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O R I G I N A L P A P E R

Enhancing Family Communication: Examining the Impact of a Therapeutic Wilderness Program for Struggling Teens and Parents

Katie Liermann1 • Christine Lynn Norton2

Published online: 19 January 2016

� Springer Science+Business Media New York 2016

Abstract Every year approximately 130 families partic-

ipate in Intercept, a program for struggling teens and their

families at the Voyageur Outward Bound School, because

they are concerned about the loss of trust, poor commu-

nication, and/or other high-risk behaviors they are experi-

encing with their children. Though families hope for

improvements in family functioning, little research has

been done on the impact of this type of program on the

parent/child relationship or how families function once

they leave the program. This phenomenological study

collected qualitative data from nine families to determine

what positive relationship outcomes emerged between

parent(s) and their adolescent child post-program, as well

as what aspects of the program curriculum were helpful in

improving the parent/child relationship. Results showed

that communication among family members improved as a

result of participation in the Outward Bound program, and

families reported utilizing new skills they had learned,

including the use of time-outs, improved listening, and

other assertive communication tools. Families reported that

the parent/child conference at the end of the program was

the most helpful aspect of the Intercept curriculum for

improving the parent/child relationship. Implications for

family therapy include support for therapeutic wilderness

programs as a viable intervention for families of high-risk

teens struggling with communication.

Keywords Therapeutic wilderness program � Family functioning � Communication � Family therapy

Introduction

The family system is an integral part of adolescents’

‘‘social, emotional and behavioral well-being’’ (Harper

and Cooley 2007, p. 393). The health and functioning of

the family system can play an important role in an ado-

lescent’s development into adulthood (Coady and Leh-

mann 2008). According to a seminal study by Resnick

et al. (1997), strong family connectedness can be a pro-

tective factor that promotes youth functioning. However,

when youth experience negative family dynamics, such as

poor communication, anger, and distrust, they can expe-

rience problems in family functioning (Steinberg 2001).

When this occurs, families may require intervention

through family therapy.

Though a wide range of systemic family therapy inter-

ventions exist (Cottrell and Boston 2002), research has

shown that therapeutic wilderness programs can improve

both youth and family functioning (Harper and Cooley

2007; Harper and Russell 2008). According to Norton

(2007), there is a continuum of therapeutic wilderness

interventions, from experience-based wilderness programs,

which include non-clinical staff, to Outdoor Behavioral

Healthcare, which involves clinical staff administering

therapeutic interventions, specifically targeting a client’s

treatment plan. Regardless of the level of clinical services

provided, most therapeutic wilderness programs utilize

adventure-based activities in the outdoors to implement

therapeutic interventions for adolescents who are strug-

gling with behavior issues, as seen by parents, schools and/

or the courts (Berman and Davis-Berman 2008).

& Christine Lynn Norton [email protected]

Katie Liermann

[email protected]

1 San Jose State University, 1 Washington Square, San Jose,

CA 95192, USA

2 Texas State University San Marcos, San Marcos, TX, USA

123

Contemp Fam Ther (2016) 38:14–22

DOI 10.1007/s10591-015-9371-5

Traditionally, it is has been thought that these programs

only treat the adolescent who attends the wilderness pro-

gram (Harper and Cooley 2007). In fact, it was not until the

late 1980’s that wilderness programs saw the opportunity to

involve the family in the adolescent’s recovery (Bandoroff

and Scherer 1994). However, research on therapeutic

wilderness programs has begun to show the need for ‘‘more

intentional and direct involvement of families in the change

process…to help families address issues preventing effec- tive family functioning’’ (Harper et al. 2007, p.126).

Therefore, more wilderness programs are involving the

entire family system, such as Outward Bound’s Intercept

program for struggling teens, which incorporates the family

into the adolescent’s experience (Outward Bound 2013a).

Every year approximately 130 families participate in the

Intercept program at the Voyageur Outward Bound School

in Ely, Minnesota. Intercept is a 28-day therapeutic

wilderness program for struggling teens and their families.

Pre-program data collected show that families participate in

this program because they are concerned about the loss of

trust, poor communication, and/or other high-risk behaviors

they are experiencing with their children. Though significant

research demonstrates the positive impact of therapeutic

wilderness interventions on youth functioning (Clark et al.

2004; Norton et al. 2014), more research is needed on the

impact on the parent/child relationship and how families are

functioning once they leave a program. The purpose of this

study is to determine what positive relationship outcomes

emerged between parent(s) and their adolescent child after

participation in the Outward Bound Intercept program.

