Best Practices

This page describe the indications (reasons for engagement) and contraindications (concerns against engagement) for outdoor therapies, separated by risk and nature components. Safety and quality of programs are discussed in terms of risk management practices and questions to ask providers. We then list the providers of programs in Canada (without endorsement of any) and international organizations associated with outdoor therapies. Last, we share state-of-the-art facilitation techniques and framing (with metaphor) methods for consideration by therapists and non-therapists alike.

INDICATIONS & CONTRAINDICATIONS

The greatest impact of outdoor therapies (also aided by traditional talk therapies with accompanying partners, families, or within small treatment groups) can be achieved with individual clients, who have not had success with other mainstream therapies. As primary therapy, adjunctive, or enriching treatment, outdoor therapies serve a combination of children, teenagers, and adults, who commonly present with one or more types of physical or mental health disorders and who can benefit from a combination of risk taking in small groups and individual immersion in nature. The following lists of indications and contraindications overlap and are by no means absolute.

RISK Indicated

  • Substance use disorders
  • Impulse control disorders
  • Behavioral disorders
  • Eating disorders
  • Personality disorders
  • Violence (perpetrators and survivors)
  • Criminal (pre-release or post delinquent)
  • Attachment issues
  • Psychosis or Schizophrenia

RISK Contraindicated

  • Periculophobia (dangers)
  • Anthropophobia (groups)
  • Autophobia (being alone)
  • Achluophobia (dark)
  • Acrophobia (heights)
  • Hydrophobia (water)
  • Chionophobia (snow)
  • Claustrophobia (feeling trapped in confined spaces)

NATURE Indicated

  • Anxiety disorders
  • Mood disorders
  • Stress disorders
  • Somatic disorders
  • Attention disorders
  • Hyperactivity disorders
  • Cognitive impairment
  • Pain reduction
  • Surgical recovery

NATURE Contraindicated

  • Biophobia (outdoors)
  • Anthrophobia (flowers)
  • Dendrophobia (trees)
  • Entomophobia (insects)
  • Zoophobia (animals)
  • Heliophobia (sun)
  • Astraphobia (lightning and thunderstorms)
  • Agoraphobia (feeling trapped in open spaces)

Also generally indicated to benefit include:

  • troubled teenagers impacted by peer pressure or socio-economic factors,
  • accident survivors,
  • refugees or migrants,
  • children under protective services,
  • absent or underperforming school students,
  • youth disconnected from culture or community,
  • adults needing respite from chronic or terminal disease,
  • palliative care patients, and
  • wounded service members.

Also generally contraindicated are those with:

  • uncontrolled or severe disorders (especially arson/pyromania and unremorseful violence),
  • obesity or lack of fitness (including poor cardiovascular health),
  • major injuries that prevent movement or locomotion,

and those who are:

  • undergoing medical treatment,
  • taking certain prescription medications, and
  • daily non-functional due to an over-reliance on others (parents) or sincerely suicidal (more than ideation).

SAFETY & QUALITY

More to come....

CANADIAN PROGRAMS

If you would like to have your program listed here alphabetically with a link to your website, please contact the coordinator below. This service is for therapy programs only. We do not list recreational, educational, or developmental programs. Thanks.

PROVINCE / TERRITORY

RISK, Adventure / Wilderness Therapy, Outdoor Behavioral Healthcare, etc.

INDIGENOUS, Land-based Healing (with or without Travel), etc.

NATURE, Forest, Nature-based, Eco-therapy, etc.

