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Attachment Processes in Wilderness Therapy
Joanna Ellen Bettmann and Isaac Karikari
Attachment is an integral part of human nature. Attachment theory presumes we
are biologically predisposed to connect to others. Founder of attachment theory,
Bowlby (1988) noted that attachment behavior “is seen in virtually all human beings
(though in varying patterns)” (p. 27). Attachment theory describes the various ways
in which we relate to each other based on our perceptions of human relationships.
These perceptions we hold result from experiences gained earlier in life (Bowlby
1980,1988). In formulating attachment theory, John Bowlby called attention to its
biological base, noting that attachment
... emphasizes the primary status and biological function of intimate emotional bonds
between individuals, the making and maintaining of which are postulated to be controlled
by a cybernetic system situated within the central nervous system utilizing working models
of self and attachment figure in relationship with each other. (Bowlby 1988, p. 120)
Attachment patterns begin in childhood but manifest throughout our lives. The mani-
festations of attachment behavior occur in different ways. In children, four attachment
styles exist: secure, anxious-resistant, avoidant, and disorganized. Secure attachment
is promoted by the ready availability and responsiveness of the caregiver to the child’s
needs. This serves as a guarantee of the caregiver’s protection and support, and con-
tributes in building the child’s confidence and boldness in facing the world and
adverse situations. In anxious resistant attachment, the caregiver’s response to the
child is characterized by inconsistencies. The caregiver is not always available. There
is thus a lack of surety regarding the caregiver’s availability.This breeds anxiety and
makes the child fearful about exploring its environment. With anxious avoidant at-
tachment the negative responses that often accompany the individual’s care seeking
behavior stirs up a desire to be emotionally self sufficient. This often becomes the
case after repeated negative responses (Bowlby 1988).
J. E. Bettmann ()·I. Karikari
College of Social Work, University of Utah, Salt Lake City, UT, USA
J. E. Bettmann
Open Sky Wilderness Therapy, Durango, Colorado, USA
e-mail: Joanna.Schaefer@socwk.utah.edu
J. E. Bettmann, D. D. Friedman (eds.), Attachment-Based Clinical Work with 219
Children and Adolescents, Essential Clinical Social Work Series,
DOI 10.1007/978-1-4614-4848-8_10, © Springer Science+Business Media NewYork 2013
220 J. E. Bettmann and I. Karikari
In adolescence, attachment patterns typically reflect the relational patterns devel-
oped with one’s earliest caregivers. This is due, in part, to self-perpetuating patterns
of relating to others, introduced in the initial primary caregiving relationship (Bowlby
1988). While Bowlby claimed that initial attachment representations and subsequent
relational and behavioral interactions are not part of what he defined as the “inborn
temperament” (Bowlby 1969, p 127), attachment representations and relational con-
structs become more rigid and defined as a person ages. Thus, the likelihood internal
working models will change after early childhood decreases (Bowlby 1973). Re-
sulting cognitive, emotional, social and developmental manifestations from initial
attachment schemas also become more rigid and less susceptible to external influence
(Benoit and Parker 1994; Sroufe 2005; Main et al. 1985).
Attachment theory speaks specifically to the impact of separations on children.
Attachment theory proposes that separations from one’s attachment figures have a
profound impact on young children. John Bowlby and his colleagues James and
Joyce Robertson demonstrated this vividly in the 1969 film “John, aged 17months,
for 9 days in a residential nursery” (Robertson and Robertson 1969). The film tracks
the institutional stay of a young British boy in an orphanage while his mother was
in the hospital delivering a baby. The video clearly shows John’s enormous distress
at the separation from his parents, his resulting protests, and eventually despair and
withdrawal. While the film tracks a toddler responding to separation from attachment
figures, older children and adults can respond similarly to separations. Kobak and
Madsen (2008) note that separations at any age constitute a threat to the caregiver’s
availability. They assert,
Older children and adults are likely to perceive threats to a caregiver’s availability when
lines of communication are disrupted by prolonged absence, emotional disengagement, or
signals of rejection or abandonment. As a result, disrupted lines of communication produce
feelings of anxiety, anger, and sadness similar to those that have been documented in young
children’s reactions to physical separations (Kobak and Madsen, p. 24).