Though this program is not a traditional Outdoor Behav-

ioral Healthcare program, the risk factors of youth in this

program are similar to those in OBH programs (Norton

2010); therefore, this research is deemed applicable and

relevant to the larger category of OBH research. Further-

more, therapeutic wilderness programs are on the same

continuum of care as OBH, and may play a key role in

addressing the mental health needs of adolescents before they

need OBH (Berman and Davis-Berman 2015). On one side of

the continuum there are [therapeutic wilderness] programs

like Outward Bound that provide adolescents with thera-

peutic adventure experiences for personal growth and

development, but do not require staff to be licensed mental

health professionals. Rather, staff administering Outward

Bound programming are trained outdoor instructors who may

also provide paraprofessional counseling and support. On the

other side of the continuum are wilderness therapy programs,

also known as Outdoor Behavioral Healthcare, a modality of

mental health treatment, in which clinical staff provide

therapy in a wilderness context. Overall programming, field

staff training, and the type of youth served is often similar,

and both types of programs play a key role in serving youth

and families, but key differences should be noted.

Therapeutic Wilderness Programs as a Family Systems Intervention

When an adolescent is struggling, the family plays an

important role in the teen’s growth and development

(Harper et al. 2007). Family systems theory reaffirms this,

by viewing the adolescent as a part of a system that focuses

not only on the individual but the relationships within the

family system (Becvar and Becvar 1999). When adoles-

cents struggle to make healthy decisions, it can affect the

entire family system, often creating conflict between par-

ents and the adolescent child. When this occurs, families

sometimes seek community-based counseling services.

Though wilderness programs historically have been used as

a last resort for families struggling with high-risk adoles-

cents, families seek out wilderness programs when they

perceive traditional therapy as ineffective (Russell 2000).

When a family makes the decision to change the family

dynamic by sending the adolescent child to Outward Bound,

the Intercept program staff first work with the adolescent to

create goals for the expedition that are transferable to home

life, gain insight as to why they were sent to this program,

and what they and their parents can change to create a more

positive home life (Norton 2007). Though it is the adoles-

cent that participates in the wilderness expedition, the parent

plays an important role in the program outcomes as well.

While the adolescent is engaged in the wilderness program,

it is the parents’ responsibility to evaluate their parenting

style and relationship with their child, by completing weekly

homework assignments, writing a letter to their child and

participating in a Parent/Guardian Seminar at the end of the

wilderness phase of the program. The letter is guided by

restorative, strengths-based questions to help the parent

reflect on what they love about their child and what they

hope for in their relationship with them upon their return

home. It is given to the youth the night before youth are

reunited with their families.

During the parent/guardian seminar, the parents and

child have a conference to determine what positive changes

they would like to sustain in the home environment. The

Intercept instructors work with the family to transfer

learning that has occurred over the past month for both the

parents and the child. This conversation includes setting

goals and expectations upon their arrival home (Norton

2007). Intercept instructors who are trained in family sys-

tems theory facilitate this therapeutic conversation, but are

not licensed family therapists. The conversation is intended

to help families connect, to provide appropriate space for

autonomy, and to help families work on regulating their

emotions by applying new skills. It is also a time to coach

the family in how to use the new skills they learned in the

program upon their return home. This model of family

intervention is similar to Doherty’s (1995) family life

Contemp Fam Ther (2016) 38:14–22 15

123

education approach, which ‘‘provides family members with

information, skills, experiences, or resources intended to

strengthen, improve or enrich their family experience’’

(NCFR 2014). Often, these conversations lead families to

be more open to the idea of participating in formal family

therapy upon their return home.

Prior Research on Family Involvement in Therapeutic Wilderness Programs

In addition to youth functioning, research on therapeutic

wilderness programs has also looked at the impact and role of

the family in treatment, as well as impact on attachment. Many

wilderness programs have a requirement of family involve-

ment in the treatment process and research has shown mixed

results on the impact of wilderness therapy on family func-

tioning (Harper and Cooley 2007; Harper and Russell 2008).

The evaluation of a 1 day pretreatment and 1 day post treat-

ment multifamily program, in addition to wilderness therapy,

showed significant impacts on youth’s behaviors post dis-

charge; however, had limited impact on family functioning

(Harper and Cooley 2007). A mixed methods study looking at

the involvement of family and impact of wilderness on family

functioning found only one out of four areas impacted in terms

of functioning, yet qualitative interviews revealed families felt

a stabilizing effect from wilderness therapy involvement

(Harper and Russell 2008). These findings point to the com-

plexity of family relationships, further highlighted by research

showing the mixed impacts of wilderness treatment on

attachment in youth participants.

Bettmann (2005) explored the impact of wilderness

treatment on youth and parent attachment and found ado-

lescents improved attachment relationships in terms of

decreased anger and increased emotional connection; yet

increases in problems of trust or communication with

parents at discharge. In a similar study, Bettmann and

Tucker (2011) found mixed results in terms of increases in

connection, but decreases in trust and communication, as

well as both positive and negative growth in attachment

with peers. These trends may be reflective of the nature of

out of home treatment, which makes family involvement

versus family engagement difficult due to distance and

expense; as well as the adolescent versus the family being

the main focus of the treatment. Attachment may also be

negatively affected by the high rate of youth who go on to

some form of aftercare after participating in OBH. Dif-

ferent than most OBH programs, in which 60 % of clients

go on to some form of aftercare (Russell and Hendee

1999), most youth attending Outward Bound’s Intercept

program return home; therefore, the program presents an

ideal climate in which to research the impact on family

functioning post-program because youth are back in the

home environment and the family has more opportunity to

use the tools that they gained in the program.

