What Is Wilderness Therapy?
Programs called wilderness therapy or outdoor behavioral health care take many forms. But they usually involve taking groups of teens out into the woods, mountains, or desert for long periods of time for immersion in wilderness living. They may also involve group and individual therapy sessions with some type of counselor.
The U.S. Bureau of Land Management defines wilderness therapy as “programs intended to provide a less restrictive alternative to incarceration or hospitalization for youth who may require intervention to address emotional or behavioral challenges.”
Kids can be sent or referred to wilderness therapy for many reasons, but the programs most often target teens with substance abuse or behavior problems. The idea is that wilderness therapy allows troubled teens to gain confidence and learn cooperation skills as they meet the strenuous challenges of outdoor living. At the same time, they’re removed from distractions and negative influences in their everyday environment.
But it’s not clear how effective these programs are. While several studies have found that the therapy helped to reduce delinquency and improve behavior, critics of wilderness therapy point out that much of this research is flawed.
Further, there have been thousands of reports of child abuse and neglect in such programs over the years. Since the early 1990s, more than a dozen teens have died while participating in wilderness therapy. Some adults who went through a wilderness program as teens say they were left with lasting trauma.
While a few states regulate wilderness therapy programs, there’s no federal law or central licensing program to oversee them.
Wilderness therapy vs. nature therapy
Not all outdoor or nature therapy is wilderness therapy. The term nature therapy may also refer to other formats, such as:
- Walk and talk therapy, which is talk therapy in an outdoor setting
- Garden therapy, in which gardening is used as a therapeutic activity
- Animal therapy, or the use of therapy animals
- Adventure therapy, which involves challenging outdoor activities such as ropes courses (and may be part of wilderness therapy)
- Forest therapy, in which trained guides help participants experience the forest through all their senses
These are all place-based programs with a therapeutic goal. They require physical engagement rather than sitting on a therapist’s couch, and have some type of focus on the relationship between people and nature.
What sets wilderness therapy apart is that it typically involves overnight stays – a few nights to a few months – outdoors in the elements. The teens usually arrive at wilderness therapy campsites on foot after a long hike or by paddling out to the site.
“It’s the outdoor living and traveling component that distinguishes wilderness therapy from other outdoor therapies,” says Nevin Harper, PhD, a professor at the University of Victoria and a licensed clinical counselor who specializes in outdoor therapies. “It’s not a group at a treatment center or in the community. They put on packs or get in canoes and go away for a period of time.”
How Wilderness Therapy Programs Work
What happens during wilderness therapy?
Activities and structure vary from program to program. There are two main models for wilderness therapy:
- Expedition, in which groups hike from site to site for primitive camping, often for a period of 2-3 months.
- Base camp, in which participants return to a base of operations between camping expeditions for group therapy, showers, etc. These programs often last 6-12 weeks.
Along with camping and hiking, activities may include:
- Adventure therapy activities like rock climbing or zip line courses
- Problem-solving games
- Farming or gardening activities
- Individual or group counseling or therapy
- Reflective activities such as journaling
While in the wilderness, participants prepare backpacking-type food over a campfire. There’s no bathroom and no phones or other electronics. It’s very difficult for kids to leave.
Contact with parents and others outside the wilderness therapy camp is limited. Some programs have the kids write their parents a letter and have parents respond. Parents may have regular communications with one of their child’s counselors. Some programs ask parents to attend in-person seminars with their child.
Wilderness therapy 'kidnapping'
About half of kids arrive at wilderness therapy through involuntary youth transport (IYT). That is, they’re taken against their will by a person or people hired by their parents, a service often recommended by the wilderness therapy program.
Some people who’ve been through wilderness therapy say that the most traumatic part of the program was this forced removal from home. Some say it felt like a kidnapping.
In a viral TikTok video, a woman named Sarah Stusek, who was transported to wilderness therapy as a teen, describes two strangers coming into her room at 4 a.m. When she reached for her phone, it was gone. When she screamed, she realized that her parents weren’t coming to save her.
Academic reviews of this practice include similar descriptions.
Harper says IYT can undermine the parent-teen relationship. “It kind of destroys their connection with their parents,” Harper says. “They’re taken against their will into these programs and not allowed to contact their parents by phone.”
Research findings on the impact of involuntary transport are mixed. Some studies suggest it has little or no effect on how the kids fare later, while some suggest it could lead to lasting trauma. Other researchers have raised questions about how the data in studies that found IYT had little effect was collected and analyzed. We need more and better research into this practice to gain a better understanding of its impact.
What happens after wilderness therapy?
Many teens who complete a wilderness therapy program don’t go straight home afterward. Estimates vary by a lot, but it’s thought that some 40%-80% of kids who finish wilderness therapy programs then go to long-term residential facilities. These facilities include therapeutic boarding schools, which combine education with therapy, and inpatient mental-health treatment programs.
