Running head: ADVENTURE THERAPY
Adventure-Based
Therapy: Theory, Characteristics,
Ethics, and Research
A paper
written to fulfill the comprehensive examination requirement
Areas: Psychotherapy, Ethics, Methodology
Sandra L. Newes, MA
Doctoral Candidate
The Pennsylvania State
University
ABSTRACT
This paper
is one of the first attempts to link established clinical theory with the
available theory of AT, as well as one of the first attempts to examine the AT
field through an objective scientific lens. First, a critical analysis of the
clinical and theoretical basis of adventure therapy is offered. Second, similarities between adventure
therapy and more traditional modalities, including object relations, cognitive,
humanistic, and behavioral therapy are presented. Third, ethical issues in AT are
discussed. Fourth, the outcome research
in AT is reviewed. Finally, a
delineation of present and future methodological considerations in AT is put
forth. Thus, this proposal seeks to lay
the groundwork for empirical applications to a developing therapeutic
framework.
Chapter 1
OVERVIEW
Chapter one
of this review consists of an overview of the paper, including a statement of
purpose and some broad shortcomings of the literature. Chapter two is focused on an overall
description of adventure-based therapy (AT), and includes sections which
discuss the history, the theory, and the definition of AT. In an attempt at further characterizing the
field, the next section compares levels of expertise of some AT practitioners
to standard mental health practitioners. The final sections of the chapter will
focus on the goals of AT and the specific characteristics of AT. Chapter three focuses on ethical issues in
AT, with an emphasis on how these ethical issues relate to the APA ethical
principles. Chapter four provides an
overview of the outcome research in AT; outcome with adults, outcome with
adolescents, and outcome as it relates to client characteristics. Finally, chapter five offers a discussion of
the present and future methodological considerations in AT research, and ends
with a call for research examining the impact of client characteristics on AT
outcome.
Statement of Purpose
Adventure-based
therapy (AT) is gradually emerging as an addition to the field of therapy,
employing diverse methods and serving such diverse populations as court ordered
juvenile delinquents, the mentally ill, PTSD sufferers, the disabled, substance
abusers, eating disordered individuals, sexual abuse survivors, as well as normal
populations. Since the introduction of
Outward Bound programming in the United States during the 1960’s, AT has been
purported to be a potentially unique therapeutic modality that can be used
either independently or as an adjunct to other forms of psychotherapy.
This paper
is one of the first attempts to link established clinical theory with the
available theory of AT. This paper is
also one of the first attempts to examine the AT field through an objective
scientific lens. Therefore, it is
intended as a preliminary movement towards a much needed increase in legitimate
scientific examination of the field of AT and, as such, can potentially be
viewed as the first step of the many that are necessary in order to provide
empirical support for any claims of treatment efficacy in this area.
In order to
accomplish this goal, first an analysis of the theoretical and clinical
characteristics of AT is offered.
Second, similarities are examined between AT and more traditional
modalities, including object relations, cognitive, humanistic psychology, and
behavioral theory are presented. Third, the ethical principles of AT are
discussed, with a particular emphasis on areas of overlap and contraction with
the APA ethical principles. Next, a
review of the literature in AT is provided. Finally, the closing
chapter will summarize the common methodological errors found in the AT
literature, and explore suggestions for future empirical exploration in the
area within the framework provided for psychotherapy outcome research. This final section will close with an
articulation of the need for individual difference-based research in AT.
It is of
note that this paper is not intended as an in-depth comparison of AT with any
one theoretical or empirical body, rather it is intended as an overview of
potential similarities that AT shares with other theories in clinical
psychology. As such, reference will be
made to the above noted theories, as well as others, without an in-depth exploration
of each. Whereas such an analysis may be
recognizably important for future empirical and theoretical research which
could scientifically explore such similarities, such an in depth
empirically-based formulation of the relationship between the process of AT and
any of these areas specifically is not the intent of this paper. Instead, this paper seeks to lay the
groundwork for future empirical applications to a developing therapeutic
framework.
It is also
important to state prior to beginning this examination that AT has not met the
rigorous criteria established for an empirically validated treatment (Chambless
& Hollon, 1998), nor has it been subjected to the high-level of empirical
analysis necessary in order to truly begin scientifically evaluating claims of
treatment efficacy. In fact, many of the studies do not utilize such basic
design considerations as random assignment and appropriate comparison
groups. In addition, no studies have
been conducted comparing AT to other established forms of treatment. There are also very limited data available on
client characteristics and of those which are available, none are based on
clinically relevant diagnostic criteria.
The theoretical basis of AT is also in the early developmental stages
and is unsupported by any empirical data.
While this type
of treatment, its claims of efficacy, and its theoretical basis are as yet
scientifically unsupported, it is a treatment whose use is clearly on the
rise. In fact, in 1993, the Association
for Experiential Education (AEE) published a Directory of Experiential
Therapy and Adventure-based Counseling Programs which included 257 programs
nationwide which were self-identified as adventure-based therapy programs. This number has almost certainly expanded
since that time. Of note as well is the
fact that at the Second Annual International Adventure Therapy Conference in
Munich, Germany (March, 2000), there were presenters from 43 different
countries. This is indicative of the
expansion of adventure-based therapy internationally as well.
Given the
increasingly widespread use of such interventions, and its particular use as a
government funded alternative to juvenile incarceration, it is important to
subject the field to informed critical analysis. The AT field is early in its development and
as such, the methodologies and theories are still rudimentary in their
development and usage. However, with the
relatively recent growth of such treatment programs this type of scientific
scrutiny is vital and can potentially contribute towards an overall movement in
AT research toward the direction of scientific rigor. Such an increase in rigor
is necessary given the state of the literature, and will be thoroughly
addressed in later sections.
Beyond the
lack of solid empirical data, one additional problem with much of the AT
literature that must be noted early in this discussion is that the intended
audience for the literature has often been practicing adventure therapists and
others involved in the outdoor field, as well as laypersons who are attempting
to gain a basic understanding of adventure-based therapy. Rarely, if ever, has writing in AT been
targeted at an audience highly trained and versed in both clinical theories and
empirically-based research, and there are very few published articles
addressing adventure-based therapy in the well-respected APA journals.
In some
ways, this has resulted in much of the literature specific to AT having been
developed in a type of vacuum. This
literature has rarely been subjected to close scrutiny and a portion of it can
be thought of in some ways as analogous to “preaching to the choir”. As such, much of the language used and the
concepts put forward by may seem overly simplistic to an audience highly
skilled in the aforementioned areas of clinical theory and empirical social
science. With this in mind, the reader
is cautioned to recognize that the early developmental context referred to
above has provided the environment for much of this published writing. Unfortunately, this is simply reflective of
the state of the field.
