association. (2020). Therapy. Retrieved from https://www.apa.org/topics/therapy/ Baron, R. A., & Branscombe, N. R. (2019). Social psychology (14th ed.). New York: Pearson. ISBN 9780134625386 Baştemur, Ş. (2019). Adventure Therapy. Current Approaches in Psychiatry / Psikiyatride Guncel Yaklasimlar, 11(2), 178–191. https://doi-org.ezproxy.tru.ca/10.18863/pgy.434071 Braunsberger, K., Trocchia, P. (2011). Sociological factors influencing high-risk physical activities among adults: A conceptual analysis. Marketing Management Journal, 21(1). 188-194. Cadman, B. (2018). Dopamine deficiency: What you need to know. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/320637 Emami, E., Amini, R., & Motalebi, G. (2018). The effect of nature as positive distractibility on the Healing Process of Patients with cancer in therapeutic settings. Complementary Therapies in Clinical Practice, 32, 70–73. https://doiorg.ezproxy.tru.ca/10.1016/j.ctcp.2018.05.005 Gass, M. A. & Gillis, H. L. (2010). Enhances: Adventure therapy supervision. Journal of Experiential Education, 33 (1), 72-89. Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. Retrieved from https://ebookcentral-proquest-com.ezproxy.tru.ca Gelkopf, M., Hasson-Ohayon, I., Bikman, M., & Kravetz, S. (2013). Nature adventure rehabilitation for combat-related posttraumatic chronic stress disorder: A randomized control trial. Psychiatry Research, 209(3), 485-493. doi:10.1016/j.psychres.2013.01.026 Jeffery, H., & Wilson, L. (2017). New Zealand occupational therapists’ use of adventure therapy in mental health practice. New Zealand Journal of Occupational Therapy, 64(1), 32–38. Retrieved from https://ezproxy.tru.ca/login?url=https://search-ebscohostcom.ezproxy.tru.ca/login.aspx?direct=true&db=ccm&AN=122651202&site=eds-live Johnson, T. (2018). The Powder of Positive Thinking - Three days in the Canadian Rockies with 51 CEO whisperer and self-help guru Matt Mosteller. Bloomberg Businessweek. (4588), 6263. Keene, B. M. (2017). Adventure therapy. Salem Press Encyclopedia of Health. Retrieved from https://ezproxy.tru.ca/login?url=https://search-ebscohostcom.ezproxy.tru.ca/login.aspx?direct=true&db=ers&AN=125600401&site=eds-live Lissak, G. (2018). Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environmental Research, 164, 149157. Mental Health Benefits of Nature. (2020). Positive Health, 261, N.PAG. Reintegration Through Sport. (2018). Adventure therapy program for patients in rehabilitation for substance abuse: A handbook for addicition counsellors. Retrieved from http://www.rtsport.eu/wp-content/uploads/2019/09/Handbook-Adventure-DrugsRehabilitation.pdf Reupert E. A. & Maybery D. (2002). Debriefing Strategies in Adventure Based Counselling. Australian Journal of Guidance & Counselling, 12, 107-117. Ritchie, S., Patrick, K., Corbould, G., Harper, N., & Oddson, B. (2016). An environmental scan of adventure therapy in Canada. Journal of Experiential Education. doi: 10.1177/1053825916655443 Russell, K. C., Gillis, H. L. (Lee), & Kivlighan, D. M., Jr. (2017). Process factors explaining psycho-social outcomes in adventure therapy. Psychotherapy, 54(3), 273–280. https://doi-org.ezproxy.tru.ca/10.1037/pst0000131 Scharlock, F. (2014). The Influence of Whitewater Kayaking on Identity Development (Undergraduate Thesis). Thompson Rivers University. Kamloops. BC. Scheinfeld, D., Rochlen, A., & Buser, S. (2011). Adventure Therapy: A Supplementary Group Therapy Approach for Men. Psychology of Men & Masculinity, 12(2), 188-194. Straus, B. (2018). Healing in Action – Adventure-Based Counselling with Therapy Groups. The Rowan & Littlefield Publishing Group, Inc. Lanham, Maryland. Walsh, F. (2002). A family resilience framework: Innovative practice applications. Family Relations, 51, 130–137. Retrieved from PsycINFO database. Werner, E. E. (1989). Children of the Garden Island. Scientific American, 260(4), 106–111. Whitehead, K. (2020). Adventure therapy: how nature is good for mental health and a challenge 52 can help us see ourselves in a new light. South China Morning Post. Retrieved from https://www.scmp.com/lifestyle/health-wellness/article/3046219/adventure-therapy-hownature-good-mental-health-and Wolff, K., Larsen, S., & Ogaard, T. (2019). How to define and measure risk perceptions. Annals of Tourism Research, 79, 105729. https://doiorg.ezproxy.tru.ca/10.1016/j.annals.2019.102759 Wood, D., & Carlson-Bancroft, G. (1991). Adventure-based therapy: recovery for adult children on a college campus. Addiction & Recovery, 11(2), 16+. Retrieved from https://link-galecom.prxy.lib.unbc.ca/apps/doc/A10696690/AONE?u=unorthbc&sid=AONE&xid=d79b3 5fb 53 APPENDIX 1: CONSENT FORM AND QUESTIONNAIRE USED OF RESEACH Survey for Micaela’s Undergraduate Thesis on the Benefits and Practices of Adventure Therapy Principal Investigator: Micaela Klutz Bachelor of Interdisciplinary Studies Student micaelaklutz@yahoo.ca 780-781-7593 Supervisor: Craig Campbell TRU Adventure Studies ccampbell@tru.ca 250-320-7624 You are invited to participate in a short survey to gather information around programing for adventure therapy. Please read and sign below to verify that you give consent for me to use the answers you provide in my research. Benefits – This survey will provide me with current information