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The Attitudes of Irish Professionals
using an Adventure Therapy approach
in Drug Rehabilitation Centres
Damien Beatty
Galway Institute of Technology, Castlebar Campus
2016
1
The Attitudes of Irish Professionals
using an Adventure Therapy approach
in Drug Rehabilitation Centres
Damien Beatty
This Dissertation was submitted in part fulfilment of the requirements for the
Bachelor of Arts Degree in Outdoor Education at the Galway-Mayo Institute of
Technology, Castlebar Campus.
2016
I hereby declare that this dissertation is my own work.
_______________________________
2
Acknowledgements
This study is entirely dedicated to my mother (Catherine) and father (Damien) for their
continuous support and encouragement throughout my years of study. I would not be in the
position I am today without your advice.
To my sisters (Shereen, Louise, and Katie), my brothers (Ian, and Jordan) for their
continuous support and respecting my space to study within a busy household, I applaud
your patience for accepting my adventurous and sometimes chaotic lifestyle.
To my tutors Kevin O Callaghan and Stephen Hannon for their unlimited hours of advice,
encouragement and belief in me. I do not envy your tutorial positions consisting of the vast
amount of hours correcting dissertation drafts and research methods. With great respect I
applaud your patience and professional guidance.
To my student support worker Celine King who guided me through the thick and thin of
this dissertation. At times I thought I would never get this research done. I definitely
applaud your patience and professional advice, I am forever in debt for your unlimited time
reading and correcting my dissertation over and over again.
To my college counsellor Michelle Kerins O Brien for supporting me through a tough year
of college. No matter how stressful and chaotic my college life became you were always
there to support and listen to me. Thank you for your time and support.
Finally to my sample group. Without having such professionals in the field of drug
rehabilitation and adventure therapy. I thank you with great appreciation for taking time
out of your busy schedules to participate in this study this research.
3
Abstract
This study focusses on the attitudes of Irish professionals using an Adventure Therapy
approach in drug rehabilitation centres with adolescents. With the lack of literature
surrounding Adventure Therapy in an Irish context this research will explore the link
between Adventure Therapy, Adolescents, Substance Abuse Addiction and Substance
Related Rehabilitation. It will examine the attitudes of professional drug rehabilitation
therapists towards an Adventure Therapy Approach within Irish drug rehabilitation centres.
The research methods used for this study were completed through a structured survey
which included a mixed method approach of open ended and close ended questions.
Contrasting the results attained from the Survey and findings of the Literature Review
identified that Adventure Therapy could potentially be an approach adopted into Irish drug
rehabilitation services considering the appropriate evidence and funding is acquired.
This study concludes that an Adventure Therapy approach would benefit models identified
in Irish drug rehabilitation programmes providing additional adequate resources are
required. It also concluded that a professional qualification for Adventure Therapy should
be considered with additional professional qualifications in the field of drug rehabilitation
therapists.
.
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Table of Contents
Clarification of Terms ........................................................................................................... 7
Chapter 1 Introduction ........................................................................................................... 8
1.1 Introduction ................................................................................................................. 8
1.2 Justification ................................................................................................................ 10
1.3 Historical Background ............................................................................................... 11
1.4 Background Information to this Topic ...................................................................... 12
Chapter 2 The Literature Review ........................................................................................ 13
2.1 Introduction ............................................................................................................... 13
2.2 Adventure Therapy .................................................................................................... 13
2.2.1 Defining Clinical Adventure Therapy ................................................................ 14
2.2.2 Adventure Therapy Models ................................................................................ 14
2.2.3 The Process of Adventure Therapy .................................................................... 16
2.3 Adolescence ............................................................................................................... 18
2.3.1 Adolescents Role in Society ............................................................................... 19
2.3.2 Key Issues involving Adolescents in today’s Society ........................................ 19
2.4 Addiction ................................................................................................................... 20
2.4.1 Substance Related Addiction .............................................................................. 21
2.4.2 Common Trends of Substance Related Addiction amongst Adolescents .......... 22
2.4.3 Adolescents Experimenting with Drugs ............................................................. 23
2.5 Substance Related Rehabilitation .............................................................................. 23
2.5.1 Substance Related Rehabilitation Models .......................................................... 24
5
2.5.2 Processes of Substance Related Rehabilitation .................................................. 25
2.5.3 Irish Rehabilitation Centres for Young People with Addiction ......................... 26
2.6 Chapter Summary ...................................................................................................... 28
Chapter 3 Methodology ....................................................................................................... 30
3.1 Introduction ............................................................................................................... 30
3.2 Restatement of Research Question ............................................................................ 30
3.3 Instrumentation .......................................................................................................... 30
3.4 Research Paradigm .................................................................................................... 31
3.5 Research Design ........................................................................................................ 31
3.6 Rationale for Research Design .................................................................................. 32
3.7 Sample Population ..................................................................................................... 33
3.8 Scope ......................................................................................................................... 33
3.9 Limitations ................................................................................................................. 34
3.10 Ethical Considerations ............................................................................................. 34
3.11 Informed Consent and Confidentiality .................................................................... 36
3.12 Validity and Reliability ........................................................................................... 36
3.13 Survey Design ......................................................................................................... 37
3.14 Data Collection Procedure ....................................................................................... 37
3.15 Data Analysis Plan .................................................................................................. 37
3.16 Chapter Summary .................................................................................................... 38
Chapter 4 Results ................................................................................................................. 40
4.1 Introduction ............................................................................................................... 40
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4.2 Summary of Statistical Analysis................................................................................ 40
4.3 Tables and Figures of Results .................................................................................... 41
Chapter 5 Discussion ........................................................................................................... 53
5.1 Introduction ............................................................................................................... 53
5.2 Literature Findings .................................................................................................... 53
5.3 Research Findings ..................................................................................................... 55
5.4 Contrasting Results .................................................................................................... 57
Chapter 6 Conclusion / Recommendations ......................................................................... 59
6.1 Introduction ............................................................................................................... 59
6.2 Summary of Main Findings ....................................................................................... 59
6.3 Recommendations ..................................................................................................... 60
Section 7 Appendences ........................................................................................................ 62
7.1 Appendix 1 Invitation to Participate in Survey ......................................................... 62
7.2 Appendix 2 Consent to Participation in Survey ........................................................ 63
7.3 Appendix 3 Survey Questions ................................................................................... 64
7.4 Appendix 4 Identification of Illegal Substances........................................................ 67
7.5 Appendix 5 Qualitative Survey Results for Question 5 ............................................ 69
7.6 Appendix 6 Qualitative Survey Results for Question 6 ............................................ 71
Section 8 Bibliography ........................................................................................................ 74
7
Clarification of Terms
Professional:
“Belonging to or connected with a profession” (Oxford Dictionary
Press, 2002, p. 1154).
Attitude:
“A settled opinion or way of thinking” (Oxford Dictionary Press,
2002, p. 87).
Adventure:
“An unusual and exciting experience” (Oxford Dictionary Press,
2002, p. 19).
Therapy:
“The treatment of physical or mental disorders” (Oxford
Dictionary Press, 2002, p. 1496).
Adolescent:
“Between childhood and adulthood” (Oxford Dictionary Press,
2002, p. 18).
Addiction:
“The fact or process of being addicted, esp. the condition of taking
a drug habitually and being unable to give it up without incurring
adverse effects” (Oxford Dictionary Press, 2002, p. 15).
Rehabilitate:
“Restore to effectiveness or normal life” (Oxford Dictionary Press,
2002, p. 1215).
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Chapter 1 Introduction
1.1 Introduction
The aim of this study is to examine the attitudes of Irish professional addiction therapists
towards the use of Adventure Therapy as an approach in a drug rehabilitation setting with
adolescents.
Adventure Therapy has been an effective and successful approach to rehabilitation. This
approach has been implemented by a number of institutes across the world since the late
1960’s (Tucker & Norton, 2012; Crisp, 1998; Gas, 1993; Kimball & Bacon, 1993). At
present there are three separate types of programmes engaging a therapeutic approach in an
outdoor setting which include:
Adventure Therapy:
Adventure Therapy is a term used by practitioners who emphasise that it is the journey in
the outdoors and the adventure experience that connects the natural environment with the
psychotherapeutic process of the individual (Richards, et al., 2011, p. 17).
Wilderness Therapy:
Wilderness Therapy was derived from the work of Kurt Hahn through Outward Bound.
Although this therapeutic experience has no direct connection with Adventure Therapy, its
use of therapeutic approaches in the wilderness environment have been for long periods of
time (Usually up to 16 weeks). This therapeutic programme offered young men to develop
their personal attributes through experiential learning in a place based environment (Gass,
1993, p. 12).
9
Outdoor Experiential Therapy:
Outdoor Therapy involves the use of experiential challenges found in the out-of-doors
environment which provides growth experiences that can help individuals make
fundamental changes in their lives (The Addiction Recovery Guide, 2015).
Outdoor Experiential Therapy focusses not only on a temporary escape from an
individual’s problem but also focusses on the essential elements that is necessary to bring
about a sustained transformation in the persons physical, emotional and spiritual wellbeing
(Red Oak Recovery, 2016).
These three therapeutic approaches define the modern sector of adventure therapy
currently present in the Republic of Ireland (Active Connections, 2011; Comeragh
Wilderness Camp, 2015). The Association for Experiential Education, (2013); Norton, et
al., (2014); Gass, et al., (2012); Tucker & Norton, (2012); Richards, et al., (2011); Norton
& Tucker, (2010); Tucker, (2009); Gillis & Gass, (2004); News & Bandoroff, (2004);
Alvarz, & Stauffer, (2001); Itin, (2001); Crisp, (1998); Buie, (1996); Gass, (1993); Gillis &
Thomson, (1996); Kimball & Bacon, (1993) all agree that Adventure Therapy works
successfully and effectively for a number of mental health issues but with the right
approach it could also work within the process of drug rehabilitation programmes.