To complete
this overview, it must be noted also that while this discussion will focus on
articulating both the proposed theoretical basis of AT and the empirical
studies that have been conducted in this area, it is important to note that
this articulation is not intended as a statement of support for adventure-based
therapy as an independent therapeutic modality unsupported by other forms of
treatment. It is also important to note
that is this discussion is in no way intended to advocate for the usage of such
treatment without ongoing empirical examination.
Chapter 2
ADVENTURE-BASED
THERAPY
This
chapter will first focus on examining the history, the theory, and the
definition of AT. In an attempt at
further characterizing the field, the next section is compares some AT
practices to standard mental health practices.
This contributes to defining AT by briefly focusing on one specific area
that AT may fall short of standard practice, in a sense defining AT by what it
is not. The final two sections will
focus on the goals of AT and the specific characteristics of AT.
History of
Adventure-Based Therapy
Kurt Hahn,
the founder of Outward Bound , is credited as being the first person to
formally incorporate experiential education in a wilderness context. In the 1920s, Hahn, a German educator,
founded the Salem school in Germany; teaching his students to discover their
own strengths and identities through examination of their own personal
experience. After being imprisoned and
later deported from Germany by the Nazis in the late 1930s, he immigrated to
England where, in 1942, he established a program to “prepare young British
seamen to survive the rigors of sailing the North Atlantic during World War II”
(Bacon & Kimball, 1989, p. 117).
Through this program, he noted that while it appeared that older sailors
were able to survive extreme levels of stress and trauma, many of the younger
and stronger sailors would die under the same conditions. From this observation, Hahn concluded that
mental aspects were equally as important as physical fitness in survival
situations.
Hahn
combined his educational philosophies , wilderness and rescue training, and
principles of social cooperation into an expanded program designed to help the
seamen increase their resilience when experiencing the demands of war and
seamanship. Hahn later utilized these
same principles in the establishment of the first Outward Bound schools, of
which the first US branch opened in the early 1960s. The program spread rapidly and by the 1970s
there were numerous agencies using Outward Bound based approaches in various
forms and environments (Bacon & Kimball, 1989). Since that time, Outward Bound has evolved
into an international corporation serving a wide variety of populations
including youth at risk, cancer victims, sexual abuse survivors, and persons
with eating disorders. Many other
populations have been served, as well as the general public.
Theoretical
Background
Experiential Education
AT
is rooted tradition of “experiential education” philosophies (Kraft &
Sakofs, 1985), defined as “learning by
doing, with reflection” (Gass, 1993).
Early roots of experiential education can be traced to the educational
writings of Dewey (Kraft & Sakofs, 1985).
This experiential learning tradition is based on the belief that
learning is a result of direct experience, and includes the premise that
persons learn best when they have multiple senses actively involved in
learning. By increasing the intensity of
the mental and physical demands of learning, the participant “engages all
sensory systems in a learning and change process” (Crisp, 1998). Psychological research on information
processing provides some support of this premise, indicating that multi-sensory
processing accounts for a higher level of cognitive activity and increased
memory. Applied specifically to the
context of AT, the multi-sensory level of the therapeutic experience inherent
in adventure activities may account for
the high level of change reported by
practitioners (Crisp, 1998), thereby suggesting that “integration of experience
may be more deeply anchored for the client because of this broad [sensory]
base.” (Crisp, 1998, p. 67).
Experiential
education theory also postulates that active learning is often more valuable
for the learner because the participant is directly responsible for and
involved in the process. In addition,
experiential learning theory is based on the belief that individuals learn when
placed outside of their comfort zones and into a state of dissonance. Learning is then assumed to occur through the
necessary changes required to achieve personal equilibrium (i.e., modern
dissonance theory). Kraft and Sakofs (1985) outline several
elements inherent to this experiential education process:
“1.
The learner is a participant rather than a spectator in learning.
2.
The learning activities
require personal motivation in the form of energy,
involvement, and
responsibility.
3.
The learning activity is
real and meaningful in terms of natural consequences for the learner.
4.
Reflection is a critical
element in the learning process.
5.
Learning must have present
as well as future relevance for the learner and the society in which he/she is
a member. “(cited in Gass, 1993, p. 4).
In
experiential classrooms, individuals are placed in “real life” situations in
which it is necessary to employ problem-solving or otherwise creative methods
of working with the environment or context at hand. Therefore, effective experiential activities
involve the participant in situations in which they must take some form of
action to successfully cope with their surroundings. Such activities may take the form of outdoor
pursuits such as hiking, rock climbing, or kayaking, but also include
team-based initiatives or games.
The Link to Therapy
Since the
advent of Outward Bound, these types of experiential education programs have
been expanded into therapeutic settings.
Gass (1993) has reworked the above experiential education principles and
discusses how these principles can be applied to therapy.
“ 1.
The client becomes a participant rather than a spectator in
therapy.
2.
Therapeutic activities require client
motivation in the form of energy,
involvement, and
responsibility.
3.
Therapeutic activities are real and meaningful in
terms of natural consequences for the client.
4.
Reflection is a critical
element of the therapeutic process.
5.
Functional change must have present as well
as future relevance for clients and their society.” (Gass, 1993, p. 5)
It is
interesting that when examining the ideas stated above by Gass (1993) it is
clear to the critical reader that these are not unique to AT. In actuality, one can see even from these
most basic statements that the theory of AT builds on the foundations and
well-established premises of cognitive and cognitive-behavioral theory,
humanistic theory, and elements of the interpersonal aspects of object
relations theory. Therefore, it appears
from this definition that what AT may offer is a potentially unique medium for
the implementation of therapeutic processes assumed to be present in many
therapeutic orientations.
Definition of Adventure-Based
Therapy
Also
referred to as “wilderness therapy,” “therapeutic adventure,” “adventure
therapy,” and “adventure-based counseling,” AT is a therapeutic modality
combining presumed therapeutic benefits of the adventure experiences and
activities with those of more traditional modes of therapy. AT utilizes a therapeutic focus and
integrates group level processing and individual psychotherapy sessions as part
of an overall therapeutic milieu. While
specific types of facilitation occur directly related to the activities (see
section on facilitation), this processing is not associated exclusively with
the activities alone. Rather, the
activities can also be conceptualized as a catalyst for the processing which
occurs before, during, and after activities; a catalyst which provides concrete
examples of the immediate consequences associated with individual and group
actions that can be referred to by both the client and the therapist. Therefore, therapists may begin with
processing exigencies around the activities themselves and branch into other
areas of relevance for clients.
