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The role of nature in psychological healing processes has a rich and deep-rooted history that can be traced back millennia. Today, therapy in the outdoors is understood and practised in many different ways, and its benefits are supported by a considerable literature.

In this article, we share the thinking behind and the practice of a wilderness therapy programme in the UK that applies psychodynamic theory in the outdoor context. It was developed by Venture Mòr, a social enterprise working with young people and adults in wilderness environments using psychodynamic psychotherapy principles. We will explain how this theoretical approach, which is usually practised in a fixed, indoor setting, can deliver insights in the outdoor context, offering a valid and effective psychotherapeutic experience. Using composite case vignettes from our practice, we will illustrate how working in a considered way in an unpredictable, uncontrollable, remote natural environment can bring additional dimensions to psychodynamic psychotherapeutic work.¹

Historical context

The origins of wilderness therapy (also known as ‘adventure therapy’) arguably lie in the Outward Bound schools developed in the 1940s in the UK. Over subsequent decades, the initial approach has been refined and, from the mid-80s, wilderness therapy programmes have developed predominantly in North America, Australia and New Zealand, and more recently in Europe. These programmes have tended to follow slightly different methodologies but share three core elements: attention to the physical self, attention to the psycho-social self and interaction with wilderness/nature.^2,3 Wilderness therapy professionals tend to be qualified in different ways and to varying degrees, and the care practices in some programmes have been questionable. However, most programmes are run within a highly professional framework and are evidenced by a growing body of outcome research.^4,5

Working therapeutically outdoors or working therapeutically with nature (the other-than-human) has developed in earnest in the UK and US since the 1990s. These practices are offered under various titles, such as ecotherapy, ecopsychology, nature therapy and walk-and-talk therapy, among others, depending on the approach, each with its own subtleties and differences.^6,7 In recent years, outdoor therapy has been championed in Britain by Hayley Marshall and Martin Jordan, who were among the co-founders of Counselling and Psychotherapy Outdoors (CAPO). Other notable psychotherapists and analysts that have contributed to the discourse are Sebastiano Santostefano, Nick Totton, Mary-Jayne Rust, Caroline Brazier, Ronan Berger, Stephanie Revell and John McLeod.

There is a growing body of literature that considers the ethical and practical implications of practising psychotherapy outdoors, as well as the benefits that can be gained from working with the other-than-human, such as the embodied experience. There is also a growing interest in the role of the other-than-human in therapeutic work and an impetus to explore the theory behind it.^1,8 Indeed, such is the interest that the Institute for Outdoor Learning has recently published a statement of good practice⁹ for professionals, including therapists, who are working or considering working in outdoor therapy.

Venture Mòr programme

The Venture Mòr wilderness therapy programme draws on wilderness therapy research with regard to the length, structure and core elements of the programme, and psychodynamic psychotherapy and ecotherapy for its underlying relational approach. It comprises a multi-week residential programme for up to eight young people, which takes place on the west coast of Scotland. The young people present with a variety of complex needs and are referred through their parents and local authorities. We work with the young person’s family and other professionals involved in their care before, during and after the programme, as the aim is to integrate the therapeutic work done during the programme with any therapeutic process that the young person is already engaged in. We take a multi-systemic approach with a psychodynamic mindset and use a treatment method based on mentalization.¹⁰

When they are out in the field, the young people are accompanied by a team of four professionals: two therapists (usually a psychotherapist and an art therapist) and two outdoor practitioners. The young person will work individually with a therapist, as well as take part in group processes. However, we regard epistemic trust as central to the therapeutic process,¹¹ so if the young person forms a trusting relationship with a particular member of staff who is not a therapist, that member of staff will be supported to work one-to-one with them.

