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The Practitioner Scholar: Journal of Counseling and Professional Psychology 1
Volume 4, 2015
The Impact of Community Based Adventure Therapy
on Stress and Coping Skills in Adults
Haley Koperski, Anita R. Tucker, D. Maurie Lung, and Michael Gass
University of New Hampshire
Abstract
Stress and coping skills are among the most essential components of the mental
health counseling field. The use of coping skills (e.g., meditation, physical
activities, appropriate uses of leisure) has been identified as an effective strategy
for stress management. Adventure therapy has emerged as a modality that can
positively augment other therapeutic approaches by improving coping skills and
assisting clients in managing stress. As with all therapies, a positive working
alliance has been found to be important toward achieving clinical outcomes. This
study explored how adventure therapy enhanced learned coping strategies for
stress and improved therapeutic alliance. Outcomes from this exploratory
research highlighted the potential of adventure therapy to decrease stress, increase
coping skills, and build therapeutic rapport with the therapist.
Keywords: stress, coping, adventure therapy, working alliance
According to the American Psychological Association (2011), stress levels for adults in
the United States continue to remain high, exceeding what is considered as healthy. Stress is
defined as “a relationship between an individual and their environment that is appraised by the
individual as exceeding his or her resources and threatening his or her well-being” (Lazarus &
Folkman, 1984, p. 5). Two processes mediate this relationship: (1) the cognitive appraisal of an
individual determining whether or not the interaction is stressful and (2) related coping
mechanisms, or processes through which an individual handles the appraised stressful interaction
(Bergdahl & Bergdahl, 2002). Coping is defined as a “person’s cognitive and behavioral efforts
to manage (reduce, minimize, master, or tolerate) the internal and external demands of the
person-environment transaction that is appraised as taxing or exceeding the person’s resources”
(Folkman, Lazarus, Gruen & DeLongis, 1986, p. 572). Exposure to prolonged stress or
appraised perceptions of stress can have negative impacts on both the psychological and
physiological health of adults (Folkman, 2011). Stress has been linked to cases of depression
(Hammen, 2005), as well as vulnerability of the human immune system (Segerstrom & Miller,
2004) and other physiological symptoms such as cardiovascular disease and irregularities
(Kashani, Eliasson, & Vernalis, 2012; Wittstein et al., 2005), sleep disturbance (Hall et al.,
2007), and negative changes in brain function (Thomaes et al., 2013)
There are a variety of coping strategies that can benefit individuals under stress and
mitigate its negative affects (Maskowitz, 2010). Researchers have found positive change in
physical and emotional well-being related to goal setting and motivation (Brunstein, Schultheiss,
& Grassmann, 1998; MacLoed, Coates, & Hetherton, 2008). In addition, exercise in the outdoors
has been specifically related to significant decreases in tension, confusion, anger, and depression
The Practitioner Scholar: Journal of Counseling and Professional Psychology 2
Volume 4, 2015
when compared to exercise indoors (Coon et al., 2011). Previous research also recognizes the
importance of a strong working alliance as a predictor of successful counseling outcomes for
clients (Gnilka, Chang, & Dew, 2012). Little research has looked at treatment alliance within
adventure therapy.
Adventure Therapy
Adventure therapy (AT) is defined as the “prescriptive use of adventure activities by
mental health professionals to kinesthetically engage clients on affective, behavioral, and
cognitive levels” (Gass, Gillis, & Russell, 2012, p. 1). Adventure therapy as a field emerged out
of experiential education and the Outward Bound movement in the United States. Experiential
education theory guided by the work of John Dewey is rooted in the idea that we learn by doing
with reflection (Dewey, 1938). Additionally, AT was influenced by the work of Outward Bound
which was first adapted in the 1970s to be used with clinical populations of youth (Kelly & Baer,
1971). In fact, Walsh and Golins’ (1976) model of the Outward Bound process first introduced
the key theoretic framework of AT. The foundational tenets of this model include putting
participants in a unique physical and social environment in which they are given prescriptive
problem solving tasks or challenges that lead to a state of adaptive dissonance, where mastery of
the task must ensue in order to reorganize the meaning and direction of the learner’s experience
(Walsh & Golins, 1976; Gass et al., 2012). All the while participants are engaged in active
reflection on and processing of the experience to ensure further learning and transfer into their
lives (Priest, Gass & Gillis, 2000).
