Wilderness therapy, aimed primarily at adolescents presenting with problem behaviors, includes a range of interventions that incorporate nature and the wilderness as prominent aspects of treatment. In theory, wilderness therapists seek to effect both behavioral and attitudinal changes. Through providing a context of challenging outdoor living and a group setting in an emotionally safe place, wilderness therapy aims to address problem behaviors and to facilitate an emerging sense of healing, well-being, and personal and social responsibility.¹ Wilderness therapy's action-oriented approach is said to be particularly appropriate for adolescents and is intended to build self-esteem, internal locus of control, interpersonal skills, trust and team building, and a sense of group belonging.²

There is, however, a shadowy legal side to wilderness therapy. When these programs are not structured in the correct way and appropriately monitored, there can be serious and sometimes deadly consequences. This article focuses on both the clinical and legal aspects of wilderness therapy and pointedly notes this industry's lack of regulation. Part I reviews much of the wilderness therapy literature, program efficacy, and controversies. Part II looks at a number of domestic and international lawsuits. Part III examines the minimal extent to which there has been regulatory oversight. Part IV provides recommendations for ensuring that wilderness therapy programs are facilitated in a way that maximizes safety and effectiveness, as well as offering a brief conclusion.

Part I. A Clinical Viewpoint: Strengths and Weaknesses of Wilderness Therapy There are many views as to exactly what wilderness therapy is. The term "wilderness therapy" is often used interchangeably with adventure therapy, wilderness adventure therapy, wilderness experience programs, challenge courses, outdoor behavioral healthcare (OBH), and other outdoor programs that vary in their structure and focus.³ In the research literature, many authors distinguish wilderness therapy from other wilderness experience programs by describing wilderness therapy as a licensed program run by licensed professionals involving assessment, treatment planning, and service delivery.⁴ Whether this distinction is consistent in the "real world" is another matter. Many self-labeled "wilderness therapy" programs do not necessarily fulfill these criteria since not all states demand these credentials.⁵

According to one estimate, there are approximately 26 wilderness therapy programs in the United States, although an earlier survey found 65 self-identified wilderness programs.⁶ One researcher reported that more than 12,000 families engage in this form of treatment in the United States every year, although again, this figure may fluctuate with the number of existing programs.⁷ As noted, though, whether all of these surveyed programs actually meet criteria for wilderness therapy remains unclear.⁸

Typical clients for wilderness therapy are adolescents aged 14-17, although there are now programs for individuals over the age of 18 as well.⁹ Historically, wilderness therapy has been associated with delinquent youth, but populations served by wilderness programs now include mild traumatic brain injury patients, victims of rape and incest, psychiatric inpatients, and developmentally disabled clients.¹⁰ Wilderness therapy has also been suggested for adolescent sex offenders, adolescents suffering depression, and even as an intervention for the entire family.¹¹

Wilderness therapy programs are typically headed by an executive director (or program director).

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