At some time in our lives most of us have walked in the mountains, explored a forest or jumped on stepping-stones across a clear, babbling brook. Some of us have abseiled off a cliff, explored a cave or climbed high obstacles and swum through mud on an assault course. Challenges and experiences in nature can be refreshing, exhilarating and awe-inspiring. They can also be frightening, exhausting and frustrating.

            Whatever our reactions to such experiences, the memories stay in our minds for years to come. Many of us have a greater feeling of well-being and are more aware of ourselves as a result of experiences in nature.

            Now imagine merging such challenges and experiences in nature with therapy led by a trained and experienced therapist and you have what we call ‘therapeutic adventure’.

There are many therapeutic models suitable for working outdoors using therapy. We have based these activities on nonverbal play therapy. The activities are designed for use with adults, teenagers and children. All of them work well with groups. Many of the activities can be adapted for work with just one client, assuming that the therapist takes part in the therapeutic activity.

            Therapists might ask the question: ‘What is the added benefit of doing therapy in nature over working with clients in the comfort of the therapy room?’

Michael Gass and Lee Gillis believe that, when done correctly, information from therapeutic adventure can provide a rich assessment of client behaviour. They write: ‘Some of the advantages of adventure experiences include: (a) the combination of ambiguity and stress that coexist in adventure experiences; (b) the increased level of validity in client responses to assessment procedures (eg clients must “walk their talk”); and (c) the ability of therapists to receive appropriate information as well as simultaneously analyse psychological processes and behavioural content’ (Gass & Gillis, 1995, page 36).

            Our own experience is that therapeutic adventure can result in dramatic and long-lasting emotional changes that may happen much quicker than within the therapy room alone. But, of course, the therapist needs to think in a different way when starting to use therapeutic adventure. There are issues of confidentiality and safety to consider, and it is important to assess clients’ needs and make adjustments in the programme in order to meet those needs.

            One of the issues in therapeutic adventure that is different from therapy indoors is that of confidentiality. Nick Ray is an outdoor activity instructor and a therapist specialising in Transactional Analysis. When working in the therapy room he makes a confidentiality contract with his (mainly) adult clients. But, he continues, ‘when working in the outdoors we can be seen by the general public and so we contract to continue the work even though there may be people present, sometimes within earshot. We decide what we will do at these points when it is no longer private. But having said that, a lot of the time I do endeavour to work where I can create a safe space, but I cannot always guarantee that we will not be interrupted’ (Ray, 2005, page 16).

            Safety – physical and psychological – is another vital factor to consider. Kaye Richards and Jenny Peel write: ‘Even though the outdoors can provide a rich milieu for therapeutic work, it also makes the client more vulnerable than they might be in a more controlled indoor setting. The outdoors has extended psychological and physical risks, eg keeping a group physically safe climbing a mountain. Therefore, working as a therapist in the outdoors expands the role of the therapist to one who may have to manage physical as well as psychological safety’ (Richards & Peel, 2005, page 7).

            The exercises contained in this book are intended as a basic introduction to therapeutic adventure. They do not need specialist equipment or qualified instructors. However, safety of the participants is such an important issue that we strongly recommend any therapist wanting to use them to become competent in at least some aspects of safety. This might involve going on a first-aid course, doing some training in outdoor leadership or going to the gym regularly and getting fit enough himself/herself to work with clients outdoors.

            If you are intending to work with clients in a setting unfamiliar to you, it is essential that you visit the area in advance, do the activities yourself and get to know the area and its potential hazards. You might also consider working in partnership with someone (not necessarily a therapist) more experienced in the outdoors than you. You could then focus on the therapeutic aspects while the other person leads the walk and arranges the areas of forest to work in, etc.  If you do this, it is essential that you establish a clear contract of confidentiality with him/her when you are working together with the clients.

