Advertisement

Contemporary Family Therapy

, Volume 38, Issue 1, pp 3–13 | Cite as

Integrating Narrative Family Therapy in an Outdoor Behavioral Healthcare Program: A Case Study

  • Steven M. DeMilleEmail author
  • Marilyn Montgomery
Original Paper

Abstract

Adolescent mental health is a significant societal concern in the United States. Diagnosable mental health disorders have been reported at rates of 10–20 % among children and adolescents and this does not include adolescents experiencing personal and interpersonal distress not meeting diagnostic criteria. Adolescents who do not respond to traditional mental health services are often placed in residential treatment centers or other out-of-home treatment programs. Outdoor Behavioral Healthcare (OBH) is growing as a viable treatment option for adolescents who struggle with emotional, behavioral or substance related problems; however, questions have been raised about how to integrate the family into an OBH treatment setting. This article describes a case study illustrating how techniques from Narrative Family Therapy can be used to accomplish this integration, and offers a view of using Narrative Family Therapy to further involve families in the treatment and post-treatment process in an OBH program.

Keywords

Outdoor behavioral healthcare Narrative family therapy Wilderness therapy Adolescents Case study 

References

  1. Anderson, H. (1997). Conversation, language, and possibilities A postmodern approach to therapy. New York: Basic BooksGoogle Scholar
  2. Anderson, N. B. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285.CrossRefGoogle Scholar
  3. Association of Experiential Education (AEE, 2015). Accreditation for outdoor behavioral healthcare programs. Retrieved from http://www.aee.org/accreditation-for-outdoor-behav-health.
  4. Becker, S. P. (2010). Wilderness therapy: Ethical considerations for mental health professionals. Child & Youth Care Forum, 39(1), 47–61. doi: 10.1007/s10566-009-9085-7.CrossRefGoogle Scholar
  5. Belfer, M. L. (2008). Child and adolescent mental disorders: The magnitude of the problem across the globe. Journal of Child Psychology and Psychiatry, 49(3), 226–236. doi: 10.1111/j.1469-7610.2007.01855.x.CrossRefPubMedGoogle Scholar
  6. Bettmann, J. E., Russell, K. C., & Parry, K. J. (2012). How substance abuse recovery skills, readiness to change and symptom reduction impact change processes in wilderness therapy participants. Journal of Child and Family Studies, 22(8), 1039–1050. doi: 10.1007/s10826-012-9665-2.CrossRefGoogle Scholar
  7. Bray, B. (2014). Going Wild. Counseling Today. Retrieved from http://ct.counseling.org/2014/12/going-wild/.
  8. Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37(5), 389–396. doi: 10.1016/j.amepre.2009.06.021.CrossRefPubMedGoogle Scholar
  9. Carr, A. (1998). Michael White’s narrative therapy. Contemporary Family Therapy, 20(4), 485–503.CrossRefGoogle Scholar
  10. Cason, D., & Gillis, H. L. (1994). A meta-analysis of outdoor adventure programming with adolescents. Journal of Experiential Education, 17, 40–47.CrossRefGoogle Scholar
  11. Clark, J., Marmol, L. M., Cooley, R., & Gathercoal, K. (2004). The effects of wilderness therapy on the clinical concerns (on Axes I, II, and IV) of troubled adolescents. Journal of Experiential Education, 27(2), 213–232. doi: 10.1177/105382590402700207.CrossRefGoogle Scholar
  12. Cottrell, D., & Boston, P. (2002). Practitioner review: The effectiveness of systemic family therapy for children and adolescents. Journal of Child Psychology and Psychiatry, 43(5), 573–586. doi: 10.1111/1469-7610.00047.CrossRefPubMedGoogle Scholar
  13. Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
  14. DeAngelis, T. (2013). Therapy gone wild. Monitor on Pscyhology, 44(8), 48–53.Google Scholar