The programme is literally and metaphorically a journey in which the participants move through the wilderness landscapes without a fixed ‘task’. Staff work with the group process as it emerges along the way. We have found this to be a natural and effective way to work with what is going on for the young person in the here and now. To facilitate this, a safe setting is established both physically and figuratively by, for example, setting spatial boundaries, maintaining a minimal daily structure and agreeing set therapy times. Martin Jordan wrote of the importance that, when working outdoors without a traditional setting, the therapist feels able to carry the setting ‘internally’.⁵ So that all staff feel confident to respond to the complex needs of the young people in this unpredictable environment, we expect the therapists to have a working knowledge of inhabiting wild environments and the outdoor instructors to have a working knowledge of psychodynamic thinking.

Psychodynamic theory outdoors

There is much research into how being outdoors confers its mental health benefits. Kaplan’s attention restoration theory, Ulrich’s stress reduction theory and Wilson’s idea of ‘biophilia’ are all examples of this. However, we are careful not to assume that the young person will automatically benefit from being outdoors. This is in line with the psychoanalyst Sebastiano Santostefano, who wrote: ‘I disagree with the basic premise that nature automatically has the power to enhance and heal a person’s mental health. I disagree because this position does not consider developmental tasks a child and adult must successfully negotiate before he or she can benefit from what nature has to offer.’¹²

We would also argue that it is essential to consider the young person’s previous experience of all and any environments, natural or not, and their relational experiences within them. Beneficial or not, this previous experience will inform the therapeutic experience and requires attention and consideration.

With this in mind, we work with the individual and group processes as they present themselves, just as in a therapeutic community. We work with conscious and unconscious processes, transference and countertransference, moments of insight, acting out, reverie, embodied experience and so forth – but we do so in an environment of space, wildness and physicality.

Transference (understood as the redirection of feelings, desires and expectations from one person to another) can occur in multiple ways in the outdoor setting: in relation to the young person’s individual therapy, in relation to the different staff members or to other young people and, arguably, in relation to the other-than-human. You could say that a multidimensional transference dialogue is occurring. The other-than-human can become a subject of transference if it is considered an ‘actant’.¹³ It is not just the context in which things occur (ie the outdoors as a space to think) or a catalyst for an emotional response (for example, a heavy storm prompting feelings of vulnerability); it can be an active part of the transference exchange.

One example of this was John, who was referred to the programme because of behavioural issues and a technology addiction. He was not interested in education and was truanting. At home he would avoid communicating with his mother and would immerse himself in gaming. We sensed that John was trying to manage complex feelings in relation to his mother, who he experienced as distant and disconnected, and also trying to make sense of never having known his father. On the programme, he expressed a fierce anger, verbally and physically, towards a female member of staff (his therapist). It seemed to us that he was transferring his unconscious negative feelings towards his mother (whom he blamed for not allowing him contact with his father) onto the female therapist. He sought out a strong male outdoor instructor, whom he idealised and depended on, perhaps in search of a missing father figure.

John initially regarded the other-than-human as an aggressor, forcing him into this vulnerable position. He felt anger towards ‘it’ for punishing him for being ‘weak’. One might interpret this as meant for his mother, who he felt was responsible for his presence in this difficult situation. Less consciously, it might also have been directed to his father, who was absent in all of this suffering. These ideas were identified and discussed within the staff team and became part of John’s individual therapeutic work. As he became increasingly close to the male outdoor instructor and more relationally aware, John became better able to relate to the other young people and staff, and the other-than-human became a more benign force that offered him opportunities to grow.

Reverie

Reverie, if understood as a state of dreaminess where phantasy (innate unconscious process) can play out,¹⁴ is sometimes recognisable in the young people on the programme. Perhaps this is induced by the immense feeling of space and the slow pace of the environment. One example of this was Kacey, a young woman who was first referred to us because she had dropped out of school and would not engage with social services. Kacey had grown up in care since her early years. She had no contact with her mother, who had been addicted to alcohol before Kacey’s birth and throughout her life. Her father was in contact with her, but their relationship was not one that she experienced as meaningful.