In adventure therapy the novel setting or experience makes an environment rich for
assessment opportunities and the positive use of eustress supports the belief that change occurs
when people are placed outside of their comfort zone (Gass et al., 2012). In addition, the role of
the therapist changes in AT from a passive and stationary therapist to a more active and mobile
one (Gass et al., 2012). This creates space for the therapist to “support, join, or confront” clients
with greater ease. The shift also removes the adventure therapist from “serving as the central
vehicle of functional change, and instead the ‘experience’ becomes the medium for orchestrating
change” (Gillis, Gass & Russell, 2014 p. 565). The therapist may now be more approachable and
achieve greater client interaction further strengthening the therapeutic alliance (Gass, 1993; Gass
et al.,2012).
At present, there is no research evaluating adventure therapy as an augmented modality
for adults coping with stress; however, it has been shown to be effective for a variety of adults in
different settings. Voruganti et al.’s (2006) two year, case-control study of an adventure-based
intervention for adults with schizophrenia demonstrated significant improvements in self-esteem
and global functioning and an average weight loss of 12 pounds. Wolf and Mehl’s (2011) study
of 247 psychotherapy clients involved in an adjunctive therapeutic challenge course intervention
found significantly more improvement in trait anxiety and self-efficacy than the control group at
follow-up, though there were no significant differences in depressive symptoms or external locus
of control. More recently, the use of a low-element challenge course intervention with adult
females in substance abuse recovery resulted in significant improvements in abstinence and self-
efficacy measures from intake to discharge (Clem, Smith, & Richards, 2012). A similar
exploratory study (Scheinfeld, Rochlen, & Buser, 2011) on the supplementary use of AT with
The Practitioner Scholar: Journal of Counseling and Professional Psychology 3
Volume 4, 2015
middle-aged men found results supporting the potential for deeper therapeutic processing, rapid
trust-building, and new perspective-taking with the AT intervention.
While the preliminary outcomes of AT with adults have been positive, there has been no
research looking specifically at stress reduction in adults in a community-based setting through
the use of AT. This research aims to fill this void in the literature. Expanding research to adult
populations in a community-based setting offers the opportunity for new insight on the utility of
adventure as an effective intervention in this setting and begins to provide evidence toward the
extension of using adventure with diverse populations. The purpose of this study was to answer
the following research questions:
1. How did this model of adventure therapy impact adult participants’ self-reported
levels of stress as measured by the Perceived Stress Scale (PSS)?
2. How did this model of adventure therapy impact varied forms of coping in adult
participants as measured by the Coping Skills Utilization Form?
3. As measured by the Working Alliance Inventory (WAI) what levels of alliance
developed through the use of this adventure therapy model of intervention?
4. What was the relationship between changes in stress and working alliance as
measured by the PSI and WAI?
Methods
Participants
The 31 participants in this study were all adults over the age of 18 years with an average
age of 40.3 years (SD = 12.2). The participants received therapy from either a dual licensed
Mental Health Counselor/Marriage Family Therapist or a Mental Health Counselor Intern
supervised by a licensed Mental Health Counselor. Clients’ average number of sessions with the
clinician was 25 sessions with a range from 12 to 36 sessions. The majority of participants
indicated relationship issues (41.9%) and work stress (29.0%) as reasons for seeking counseling
as well as those coping with a major life change (16.1%). Three participants indicated anxiety
and depression as the primary reason for seeking counseling, with one indicated “chronic pain”
and one identified as being a “teen mom.” Of the 31 participants, 18 identified as “Caucasian” of
“Western European” descent, seven as “Caucasian,” and four as “mixed race,” one “Caucasian”
of “Eastern European” descent, and one as “Caribbean African American” descent. About three
quarters of the participants (71.0%), identified their gender as female, with 22.6% identifying as
male and one identifying as transgender.
Procedure
From August 2012 until October 2013 all adult clients seeking counseling services at a
small community agency in Florida were invited to participate in this study, which was approved
by the Institutional Review Board at the first author’s university. Data was collected from
participants both at intake and discharge. All 35 adult clients who started treatment during this
period consented to participate in the study, two of these clients did not finish treatment and
another two clients finished treatment, but did not complete the outcome measures. Hence, there
was an attrition rate of 11.4%.