Methods

A phenomenological, qualitative approach was used in this

study in order to gain in depth, descriptive information

regarding the lived experiences of families who participate in

the Intercept program. This study queried nine families through

open-ended pre-post course questionnaires administered to

parents one-month prior and 6 months after the program, as

well as in-depth phone interviews with parents conducted

3 months post-program. Both the questionnaires and the

interviews sought to answer the following research questions:

(1) How has the parent/child relationship been impacted

since participating in the Intercept course?

(2) What, if any, aspects of the Outward Bound

Intercept curriculum made a positive impact on the

parent/child relationship?

The open-ended questions utilized in the questionnaire

and in the qualitative interviews focused on how the par-

ent-adolescent relationship has changed since the Intercept

course in particular, especially in regards to communica-

tion, trust and connectedness. Questions asked also exam-

ined what aspects of the Intercept course were beneficial in

improving the parent-adolescent relationship, with a focus

on the specific skills the family has used since participating

in the program. The following are a sample of the interview

questions asked to the parents who participated in the

Outward Bound Intercept course.

(1) What can you tell me about the improvement in your

relationship with your son/daughter in regards to

connectedness, trust and communication?

(2) What can you tell me about the frustrations that exist

in your relationship with your son/daughter in regards

to connectedness, trust and communication?

(3) What parts of the Intercept curriculum did you find

useful?

(4) What components of the parent/guardian seminar

have been helpful in improving the relationship with

your son/daughter?

Participants

Twenty families were invited to participate in this study by

an Outward Bound staff member, over the phone or via

email. A convenience sample of nine families agreed to be

in the study; however, given the depth of the phe-

nomenological approach, the sample size was deemed to be

appropriate for this level of inquiry (Groenewald 2004).

16 Contemp Fam Ther (2016) 38:14–22

123

The sample included families of primarily Caucasian

background, middle to upper class socioeconomic status,

and mixed family structures (i.e. adopted children, married,

divorced, raised by grandparents). Because one of the

researchers in this study was involved in working directly

with families in the Outward Bound Intercept program, a

different Outward Bound staff member informed the fam-

ilies of the consent process via phone. The IRB at San Jose

State University approved this study, and informed consent

was gained in writing from families who agreed to be in the

study. Consent forms explained the research topic, what

was expected of them through their participation (i.e. sur-

vey, interviews, time commitment, etc.). Information about

the identity of the families participating in the study has

been kept highly confidential and for this reason, family

demographics are not provided.

Program

This study conducted research with families who partici-

pated in Outward Bound’s Intercept program to better

understand the impact of the program on family relationships

and communication. Outward Bound is an adventure-based

organization that operates in 33 countries around the world,

with nine wilderness programs alone in the United States.

Every year approximately a quarter of a million youth and

adults participate in an Outward Bound course worldwide,

with almost 33,000 of those participants attending expedi-

tions in the United States (Outward Bound International

2012). Significant to all Outward Bound courses are

wilderness expeditions in which participants move through

three phases: training, main, and final expedition. At each

phase the group gains more autonomy such as they would in

life (infancy, adolescence, adulthood). All students also

participate in a solo experience where they spend a prede-

termined amount of time away from the group, supervised by

an instructor, in which to reflect on their lives and connect

with the natural world. In particular, Outward Bound’s

Intercept courses for struggling teens believe in the ability of

the wilderness to impart confidence and strength to the

adolescent, which can become the building blocks for a

healthy adulthood experience (Outward Bound 2013a). An

Outward Bound Intercept course also includes parent

involvement in a 3 day Parent/Guardian Seminar at the end

of the 28-day wilderness expedition. At the Voyageur Out-

ward Bound School the seminar is divided into four com-

ponents: facilitated multi-family group discussions on

course curriculum and adolescent development; a parent

conference with the Intercept instructor that provides parents

with information on how their teen performed on the

wilderness expedition; group presentations by the students to

the parents in which youth show a slide show with photos

from their trip, discuss highs and lows, share tools they

learned to take home and try to help parents experience what

they experienced; and the parent/child conference, a facili-

tated, therapeutic conversation between parents and their

teen. Through these components the parents learn the skills

their teen learned and utilized on their wilderness expedition.

These skills are related to communication, trust, and other

needs specific to each family.

Analysis of Data

All of the parent qualitative survey questions were

administered as part of the online questionnaire using SJSU

Qualtrics survey software. The survey data was coded and

analyzed thematically using a constant comparative

method of sequential coding (Strauss and Corbin 1990).

The interview responses were recorded (with consent),

transcribed, coded and thematic analyzed using the same

data analysis methods. Consistent with qualitative phe-

nomenological data analysis procedures as described by

Creswell (2013), data in the form of participant statements

from the questionnaires and interview transcripts were

coded and categorized using open, axial and then selective

coding methods. Throughout this process, the researcher

became immersed in the data in order to effectively

interpret and understand the meaning of participants’

experiences. To minimize bias, the second researcher, who

had no contact with the families, also examined the data to

assure consistent interpretations across analysts.

