Categories
Brief Articles

Explaining Therapeutic Change in Residential Wilderness Therapy Groups

Lee Gillis, PhD
Lee Gillis, Ph.D.
Keith Russell, Ph.D.
Keith Russell, Ph.D.

Residential wilderness therapy or adventure therapy is “the prescriptive use of adventure experiences provided by mental health professionals, often conducted in natural settings that kinesthetically engage clients on cognitive, affective, and behavioral levels.” (Gass, Gillis & Russell, 2012 p.1).  The term adventure therapy is used in the literature interchangeably with “wilderness therapy” (Russell, 2001) and “outdoor behavioral healthcare (OBH)” (Russell & Hendee, 2000).  All these terms refer to treatment that takes place with small groups often in outdoor settings utilizing either short (1-5 days) forays into nature or extended expeditions (14-60 days) where participants are immersed in a wilderness setting. White’s (2015) history of the field points to an evolutionary tree for adventure therapy whose DNA includes therapeutic summer camps, Boy Scouts, Outward Bound, and even The Church of Jesus Christ of Latter-day Saints.  The recorded history of this therapeutic intervention dates back to 1861.

How does Outdoor Behavioral Healthcare look in practice?

Therapeutic outdoor experiences typically occur in small groups (4-8 clients). Most of the groups are “open” with clients entering and leaving as they go through intake or discharge; it is rare these days to have a cohort of clients who go through a whole program together.  Thus, the group climate can be in constant flux and how congruent a member’s perceptions are with the rest of the group has been found to have implications for treatment progress. At least that is the premise put forth in the Gillis, Kivlighan, & Russell (2016) manuscript in volume 53 of Psychotherapy.

Theoretically, the OBH group therapy that takes place has the members’ shared experience(s) of paddling, hiking, rock climbing, etc. on which to reflect and give feedback to one another.  Individuals set therapeutic intentions prior to an outing and project when they may have opportunities to engage in that intention.  For example, prior to a recent river crossing, one group member, based on his past history with the group, wanted to step up and take the lead with his peers as he had been sitting back and letting others take charge in previous activities.  He projected that once they arrive at the river would be his first opportunity to step forward.  Conversely, another group member stated his therapeutic intention was to stay quiet and listen to others as he had previously blurted out what he was thinking with little regard for what other group members wanted to do.  In each case the group members offered suggestions to clarify the intentions and question how they might see it realized.  The intentions are written down in the group room and then used as the basis for feedback in the group session following the experience.

Many of us who embrace this particular experiential approach find a strong foundation in principles of Gestalt Therapy, Psychodrama, and Carl Rogers’ Person Centered groups while grounding ourselves in evidence based cognitive behavioral approaches to treatment.  The conscious and intentional use of metaphor (Bacon, 1983; Gass, 1991), influenced by Milton Erickson’s work, is also prominent among many adventure therapists.  For example, the river crossing mentioned above provides numerous therapeutic metaphors to discuss in a group session whether they be being mindful of how one steps forward in life when the footing is unsteady or simply the challenges of getting from one place to another (one side of the river to the other).

Making sense of the adventure therapy group climate black box

The metaphor of a “black box” (Ashby, 1956) is often used when trying to make inferences about how change takes place within a program when examining only inputs (pretests) and outputs (posttests). Positive pre to post treatment changes in client progress as measured by the Outcome Questionnaire 45.2 (OQ 45.2) (Lambert & Finch, 1999) and Youth Outcome Questionnaire 2.0 SR (YOQ 2.0 SR) (Bulingame, et al 1996) during adventure therapy experiences for adolescents and young adults has been well documented (c.f., Bettmann et al., 2016, Gillis, et al. 2016, Norton et al, 2014). Meta-analyses have consistently demonstrated moderate (d = 0.45) effect sizes for adventure therapy (c.f., Bowen, Neill & Crisp, 2016; Cason & Gillis, 1994).