With substance related addiction becoming an overwhelming problem amongst adolescents
across the Republic of Ireland in recent years (National Advisory Committee on Drugs,
2011; Butler & Mayock, 2005; Health Promotion Unit, 2003), it identifies that substance
abuse is a growing issue. Substance related rehabilitation treatment and residential services
are struggling to keep up with their day to day duties due to the rise in the number
adolescent drug addicts in recent times (Irish Medical Organisation, 2015; Drugnet Ireland,
2011; Barnardos, 2010; Health Service Executive, 2007). With key issues arising such as
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substance abuse it might allow the use of an Adventure Therapy approach to build a
relationship between the adolescent and a therapist while working on their problems
through an experiential learning environment.
While adventure activities are not the only approach towards effective drug addiction
rehabilitation, there are also key methods to psychologically removing the individual from
their life back home (Red Oak Recovery, 2016). Adventure Therapy components towards
addiction rehabilitation may range from individual and group programmes. These methods
provide nutritional education, boundary setting, communication skills and social skills
development as part of the Adventure Therapy program (Red Oak Recovery, 2016). An
Adventure Therapy approach would be resonable to presume that it may alleviate the
pressure on present services providing beneficial outcomes for drug rehabilitation
programmes with adequete training offered to providers.
1.2 Justification
The aim of this study is to examine the attitudes of professional drug rehabilitation
therapists who might use an Adventure Therapy approach in the process of substance
related rehabilitation amongst adolescents in the Republic of Ireland.
This research topic was selected as a result of a past personal experience witnessing on a
first-hand basis, the impact of drug abuse amongst adolescents in one of Ireland’s most
disadvantaged areas. Adventure Therapy has been identified to be an effective approach
with challenging adolescent’s behaviour (Gass, et al., 2012).
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Due to the lack of written information within this area in the Republic of Ireland, the
author wishes to examine the attitudes of professional drug rehabilitation therapists
towards the use of an Adventure Therapy approach in an Irish context.
1.3 Historical Background
The use of Adventure Therapy started in 1901 within the Manhattan State Hospital East,
United States of America. The institute introduced tent therapy to isolate patients suffering
with TB form other patients. By introducing this strategy the hospital found unexpected
health benefits for patients related to being outside (Association for Experiential
Education, 2013). In 1906, the San Francesco Psychiatric Hospital moved their patients
into tents after an earthquake caused structural damage to the institute. The mental health
of the patients witnessed dramatic improvements as the patients demonstrated improved
social interactions (Association for Experiential Education, 2013). These two events
documented the first cases of using the outdoor environment therapeutically which formed
the foundation concept of Adventure Therapy.
In 1929, the first approach of using camping as a therapeutic tool was designed by Camp
Ahmek, Canada. This specialised programme witnessed the different changes in social
behaviours amongst young males through socialising in a wilderness setting (Association
for Experiential Education, 2013). The second programme that was designed using the
outdoor environment therapeutically emerged in 1946 as part of the Salesmanship Club of
Dallas. This club programme represented the camping experience seeking out its
therapeutic application as their primary goal (Association for Experiential Education,
2013).
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With the lack of Irish documentation it is unclear when an Adventure Therapy approach
was first introduced into the Republic of Ireland. Active Connections (2011) identify that
their aims is “to have Adventure Therapy as an option for all people in need, and at risk in
the country”, Comeragh Wilderness Camp (2015) also attempts to provide a “unique
therapeutic programme for young males who are having difficulty in their home and
school”.
1.4 Background Information to this Topic
Ryan & Larissa (2012, p. 2) cited in Gillis & Thomsen (1993) noting that Adventure
Therapy is an active experiential approach towards group psychotherapy and counselling.
Not only does it utilise an activity base but also it employs real and or perceived risk as a
clinical agent to bring about desired change.
This experiential phase of therapy has had a successful record in North America helping
young adults boost their self-esteem and self-concept by providing an environment in
which they can remove themselves form their daily life distractions (Red Oak Recovery,
2016). While the therapeutic benefits of these programs include connecting with the
natural out-of-doors environment, it also helps to improve the ability to trust ones
judgement through the individual experience of teamwork, building on the attributes of
self-control and taking responsibility for ones own individual actions (The Addiction
Recovery Guide, 2015).
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Chapter 2 The Literature Review
2.1 Introduction
This literature review will focus on themes within Adventure Therapy, Adolescents,
Substance Related Addiction, and Rehabilitation. Many practitioners and professionals are
beginning to identify the negative consequences of a clinicalised health system and that
there are a variety of other potential approaches being explored (Kim, et al., 2009).
Adventure Therapy is one such approach to which has shown to have significant success
with adolescents suffering from physical and mental health difficulties (Gass, et al., 2012;
Tucker & Norton, 2012; Gass, 1993).
2.2 Adventure Therapy
Adventure Therapy as an approach benefits adolescents who abuse substances and is used
amongst various professional practitioners however, Adventure Therapy is a wide topic.
Richards, et al. (2011, p. 17) identifies a number of adventure therapy programmes that
describe work which falls under the umbrella of Adventure Therapy. These include:
Adventure Based Counselling
Wilderness Therapy
Wilderness Adventure Therapy
Therapeutic Outdoor Programming
Bush Adventure Therapy (Australia)
Outdoor Behavioural Health Care
Nature Based Therapy
Eco Therapy
Horticultural Therapy
For this research the author will focus directly on the area of clinical based Adventure
Therapy.
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2.2.1 Defining Clinical Adventure Therapy
Defining Adventure Therapy solely as a clinical tool which therapeutically changes
behavioural patterns in individuals within a natural environment setting is difficult.
However, many researchers agree on the terms and understanding of Adventure Therapy.
Researchers have defined Adventure Therapy as a prescriptive use of adventure
experiences. Using the natural environment to focus on group based therapy, Adventure
Therapy is used as a clinical tool to engage individuals in programmes to promote
therapeutic changes in their behaviour. It is agreed that this therapeutic intervention
approach uses adventure activities to engage clients on cognitive, affective, and
behavioural levels (Gass, et al., 2012; Tucker & Norton, 2012; Norton & Tucker, 2010;
Tucker, 2009; News & Bandoroff, 2004; Alvarz, & Stauffer, 2001; Gass, 1993).
Gass, et al., (2012) and Gass (1993) clearly identifies Adventure Therapy as practices that
are placed in an out-of-doors environment were participants undergo extensive therapeutic
changes. These group based programmes focus on a variety therapeutic outcomes while
promoting changes in the individual behavior. Itin (2001) agrees that Adventure Therapy is
identified as adventure based practice with change directed at the individual’s behavior
patterns that support therapeutic change.
2.2.2 Adventure Therapy Models
There are a number of Adventure Therapy models which contribute to modern clinical
practices (Norton, et al., 2014; Tucker & Norton, 2012; Gass, 1993).
The most common and significant Adventure Therapy models have been documented in a
number of research reports from North America. A number of institutes in North America
15
use Adventure Therapy models as an intervention tool towards a variety of mental health
complications such as substance related addiction (substance abuse, dependency, health
issues), continuous anti-social behaviour (property vandalism, robbery, assault), and family
therapy (Wilderness Treatment Centre, 2015; Blue Fire Wilderness Therapy, 2015;
Equinox Counselling & Wellness Center, 2016; Second Nature Wilderness Therapy, 2016;
Elements Wilderness Program, 2014; Alaska Crossings, 2016). While Gass (1993, p. 9)
notes that “Adventure Therapy has evolved into three distinct areas - Wilderness Therapy,
Long Term Residential Camping, and Adventure Based Therapy”. This observation was
added to in Gillis & Gass (2004, p. 2) the three distinct models were expanded:
1. “Challenge / ropes courses and through the initiative
experiences associated with Adventure Therapy approaches,
2. Wilderness based therapy, example; Outward Bound 20-60 day
wilderness travel programmes,
3. Long Term Residential camping therapy, example; stationary,
primitive living programmes”.
Previously Crisp (1997, p. 58) distinguishes Adventure Based Therapy as an emphasis on
the contrived nature of the task. He identifies that Adventure Therapy programmes are
designed around particular tasks influenced by the therapist to meet specific outcomes for
the needs of each individual. This statement highlights the benefits of an Adventure
Therapy approach and how it can potentially meet the needs of individuals who suffer from
substance related addiction in a drug rehabilitation programme.
While wilderness therapy is a therapeutic experience that occurs in a remote wilderness
setting. These programmes commonly consist of small groups were the client participates
in the programme for multiple days with round the clock intervention. This particular type
of therapy is limited to one extensive experience, which often follow up contact with
therapy is often limited (Gass, 1993, p. 9). Depending on the programmes goals, the
16
outcomes for individuals involved are critical to achieve the difference in behaviour
patterns. While this once off wilderness experiences focusses on an intense therapeutic
experience it is short lived while other programmes such as Long Term Residential
Camping Therapy consists of longer periods with follow up sessions.
With long term residential camping therapy, these programmes value the wilderness
environment for a long period of time and focus on the individual behaviour patterns
(Gass, 1993, p. 10). Buie (1996) utilises the long term residential camping therapy model
by “having a permanent base camp, and temporary camp sites built by campers (typically
tent-covered wood platforms)”. This approach can benefit the outcomes by monitoring
each site which can identify each group’s performance while participating in these
specialised programmes.