As such, AT
lends itself well to multimodal treatment and can be utilized as an intervention
independent from other treatments or as an adjunct to other well-established
treatments. Importantly, therapists are able to use
any type of therapeutic orientation they adhere to in the processing that
occurs around the activities. This view contrasts with the commonly held
assumption that the postulated change which may occur in AT is singularly
related to the activity participation.
Ringer
(1994) defines AT as a generic term referring to a class of change-oriented,
group-based experiential learning processes that occur in the context of a
contractual, empowering, and empathic professional relationship. Elements of this definition are not unique to
AT and can be assumed generally in many therapeutic traditions. However, the emphasis on “group-based
experiential learning processes” in a typically outdoor and active setting is
clearly a combination differentiating AT from other forms of therapy.
Interestingly,
Ringer’s definition does not mention “adventure.” This purposeful omission challenges one common
misconception about AT: namely, that in order to accomplish their goals,
clients must necessarily subject themselves to adrenaline-fueled feats of
daring and technical skill. The fact
that “adventure” is not seen as an end unto itself distinguishes it from other
types of outdoor programs devoid of therapeutic focus. In line with this
definition, adventure or outdoor experiences alone are not assumed to be
sufficient to facilitate deep-level therapeutic growth and change. Instead, it is the processing of the actual
experience with the client that promotes the therapeutic process. Therefore,
the use of the word “adventure” may in fact be misleading and terms such as
“activity-based psychotherapy” may be more appropriate (Gillis, 1992). Unfortunately however, this term has not
become one of common usage in the literature and adventure-based therapy, with
all of its connotations, is the name that has become standard.
In
examining this discussion, it can be seen that there are problems with
delineating distinct and defining parameters of AT. To address this problem, professionals within
the field have been involved in an ongoing debate as to how to best articulate
a clear definition of what is unique to AT as a treatment modality. Such a definition must necessarily
incorporate widely accepted therapeutic principles while also differentiating
AT from other therapies and from other types of outdoor adventure programs. In an attempt to focus such definitions,
Simon Crisp (1997) has stated on the Association for Experiential Education
listserve what he believes to be a succinct and viable definition:
“1) Wilderness and/or Adventure methods are
utilized in the service of therapeutic practice. Therapeutic practice involves;
a) the
identification of a problem the client presents with,
b) application of a theoretical framework based on a theory of personality, behavioral and psychological problems and process of change that explains the origin and nature of the problem,
c) selection of strategies of client
management and method(s) of intervention which logically relate to b),
d) strategies and methods are routinely
reviewed and modified according to client need.
2) Professional relationship between therapist
and client with the following characteristics;
a) therapist brings to the relationship
training and experience necessary and appropriate to meet the needs of the
client, including a capacity to manage any potentially competing needs of the
therapist,
b) a contract is formed between therapist
and client about the aims, limits, methods and expected outcomes of therapy,
c) therapist works towards the best
interests of the client and holds this at all times the over-riding principle
in determining the actions of the therapist,
d)
therapist acts to protect
the client from harm (physical and psychological). “(personal communication,
1997).
Once again, the singularly unique
aspect of this definition is the emphasis on activities as a means of accomplishing
the other common therapeutic goals.
Again, it is also this focus on the use of activities to accomplish said
goals which seems to differentiate AT from most other therapeutic orientations.
Based on
this, perhaps AT can be best be seen as an activity-based approach to treatment
that attempts to meet similar goals as do other treatments. Therefore, what must be parceled out as
theoretically unique to AT is the mechanism by which AT can accomplish these
goals in ways that are more efficacious than other treatments for particular
clients. This is a question that remains
as yet unanswered. Simply put, it is
essential that the area of AT begin holding itself accountable for answering
the questions posed to all other treatments: Is this treatment effective? For whom, and under what circumstances?
Thought of
in this way, AT can begin to be seen as more similar to other types of
treatments than different. The logical
assumption should follow then that AT is assumed to operate under the same
scientific and clinical umbrella as other mental health treatments, and
obviously practitioners of AT should be
held accountable to the same standards as other practicing mental health
professionals. Unfortunately, in reality
this is not always the case. For reasons
that remain unclear, AT is often presented by its proponents as though it is a
unique and separate entity, an entity somehow not responsible for upholding
such standards. This presents a clear
contradiction between established standards of mental health practice and AT.
Adventure-Based
Therapy Practitice vs. Standard Mental Health Practice
Discrepancies
between AT and standard mental health practices can seen through an examination
of the training levels of adventure-based practitioners in therapeutic skills,
the required adherence to ethical standards in the AT field, and the level of
theoretical knowledge of adventure-based practitioners.
The first
clear discrepancy is seen is shown through a scrutiny of training levels of
adventure therapists themselves. Given
that AT does focus on therapeutic goals similar to other mental health
treatments, it seems necessary that persons employed in the role of adventure
therapists are skilled not only in “hard skills” ( i.e., wilderness experience,
climbing, hiking, team initiatives), but are also skilled in the techniques and
applications of psychological intervention (soft skills).
Unfortunately,
it appears that reality may not reflect this combined necessity. Berman (1995) conducted a straightforward
survey asking about the training of adventure-based therapy practitioners. Berman’s results show that many
adventure-based therapy programs in the United States employ persons to
facilitate adventure-based programming who are lacking in such “soft skill”
areas. This is clearly a concern for the
continued use of AT treatments, and could potentially open such programs to the
possibility of serious ethical violations.
While such
concerns are currently being addressed by the leaders within the field (for
further information, the reader is urged to contact the Therapeutic Adventure
Professional Group(TAPG) of the
Association for Experiential Education (AEE)), this is an area of AT easily
subjected to well-justified criticism.
Given the fact that the AT field is in its early developmental stages,
such issues undoubtedly will continue to arise until a solid set of mandates
and guidelines regarding such competencies are established.
Related to
this, another discrepancy between AT and mental health is that while at present
such a set of ethical guidelines for AT do exist, they are not actually
enforceable. Unlike the APA ethical
standards, an AT professional cannot be held accountable to maintain these
ethical principles in their practice, nor is there any governing body which
limits which types of programs can call themselves “adventure-based
therapy”. If it can be assumed that AT
should be thought of as similar to other types of mental health treatment, it
is logical to wonder why the AT field is not held to such standards. Presently however, this question remains to
be answered. The area of ethics in AT
will be further discussed later in this paper.