  15. DeMille, S. M. (2015). Do therapeutic factors and client gender impact treatment outcomes for adolescents participating in outdoor behavioral healthcare treatment? (Doctoral dissertation). Minneapolis, MN: Capella University.Google Scholar
  16. DeMille, S. M., & Burdick, M. (2015). A theoretically anchored and multi-modal treatment approach in an outdoor behavioral healthcare program. Journal of Therapeutic Schools and Programs, 7(1), 19–30.Google Scholar
  17. DeMille, S. M., Comart, C., & Tucker, A. R. (2014). Body composition changes in an outdoor behavioral healthcare program. Ecopsychology, 6(3), 174–182. doi: 10.1089/eco.2014.0012.Google Scholar
  18. Diamond, G. S., Serrano, A. C., Dickey, M., & Sonis, W. A. (1996). Current status of family-based outcome and process research. Journal of the American Academy of Child and Adolescent Psychiatry, 35(1), 6–16. doi: 10.1097/00004583-199601000-00007.CrossRefPubMedGoogle Scholar
  19. Epston, D., & White, M. (1992). Experience, contradiction, narrative and imagination. Adelaida: Dulwich Centre Publication.Google Scholar
  20. Faddis, T. J., & Bettmann, J. E. (2010). Reflecting teams and other innovative family therapy techniques adapted for outdoor behavioral healthcare. Journal of Therapeutic Schools and Programs, 1(1), 57–69.Google Scholar
  21. Fauber, R. L., & Long, N. (1991). Children in context: The role of the family in child psychotherapy. Journal of Consulting and Clinical Psychology, 59(6), 813–820. doi: 10.1037/0022-006X.59.6.813.CrossRefPubMedGoogle Scholar
  22. Freedman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: Norton.Google Scholar
  23. Gass, M., Logan, P., Christensen, N., Hallows, G., Liebing, M., Smith, P., Pace, S., & Tierney, S. (2014). Manual of Accreditation Standards for Outdoor Behavioral Healthcare Programs (1st ed.). Boulder, CO: Association of Experiential Education.Google Scholar
  24. Gillis, H. L., & Gass, M. A. (2010). Treating juveniles in a sex offender program using adventure-based programming: A matched group design. Journal of Child Sexual Abuse, 19(1), 20–34.CrossRefPubMedGoogle Scholar
  25. Hair, H. J. (2005). Outcomes for children and adolescents after residential treatment: A review of research from 1993 to 2003. Journal of Child and Family Studies, 14(4), 551–575. doi: 10.1007/s10826-005-7188-9.CrossRefGoogle Scholar
  26. Harper, N. J., & Russell, K. C. (2008). Family involvement and outcome in adolescent wilderness treatment: A mixed-methods evaluation. International Journal of Child and Family Welfare, 1, 19–36.Google Scholar
  27. Harper, N. J., Russell, K. C., Cooley, R., & Cupples, J. (2007). Catherine Freer wilderness therapy expeditions: An exploratory case study of adolescent wilderness therapy, family functioning, and the maintenance of change. Child & Youth Care Forum, 36(2–3), 111–129. doi: 10.1007/s10566-007-9035-1.CrossRefGoogle Scholar
  28. Jones, C. D., Lowe, L. A., & Risler, E. A. (2004). The effectiveness of wilderness adventure therapy programs for young people involved in the juvenile justice system. Residential Treatment for Children and Youth, 22(2), 53–67.CrossRefGoogle Scholar
  29. Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O., et al. (2011). Child and adolescent mental health worldwide: Evidence for action. The Lancet, 378(9801), 1515–1525.CrossRefGoogle Scholar
  30. Lambie, I., Hickling, L., Seymour, F., Simmonds, L., Robson, M., & Houlahan, C. (2000). Using wilderness therapy in treating adolescent sexual offenders. The Journal of Sexual Aggression, 5(2), 99–117. doi: 10.1080/13552600008413302.CrossRefGoogle Scholar
  31. Leichtman, M., Leichtman, M. L., Barber, C. C., & Neese, D. T. (2001). Effectiveness of intensive short-term residential treatment with severely disturbed adolescents. American Journal of Orthopsychiatry, 71(2), 227. doi: 10.1037/0002-9432.71.2.227.CrossRefPubMedGoogle Scholar