The Practitioner Scholar: Journal of Counseling and Professional Psychology 4
Volume 4, 2015
Measures
The following three measures and one demographic form were used to collect data from
participants in this study.
The Perceived Stress Scale (PSS). The PSS was designed to measure the self-appraisal
of life stress (Cohen, Kamarck & Mermelstein, 1983) as well as the global experience of stress,
so scores are inclusive of the effects of contextual and chronic stress (Cohen & Williamson,
1988). The scale has three versions: 14, 10, and 4 question options. The 10-question version was
used because it was determined to have just as good or better psychometrics as the 14-question
version (Cohen & Williamson, 1988). Reliability according to internal consistency had an alpha
of .78. The construct validity was determined to be moderately good, with elements correlating
significantly to parts of Stress Measures, Self-Reported Health and Health Services Utilization
Measures, the Life Satisfaction Scale, and measures of help-seeking behaviors (Cohen &
Williamson, 1988). The perceived stress scale was administered and completed by participants
at intake and discharge.
Coping Skills Utilization Scale. This scale was created specifically for this study to
evaluate the use of coping skills taught at this community based counseling center. The scale
asks participants to indicate their frequency of participation in 17 activities over the previous 30
days. Response format consisted of six Likert responses (Never, Once per Month, Couple Times
per Month, Once per Week, A Couple Times per Week, Daily). Participants were also able to
report an additional three leisure activities and indicated the frequency of their participation of
activities during the past month. This tool was developed collaboratively with the counseling
center and the researchers of this study and represents the first time this tool was used. Activities
chosen for inclusion were based on those supported by research as effective coping methods to
reduce stress such as buying fresh flowers (Haviland-Jones, Rosaria, Wilson, & McGuire, 2005),
expressing gratitude (Emmons & McCollough, 2003; Kashdan, Uswatte, & Julian, 2006;
Maskowitz, 2010), listening to cheerful music (Marotos, Gold, Wang, & Crawford, 2008),
practicing a form of meditation (Chu, 2010); performing acts of kindness (Otake, Satoshi,
Tanaka-Matsumi, Otsui, & Fredrickson, 2006), journaling (Emmons & McCollough, 2003),
planting seeds (Fried & Wichrowski, 2008), exercise (Coon et al., 2011) and setting goals
(Brunstein et al., 1998; MacLeod et al., 2008). In addition, clients were asked to report on their
engagement with activities commonly used in adventure therapy. See Figure 1 for a copy of the
measure.
Working Alliance Inventory (WAI). The WAI was developed based on Bordin’s (1975,
1979) multidimensional theoretical view of the working alliance, exploring client’s experiences
with the therapist according to bond (mutual trust, acceptance and confidence), goals (mutual
understanding and value of outcomes), and tasks (behaviors and cognitions in session) (Horvath
& Greenberg, 1989). The subscales scores range from 12-84 with a total score ranging from 36-
252. Higher scores indicate a positive working alliance (Hanson, Curry, & Bandalos, 2002).
During development and subsequent trials in a variety of settings the three subcategories of
counseling, peer review, career counseling in both the short and long form WAI (36 or 12-items)
have shown consistent reliability with an alpha ranging from .87-.93 (Horvath & Greenberg,
1989). The construct validity showed that when WAI subscales were measured against other
tools deemed as similar to measuring aspects of alliance, it showed good convergent and
The Practitioner Scholar: Journal of Counseling and Professional Psychology 5
Volume 4, 2015
Figure 1 Coping Skills Utilization Form
Coping Skills Utilization Form
Please write the number that best represents how often you participated or completed
the following activities in the blank space provided.
In the last month, how often have you participated in the below listed activities for 30
minutes of more?
1. __ Hiked/Walked Outside
2. __ Sailed
3. __ Canoed/Kayaked
4. __ Climbed Trees
5. __ Participated in Outdoor Challenge Activities
6. __ Participated in Indoor Challenge Activities with therapist
7. __ Participated in Indoor Challenge Activities at home
In the past month, how often have you used the following coping strategies?