Although these models of Adventure Therapy focus on the therapeutic approach each
developed programme must be taken with great care to ensure the success of its intended
outcomes. Understanding the connection between these models in practice, it can
acknowledge how each model can benefit towards an Adventure Therapy approach in an
Irish context. Identifying this key link between these models and the research topic it
constitutes that there is extensive background research done within this specialised area in
North America. This current research supports additional background knowledge when
examining the attitudes of professional drug rehabilitation therapists using an Adventure
Therapy approach within an Irish context.
2.2.3 The Process of Adventure Therapy
There are a number of different processes that utilise Adventure Therapy programmes such
as “prevention, dropout, reintegration, and family” (Gass, et al., 2012), though it may have
17
different effects on the outcome for many individuals. From continuous evaluations and
assessments on newly developed programmes over the past decade, professional
practitioners and theorists claim that adventure programming has had a positive affect
while working with particular sub groups such as adolescents in an out-of-doors
environment (Gass, et al., 2012; Gass, 1993).
Gillis & Thomson (1996, p. 7) agree with this statement by identifying that Adventure
Therapy works through “an active, experiential approach to group (and family)
psychotherapy or counseling”. As they acknowledge that most of the therapeutic work
goes on in one-to-one conversations between the therapist and client while participating in
an activity, they emphasise that they must employ real or perceived risk to grasp that
significant clinical agent for the success of the programme.
With a different approach from Nold & Wilpers (1975, p. 155) they argue that “adventure
programmes are only part of the rehabilitation process” in addiction groups. While this
statement signifies that Adventure Therapy cannot be the only approach towards a
rehabilitation process, Gass (1993, p. 5) also agrees that “Adventure Therapy is not used to
replace other therapeutic interventions and practices; instead, it is used to enhance
established treatment objectives and to provide a richer therapeutic environment for change
so that the therapy itself is more successful”.
The process of an Adventure Therapy model is a critical element in the development of a
programme which witnesses its clients participating in a physically and mentally active
role. This process allows the participant to develop through an experiential approach in an
out-of-doors environment.
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2.3 Adolescence
As this study focusses on the attitudes of Irish professionals using an Adventure Therapy
approach in drug rehabilitation centres with adolescents, it is obligatory to emphasise the
importance of why adolescents experiment with drugs and identify the common trends
within this industry. It also explores the impact of substance related addiction and how
adolescents don’t recognise future consequences from experimenting with such substances.
As the topic of this subject focusses in part on adolescence and substance abuse, addiction
is therefore important to identify the concept of adolescence and explore the different roles
that adolescents play in society along with key issues they face during this period in life.
Kaplan (2004, p. 1) defines the term adolescence to be “the period of life between
childhood and adulthood”. While Leener (2010, p. 1) supports this definition by
acknowledging that it is a period in one’s life when they transform childlike behaviour
patterns to adult like behaviour patterns, he considers that it is important to recognise one’s
characteristics in order for a change to develop into an adolescent.
Gass (1993, p. 39) agrees that the transition from adolescents into adulthood is a difficult
one. As some adolescents who do not develop certain attributes and responsibilities before
reaching a certain age may be ill equipped for the life journey ahead of them.
During this period in a young person’s life, they develop a more physically advanced
change in their body known as puberty which usually takes place between the ages of
twelve to eighteen years old (BBC, 2015). They develop an understanding of society and
how the world works through various forms of education and experiences. This not only
offers an opportunity for them to create an identity in society but also encourages them to
express their needs and interests amongst peers (Kaneshiro, 2015; American Psychological
Association, 2002; Dunham, et al., 1995; Archer & Waterman, 1983; Erikson, 1959).
19
2.3.1 Adolescents Role in Society
Adolescents find their role in society through active searching which leads to discoveries
about themselves (James, 1986). As an adolescent turns eighteen years of age, society
entrusts them with certain privileges such as voting, driving, serving in armed forces,
purchasing and drinking alcohol, further education, legal sexual relationships and marriage
which acknowledge their roles as adults (James, 1986).
Perkins (2007, p. 1) identifies that an adolescents identity is influenced by their current
culture trends. While acknowledging these trends he also concludes that there are a number
of important developmental roles for adolescents to develop their identity in society. The
desire to achieve social responsibility one must acquire a set of ethical values to prepare
for an economic career with possible interests of marriage and family life.
This study allows an understanding of the role of adolescents in today’s society, while
focusing on the young person creating their own identity through a range of different
experiences. It can also include an opportunity for experimentation that can potentially
lead to some form of substance related abuse.
2.3.2 Key Issues involving Adolescents in today’s Society
Key issues involving adolescents in today’s society is an important aspect for this study.
While adolescents get a sense of independence, risk taking is on high demand as they want
to experiment to find their own identity therefore there is a high emphasis on approval of
peers (ReCAPP, 2007). This involves experimenting and experiencing Physical
Development, Cognitive Development, Emotional Development, Social Development, and
Behavioral Development (National Institute on Drug Abuse, 2014; American Academy of
20
Child and Adolescent Psychiatry, 2011). Part of this psychological transition, it offers an
adolescent the opportunities to experiment with new behaviors which can result in risk
taking, a normal part of adolescent development. Risk taking behavior includes developing
realistic assessments of themselves while gaining peer acceptance and respect. This
behavior helps to shape their identity by exploring new decision making skills, but
unfortunately may pose a real treat to their own health and wellbeing (ReCAPP, 2007).
While an adolescent begins to achieve a realistic sense of identity they also experiment
with the different ways they appear and behave. Although they may approach these
different transitions in his or her own unique way (American Psychological Association,
2002, p. 15) they also explore other areas of concern such as education, sexual
relationships, drug and alcohol abuse (American Psychological Association, 2002, p. 29).
Adolescence is “a time when experimenting with alternatives is developmentally
appropriate, except when it seriously threatens the youth’s health or life” (American
Psychological Association, 2002, p. 15).
In Adventure Therapy adolescents have the opportunity to take risks in a safe and
controlled environment. Where the risk may be real are perceived and is controlled.
2.4 Addiction
Medilexicon (2015) defines addiction as “An individual who does not have control over
what they are doing, taking or using. Their addiction may reach a point where it becomes
problematic which may cause harm to themselves our others around them”. However the
Norlien Foundation (2014) broadens this definition by breaking it into three categories:
21
Behavioural / Process Addiction example: Gambling, Food,
Sex, Internet, Video Games, Work
Substance Related addictions example: Tobacco, Alcohol,
Street Drugs, Prescription Drugs
Multiple Addictions and Co-morbid Factors example: Any type
of addiction plus depression, anxiety.
2.4.1 Substance Related Addiction
Substance related addiction is one of the most recognisable forms of addiction in Irish
society as the physical and mental impact upon one’s body can vary depending on their
usage of a substance related drug (Butler & Mayock, 2005; Corrigan, 1986; Dean, et al.,
1985). American Psychiatric Association (2000) defines substance related addiction in the
Diagnostic and Statistical Manual of Mental Disorders as:
“A maladaptive pattern of substance use leading to clinically
significant impairment or distress, as manifested by three (or more)
of the following, occurring any time in the same 12-month period:
1. Tolerance.
2. Withdrawal.
3. Substance quantity increases.
4. Persistent desire to reduce quantity of substance.
5. More time consumption to obtain substance.
6. Personal interests are reduced because of substance use.
7. Continued usage despite knowledge of physical and
psychological problems”.
Substance related addiction is a psychological or physiologic dependence of a substance
which is beyond an individual’s voluntary control. With persisting usage of a substance
despite problems related to its dependency it may be diagnosed. While trying to withdraw
22
from an addictive substance the individual may experience psychological and/or physical
withdrawal symptoms (MediLexicon, 2015; American Psychiatric Association, 2013).
Although these statements clearly define substance related addiction as a term used for an
addict who does not have full control over their behavior towards a substance. The
influence of a substance within an individual’s body may put themselves and others at risk
through their actions, therefore their dependency for the substance becomes addictive.
2.4.2 Common Trends of Substance Related Addiction amongst Adolescents
There are a number of trends for substance related addiction in today’s society. The
National Advisory Committee on Drugs (2011, p. 8) recognise that the most common
substance related addiction in the Republic of Ireland alone relates to Tobacco and
Alcohol. While other illegal drugs are also easy accessible to the adolescent group the most
common ones can be found in Appendix 4.
The Global Drug Survey (2014, p. 14) clarifies that the most common illegal substances
consumed in Irish society are Opioid Pain Killers and Benzodiazepines which is a common
substance taken by young people.
The Health Promotion Unit (2003) acknowledges all forms of drugs stated in Appendix 1
and recognises the same trends as expressed in other studies presented by the Global Drug
Survey (2014, p. 14) and the National Advisory Committee on Drugs (2011, p. 8).
23
2.4.3 Adolescents Experimenting with Drugs
Both Drug.ie (2015) and Irishhealth.com (2015) agree on the reasons as to why adolescents
take drugs. An adolescent believes that in taking drugs they feel and look grown up; they
take them to feel good and for fun; because their friends do and for the experience or out of
curiosity. Those surveyed also suggested that they use drugs to escape problems
(Irishhealth.com, 2015).
According to National Advisory Committee on Drugs (2011, p. 8) experimentation
amongst young people starts off on other substances such as tobacco and alcohol,
dependency on these substances can potentially lead to more explicit drugs such as
cannabis and with extensive use of such substance can lead to an addiction (The Children's
Research Centre, 1997, p. 8; Smyth, 2006).