Russell, Gillis, & Heppner (2016) recently found that changes in the non-reactive factor of trait mindfulness (Baer, et al., 2008) helped explain OQ 45.2 change in young adults being treated for substance use disorder in an OBH program despite the program studied not having formal mindfulness training.  The authors posited adventure therapy as a mindfulness-based experience (MBE) especially when involved in reflecting on their excursions into the wilderness with explicitly stated therapeutic goals to achieve while out on trail.

The global changes in the non-reactive mindfulness factor among clients does not examine how engagement in the group experience influences outcome.  That was the purpose of the Gillis et al. (2016) manuscript in volume 53 of Psychotherapy. We examined how other member and person context moderate the relationship between group members’ perceptions of engagement and their treatment outcome using the actor partner interdependence model (APIM).

When the other group members generally see the group climate as engaged, higher general perceptions of engagement for the member are related to fewer depression and anxiety symptoms, clarity of social roles and interpersonal relationships.

When the other group members generally see the climate as not engaged, higher general perceptions of engagement for the member are related to more problems.

When the group member generally sees the climate as engaged, higher member biweekly perceptions of engagement related to fewer problems during that 2-week period.

When the member generally sees the climate as not engaged, higher biweekly perceptions of engagement for the member are unrelated to changes in problems.

Summary and Conclusions

In essence, this research is highlighting the role that congruence in member, group, and leader perceptions play in effectuating treatment outcome. When these perceptions become misaligned, individual client well-being can be affected, which in turn could create a cascading effect, leading to isolation and withdrawal from the group, thus affecting overall group engagement.  Monitoring these perceptions of engagement in conjunction with progress monitoring is warranted.  Practical implications for group therapists are to routinely monitor how group members view the group climate.

In this article we used the five item engagement subscale of MacKenzie’s (1983) Group Climate Questionnaire. We have recently switched to the Group Questionnaire available at oqmeasures.com in an attempt to examine how the three factor structure (positive bonding, positive working, and negative relationship) might provide more information to both therapist and to group members when used in progress monitoring. We will continue to examine the effects that bonding and working relationships has on treatment outcome both in the moment and during the weeks prior to group and community meetings because of our preliminary findings.

Finally, as authors, we are deeply indebted to Dr. Dennis Kivlighan for the APIM analysis and mentorship with the statistics!

References

Ashby, W. R. (1956). An introduction to cybernetics. An introduction to cybernetics. London: Chapman & Hall Ltd

Bacon, S. B. (1983). The conscious use of metaphor in Outward Bound. Denver, CO: Colorado Outward Bound School

Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and no meditating samples. Assessment, 15(3), 329-342.

Bettmann, J. E., Gillis, H. L., Speelman, E. A., Parry, K. J., & Case, J. M. (2016). A meta-analysis of wilderness therapy outcomes for private pay clients. Journal of Child and Family Studies, 1-15.

Bowen, D. J., Neill, J. T., & Crisp, S. J. (2016). Wilderness adventure therapy effects on the mental health of youth participants. Evaluation and Program Planning, 58, 49-49.

Burlingame, G. M., Wells, M. G., Hoag, M. J., Hope, C. A., Nebeker, R. S., Konkel, K., McCollam, P., & Reisenger, C.W. (1996). Manual for youth outcome questionnaire (Y-OQ). Stevenson, MD: American Professional Credentialing Services.

Cason, D. & Gillis, H.L. (1994). A meta-analysis of outdoor adventure programming with adolescents. Journal of Experiential Education17(1), 40-47.

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, practice, & research. NY: Routledge Publishing Company

Gass, M. A. (1991). Enhancing metaphor development in adventure therapy programs. Journal of Experiential Education14(2), 6-13.