1. __ Bought fresh flowers for yourself and kept them in a space where you can see them
2. __ Expressed gratitude to at least three people
3. __ Listened to bright and cheerful music you enjoy for at least 15 minutes
4. __ Practiced a form of meditation for at least 10 minutes
5. __ Exercised for at least 30 minutes
6. __ Count and journal every act of kindness you performed
7. __ Journal at least 2 pages about things you are grateful for in your life
8. __ Plant seeds and take care of them as they grew
9. __ Set your own goal, tracked progress, and told someone when you completed the
goal.
In the past month, how many leisure activities have you done? (List & Report How
Often?)
Activity 1: ____________________________ How Often? _____________
Activity 2: ____________________________ How Often? _____________
Activity 3: ____________________________ How Often? _____________
Scale
1-Never
2-A couple of times per month
3-Once a month
4-A couple of times per week
5-Once a week
6-Daily
divergent validity with common variance for empathy greater (48%-52%) than goals and tasks.
This supports that an empathetic connection as measured by bond on the WAI is especially
The Practitioner Scholar: Journal of Counseling and Professional Psychology 6
Volume 4, 2015
important to the working alliance as measured by other tools. This scale was administered and
completed by participants at discharge.
Intervention Description
For the purpose of this study, client’s clinical long-term goals included: (1) the reduction
of the overall frequency of the stress response so that daily functioning was not impaired and (2)
the reduction of the overall intensity of the stress response so that daily function was not
impaired. Clinical short-term client goals included increases in the ability to do the following:
(a) determine whether or not an interaction was stressful,
(b) identify factors contributing to stress,
(c) express emotions related to identified stressors,
(d) regulate emotions, and
(e) increase coping strategies for managing identified factors contributing to stress.
The primary adventure therapy model to meet these goals at this specific counseling
center was the power of therapeutic experience through meaningful activity. On average, three
sessions per month were 50 minutes long and one session was 90 minutes. Within those sessions
the length of time that clients were engaged in activities ranged from 30- 90 minutes (depending
on the type of activity). For example, in a 50 minutes session, the client may have tree climbed
for 30 minutes or engaged in a problem solving activity and then participated in guided reflection
for 20 minutes. If the therapist and client went sailing, the sailing occurs for 90 minutes and
other than discussion on the boat, the following session was dedicated to additional reflection.
Meaningful activities used in therapy included problem-solving games and initiatives, as
well as outdoor adventures. Problem-solving games/challenges, such as a “mouse trap bounce”
helped clients to increase frustration tolerance or practice strategies to reduce anxiety. For
purpose of clear explanation, these challenges are different than games. For the mousetrap
bounce, “set” mousetraps are placed in a circle so that they all touch and if one goes off, so will
all of the others (think of dominoes). Once the mousetrap circle is in place, the client is given a
ball and invited to bounce a ball in the middle of the circle to the counselor without setting off
the traps. A metaphor, (e.g., explosive situations) may guide the therapist to notice how the client
responds if the mousetraps were set off and to ask questions about this response, (e.g., “What”
(not who) causes “explosions” in your life or family? How were your responses here similar or
different than your responses to those types of explosions?). This type of activity provides an
opportunity to assess current coping strategies, increase understanding of how coping strategies
manifest themselves, identify areas where coping strategies may need to be learned, as well as
practice newly learned coping strategies. The 25 selected problem-solving challenges offered
during the course of therapy were chosen from books that focus on the use of adventure activities
for therapy (Lung, Stauffer, & Alvarez, 2008; Aubry, 2008). Client preference and therapeutic
goals helped identify which activity was selected.
Similar activities such as sailing, kayaking, canoeing, or tree climbing were incorporated
into the therapeutic process with the same intention and processing. As with the example above,
during these activities client’s strengths and abilities were emphasized to enhance areas that
support client’s clinical goals, while also identifying potential obstacles or areas for development
supporting the client’s clinical goals. No particular skills were required to participate and each
The Practitioner Scholar: Journal of Counseling and Professional Psychology 7
Volume 4, 2015
session was customized for the client.
Choosing the particular activity was extremely important in the therapy process as well.