Such dynamics are relevant to wilderness therapy settings, which consist of adoles-
cents’ prolonged absences from their caregivers, emotional disengagement due to
their isolation in wilderness environment, and potential signals of abandonment by
being sent away to treatment.
Changes in Attachment
Attachment patterns developed during childhood can be modified significantly based
on later experiences and encounters a person has in life (Bartholomew and Horowitz
1991; Bettmann 2007; Qi-Wu et al. 2010).While the majority of populations will re-
main relatively stable in regards to attachment classification, a minority experience
life events which may change attachment security. Waters et al. (2000) demon-
strated this phenomenon in a longitudinal study investigating the relationship between
negative life events and changes in attachment classifications. They assessed the at-
tachment styles of 50 adults between the ages of 20 and 22 years old. A previous
Attachment Processes in Wilderness Therapy 221
attachment study assessed these adults at 12 and 18 months of age (Waters 1978).
Waters et al. (2000) found that change from secure to insecure attachment classi-
fication occurred with loss of a parent, life-threatening illness of parent or child,
parental divorce, parental psychiatric disorder, and physical or sexual abuse by a
family member.
In another study, Iwaniec and Sneddon (2001) measured attachment in infants
who experienced failure to thrive symptoms and measured the same participants at
20 years of age. They found that attachment classification changed from insecure to
secure in participants who experienced positive changes in environmental circum-
stances: Six were removed from home environments and placed into stable foster
care homes, one was adopted, and one child remained in the home environment,
but the mother left the child’s father and established a positive relationship with a
new partner. Furthermore, in a review of findings from the Minnesota Longitudinal
Study on risk and adaptation from birth through adulthood, Sroufe (2005) explored
implications of negative and positive life events on attachment representations. He
concluded that attachment representations may shift from secure to insecure and from
insecure to secure, depending on life events. He asserted that attachment representa-
tions in infancy only probabilistically predict attachment representations in later life
and that many layered complexities play a role in forming relational development.
Changes in Attachment Due to Clinical Intervention
Some research has explored shifts in attachment classification due to psychothera-
peutic intervention (Fonagy et al. 1995; Korfmacher et al. 1997;Levyetal.2006).
Levy et al. (2006) evaluated changes in attachment representations among 90 peo-
ple with bipolar disorder receiving 1 of 3 year-long group therapy interventions:
transference focused psychotherapy (TFP), dialectical behavior therapy (DBT), and
modified psychodynamic supportive therapy (SPT). Using the Adult Attachment
Interview (George et al. 1996), results indicated a three-fold increase of participants
classified as securely attached from pre to post in the TFP group (from 5 to 15 %).
Researchers found no differences in attachment classification from pre to post in
the DBT or SPT groups. Such findings indicate that attachment representations may
indeed shift as a result of clinical intervention. Similar to attachment theory, TFP
is rooted in psychodynamic theory. Both trace problems to internally held beliefs
and cognitions and thus focus on positively altering negative or dysfunctional inter-
nal working models to enable clients improve conceptions of their relationships and
interactions (Levy et al. 2006).
In a similar study using different measures, Travis et al. (2001) analyzed intake
and discharge interviews in a clinical population with significant interpersonal prob-
lems. The authors rated interviews based on Bartholomew and Horowitz’s (1991)
rating system, using four attachment prototypes: secure, fearful, preoccupied, or
dismissing. Participants in the study received a 25-session, time-limited dynamic
psychotherapy group intervention. Of the 29 participants receiving treatment, none
222 J. E. Bettmann and I. Karikari
were classified as secure at intake. However, at discharge, seven participants were
classified as secure (24 %). Notably, prior to treatment, 11 participants were classi-
fied as preoccupied, 16 as fearful, and 2 as dismissive. At post-treatment, 10 were
classified as preoccupied, 8 as fearful, and 4 as dismissive. Overall, 19 (66 %) partic-
ipants changed attachment classification from pre- to post-intervention. While, the
small sample size of this study limits the generalizability of its findings, its results
suggest the attachment classification can shift as a result of psychotherapeutic inter-
vention. Similar to attachment theoretical approaches, the dynamic psychotherapy
used in this study focuses on clients’ relational patterns which manifest in sessions
with the therapist. The therapist’s relationship with the client is considered a key fac-
tor in effecting change. In this model, the therapeutic relationship serves as positive
model in helping rectify the client’s maladaptive schemas of relationships (Travis
et al. 2001).
