Here are the slides from an adventure therapy professional development workshop I ran in Adelaide in March of 2017. The seminar discussed the importance of engagement, a therapeutic relationship, and provided a brief introduction to Feedback-Informed Treatment (FIT) and how we have incorporated FIT into our adventure therapy program.

4. Ummannaq, Greenland

19. About Me
Education
BSW - University of Maryland – Baltimore County
MSW[AP] - Charles Sturt University
Run a small adventure therapy program in SA
Awarded Australian Postgraduate Award by CSU
Australian Association for Bush Adventure Therapy

20. Co-Adventuring with At-Risk Youth
• The Business of It All – Consumers, Professionals, & Service Delivery
• Finding What Works – Research & Practice
• Feedback & Continuous Quality Improvement

21. 1976 in Australia

22. 1976 in Psychology & Social Work
• Smith & Glass conduct meta-analysis of therapy outcomes
• Clients are better off than 75% of people who do not engage
• No difference in outcomes between types of interventions provided

23. 2017: What’s changed?
• No improvement in outcomes.
• Dropouts average at 47%
• No one type of intervention has proved itself superior
• Supershrinks: Some therapists achieve better outcomes than others
• No evidence to support that we get better with experience

24. Therapeutic Factors

25. Quality of Participation
• Relationship improves Engagement
• Engagement predicts Outcome

26. Adventure Therapy Specific Ingredients
• Time in Nature
• New Environment
• Away from Home
• Fun / Engaging
• Hard Skills (i.e. Navigation)
• The Metaphor of Survival
• Relationship to Team Leader
• Peer / Social Environment
• Team initiatives
• Climbing / Abseiling
• Group Responsibilities
• Self Sufficiency
• Time for Reflection
• Exercise (i.e. Hiking)
• Healthy Sleep Patterns
• Nutrition
• Journaling / Worksheets
• Time Spent Problem Free

27. The Importance of Feedback
• Participant ratings of experience are better than our guess
• Tailor-Fitting Our Programs
• Reduces the likelihood of participants getting worse under our care
• Critical to effective follow-up

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ORS SRS Collateral ORS
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31. Creating a Culture of Feedback
• Ask participants for ’Task Centered’ Feedback
• Thank participants for their feedback
• The key is not to measure, the key is to obtain negative feedback
• Don’t worry about honesty, worry about engagement
• Create an environment for creative suggestions

35. Attending to your Participants
• Make them feel very special
• Validate their efforts to solve their problems
• Empathy not only for the negative, can we be empathic to the good?
• Try not to validate the problem story as often
• Create a picture of the participant that is on the move

37. • Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77(4), 693-704.
• Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors of therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33-56). Washington, DC: American Psychological
Association.
• Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842-852.
• Bertolini, B., & Miller, S. D. (2012). ICCE manuals of feedback-informed treatment (Vol. 1). Chicago, IL: ICCEPress.
• Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252-260.
• Bowen, D. J., & Neill, J. T. (2013). A meta-analysis of adventure therapy outcomes and moderators. The Open Psychology Journal, 6, 28-53.
• Brown, J., Dreis, S., & Nace, D. (1999). What really makes a difference in psychotherapy outcome? Why does managed care want to know. In M. A. Hubble & S. D. Miller (Eds.), The heart and soul of change (pp. 389-406). Washington DC: APA Press.
• Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thurnton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337-345.
• Diaz, C., & Drewery, S. (2016). A critical assessment of evidence-based policy and practice in social work. Journal of Evidence-Informed Social Work, 13(4), 425-431.
• Draper, S., Bjorklund, E., Hess, J. Z., & Preece, N. (2013). Poison apples, big bad wolves, and other "happy hending" spoilers: Overcoming barriers to enduring change following youth residential treatment. Journal of Therapeutic Schools and Programs, 4(1), 69-97.
• Duncan, B. L., & Miller, S. D. (2007). The Group Session Rating Scale. Jensen Beach, FL: Author.
• Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-directed, outcome informed therapy. San Francisco, CA: Jossey-Bass.
• Duncan, B. L., Miller, S. D., & Sparks, J. A. (2007). Common factors and the uncommon heroism of youth. Psychotherapy in Australia, 13(2), 34-43.
• Duncan, B. L., Miller, S. D., Sparks, J. A., Claud, D. A., Reynolds, L. R., Brown, J., & Johnson, L. D. (2003). The session rating scale: Preliminary psychometric properties of a "working" alliance measure. Journal of Brief Therapy, 3(1), 3-12.
• Fernee, C. R., Gabrielsen, L. E., Andersen, A. J., & Mesel, T. (2017). Unpacking the black box of wilderness tehrapy: A realist synthesis. Qualitative Health Research, 27(1), 114-129.
• Gabrielsen, L. E., Fernee, C. R., Aasen, G. O., & Eskedal, L. T. (2015). Why randomized trials are challenging within adventure therapy research: Lessons learned in Norway. Journal of Experiential Education, 39(1), 5-14.
• GAO. (2007). Residential treatment programs: Concerns regarding abuse and death in certain programs troubled youth. Retrieved from United States Government Accountability Office: http://www.gao.gov/new.items/d08146t.pdf
• Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70(2), 439-443.
• Gillis, H. L., Speelman, E., Linville, N., Bailey, E., Kalle, A., Oglesbee, N., . . . Jensen, J. (2016). Meta-analysis of treatment outcomes measured by the YO-Q and Y-OQ-SR comparing wilderness and non-wilderness treatment programs. Child and Youth Care Forum, 45, 851-863.
• Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., & Sutton, S. W. (2005). A lab test and algorithms for identifying clients at risk for treatment failure. . Journal of Clinical Psychology, 61(2), 155-163.
• Hubble, M. A., Duncan, B. L., Miller, S. D., & Wampold, B. E. (2010). Introduction. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapyq (2nd ed.). Washington DC: American Psychological Association.
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