When a client came into a session he or she was asked what he or she would like to work on
during that session. If the client was not able to identify anything, the practitioner provided
several choices based on the treatment goals that were collaboratively developed. Once the goal
was established for the session, the client decided if he or she would like to stay inside or go
outside and also if they would like to do a physical activity, or problem-solving activity (none of
which was always mutually exclusive). Based on this information, the practitioner facilitated the
activity. Practitioner participation in the activity varied depending on the goal and the client. For
example, one client was particularly anxious participating in activities related to water due to her
limited swimming ability. Although there is always a lifeguard and all participants wear PFDs,
the practitioner was more active in the actual sailing of the boat. For the client being on the boat
and moving around following the directions of how to change the sails were enough challenge
for this client. In comparison, another client who has sailed since childhood was challenged to
dock the boat by themselves under sail power only, a significantly difficult and often stressful
activity. In addition to the actual adventure activities and their influence on coping and perceived
levels of stress, the skills learned in adventure therapy could be useful and effective resources for
creating positive affect and coping with stress outside of the therapeutic setting.
Findings
Stress and Coping
Paired samples t-tests were used to look at changes in stress as measured by the PSI and
coping as measured by the Coping Skilling Utilization Form, from intake to discharge including
Bonferroni corrected p values to limit Type I error. Participants decreased stress and increased
coping skills scores over the course of treatment. Participants total perceived stress scores
reduced by a mean 13.6 points from intake to discharge. Participants had a total mean intake
score of 25.4 (SD = 5.5) and a total mean discharge score of 11.8 (SD = 6.4). A paired sample t-
test indicated significant differences between intake and discharge perceived stress scores (t =
12.1, df = 30, p < .001) with a large effect size (d = 5.12, CI 3.18-7.41), supporting a large
positive clinical change.
Table 1 shows the mean frequencies of engaging in coping strategies reported at intake
and discharge by participants. Participation scores in all activities (except counting and
journaling acts of kindness) significantly increased from intake to discharge, with some of the
largest increases occurring for hiking, participating in outdoor challenges, participating in indoor
challenges with therapist, listening to music, meditation, planting seeds, and journaling. Such
findings support a mix of types of coping with strong effects sizes of 1.0 or greater for most
changes. Change scores were computed for each coping activity, as well as the Perceived Stress
Scale to further explore the relationships between stress and particular coping skills. Pearson
correlation analyses were conducted between changes in stress and changes in each activity but
no significant relationships were found, further supporting that no single activity accounted for
the decreases in stress.
The Practitioner Scholar: Journal of Counseling and Professional Psychology 8
Volume 4, 2015
Table 1
Frequencies of engaging in various coping activities
*p < .05, **p< .01, ***p < .001 (Bonferroni Corrected)
Note: Mean frequencies for 1 = never, 2 = a couple times per month, 3 = once a month, 4 = a
couple times per week, 5 = once a week, 6 = daily.
Activity
Mintake
(SD)
MDischarge
(SD)
Mchange
t
d
95% CI
(lower –
upper)
Hiked or walked outside
3.6 (1.6)
5.0 (1.2)
1.3 (1.9)
4.0***
2.2
1.8 - 2.8
Sailed
1.0 (.18)
1.8 (.48)
.77 (.43)
10.1***
5.4
5.3 - 5.5
Canoed/kayaked
1.2 (.40)
1.9 (.75)
.71 (.82)
4.8***
2.7
2.5 - 2.9
Climbed Trees
1.0 (0.0)
1.2 (.58)
.16 (.58)
1.5
1.5
1.3 - 1.5
Participated in outdoor
challenge activities
1.0 (0.0)
2.2 (.82)
1.2 (.82)
7.9***
6.5
6.3 - 6.5
Participated in indoor
challenge activities with
therapist
1.0 (0.0)
3.1 (.81)
2.1 (.81)
14.7***
11.6
11.3 - 11.6
Participated in indoor
challenge activities outside
treatment
1.0 (0.0)
1.4 (.72)
.39 (.72)
3.0**
2.5
2.2 - 2.5
Bought fresh flowers and kept
them in a space you can see
1.2 (.58)
1.7 (.73)
.58 (.92)