A 2016 article in the journal Contemporary Family Therapy said that wilderness therapists at Open Sky Wilderness Therapy recommend that 95% of participants go on to long-term residential therapeutic schools or programs. The article also said that 80% of parents take this recommendation.
The article notes that often wilderness therapy is just the beginning of the process of change for teens who aren’t ready to return to the challenges of their home environment. It also acknowledges that many parents question, “If my child will end up at boarding school anyway, what was the point of wilderness therapy?”
Are there any benefits of wilderness therapy?
We don’t have definitive scientific answers about whether wilderness therapy helps troubled teens.
For a 2022 report, the Washington State Institute for Public Policy reviewed 88 studies into wilderness therapy. The public policy review group said that many of the studies found improvements in things like behavior, self-image, and depression. But it noted that the results varied. And because most studies didn’t include comparison groups, it’s not clear whether these improvements actually resulted from wilderness therapy.
Randomized, controlled clinical trials are considered the gold standard for research. In this type of study, researchers take a large number of people who all have the same problem – for example, teens who steal compulsively – and divide them in two groups at random. Half get wilderness therapy, and the other half standard psychotherapy. Afterward, researchers determine through scientific methods whether one therapy was more effective than the other.
Instead, much research on the benefits of wilderness therapy programs is based on entrance and exit surveys, called pre-tests and post-tests, that the kids themselves answer at the beginning and end of their programs.
These tests are usually given when the teens are at the camp and don't know when they'll be allowed to leave, Harper says. They don’t measure how the teen was doing at home before the program and compare that to how they’re doing afterward. Kids might take the tests when they’re scared, angry, or eager to leave, he says.
“Of course you’re going to respond in the positive. You’re going to say, ‘I’m doing great. Get me out of here,’” Harper says.
Some kids don’t take a pretest or a post-test at all, which means the effects of the treatment aren’t being monitored, he says.
Much of the pre- and post-test data available to researchers is managed by the Outdoor Behavioral Healthcare Center at the University of New Hampshire, which promotes research, accreditation, and risk management in wilderness therapy programs. Critics have called this a conflict of interest. Representatives from OBHC didn’t respond to requests for an interview.
Is Wilderness Therapy Safe?
While wilderness therapy may help some teens, it could harm others.
A 2024 study in the journal Youth, co-authored by Harper, showed that kids are sent to wilderness therapy for a variety of reasons ranging from rebellious behavior to learning disabilities, substance use, and serious mental health conditions. It’s unclear, the study says, whether these are diagnoses made by doctors or labels assigned by parents or program staff.
The study showed that 1 in 3 teens sent to these programs didn't meet medical standards (called clinical criteria) for needing residential treatment. “These are kids that should maybe just be getting some community counseling,” Harper said.
And it showed that 40% of those who didn’t meet the clinical criteria showed no change by the end of their program. Twenty percent came out of the program worse, according to their post-test results.
As for kids who did meet clinical criteria for treatment, whether the program helped them depended on why they were sent. Kids sent to wilderness therapy because of autism, Asperger’s, ADHD, or PTSD or other trauma-related issues were more likely to come out in worse condition.
About 70% of kids who went for substance use, anxiety, or depression showed improvement on their surveys. Still, the authors note, it’s unclear whether they needed a program this invasive and – at an out-of-pocket cost of about $558/day – this expensive.
Wilderness therapy abuse
In an investigation commissioned by Congress, the U.S. Government Accountability Office (GAO) found thousands of reports of abuse and neglect at wilderness programs from 1990 till the close of its probe in 2007. The issues it found included:
- Inadequately trained staff members
- Failure to provide enough food
- Reckless or negligent operating practices
- Improper use of restraint
One account in the GAO report describes a camp at which kids got an apple for breakfast, a carrot for lunch, and a bowl of beans for dinner during a program that required extreme physical exertion. According to the report, kids who admitted to wanting to leave their program were forced to sit in the sun in 113-degree heat for hours while other kids sat in the shade. Another account reports requiring kids to fast for 2 days.
Reports describe unqualified and unprepared staff, sometimes teenagers themselves, who didn't have the experience, equipment, or supplies to deal with dehydration and other illnesses out in the wilderness.
Kids who complained of sickness due to hunger, exhaustion, dehydration, and exposure were sometimes accused of faking and were ignored rather than being given medical attention, food and water, according to the government report.
The Outdoor Behavioral Healthcare Council, an industry group, says on its website that many outdoor behavioral programs have moved past the tough-love boot camp model described in the GAO report. The council has worked to establish an accreditation process that includes ethical, risk management, and treatment standards.
But the Alliance for the Safe, Therapeutic and Appropriate Use of Residential Treatment (A-START), an advocacy group, says it continues to hear accounts of abuse from teens and parents.
Wilderness therapy deaths
In some cases, teens have died while taking part in wilderness therapy programs.
