Week 9: Adventure Therapist Competencies

Topic: How do competencies for becoming an adventure therapist compare and contrast with a different method of experiential treatment?

Gass, Gillis, and Russell provide a detailed chapter on the competencies held by adventure therapists in Adventure Therapy: Theory, Research, and Practice. The authors explain how a true adventure therapist is competent in three areas, holding the knowledge and skills of an adventure leader, a counselor or therapist, and a client specialist. Possessing an exemplary level of competency in each of these areas would take a substantial amount of time, therefore, I feel such individuals are extremely valuable.

Another form of experiential therapy that has a similar method for competency development is equine assisted psychotherapy. This website discusses the EFPL (Equine Facilitated Psychotherapy and Learning) Certification. Similar to AT, there are different areas of competency that come together to form a true equine therapist or a complete treatment team. These include a licensed counselor or therapist, an education specialist, a horse specialist, and a riding instructor. As seen here, according to the EAGALA Certification information, they require a treatment team of a mental health specialist and equine specialist as opposed to allowing one individual to perform both roles.

The Certification Board for Equine Interaction Professionals website provides information on this organization and the training programs they provide. This organization came together with the purpose of creating a knowledge base for best practices in this field as well as standards for excellence. The website expresses the concern felt when equine programs began to spring up and there were no such standards or certification boards. A few incompetent programs or services could catch media fire and potentially ruin the whole profession. AT professionals have also recognized the need to create standards and best practices as well as conduct research to inform the public as to the benefits of AT.

One thing is clear from the text and from both of the websites discussed here; in both fields, professionals are expected to continuously build their knowledge, skills, and overall competencies throughout their career. This not only means keeping up to date certifications and attending the latest training seminars, but also simply having an open outlook and always making room for growth.



References:

Certification Board for Equine Interaction Professionals. Retrieved from: http://www.cbeip.org

EAGALA. Certification Program. Retrieved from: http://www.eagala.org/Certification_Program

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York: Routledge/Taylor & Francis Group.

HEAL: Equine-Facilitated Psychotherapy and Learning. EFPL Certification. Retrieved from: http://humanequinealliance.org/the-heal-model/efpl-certification/

Week 8: AT Assessment

Topic: Compare and contrast the approach to AT assessment presented in Chapter 7 to at least 2 different approaches to assessment in mental health treatment


In Adventure Therapy: Theory, Research, and Practice, Gass, Gillis, and Russell provide information on primary processes Adventure Therapists utilize in forming client assessments. The authors detail two models that compliment each other well when used simultaneously. The CHANGES (Context, Hypothesis, Action, Novelty, Generating, Evaluation, and Solutions) model provides a system for assessing the client at a macro level from the beginning of treatment to to solution discovery. On the micro level, the GRABBS (Goals, Readiness, Affect, Behavior, Body, and Stage) model provides an outline for assessing the client in the moment. Putting the two models together provides the Adventure Therapist with an overarching assessment ability as well as an in the moment assessment ability. It is key to recognize how much these models benefit Adventure Therapists in performing the ongoing assessment of clients throughout an AT experience. Ongoing assessment gives Adventure Therapists the necessary information to make treatment adjustments and shifts which is vital to maintaining a productive treatment plan concurrent with evolving client needs.

In my search for different assessment approaches, I came across this webpage from the National Clearinghouse on Families and Youth (NCFY). The webpage displays a table with an extensive list of assessment tools for "measuring mental health, substance abuse, and independent living skills in adolescents." The webpage provides three roles of assessments: "Identify strengths and needs; Measure baseline and changes over time; Accurately identify youth in need of treatment." According to the table, none of the assessments last more than 2 hours and the majority only take 30 minutes or less. Out of 39 assessment tools, 20 do not require any special training to perform the assessment. The good majority of these assessments are in the form of questions. From this information, it appears that these assessments are designed to gain information on a specific aspect of adolescent issues in a short amount of time.

A study from the World Psychiatry online journal studied the reliability and benefits of the development of the Global Mental Health Assessment Tool- Primary Care Version (GMHAT/PC). Results indicated that this computer-based assessment tool is reliable and due to its ease of use, it is very beneficial for Primary Care Physicians and professional who do not have extensive training in mental health disorders. The article spoke on how beneficial such a tool could prove to be because of the great benefits it would provide for early detection of mental health disorders. You can find the article here.