According to Auerbach and Silverstein (2003), it is

important to exercise reflexivity when conducting qualita-

tive research through the active self-examination of the

researcher’s biases and participation in the research process.

In this study, the researcher and the second author have also

worked as instructors for Outward Bound and value the

therapeutic adventure approach. Therefore, it was particu-

larly important for us as the researchers to recognize and own

our personal views, values, and biases throughout the

research process. We instituted efforts to maximize our plan

to elicit parents’ views of the therapeutic adventure approach

and not impose our values on them. These reflexivity efforts

included discussions with other clinical, research, and

teaching professionals, keeping notes throughout the

research process, and prioritizing an awareness of parents’

feedback about the program. Furthermore, a phenomeno-

logical explorative research design was selected in order to

prevent or restrict the researchers’ bias (Groenewald 2004).

Findings

This study used open-ended questions on all surveys (pre-

program, one-week and six-month post-program) and par-

ent interviews at three-month post intervention.

Contemp Fam Ther (2016) 38:14–22 17

123

Throughout the multiple sources of qualitative data col-

lected, communication stood out as a positive theme from

pre-program to six-month post-program data, which sup-

ports its significance in this research.

Pre-Program Survey Themes

Communication and Trust

The pre-program survey highlighted themes of improved

communication and trust as desired outcomes of the

Intercept course, as evidenced by this parent quote: ‘‘I

would like to see trust in the relationship. I have lost trust

in my son after repeated and compulsive lies to the point I

am skeptical about anything that he says’’. And this father

expresses comparable frustrations with truthful communi-

cation at the root of the problem:

‘‘I would like to see improved communication. I

would like for my son to be truthful with us and with

everyone so that when we speak to each other it is

based on substance rather than something made

up…to leave him alone.’’

The need for open and honest communication was a

common theme among parents sending their youth to

Outward Bound. Families reported feeling stuck in avoi-

dant or confrontational patterns of communication, which

negatively affected levels of trust.

One-Week Post-program Survey Themes

Communication

At one-week post-program, the parent survey data specified

less argumentative communication, having a common

language, and listening to their teen more. One parent

commented: ‘‘The communication is more open. We have

a common language now that helps us understand each

other. I think he appreciates what I do for him more and

shows it. He says how he feels more often.’’ Another parent

reported:

‘‘We are communicating better on both sides. I am

more patient as is he. He smiles more. I think we both

can see the other’s perspective better. We have been

using rules for fair-fighting and have been taking time

outs (breaks) like we did at Outward Bound.’’

One area of frustration for several of the parents was

comprised of mothers’ desire for their sons to be more

emotionally expressive. This was revealed several times in

the following comments:

‘‘I wish he would express himself more; let us know

what he is feeling and thinking.’’

‘‘He still seems to not want to talk to me and is easily

frustrated with much of the communication with

me.’’

‘‘I don’t know how he really is feeling, but it is not as

bad as it was in the past.’’

Course Components

When asked what the most important components of the

Intercept course were, a prevalent theme emerged for

parents. They reported that the parent/child conference and

workbook were most beneficial for improving their rela-

tionship with their teens because it got them involved in

their child’s treatment process. Parent’s thorough attention

on the workbook over the course of the month their teen

was in the program helped them be more reflective, as

evidenced by this parent quote: ‘‘The workbook questions

forced me to think through things in advance that I would

not have done’’.

The parent/child conference was significant to parents

because of the staff that lead the conference. One parent

said, ‘‘The leadership is so professional and compassionate.

Even though [instructor] was not a counselor, we got so

much out of the meeting because she really knew our son.’’

Another parent commented: ‘‘Hearing how staff approa-

ched issues with [my son], how they helped him develop

skills, was beneficial in improving this relationship.’’ This

parent similarly reported:

‘‘The parent/child conference was very beneficial. In

particular, there was a un-biased third party facili-

tating the conversation who was the same individual,

the field instructor, that spent the past 4 weeks with

my child; this was someone that my child trusted to

be the one facilitating the conversation.’’

Three-month Post-program Interview Themes

At 3 months post-program, parents were interviewed

over the phone. The interviews were transcribed and

coded for themes in parent/child relationship and com-

ponents of the Intercept course that were reported as

being beneficial. Again, the main theme that emerged

was improved communication, which triangulates the

findings from the survey data. Course components that

parents found helpful were related to the Parent Seminar

weekend, specifically, information on the adolescent

brain and the group presentations presented by the teens

to the parents.

18 Contemp Fam Ther (2016) 38:14–22

123

Communication

Qualitative data collected showed three aspects that con-

tribute to improved communication between the parents

and their teen: improved listening, taking ‘‘time-outs,’’ and

using specific communication skills taught at Outward

Bound. A father stated: ‘‘One of the things that is good is

that we are both listening, I mean not just [wife] and I but

[son] is listening to each other’’. Another parent reflected

on how improved listening creates more understanding in

his relationship with his teen:

‘‘I do think it’s been [a] helpful thing with our rela-

tionship too that I see his side a little bit more than,

gosh darn why is he doing this and I think it makes

these moments not quite as bad…knowing and understanding on both sides.’’

