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Family Therapy With A Twist…and a Shake and a Shout:
Adventure Family Therapy in Practice
Scott Bandoroff, Ph.D.
Peak Experience
541) 951-4329
Abstract
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Adventure therapy has become increasingly recognized as an effective intervention that has the power to engage challenging adolescents. Adventure programming with families is a natural outgrowth of this successful method of treatment. Adventure interventions with families have been touted for their capacity to fully involve participants in dynamic interactions that create therapeutic movement (Gass, 1990). Although its use is not widespread, adventure family therapy interventions are well-suited to the therapy office. The purpose of this paper is to make adventure family therapy more accessible to mental health professionals by presenting it as a viable option in an outpatient setting. The theoretical basis for adventure family therapy will be discussed, followed by a description of an adventure family therapy outpatient group. A sample group session will also be described.
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Adventure therapy is gradually becoming a recognized form of intervention in the field of adolescent mental health. There has been a dramatic rise in the number of teens being referred to wilderness programs and correspondingly, a substantial increase in the number of wilderness programs in the U.S. serving troubled youths (Russell, 2000). Many of these programs are becoming more psychologically sophisticated and include regular contact with a trained therapist. Wilderness programs are not the only venue for adventure therapy; ropes courses are experiencing a renewed interest and initiative activities are finding their way into traditional mental health agencies as a tool for skill-building groups. In an effort to reach alienated teens, more mental health and juvenile justice programs in the U.S. are risking innovation and are introducing adventure pursuits such as rock climbing, rafting, and hiking.
In keeping with this trend, there has also been increased interest in using adventure interventions with families. The field of adventure family therapy is relatively new and was only first cited in the literature in 1984 (Roland & Hoyt). More recently, in a 1991 survey, Gillis, Gass, Bandoroff, Rudolph, Clapp, and Nadler found that many programs reporting the use of adventure family therapy were operating in the context of psychiatric hospitals. Although such programs have diminished in the U.S. due to the decreasing use of hospitalization in mental health treatment, on the other hand, many wilderness programs have increased their contact with the families of their participants. This generally involves the use of some initiative activities during parent workshops, which offered at the conclusion of many wilderness programs. Some programs have even taken parents out into the wilderness to experience the impact of the natural environment in re-establishing the bond with their children. For example, the Family Wheel program integrated a four-day multiple family experience at the conclusion of a standard 21-day wilderness therapy expedition (Bandoroff,1994). There has been some research to support the use of adventure family therapy (Bandoroff, 1994; Clapp & Rudolph, 1990), but for the most part, research is lacking.
Despite the powerful potential of a wilderness experience for the family, this type of intervention, like a wilderness therapy expedition, remains outside the scope of most mental health practitioners. There are many logistical barriers to overcome, not to mention the technical skills required to deliver such an intervention. However, the wilderness is not a prerequisite to a successful adventure family therapy intervention. This paper will describe a more practical family intervention that utilizes the precepts of adventure therapy in a more traditional outpatient mental health setting.
Theoretical Foundations of Adventure Family Therapy
Activity-Based Psychotherapy
The concept of activity-based psychotherapy in the treatment of families is not a new idea. Satir (1972) was a strong advocate of the use of experiential activities, Papp (1976) pioneered the use of family choreography, and Moreno (1945) introduced psychodrama. Although adventure family therapy is clearly an outgrowth of adventure therapy, it also has roots in these earlier activity-based family interventions.
Adventure Therapy Processes
The adventure family experience entails many of the same processes and benefits as standard adventure therapy. In describing adventure therapy, Gass (1990) writes that, "...it turns passive therapeutic analysis and interaction into active and multi-dimensional experiences" (p. 3). This is equally true when engaging families in adventure activities. The holistic nature of the experiences provides physical, affective, and cognitive interactions for examining family patterns and beliefs (Gass, 1993). The family is placed in an environment that requires healthy family processes for successful adaptation. To overcome the challenges with which they are confronted requires effective communication, trust, and good problem-solving. These skills, in turn, contribute to effective structure and intimacy which can increase family cohesiveness and adaptability.
The unfamiliar tasks presented to the family provide the therapist with clear representations of family interactions. Many of the problems encountered by the structural family therapist, identified by Minuchin (1974), can be alleviated in adventure family therapy: for example, acceptance into the family structure, failure to recognize family subsystems, and the possibility that verbal techniques will not reveal critical issues (Gass, 1993). "This experiential process causes family members to actually display their structure, behavior patterns, rules of interaction, and methods of communication in accomplishing this task" (Gass, p. 126). This information is also available to the family as they receive vivid representations of positive as well as negative behaviors. Obstacles to the therapist joining the family, such as mistrust, are greatly reduced by the informal setting, the natural engagement elicited by the adventure activities, and the success orientation of the activities. The absence of expectations and preconceived notions of success creates a non-risk atmosphere where families can explore problems instead of being overwhelmed by them (Ibid).