While wilderness therapy programs do not explicitly aim to change adolescents’
attachment classifications, some such programs work on the familial attachment
relationships of their clients (Bettmann 2007). Using intensive family therapy
interventions, wilderness therapy programs aim to improve adolescents’familial rela-
tionships. Such improvement seems likely to impact those attachment relationships.
Using an in-depth case example, this chapter will explore how attachment processes
emerge and are worked through in the context of wilderness therapy settings. First,
however, we must explore what wilderness therapy is. What is this treatment type
which thousands of adolescents attend each year (Russell and Hendee 2000)?
History of Wilderness Therapy
We will begin by exploring its origins. The precursors of wilderness therapy include
“tent therapy,” a term coined in reference to the use of tents for housing patients
outdoors (Williams 2000, p. 48). This approach was used by some mental hospitals
in the United States in the early 1900s. The effects were favorable, and its proponents
attributed its beneficial effects to the outdoor setting as well as the group interactions
that occurred there (Williams 2000). In 1929, Campbell Loughmiller founded the
first outdoor camping program; this program utilized adventure therapy and was
aimed at underprivileged children in Texas. Loughmiller focused on socialization of
clients through the use of small group cooperation (Russell and Hendee 2000).
Another historical contributor to wilderness therapy was the Outward Bound pro-
gram, a pioneering effort in outdoor/adventure programs which held education as
an integral component (Bandoroff and Scherer 1994; Gillis et al. 2008). Founder of
Outward Bound, Kurt Hahn understood the wilderness experience as a catalyst for
self-discovery, growth, and development (Kimball and Bacon 1993; Bandoroff and
Scherer 1994). Kurt Hahn, to whom most authors link the beginning of contempo-
rary outdoor and adventure education programs, created the first Outward Bound
program for Blue Funnel Shipping line, a Britain-based company, in 1942. The
month-long program had as its primary goal the fostering of participants’ indepen-
dence and resilience, as well as creativity and ingenuity (Russell 2006). The program
Attachment Processes in Wilderness Therapy 223
was reestablished in the United States in 1962, and became incredibly popular over
the decades that followed (Kimball and Bacon 1993).
The incorporation of wilderness survival skills in wilderness therapy can be traced
back to the Department of Youth Leadership at Brigham Young University (BYU)
in the 1960s. Desert survival classes developed by BYU instructors became quite
popular with students. The creators noticed that students appeared to have improved
levels of self-esteem, which led to the development of a program for struggling
freshman students. Soon after, the curriculum was adapted for troubled adolescents,
eventually leading to programs such asAspen AchievementAcademy and the Anasazi
Foundation (Russell and Hendee 2000).
A national survey conducted in 2000 revealed that 116 wilderness therapy pro-
grams existed in the United States, of which 86 participated in the survey (Russell
and Hendee 2000). The majority of the programs that participated in the survey iden-
tified as private pay programs for which parents pay out of pocket or utilize their own
insurance (81 %), while programs for adjudicated youth constituted a smaller per-
centage (19 %). Approximately 9,100clients attended the programs in 1999, with an
average of a little over 100clients in each program. The authors estimate that with the
inclusion of non-participating programs, wilderness programs serve approximately
11,000 clients a year (Russell and Hendee 2000).
These days, wilderness therapy treatment is commonly used as treatment for a
variety of individual and family issues.Adolescents ’ presenting problems typically
include oppositional defiant disorder, substance abuse, depression, anxiety, trauma,
and varied behavioral and emotional disorders and issues (Russell and Hendee 2000).
Wilderness therapy programs typically do not treat acute psychosis, sexual deviance,
extreme suicidal behavior, severe forms of behavioral and conduct disorders, and
certain medical complications (Clark et al. 2004; Somervell and Lambie 2009).