Another
seemingly obvious standard of mental health treatment commonly overlooked in
the AT field is the assumption that treatment should be solidly informed by a
solid foundation in psychological theory and application. However, a survey of 31 wilderness programs
specializing in adventure-based therapy found that very few of the programs
contacted were able to identify what type of therapeutic process they were
utilizing with their clients and tended to have little or no research to
support their programs (Davis-Berman, Berman, & Capone, 1994). This is another clear problem within the
field. While there are numerous attempts
being made currently to delineate the theories and processes of AT, it appears
that much of this information is not reaching the actual practitioners. It seems possible, therefore, that there are
many people working within the AT field who may be operating outside of the
realm of accepted clinical practice.
It is of
note that while AT defines itself as meeting the same therapeutic goals as
other treatment modalities, the above two studies provide evidence suggesting
that there may be an underlying belief in the field that AT is unique enough
that it is unnecessary for adventure-based practitioners to be held to the same
standards of expertise as other therapists.
Not only is this a clear contradiction from established practice, it is
also a fairly naive claim. The informed
reader obviously wonders how is it that adventure therapists can be expected to
work effectively with clients and meet stated therapeutic goals at least as
well as other treatments when many of the therapists themselves are simply not
as well grounded in the theories and practice of psychotherapy. Interestingly, leading members of the AT
field are involved in an ongoing debate regarding this issue, with some
advocating for a required level of competency as reflected by a specified level
of training, and others who advocate “training through experience”. This
discussion may reflect a presently existing division one finds between those AT
practitioners who have followed the more established route of academic and
clinical training and those who have learned their clinical skills through
direct experience.
From the
standpoint of clinical psychology, this appears to be simply a moot point. The eventual outcome to such a debate
obviously must involve holding AT to the same standards of care as are other
mental health treatments. Simply put,
while AT may have some unique elements, to be instituted as a viable
therapeutic modality AT must adhere to the same established therapeutic
standards as do all other treatments.
However, in order for this change to occur there must be further efforts
made to establish a sense that AT shares more similarities with other mental
health treatments than was previously assumed.
It is only with the establishment of such a belief, as well as a clear
semantic and theoretical link, that AT will in actuality operate under the
aforementioned umbrella of scientific and clinical practice.
As the discussion in this and the
preceding section illustrate, the AT field has not reached consensus on what
constitutes an adventure therapy program in definition, theory, or in
application. In addition, there appears
to be an underlying assumption that while AT may involve working towards
therapeutic goals and may endorse therapeutic principles, AT is somehow uniquely
different enough to not be held accountable to the same standards as are other
mental health treatments.
To
add to the confusion on this level, a wide variety of organizations and
agencies consider themselves to fall within the realm of adventure-based
therapy. Such organizations employ
widely differing levels and types of adventure programming, thus it is difficult to get an exact sense of what
is meant by the term “adventure-based therapy.
Therefore, it may be helpful to focus the discussion on the goals of
AT. The reader will also be given
increased knowledge and understanding of the goals of AT in the following
section which delineates the specific characteristics of AT.
Goals of Adventure-Based Therapy
AT
proponents have articulated a variety of goals that may be associated with the
approach. While recognizably unsupported by solid empirical data, as well as
not clearly linked to the reduction of pathological symptomatology, the
following section will broadly summarize these interconnected goals. First,
clients are thought to generally increase in self-awareness, leading to an
increased recognition of behavioral consequences and available choices; second,
clients are thought to learn healthier coping strategies leading to increased
environmental control; third, through AT, clients are thought to be provided
tangible evidence of success, thereby disproving negative self-conceptions and
leading to a more positive self-concept; fourth, clients are thought to learn
creative problem-solving, communication, and cooperation skills; and fifth, AT
is thought to facilitate realistic appraisal of individual strengths,
weaknesses, and self-imposed limitations.
Ultimately, this increased awareness is thought to lead to better
decision-making.
Overall, AT
programs have the overriding goal of an increasing self-awareness in a variety
of domains. In line with this, it is
thought by AT theorists that connections between behavior and the results of
such behavior become more apparent.
Therefore, clients can be provided with concrete examples of
dysfunctional behavior and shown that alternative behavioral and interpersonal
choices can lead to success. Relatedly,
Bandoroff (1989) argues that adventure activities, with the feedback and
consequences available through such experiences, provide learning that enables
participants to begin regulating their own behavior. Amesberger (1998) expands on this goal,
noting that AT involves:
“….the reflection on internalized norms and values
with the aim to support a person to find new and more suitable structures for
his or her life. Destructive and
dysfunctional behaviors or emotions should be recognized in their effects, as
well as helpful and effective ones.” (p.29).
Of note is the fact that these
tenets are clearly embedded in the therapeutic process itself.
Taylor
(1989) postulates that that the exposure
to uncertainty or ambiguity accompanied by increases in levels of confidence
and skill that can be achieved through the AT process will facilitate a
healthier coping response. It is believed that as clients learn and use new
modes of coping they gain greater control of their environment (Nadler &
Luckner, 1992). It is hoped that by
coping with the treatment environment in new ways, clients can learn to achieve
increased personal and environmental control outside of the treatment. This is an experience which may be novel for
many clients.
According
to Herbert (1996), through AT “persons challenge themselves, and in doing so,
(re)learn something about themselves.” (p.5). To accomplish this, mastery
tasks, or initial successes, associated with the activities counteract and
disprove internally focused negative self-evaluations, learned helplessness,
and dependency (Kimball & Bacon, 1993) at a time when such processes may be
intensely activated. This heightened
activation combined with concrete evidence of success may facilitate further
learning. Ultimately, feelings of
success and control also associated with the mastery tasks can then serve as
additional reinforcers to support changed behaviors. Thus, it is a circular process of
interpersonal and intrapersonal activation, success, and reinforcement.
Priest and
Baillie (1987) discuss additional possibilities for client change, stating that
“The aim of adventure education is to create astute adventurers: people who are
correct in their perceptions of individual competence and situational risk” (p.
18). ). Relatedly, through AT, clients
can learn skills related to problem-solving, cooperation, communication, and
facing challenge (Herbert, 1996). It is
thought that through this process, clients learn to more realistically appraise
their own personal strengths and weaknesses, both on a personal and an
interpersonal level.
Through
this process, clients begin to recognize their own self-imposed limitations and
increase in their awareness of available choices, thus becoming better able to
accept responsibility for their level of success or failure. As clients
increase in this self-knowledge and self-awareness, it is believed that they
are ultimately able to make more realistic and healthy decisions. These are important skills many clients lack.
Moreover, Taylor (1989) notes that the increased levels of confidence, skill,
and self-awareness that participants may gain through AT encourages clients to
see uncertainty as a challenge and not a threat, a change with potentially
far-reaching positive consequences for clients.