Taking ‘‘time-outs’’ added to improved communication

because when family members noticed the conversation

spiraling into an argument or that they were not listening to

each other, then a ‘‘time-out’’ was suggested, with the

stipulation to come back in a certain timeframe and finish

the conversation. Several parents identified this as an

important element:

‘‘It is the idea if you are frustrated or something is

bothering [you], step away for a moment and go

collect yourself. He [son] use to just storm off

sometimes, I mean like slamming doors and all that.

Now when he gets upset, he does walk away, but he

does it in a much more cool collected way and then

able to come back and move forward.’’

‘‘The time outs have helped out a lot, if one of us

feels like the discussion is going in a really negative

direction, then one of us will say ‘okay, we need to

take a break,’ and we will come back to this at

another time, you know like 15 or 20 min later and

that has been really beneficial as well, instead of

being angry and saying the same thing over and over

again.’’

Finally, communication skills such as using assertive

communication strategies enabled families to work toge-

ther in solving problems, as per this example:

‘‘We communicate a little bit better; I think there is a

little less heat in our conversations. I think because of

the skills we all learned at the Intercept course on

communication have come in handy for us, I think we

all fall back on them quite a lot which is awesome,

but remembering what we learned, this isn’t [the]

way we should be digressing into an argument, we

should be talking about this conservatively and

appropriately, so I think that has been a really great

thing. I think that [my son] feels more comfort-

able speaking his mind… and we are all communi- cating better. We are more assertive in our

communication.’’

Course Components

Parents reported specific aspects of the Parent Seminar as

helpful to their relationships with their teens. These

included information they received about the teenage brain

and the teen’s group presentation to their parents. Learning

about adolescent brain development was useful informa-

tion to parents as they were able to recognize why their

teen may be making the choices they make. These two

comments speak to the impact of this information on par-

ents’ ability to better understand their teens:

‘‘His [son] brain isn’t working like ours is, but that

conversation with [facilitator] to kind of reset us to

expectation was very useful.’’

‘‘When the [facilitator] talked about the teenage

brain, I learned how stunningly wonderful it is, even

though it is big into risk taking.’’

The parents were equally impressed with the group

presentation and their teens’ part in it. One parent said:

‘‘Coming from them and seeing the interaction

between them, I don’t know it was just really, really

moving and it gave me a feeling of unusual cama-

raderie that…I was sort of unaware that it could exist with teenagers because you hear so much about all

the social stuff that goes on with bullying and caddy

remarks and heartbreak and people being mean.’’

Another mother was impressed with her son’s role in the

group presentation:

‘‘When I sit here and reflect on it when the kids were

all presenting together…listening to [my son] stand up in front of that room and talk, I was in tears

because he has never been that confident and that

assured speaking in front of people and feeling

comfortable in his own skin, that was huge I was on

the verge of tears multiple times throughout that

whole thing…to see that transition in my child.’’

Six-month Post-Program Survey Themes

Communication

At 6 months post-program, parents reported that the com-

munication skills they gained were still useful. They

reported continued relationship improvements, such as,

increased trust and a better understanding of each other,

Contemp Fam Ther (2016) 38:14–22 19

123

often supported by the use of time-outs. One parent stated:

‘‘We take step backs when emotions run too high. We

forgive and try to start anew. We have learned to commu-

nicate better, take time outs, and regroup.’’ Another said:

‘‘We have a greater level of honesty and trust. He

[son] has taken on more responsibility and I have

tried harder to listen and understand his point of

view.’’

However, despite these positive results, there remain

frustrations of continued lying and a struggle to get

schoolwork completed. One mother said about her son:

‘‘He continues to lie to get out of doing something or to get

out of trouble.’’ Another parent recognizes that her son is

trying, but knows that he can do better in his schoolwork:

‘‘Still schoolwork, while improved, he still does not put

forth his best effort. At least he is now doing enough to get

by, but just that.’’

Course Components

At 6-months post-program, parents continue to report that

the Intercept course was beneficial because of the parent/

child conference. This was once again evidenced by the

following comments:

‘‘The parent/child conference was helpful, because it

forced [my son] to open up to not only his own

feelings, but also to see how he affects his family.’’

‘‘The [parent] seminar was helpful, because we were

able to share ideas among the parents’’.

Overall, parents observed the positive impact the expe-

rience had on their child, even 6 months later, as measured

by the six-month post program survey. One parent reflected

on this by stating: ‘‘What stays with me at this point in time

is my respect for what my daughter accomplished on her

OB journey, which was so much more than I knew she was

capable of.’’