Definition of Wilderness Therapy
Wilderness therapy is a behavioral healthcare model and a distinctive approach to
adolescent mental health treatment (Becker 2010; Russell 2003). Wilderness ther-
apy falls under the general framework of wilderness experience programs, which are
programs that are operated in outdoor locations with the goal of client improvement
through therapy, recreation, leadership formation, and/or instruction (Friese et al
1998; Russell 2001; Russell and Hendee 2000). Wilderness therapy, however, has
specific characteristics that set it apart from other wilderness experience programs
(Russell 2001; Russell et al. 1999). First, wilderness therapy is generally conducted
in isolated wilderness environments, separating the client from settings they are ac-
customed to (Bettmann and Jasperson 2008; Kimball and Bacon 1993; Powch 1994;
Russell et al. 1999). Program sites do not have amenities like indoor plumbing or
electricity, and clients do not have access to computers or cell phones (unless used for
family therapy interventions). Programs typically last between 3 and 8 weeks, provid-
ing a lengthy experience of living in a wilderness environment. Length of treatment
is determined either by program model or clients’ progress on treatment goals.
224 J. E. Bettmann and I. Karikari
Living in a wilderness environment allows participants to focus more completely
on the experience at hand (Bettmann and Jasperson 2008). In wilderness therapy,
clients learn and use primitive outdoor survival skills (Bettmann and Jasperson 2008;
Kimball and Bacon 1993; Russell et al. 1999). For example, clients are often expected
to make fire without matches or lighters, prepare meals over a campfire, prepare their
own shelters using tarp and rope, etc. (Kimball and Bacon 1993). Many programs
also include outdoor challenges, such as difficult hikes, rock climbing, river rafting,
rappelling, etc. (Kimball and Bacon 1993; Crisp 1996). The length of wilderness
therapy programs varies greatly (Kimball and Bacon 1993), but normally ranges
from 3 to 8 weeks (Newes and Doherty 2007).
These programs are most often created for adolescent clients (Becker 2010;
Williams 2000), although adult programming is also available (Bettmann and
Jasperson 2008). Wilderness therapy programs are typically not used as the first-
line treatment for adolescent mental health issues (Clark et al. 2004; Russell
2007). However, for adolescents who appear less receptive to traditional forms of
therapy, wilderness therapy programs present one viable option (Clark et al. 2004;
Russell and Phillips-Miller 2002). Russell and Phillips-Miller (2002) found that
clients voiced various reasons for attendance at a wilderness therapy program, in-
cluding: school difficulties, abuse of drugs and/or alcohol, lack of success in other
treatment modalities, emotional issues, and the client feeling as though they “needed
help” (p. 422).
Therapy in this unique setting is carefully structured and includes “a process of
assessment, treatment planning, the strategic use of counseling techniques (including
group dynamics which are often a component of outdoor education programs), and
the documentation of change” (Berman and Davis Berman 2000, p. 1). Russell
(2001) asserts that wilderness therapy programs employ licensed therapists who are
trained in the program’s specialties, can create and tailor treatment plans, and help
to manage aftercare services for clients. Romi and Kohan (2004) make the assertion
that wilderness programs are:
... a complex of components that impact on the participant and create a synergism that
is greater than the sum of all separate influences. People and nature combine so that each
pre-structured program becomes a unique creation, influenced by the personalities of the
individuals involved—participant or professional—and by the terrain and the vicissitudes of
natural phenomena (p. 133).
In its particular therapeutic approach, wilderness therapy does not attempt to force
change. Rather, through its skilled personnel, it uses interventions such as psycho-
educational lessons, outdoor activities, and group psychotherapy in a bid to help
change identified behavior (Russell 2001).
What about wilderness therapy is particularly helpful to clients? Russell and
Hendee (2000) studied this, exploring the variables that clients found most helpful
in this treatment type. First, the adolescent participants cited solo time, which is a
scheduled time designated for clients to be alone to reflect upon their lives. Solos
typically last 2 to 3 days, where clients set up their own campsites within hearing,
but out of sight of staff. Adolescents are expected to take care of themselves in their
Attachment Processes in Wilderness Therapy 225
campsites: building their own shelters, cooking their own meals, and completing
therapeutic assignments designed by the treatment team. The clients also described
the importance of relationships with program staff and therapists. Specifically, clients
cited “non-confrontive and caring” (Russell and Hendee 2000, p. 172) relationship
styles as helpful in engaging them in working through personal issues. Although the
adolescents noted the difficulty of living in wilderness environments, they also indi-
cated that it was empowering to master skills like hiking, reflection, and observation
of the natural beauty around them (Russell and Hendee 2000). Other researchers ex-
amining the positive effects of wilderness therapy cite similar critical factors, noting
the centrality of the wilderness environment, positive group dynamics, challenging
and engaging activities, and therapist–client relationships (Becker 2010; Russell and
Phillips-Miller 2002; Somervell and Lambie 2009).