Ultimately,
these proposed changes can perhaps be summarized in this inherent underlying
assumption embedded within the adventure-based therapy literature: the
assumption that by becoming aware of available choices, and by experimenting
with different behaviors in a novel environment where one is receiving
immediate and realistic feedback, clients can learn to actively influence their
probability of success. Furthermore,
through AT clients learn to demonstrate personal competencies, build upon
skills, accept personal responsibility, more accurately assess themselves, and
maintain a higher degree of control over their environment. It is also believed that having an increased
capacity to regulate one’s own behavior will facilitate further increases in
levels of self-awareness, competence and a more internal sense of control of
one’s own world.
It is
important to note once again that these assumptions and goals are not unique to
AT. In fact, statements such as above
with their emphasis on self-awareness and the interpretations of challenge vs.
threat carry clear elements of humanistic theory, and the focus on
self-knowledge and the increased awareness of available choices directly
parallels the humanistic tradition (Csikszentmihaly, 1990; Raskin, &
Rogers, 1989; Maslow, 1971). In addition, one can see elements of
cognitive, behavioral, and object relations theory embedded in this discussion
of the goals of AT. Such similarities
will be summarized in detail in a later section.
It is also
important to point out that the discussion of the goals of AT involves sweeping
and unsubstantiated claims with little empirical support. In addition, in the examination of such goals
one can see very little that is focused on the alleviation symptomatology
specifically relevant to psychopathology.
In some ways this parallels the state of the literature, as it will be
seen that no studies have utilized measures of clinically relevant symptom
reduction. However, given the
possibility of parallels between AT and such well-established therapeutic
orientations, it may have potential therapeutic benefit and as such is
deserving of continued investigation.
Further parallels between AT and other therapeutic traditions will be
seen in throughout the discussion of the specific characteristics of AT.
Characteristics
of Adventure Therapy
Having discussed the history, theoretical background, definition, some basic discrepancies between AT practice and standard mental health, and the goals of AT, a discussion of the specific characteristics of AT is warranted. Thirteen characteristics, including those delineated by Kimball and Bacon (1993), will be discussed in turn: (1) multiple treatment formats, (2) group focus, (3) processing, (4) applicability to multimodal treatment, (5) sequencing of activities, (6) perceived risk, (7) unfamiliar environment, (8) challenge by choice, (9) provision of concrete consequences, (10) goal setting, (11) trust building, (12) enjoyment, and (13) peak experience.
Multiple Treatment Formats
First, adventure programs range in scope from those which incorporate adventure-based techniques with more traditional modes of therapy to those that utilize full-scale extended expeditioning as their therapeutic medium. These types of programs are differentiated based on where the therapy is taking place, for what length of time the client
is involved, and what types of programming are being utilized (Gillis, 1995). As Gass (1993) suggests, three main areas exist within the adventure-based therapy field. These include (a) activity-based psychotherapy, (b) wilderness therapy, and (c) long-term residential camping
Given the diversity of programs, it is important to be clear as to what type of program is being referred to under this broad rubric of “adventure-based therapy” when considering AT from a scientific perspective. Unfortunately, this distinction is not always clearly noted and can be difficult to determine when examining the literature.
Activity-based psychotherapy
Activity-based
psychotherapy (Gillis, 1992), occurs at
the therapeutic facility of the client or at another nearby facility designed
for such interventions. This type of
therapy utilizes adventure activities as one type of intervention in the
client’s overall treatment plan. The AT
intervention is typically one day in duration and is used an adjunct to
concurrent inpatient or outpatient treatment, although the client may
participate in more than one such program (Banaka & Young, 1985; Witman,
1987; Witman & Preskanis, 1996).
This type
of format is often used in inpatient settings, but can also be used in
combination with outpatient psychotherapy.
The experiences tend to be contrived (i.e. the facility and initiatives
are developed specifically for such an intervention), and focus on team games
and problem-solving. These types of
activities can also be used in conjunction with high or low challenge ropes
courses.
Crisp
(1997) more fully defines this type of adventure-based therapy by its “emphasis
on the contrived nature of the task, the artificiality of the environment and
the structure and parameters of the activity being determined by the therapist.”
(p.58). In addition, he notes that the
goals of the particular activities are often a specific outcome. These outcomes are typically planned for, and
influence the choosing of the activities by the therapist.
While the
activities chosen in this type of intervention may indeed be quite unique to
AT, the conscious use of therapeutic technique designed to work towards a
specific outcome is obviously not unique to this type of therapy. In addition,
it can be noted that potentially all therapeutic situations can be thought of
as contrived, again leading one to wonder how AT is unique in this way.
With
regards to research design, this type of treatment has been utilized in
efficacy studies of adventure-based therapy with participants from typically
higher risk groups, (e.g., psychiatric populations (Banaka & Young, 1985;
Witman, 1987; Witman & Preskanis, 1996)). Comparisons can be made between
groups who participate in an adventure-based intervention as an adjunct to
other treatment vs. those who participate in the standard treatment alone.
Statements such as these are provided at this point in order to render a more
integrative understanding to the informed scientific reader. A complete discussion of the research-based literature will follow in
a later section.
Wilderness therapy
The second
format discussed by Gass (1993) is wilderness therapy, and this type of program
is most typically associated with the general term “adventure-based
therapy”. Such programs can be easily
utilized as an independent treatment and are commonly seen in the efficacy
literature for AT.
In
wilderness therapy, programs utilize an expedition-oriented format in remote
settings and treatment traditionally lasts anywhere from 7 to 31 days, although
programs also utilize alternative lengths. These programs typically follow an
Outward Bound type model, and the teaching and practicing of wilderness skills
is an important aspect. Not only is the
learning of these skills necessary for the client’s survival and comfort, but
it is also believed that this learning provides an opportunity for clients to
increase their skill base and thus their own individual level of perceived
competence (i.e., self-efficacy theory).
This format also provides experiences that may have more personal and
concrete consequences for the participant, i.e., basic survival needs not being
met properly, as well as allowing for full and extended immersion in the
experience.
The
learning of such skills is thought to combine with the interpersonal learning achieved
through the group interaction. Activity
outcomes are often related to patterns of behaving within the group and the
reenactment of social roles seen in such a group situation. Change is seen to emerge from interpersonal
and intrapersonal insight, increases in perceived self-efficacy, and the
process of the group over time. Because of the nature of the intervention,
groups remain intact, thereby potentially fostering an intensification of the
group experience.
One problem
with these types of programs is that follow-up tends to be limited and
conducted by professionals who have not been involved in the wilderness
experience. Such professionals may be
unfamiliar with the client’s experience and therefore less able to build on the
treatment gains experienced by the client. From both a research and a clinical
standpoint, this lack of follow-up provides significant problems when
evaluating long-term treatment gains associated with this type of program
(Wichman, 1991).