Canada-wide

 

 

 

AB (Alberta)

 

 

 

BC (British Columbia)

 

 

 

MB (Manitoba)

 

 

 

NB (New Brunswick)

 

 

 

NL (Newfoundland & Labrador)

 

 

 

NS (Nova Scotia)

 

 

 

NT (Northwest Territories)

 

 

 

NU (Nunavut)

 

 

 

ON (Ontario

 

 

 

PE (Prince Edward Island)

 

 

 

QC (Quebec)

 

 

 

SK (Saskatchewan)

 

 

 

YT (Yukon Territory)

 

 

 

INTERNATIONAL ORGANIZATIONS

RISK: Adventure/Wilderness/Outdoor Behavioral

NATURE: Bush/Forest/Nature-based/Ecotherapy

FACILITATION

Facilitation means to make growth easier and is about non-therapy techniques. This includes anything the facilitators (outdoor leaders, group counselors, or community elders representating the therapist or the therapists themselves) do before, during, and after the risk taking or nature immersion experience to assist the clients in learning and/or changing more effectively.

 

In the next table, facilitation techniques are arranged on the basis of complexity and difficulty across 4 types of outdoor programs and their primarily intended changes:

  1. Recreation (changes the way people FEEL),
  2. Education (changes the way people THINK),
  3. Development (changes the way they BEHAVE), and
  4. Therapy (changes the way they RESIST CHANGE).

 

Practitioners ought to be competent in the techniques listed for their type of programs, but also in those for the columns to the left.

PROGRAM TYPE

Recreation (FEELING)

Education (THINKING)

Development (BEHAVING)

Therapy (RESISTING)

FACILITATION TECHNIQUES

NONE (the experience speaks for itself to entertain and enable feelings of joy and happiness)
FUNDAMENTALS (organizing for unsequenced discussion with a few simple questions)
FUNNELLING (asking a sequence of questions after the experience to distill specific changes)
FREEZING (stopping the action with a time out to ask a single provocative question)
FRONTLOADING (asking one or two questions before the experience to center attention on change within the experience)
FORTIFYING (a stepwise order of techniques designed to strengthen against resistance)
FOCUSING (shifting the emphasis away from the problem and on to solutions)

 

Fundamentals

Fundamentals refers to the basics of facilitating an unstructured group discussion by asking a minimum of three open-ended questions (what? so what? now what?) in a sharing circle.

Circles are good because they are warm and inviting, offer excellent hearing and eye contact, and allow for the observation of body language.

In these circles, people take turns speaking and have the right to pass and have their disclosures remain confidential.

Since this basic technique is an unstructured form of questioning, it lends itself best to exploring and confirming client issues.

Aside from ethical considerations, know why and what you are facilitating with respect to the program purpose and clients' needs.

Stay neutral and avoid taking sides or getting drawn into group conflict by clearly knowing your own values and triggers.

DO: discuss group process and not outcomes, allow enough time for discussion, balance doing & talking, make debriefs recent, proximal to the experience, and free of distractions.

DON’T: answer for clients, worry about right answers, compare clients to others, judge performance, offer false feedback, assume you know best, or focus on the negatives too early in the process.

Funnelling

Funnelling involves asking six structured and sequenced questions in sharing circles:

  1. Replay (used to remind clients of the past when the experience was not immediately recent) - Can you review the last experience for me?
  2. Remember (used to identify a good or bad example of the topic being discussed) - Do you recall a particulat time when __[topic]__ was excellent (poor)?
  3. Affect/Effect (used to discover the influence of the example) - How did that event impact you personally (the group and/or the task)?
  4. Summation (used to identify the lessons learned from the above) - How would you summarize your learning from our discussions?
  5. Application (used to metaphorically connect the experience to daily living) - Do you see any parallels between this learning and your life (at school, work, or home)?
  6. Commitment (used to pledge future changes) - What will you do differently in the next experience (or when you return to you daily life)?

Since this technique is a structured form of questioning, it lends itself best to enabling clients to change their thoughts (and feelings).

Freezing

When clients appear to be “stuck in a rut” and unable to extricate themselves, simply call a time-out to freeze the action and ask a single provocative question (How is your communication right now?), then return to the action as soon as possible.

Frontloading

Asking one or two questions, from this list of six types, immediately before the experience begins, so as to turn clients atention toward change.