The main work that Kacey undertook on the programme was in relation to her feelings about her mother. One evening she took herself away from the main group and sat on her own, hacking rhythmically at a rotten log for more than an hour. The hacking, which on a conscious level she described as ‘fun’, could be seen as a way of expressing a less conscious phantasy and discharging her pent-up rage against her mother. Her behaviour could have been the actions of a pre-verbal self that wanted to destroy her mother in order to protect herself. That Kacey was able to do this, without anyone interrupting or trying to stop her, perhaps meant she could later transform this pre-verbal experience from body-action mode into words.¹⁵ Later, with her therapist, Kacey was able to articulate and explore the experience, exemplifying Bion’s alternative meaning of reverie – the therapist’s capacity to sense and make sense of what is going on inside the infant.¹⁶

Embodied experience

If we continue to think about pre-verbal experience and the ‘language’ of movement being the first that we learn in the womb,¹⁷ we find that outdoors we can work with embodied experience.¹⁸ In keeping with Stern’s idea that clients often reveal more in how they move than in the words they say, we notice that the young people express themselves unconsciously through their moving, being, breathing and so forth, at an implicit level of functioning.^12,19,20

One young man, Finn, was recovering from a severe eating disorder and long-term self-harm issues. He was referred from an eating disorders unit towards the end of his treatment. He was manifestly uncomfortable in his own body, moving awkwardly through the landscape, often losing his balance and unable to keep up with the rest of the group. Some of this could be attributed to actual physical difficulties, but it also seemed that he was embodying some of his psychological struggles. As time passed, however, he was able to acknowledge that, despite these difficulties, he did have some physical capability. He became more comfortable somatically: for example, his posture relaxed and his movements became steadier and more confident. He also felt able to show his scarred skin, which he had hidden from others for several years.

He was reluctant to engage in spoken therapy, but we were able to talk with him about these physical changes; an embodied shift like this can be very significant for someone recovering from a condition so embedded in a physical self-construct.¹² For Finn, the programme also marked a shift towards being able to put into words what was going on for him. When he left the programme, he re-engaged with the talking therapy that he had previously abandoned. This experience supports current research into short-term wilderness interventions, which has shown that they can serve as an impetus for young people to re-engage with services and longer-term treatment.²¹

Boundaries

Despite the absence of the physical, temporal structure of the therapy room,^22,23 we aim to establish a holding environment with these principles in mind. For some young people, themes around boundaries are precisely what they need to explore, and the outdoor community allows their issues to be acted out and responded to in relative safety. An example of this was Molly, who was referred onto the programme because of concerns about self-harm and risky behaviour.

Molly had been adopted early in life and was struggling with attachment difficulties and grappling to negotiate boundaries and relationships. All the young people in her group were invited to undergo a period of solo time and were given very clear instructions about physical boundaries and safety procedures. Molly quickly overstepped the prescribed boundaries and began walking away up a hill. This prompted an honest conversation about her difficulties with being kept safe and gave insight into her belief that no one could be trusted to keep her secure. This in turn led to further conversations about her own difficulty in keeping herself safe and her need to put herself in risky situations. In this way, the outdoors setting became a transitional space in which she felt sufficiently held to be able to ‘play’, in Winnicott’s sense of the word.²⁴ Molly tested the boundaries and, as a result, new thinking took place.

We have shared here just a few observations and vignettes from our work as therapists in the outdoors, with the aim of adding to the thinking around psychotherapy and the other-than-human. From our experience to date, we are convinced that the application of psychotherapy in other-than-human spaces and, in particular, wilderness therapy, offers real potential as a distinct therapeutic model in its own right, capable of reaching clients with new insights and in particular those who may otherwise struggle to engage with traditional mainstream services.

Further research is always needed, and we are currently collecting data on the outcomes and impact of the Venture Mòr wilderness therapy programmes. We welcome contact from mental health professionals and psychotherapists working with the other-than-human, or who hope to do so.