In relating these three different assessment approaches, I feel that each type obviously serves its own purpose. The purpose for which the GMHAT/PC was created is definitely important. Children and adolescents do not receive mental health treatment unless the need is noticed. For far too many, the supervision is not present that would notice such disorders. Having a way for the everyday general practitioner to quickly and effectively assess mental health in patients is extremely positive. If more adolescents were diagnosed earlier in their lives, they would be able to receive necessary treatment earlier as well. Suffice to say, this would decrease the likelihood of adolescents engaging in destructive and harmful behavior to themselves and others.

The many assessment tools listed on the table provided by the NCFY, are similarly beneficial for determining the presence of a mental health condition and appropriately naming it, however these tools are appear much more specific. For the purposes of my discussion here, administering assessments like these would be the appropriate next step. Of course, I will argue that an appropriate third step is AT. An Adventure Therapist can information provided from various assessments in determining the context of clients' situations. The main difference comes in the ongoing assessment of the clients. A seasoned Adventure Therapist can effectively utilize the CHANGES and GRABBS models to provide a system and means for assessment that is far more detailed, personalized, and up to date with clients' ever-developing treatment. I do not suggest any one tools as better or worse than another. They all have their use and place in mental health treatment.


References:

Assessment and Screening Tools for Measuring Mental Health, Substance Abuse, and Independent Living Skills in Adolescents. Prepared for the Family and Youth Services Bureau by the National Clearinghouse on Families and Youth. Retrieved from: http://ncfy.acf.hhs.gov/book/export/html/476

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York: Routledge/Taylor & Francis Group.

Sharma, V.K., Lepping, P., Cummins, A.GP., Copeland, J.RM., Parhee, R., Mottram, P., (June 2004). The Global Mental Health Assessment Tool- Primary Care Version (GMHAT/PC). Development, reliability, and validity. World Psychiatry, 3(2). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414685/

Week 6: Nature's Benefits

Topic: Pick one of the therapeutic benefits of nature and link them to research in one or more of the following areas: Abnormal, Behavioral Neuroscience, Cognitive, Developmental, Learning, and Social.

The therapeutic benefit of nature that I found most interesting in chapter 5 of Adventure Therapy: Theory Research, and Practice, is the idea of soft fascination originally theorized by Kaplan and Kaplan (Gass, Gillis, and Russell, 2012). According to the text, "Soft fascination occurs when involuntary attention is engaged and demands on a depleted direct attention are diminished, thus making restoration possible" (p. 106). An example of this is watching a butterfly flutter from flower to flower. This does not necessitate a great deal of attention on the part of the onlooker, but its ability to fascinate the onlooker is ever-present nonetheless. The text explains how cognitive reflection can take place during such experiences because the onlooker is fascinated and stimulated.

In this entry of her Blog entitled, Threads of Awakening, Leslie Rinchen-Wongmo discusses research on direct attention and soft fascination. She provides an interesting comparison between these two types of attention and two types of meditation. She links direct attention to breath work and visualization techniques. She links soft-fascination to sky gazing and simple resting meditation. She sums up her insight suggesting, "With directed-attention meditation methods, one pulls the attention back from its wanderings and places it on the object of meditation. In what I’m now viewing as soft-fascination methods, the task is to notice, to open, to include, and to rest – in fascination." 

In relation to Adventure Therapy, I feel that mediation techniques similar to this idea of soft fascination could be extremely useful tools. I think AT practitioners could build on soft fascination to teach participants meditation methods which they can utilize once they leave the wilderness. It would be extremely beneficial for participants who are to return to homes where they will not experience significant time with nature to learn a mediation practice that utilizes soft fascination but does not necessarily require a remote natural setting. 

In a Psychology Today article, Michael Formica discusses research on meditation and the brain. Results demonstrate long term meditators as having larger areas of the brain that deal with emotion regulation. "Meditators displayed a significantly larger volume of hippocampal tissue, as well as a similarly increased volume of tissue in the orbito-frontal cortex, the thalamus and the inferior temporal gyrus." Formica goes on to explain that while meditation has been long recognized to reduce stress and aid cognitive functioning, this research highlights significant evidence of such occurrences in brain structure. 

As seen here, there are many different recognized forms and styles of meditation. Some of this could be considered "directed-attention" methods and some "soft-fascination methods," and they may all have the potential for positive effects on brain structure and cognitive functioning. Project Meditation even provides meditation techniques for specific mental illnesses and overall psychological issues. 

All in all, there is a great deal to be learned about the benefits of meditation and soft fascination in the world of Adventure Therapy. I wonder what methods of meditation will provide the best results for participants. I also wonder in what ways soft fascination type practices will be beneficial and in what ways direct attention practices will be beneficial. Most importantly, how can AT professionals ensure that participants leave programs with such skills so that they can reap the benefits back home?