Adulterer evidence suggests that during the adolescent stage in life there are certain
behaviours that influence ones approach of risk taking. The reason why adolescents
experiment with substances such as drugs is because it is part of forming an identity,
leading them into adulthood and also shows the importance of social bonding with their
peers.
2.5 Substance Related Rehabilitation
While this study focusses on the attitudes of Irish professionals using an Adventure
Therapy approach in drug rehabilitation centres with young drug addicts, this section
identifies models of rehabilitation that exist within the republic of Ireland. This section also
explores the current processes and availability of services and institutes to adolescents who
suffer from substance related addiction within the republic of Ireland.
24
The World Health Organisation (2011, p. 96) defines rehabilitation as “a set of measures
that assist individuals who experience, or are likely to experience, disability to achieve and
maintain optimal functioning in interaction with their environments”. Oxford Dictionary
(2002, p. 1439) defines substance related abuse as “An intoxicating, stimulation, or
narcotic chemical or drug, especially an illegal one”. When combining both aspects of
substance related abuse and rehabilitation the Department of Community, Rural and
Gaeltacht Affairs (2007, p. 7) conclude that substance related rehabilitation is “A
structured developmental process whereby individuals are facilitated to become fully
involved in the process of regaining their capacity for daily life free from the impact of
problem drug use”.
The undersanding of these statements acknowledge that substance related rehabilitation is
directly referred to the rehabilitation of those who suffer from a chronic substance related
addiction. This defrintiates ones overall context of rehabilitation to a more specific
rehabilitation setting such as substance related rehabilitation. The connection between
substance related rehabilitation and the study topic is in fact an important element for the
justification of professional clinical therapists. While exploring their methods of practice
within the work place it might identify a gap that could promote the use of an adventure
therapy approach in a rehabilitation setting.
2.5.1 Substance Related Rehabilitation Models
There are a number of rehabilitation models available for those who suffer from substance
related addiction. The Department of Community, Rural and Gaeltacht Affairs (2007, pp.
20 - 21) noted in the National Drugs Strategy 2001 - 2008 that due to the broad socio-
demographic use of drugs there is not one over all model that will suit all. However it is
25
also recognised that in all models there are some constraints that must be in place to
provide a successful and effective programme, these include:
Preparation for and rapid access to rehabilitation
Social and environmental factors
Retention in a residential programme where appropriate.
Doyle & Ivanovic (2010, p. 9) adds to these measures, noting that an individual’s needs
and experiences must also be taken into consideration in order to improve a successful
outcome. The measures considered include:
Drug Specific Intervention
Family Support and Childcare
Aftercare
The Centre for Substance Abuse Treatment (2005) distinguishes two models of substance
related rehabilitation by using an outpatient programme and a residential programme
approach.
From the research provided it concludes that all models of current rehabilitations are
developed to meet the individual needs of addicts. All the models of rehabilitation
programmes aim towards one goal which is to successfully rehabilitate an individual
suffering from addiction and re-conform them back into society.
2.5.2 Processes of Substance Related Rehabilitation
Considering the models recommended by Doyle & Ivanovic (2010), the Department of
Community, Rural and Gaeltacht Affairs (2007) and the Centre for Substance Abuse
Treatment (2005), the process of substance related rehabilitation must also judge what is
suitable for each individual case. The World Health Organisation (2011) who overview the
population of world health, identifies the process of substance related rehabilitation by
26
addressing such problems and addressing the needs of each individual. These factors
include adapting the problem to appropriate measures taken for each individual such as
planning, implimenting and coordinating interventions and assessing the after effects.
The National Institute on Drug Abuse (2009) and Nordqvist (2009) recognise that drug
addiction is a complex illness that often goes untreated. They add that there are many
effective approaches to treatments including programmes, medications, and behavioural
treatments including psycotherapy (National Institute on Drug Abuse , 2009; Nordqvist,
2009). All of whom help with withdrawl symptoms from addictions to depressants,
stimulants, and opioids.
The Department of Community, Rural and Gaeltacht Affairs, (2007, p. 12) in tandem with
the World Health Organisation (2011), the National Institute on Drug Abuse (2009) and
Nordqvist (2009) suggest that specific treatment options in tackling addiction for
adolescents can vary in methods and approaches.
These processes identify that there are a variety of treatments available to those who suffer
from substance related addiction and are undergoing rehabilitation programmes. As
addiction is targeted from a number of angles, rehabilitation therapists offer help to the
individual to conform back into society from their illness which many of these practices
are also recognised in the Irish context!
2.5.3 Irish Rehabilitation Centres for Young People with Addiction
There are two main identified residential centres in the Republic of Ireland that focus
specifically on adolescents who suffer from addiction which are:
1. Aiseiri (Aislinn) Treatment Centre, Co Kilkenny
2. Matt Talbot Treatment Centre
27
Aiseiri (Aislinn) Treatmeant Centre (2015) state that their centre was established in 1998,
making them the country’s first adolescent residential addiction treatment centre. Their
treatment programmes are residential up to twelve young people at any given time and
offer a number of therapies in the facility that range from:
One to One Counselling
Group Therapy
Recreational Therapy
Behavioural Therapy
Peer Groups
Crises Intervention
Motivational Interviewing
Social, and Life Skills
The Matt Talbot Treatment Centre (2015) was Irelands second established residential
treatment centre for adolescent boys aged 14 – 18 years old with serious substance misuse
and co-existing psycho-social challenging issues. Their treatment programmes can reside
up to twelve adolescent boys at any given time and can offer therapies in their facility
ranging from strategies offered in the Aislinn Centre but also focussing on therapies such
as:
Harm Reduction
Motivational Therapy
Personal Development Skills
Other facilities in the Republic of Ireland whom offer non-residential treatment for
adolescents with their fight against addiction include:
1. YODA Project, County Dublin
2. Youth Health Services, County Cork
3. Canal Community Local Drugs Task Force, County Dublin
4. ACRA Treatment Facility, County Dublin
28
These non-residential facilities offer a number of treatment approaches and aftercare
support for young people.
In conclusion, Residential services play a critical role in rehabilitating these young people
from their illness and reintroducing them back into society with the higher concepts of
conforming and reducing further harm to themselves and others around them.
2.6 Chapter Summary
Adventure Therapy programmes are utilised through active participation of a variety of
tasks / challenges which comprehend effective decision making. This is what influences
the change of an individual’s attitude and behavior towards a variety of issues through a
method of therapeutic practice within the wilderness context. Clinical Adventure Therapy
use these therapeutic intervention tools through a variety of models to focus in on one to
one conversations between the therapist and the client to build a trusting relationship to
underpin the individual’s problems. Although Adventure Therapy programmes are only
part of the process it can influence the individual’s physical and mental participation in the
rehabilitation process. Through utilising these Adventure Therapy programmes it has an
active experiential approach which was a positive effect on a number of sub groups
including adolescents.
As adolescents take high risks in developing an identity in society through behavioral
developments, it is essential that their role in society is processed through active searching
which leads to discoveries about themselves and finding independence. While key issues
involving behavioral development access the experimentation process in risk taking, it may
pursue a more dramatic threat to their health and wellbeing through the use of tobacco,
alcohol and drugs.
29
With current research stating that substance abuse is increasing amongst adolescents in
Irish Society, it acknowledges that addiction poses a real threat to their health and
wellbeing. Common trends of substance abuse amongst adolescents identifies that there are
number of drugs that are easily assessable to this group. Adolescents acknowledge that
there are many reasons for experimenting with such substances and it is part of forming
their identity in society.
As continuous substance abuse forms an addiction there are currently a lack of facilities for
these young people to get help in the Republic of Ireland. Identifying current models in
place to intervene in such circumstances the process can be complicated as addiction is
recognised as a complex illness. Drug rehabilitation services play a critical role in
reintroducing these adolescents back into society with higher concepts of the young person
avoiding such substances in future.
Forming a link from this chapter back to the research question identifies a connection of an
Adventure Therapy approach that could potentially benefit young people who suffer from
substance related addiction in drug rehabilitation centres in the Republic of Ireland.
Acknowledging such an approach the researcher would like to examine the attitudes of
Irish professionals currently in this field on the use of this approach in drug rehabilitation
programmes in Ireland.
30
Chapter 3 Methodology
3.1 Introduction
This methodology Chapter will consider the research question, identifying the research
paradigm, exploring the research design and the rationale behind the research design. It
examines the sample population and concluding how the sample group was identified
through sampling techniques. The scope, limitations, ethical considerations, informed
consent and confidentiality statement. The instrumentation used for this study, its
reliability and validity of the sample group towards this research and its survey design will
be explained. Finally it will examine the data collection procedures identifying a plan of
how the data collected will be analysed and presented in the results Chapter.
3.2 Restatement of Research Question
The aim of this study was to examine the attitudes of professional addiction therapists
towards the use of adventure therapy as an approach in a drug rehabilitation setting with
adolescents.
3.3 Instrumentation
Instrumentation used to conduct surveys were used through a mixed method approach.
While the survey consisted of fourteen questions of both open and closed ended questions,
it is evident that the Likert scale was used for a number of questions. The Likert scale
explored quantitative methods of research while other forms of qualitative research
explored the attitudes of respondents and their perceptions towards the topic of study. With
a mixed method approach it offered a variety of results to be collected from the sample
group allowing the researcher to explore the attitudes of Irish Professional Therapists using
31
both qualitative perceptions of adventure therapy and quantitative perceptions of an
adventure therapy approach being used in a drug rehabilitation programme.