Long-term residential
The
third type of therapeutic adventure program is long-term residential
camping. This format has tended to be
used primarily with youth at risk and adjudicated adolescents. Program length varies, ranging from several
months to over a year. Such programs are
characterized by Buie (1996) as
utilizing considerable acreage, having a permanent base camp, and temporary
camp sites built by campers (typically tent-covered wood platforms). Clients are responsible for providing for
their own survival needs and, according to Gass (1993) “the client change is seen to be associated
with the development of a positive peer culture, confronting the problems
associated with day-to day living, and dealing with existing natural consequences”
(p. 10). Education in traditional school
subjects is also provided during such programs.
If left
without further explanation, this definition suggests that while these programs
may operate in a different setting than typical non-therapeutic residential
facilities for children (e.g., boarding schools), there may be no clear
difference between such programs and any other type of residential
atmosphere. However, again it must be
made clear that such programs have a stated therapeutic emphasis and therefore
attempt to utilize some level of therapeutic processing to facilitate
therapeutic growth and change. As can be
assumed, however, it is often unclear to what degree and in what way this
emphasis is adhered to.
Research
designs based on both of the latter programs typically compare persons who have
been involved in an adventure program with those who have been involved in some
other restricted setting for similar
lengths of time, i.e., incarceration, probation or juvenile detention
(Castellano & Soderstrom, 1992; Kelley & Baer; 1971; Willman &
Chun, 1973). Given the high levels of
criminal involvement and societal dysfunction often found with the clientele
typically referred to such programs, objective outcomes measures such as
recidivism rates, academic success or employment rates have been used as a
basis of comparison.
Group Focus
The second
characteristic of AT is group focus, and AT is almost exclusively a group
process. As in many therapeutic settings
groups typically range from 6 to 14 people (Kimball & Bacon, 1993) and the
clients tend to be somewhat heterogeneous in terms of therapeutic issue or
diagnostic category.
As with any
group psychotherapy, this group component is a vital part of the overall
therapeutic aspect of the intervention. Similar to any therapy group, the group
in AT provides support, feedback, and a potent interpersonal context. Uniquely, however, in AT specific activities
are presented to the group as challenges to be overcome, and success depends on
each individual member participating in their completion (e.g., by standing on
a platform, scaling a rock face, or negotiating unmarked terrain to a specified
destination). In order to master any of the challenges, the group must
cooperate, apply skills, creatively problem solve, and rely upon each other.
Herbert
(1996) discusses more completely the issue of creative problem solving as it
relates to AT. He notes that each
activity is concrete and has a clear beginning and a clear ending. Problems can typically be solved in a number
of ways, and there are also a number of ways that groups and individual clients
tend to approach a problem unsuccessfully, thereby increasing the level of
perceived difficulty of the activity.
What is expressly different about AT and other problem-solving formats
is that in order for the tasks to be completed, all participants must play a
role in order for the group to succeed (i.e., utilization of superordinate
goals). Therefore, activities require
the group to discuss and decide on different strategies, implement such
strategies, modify those that are unsuccessful, or implement new strategies;
all potentially important skills for clients to practice. Not only does this process involve the
completion of the task, but group dynamics involved in the decision making
process are closely followed and the interpersonal aspects of the activity are
then processed by the therapist in a similar fashion as any other type of group
therapy.
Drawing
from the theory of interpersonal group psychotherapy (Yalom, 1995), it is
further thought that group focus leads to the intensive activation of a
client’s interpersonal patterns, which, in conjunction with appropriate
therapeutic processing, facilitates therapeutic change. This assumption also echoes Yalom’s “social
microcosm” theory of group functioning in which it is assumed that “patients
will, over time, automatically and inevitably begin to display their
maladaptive behavior in the therapy group” (Yalom, 1995, p. 28). Therefore, this group context provides an
environment for the enactment of individual pathology and the problem-solving
associated with the group process may lead to further concrete representations
of this, as well as provide an opportunity for the practice of new behaviors.
Also
similar to interpersonal group psychotherapy, it is not just WHAT happens
during this problem-solving process but HOW it happens in the group that is of
interest. For example, how did the group
decide on which strategy to use? Who was
the leader? Did some clients participate
in the decision making process more fully than others? Is this a common response for them or a new
behavior? What was it like to work
through this problem? How did it
feel? Each of these components, along
with others that can lead into deeper level therapeutic processing, provide a
rich opportunity to observe and process a client’s relational processes.
Finally, it
is also thought that the more active and concrete nature of the “task” in AT
may lead to greater involvement for all clients than does traditional group
psychotherapy. Importantly, such higher
levels of involvement have been shown to be a significant predictor of
psychotherapy outcome (Gomes-Schwartz, 1978)
While these same principles operate in traditional group psychotherapy,
realistically certain members in a traditional therapy group can achieve
“success” regardless of the level of participation of others. While it can recognizably be argued that a
skilled group therapist in any therapy setting can involve the entire group, or
in fact involve the entire group around any individuals client’s lack of
participation, it may be that this type of “non-participation” with it’s impact
on the group is less likely to occur in an AT setting. Simply put, it is thought to be more
difficult for a client to remain unengaged as the activities themselves
necessitate participation. There are no
data, however to support such a statement.
Processing
Another
descriptor of AT programs is that a great deal of time is spent processing the
experience with clients and facilitating the transfer of learning into a
client’s daily life. It must be noted again that this processing is not
necessarily associated exclusively with the activities alone. As mentioned in the introduction, the
activities can be conceptualized as a catalyst for the processing which occurs
before, during, and after activities, a catalyst which also provides concrete examples of the
consequences associated with individual and group actions. It must also be noted once again that this
processing is not necessarily associated exclusively with the activities; a
statement made as a direct contrast to the view that any change which may occur
is theoretically associated with the activities themselves.
To engage
in this processing, tools such as individual psychotherapy, group psychotherapy
therapy, journal writing, individual time for reflection, modeling,
self-disclosure, and metaphoric processing (Gass, 1993) may be utilized
throughout the course of an AT program.
While the techniques listed above may be familiar to clinicians, the
extensive use of metaphoric processing is an aspect of AT which may be fairly
unique in it’s application and thus warrants further discussion
Metaphors
are used with the client to link the learning and growth provided through the
adventure-based experience to situations found in his or her “real- life”,
thereby providing the generalization so necessary for the maintenance of any
gains that may be achieved through the adventure-based intervention. It is important to recognize that this
perceived lack of relevance to realistic situations the client may encounter is
one of the most commonly put forth criticisms of AT. Advocates of AT claim that this metaphoric
processing provides the necessary link between the AT experience and the
“real-world”, however there is no data available as to the efficacy of such
processing in generalizing treatment gains.