References:

Faregreen, C. Project-Meditation.Org. Meditation Psychology. Retrieved from: http://www.project-meditation.org/a_bom1/meditation_psychology.html

Formica, M. J. (June 10, 2010). Psychology Today. Enlightened Living: Mindfulness practice in everyday life. Research Suggests Meditation Increases Gray Matter. Retrieved from: http://www.psychologytoday.com/blog/enlightened-living/201006/research-suggests-meditation-increases-gray-matter

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York: Routledge/Taylor & Francis Group.

Rinchen-Wongmo, L. (2009). Threads of Awakening. Environment, Meditation, & Soft Fascination. Retrieved from: http://threadsofawakening.com/environment-meditation-soft-fascination

The Meditation Society of America presents Meditation Station. 108 Meditation Techniques. Retrieved from: http://www.meditationsociety.com/108meds.html

Week 5: AT Research

Topic: Pick one of the outcome areas of AT research and link them to research in one or more of the following areas: Abnormal, Behavioral Neuroscience, Cognitive, Developmental, Learning, and Social.

In Adventure Therapy: Theory, Research, and Practice, Gass, Gillis, and Russell include the results of a few studies that showed a decrease in client substance abuse after an AT experience (2012). The key word here is ‘few’. The authors make it clear that more research with greater significance must be obtained to understand the relationship between AT and clients with substance abuse. With much time and attention, AT researchers will better understand this relationship, the AT elements that impact substance abuse reduction most, and how to best implement this knowledge and form programs that consistently report significant research results.

In chapter 13, the authors mention the “black box effect in AT research.” Essentially, clients enter an AT program, the “black box,” and exit a changed person. It is clear that the client has been transformed, however placing a finger on the exact elements of the AT experience which facilitated the transformation proves difficult.

In a best-case scenario: a client enters a program with a drug abuse problem and exits with the skills necessary to abstain from drugs, live a fulfilling life, and become a positive force in society. 

In a best-case scenario: the AT program providing this experience knows the exact aspects of the experience that facilitated the transformation and knows how to adapt them to other clients to produce positive results time and time again. 

 AT has great potential for clients with substance abuse problems due to the fact that the population with the greatest need for treatment falls in the age range of most AT programs. According to the National Institute on Drug Abuse, “Drug use is highest among people in their late teens and twenties. In 2011, 23.8 percent of 18- to 20-year-olds reported using an illicit drug in the past month (Drug Facts, 2012).”

From much research, the National Institute on Drug Abuse also reports “Principles of Effective Treatment”.  The nature of substance abuse and its effects on the individual are explained in regard to effective treatment. The various principles are easily linked to each of these schools of psychology: 

• Abnormal: 
• Principle 9. "Many drug-addicted individuals also have other mental disorders."

• Behavioral Neuroscience:
• Principle 1. "Addiction is a complex but treatable disease that affects brain function and behavior."

• Cognitive: 
• Principle 3: "Treatment needs to be readily available."
• When individuals think they may want help, it needs to be available because before long, the individual may reconsider. 

• Developmental: 
• Principle 8: "An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs."

• Learning: 
• Principle 5. "Remaining in treatment for an adequate period of time is critical." 
• Three months or longer is advised for substance abuse treatment.

• Social: 
• Principle 6. "Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment." 

Overall, it is clear that AT research has a long way to go in determining the magic inside the black box. Multiple schools of psychology and respective research need to be in constant consideration and regularly utilized in the ongoing development of AT research and program development. It seems clear that the major difficulty will be determining the most successful practices and treatment programs for varied individuals. Between client factors of age, drug(s) of choice, co-occuring mental health diagnosis, family, education, and other demographics and AT therapeutic factors of instructor, therapist, location, activities, and discussion AT researchers have many variables to take into account and twiddle around with in the black box until the box turns crystal clear.

                                                                                                                  Picture done by me in Paintbrush

References:

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York: Routledge/Taylor & Francis Group.

National Institute on Drug Abuse (December 2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved from: http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment

National Institute on Drug Abuse (December 2012). Drug Facts: Nationwide Trends. Retrieved from: http://www.drugabuse.gov/publications/drugfacts/nationwide-trends

Week 3: Comparing Approaches

Topic: Compare and contrast the approach to AT treatment presented in Chapter 3 to at least 3 different approaches to mental health treatment.