Gillis Jr, H. L., Speelman, E., Linville, N., Bailey, E., Kalle, A., Oglesbee, N.,Sandlin, J., Thompson, L., & Jensen, J. (2016). Meta-analysis of treatment outcomes measured by the Y-OQ and Y-OQ-SR comparing wilderness and non-wilderness treatment programs. Child & Youth Care Forum, 45, 851-863

Gillis, H. L. (L.), Jr., Kivlighan, D. M., Jr., & Russell, K. C. (2016). Between-client and within-client engagement and outcome in a residential wilderness treatment group: An actor partner interdependence analysis. Psychotherapy, 53(4), 413-423. http://dx.doi.org/10.1037/pst0000047

Lambert, M. J., & Finch, A. E. (1999). The Outcome Questionnaire. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed.) (pp. 831-869). Mahwah, NJ: Lawrence Erlbaum Associates.

MacKenzie, K. R. (1983). The clinical application of a group climate measure. In R. R. Dies & K. R. MacKenzie (Eds.), Advances in group psychotherapy: Integrating research and practice (pp. 159–170). Madison, CT: International Universities Press.

Norton, C. L., Tucker, A., Russell, K. C., Bettmann, J. E., Gass, M. A., Gillis, H. L., & Behrens, E. (2014). Adventure therapy with youth. Journal of Experiential Education37(1), 46-59.

Russell, Keith C. (2001). What is wilderness therapy? Journal of Experiential Education, 24(2) 70-79.

Russell, K. C., Gillis, H. L., & Heppner, W. (2016). An examination of mindfulness-based experiences through adventure in substance use disorder treatment for young adult males: A pilot study. Mindfulness, 7(2), 320-328.

Russell, K. C., & Hendee, J. C. (2000). Outdoor behavioral healthcare: Definitions, common practice, expected outcomes, and a nationwide survey of programs. Idaho Forest, Wildlife, and Range Experiment Station.

White, W. (2015). Stories from the field: A history of wilderness therapy.  Wilderness Publishers.

*This article was first published in The Society for the Advancement of Psychotherapy February 26, 2017.  Gillis, H. L., & Russell, K. C. (2017, February). Explaining therapeutic change in residential wilderness therapy groups. [Web article]. Retrieved from: http://www.societyforpsychotherapy.org/explaining-therapeutic-change-in-residential-wilderness-therapy-groups

Categories
Brief Articles

Career Paths: Group Psychology and Group Psychotherapy

Lee Gillis, PhD
Lee Gillis, Ph.D.

It is difficult to imagine you will embark on a career path after completing your undergraduate degree in psychology that will not require you to work with a group. Clinical, counseling, social, industrial-organizational, addiction, child and adolescent, military and sport psychologists, among others, all work with groups. We may take different academic paths in graduate school, but we all share a belief in the power of the group. If you have an interest in groups you may wish to consider joining us and becoming a group psychologist or group psychotherapist.

What We Do

Group psychologists specialize in social, industrial-organizational, addiction, child and adolescent, military and sport psychology. We are interested in such issues as researching group factors that help an organization function more efficiently, enable addicts to reduce destructive behaviors, keep youth from bullying one another, lessen the impact of PTSD and allow individuals to perform at peak levels — and that’s just scratching the surface.

Group psychologists are also interested in leadership. For example, we research whether there are natural born leaders. We explore leadership traits that can help transform a group into a high-performing team.

Clinical and counseling psychologists conduct individual, couples, family and group psychotherapy. Research demonstrates that group psychotherapy is as effective as individual psychotherapy (Burlingame, Strauss, & Joyce, 2013), and it costs less. When clinical and counseling psychologists practice in independent practice, community mental health clinics, university counseling centers, veterans’ hospitals, recovery centers or geriatric facilities, to name a few places of employment, they are often asked to conduct group psychotherapy. Groups are efficient; groups are effective.

Group psychotherapy offers its members therapeutic benefits that cannot be as easily obtained in individual therapy. For instance a group member can experience universality — when they realize that at least one other person in their group feels similarly to them, when before, they felt they were the only person in the world who had ever had such feelings. Group psychotherapy can instill hope as group members develop insight and learn social skills while receiving feedback from others.