Parents also commented on witnessing an increase in

their teens’ confidence and the positive impact the wilder-

ness expedition had on their teen. According to parents,

youth gained a sense of pride from the physical and emo-

tional rigors of the wilderness expedition, as indicated by

this quote: ‘‘Looking back, its a marker for how good he can

feel about himself. He gained self confidence’’.

Discussion

This study collected multiple sources of qualitative data

from parents in order to explore positive relationship out-

comes between parent(s) and their adolescent child after a

therapeutic wilderness course. Across all of the qualitative

data collected, improved family communication emerged

as a theme for parents. This remained true immediately

after the therapeutic wilderness intervention and was sus-

tained three and 6 months later. This is especially positive,

as this was a main point of concern for families going into

the program. The communication skills the parents found

to be beneficial in improving the relationship were having a

‘‘common language’’ and listening to their teen. By

demonstrating listening skills, parents began modeling the

behavior they want to see in their teen. Parents and teens

also learned to communicate more assertively, and take

time outs to manage themselves and better resolve conflict.

All of these improvements in communication brought

about increased trust and better relationships. Though this

study focuses on improvements in family communication

and relationships, parents also noticed positive behavioral

changes in their teens, similar to findings from other studies

showing improvements in youth functioning post-wilder-

ness program (Norton 2008, 2010; Russell 2000). In Rus-

sell’s study, adolescents articulated finding success in

improving their family relationships, increasing abstinence

from drugs and alcohol, and improving performance in

school. Likewise, in Norton’s research, similar positive

results were found in school improvement, improved

family relationships and increased self-confidence in the

teens. This study validated this prior research; however,

more research needs to be conducted on youth functioning

following a therapeutic wilderness experience.

This study also examined which aspects of the program

helped improve positive relationship outcomes within the

family. In this study the families found the skills taught

during the expedition and the Parent Seminar to contribute

to improvements in family relationships. The parallel pro-

cess of parents and teens learning the same skills and tools

was highly beneficial for creating lasting change in the

family system. The group presentations at the end, also gave

youth an opportunity to teach some of these skills to their

parents, taking a leadership role in improving family

functioning. Furthermore, though the wilderness interven-

tion targeted the teen as the main participant, the program

found ways for parents to be fully engaged in the process as

well. The parents spent the first 25 days of the program

writing in the workbook in order to reflect on their rela-

tionship with their teens and addressing their parenting

style. Then, they attended the Parent Seminar to experien-

tially learn and practice the interpersonal skills their teens

were taught. In many cases, this learning came directly from

their teen and the Outward Bound staff, which was very

empowering. The final parent/child conference provided an

opportunity to bring these skills together to have a con-

versation with other families about how to use what was

learned in the program at home. The outcomes of this study

reflect the continued use of these skills at home.

20 Contemp Fam Ther (2016) 38:14–22

123

Limitations

The families in this study reported improved family com-

munication and enhanced quality of their relationships with

each other. This qualitative study offers descriptions of the

ways in which these families were impacted by their par-

ticipation in the therapeutic wilderness program. The study

gained parent perspectives on changes in the family sys-

tem, and found that these changes were sustained six-

months post-program. However, consistent with qualitative

findings, especially with such a small sample size, we

cannot provide causal connections regarding the findings,

and we cannot generalize the findings to other populations

or even to other families who participate in OB Intercept

courses. Additional studies of this nature are needed to

clarify and extend our findings, and studies of a quantita-

tive nature will provide the causality and generalizability

so important for a complete picture of the efficacy and

importance of therapeutic wilderness programs for youth-

at-risk and their families. Furthermore, future studies

should also include the adolescent participants’ perspec-

tives on changes in family functioning post-program.

Implications for Family Therapy

Despite these limitations, several implications for family

therapy have emerged as this study unfolded. First, we know

that a therapeutic wilderness program that engages both youth

and parents can be a positive intervention for families strug-

gling with communication. This is in contrast to earlier

research, which found that communication among family

members diminished somewhat after wilderness treatment

(Bettmann and Tucker 2011). Understanding the reason for

this discrepancy was beyond the scope of this study; however,

it may be related to the aforementioned fact that many youth

in wilderness treatment (vs. Outward Bound) often go on to

some form of residential aftercare instead of going home to

live with their families, which may impact communication.

Truancy, anger, defiance, low motivation, and risky

behaviors such as drug and/or alcohol use are also reasons

families may send their adolescent children to a therapeutic

wilderness program (Outward Bound 2013b). Findings

from this study show that this type of program may also

have a positive impact on these issues. Based on these

findings, as well as prior research showing the documented

benefits of family participation in an adolescent’s treatment

(Harper et al. 2007), family therapists who work with

families struggling with similar challenges may refer them

to this type of program.

Having parent involvement in this type of program

increases positive outcomes, as parents have the opportu-

nity to reflect on their parenting and family relationships,

and then practice the skills and reflect on their parenting.

Likewise, the psychoeducational information provided to

parents during the Parent Seminar at the end of the Out-

ward Bound course helped build a sense of parental effi-

cacy by giving them tools to help better cope with their

child’s struggles. Based on earlier research showing that

family-based psychoeducation effectively reduces relapse

rates (Fristad et al. 1998), this may allow for the thera-

peutic wilderness experiences to have more lasting effects.