3.4 Research Paradigm
The mixed method approach allows a combination of methodologies within the same study
as it offers research techniques that suits the research topic. The link between both
positivist, post-positivist paradigms and the methodology type for this study allowed
attitudes to be examined from the sample population (Guthrie, 2010, p. 45). The
appropriate measure used for this study allowed a high level of reliable results to be
collected from the sample source (Guthrie, 2010, p. 43). Considering this method it
identified the importance of having a mixed method approach to examine the attitudes of
Irish professionals using an adventure therapy approach in drug rehabilitation centres.
3.5 Research Design
The research was located in six Irish residential and non-residential institutes that work
with the rehabilitation of young people who suffer from substance addiction.
The reason for choosing the mixed method approach was that the population of the focused
group is based across a wide area. The quantity of the samples were of a sufficient amount
to research this study from a number of clinical rehabilitation institutes across the Republic
of Ireland. An additional reason for choosing this method was due to time constraints as
the study was based over an eight month period.
The research involved sending out fifty individual questionnaire surveys by email to the
intended sample groups who work directly with adolescents in rehabilitation services in a
number of institutes across the country. The survey consisted of fourteen questions relating
32
to an adventure therapy approach in the process of a substance related rehabilitation
amongst adolescents.
The mixed method approach that had been used throughout the survey consisted of a
number of open ended and closed ended questions that collaborated a series of professional
attitudes towards an adventure therapy approach in substance related rehabilitation centres
across the Republic of Ireland. Not only focusing directly on their attitudes but the
questionnaire survey also looked at the possible approaches for Adventure Therapy to be
used in Irish rehabilitation centres. The reason behind chosen multiple institutes across the
Republic of Ireland was that it created an overview of the study in multiple institutes and
not only focussing on one rehabilitation centre.
3.6 Rationale for Research Design
The rationale for using a mixed method questionnaire survey approach was that it would
“obtain information from a representative selection which can be analysed and patterns
extracted and comparisons made” (Bell, 1999, p. 13). This method for collecting data
offered a personal perspective from the respondents on their attitudes of using an
Adventure Therapy approach. These findings included a number of different institutes
therefore acknowledging if an Adventure Therapy approach could be adopted into the
rehabilitation process in Ireland.
While researching “Doing your Research Project” (Bell, 1999) the conclusion was to use a
mixed method open ended and closed ended questionnaire survey approach. This survey
was emailed to the identified sample group as the economical methods were cost effective
and easily accessed. A survey method was found to offer more friendly open and closed
ended questions which was suitable for this type of study and within the available
33
timeframe. This would provide a more dynamic and accurate result on the research in
question which could be initially analysed for the final result.
3.7 Sample Population
The description of the sample population included over eighteen years old, mixed gender,
clinical rehabilitation therapists who work directly with adolescents suffering from
substance related addiction in rehabilitation centres across the Republic of Ireland.
Samples researched and considered for this research consisted of fifty professional clinical
therapists who work directly with young people who suffer from substance related
addiction. These samples consisted of two residential centres and four non-residential
centres.
The two residential centres which were the Aiseiri Aislinn Treatment Centre (Kilkenny)
and Matt Talbot Treatment Centre (Cork) included ten surveys to each centre.
The four non-residential centres which had been selected for this study included YODA
Project (Dublin), Youth Health Services (Cork), Canal Community Local Drugs Task
Force (Dublin), ACRA (Dublin) which each centre received five surveys.
An additional ten surveys were emailed to individuals whom have a direct connection in
working in the area of Adventure Therapy and addiction within drug rehabilitation
institutes.
3.8 Scope
The scope of this study focused on a broad range of academic articles, journals, reports,
books, and online literature. With key areas of the primary research focussing on Irish
34
materials, other sources of information were selected from a number of literature based in
North America and Europe.
3.9 Limitations
The limitations of this study was limited to the Republic of Ireland. While acknowledging
the time constraints of the study this also limited the size of the intended sample group.
Individuals who wished to participate in this study must have been over the age of eighteen
years old. Although the study itself focussed around adolescents they were not asked to
participate in the research.
3.10 Ethical Considerations
Ethical considerations was a critical element of conducting research. These considerations
that needed to be addressed for this study were:
1. An agreement between tutor and pupil of finalised research survey before
submitting it to any institutes.
2. No minor under the age of eighteen years old will be considered for this research.
3. Ensure respondents that participation is entirely voluntary.
4. Ensure that all respondents that participate in the survey are entirely safe from any
harm.
5. Include a written information front sheet (See Appendix 1) detailing the proposed
study and research area which shall include:
Study title
Invitation paragraph
What is the purpose of the research
35
What will happen to the person if they take part
What is to be done with the information they will provide
Who will review this study
6. All participants will mark an X on a consent to participate in survey if they wish or
do not wish to respond to the survey.
7. The use of offensive, discriminatory, or other unacceptable language needs to be
avoided in the formulation of the questionnaire survey.
8. Inform participants in writing of their right to withdraw from the research at any
time.
9. Maintain the highest level of respect in discussions and analyses throughout the
research.
10. Additional contact information for researcher and reviewing Institute. In this case
Galway Mayo Institute of Technology Castlebar Campus.
11. All respondent’s information will be kept strictly confidential under the Data
Protection Act (2015).
Bell (1999, p. 46) stated that the researcher must “decide whether participants will receive
a copy of the report as there are cost and time implications”. All participants who wish to
request a copy of this particular research may do so in writing to the reviewing institute. In
this case it is Galway Mayo Institute of Technology Castlebar Campus.
These ethical considerations were adopted into this study. Other ethical considerations that
had been identified during this research were not practical or relevant for this type of study,
consisted of risk assessments of the samples and a debriefing session if a form of deception
was included.
36
3.11 Informed Consent and Confidentiality
An Informed consent and confidentiality agreement to participate in the study consisted of
a hand written document between the respondent and the researcher (See Appendix 2).
3.12 Validity and Reliability
The validity and reliability of the study was supported by professional therapists from a
number of backgrounds in clinical addiction rehabilitation. A number of professional
clinical therapist respondents from different drug rehabilitation institutes within the
Republic of Ireland provided reliable results for the research by not supporting biased and
intentional incomplete results. This method of collecting data from a number of drug
rehabilitation institutes would identify if respondents were directed to responding to the
survey in a particular way by their institute.
A validity approach was to ensure that questions being asked in the survey was valid to the
study topic. Identifying the focussed sample group also insured that participants who
responded were a valid source for appropriate results towards the study and not the general
public who could potentially provide inaccurate results.
Reliable and valid approaches for collecting data were critical aspects for this study. As it
focussed on the attitudes of Irish clinical professionals in drug rehabilitation centres and
not the general public it allowed the researcher to build on the understanding and
perceptions of an Adventure Therapy approach used in the Republic of Ireland which may
influence further research in this field.
37
3.13 Survey Design
Based on current research of Adventure Therapy approaches in North America and
Substance related rehabilitation methods in the Republic of Ireland, the researcher
identified a number of questions to examine the attitudes of Irish Professional therapists
working in the area of substance related addiction with adolescents. These selection of
questions were carefully identified and selected to be viable for this study (Appendix 3).
Not only did the researcher acknowledge other Adventure Therapy approaches in North
America and Europe but he designed the survey to be judgemental free. It also gave the
opportunity for the researcher to examine the attitudes of the sample group towards
Adventure Therapy approaches and correspond them with literature research highlighted in
the Literature Review Chapter.
3.14 Data Collection Procedure
Data collection procedures for receiving surveys were through either online submission at
[email protected] or by post to the researcher’s home address at 11 Brookview Drive,
Brookfield, Tallaght, Dublin 24.
3.15 Data Analysis Plan
Qualitative and Quantitative data that was collected for this study was conducted through a
number of surveys. The results required different types of data analysis which were
synthesised through categorisation and description. These included:
38
Question Sequence Data Sequence
1, 2, 3, 4 Measurement Data
5, 6 Qualitative Data
7, 8, 9, 10, 11, 12 Measurement Data
13, 14 Scaled Data
3.16 Chapter Summary
In summary, the Methodology Chapter focused on research methods that had been based
on the research question “The Attitudes of Irish Professionals using an Adventure Therapy
Approach in Drug Rehabilitation Centres”. Within this Chapter it explored the different
approaches that were available to carry out this study.
The instrumentation that was used to conduct research consisted of a mixed method
approach survey. This survey included fourteen open and closed ended questions to
examine the attitudes of Irish professionals working in the field of drug rehabilitation and
their perceptions of the use of an Adventure Therapy approach.
While acknowledging the research paradigm as both a positivist and post-positivist, the
appropriate research design allowed for reliable results from the sample group. The sample
group included a number of drug rehabilitation institutes across the Republic of Ireland
along with individuals already working in the field of Adventure Therapy.
The rationale for using a mixed method questionnaire survey approach was that it offered a
personal perspective of respondents and offered viable results. Due to the timeframe of the
research the study was limited to a selected sample group and introducing economical
methods that were cost effective the surveys were emailed to the sample group.
39
Considering the scope and limitations to the study, it focussed on adolescents but with the
research considering vulnerable young people they were not asked to participate in the
study as all respondents needed to be over the age of eighteen years old. Ethical
considerations were carefully considered as the author was researching a particularly new
area of study in the Republic of Ireland.
All respondents who wished to participate in this study done so at a voluntarily and
anonymous basis. In order to participate in this study respondents were required to mark an
informed consent and confidentiality agreement.
As the validity and reliability of this study was supported by professional rehabilitation
therapists it ensured the results to be adequate and appropriate for this particular research.