When using
metaphor in AT, the therapist takes on the role of conduit, actively helping
the client to build such metaphors.
Adventure-based practitioners postulate that the use of metaphor helps
the client to continue utilizing the learning and growth provided through the
adventure experience in ongoing and
productive ways. It is believed
that through this use of metaphor, adventure-based experiences can help provide
clients with concrete tools designed to help them to successfully negotiate
their own personal challenges upon completion of the intervention. Interestingly, this belief that therapy can
function to provide the mechanism for
clients to continue their own change process outside of the therapeutic context
mirrors cognitive therapy. In fact, Beck
and Weishar (1989) note that in cognitive therapy, “Patients are told that the
a goal of therapy is for them to learn to be their own therapists.” (p. 305).
Processing
in AT will be revisited in the discussion of AT facilitation occurring later in
this paper.
Applicability to Multimodal Treatment
Another
characteristic of AT is its applicability to multimodal treatment. As aforementioned, AT can be used either as
an independent intervention or as an adjunct treatment. Importantly, the focus on group level
processing in combination with the individual psychotherapy which takes place
around the activities does not preclude a therapist from utilizing standard and
accepted treatment orientations and practices in the therapy associated with
the activities.
Sequencing of activities
Fourth, in
order to allow for the group to develop the skills and the level of cohesion
necessary to achieve success in the activities, such activities are
incrementally sequenced in difficulty.
This sequencing also provides initial successes, or “mastery tasks”,
fostering feelings of capability while counteracting internal negative
self-evaluations, learned helplessness, and dependency (Kimball & Bacon,
1993). This provision of a mastery task
(success) concurrent with the activation of negative self-evaluations is an
important component for the therapeutic change thought to be associated with
AT, as the mastery task is thought to provide an opportunity to tangibly
disprove such evaluations. It is the
therapists role to facilitate such a transfer as such connections are not
believed to be an automatic reaction to the activities.
Conversely,
activities presented with inappropriate sequencing can be counter-productive
and reinforce negative self-conceptions for individual participants. The
activation of such negative internal processes for a client without the
opportunity to counteract such feelings with success can further reinforce
existing beliefs in personal ineffectiveness.
In addition, such negative conceptions can also permeate the development
of a group identity. Therefore, it is vital
that the therapist not create a situation in which the group repeatedly experiences
failure as it can be recognized that this dynamic can carry the highest
potential for emotional harm and would be likely to limit therapeutic
potential. As with other types of
therapy groups, it is recognized that success is often dependent on the
facilitator remaining aware of where the group is in its development (Yalom,
1995) and taking this into consideration when planning.
Perceived Risk
While
sequencing is extremely important and requires the therapist’s clinical
judgment and acumen to choose activities wisely, on the surface challenges are
often structured so as to appear to be impossible or dangerous to the group. In
actuality, the challenges are in fact low in actual risk but high in perceived
risk, with the term “risk” referring to not only physical risk, but also intra-
and interpersonal risk as well. For
example, standing on a platform and falling backwards into the arms of others
requires more trust than utilizing another person’s support to cross a
log. However, at earlier points in a
groups development this need to be supported (i.e., depend or rely on someone
else), could be perceived as carrying as high a level of interpersonal risk,
along with the associated intrapersonal risk, as any physical activity for some
clients.
Conceptually, perceived risk is thought to
create tension and disequlibrium within the individual, ultimately leading him
or her to a position of choice (i.e., dissonance theory). With regard to this conviction, Herbert
(1996) notes that “In order for a person to achieve equilibrium, persons are
challenged to make necessary adaptations.” (1996, p. 5). He goes on to state
that “Adventure-based work recognizes that it is the effort to overcome
obstacles and, in effect, overcoming one’s own fears that is critical.” (p.
5). Through this combined of process of
relieving dissonance and overcoming fears, it is commonly believed in AT that
clients are shown that old patterns are destructive and new choices can lead to
more successful behaviors.
So central
to AT is this perception of risk, that Amesberger (1998) notes “The most
striking difference between adventure-based therapy and traditional
psychotherapy is the client’s strong involvement in a reality that is neither
harmless nor perfectly safe” (p. 29). One could argue however, that this belief
also permeates traditional psychotherapy as well. For many clients, the deep level of emotional
sharing found in a traditional therapy setting carries a high level of perceived
risk, and the early sharing of basic information with a therapist may be as
threatening as later sharing of seemingly much more personal information. Therefore, it seems this difference may be
much less apparent than Amesberger believes.
Unfamiliar Environment
Another
core characteristic of AT is that it is usually conducted in an environment
unfamiliar to the client. This use of an unfamiliar and novel environment is
thought to unbalance the client, further activating their underlying inter- and
intrapersonal processes. It is
hypothesized that the client has no familiar template from which to draw their
reactions to the new situation, and thus it is the conviction of AT
practitioners that the client must eventually rely on potentially new and
ideally healthier ways of behaving in order to achieve success (Gass, 1993) and
equilibrium. In a sense, this can be
perhaps be conceptualized as providing an opportunity for clients to be free of
past determinism.
This
conception appears, however, to overlook an important intermediate step. While this unfamiliarity with the environment
may ultimately result in new ways of behaving for a client, the social
microcosm theory of group psychotherapy (Yalom, 1995) implies that prior to
engaging in new behaviors, the client will first begin utilizing earlier
learned and more dysfunctional ways of behaving. It can be assumed that only through this
activation of dysfunctional ways of behaving will more functional ways become
apparent to the client.
To link AT
with the social microcosm theory, the assumption underlying the unfamiliar
environment in AT theory is that by taking a person out of their normal
context, the client is exposed to new situations where old patterns of coping
probably will not work. If this does
result in dysfunctional behavior being evidenced first (social microcosm
theory), it is possible that through the AT activities the client may be
provided with more tangible evidence of the consequences of dysfunctional
behavior than is typically provided in group psychotherapy. These concrete consequences of dysfunctional
behavior in combination with a novel environment, an environment which may
necessitate new ways of behaving, could provide an impetus for change. In addition, the group can also provide
reinforcement for new ways of behaving.
Theoretically, this can also be seen as similar to the stimulus-control
tenet of operant learning theory.
This
environmental unfamiliarity in AT is also thought to allow for the client to
experience the therapy not only without drawing from their standard template of
behaviors, but also without drawing from their typical expectations and
defenses. Therefore, it is thought that
this unfamiliarity may allow for a client to approach the therapeutic
experience with less of a defensive posture.