3.5**
1.7
1.5 - 1.9
Expressed gratitude to at least
3 people
4.7 (1.4)
5.3 (1.3)
.65 (1.5)
2.3*
1.0
.5 - 1.5
Listened to bright and
cheerful music for at least 15
minutes
4.3 (1.6)
5.8 (.76)
1.5 (1.7)
4.6***
2.8
2.6 - 3.4
Practiced a form of meditation
for at least 10 minutes
2.5 (1.8)
5.1 (1.4)
2.5 (2.5)
5.7***
3.6
3.1 – 4.3
Exercised for at least 30
minutes
3.5 (1.8)
5.0 (1.2)
1.5 (2.0)
4.2***
2.2
1.5 – 2.2
Counted and journaled every
act of kindness you performed
1.6 (1.1)
1.6 (1.1)
0 (1.4)
0.00
0
-0.4 - 0.4
Journaled at least two pages
for things you are grateful for
in life
1.4 (1.2)
2.5 (1.6)
1.1 (2.0)
3.0**
1.8
1.2 – 2.2
Planted seeds and taken care
of them as they grew
1.8 (1.6)
3.2 (2.0)
1.4 (2.6)
2.9**
1.7
1.0 – 2.3
Set goal, tracked progress, and
told someone when completed
goal
1.9 (1.2)
4.0 (1.8)
2.1 (2.2)
5.2***
3.1
2.5 – 3.5
The Practitioner Scholar: Journal of Counseling and Professional Psychology 9
Volume 4, 2015
Working Alliance and Stress
The total mean score of the working alliance for the 31 participants at discharge was
229.7 (SD = 15.1). The total subscale score for task was 77.5 (SD = 6.4), for bond, 74.7 (SD =
3.6), and for goals 77.4 (SD = 6.8). Such scores reflected a positive rating of a working alliance
at discharge because the scores fell on the higher end of the range of scores possible (total: 36-
252; subscales: 12-84) for this instrument. As shown in Table 3, a Pearson’s correlation
analysis found a significant positive correlation between changes in perceived level of stress and
the total working alliance (r = .36, p = .05), including a significant positive correlation with the
Bond (r = .40, p = .03) and Goal (r =.36, p =.05) subscales. However, no significant relationships
were found between working alliance and age, length of treatment, or frequency of adventure
activities.
Discussion
Stress and Coping
In this study stress levels decreased after participants’ engagement in this adventure
therapy model. At intake, participants had a mean score of 24.5 with a discharge mean of 11 on
the PSI. PSI scores can range from 0-40, and in this study, an intake score of 24.5 was
considered high while 11 was considered to be part of the low range of stress (Cohen &
Williamson, 1988). Hence, an overall mean score of 11 for participants in this study indicated
significant stress reduction at treatment discharge. A variety of coping strategies appeared to be
related to decreased levels of stress among participants, suggesting that multiple coping
strategies were used together to help mitigate the negative impact of stress.
In terms of utilizing coping strategies, participants reported increases in all forms of
coping. Some activities showed greater increase than others (e.g., practicing a form of
meditation for at least 10 minutes, participating in indoor challenges with therapist, exercising
for at least 30 minutes, setting a goal and tracking its progress). These results support previous
research linking these coping strategies to stress reduction and improved overall health (Chu,
2010; Coon et al., 2011). As shown in Table 2, participants also reported increases from intake to
discharge in hiking/walking outside, listening to bright and cheerful music for at least 15 minutes
a day, planting seeds and taking care of them as they grow, and expressing gratitude toward
others and tracking personal gratitude. These findings further support previous research
identifying these activities as effective coping strategies to mitigate negative affect and reduce
stress (Coon et al., 2011; Emmons & McCullough, 2003; Haviland-Jones et al., 2005; Kashdan
et al., 2006; Maskowitz, 2010; Otake et al., 2006). In terms of adventure therapy activities, this
study was the first to look at specific aspects of adventure therapy used by adults in a
community-based setting. Participants reported increases both in activities done with the
therapist as well as activities done on their own. This is important due to the goal of teaching
coping skills in a manner where clients can integrate or transfer skills into their lifestyles. This
transfer of learning is an underlying component of adventure therapy (Gass, 1995). For clients,
learning such skills or attitudes from specific interventions such as the one in this study is of
most value and effective when clients can utilize these skills and ideas in future experiences
outside of therapy (Gass et al., 2012).