With current research based on Adventure Therapy approaches in North America and
Substance related rehabilitation methods in the Republic of Ireland it offered an
opportunity for the researcher to examine the attitudes of Irish professionals working in
rehabilitation centres.
Data collection procedures allowed for a quick and effective collection of surveys for this
research. While the data analysis plan allowed for the questions to be categorised into four
different measurements for easy and effecting reading of the results.
40
Chapter 4 Results
4.1 Introduction
This Chapter will provide all results and data attained from responded surveys examining
the attitudes of Irish Professionals using an Adventure Therapy approach in Drug
Rehabilitation Centres with Adolescents. The study conducted a fourteen question survey
on fifty clinical rehabilitation therapists and adventure therapy therapists across a number
of institutes in the Republic of Ireland.
4.2 Summary of Statistical Analysis
Of the fifty survey’s sent out for this study twenty one were received completed correctly
and deemed viable for this research. This identified a respondent rate of 42%. The results
of the survey show a number of professional therapist’s attitudes and perceptions towards
the use of an Adventure Therapy approach with Adolescents in an Irish Drug
Rehabilitation context.
41
4.3 Tables and Figures of Results
Figure 1.
The above chart identifies the distribution of gender within the survey. It shows the male
population of respondents at 57% and the female population of respondents at 42% which
highlights the overall quantity of the 21 respondents who participated in the study.
42
Figure 2.
The above chart identifies the distribution of the age breakdown amongst the population of
the survey. Of the 21 viable respondents 10% were between the ages of 18 and 24, 40%
were between the ages of 25 and 34, 35% were between the ages of 35 and 44, and 15%
were between the ages of 45 and 54.
43
Figure 3.
The above chart identifies the distribution of Professional Occupation analysis within the
survey. These results show that the 21 respondents were made up of 5% of Councellors,
15% of Psychologists, 5% of Psychotherapists, 10% of Social Workers, 10% of Nurses,
and 55% of other occupations such as Adventure Therapists, and Social Care Workers
while only 1 respondent skipped this question. This was an unexpected result as the
researcher was focussing on a specific sample group which thought might have produced
more clinical therapist respondents.
44
Figure 4.
The above chart identifies if the respondents organisation provide an Adventure Therapy
approach in its programmes. While all 21 respondents successfully answered 52% of them
answered “yes” that their organisation does provide an Adventure Therapy approach while
48% of them answered “no” to the question.
Qualitative Data:
Question 5 in the survey consisted of a qualitative response from the respondents which
focussed on why their “organisation do / do not utilise an Adventure Therapy approach”.
The results showed a number of interesting and valuable points as to why their
organisation do and do not utilise an Adventure Therapy approach in drug rehabilitation
centres (See Appendix 5).
45
Question 6 in the survey also consisted of a qualitative response from the respondents
which focussed on the respondent’s perception of Adventure Therapy as an approach, in a
drug rehabilitation setting.
These results showed that many respondents believed that it was a successful and effective
approach in a drug rehabilitation setting in the Republic of Ireland while others argued that
the approach is not a stand-alone service and needs to be implemented properly into the
rehabilitation ethos and theory evidence. (See Appendix 6).
Figure 7.
The above chart identifies the respondent’s answers by acknowledging that 70% of them
agree with between the ages of 13 and 18 Adventure Therapy would be most beneficial.
This result was closely followed by 65% of the respondents agreeing that 18 to 25 year
olds would also benefit from the use of an Adventure Therapy approach in a drug
46
rehabilitation centre. Surprisingly 45% of the respondents also agree that an Adventure
Therapy approach as young as 8 years old can benefit from its intervention with a drug
rehabilitation program followed by 35% agreeing that 25+ would benefit from this
approach.
Figure 8.
The above chart identifies which gender would benefit more from using Adventure
Therapy as an approach during their rehabilitation process. 95% of the respondents
concluded that males would benefit more from this approach compared to 65% concluding
that females would also benefit from this process.
47
Figure 9.
The chart above identifies the respondent’s interests towards an Adventure Therapy
approach and acknowledges where an Adventure Therapy programme would suit best.
40% of the respondents conclude that Adventure Therapy programmes would be more
beneficial towards an intervention programme, while an equal 30% of respondents state
that an Adventure Therapy approach would also benefit prevention and aftercare
programmes.
48
Figure 10.
The chart above identifies which Adventure Therapy programme would be most beneficial
towards adolescents suffering from substance abuse addiction. 70% of respondents
conclude that group residential programmes would be most beneficial while 30% of
respondents state that one on one day programmes would be most beneficial towards an
Adventure Therapy approach involving adolescents suffering from substance abuse
addiction.
49
Figure 11.
The chart above identifies what duration should an Adventure Therapy programme be
delivered as part of a drug rehabilitation process. 45% of respondents conclude that a
programme lasting 12 to 16 weeks would benefit the rehabilitation process most, were 30%
of the respondents state that a programme lasting 4 to 8 weeks in duration would also have
a beneficial affect followed by 25% of the respondents state that 8 to 12 weeks would be
an appropriate duration for an Adventure Therapy approach in a drug rehabilitation
process. Surprisingly none of the respondents selected the 1 – 4 weeks duration suggesting
that an intervention programme should be based over a longer period of time.
50
Figure 12.
The chart above identifies where the most beneficial positioning of an adventure
experience within the therapy programme. With 60% of the respondents concluding an
adventure experience would benefit most in the middle of the programme, 45% of the
respondents state that it should be positioned at the beginning of the programme and 35%
concluding that it would benefit most near the end of the programme. With not much
difference positioning an adventure experience between the different stages of a therapy
programme it might be fair to say that some form of an adventure experience should be
present throughout the programme.
51
Figure 13.
The chart above measures the attitudes of professional rehabilitation therapists towards an
Adventure Therapy approach by working with professional outdoor educational
individuals throughout a structured programme. 52% of the respondents stated that they
would be very willing to work with outdoor educational professionals offering an
Adventure Therapy approach in their programme, while 29% said that they would be
willing, and 19% stated that they might be interested. None of the respondents identified
that they would not be willing to work with outdoor educational professionals using an
Adventure Therapy approach.
52
Figure 14.
The chart above measures the attitudes of professional rehabilitation therapists towards
gaining additional training to promote the use of Adventure Therapy in a drug
rehabilitation setting. 52% of the respondent conclude that they are very willing to gain
additional training, while 14% state that they would be willing, 29% of the respondents
said that they might be interested in gaining additional training were only 5% said that they
were not willing to gain additional training.
53
Chapter 5 Discussion
5.1 Introduction
In this Chapter, results attained from the survey will be discussed further and compared
with the findings in the Literature Review. Discussion requires two or more points of view
therefore the structure of this Chapter is an important element in this study. Identifying
four themes in the Literature Review helped outline the importance of the questions
selected for the survey. As there is a lack of evidence on literature surrounding Adventure
Therapy in an Irish context, it was the researcher’s ambition to examine the attitudes of
Irish professionals working in a drug rehabilitation setting on an approach for Adventure
Therapy programmes.
5.2 Literature Findings
The literature introduces the concept to a number of different Adventure Therapy
approaches and how they have been used as successful and effective tools towards mental
health issues in North America. Following the Adventure Therapy ethos it offers an
individual a therapeutic adventure experience focussing on underpinning their problems
and working on their behaviour patterns to overcome the issue at hand. This approach is
evident to successfully work in North America but there is a lack of knowledge and theory
behind its approach in an Irish context.
Using Adventure Therapy is identified to be a clinical tool that engages the client in an
intervention process that contributes to their cognitive, affective and behavioural levels.
Adventure Therapy models use a wilderness based programmes through a number of
different challenges focusing on an active experiential approach. These approaches are
essential elements that bring about sustained transformation in the persons psychological
54
state. Identifying a deliberate intentional psychotherapeutic programme located in the out-
of-door environment it achieves a number of therapeutic benefits but does not necessarily
reflect on structured psychotherapeutic strategies in the programme itself. The integration
of psychotherapeutic theory and practices in the outdoor environment is an important
approach in developing the field of Adventure Therapy. Although Adventure Therapy is
considered an intervention tool many authors conclude that the tool itself should not
remove other important interventional measures in programmes.
As more international practices tackle the imbued nature of psychological distress, it
encourages openness so as to offer a variety of theoretical approaches. This enables
practitioners to tailor programmes and interventions to meet the unique needs of their
clientele.
As this study focusses on the attitudes of Irish professionals using an Adventure Therapy
approach in drug rehabilitation centres with adolescents, therefore it is important to
emphasise why adolescents experiment with drugs.
In Chapter 2.4.3, it is identified that an adolescence behavior increases in level with risk
taking when in company with peers and friends as they want to fit into an identity role
within their social group. It also states that experimenting with drugs is part of a coping
strategy when faced with challenges that have unclear outcomes. There is a wide
availability and easy accessibility of illegal drugs at present in Irish society which
recognises that more young people can experiment with drugs.
It is evident that one of the key issues involving adolescents in today’s society is substance
related abuse. It is acknowledged that continuous abuse of a substance can potentially lead
to an addiction. Substance related addiction is one of the most recognisable forms of
addiction in the Republic of Ireland. Common trends in drugs previously identified are
55
being easily accessed by Irish adolescents. It recognises the negative effects that drugs has
towards a young person’s future of forming a self-identity and an active role in society.
Examining Irish substance related rehabilitation models acknowledges that the main target
group that is focused on in Irish society is adults. Exploring the services specifically
available to young people, it is identified in Chapter 2.5.4 that there is a lack of facilities
and resources available to them across the Republic of Ireland.