  32. Lewis, S. F. (2013). Examining changes in substance use and conduct problems among treatment-seeking adolescents. Child and Adolescent Mental Health, 18(1), 33–38. doi: 10.1111/j.1475-3588.2012.00657.x.CrossRefGoogle Scholar
  33. Magle-Haberek, N., Tucker, A., & Gass, M. (2012). The effects of program differences within wilderness therapy and residential treatment center (RTC) programs. Residential Treatment for Children and Youth, 29(3), 202–218. doi: 10.1080/0886571X.2012.697433.CrossRefGoogle Scholar
  34. Marion, J. L., & Reid, S. E. (2007). Minimising visitor impacts to protected areas: The efficacy of low impact education programmes. Journal of Sustainable Tourism, 15(1), 5–27. doi: 10.2167/jost593.0.CrossRefGoogle Scholar
  35. McLeod, J. (2010). The role of case studies in the development of theory and practice in counselling and psychotherapy. In Mc. Leods. Case (Ed.), Study research: In counselling and psychotherapy (pp. 1–15). London: SAGE Publications Ltd.Google Scholar
  36. Minuchin, S. (1998). Where is the family in narrative family therapy? Journal of Marital and Family Therapy, 24(4), 397–403.CrossRefPubMedGoogle Scholar
  37. National Building Bridges Initiative (2007). Innovative Practices for Transformation. Workgroup webinar. March.Google Scholar
  38. Norton, C. L. (2008). Understanding the impact of wilderness therapy on adolescent depression and psychosocial development. Illinois Child Welfare, 4(1), 166–178.Google Scholar
  39. Norton, C. L. (2010a). Exploring the process of a therapeutic wilderness experience: Key therapeutic components in the treatment of adolescent depression and psychosocial development. Journal of Therapeutic School and Program, 4(1), 24–46.Google Scholar
  40. Norton, C. L. (2010b). Into the wilderness—A case study: The psychodynamics of adolescent depression and the need for a holistic intervention. Clinical Social Work Journal, 38(2), 226–235. doi: 10.1007/s10615-009-0205-5.CrossRefGoogle Scholar
  41. O’Connell, M. E., Boat, T., & Warner, K. E. (Eds.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington DC: National Academies Press.Google Scholar
  42. O’Connor, T. S. J., Davis, A., Meakes, E., Pickering, R., & Schuman, M. (2004). Narrative therapy using a reflecting team: An ethnographic study of therapists’ experiences. Contemporary Family Therapy, 26(1), 23–39.CrossRefGoogle Scholar
  43. O’Connor, T. S. J., Meakes, E., Pickering, M. R., & Schuman, M. (1997). On the right track: Client experience of narrative therapy. Contemporary Family Therapy, 19(4), 479–495.CrossRefGoogle Scholar
  44. Outdoor Behavioral Healthcare Council (OBHC, 2015). About us. Retrieved from https://obhcouncil.com/about/standards/.
  45. Riordan, R. J. (1996). Scriptotherapy: Therapeutic writing as a counseling adjunct. Journal of Counseling and Development, 74(3), 263–269.CrossRefGoogle Scholar
  46. Russell, K. C. (2003). Assessing treatment outcomes in outdoor behavioral healthcare using the Youth Outcome Questionnaire. Child & Youth Care Forum, 32, 355–381. doi: 10.1023/B:CCAR.0000004507.12946.7e.CrossRefGoogle Scholar
  47. Russell, K. C. (2005a). Preliminary results of a study examining the effects of outdoor behavioral healthcare treatment on levels of depression and substance use frequency. Journal of Experiential Education, 27, 305–307.Google Scholar
  48. Russell, K. C. (2005b). Two years later: A qualitative assessment of youth-well-being and the role of aftercare in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 34, 209–239. doi: 10.1007/s10566-005-3470-7.CrossRefGoogle Scholar
  49. Russell, K. C. (2006). Evaluating the effects of the Wendigo Lake Expedition Program on young offenders. Youth Violence and Juvenile Justice, 4(2), 185–203.CrossRefGoogle Scholar