Families play a critical role in adolescents’ wilderness treatment. The family is
sometimes regarded as a contributing factor in the problems adolescents face and thus
intervention with the family system is important (Bandoroff and Scherer 1994). Some
programs integrate elements of family therapy with wilderness programs (Bandoroff
and Scherer 1994), which is an element Russell (2001) cites as a core feature of
wilderness therapy. Such interventions may include mailed written assignments for
clients and their families, family therapy via phone calls, and weekly phone contact
between the program therapist and clients’ families (Bettmann and Jasperson 2008).
Some programs incorporate family seminars that include family therapy, groups,
learning and usage of primitive skills, and trekking at the end of the client’s stay
(Bandoroff and Scherer 1994). Including families in the wilderness therapy process
also aids in prospects for aftercare, as families can incorporate the skills they learned
in their homes, creating an environment that sustains improved family relationships
(Bandoroff and Scherer 1994).
Theoretical Foundations of Wilderness Therapy
Russell (2001) posits that, although wilderness therapy programs stem from various
theoretical perspectives, several prevalent themes exist. First, wilderness therapy
seems to be a blend of the Outward Bound, cognitive behavioral, and family sys-
tems models. Clients are exposed to challenging wilderness environments and then
process the experience through these therapeutic modalities. Natural consequences
are another important theoretical concept. Staff members are encouraged to let ado-
lescents learn lessons on their own through experiences with the environment. Thus,
staff members are able to take a caring, compassionate, and calm approach with
clients, as natural consequences take the place of punishments. For example, an
adolescent who rushes to build his primitive backpack quickly may end up with his
backpack falling apart later in the day, a natural consequence to his rushing the task.
Similarly, an adolescent who builds a poorly constructed shelter may find that he
gets wet one night when it rains. Staff permits such natural consequences to occur,
while also stepping in to support students in building new skill sets when needed.
226 J. E. Bettmann and I. Karikari
Finally, metaphors, rites of passage, and times for reflection are also incorporated
into most programs, mimicking traditional cultural practices (Russell 2001).
Hill (2007) also notes a collection of concepts which form the philosophical
foundations undergirding wilderness therapy. These concepts include “full value
contract,” which refers to a group’s agreement to maintain positive regard for its
members and their contributions (Schoel et al. 1988, p. 33). This mindset becomes
evident in the interactions that take place within the wilderness therapy group. No-
tably, the contract happens in the form of encouragement, the setting of goals or
targets, and the way in which confrontations take place. Wilderness therapy also
incorporates concepts from diverse models of therapy such as Adlerian therapy,
behavioral therapy and reality therapy. For instance modeling, behavioral reinforce-
ment, behavioral rehearsal, and behavioral contracts are typical wilderness therapy
interventions which derive from behavioral therapy. Wilderness therapy’s strength-
based and egalitarian interactions between counselors and clients have links with
Adlerian therapy (Hill 2007).
Attachment Processes in Wilderness Therapy Settings
Wilderness therapy and adventure-based therapeutic programs offer participants op-
portunities to gain new perspectives (Kluge 2007) and develop positive relationships
that help mitigate negative behavioral patterns (Black et al. 2010).As a mental health
treatment modality (Russell 2001), wilderness therapy can address attachment-
related issues (Bettmann et al. 2008). Yet the study of attachment processes within
the context of wilderness therapy is a relatively unexplored terrain (Bettmann 2007;
Bettmann et al. 2008; Bettmann and Jasperson 2008).
Notably, out-of-home treatments for adolescents present a distinct challenge for
attachment-based clinical work. How can treatment enhance the attachment bonds
between family members when the treatment is residential, by definition keeping the
adolescent and his parent apart? Further, in wilderness therapy programs, adolescents
are far from their familiar family and friends, evoking strong attachment needs and the
need for new relationships within the treatment setting. The wilderness setting and its
therapeutic community of strangers activates the attachment system. Bowlby noted
that the attachment system is activated by “strangeness, fatigue, anything frightening
and unavailability or unresponsiveness by attachment figure” (Bowlby 1980, p. 40).