A number of treatment models within the substance related rehabilitation framework has
distinguished that there are procedures in place to meet specific outcomes of structured
programmes. A number of different treatments such as medications, clinical therapy and
behavioral treatments illustrates a connection with an Adventure Therapy approach that
could benefit adolescents who suffer from substance related addiction in rehabilitation
programmes within the Republic of Ireland.
When reviewing the four Chapters of the Literature Review and studying the influence of
Adventure Therapy on adolescents. They are shown to contribute to an effective approach
towards an Adventure Therapy programme with adolescents suffering from a substance
related addiction in drug rehabilitation centres across the Republic of Ireland.
5.3 Research Findings
Analysing all twenty one results and data attained from respondents identified the different
attitudes towards the use of an Adventure Therapy approach in drug rehabilitation centres.
Learning about the distribution of the selected sample population the researcher identified
key areas such as gender breakdown, age breakdown, and professional occupation to
distinguish each individual respondent background.
56
Highlighting the respondent’s background, the researcher identified if the respondents
organisation provides an Adventure Therapy approach within their programmes. This
offered an opportunity for the researcher to ask the respondents two qualitative questions
surrounding why their organisation do or do not utilise an Adventure Therapy approach
and what is their own individual perceptions of Adventure Therapy as an approach, in a
drug rehabilitation setting.
This information provided more in depth questions about Adventure Therapy and who
would benefit from using such approaches in a drug rehabilitation setting. These included
identifying an appropriate age group and acknowledging a gender difference.
Understanding the background of potential individuals who would benefit from using such
an approach in a drug rehabilitation setting, it was viable to find out were an Adventure
Therapy approach would be most beneficial within the programme. This was identified
through a prevention tool, intervention tool, or as an aftercare tool. Concluding that an
Adventure Therapy approach should be used as an intervention model it was important to
distinguish either which a one on one day programme or a group residential programme
was more beneficial towards adolescents suffering from substance abuse addiction.
Identifying a duration of an Adventure Therapy programme being delivered as part of a
drug rehabilitation process is an important element which the most favourable option from
respondents being twelve to sixteen weeks. Examining a positioning strategy for an
adventure experience within a therapy programme the most priority was in the middle of
the programme.
These concepts made an important statement concerning the professional rehabilitation
therapist’s attitudes towards an Adventure Therapy approach which opened up an
interesting point as to how willing are these therapists in working with outdoor educational
57
professionals promoting the use of an Adventure Therapy approach and how willing are
they to further their own training to provide such programmes.
5.4 Contrasting Results
Having carefully explored the number of themes covered within the Literature Review and
analysing the final results from the survey illustrated a number of important aspects. These
were considered when examining the attitudes of professionals who might use an
Adventure Therapy approach in drug rehabilitation centres.
While an Adventure Therapy approach is a successful and effective intervention tool in
North America there are a number of barriers for this approach to be adopted into an Irish
context. The main constraint acknowledged by respondents in the survey is access to
funding and cost for facilitating such a programme. With the lack of drug rehabilitation
facilities and resources designed for adolescents in the Republic of Ireland, a policy
specifically designed to intervene with such an approach involving young people could
become problematic if the structure is not properly supported by current evidence.
It was identified that a positive pattern towards the attitudes of Irish professional therapists
who stated that they would be willing to work with other outdoor professionals through an
Adventure Therapy approach in a drug rehabilitation programme. The respondents also
shared similar attitudes towards additional professional training in this field. There was a
mixed response in surveys towards an Adventure Therapy approach in drug rehabilitation
programmes. One individual noted that “it would provide those in need of drug
rehabilitation with a natural setting where they would feel free to explore the reasons
behind their drug use. Group based activities would encourage people to open up and
engage with others who have experienced similar addictions”. Another individual
disagreed with the approach by stating that Adventure Therapy is “An effective tool but it is
58
not a standalone service …… lighter activities are more effective than typical "adventure
therapy" activities. Activities with less adrenaline leads to more constructive reviews and
less post active euphoria, which leads participants to the belief that change has occur but
once back in the mainstream of their lives they refer back to old patterns”.
Acknowledging that rehabilitation therapists are highly qualified to work with adolescents
in a drug rehabilitation setting, two respondents noted that there are no professional
qualifications currently in the Republic of Ireland to work as an Adventure Therapist. With
self-proclaimed Adventure Therapists operating in the Republic of Ireland they are
identified as not being actual professional therapists. This might be an indication that it is
now time to introduce a recognised professional qualification for this area of expertise.
Adventure Therapy is a tool and should not be a stand-alone intervention method. It is
important not to underestimate its successful recognition of approaches in North America.
Identifying that professional rehabilitation therapists have a positive attitude towards
understanding more about this approach opens up more awareness into a professional
approach in this specialised field.
59
Chapter 6 Conclusion / Recommendations
6.1 Introduction
In this Chapter, the author will conclude his summary of the main findings towards this
study on examining the attitudes of Irish professionals using an Adventure Therapy
approach in drug rehabilitation centres with adolescents. Following the conclusion the
author will express any recommendations for further research on this topic including
important factors considering a follow up study of this research.
6.2 Summary of Main Findings
Summary of the main findings have illustrated that a number of Adventure Therapy
approaches have been used as successful and effective tools towards mental health issues
by providing a therapeutic adventure experience through an intervention process in North
America. These therapeutic focussed programmes consist of long durations with a
continuous one on one around the clock intervention. With a number of processes involved
in a Adventure Therapy programmes it highlights the effectiveness of having a structured
programme with an experiential approach. Evidence states that an Adventure Therapy
approach has a successful rate amongst sub groups such as adolescents.
During the period of adolescence the young person strives to create an identity for
themselves in society by trying new experiences and experimenting with new things such
as social relationships, sexual relationships, substances such as tobacco, alcohol and
sometimes drugs. Comparing a young person’s behaviour with risk taking and
experimentation during adolescence identifies a possible issue of drug abuse which could
potentially lead to an addiction problem if untreated. Examining a number of treatment
models within addiction rehabilitation services illustrates that there are a number of
60
programmes available for individuals but there is a lack of facilities and resources
available for adolescents in the Republic of Ireland.
While surveying a number of different professional rehabilitation therapists, the results
identified a positive attitude towards an adventure therapy approach. It also illustrated the
respondents concerns about using an effective Adventure Therapy approach in a drug
rehabilitation setting with the lack of evidence based in an Irish context and funding
restrictions.
There was a close margin of respondent’s organisations offering and not offering
Adventure Therapy approaches within their rehabilitation programmes. The results also
identified the therapist’s attitudes towards an Adventure Therapy approach by finding that
it is the most beneficial approach towards developing an Adventure Therapy programme.
These findings included gender breakdown, age breakdown, type of programme, position
of Adventure Therapy approach within a programme, and the duration of a programme.
Analysing the results attained from the research survey and comparing them with the
findings of the Literature Review not only illustrate the significance between Adventure
Therapy and other rehabilitation methods but offers a new intervention approach for drug
rehabilitation therapists. These results from the study were only achieved by examining the
attitudes of Irish professional therapists using an Adventure Therapy approach in drug
rehabilitation centres.
6.3 Recommendations
With the lack of evidence supporting Adventure Therapy in an Irish context it is
recommended that a more straight forward approach towards Adventure Therapy should be
studied. While this research focussed on a specialised area surrounding adolescents,
61
substance related addiction and rehabilitation models, the author found the study itself
difficult to remain focussed in that specific area. Although the study was narrowed down
as small as possible for the author’s best interests it still remained a large area to study.
Two recommended follow up studies towards this research can include (1) Identifying a
professional qualification framework for Adventure Therapists operating in the Republic of
Ireland and (2) Identifying a policy for best practice of an Adventure Therapy approach in
the Republic of Ireland.
62
Section 7 Appendences
7.1 Appendix 1 Invitation to Participate in Survey
The Attitudes of Irish Professionals
using an Adventure Therapy approach
in Drug Rehabilitation Centres
Damien Beatty
The researcher would like to invite you to participate in a fourteen question survey which
is part of a dissertation study on the Attitudes of Irish Professionals using an Adventure
Therapy approach in Drug Rehabilitation Centres for Young People within the Republic of
Ireland.
The purpose of this study is to explore the attitudes of drug rehabilitation therapists on the
use of an adventure therapy approach amongst adolescents in an Irish context.
Respondents who wish to voluntarily participate in this study will have all their
information and details kept strictly private and confidential and will not be passed on or
shared with any third parties.
This study will only be reviewed by Galway-Mayo Institutes of Technology, Castlebar
Campus. Any further enquiries about this study can contact Mr Kevin O Callaghan
(Supervising Tutor of Galway-Mayo Institute of Technology) at
Participants have the right to withdraw from this study at any time and if have any
questions about this study can contact the researcher either by [email protected] or 085
746 2990.
63
7.2 Appendix 2 Consent to Participation in Survey
By agreeing to participate in this survey I understand that I can remain anonymous and that
the data is to be used solely for an undergraduate dissertation study on the Attitudes of
Irish Professionals to an Adventure Therapy approach in Drug Rehabilitation Centres for
Young People within the Republic of Ireland.
In addition I understand that if I am responding to the survey that I should complete and
submit the relevant information no later than Tuesday 05th April 2016.
I understand that if I have any questions or concerns regarding this research, am free to
contact the researcher Mr Damien Beatty at [email protected] or on 085 746 2990.