  50. Russell, K. C. (2008). Adolescent substance-use treatment: Service delivery, research on effectiveness, and emerging treatment alternatives. Journal of Groups in Addiction and Recovery, 2(2–4), 68–96. doi: 10.1080/15560350802081264.CrossRefGoogle Scholar
  51. Russell, K. C., & Farnum, J. (2004). A concurrent model of the wilderness therapy process. Journal of Adventure Education and Outdoor Learning, 4, 39–55. doi: 10.1080/14729670485200411.CrossRefGoogle Scholar
  52. Russell, K. C., & Gillis, H. L. (2010). Experiential therapy in the mental health treatment of adolescents. Journal of Therapeutic Schools and Programs, 4(1), 47–79.Google Scholar
  53. Russell, K. C., Gillis, H. L., & Lewis, T. G. (2008). A five-year follow-up of a survey of North American outdoor behavioral healthcare programs. Journal of Experiential Education, 31(1), 55–77. doi: 10.1177/105382590803100106.CrossRefGoogle Scholar
  54. Russell, K., & Hendee, J. (2000). Definition, common practice, expected outcomes, and a nationwide survey of programs (Technical Report 26). Moscow ID: University of Idaho.Google Scholar
  55. Russell, K. C., & Sibthorp, J. (2004). Hierarchical linear modeling of treatment outcomes in outdoor behavioral healthcare. Journal of Experiential Education, 27, 176–191.CrossRefGoogle Scholar
  56. Safran, J. D., Muran, J. C., & Proskurov, B. (2009). Alliance, negotiation, and rupture resolution. In R. Levy & S. J. Ablon (Eds.), Handbook of evidence based psychodynamic psychotherapy (pp. 201–205). New York: Humana Press.CrossRefGoogle Scholar
  57. Stage, S. A. (1998). Predicting adolescents’ discharge status following residential treatment. Residential Treatment for Children and Youth, 16(3), 37–56. doi: 10.1300/J007v16n03_03.CrossRefGoogle Scholar
  58. Substance Abuse and Mental Health Services Administration. (2012). National survey on drug use and health: Mental health findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  59. Telep, T. (2014). The man who takes troubled youths to therapy camp. BBC News Magazine. Jan 1, 2015. Retrieved from http://www.bbc.com/news/magazine-26513805.
  60. Tubman, J. G., Montgomery, M. J., & Wagner, E. F. (2001). Letter writing as a tool to increase client motivation to change: Application to an inpatient crisis unit. Journal of Mental Health Counseling, 23(4), 295–311.Google Scholar
  61. Tucker, A., Smith, A., & Gass, M. (2014). The impact of presenting problems and individual client characteristics on treatment outcomes in residential and wilderness treatment programs. Residential Treatment for Children and Youth, 31(2), 135–153.CrossRefGoogle Scholar
  62. Tucker, A. R., Zelov, R., & Young, M. (2011). Four years along: Emerging traits of programs in the NATSAP Practice Research Network (PRN). Journal of Therapeutic Schools and Programs, 5(1), 10–28.Google Scholar
  63. Walsh, V., & Golins, G. (1976). The exploration of the Outward Bound process. Denver, CO: Outward Bound School.Google Scholar
  64. White, M. (1989). Select papers. Adelaide: Dulwich Centre Publications.Google Scholar
  65. Who Do We Serve? (2015). The wilderness advisor, 1, 7–8.Google Scholar
  66. White, N. W. (2011). Stories from the elders: Chronicles and narratives of the early years of wilderness therapy. Franklin Pierce University.Google Scholar
  67. Wright, A. (1983). Therapeutic potential of the outward bound process: An evaluation of a treatment program for juvenile delinquents. Therapeutic Recreation Journal, 17(2), 33–42.Google Scholar
  68. Zelov, R., Tucker, A. R., & Javorksi, S. (2013). A new phase for the NATSAP PRN: Post-discharge reporting and transition to the network wide utilization of the Y-OQ 2.0. Journal of Therapeutic Schools and Programs, 6(1), 7–19.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.RedCliff AscentEnterpriseUSA
  2. 2.Capella UniversityMinneapolisUSA

Personalised recommendations