Through the use of metaphor, the adventure activities play a key role in freeing entangled families. The task must be framed in such a way that it resembles a family problem so that the activity begins to acquire symbolic meaning as a metaphor for the family. During the process of completing the activity, the exercise and the metaphor become one (Gass, 1991). The task itself can be tailored to meet the needs of a particular family. For example, a dominant parent may be instructed that he or she can only communicate through their spouse. This experience provides the family with an opportunity to assume new roles and respond in ways that expand their typical patterns of interaction, reframing the problem in the process (Gillis & Bonney, 1989). Moreover, the symbolic nature of the activities creates rituals that punctuate the changes in structure and anchor therapeutic gains.
Healthy Family Functioning
In order to help troubled families achieve competence, an understanding of healthy family functioning is necessary. The area of healthy family process is relatively undeveloped in the mental health literature due to the focus on pathology. Families face a multitude of stressors from life events and normative developmental transitions. Ultimately, their adjustment depends upon the family's resources (Walsh, 1984). It is important to recognize that family resources are not the exclusive domain of healthy families. Imber-Black (1986) stresses, "All families are problem-solving entities" (p. 148). Any existing family, whether healthy or dysfunctional, has solved thousands of problems, utilizing the resources of individual members and the collective resources of family and friends. The resource model of family therapy views therapy as a process to facilitate or mobilize a family's creative capacity to solve problems, effect healing, generate development, and gain new knowledge (Friedman, 1986; Imber-Black, 1986; Karpel, 1986).
The competency-based orientation of adventure family therapy diminishes families' initial defenses and leads to healthy change. The successful completion of activities enables the families to focus on their abilities rather than their dysfunctions and to gain a sense of mastery. While struggling through progressively difficult tasks, families discover strengths and untapped resources. Family members notice positive qualities in each other that had been lost in their coercive cycle of conflict. Moreover, families learn that they are capable of coping constructively and effectively during periods of high stress. The activities provide a common goal and sense of purpose that challenges the family to work together toward a shared accomplishment. Through this process, healthy functioning is reinforced and self-empowerment is achieved (Gass, 1993).
Brief Therapy
Adventure family therapy is well-suited for the emphasis on brief therapy that has resulted from the growth of managed care (Kiesler & Morton, 1988; Mohl, 1998)). Brief therapy is not simply a short-term version of traditional therapy. Papp (1976b) contends, "Brief therapy, by its very nature, must be highly structured, intensely focused, and directive" (p. 350). The therapist must structure tasks to compel families to view their problems differently, relate to each other differently, and conceive of change differently. This cannot be accomplished through intellectual insight alone, but must include physical and emotional components as well. The form that a problem takes becomes rigidified through repetition, and the problem is inaccessible to change as long as it remains in its predictable form. The task of therapy is to cast the problem into a new and more flexible form which renders it accessible to change. In essence, the problem changes as the form changes (Ibid). Using adventure activities to access the problem, through the use of metaphor, clearly accomplishes the goal of approaching the problem from a different perspective. This, in turn, can help expedite the course of therapy.
Multiple Family Therapy
When employed in a group setting, the multiple family therapy format is another tool that contributes to the power of the adventure family intervention. It provides an opportunity to learn from other families and share observations about how other families operate. Family rules and myths can be challenged and new perspectives offered. The group offers a cross-generational variety of substitute figures for transference which allows the individual to experiment with behaviors not yet tolerable in one's own family (Leichter & Schulman, 1972). Of course, the multiple family format also provides a network of support for families who often feel isolated and misunderstood.
The Family Challenge Program: Adventure Family Therapy in Outpatient Treatment
The Family Challenge Program (name originally used by Clapp & Rudolph, 1990) is an eight-week multiple family therapy group in the U.S. utilizing initiative activities to help address family issues. According to the descriptive model of adventure family therapy interventions developed by Gillis et al. (1991), the Family Challenge Program would fall into the enrichment category. The program provides topic-focused skill-building sessions to intentionally address common family issues such as communication, trust, and boundaries. The initiative activities are specifically related to the skill being taught rather than tailored to a particular family’s issues. Such prescriptive tailoring would be necessary in order for the adventure intervention to be considered the primary therapeutic modality (Ibid). The Family Challenge Program could also be categorized as adjunctive therapy since the vast majority of the families in the program participate in conjoint family therapy as well.