Golins (1978) contrasts AT to traditional therapy methods on this issue
of defensive posturing, noting that “traditional individual or group therapy
methods may be particularly threatening for persons who have difficulty
expressing themselves and/or establishing new relationships.” (cited in
Herbert, 1996, p. 6). To compare this
with traditional psychotherapy research, Orlinsky and Howard (1986) have found
“the dimension of the patients openness vs. defensiveness to be related to
outcome”(p. 219). If in fact AT does
work to lower defenses, this finding suggests that lowered defensiveness may
contribute to a more positive outcome for clients. As with other claims of AT however, this
premise is purely speculative in nature.
As with
dysfunctional behaviors, it is thought in AT theory that when a client’s
defenses do inevitably become activated, the therapist and the client may be
provided with tangible examples through the activities and the interpersonal
interactions around the activities of the ways in which defenses operate in a
client’s life. In addition, the
unfamiliar and novel AT setting may then provide a situation that is less
threatening for some clients to experiment with new and less defensive
behavioral and relational patterns.
While such
opportunities are available in traditional settings based on interactions with
the therapist or other group members, the examples and outcomes of behaviors
and defenses may be more concrete for the client in the AT setting,
particularly for those with a low level of insight capability. In this sense the activities can be perhaps
again be best conceptualized as the catalyst for such defensive reactions with
the therapist and the group providing the medium for the activation, the
recognition, and the processing of such defenses. Viewed in this way, AT
parallels many of the principles of interpersonally-oriented individual and
group psychotherapy. Given this
relationship, it is possible that AT may provide an alternative and potentially
less threatening medium for the achievement of similar goals as group
psychotherapy which may work better for some clients. As with all of these theoretical
postulations, however, this is purely suppositional as there are no data to
provide support for this contention.
Finally,
while it could be argued that the atmosphere of a traditional therapy session
may be completely alien to one unfamiliar with the process, this unfamiliarity
is realistically based on the relationship between the therapist and the client
as opposed to the actual office setting.
AT settings, in contrast, are typically unfamiliar physically as
well. It is thought that these multiple
levels of unfamiliarity add an additional level of novelty to the AT experience beyond that found in the
standard therapy room. In addition, the
AT setting often changes, either literally or through the choice of activities,
and therefore is felt to remain somewhat more novel throughout the process than
traditional psychotherapy.
The Relationship between
perceived risk and environmental
unfamiliarity
Herbert
(1996) discusses how the unfamiliarity of the environment and the high level of
perceived risk interact and how this combination is presumed to affect the
client. He refers to this interaction as “challenge/stress”, and reviews how it
is believed by AT proponents that the dissonance created by the unfamiliar
environment, in combination with a high level of perceived risk, results in an
increased intensity of the activation of interpersonal and intrapersonal
processes. Herbert goes on to discuss this interaction and subsequent
activation as a potential change mechanism, noting that “Stressful experiences
that are likely to occur throughout an adventure based program serve as impetus
for individual change” (p.5). Gass
(1993) also discusses this phenomena, referring to this type of stress as
positive stress, or “eustress”
It is this
belief in client dissonance and the associated intensive activation of intra-
and interpersonal processes, the unbalancing based on the lack of familiar
“templates”, the opportunity for new behavioral choices, the reinforcement
provided by the activities, and the associated processing that moves AT most
completely away from outdoor adventure programs and into the realm of therapy.
Again it should be noted that while the form this unbalancing takes may be seen
differently based on theoretical orientation, this may found in any type of
therapeutic setting.
Nevertheless,
it is thought in the AT literature that clients who make new behavioral choices
in order to complete a novel challenge they had interpreted as carrying a high
level of risk, particularly one they had previously thought themselves
incapable of, are thought to see themselves differently with the ultimate goal
being the recognition of their own self-imposed limitations. Through seeing themselves differently,
clients gain in self- esteem, and such gains which have been linked to
decreases in anxiety and depression (Gilbert, 1992). Relatedly, Priest (1993) has suggested that
participants will be able to influence their probability of success in an
adventure experience if they have realistic perceptions of risk involved in the
choices they make, as well as a realistic sense of their own competence. In
addition, on the intrapersonal level the client is presented with concrete
examples of whether their typically negative self-evaluations and
self-expectations triggered through the interaction of perceived risk and
environmental unfamiliarity have been proven or disproven.
Challenge by Choice
Related to
the discussion of perceived risk is the recognition that clients are given the
option of “challenge by choice”. This
allows for a client to choose not to participate in an activity with which they
are not personally comfortable. It is
important to recognize that the choice to not participate in an activity is not
necessarily negative and may have as many therapeutic implications as
participation (i.e., choosing not to participate is still a choice). Such an
instance may potentially reflect positive steps toward clients asserting their
personal boundaries by recognizing and acting on personal discomfort, a
potentially important issue for many clients.
In such a situation, the therapist should make every effort to include
the client in some way, such as spotting or observing. According to Royce
(1987), “The key to growth in any situation is that the participants should
choose to confront their fear rather than being forced to engage in fearful
activities. This allows for the individual
to take control of their life instead of being other-directed.” (p.28).
As one can
perhaps infer from the above statement, “challenge by choice” is thought to be
based not only on the recognition of risk involved in activities and related
boundary issues, but also to an extent on the construct of learned helplessness
(Seligman, 1975). Groff and Datillo
(1998) discuss learned helplessness theory as it relates to AT, noting that
past experiences leading to attributions which result in feelings of helplessness
can generalize to other areas of a persons life, potentially resulting in a
decreased motivation to engage in activities of which he or she is unsure of
the outcome. As learned helplessness has
also been espoused as a causal element in depression, this may be an important
link to explore regarding AT’s potential for therapeutic change.
It is
believed that “challenge by choice” can help lead to the recognition of the
power of individual choice that can perhaps begin mitigating learned
helplessness (Groff & Dattilo, 1998), thus contributing to the development
of a greater sense of control for the client and more realistic cognitive
attributions for events. Should such a
decrease in learned helplessness occur, it may contribute to decreases in
depression levels for some clients.
While there is no evidence based on AT to support such a statement, if
this proposed phenomena were to occur it seems the theory would predict that
through increased recognition of alternative choices (e.g., choosing
non-participation) in combination with alterations in attribution styles that
may be developed through the processing of such choices, clients may develop an
increased sense that their level of personal control can be related to
external, specific and unstable causes, as opposed to internal, global and stable
causes associated with feelings of lack of control (Comer, 1998).
Schoel et
al. (1988) share this example to illustrate the power of challenge by
choice:
“A short-term patient [from the In