Wilderness therapy incorporates such elements (Berman and Davis-Berman 2000;
Romi and Kohan 2004).
In wilderness therapy settings, adolescents enter an environment of strangers:
typically joining a group of eight other same-sex peers and three staff in the wilder-
ness. This will be the adolescent client’s group for the next month or 2 and strong
relationships will form between them. But at the start, the adolescent joins a group
of strangers in the middle of nowhere. Thus, their attachment system is strongly acti-
vated by the strangeness of the wilderness setting and the unavailability of their usual
attachment figures. For the next month or 2, adolescents will be able to write their
Attachment Processes in Wilderness Therapy 227
parents, but will have no contact with peers from home. They won’t be able to make
phone calls, send emails, or text attachment figures. Separated from all attachment
figures in their home lives, adolescents’attachment systems are strongly activated at
the beginning of treatment.
Such activation leads to a range of adolescent behaviors, from withdrawal to act-
ing out. Adolescents sometimes withdraw, speaking little and refusing to participate
in daily activities. Others act out, by yelling, name-calling, becoming physically ag-
gressive, running away, or exhibiting other behaviors.While most programs attempt
to manage these varied behaviors with purely behavioral responses, we suggest that
programs understand such adolescent conduct as reactions to the activation of their
attachment systems. Reconceptualized, adolescents are simply responding to the
threat that they perceive in the strangeness of the wilderness environment.
In the context of such activation, program staff needs to work hard to engage
new adolescent clients in empathic, nurturing relationships. For the month or 2
that adolescents are in the wilderness, they will need new attachment relationships.
They will need relationships which fulfill attachment functions, such as secure base
and safe haven (Cassidy 2008). Staff or peers in wilderness therapy settings can
fulfill such roles, but likely only if they are primed to do so. In-the-field training
provided by such programs should coach staff to do this. Regular staff training
should focus on alerting staff on how to attend to the critically important therapeutic
relationships which evolve between staff and adolescent clients. Programs should
provide mentoring for staff in order to develop these skills, encourage staff to observe
therapy sessions at times, and encourage frequent debriefing of cases with program
therapists. All of these approaches are likely help staff to recognize their critical
positions as attachment figures. Staff who conceptualize their roles as attachment
figures are likely to provide the attuned, attentive emotional responses to adolescent
acting out which adolescents need.
Bowlby noted that it takes “a familiar environment and the ready availability
and responsiveness of an attachment figure ... touching or clinging, or the actively
reassuring behavior of the attachment figure” to deactivate the attachment system (p.
40). Staff and therapists in wilderness therapy programs can provide such availability
and responsiveness if alerted to the primacy of their clients’ attachment needs. The
case study below illuminates such relational dynamics between a client and her
therapist in a wilderness therapy program.
Case Study
Amy1was a 15-year old Caucasian female who presented to treatment at a wilderness
therapy program where I [JB] was the therapist. Raised in an upper middle class home
in a suburban East Coast city, Amy was the 3rd of 4 children raised by her parents,
who were now married for 21 years. In many ways, she was similar to her peers
in the program: acting out at home, substance abusing, oppositional at home and
sometimes at school.
1A pseudonym
228 J. E. Bettmann and I. Karikari
However, my initial session with her was significantly irregular. Most of my
clients in the wilderness therapy program were angry to be there, having been sent to
treatment by their parents for problems that the adolescents themselves didn’t see as
problems. In our initial sessions, I was used to their angry narratives, long-winded
diatribes against the stupidity of parents and adults in general. However, my initial
session with Amy was absent of any dialogue.
When I was introduced to Amy, she was on her third day in the program. The three
staff in her group of eight girls informed me that she had not yet spoken to anyone
in the program. This was striking. I had not yet encountered such a client. I thought,
“well, I’m the therapist. She’ll definitely talk to me.” After the introductions by staff,
I invitedAmy to an individual psychotherapy session with me. We sat about 150 feet
from the staff and girls group, and I began the session as I generally did with other
students by asking Amy how things were going and other opening questions. She
was silent. I explained to her my role and who I was as a field therapist. She was
silent. I explained to her how eager I was to get to know her and hear what she had
to say. She was still silent.