The Family Challenge Program was developed in 1995 in a juvenile justice setting to serve a high-risk caseload of chronic juvenile offenders. The families of these youths are typically multi-problem families with many stressors and limited external resources. At the outset of treatment, parents are usually exhausted and disillusioned, and family relationships are strained. The overarching goals of the program are to reconnect families with their resources and to re-establish emotional ties within the family. The specific goals of the program can be seen in Table 1.
Program Structure
The program curriculum is divided into seven sessions with each session devoted to a given skill or theme (see Table 2). In addition to the programmatic goals listed in Table 1, there are specific goals for each session related to the skill being emphasized that week.. The skills were selected by the author as resources considered to be critical to healthy family functioning (Bandoroff, 1991; Karpel, 1986). These include cooperation, communication, trust, boundaries, and negotiation. The program begins with an introductory session and concludes with a farewell session. In addition, there is an optional session that takes place on a group challenge course which offers a series of initiatives and provides the opportunity to develop many of the skills highlighted during the program.
The weekly two-hour sessions follow an established structure to create consistency and a sense of predictability. The structure is also designed to provide a progressive sequence of activities. Each session begins with an icebreaker to decrease participants’ anxiety, to establish a mindset of active participation, and to re-establish the group connection. The icebreaker is dropped in the latter sessions to maximize time, and then the sessions begin with the “check-in.” The check-in is introduced in the first session as a “circle of safety” where participants are provided an opportunity to create physical and emotional safety. The check-in is a brief ‘go-around’ where participants share a feeling, report any physical limitations, and provide a progress report on their family goal from the previous week.
After the check-in, the theme of the session is introduced to the group through an initiative activity. The value of this approach is that participants are actually engaged in the skill being taught, during the course of the activity. As the group gathers to debrief the exercise, participants are able to reflect on their experience of the skill rather than simply talking esoterically about the skill as a concept.
After a break for snacks, the group reconvenes for a brief didactic session introducing a tool that is critical to the skill for the day. For example, active listening is taught during the communication group. The didactic piece is followed by an experiential exercise that is completed in individual family units. This provides an opportunity for each family to come together to practice the skill and prepare to take the skill home with them. The term experiential exercise is used to distinguish it (artificially at times) from an initiative activity because the experiential exercises do not come from the adventure field. An example of an experiential exercise would be an arts and crafts activity or a sculpting exercise. Finally, each family is required to develop a written goal for the week that represents a plan for generalizing the skill to their home environment. There is a weekly goal form, which the family takes home, that provides a space where each family member describes an action step that s/he will take to support the family goal. The goals are shared with the group to establish public accountability, and the session concludes with participants voicing appreciations for other group members.
Sample Session: Developing Appropriate Boundaries
Appropriate boundaries are considered a critical resource for healthy family process, because many families become stuck in the transition from childhood to adolescence (Garbarino, 1982). Such families tend to maintain loose boundaries characteristic of the over-involvement appropriate for young children (McGoldrick & Carter, 1982; Quinn, Newfield, & Protinsky, 1985). They fail to develop the flexibility required for adolescents where boundaries must be more rigid, respecting the adolescent’s need for privacy and the opportunity for individuation (McGoldrick & Carter, 1982). Developing Appropriate Boundaries is session five in the Family Challenge curriculum and follows Building Trust. This sequence of sessions is important because a certain level of trust must be achieved before parents will feel comfortable establishing more flexible boundaries.
The initiative activity that is used to demonstrate the skill of appropriate boundaries is called “Lighthouse.” It is commonly known in the adventure field as “Minefield.” The activity involves designating an area to be the harbor and scattering objects throughout the area to represent mines. The mines can be named by the families to represent the challenges that adolescents face today. The adolescents are then blindfolded and must be directed by their parents from one end of the area to the other without hitting a mine. The metaphor establishes the adolescents as ships to be launched but they must navigate the treacherous harbor in order to reach the open sea. The parents are lighthouse attendants and can see the mines but must stay on shore. Parents will naturally attempt to control their teen’s every move in order to ensure their safety, although adolescents clearly need the opportunity to captain their own ships. After several minutes, the activity is stopped to point out this dilemma. If time allows, it can be interesting to give the families a chance to solve this dilemma. One suggestion is that the lighthouse attendants can only respond to questions from the captains. This places the responsibility with the adolescents while maintaining the parents as resources. Although this particular metaphor presentation focuses on adolescents, younger children may be used to monitor the harbor and make the explosions. An alternative is to send the younger children out into the water as well and direct them around the harbor (but not out to open sea) with intensive supervision. This provides the opportunity to contrast communication and supervision styles, representative of different types of boundaries, for younger and older children.