            Another aspect of safety to consider is insurance. Are you insured to work therapeutically in this setting? If not, what additional insurance do you need? Be aware that insurance companies providing cover for groups have exclusion clauses for hazardous activities that can include mountaineering. Be careful how you explain the activities to them. ‘Walking with clients in the mountains’ may, in their view, be acceptable and very different from the unacceptable ‘mountaineering’, which involves climbing gear. If you are taking clients away for a weekend or a week, they would need their own holiday insurance, which may cover some of these insurance needs.

In the case of young people, you will need parents/carers’ written permission for many of the activities in this book. You will also need to ensure that clients of any age are medically fit to take part. A carefully worded letter (checked out by a friendly solicitor) that is signed by the client or by a young person’s parent/carer could well prevent possible serious problems if in the unlikely event something were to go wrong.

            As a therapist working with clients outdoors, it is important that you have ways of monitoring the effectiveness of the therapy. In the case of young people, one way is through a clinical governance measure such as the Strengths and Difficulties Questionnaire (Goodman, 1999). This uses tick-box forms to measure aspects of the young person’s emotional and behavioural issues before and after therapy. An additional form of monitoring is to use a specialist outdoor therapy assessment tool. Therapeutic adventure can be assessed using two tools: the GRABBS and the CHANGES models, outlined on the following pages.

            GRABBS (Schoel, Prouty & Radcliffe, 1988) stands for:

Goals What are the goals of the outdoor experience for the group, the individual client and the therapist?

Readiness How ready are the clients for the outdoor activities the therapist is offering?

Affect What is the level of affect (feeling) among the clients?

Behaviour How have the clients behaved so far towards each other, the therapist and the outdoor experience itself?

Body Are the clients treating each other’s bodies with respect?

Stage What stage is the group at (Forming? Norming? Performing? Mourning? – see Tuckman, 1965)?

The GRABBS model can be used in conjunction with the CHANGES assessment model (Gass & Gillis, 1995):

Context Where is the therapist working and what are the goals? What previous experiences can inform the therapist? What competencies does he/she possess, and what extra research/training is needed to ensure success in therapeutic adventure?

Hypothesising What information about working with clients in the therapist’s past experience can be used as a hypothesis for understanding clients’ behaviour? What formal sources (such as assessment tools) and informal sources (such as intuitive assessment of group engagement in activities) can inform this hypothesis?

Action that is Novel In what ways do the clients’ responses to a novel therapeutic adventure experience confirm the therapist’s initial hypotheses? How might the therapist adapt, revise or reject his/her thoughts in the light of observable response to the activities? What other interventions might be effective, based on seeing the real issues of the client, not just those seen at the social level?

Generating information, stories and ideas What verbal stories or behavioural information is the therapist getting that can generate therapeutic objectives and procedures? What nonverbal ideas is he/she obtaining in the areas of clients’ values and beliefs? How are the clients functioning within the outdoor group in terms of closeness, intimacy, roles and power? What therapeutic needs do the clients have, and how can these be met?

Evaluation What tentative decisions has the therapist come to in terms of: symptoms and diagnosis; clients’ motivation, strengths and needs; and possible interventions? Which hypotheses are confirmed and which rejected by the clients’ behaviour?

Solutions What potential client solutions can be identified and constructed as a result of the evaluation process? What would be effective in helping to solve the clients’ therapeutic issues?

For therapists new to working outdoors, or who would like further background information, read Roger Day’s article ’Being OK, Keeping OK’ in Appendix 1.

The book Therapeutic Adventure contains 64 activities divided into eight sections, in different colours. The activities on the eight coloured pages can be cut out and laminated for use. These activities can be used for any therapeutic individual or group work. They can be used in a directive or nondirective way.

            In nondirective individual therapy the client might choose a card at random and, with the therapist’s help, take part in the activity. In directive group or individual therapy the therapist selects cards in advance and encourages the individual or whole group to take part. Cards from the different sections could be used or the emphasis could be on one or two categories.

            Please note that not all the activities are suitable for every client. The therapist knows his/her clients and can select those most suitable or remove those that he/she considers unsuitable or unhelpful for a particular client.

Roger & Christine Day