Why You Should Pursue This Career

If what is projected about your work environment in the future is true, most of you reading this article will be part of a group or team in your work world. The recently revised APA Guidelines for the Undergraduate Psychology Major (PDF, 447KB) places emphasis on enhanced teamwork capacity (Goal 5.4) and specifically states that those with a baccalaureate degree in psychology should be able to, among other things, “collaborate successfully on complex group projects,” “assess basic strengths and weaknesses of team performance on complex projects” and “work effectively with diverse populations.”

According to the Bureau of Labor Statistics, there will be an increase in the need for industrial-organizational psychologists at a rate much greater than in other fields of employment. In addition, as mental health care gains parity with physical health care under the Affordable Care Act, demand for psychological services may increase. There is no doubt that psychologists will increasingly work in collaborative teams with medical doctors, social workers and other health care professionals to help provide more interdisciplinary, effective and efficient treatment. As a psychologist who understands both group dynamics and group psychotherapy, you will be a double asset to the teams in which you belong.

How To Get Involved

After graduating with an undergraduate degree in psychology, most group psychologists and group psychotherapists pursue a graduate degree at the master’s or doctoral level. Research psychologists pursue careers in academia or industry. Clinical and counseling psychologists who specialize in group psychotherapy attend doctoral programs accredited by APA, and many pursue a license to practice psychology.

Group psychologists and group psychotherapists may both belong to Div. 49 (the Society of Group Psychology and Group Psychotherapy). The division welcomes all psychologists who believe in the power of group. You can become a student affiliate member of Div. 49 or join us on Facebook, Google+ or LinkedIn. You are also invited to attend our division’s activities at the annual APA convention. We would love to connect with you.

References 

Bureau of Labor Statistics, U.S. Department of Labor (n.d.). Occupational outlook handbook, 2014-15 edition, Psychologists.

Burlingame, G. M., Strauss, B., & Joyce, A. S. (2013). Change mechanisms and effectiveness of small group treatments. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.; pp. 640-689).

This article first appeared in the Psychology Student Network (January 2015).

Categories
News

Call for Nominations for President-elect and for Member-at-Large

Lee Gillis, Ph.D.
Lee Gillis, Ph.D.

Self-nominations will be considered.

From the Bylaws:
The Committee on Nominations and Elections will issue a call for nominations to all members by the appropriate deadline of the year prior to the calendar year. A validating procedure shall be used to assure that nominations are made by appropriate voting members of the board.

The Nominations and Elections Committee shall seek advice on nominations from the Board of Directors and other members of the Division currently or recently in leadership. Any eligible member recommended by the Nominating Committee, a Board Member, or receiving at least 10 or more nominations from the general membership shall appear on the ballot as a nominee after
ascertaining that the nominee is qualified and willing to serve if elected. At least two names should be placed in nomination for each office.

President-elect
The President-elect shall be a member of the Executive Committee and the Board of Directors with the right to vote and shall perform the duties traditionally assigned to a Vice-President. In the event that the
President shall not serve her/his full term for any reason, the President-elect shall succeed to the remainder thereof and continue to serve through her/his own term.

The President shall be the Member or Fellow who has just completed a term as President-elect. The President shall succeed to office on January 1 following the completion of her/his President-elect year. The President, or her/his designee from the Board, shall preside at all meetings, shall be the Chair of the Executive Committee and the Board of Directors, and shall perform all other usual duties of a
presiding officer. The President shall cast a vote at meetings of the Board of Directors only when the vote would make or break a tie.

Member-at-large
Members-at-large of the Board of shall represent the interests of the membership at large on the Board of Directors.

Please send nominations by October 31, 2014 to lee.gillis@gcsu.edu
Both elected members will begin service on January 1, 2016 and serve a 3 year term.

 

Categories
Columns

Presidents Column

Lee Gillis, Ph.D.
Lee Gillis, Ph.D.

It is so great to be part of a good group.  That describes our Society – a functioning group.  This year’s convention demonstrated how well we function from the work of Drs Jill Paquin and Joe Miles in crafting an excellent program that attracted multiple APA attendees to hear papers, experience skill sessions and observe well crafted posters.  We ended the convention with one of our signature institution, our annual social event hosted by Kathy and John Ritter.  We are so thankful for their service to the Society and hosting all these years.