Katarina Horrox is an art therapist who has worked in therapeutic roles in secure, institutional and community settings in Spain and the UK. She currently works in private practice, in schools, and in the outdoors as Venture Mòr’s Senior Field Therapist. She is a member of the Spanish Association of Art Therapists and a trainee member of the British Psychoanalytic Council.Ìý

Andy Hardie’s background is in outdoor learning and personal development. He is an accredited practitioner of the Institute for Outdoor Learning and holds a variety of guiding and coaching qualifications in outdoor and adventure activities. He is a psychodynamic therapist, an accredited member of Ïã¸ÛÁùºÏ²Ê¾«×¼×ÊÁÏ and a trainee member of the British Psychoanalytic Council.Ìý

References

1. Jordan M, Marshall H. Taking counselling and psychotherapy outside: destruction or enrichment of the therapeutic frame? European Journal of Psychotherapy & Counselling 2010; 12(4): 345–359.
2. Gabrielsen LE, Harper NJ. The role of wilderness therapy for adolescents in the face of global trends of urbanization and technification. International Journal of Adolescence and Youth 2018; 23(4): 409–421.
3. Gass M. Adventure therapy: therapeutic applications of adventure programming. Dubuque, IA: Kendall/Hunt Publishing; 1993.
4. Bowen DJ, Neill JT. A meta-analysis of adventure therapy outcomes and moderators. The Open Psychology Journal 2013; 6: 28–53.
5. Becker SP, Russell KC. Wilderness therapy. In: Levesque RJR (ed). Encyclopedia of Adolescence (2nd ed). New York, NY: Springer; 2016 (pp1–10).
6. Jordan M. Nature and therapy: understanding counselling and psychotherapy in outdoor spaces. London: Routledge; 2015.
7. Roszak T, Gomes MA, Kanner AD. Ecopsychology. San Francisco, CA: Sierra Club Books; 1995.
8. Jordan M, Hinds J (eds). Ecotherapy: theory, research and practice. London: Palgrave; 2016.
9. Richards K, Hardie A, Anderson N. Outdoor mental health interventions: Institute for Outdoor Learning statement of good practice. Carlisle: Institute for Outdoor Learning; 2019. www.outdoor-learning.org/Good-Practice/Good-Practice/Outdoor-Mental-Health
10. Fonagy P, Allison E. The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy 2014; 51(3): 372–380.
11. Fonagy P, Campbell C, Bateman A. Mentalizing, attachment, and epistemic trust in group therapy. International Journal of Group Psychotherapy 2017; 67: 176–201.
12. Santostefano S. The sense of self inside and environments outside: how the two grow together and become one in healthy psychological development. Psychoanalytic Dialogues 2008; 18(4): 513–535.
13. Bennett J. The force of things: steps toward an ecology of matter. Political Theory 2004; 32(3): 347–372.
14. Freud S. Five lectures on psychoanalysis. New York, NY: WW Norton & Company; 1952.
15. Santostefano S. Child therapy in the great outdoors: a relational view. Hillsdale, NJ: Analytic Press; 2004.
16. Bion WR. Elements of psychoanalysis. London: Heinemann; 1963.
17. Stern D. The interpersonal world of the infant. New York, NY: Basic Books; 1985.
18. Marshall H. A vital protocol – embodied-relational depth in nature-based psychotherapy. In: Jordan M, Hinds J (eds). Ecotherapy: theory, research and practice. London: Palgrave; 2016 (pp148–160).
19. Stern D. Forms of vitality: exploring dynamic experience in psychology, the arts, psychotherapy, and development. Oxford: Oxford University Press; 2010.
20. Bucci W. Psychoanalysis and cognitive science: a multiple code theory. NY: Guilford Press; 1997.
21. Bettmann J. Poster summaries II. Human development: intersections with psychoanalytic perspectives: changes in adolescent attachment relationships as a response to wilderness treatment. Journal of American Psychoanalytic Association 2007; 55(1): 259–265.
22. Freud S. Complete psychological works of Sigmund Freud, vol 12: ‘Case History of Schreber’, ‘Papers on Technique’ and other works. London: Vintage Books; 2002 (first published Hogarth Press, 1958).
23. Goldsmith G. The therapeutic setting in psychoanalysis and psychotherapy. Presentation. 15th European Psychoanalytical Summer School. Odessa, Ukraine; 2008.
24. Winnicott DW. The maturational process and the facilitating environment: studies in the theory of emotional development. Madison, CT: International Universities Press; 1988.

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