The Practitioner Scholar: Journal of Counseling and Professional Psychology 10
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Table 2
Correlations between PSS Change, Age, Gender, Length of Treatment and WAI
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(1) PSSa Change
1
(2) Age
.22
1
(3) Gender (Male = 0)
-.43*
.04
1
(4) Length of Treatment
-.14
-.21
-.05
1
(5) WAIb Total
.36*
.22
.16
-.00
1
(6) WAI Task
.25
.32
.09
.03
.93***
1
(7) WAI Bond
.40*
.00
.15
.20
.74***
.51**
1
(8) WAI Goal
.36*
.18
.19
-.14
.97***
.85***
.64***
1
Note. aPerceived Stress Scale, bWorking Alliance Inventory, *p < .05, ***p < .001
This model of adventure therapy seemed to have allowed clients to find the methods of
coping that worked for them, as opposed to using a structured model to be applied to all clients
universally. It appears that no one specific coping technique was related with decreases in stress,
so perhaps it is the combination of coping methods chosen by the client that makes the most
meaningful change for the clients. This client-centered approach aligns well with the adventure
therapy model. Adventure therapy aims to remove the therapist as the medium of change, and
instead uses adventure and experiential activities in which that the client actively engages to
orchestrate change (Gass et al., 2012). This is an effort to place as much responsibility for
change in control of the client. Empowering clients to have choice and control in this treatment
process may have supported greater change for clients coping with high stress.
Working Alliance
This study was interested in examining reported levels of treatment alliance by
participants. On average clients reported a high level of alliance with their clinician, which was
significantly correlated with overall working alliance, bond, and goals. Individuals with
significantly larger decreases in stress appeared to have higher bonds with their clinician as well
as a stronger alliance around client goals. This was not true in terms of decreases in stress and
working alliance task. The significant correlation within the bond and goal categories could be a
result of the adventure therapy model. Underlying characteristics found in AT may have
contributed to strengthening the working alliance in bond and goal areas.
Within adventure therapy, clients have participatory roles in their treatment. Along with
the framework of the experiential and adventure activity, this role requires a certain level of
mutual trust and confidence between the client and the therapist. Furthermore, the changing role
of the therapist (as mentioned earlier) could impact the strength of alliance. If the therapist is
removed as a central figure in the change process while maintaining clear and appropriate
boundaries, clients may feel more comfortable approaching and interacting with the therapist and
deepen their level of alliance (Gass, 1995). In addition to the intentional focus on client’s active
participation, sometimes novel or challenging experiences in treatment set the stage for a
significant level of trust to develop throughout the therapeutic process.
The Practitioner Scholar: Journal of Counseling and Professional Psychology 11
Volume 4, 2015
Goal setting as a means of coping with stress was reinforced by the findings in this study.
However, the participatory and active role of the client in this adventure therapy model also may
have contributed to strengthening the working alliance around client goals. Clients may have
placed greater value on outcome because of their direct involvement and personal choice in the
adventure and experiential activities used in their treatment. In adventure therapy models such as
the one in this study, the therapist provides experiences where clients choose to participate or not
(Tucker, 2009). Based on a thorough assessment, the therapist presents activities that are most
closely matched to client’s clinical needs (Schoel & Maizell, 2004). Together the client and
therapist share observations, thoughts, feelings, and overall reflections about the experience --
either before, during, or after -- which can allow new insights and perspectives to develop
(Schoel & Maizell, 2004). This reflection and shared experience may work to lay the foundation
for healthy change and positive treatment outcomes. These adventure therapy components make
for powerful therapeutic experiences for clients where the therapeutic alliance is potentially
strengthened, particularly around the bond and treatment goals.
It is unclear why there was not a significant correlation in the task component; however,
this may be due to how adventure therapy is conducted. For example, when presented with
problem-solving initiatives or active challenges, clients are not necessarily given specific
directions on how to solve or approach a challenge. This is intentional as a way to help clients
increase their problem-solving capacity on their own when faced with stress or challenges.
Hence, when clients were asked questions on the WAI which are part of the task subscale like
question #7 “I find what I am doing confusing in therapy” or question # 31 “I am frustrated by
the things I am doing in therapy” and they respond “often,” “very often,” or “always,” this is
actually reflective of the adventure therapy process. In fact, over the course of evaluation, seven
participants shared with the researchers their confusion over questions which were all on the task
subscale. For example, one participant responded, “question #7 which asks if things are
confusing. Yes, they are and then they make sense.” Similarly, another participant said regarding
question #31, “Sometimes the activities cause frustration. This is part of the process.” It may be
that for this type of therapy, the task subscale may not be the best measure of alliance. In
Bordin’s (1979) article, he made note of certain therapies, such as client-centered therapy where
tasks are never “specifically assigned yet develop gradually and ambiguously,” a point which
supports our findings (p. 254). This could shed light in terms of why this adventure therapy
model, which is client-centered, may not have shown a correlation in the task component of the
working alliance and is important to consider in future research.