I experienced strong countertransference in her silence. At first, I felt rejected, hurt
by her unwillingness to open up to me at all. I felt inadequate as a therapist, assuming
that my techniques were poor, my interventions inappropriate. However, I began
thinking about what would make Amy silent. Using an understanding of attachment
theory, I hypothesized that Amy was deeply wounded by her relationships with
primary caregivers. I assumed that such wounds, if they existed, made it difficult or
impossible for her to trust other adults. I conceptualized Amy as avoidantly attached,
one whose style was to avoid close relationships. I considered the strategies of
avoidantly attached individuals: the emotional withdrawal, the unease with intimacy,
the over-regulation of emotion.
Using this knowledge, I approached our relationship cautiously, but with warmth.
As the therapist and thus the treatment team leader, I encouraged the staff to respond
to Amy with availability, empathy, and emotional responsivity. In short, I encouraged
them to act as available attachment figures so that Amy might begin to engage and
eventually to trust. On her fifth morning in the program, the previously silent Amy
asked staff to pass her a piece of her clothing as she was packing up. The staff
responded warmly and excitedly, pleased to begin engaging with Amy.
The therapists’ schedule at this program placed therapists in the wilderness with
the group of nine clients and three staff for two consecutive days each week.When I
returned to the group the following week, I found Amy significantly changed.While
she was still angry, her anger was directed at her family. She spoke eagerly with
me, wanting to share her displeasure with her parents and to strategize how to leave
the wilderness program early. I empathized with Amy’s situation—being sent to
treatment she believed she didn’t need—and encouraged her to share her feelings
with her family in letters. She was resistant to writing her family, but did so: long,
angry letters filled with epithets, blaming, and threats. The Amy I had experienced in
session, the Amy who was eager to share, was nowhere evident in her letters. I was
enormously encouraged by her willingness to engage in a therapeutic relationship,
but perplexed by the vitriolic language in her communication with her family.
Attachment Processes in Wilderness Therapy 229
In subsequent weeks, Amy continued to engage eagerly in a relationship with
me and with the staff. She formed friendships with some of the girls in her group
and made progress in moving through the level system of the program. However,
her letters to her family continued to blame them and to threaten. Unusually, her
anger was not limited to her parents, but spread equally on her three siblings as
well. Adolescents in wilderness therapy programs are often angry at parents at the
beginning of treatment, but tend to become less angry as treatment progresses and
they see positive changes in themselves. I was concerned about the continued high
level of Amy’s anger at her family which seemed unusually long-lasting.
As per the program’s protocol, I spoke weekly with Amy’s family, giving them
updates on her progress and encouraging them to be warm and responsive to her
concerns in their letters back to her. I encouraged them not to respond to her anger
with their own, but to allow her reflect her upset, and they were able to do this.
However, I was troubled by Amy’s inability to work through conflict with parents.
She seemed able to work through conflict with peers in the program, for example,
giving “I feel” statements to her peers when coached by staff when her peers did not
do the dishes as assigned.
The program lasted 7 weeks; at the end of it, all families came to the wilderness
site for 2 days of family therapy. Unlike all of her peers graduating that week, Amy
refused to hug her parents when she first saw them after 7 weeks away. They were hurt
by this and turned to me, asking for answers. I continued to be baffled by Amy’s fierce
anger and rejection of them, but conceptualized her anger as hurt. I understood her
to be suffering from deep wounds with her primary attachment figures, her parents.
What I didn’t understand was what hurt her. I encouraged her parents to remain open
and warm with her; this was difficult for them to do. Her parents tended to talk to
each other, rather than risk her anger and disdain.
After they had spent 24 h together doing family therapy activities and some un-
structured time, I met Amy and her parents for our first and last hour-long family
therapy session in person. She was due to graduate the next day and to go home
with her family. I resolved to spend the session helping Amy to amplify some of her
wounds with her attachment figures. In this session, Amy began with her anger and
blaming, but through my gentle questioning, quickly devolved into tears. I had seen
her cry in sessions previously, but her parents hadn’t seen her cry in years and they
were shocked. I encouraged them to respond to her with empathy and warmth, even
if they didn’t understand the source of her distress. With encouragement, Amy spoke
about her feelings of rejection by her whole family. In one critical moment, Amy
spoke about an incident in which her parents and siblings went out for ice cream,
but didn’t invite her. She spoke about how isolated and lonely this made her feel.