to be able to more accurately establish the best practices in adventure therapy programming. As well, you will receive a copy of the completed thesis by email. Risk – There is no risk involved with this survey. It will only take about 5-10 minutes of your time. This survey is completely voluntary, and you have the right to stop at any time while writing the survey. It is a short survey of 7 questions that should take about 5-10 minutes of your time. If you choose to participate you can provide as much or as little information as you are willing to give, however, the more the better for my research. I am using the information gathered form these surveys to help determine the best practices for Adventure therapy. The summary of the research I gather from these surveys will be put into my thesis which will then be made public, I will email a link to the thesis once it is completed. No names will be involved, this is a completely anonymous survey. All information collected will be stored in a secure location for 7 years, after which it will be destroyed. No one but myself and my supervisor will have access to the information gather from these surveys. 54 If you have any questions don’t hesitate to ask. You can contact myself, Micaela, at micaelaklutz@yahoo.ca or 780-781-7593 or the Dean of the faculties of arts, Dr. Richard McCutcheon, at 250-828-5170 or rmccutcheon@tru.ca. Please submit this form along with the survey if you choose to participate. I fully consent to participating in this survey and will answer the questions truthfully and to the best of my ability. Signature: Date: 55 Micaela’s Thesis Survey These questions are in regard to the programming of the adventure therapy trips run by your company. If your company runs programs for both youth and adults, please answer in regard to the adult program only. When answering, please indicate if the answer would be different if money or resources were not an issue. 1. What market do you run trips for? 2. What adventure activities have you found to be most effective to facilitate on your trips? For example, hiking or canoeing. 3. What do you find is the ideal length for trips? 4. What is the ideal group size of participants on your trips? 5. What is the ideal ratio of participant to leaders? 6. How many touch points with participants are needed to make progress? 7. What’s one thing that you think really makes a difference on your trips? 8. What other strategies to you find make your program successful? Please feel free to share any other information you feel may be helpful. Please email the completed survey and consent form to micaelaklutz@yahoo.ca Thank you for your participation, it is much appreciated. Once my thesis is completed and defended, I can email you a copy if you are interested. 56 APPENDIX 2: ETHICS APPROVAL November 27, 2019 Ms. micaela klutz School of Tourism\Adventure Guide Thompson Rivers University File Number: 102268 Approval Date: November 27, 2019 Expiry Date: November 26, 2020 Dear Ms. micaela klutz, The Research Ethics Board has reviewed your application titled 'The Benefits and Best Practices of Adventure Therapy. An Undergraduate Thesis'. Your application has been approved. You may begin the proposed research. This REB approval, dated November 27, 2019, is valid for one year less a day: November 26, 2020. Please note: On the consent form you have listed the Chair of the REB as Kathryn McNaughton. We are unsure of who this person is. Please correct to reflect contact information for the REB Chair at 250.852.7122. Thank you Throughout the duration of this REB approval, all requests for modifications, renewals and serious adverse event reports are submitted via the Research Portal. To continue your proposed research beyond November 26, 2020, you must submit a Renewal Form before November 26, 2020. If your research ends before November 26, 2020, please submit a Final Report Form to close out REB approval monitoring efforts. If you have any questions about the REB review & approval process, please contact the Research Ethics Office via 250.852.7122. If you encounter any issues when working in the Research Portal, please contact the Research Office at 250.371.5586. Sincerely, Joyce O'Mahony Chair, Research Ethics Board 57 GLOSSARY OF TERMS Some terminology can have varying meanings, however, the definitions used in this paper are stated below: Adventure Therapy – a form of therapy that occurs in the wilderness with the use of adventure activities Comfort Zone – a psychological state where an individual feels safe, relaxed, and in control Mental Well-being – the mental health and stability of an individual Office Style Therapy – Therapy that occurs in an office setting, involving one-on-one interactions between instructor and participant Screen time – Time spend looking at a phone, computer, or TV Therapy – a process intended assist with the participants \mental health Therapeutic Process – the process where the instructors apply techniques to help the participant develop better habits (American Psychological Association, 2020) Therapy Sessions – the part of the program that is focused on facilitating therapy to the participants Touchpoints – the number of times an organization interacts with a participant 58