Both parental involvement and family-based psychoedu-

cation are especially important components of family

therapy in residential treatment settings. Although youth

are often the primary client of residential programs, the

findings from this study reinforce earlier research findings

which all for a family-centered approach to residential care

(Walter and Petr 2008).

Given that this type of program has such a positive

impact on family communication and relationships, it may

also be an effective tool for family therapists to utilize in

order to promote treatment engagement. Research on

treatment engagement has examined the relationship

between family dynamics and treatment participation. For

example, negative parent interactions with youth have been

shown to predict treatment disengagement (Fernandez and

Eyberg 2009). Recent research also indicates that families

are most at risk of dropout due to family difficulties (Burns

et al. 2008). Similarly, problems with family dynamics are

related to the highest proportion of families who drop out

of treatment (Johnson et al. 2008). If a therapeutic

wilderness programs can help a family improve commu-

nication and family relationships, then perhaps families

will experience more cohesion, and be better equipped to

resolve potential conflicts between parents and youth by

finding common treatment goals. According to Gopalan

et al. (2010), these variables are important for promoting

engagement, which may mean that therapeutic wilderness

programs have utility in increasing treatment retention.

In order to further assess this assertion, as well as to support

families who have participated in therapeutic wilderness

programs, follow-up is needed. This could include individual

and/or family therapy to help maintain the communication

skills that families learned in the program. In the interviews,

parents who participated in this study commented on the need

for follow up after the Intercept course. Family therapists

could play an integral role in helping implement follow-up

programming in the community. Even early studies of Out-

ward Bound programming stated the importance of providing

community-based programs that have adventure challenges,

community service, alternative education and counseling

(Kaplan 1979). Norton (2007, 2008) also supports the need

for follow up in her prior research on the Intercept program.

After all, the most important aspect of family therapy is cre-

ating lasting change in the family system, long after treatment

has ended.

Contemp Fam Ther (2016) 38:14–22 21

123

References

Auerbach, C. F., & Silverstein, L. B. (2003). Qualitative data. An

introduction to coding and analysis. New York: New York

University Press.

Bandoroff, S., & Scherer, D. G. (1994). Wilderness family therapy: An

innovative treatment approach for problem youth. Journal of Child

and Family Studies, 3(2), 175–191. doi:10.1007/BF02234066.

Becvar, D. S., & Becvar, R. J. (1999). Systems theory and family

therapy: A primer (3rd ed.). Lanham, MA: University Press of

America.

Berman, D., & Davis-Berman, J. (2008). The promise of wilderness

therapy. Boulder, CO: Association for Experiential Education.

Berman, D., & Davis-Berman, J. (2015). Finding a place for adventure

therapy and therapeutic adventure on the continuum of care. In C.

L. Norton, C. Carpenter, & A. Pryor (Eds.), Adventure therapy

around the globe: International perspectives and diverse approaches

(pp. 75–89). Champaign, IL: Common Ground Publishing.

Burns, C. D., Cortell, R., & Wagner, B. M. (2008). Treatment

compliance in adolescents after attempted suicide: A 2-year

follow-up study. Journal of the American Academy of Child and

Adolescent Psychiatry, 47(8), 948–957. doi:10.1097/CHI.

Ob013e3181799e84.

Bettmann, J. E. (2005). Shifts in attachment relationships: A

quantitative study of adolescents in brief residential treatment.

Doctoral dissertation, Smith College School for Social Work,

Northampton, Mass.

Bettmann, J. E., & Tucker, A. R. (2011). Shifts in attachment

relationships: A study of adolescents in wilderness treatment.

Child & Youth Care Forum, 40(6), 499–519.

Clark, J. P., Cooley, R., Gathercoal, K., & Marmol, L. M. (2004). The

effects of wilderness therapy on the clinical concerns (on axes I,

II, and IV) of troubled adolescents. Journal of Experiential

Education, 27(2), 213–232. doi:10.1177/105382590402700207.

Coady, N., & Lehmann, P. (Eds.). (2008). Theoretical perspectives

for direct social work practice. New York, NY: Springer

Publishing Company.

Cottrell, D., & Boston, P. (2002). Practitioner review: The effective-

ness of systemic family therapy for children and adolescents.

Journal of Child Psychology and Psychiatry, 43(5), 573–586.

doi:10.1111/1469-7610.00047.

Creswell, J. W. (2013). Qualitative inquiry and research design:

Choosing among five traditions. Thousand Oaks, CA: Sage.

Doherty, W. J. (1995). Boundaries between parent and family

education and family therapy: The levels of family involvement

model. Family Relations. doi:10.2307/584990.

Fernandez, M. A., & Eyberg, S. M. (2009). Predicting treatment and

follow-up attrition in parent–child interaction therapy. Journal of

Abnormal Child Psychology, 37(3), 431–441. doi:10.1007/

s10802-008-9281-1.