  1. Revisiting (used to remind clients of past commitments) - Remind me; what were you going to do differently this time?
  2. Motivation (used to metaphorically connect clients to their daily lives in advance) - Where might learning from this experience be useful in the future?
  3. Objectives (used to identify lessons to be learned) - What do you think you will get from participating in this experience?
  4. Function (used to discover what is already being done well) - What will you need to succeed and how can we make sure that happens?
  5. Dysfunction (used to avoid failure or setbacks) - What has held you back in the past and how do we make sure that doesn't occur now?
  6. Prediction (used to orient clients toward a particular behavior or expectation) - What do you think is going to happen next in this experience?

Since this technique provides a reminder that centers attention immediately before engaging in the experiences, it lends itself best to enabling clients to change their behaviours (plus thoughts and feelings) during the experience and provide a direct comparison to their past behaviours.

Fortifying

This stepwise sequence of six psychotherapeutic techniques is aimed at bringing client transformation, when they are clinically resistant to change. Try the least intrusive method first and, if it fails, then progress to the next step.

  1. Client is Unaware of the change (use CLARIFICATION technique) - Have an admired friend or peer (not the facilitator) explain the change.
  2. Client is Unwilling to change (use NEGOTIATION) - Make a contract around what is needed to accomplish the change, then get those resources.
  3. Client is in Disagreement with the change (use CONFUSION technique) - Genuinely and respectfully ask the client to help you understand.
  4. Client is Unconsciously Opposing change (use PARADOX) - Behave unexpectedly from usual, in a reverent version of reverse psychology.
  5. Client is Consciously Opposing change (use Double Bind) - Describe two options going forward and ensure both are in the client's best interest.
  6. Client is Apathetic toward change (use ROLE SHIFT) - Find another perspective, position, or opportunity for each client, before removing them.

Ultimately, this form of treatment does not work for every single client and some may need to be referred to an alternative situation.

Focusing

Focusing refers to where the client's awareness and the facilitator's attention are directed. Both can center on the problem that presents or solutions that are not directly related to the problem and so are more welcomed as change by resistant clients. Here are the differences.

PROBLEM FOCUS

SOLUTION FOCUS

  • Centers on reducing problems
  • Looks at what clients are doing wrong and incorrectly
  • emphasizes what they don't want
  • Highlights what must be done better
  • Seeks to eliminate weaknesses
  • Interested in WHY the problem happens (what causes and sustains it?)
  • Centers on enhancing solutions
  • Looks at what clients are doing right and correctly
  • Emphasizes what they do want
  • Highlights what is already being done well
  • Seeks to accentuate strengths
  • Interested in WHEN the problem doesn't occur (what exceptions exist?)

A solution-focused facilitator is not simply sugar coating or pointing out the positives. This strength-based approach requires a philosophical shift and rewording of questions. Consider these three examples.

AFTER (funneling): On a scale from 0-low to 10 high, how was your ________ in this activity? 

  • Problem = What will you need to do to increase that number in the next activity? 
  • Solution = What are you already doing, that your number would be lower if you didn’t do it?

DURING (freezing): Time out!

  • Problem = What is not working for you in your ____________? 
  • Solution = What is going well for you right now in your________ and how can you do more?

BEFORE (frontloading): Before we start this activity, I just want to know…

  • Problem = What are some things we might do that would lead to our failure and how can we avoid these individually and as a team? 
  • Solution = What are some things we might do that would lead to our success and what can we do as individuals and team members to ensure these occur?

FRAMING

Framing refers to the way a risk taking or nature immersion experience is introduced to clients by the facilitator. Four kinds of frames or introductions are common:

  1. Fantasy (uses imaginary playful terms like volcanic eruptions, poison peanut butter, radioactive yoghurt, etc.),
  2. Reality (uses actual names for objects such as tree, rope, grass, chair, etc.),
  3. Contextual (describes a metaphor that is general to the category of clientele), and
  4. Isomorphic (describes a metaphor that is specific to that clientele only and requires their action to mirror their needed growth).

 

These frameworks are most commonly used in the following program types. However, any frame or introduction can be used in any program type.

