Let’s get nerdy about therapy for a second and think about how it works. While I was overseas visiting family in the states, I received an enquiry from a mother concerned about her adolescent daughter, who has been self-harming, smoking marijuana, and starting to further disengage from school. Her email told me she had “exhausted all her local resources” but was warned by her daughter’s psychologist that adventure therapy programs like ours do not work as well as other more traditional talk therapies.
Talking with more than 50 new families each month, we get these types of questions a lot. The answer, from our view and based on the available evidence, is much simpler than I think we give credit to. But it does take some navigating through what we already know about therapy, so bear with me for a second.
Since the first large scale therapy study which was published in 1977 the evidence has remained the same. People that are struggling who engage in therapy of some kind tend to be better off than about 70-80% of those that do not. The way researchers find these outcomes is by using two groups. Say 100 people go to see a psychologist, social worker, and counsellor, and 100 do not. When we look at their reported levels of change, the group that saw the professional tend to report feeling better off that 70-80% of the people who did not.
For the field of therapy, this is great news. These outcomes are better than many common medical treatments like taking an ibuprofen for a headache or putting fluoride in water to strengthen your teeth. Therapy works.
Here is where it gets tricky. Not too often do researchers ask: Is this one therapy better than that other therapy? Let’s take the same 100 people and send them to a specific therapy, such as Cognitive Behavioural Therapy which is often mandated by the Australian Medicare system and how we train many psychologists while they are studying at University. Then, we’ll take the other 100 and send them to a totally different therapy, say something like Psychodynamic Therapy (don’t worry about the jargon…I find it confusing too!). When this happens, historically, there is little to no difference in outcomes between the two therapies. In fact, the biggest study of adolescent depression the field has ever conducted is just one of the many studies that has led to this same finding. On average, all the participants will be better off for engaging in some sort of help rather than doing nothing at all.
For decades and probably longer, practitioners have been divided in arguing which therapy is the best. This can be quite a silly debate since the evidence has shown and will continue to show that all the therapies tend to be equally effective. This is also good news for therapy. Comparing therapies is similar to comparing ibuprofen to paracetamol. Both contain different ingredients but they tend to work the same.
Although this post has started with a brief look at the statistics and allowed me the chance to showcase the therapy nerd I am, let’s get back to the mother’s concern. She wanted something new after exhausting her local resources. The professional she saw gave her advice that was contraindicative to what the evidence says. The recent research work I have done with my fellow adventure therapy colleagues around the world has shown this. When adventure therapy is compared to another genuine therapy that is designed to work and does not containing anything adventurous, the outcomes are still the same. In the thirty to forty years of adventure therapy research we have, our outcomes are on par with all of the “mainstream” therapies we have been compared with.
Here’s the kicker. The outcomes are the same because the therapy itself is not the secret sauce. It’s the people involved, the characters staring in the play. Now to get philosophical for a second, adventure therapy is part of the process, a verb, by which our program operates. It’s where our team feels we are at our best. Adventure therapy is not a noun, a thing that works independently of who the practitioner is, who the client is, and all the nuanced context that we cannot capture as researchers.
So, if all the therapies tend to be equally effective then how do I know if I’m in the right place? This is such an important question and one I’m obsessive about trying to help potential service users with. Whether or not your therapist is monitoring your outcomes, which they should do routinely, you should feel you are in the right place and making strides sooner rather than later. The longer you are engaged in a therapeutic relationship and you aren’t feeling the benefit, the more likely you are to simply not want to return. Why would you? You aren’t feeling better. Or worse, you are urged to keep going without experiencing the great benefit therapy has to offer.
When you or your child does connect with that therapist that inspires hope and optimism, it’s obviously worth continuing. When it’s working, keep going but like anything there can be a plateau in progress. Imagine a weight lifter at the gym. For building muscle, they might demonstrate incredible progress early on followed by a slow and gradual growth. Gym enthusiasts often call this a plateau and it can be when people stop going all together.
In therapy, this is the time where you might start spacing out how often you see your therapist. This is why our program provides an intense 14-day expedition. Intense being that it’s a lot of activity in a new environment and a circuit breaker from how things have been going at home. As our participants return home, we keep working with them. As progress plateaus, we start having our follow-up sessions less often, similar to seeing the dentist every so often for a check-up.
Although I am passionate about adventure therapy, I am more dogmatic towards trying to find ways to make our services more effective for the people that come on our programs. As a program director, this involves following the evidence. If people aren’t feeling the benefit, and early on, we take that responsibility seriously and find what changes we can make to the program to help. There is no cookie cutter experience in the wilderness and it’s our job to focus our aim on our client’s experience within an adventure therapy program, the process, and not focusing on adventure therapy, the noun.
The evidence simply isn’t there. For this rightfully concerned mother, the evidence suggests that anything we can get her daughter engaged with, whether its adventure therapy or another therapist’s couch is simply the right next step. Maybe we can think outside of the therapy box and find a local church group, youth centre, or sporting club to engage with. We want people around that inspire her daughter. Those who build that important working relationship and evoke more quality participation are the ones for her.
As always, I am happy to chat with anyone about any of this. I look forward to hearing from you all.
Will Dobud MSW