Fristad, M. A., Gavazzi, S. M., & Soldano, K. W. (1998). Multi-family

psychoeducation groups for childhood mood disorders: A program

description and preliminary efficacy data. Contemporary Family

Therapy, 20(3), 385–402. doi:10.1023/A:1022477215195.

Gopalan, G., Goldstein, L., Klingenstein, K., Sicher, C., Blake, C., &

McKay, M. M. (2010). Engaging families into child mental

health treatment: Updates and special considerations. Journal of

the Canadian Academy of Child and Adolescent Psychiatry,

19(3): 182–219. Retrieved on 10/10/15 from http://www.ncbi.

nlm.nih.gov/pmc/articles/PMC2938751/.

Groenewald, T. (2004) A phenomenological research design illus-

trated. International Journal of Qualitative Methods, 3, 1–26.

http://hdl.handle.net/10500/2573.

Harper, N., & Cooley, R. (2007). Parental reports of adolescent and

family well-being following a wilderness therapy intervention:

An exploratory look at systemic change. Journal of Experiential

Education, 29(3), 393–396. doi:10.1177/105382590702900314.

Harper, N., Russell, K. C., Cooley, R., & Cupples, J. (2007).

Catherine Freer wilderness therapy expeditions: An exploratory

case study of adolescent wilderness therapy, family functioning,

and the maintenance of change. Child & Youth Care Forum, 36,

111–129. doi:10.1007/s10566-007-9035-1.

Harper, N. J., & Russell, K. C. (2008). Family involvement and outcome

in adolescent wilderness treatment: A mixed-methods evaluation.

International Journal of Child & Family Welfare, 1, 19–36.

Johnson, E., Mellor, D., & Brann, P. (2008). Differences in dropout

between diagnoses in child and adolescent mental health

services. Clinical Child Psychology and Psychiatry, 13,

515–530. doi:10.1177/1359104508096767.

Kaplan, L. (1979). Outward Bound: A treatment modality unexplored

by the social work profession. Child Welfare, 58, 37–47.

National Council on Family Relations (NCFR). (2014). Family life

education. Retrieved on 10/11/15 from https://www.ncfr.org/

sites/default/files/downloads/news/fle_cfle_2014_0.pdf.

Norton, C. L. (2007). Understanding the impact of wilderness therapy

on adolescent depression and psychosocial development. Dis-

sertation abstracts international: Section A. Humanities and

Social Sciences, 68(4-A), 1661.

Norton, C. L. (2008). Understanding the impact of wilderness therapy

on adolescent depression and psychosocial development. Illinois

Child Welfare, 4(1), 166–178.

Norton, C. L. (2010). Exploring the process of wilderness therapy:

Key therapeutic components in the treatment of adolescent

depression and psychosocial development. Journal of Thera-

peutic Schools and Programs, 4, 24–46.

Norton, C. L., Tucker, A., Russell, K. C., Bettmann, J. E., Gass, M.

A., & Behrens, E. (2014). Adventure therapy with youth. Journal

of Experiential Education, 37(1), 46–59.

Outward Bound. (2013a). What is an Outward Bound course? Retrieved

December 7, 2013, from http://www.outwardbound.org/wilder

ness-expeditions/outdoor-trips/outdoor-education-courses/.

Outward Bound. (2013b). Intercept for struggling youth. Retrieved

September 24, 2013, from http://www.outwardbound.org/inter

cept/struggling-youth/.

Outward Bound International. (2012). Outward Bound International

Annual Report 2012. Retrieved from http://www.outwardbound.

net/about-us/anual-reports/.

Resnick, M., Bearman, P., & Blum, B. (1997). Protecting adolescents

from harm: Findings from the National Longitudinal Study on

Adolescent Health. Journal of the American Medical Associa-

tion, 278, 823–832. doi:10.1001/jama.1997.03550100049038.

Russell, K. (2000). Exploring how the wilderness therapy process

relates to outcomes. Journal of Experiential Education, 23(3),

170–176. doi:10.1177/105382590002300309.

Russell, K. C., & Hendee, J. C. (1999). Wilderness therapy as an

intervention and treatment for adolescents with behavioral

problems. In Personal, societal and ecological values of

wilderness: 6th World Wilderness Congress Proceedings on

Research and Allocation (Vol. 2). US Department of Agriculture,

Forest Service, Rocky Mountain Research Station.

Steinberg, L. (2001). We know some things: Parent-adolescent

relationships in retrospect and prospect. Journal of Research on

Adolescence, 11(1), 1–19. doi:10.1111/1532-7795.00001.

Strauss, A. L., & Corbin, J. M. (1990). Basics of qualitative research

(Vol. 15). Newbury Park, CA: Sage.

Walter, U. M., & Petr, C. G. (2008). Family-centered residential

treatment: Knowledge, research, and values converge. Residen-

tial Treatment for Children & Youth, 25(1), 1–16. doi:10.1080/

08865710802209594.

22 Contemp Fam Ther (2016) 38:14–22

123

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