Psychiatry doesn't work well for behavioral problems. In the old days, psychotherapy was the primary treatment, but it didn't help much. You mostly hoped the kid's behavior would improve with age before he got into too much trouble (as happened two thirds of the time).
Now, antipsychotics have become the most commonly used psychiatric treatment (especially for poor kids), even though the indications are unclear and the risks considerable. Antipsychotics cause obesity and raise the risk of diabetes, heart disease and a shortened life expectancy.
When the behavioral transgressions are severe, the kid may even wind up in juvenile detention-which usually makes the delinquency much worse.
The Army used to help straighten out misbehaving teenagers, but is less available now that the military services have become more selective.
Wilderness programs are a useful last resort that may save the day when all else has failed. Cynthia Cohen, M.S.P.H., can describe the format from two perspectives: mother and consultant (Director of Pathway Partners, New York and Massachusetts). Ms Cohen writes:
"A wilderness therapy program gave my son his life back. Although I had worked in mental health and education. I felt helpless and overwhelmed when Adam, at 15, was anxious and depressed, quitting things, unmotivated, and making bad choices. Nothing worked- therapy, contracts, consequences, tutoring. Finally, after agonizing for a year, his father and I sent him to a therapeutic wilderness program.
It worked wonders. After a couple of weeks, he began to be accountable and found new ways of thinking about himself. Our whole family experienced life changing effects.
Adam is now a thriving college student -- interesting, caring, hard working, social and fun loving, close to his friends and our family. We even work as educational consultants together, assessing programs and guiding families.
What makes wilderness work? Nature is the consummate teacher. It can't be blamed when things go poorly. Opportunities for metaphors proliferate. There are no walls, and participants open up to possibilities.
Students and field staff live together in an outdoor community filled with profound and intense experiences. Students learn to cook for themselves. They are physically active and push themselves to accomplish things they wouldn't have expected they could do. They are out of their comfort zones - old ways of avoiding aren't there.
The absence of technology fosters communication on a deeper, more personal level. Participants are all working on themselves, dealing with hard issues. Peers and staff provide 24 hours a day of repatterning of responses and behaviors.
Participants develop motivation, the ability to push through when things are difficult, and confidence through accomplishments - whether building a fire with no implements, hiking with a heavy backpack, relating to peers in meaningful ways, or pursuing adventures like rock climbing. They work with their families improving relationships.
Adam explains: ' Imagine the difficulty of leaving home where all your friends, your family, and comforts are. You then are in the midst of a situation that you don't want to be in. You may be overcome with distrust for your family who sent you there and a fear of the future overtakes you. But through immense effort, practicing and applying the skills learned to a variety of experiences and opportunities you create lasting success and agency. You develop the desire to continuously practice skills learned in wilderness that also keep popping up in my current life'.
Programs don't fix people, rather they help them open up to develop new perspectives. Adam found the strength to persevere, to learn, to achieve, to find meaning. Growth comes in layers- the results are ongoing and often take years to be fully realized. Participants also have fun.
There are concerns about therapeutic wilderness. Research is limited. Most outcome measures are inadequate. Standards remain to be established. Transportation remains controversial. Students report feeling kidnapped when taken from their home unwillingly by strangers who take them to a strange and faraway place. Some programs are rigid and do not adopt state of the art approaches. Parents may not be adequately involved. Some programs still implement a break-them-down-to-build-them-up approach, which is demeaning and ineffective because it does not inspire intrinsic motivation and ignores the family component.
And programs are extremely costly, from about $400-600/day, for 6-10 weeks, with usually only small amounts covered by insurance. Results are magical for some, but not everyone. Wilderness programs are inappropriate for people who are violent, or have extreme physical disabilities or illnesses, or who need to detox from drugs. Specialized programs exist to treat people with these issues."
Thanks Ms Cohen. The biggest disadvantage of wilderness programs is their price tag -- at least about $20,000, sometimes much more. This is money well spent for those families who can afford it, but what about those who can't?
It would be useful to bring the wilderness approach to the juvenile justice system, which spends wasted fortunes turning incarcerated kids into hardened criminals. Some jurisdictions have used wilderness programs as an alternative to juvenile detention. This should be extended far more widely. It would be good for the kids, for their families, for the juvenile justice system, and for society.