PROGRAM TYPE

Recreation (FEELING)

Education (THINKING)

Development (BEHAVING)

Therapy (RESISTING)

FRAMEWORK

FANTASY

REALITY

CONTEXTUAL

ISOMORPHIC

Metaphor

A metaphor is an idea, object, or description used in place of a different idea, object, or description to denote comparative similarity between two apparently different things. Three different but related outdoor therapy examples might be:

  1. the treatment process is much like the expeditionary journey; it is more about the voyage than the destination (adventure/wilderness therapy);
  2. after a devastating fire, the forest/bush recovers by healing scars and generating new growth, much like therapy (nature-based ecotherapy); and
  3. resource extraction damage and calls for healing the land are analogous to intergenerational trauma for indigenous people (land-based healing).

In the outdoors, metaphor is a powerful device that enables clients to connect their risk taking adventure or nature immersion eco-therapy with their daily lives. The closer the linkages, the more learning transfers, which results in more lasting change. Without metaphor, the two settings (outdoors and daily living) would be so different that transfer would be severely diminished. Metaphor makes meaning of each experience.

The facilitator's job is to apply the aforementioned techniques to strengthen and clarify these connections, thereby enhancing transfer through the conscious use of metaphor. Three methods are most common:

  1. Spontaneous (during or much later). where clients consider important and relevant connections without assistance from anyone;
  2. Analogous (after the experience), where clients discover connections through reflective discussions; and
  3. Structured (before the experience), where experiences are framed or introduced as a contextual message or isomorphic metaphor.

In funnelling (after), clients reflect on metaphors with the question: How was this like life?

In frontloading (before), clients imagine an upcoming metaphor: What will be a moral for this story?

In framing (before), the experience is introduced with a deliberate metaphor that fits the clients loosely (contextual) or precisely (isomorphic).

While the contextual metaphor makes sense at all times to any client in their common category of similar issues, the isomorphic metaphor (same structure) only makes sense to a particular client with unique issues at that moment. The isomorphic introduction tells clients the metaphor in advance and allows them to operate fully within that framework during their experience with the intent that behaviors shown in the experience will emulate those desired in life and thus will bring growth. Obviously, knowing a client extremely well is necessary to create these metaphors.

EXAMPLES OF THE FOUR INTRODUCTIONS (rules and safety concerns are identical).

Fantasy (for children wanting to feel good and have fun): Welcome to Spider's Web. You cannot pass around, under or over, but must go through to safety. To get from this low level floodplain to higher ground before the flood comes, you must pass each other through the spider's web using each opening only once. If you contact the web, the spider bites everyone and you must start over. You have 20 minutes before the flood arrives.

Reality (for analytical adults who over think their issues): The task is to get from this side to that side by passing each other through a unique opening of these strings. Once used, the opening is closed to further use. If anyone touches a string, the group starts over without resetting the clock. You have 20 minutes.

Contextual (for high school teens readying to drop out): Here, we are readying to drop out, but there is your goal of graduation. How can you work together to graduate by passing through the problems of the school year? Obviously, you must take your own unique path with the help of your friends, but once taken, no one can follow you exactly. Be sure not to encounter a problem in the school year that can cause all of you to fail and return everyone back to here and readying to drop out. You have 20 minutes to graduate.

Isomorphic (for store warehouse workers struggling with unethical behavior): Welcome to Distribution Network. This time, you will be shipping goods from your warehouse to my stores through the network. Since my stores are in different locations, you will need to send each shipment through its own unique route. If any shipment is damaged in transit by contacting the network, you will need to voluntarily take it back to the warehouse for repair before shipping again. If any goods arrive at my store damaged, I will return all shipments and we will renegotiate our contract. Delivery deadline is 20 minutes from now.

The stronger the metaphor, the more likely group discussion is to center on real life problems rather than simply "playing the game."

CONTACT: s i m o n _ p r i e s t @ y a h o o . c o m (please remove spaces)