Your Board has been a functioning group too.  We have not been afraid to debate issues important to members – to gather data – to make recommendations and to explore ways to invest our resources in ways that will benefit the Society in the long run.

Below I have highlighted the initiatives of my presidential year with an update on progress.  None of these initiatives could have been accomplished without the involvement of your Board members as well as committee chairs and their respective members.

Theme Connecting to the group experience
Initiatives for 2014 November 14 Update
Face of society
  • Embrace and utilize social networking connections to promote our publications, website and increase our visibility within APA and beyond
  • With Board approval and exceptional leadership of Secretary Dr. Jen Alonso, Social networking on Face book, Google+, and Linked In has increased astronomically
Membership
  • Connect the people who publish in the Journal with those who present at the Convention and write for the Newsletter – be relevant to both psychology and psychotherapy.
  • Promote ECPs everywhere throughout the Division.
  • Help undergraduates connect to group psychology & group psychotherapy graduate programs
  • In progress as we consider proposals from two groups on who will publish Group Dynamics for the next ten years.  Ongoing discussions on the need for and the feasibility of a second journal focused on group practice
  • Have appointed ECPs to APA committees where possible: Dr. Paquin to Committee on Women in Psychology and Dr. Diederich as liaison to the Board of Professional Affairs
  • Finding ways to communicate to undergraduate psychology majors and those who teach them on opportunities for studying and practicing group psychology and group psychotherapy.
Member benefits
  • Google+ Hangouts, Face book Group, Topic based phone discussions, Newsletter, Journal, APA Communities – places to share idea and connect with like-minded professionals.
  • Successes attributed to Secretary Dr. Alonso, TGP editor Dr. Treadwell, Membership Director Dr. Diederich, and Program Chairs Dr. Paquin & Dr. Miles
  • Recognition of Board members for outstanding service
Infrastructure
  • Ensure that Policy manual is an accurate representation of what we do and when we do it; and that the manual is connected to the Bylaws.
  • In progress needing support from all board members
Liaisons
  • Making more connections among Divisions within APA; Being involved on APA committees that matter to our members.
  • Success attributed to Program chairs Drs Palquin and Miles as well as Drs Diederich and Paquin

 

In my Presidential address I discussed how APA Undergraduate Guidelines  offer learning objectives that focus on teamwork.  I issued a call for all of us to help those who teach undergraduates understand the need for helping groups establish norms and boundaries of acceptable behavior.  We are the experts here and have much to offer our colleagues who might not understand the power of a small group experience.  We know that power can be very positive in a well functioning group and destructive when a group falls into negative behaviors.  Too often I hear from my student’s horror stories of group experiences run amuck.  Many of these bad experiences could have been avoided had the professors set up some basic guidelines for operating in a group.  Help your colleagues understand how effective groups can be.

In the discussion following the address, many shared how other majors and programs outside of psychology were seeking group classes for their students.  We heard examples of pharmacy students, information technology students, engineering students, and medical students all in need of learning what many of us teach – good group skills.  Look for opportunities in your circles of influence to offer group skills where needed.

Graduate training in group psychology and psychotherapy seems to be waning and this is a sad state of affairs.  Many of us know that group is not mentioned in APA’s Guidelines And Principles For Accreditation Of Programs In Professional Psychology.  We know what is not required is often not taught.  I urge members to work towards including group as an area of training for all professional psychologists.  We hear too often that doctoral students graduate with very little group training but are expected to conduct group sessions in their post-doctoral employment.  From the survey of Directors of Training, we know that group training is not emphasized to the same extent as individual.

We must rally our voices and support group training.  To that end, I want to applaud Dr. Nina Brown for her work on having Group recognized as a specialty.  We encourage and support Dr. Brown and the cross association team she has engaged to carry on with this important work.