Her mother responded with surprise, explaining, “we didn’t think you’d want to go.
You never acted like you wanted to be with us.” Amy described that similar incidents
happened numerous times, resulting in her feeling of isolation and loneliness.
It appeared that Amy’s hurt in her most important attachment relationships resulted
in her complete withdrawal, until even those closest to her perceived that she didn’t
want to be with them. Amy’s avoidant attachment strategies served to protect her
from some hurt, but isolated her to an extreme extent. Her anger towards her family
230 J. E. Bettmann and I. Karikari
was apparently a cover for the hurt she felt.Amy’s ability to explain her hurt feelings
to her family was the beginning of a rebuilding relationship between them.
Amy left the wilderness program the next day, headed to a therapeutic boarding
school for the next year. In this environment, she would receive therapeutic and
academic support. Her family headed to their home some states away. Six months
later, I received a letter from Amy describing her appreciation for being seen and
heard clearly while in wilderness. She expressed pride in her progress and pleasure
at her achievements. Her letter brought me into tears. In wilderness therapy, Amy
experienced being heard and understood, her hurt feelings were identified and am-
plified. This experience helped her to reconnect with her family and begin to modify
her expectations of relationships.
Conclusion
This article presented a reconceptualization of adolescent dynamics in wilder-
ness therapy settings, exploring how acting-out adolescent behaviors can be best
understood in the context of powerful attachment dynamics. Adolescents enter-
ing wilderness therapy programs or other out-of-home care settings encounter
strangeness, separation, loss, and change. All these activate the attachment sys-
tem, but in an environment where there are no familiar attachment figures. In the
case of wilderness treatment, clients have little access to their primary attachment
figures: only through letters can they connect. In such an environment, adolescents’
behaviors should be reconceptualized as attachment-seeking behaviors, even when
they look angry, rejecting, withdrawn or avoidant.
But can brief treatment—such as a 7-week wilderness therapy program—change
our clients’ attachment relationships? While brief treatment seems unlikely to
change attachment classification, it may shift adolescents’ expectations of what their
attachment figures can provide.
In the case of Amy, it seemed likely that her experience of open, warm, empathic,
and attuned staff in the wilderness therapy program had enabled her to believe that
her relationships with others could be so. Program staff met her avoidant withdrawal,
anger, and blaming with warmth and acceptance. It seemed that perhapsAmy’s new
relational experience with program staff and therapists enabled her unconsciously to
hope for more in her primary attachment relationships. Such hope may have led to her
sharing of her hurt with her family, a critical first step in rebuilding their attachment
relationship.
Wilderness therapy programs are uniquely positioned to work with adolescents’
attachment behaviors because the treatment environment itself is likely to activate
the attachment system. In the context of such activation, programs need to under-
stand adolescents’ aggressive acting or withdrawn behaviors as deriving from unmet
attachment needs. Programs should train their staff and therapists to recognize ado-
lescents’ attachment bids, hidden though they may be. This training may enable
programs to make significant gains with their clients.
Attachment Processes in Wilderness Therapy 231
Social workers wishing to learn more about such programs can do so through
the National Association of Therapeutic Schools and Programs (www. natsap.com)
or the Association of Experiential Education (www.aee.org). Both of these trade
groups gather together programs doing similar work. By attending conferences put
on by these groups or learning about their member programs on their websites, social
workers can begin to get familiar with the work of these programs.
As psychotherapy is primarily a relational enterprise (Norcross 2002), psychother-
apy in the wilderness is even more so. Wilderness therapy programs need to provide
their adolescent clients with stable, responsive, and attuned figures who can meet
attachment needs while adolescents’ primary attachment figures are unavailable.
Wilderness programs that serve troubled or vulnerable youth generally serve both
corrective and preventive functions. This happens with the diversion of attention away
from dysfunctional behavior and the instructing of youth in healthier responses and
choices (Berman and Davis-Berman 2000) by equipping them with skills in handling
difficult situations (Romi and Kohan 2004). These activities happen in the context
of psychotherapeutic relationships. Understanding acting-out adolescent clients as
displaying attachment needs, and in need of figures who can meet those needs, allows
wilderness therapy programs to perceive the drives underneath the behaviors. Such
understanding will both deepen and improve the treatment.
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