In Adventure Therapy: Theory, Research, and Practice, Gass, Gillis, and Russell explain an integrative approach that is used in the field of AT (2012). This approach is termed the ABC-R model, which stands for Affect, Behavior, Cognition, and Relationships. The text explains how adventure therapists are able to use this model to adapt to the client’s needs. The therapist will recognize where to start with a client, utilizing the client’s affect, behavior, or cognition as an initial way to make a connection. Once the therapist has made it this far, the text explains how important the building of quality relationships is in the ability for the therapist to access the other two components. The relationship between the therapist and the client is definitely the highest priority, but other relationships, like with the family or field staff are important as well.

Group therapy is closely related to the AT therapeutic approach due to the fact that they both utilize a combination of the foundational psychotherapeutic schools of thought, like psychoanalytic, interpersonal, behavioral, and cognitive psychology among others. Here is the American Group Psychotherapy Association website.

Art Therapy is quite similar to AT. Other than the fact that one utilizes adventure and the other art, both share the common approach to meet the client where he or she is. According to the American Art Therapy Association’s website, art therapists are trained to bring out clients' inherent art producing abilities to access their thoughts, feelings, and behaviors. 

Another approach to mental illness treatment is Dialectical Behavior Therapy (DBT). According to Behavioral Tech, LLC, DBT was first created for patients with Borderline Personality Disorder in response to problems that surfaced when applying the Cognitive Behavioral Therapy (CBT) approach. Essentially DBT is a form of CBT with three significant added, or more focused strategies; validation of feelings and thoughts, desire to change, and dialectical strategies which serve as the means to balance acceptance (validation) and change. Practicing mindfulness is essential to this process. This approach is extremely client driven and requires the therapist to meet the client where he or she is, just like the AT approach.

It seems clear that all of these approaches have in some way come about due to a recognized need for psychotherapy to be more adaptable to clients' needs as opposed to applying a specific and rigid approach that leaves little room for sufficient adjustments. All of these can be used individually (other than group therapy) or in a group setting or can utilize a combination of the two. It seems as though the more flexible an approach can be without jeopardizing the integrity of the treatment.



References:

American Art Therapy Association. Retrieved from: http://www.arttherapy.org

American Group Psychotherapy Association. Retrieved from: http://www.agpa.org

Behavioral Tech, LLC. DBT Resources: What is DBT? Retrieved from: http://behavioraltech.org/resources/whatisdbt.cfm.

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York: Routledge/Taylor & Francis Group.

Week One: AT Compared

Topic: Compare and contrast the definition of Adventure Therapy with at least three (different) approaches to mental health treatment.


According to Gass, Gillis, and Russell, “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.” This definition has three main elements. First, the definition calls for "prescriptive use. . .provided by mental health professionals." This means that AT is utilized by professionals to conduct intentional therapy based on client needs. Second, the adventure activities are "often conducted in natural settings." This is the main unique element that sets AT apart from other approaches to mental health treatment. Finally, AT is meant to "kinesthetically engage clients on cognitive, affective, and behavioral levels." These three elements are the basis of psychology and therapy. AT claims to engage patients thoughts, feelings, and actions through the use of active experiences. As aforementioned, the primary aspect of the AT approach that sets it apart from others, is the utilization of adventure activities as the means to asses the patient and bring about positive growth and change. 

Other approaches to mental health treatment include psychoanalysis, cognitive behavioral therapy, and group therapy. Here are definitions of each:

“Psychoanalytic treatment explores how. . . unconscious factors affect current relationships and patterns of thought, emotion and behavior. Treatment traces theses patterns back to their historical origins, considers how they have changed and developed over time, and helps the individual to cope better with the realities of their current life situation” (About Psychoanalysis). 

"Cognitive behavioral therapy (CBT) is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors. By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping" (Duckworth & Freedman).

"Group therapy is a type of psychotherapy that involves one or more therapists working with several people at the same time" (Cherry). 

Overall, AT is similar to these treatment approaches do to the fact that they all have the same underlying goal, which is to help the patient grow cognitively, affectively, and behaviorally. Psychoanalysis focuses on the unconscious and the past in discovering patterns associated with these three elements. CBT also focuses on these patterns and the negative, destructive connections between the elements. The thing about AT is that it can utilize psychoanalysis, CBT, group therapy, and an array of other treatment approaches but other approaches cannot utilize AT, for then it would be AT. 

References

Cherry, K. (2013). What is Group Therapy? Retrieved from: http://psychology.about.com/od/psychotherapy/f/group-therapy.htm

Duckworth, K., & Freedman, J. L. (2012, July). Treatment and Services: Cognitive Behavioral Therapy (CBT)? Retrieved from: http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York: Routledge/Taylor & Francis Group.

About Psychoanalysis. (2013). http://www.apsa.org/About_Psychoanalysis.aspx#What