Limitations
There are several limitations that are important to discuss in terms of this study. First of
all, the sample for this study was small without comparison groups and follow-up data were not
collected. Without a comparison group it is unclear if the client improvements were due in part
from their participation in the adventure therapy or from other outside influences. It also is
unclear if after leaving treatment client change remained. The sample was mostly Caucasian and
female, so it is unclear how this intervention would impact male clients or non – Caucasian
clients. Clearly, more long-term research is needed with larger samples of diverse adult clients.
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In addition, the Coping Skills Utilization Form was created by the researchers who
recognize some limitations with its use. First of all, it has not been tested for reliability or
validity. Furthermore, it did not ask the frequency of “Participation in Outdoor Challenges with
the Therapist”, although these activities were completed with the clinician over the course of
treatment, at least once every four sessions. In fact, each client over the course of treatment
engaged with the clinician in hiking, rock climbing and at least one water activity (kayaking,
canoeing or sailing). Because clients were given by the clinician a list of possible coping skills
they could use for decreasing stress and also completed the Coping Skills Utilization Form at
intake, it is unclear if the list itself became part of the therapeutic process influencing their
frequency of coping skills usage. Clearly, future research is needed including long-term follow
up to see if the coping skills learned by clients were successfully transferred into the clients’
lives after treatment.
Practice Implications
This study highlights a new, alternative intervention aimed to improve coping strategies
in adults in order to manage both real and perceived stress as well as mitigate its deleterious
effects. Adventure therapy has a long history of evidence showing its effectiveness as both a
primary and adjunct intervention with youth (Norton et al., 2014); yet it has only recently been
considered when working with adults (Scheinfeld et al., 2011; Vorungati et al., (2006). However,
it is logical that it may have the same positive clinical applications with adults because it is an
active approach to therapy that is both flexible and goal oriented. This allows clients to be full
participants in their choice of treatment according to the mutually agreed upon goals. In essence,
adventure therapy takes the client out of the chair, compelling a more active participation in
one’s own treatment (Lung, Stauffer, & Alvarez, 2008).
Adult beliefs about autonomy and self-direction can shape learning as well as the
therapeutic process (Fink, 2003). Many adult learners may be resistant to new learning when it is
perceived that the educator is imposing information, ideas or actions (Knowles, Holton, &
Swanson, 2005). Adventure therapy allows the role of the practitioner to facilitate a more self-
directed learning. This helps the client to increase responsibility for change as well as engages
the client’s internal motivation for learning or change. Facilitated reflective learning
opportunities for adults specifically help the learner to examine existing biases or habits based on
life experiences, which helps create a shift toward a new understanding of knowledge and
behavior (Fidishun, 2000; Fink, 2003). This concept is at the core of a truly transformative
psychotherapy experience.
In addition to engaging multiple learning styles, adventure therapy is holistic in nature. It
engages clients on physical, cognitive, and affective levels while at the same time it can be seen
as fun (Schoel & Maizell, 2004). According to the National Institute of Play (2009), play is the
path toward a healthier and more fulfilling life because it allows clients to seek out novelty,
generate optimism, and feel enthusiastic. Additionally, play increases frustration tolerance by
making perseverance fun, increases coping skills and can foster empathy, a sense of belonging,
and strengthen relationship (National Institute for Play, 2009). When nourished, playful
communications and interactions produce a climate for easy connection and a deepening, more
rewarding relationship - true intimacy (National Institute for Play, 2009). All of these outcomes
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are directly related to personal health and well-being.
Finally, any discussion of adventure therapy must also highlight the need for training for
clinicians. Therapists who engage in adventure therapy, must not only understand clinical
theories and interventions, they must also understand how to choose and safely facilitate the
adventure experience so that is provides an opportunity for meaningful learning and change for
the client (Tucker & Norton, 2013). Therapists must be able to accurately assess the client, client
functioning and work collaboratively with the client to choose activities that will challenge the
client, but not put the client at physical or emotional risk (Gass et al., 2012). Hence, with the
proper training adventure therapy has the potential to offer a new way to engage with adults in a
clinical setting.
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