Finally to the wonderful Board and supporting cast that I have had the pleasure of working with – I am truly grateful.  Drs Maria Riva, Dennis Kivlighan, Rebecca MacNair-Semands, Jennifer Alonso, Leanne Diederich, Rex Stockton, Joe Powers, and John Dagley – Thank you!  To Tom Treadwell, David Marcus, Cheri Marmaroush, Eric Chen, Jeanne Steffen, Jill Paquin, and Joe Miles – the Society could not have done this without you.

Thank you for a year I will not forget.  I pass the gavel in confidence to Dennis Kivlighan who has some grand plans.

Categories
Welcome

President’s Column

Lee Gillis, PhD
Lee Gillis, Ph.D.

Lee Gillis, Ph.D.
President

As this is the preconvention column I’d like to begin by highlighting a few important events. We hope all of you will join us for the Arthur Teicher Group Psychologist of the Year address to be given by Dr. Les Greene. That event will take place on Saturday, August 9 at noon in the Convention Center. Dr. Green joins an illustrious group of previous winners and we’re looking forward to hearing his remarks.

We also have an invited address by Dr. Ruth Ellen Josselson that will take place on Thursday, August 7 at 2:00 in the Convention Center.

  • Numerous students and other division members will be presenting posters on Thursday at 1:00 in the Convention Center. We hope you can join us in this session as well as the other skills sessions and symposia that will presented at the annual convention. Dr. Jill Paquin and Dr. Joe Miles have done an exceptional job of putting together this year’s program.
  • Least I forget, the business meeting of the Society will be Friday afternoon at 3:00 in the Convention Center and our Annual Social will take place on Saturday 6:00-9:00 in the Division’s Suite. We have been confirmed for a suite in the Grand Hyatt Hotel. As in past years, the room number of the suite will be available at the convention.

Let me say how much I appreciate the work of your elected board members, our journal and newsletter editors, and the program chairs for the convention. This is been quite an active group for the past six months. They are serving you well!

Here is a short update on several of the initiatives that are taking place this year.

  • Firstly, working in collaboration with Sean Woodland, student representative; Rosamond Smith, student member; and Dr. Leann Diederich, membership chair. A survey was sent to Directors of Training in both clinical and counseling psychology programs to ascertain the importance placed on group. So far we have received 54 responses. Sixty three percent of those responding reported to provide a group specific class. Eighty one percent of those group classes were experiential; 60% involved rotating leadership, 52% utilized peer leadership. When asked about the value placed on various therapy modalities using a 10 point scale, individual therapy received a 9.65 compared with the group with a 5.84, family with a 5.7, and couples with a 4.95. These are all preliminary numbers. We plan to have a more complete report in the next TGP along with a listing those graduate programs that gave us permission to do so.
  • Secondly, at the Midwinter meeting the Board voted to support our secretary, Dr. Jennifer Alonso, to increase our visibility on social networking sites. She was authorized to oversee someone who would make regular postings to our Facebook group in order to increase the visibility of the society, especially among early career professionals and students. Anyone who “likes” the Facebook group for Society has seen a substantial uptick in daily postings! These postings are supplemented by “Wisdom on Wednesdays”, a project of our ECP group. Current plans are to expand posting to Google+, LinkedIn, and to use our Twitter account during the convention to keep members who wish to follow us abreast of events in the moment.
  • Thirdly, many of you responded to the survey requests asking your opinion of beginning a second journal. An ad hoc committee led by Dr. Joe Powers is conducting this work. This group is examining the results of the survey and will make a recommendation to the Board at the August meeting.
  • Again, I want to encourage interested members to explore the APA communities, the membership-only website, where we are storing current and archival information about the Division, including our current Bylaws, Policy manual, minutes, and budgets. There are other features on the site that may or may not be used in the future; for now it serves as excellent cloud storage for materials that heretofore have been stored on various board members computers or in storage boxes.

I do hope everyone’s summer is going well and I look forward to seeing all of you at the Convention in Washington or online. Do not hesitate to contact me at lee.gillis@gcsu.edu or 478-445-0865.