Agree to participate _____________ (Place X mark here)
Do not wish to participate _____________ (Place X mark here)
64
7.3 Appendix 3 Survey Questions
Please tick boxes with a clear X:
1. Gender: Male Female
2. Age: 18 – 30 30 – 40 40 – 50 65+
3. Occupation: Counsellor Psychologist Psychotherapist
Social Worker Nurse Other:__________
Adventure therapy is the prescriptive use of adventure experiences often conducted in
natural settings that kinesthetically engage clients on cognitive, affective, and behavioral
levels (Gass, et al., 2012). Its focus is on a group-based activity therapy in which adventure
activities are used as a clinical tool to promote therapeutic changes in clients (Tucker &
Norton, 2012).
4. Does your organisation provide an adventure therapy approach in its programmes?
Yes No
5. Please outline why your organisation does / does not utilise an adventure therapy?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
65
6. What is your perception of adventure therapy as an approach, in a drug rehabilitation
setting?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
7. Which age group do you think would benefit most from using an adventure therapy
approach?
8 – 13 13 – 18 18 – 25 25+
8. Which gender would benefit more from using adventure therapy as an approach during
their rehabilitation process?
Male Female
9. Do you think an adventure therapy approach be more beneficial towards a:
Prevention Programme Intervention Programme Aftercare Programme
10. Which adventure therapy programme do you think would most beneficial towards
adolescents suffering from substance abuse addiction?
One on One Day Programmes Group Residential Programmes
66
11. What duration should an adventure therapy programme be delivered as part of a drug
rehabilitation process?
1 – 4 Weeks 4 – 8 Weeks 8 – 12 Weeks 12 – 16 Weeks
12. Where would be the most beneficial positioning of an adventure experience within the
therapy programme?
Beginning of Programme Middle of Programme End of Programme
13. Rate your willingness to work with Outdoor Educational Professionals in using
Adventure Therapy?
(Not willing) 1 2 3 4 5 (Very Willing)
14. Rate your willingness to gain additional training to promote the use of adventure
therapy in a drug rehabilitation setting would you as an individual?
(Not willing) 1 2 3 4 5 (Very Willing)
Please submit this survey either online to [email protected] or by post to 11 Brookview
Drive, Brookfield, Tallaght, Dublin 24 by Tuesday 05th April 2016.
Thank you for participating in this survey, if you have any queries about this survey please
don’t hesitate to contact the researcher on either [email protected] or 085 746 2990.
67
7.4 Appendix 4 Identification of Illegal Substances
Cannabis:
“A hemp plant of the genus Cannabis” (Oxford Dictionary Press,
2002, p. 213).
Heroin:
“A highly addictive crystalline analgesic drug derived from
morphine” (Oxford Dictionary Press, 2002, p. 661).
Methadone:
“A potent narcotic analgesic drug used to relieve severe pain”
(Oxford Dictionary Press, 2002, p. 909).
Other Opiates:
“Drugs containing, derived from, or resembling opium” (Oxford
Dictionary Press, 2002, p. 1019).
Cocaine:
“A drug derived from coca or prepared synthetically, used as a
local anaesthetic and as a stimulant” (Oxford Dictionary Press,
2002, p. 278).
Amphetamines:
“A synthetic drug used esp. as a stimulant” (Oxford Dictionary
Press, 2002, p. 44).
Ecstasy:
“A powerful stimulant with hallucinatory drug” (Oxford
Dictionary Press, 2002, p. 446).
LSD:
“A potent hallucinogenic and psychedelic drug” (Oxford
Dictionary Press, 2002, p. 853)
Magic Mushrooms:
“A toadstool of the genus Psilocybe, containing psilocybin”
(Oxford Dictionary Press, 2002, p. 865).
Solvents:
“A dissolving or weakening agent” (Oxford Dictionary Press,
2002, p. 1380).
68
Poppers:
“A small vial of amyl nitrite used for inhalation” (Oxford
Dictionary Press, 2002, p. 1127).
Tranquillizers:
“A drug used to diminish anxiety” (Oxford Dictionary Press, 2002,
p. 1529).
Anti-Depressants:
“A drug or agent that alleviates depression” (Oxford Dictionary
Press, 2002, p. 57)
Opioid Pain Killers:
“Any Compound resembling cocaine and morphine in its addictive
properties or physiological effects” (Oxford Dictionary Press,
2002, p. 1019).
Benzodiazepines:
“A heterocyclic organic compound of a kind including several
tranquillizers such as Librium and Valium” (Oxford Dictionary
Press, 2002, p. 133).
69
7.5 Appendix 5 Qualitative Survey Results for Question 5
Respondents who agree that their organisation do utilise an Adventure Therapy approach
in drug rehabilitation centres state that:
The organisation would use adventure therapy as an activity for some service users
as part of their individualised day services. It would be used in promoting trust,
building relationships, for guided participation and learning new skills. It can also
be relevant for inclusion in group programmes where service users would otherwise
be alone with staff in individualised services.
We offer therapeutic outdoor activities that focus on behaviour and substance
misuse. We do this because the outdoors offer a relaxing environment and breaks
down barriers between client and worker.
We utilise AT as it allow relationship to be established swifter, it has a high
engagement rate and the combination of physically and psychologically demanding
activities deliver direct and instant results with regard building experiences.
Yes we do as we find that it provides an opportunity for clients (Young People) to
re-acquire self-discipline and self-worth in recovering from addiction.
I work in a rehabilitation centre and we bring the young people on nature walks and
plant flower pots with them. We also work through art and team challenges.
To reduce stress, build confidence and self worth.
Because we feel it can greatly benefit recovering users.
Because it works, you are dealing with practical minded people engage them with a
practical hands topic.
We have found it to be effective.
It is a part of the Program.
70
While respondents whose organisation did not utilise an Adventure Therapy approach
argued that it was due to:
Cost (Perceived) B. Evidence Based C. Its "New".
Cost of Providing and Lack of Evidence.
Funding restraints.
Lack of funding.
Something we have not explored.
Predominantly medical model in a healthcare setting. We meet people weekly for
1:1 work.
Lack of facilities and funds.
Never heard of it.
The efficacy of using adventure therapy is not fully understood. Most of the courses
focus on teaching students bodies of knowledge rather than addressing approaches
to learning and development. I also believe that there are no suitable qualified staff
to deliver adventure therapy.
Not employing qualified therapists. While all of the staff are highly qualified in
outdoor education, psycho-analysing clients should be left to professional therapists
that spend hundreds of hours in training specifically in the field of psychology and
therapy.
71
7.6 Appendix 6 Qualitative Survey Results for Question 6
Respondent’s perceptions of Adventure Therapy as an approach in a drug rehabilitation
setting agree that:
It is an excellent way of helping people step outside their comfort zone and
measure their potential.
It is a holistic, natural therapy that uses nature as a catalyst for change.
I think would be very beneficial in rehabilitation. It channels a persons energy in a
safe environment. I believe it would help build an individual's morale, learning
skills, having another focus, engaging with peers.
It's great because getting out and doing something fun or creative is of huge benefit
to keeping active and maintaining positive mental health.
I think it is a creative approach. It provides people with a purpose and meaning in a
fun and relaxed environment. May help keep people motivated on their journey of
recovery and believe in themselves.
Our perception on an adventure therapy approach in a drug rehabilitation setting is
that it offers a unique psychoanalysis through experiential learning in a wilderness
context.
It helps to overcome addiction by learning more about themselves and what is
important to them.
As an approach it would provide those in need of drug rehabilitation with a natural
setting where they would feel free to explore the reasons behind their drug use.
Group based activities would encourage people to open up and engage with others
who have experienced similar addictions.
I believe that AT give the participant challenge and close to instant reward, it also
give people natural based highs
72
Keep people occupied and away from drugs.
It would be very interesting to see it in practice with the right policies in place.
I have not used it myself but would have heard from colleagues (in a clinical
setting) who have utilised such an approach. They comment on its usefulness in
engaging the client in a supportive environment, which help to develop coping and
management skills that are not addressed in the more 'conventional' drug
rehabilitation programmes. Some of these would be developing a sense of purpose,
self efficacy and trust (in oneself and in others).
While respondents who do not agree with an Adventure Therapy approach in a drug
rehabilitation setting argue that:
It would depend on the overall ethos and theory of the drug rehab setting.
Adventure therapy could be swallowed up in a traditional approach (which might
have little or no evidence base) and be offered as an add on.
It works not all the time, the sports are really the vehicle, it's the positive
experience, and lack of free time to use it, also gives s positive release of
endorphins too.
Adventure therapy for me in drug rehabilitation can be an effective tool but it is not
a standalone service. Links/transference onto their lives back home need to be
conducted in order for real change to occur. It is important that adventure activities
are not used because we perceived them to be beneficial. The needs of the client
need to be taken into account and then the activity built around that need or desired
outcome. I have found lighter activities more effective than typical "adventure
therapy" activities. Activities with less adrenaline leads to more constructive
73
reviews and less post active euphoria, which leads participants to the belief that
change has occur but once back in the mainstream of their lives they refer back to
old patterns. This is why for me adventure therapy is great tool but there is a lot to
consider when taking a group out such a programme.
Using risk and fear for personal growth with clients that already lead precarious
lives is simply another negative in their life. Do they need to be challenged? What
if they fail at the rock climb? Or high ropes course? What does this reinforce? The
outdoors has so much more potential than just providing adventurous activities.
Safe and predictable environments have shown that clients respond better to
personal growth. Berman and Davis-Berman 2002, 2005.
I do not know enough about it.
I have no knowledge of it.
It is not practical.
74
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