The GAO report detailed 10 deaths that occurred between 1990 and 2004. The causes of death included dehydration, heat exhaustion (hyperthermia), injuries after being restrained that were ruled a homicide, infection, and suicide.
While the testimony summarized in the 2007 government report was intended to help end these abuses and force oversight or regulation of these programs, reports of deaths have continued since then. In 2024, a 12-year-old boy smothered the day after he arrived at a wilderness therapy camp in North Carolina. An autopsy found that he couldn’t breathe in the tightly sealed tent where he was made to sleep.
Long-term effects of wilderness therapy
There’s little, if any, research into what becomes of adult alumni of wilderness therapy programs years later.
One 2004 study found that 83% of wilderness therapy participants who took part in a structured interview said they were doing better 2 years after their programs ended. But this relied on the participants’ own assessments.
While some families have said they’re convinced wilderness therapy helped them, there are also many anecdotal and media reports of long-term trauma. Many adults who went through these programs as teens identify as survivors of institutional abuse.
Wilderness Therapy Alternatives
Any therapy program that takes a child out of their home should be reserved for kids with very serious problems who’ve exhausted all available resources at home, says Anne Marie Albano, PhD, director of the Center for Youth Mental Health at NewYork-Presbyterian Hospital.
If your child’s licensed mental health care provider recommends a residential program, Albano offers the following advice:
Get a referral from your provider. Look into programs that your health care provider or health care facility has a relationship with, such as those affiliated with a hospital or health system. “When kids go away, there needs to be coordination with the home team because we’re going to get them back,” Albano says.
Choose a program staffed with licensed mental health professionals. Make sure the staff are psychologists, social workers, or other professionals. “If there aren’t psychiatrists on staff, the staff should have regular consultations with psychiatrists,” she says.
Make sure the program has a clear, clinically proven model of care. “Wilderness therapy” is not a specific clinical program. Albano advises that parents look for evidence-based models, such as “dialectical behavioral therapy” or “cognitive behavioral therapy.”
Find a program for other kids with the same diagnosis. There’s no scientific evidence to support putting kids with an array of problems in a program together under the label of “troubled teens.” Choose a program specifically focused on your child’s condition.
If you and your teen would like it, Albano says, “there are programs where there may be a component of working with animals, gardening, farming, hiking, or spending time outdoors. But those are ancillary. They are not standalone, evidence-based treatments.”
A few alternatives to wilderness therapy include:
- Wraparound therapy. This is team-based care for kids with the most serious needs. The team includes family members and friends as well as mental health professionals. The format allows the child and family to get intensive therapy without removing the child from home.
- Universal school-based prevention and intervention programs for aggressive and disruptive behavior. This approach involves school-based training and counseling for the child and their family. The training happens in the classroom with all the students rather than single out troubled kids.
- Trauma-focused cognitive behavioral therapy (CBT). CBT is a type of psychotherapy or talk therapy. This format can be tailored to many different issues, ranging from trauma to insomnia to obsessive compulsive disorder.
How to Get Support After Wilderness Therapy
A few organizations provide support for people who need it after wilderness therapy.
Breaking Code Silence and Unsilenced are nonprofit groups whose mission is to end abuse in troubled teen programs and support survivors of abuse. Both have websites with state-by-state guides for reporting child abuse, privacy violations, ethics violations, and fraud within troubled teen programs.
Unsilenced also provides links to support groups and offers a Survivor’s Guide.
How to get legal help
Both Unsilenced and HelpingSurvivors.org, a group for victims of sexual abuse and assault, can help connect you with an attorney.
Takeaways
Wilderness therapy generally involves taking groups of teens into the woods, mountains, or desert for immersion in wilderness living. The idea is that meeting the challenges of outdoor living helps them gain confidence and learn cooperation. But it's not clear how effective these programs are, and there have been reports of neglect and abuse. Before sending your child to any residential therapy program, seek a recommendation from a licensed mental health care provider.
Wilderness Therapy FAQs
Why do kids get sent to wilderness therapy?
Kids are sent to wilderness therapy for many reasons, ranging from rebelliousness and problems at school to diagnosed mental illnesses.
How does wilderness therapy affect mental health?
We need more good research into the effects of wilderness therapy. According to teens’ own assessment of themselves after the programs, some benefit while others leave the program unchanged or worse. Some adults who completed a wilderness therapy program as teens have said they suffered trauma for years after.
What is Breaking Code Silence?
Breaking Code Silence is a nonprofit organization that represents people who were abused or traumatized by the troubled teen industry and aims to prevent future abuse.
Is wilderness therapy legal in the U.S.?
Wilderness therapy is legal. But many critics say it’s poorly regulated and needs more oversight. The Stop Institutional Child Abuse Act, which would establish federal data-collection and reporting standards for the “troubled teen” industry, was introduced in Congress in 2023. But it had not been enacted as of late 2024.
