Catherine Freer Wilderness Therapy Programs

Success » Long Lasting Results

Long Lasting Results

Long-Term Outcome Research Program
The Outdoor Behavioral Healthcare Industry Council (OBHIC) and the University of Idaho Wilderness Research Center formed a contractual research cooperative in 1999 to do formal research on the efficacy and processes of wilderness treatment. Dr. Keith Russell, then a professor at the University of Idaho, has been the primary researcher involved. (He is now at the University of Minnesota.)

We were a founding member of OBHIC and were instrumental in helping facilitate as well as participate in the outcome study. Our first effort was a pre- and post-treatment study using the Youth Outcome Questionnaire (YOQ), a well designed and established research instrument on therapy effectiveness. Published in November 2001 (Assessment of Treatment Outcomes in Outdoor Behavioral Healthcare, Technical Report 27, University of Idaho Wilderness Research Center), this research on 850 young people queried both parents and the adolescent participants. The data indicates that clients entered wilderness programs with about the same level of dysfunction as adolescent patients entering psychiatric hospitals. At graduation (the programs ranged from three to eight weeks in length), their average scores were slightly above the normal adolescent range. To understand the full importance of this result, it is essential to note that the participating wilderness programs have 97 percent program completion rates. Most adolescent chemical dependency and psychiatric treatment programs have high drop-out/early discharge rates, and outcome studies typically do not include those clients in their follow-up results.

The research continued, with follow-up data on the Youth Outcome Questionnaire for three, six and 12 months post-treatment. The question here was whether brief, intensive programs like wilderness treatment lose their effectiveness after a brief period of time. The answer from this research is quite clear: there is probably a slight deterioration at six months (as judged by parents); but at 12 months, both parents and their children believe the young people are functioning better than at program graduation, and at the high end of the average range for normal adolescents. This trend is especially clear for Catherine Freer, a briefer, more intensive program.

A third phase of this study called a sample of 144 of the study participants at two to three years following program graduation. A structured phone interview with parents and treatment participants asked how the kids and their families are doing in school, at home, with friends and with their sobriety, and what elements of wilderness treatment were most and least helpful to them. The responses by parents and youth suggest that the majority is doing well 24 months after treatment. More than 80 percent of parents and over 90 percent of graduates contacted believed that their wilderness treatment experience was effective two years after the process.

OBHIC plans to contact these clients again at five years after graduation, both to learn how graduates are faring in the long run, and how their development into their twenties compares with that of ordinary adolescents.

OBHIC Substance Abuse Treatment Study
The Outdoor Behavioral Healthcare Industry Council (OBHIC) member programs began collecting data in the summer of 2003 for a large-scale research effort with approximately 2,000 clients. This will be a multi-dimensional study of substance abuse treatment and effectiveness, using diagnostic information and several test instruments, and include a six-month follow-up. A depression and anxiety-screening inventory, a questionnaire on client-staff relationship quality, and a client satisfaction survey are included.

Effectiveness of Catherine Freer’s Therapy for Personality Disorders
Dr. Jeff Clark completed a doctoral dissertation in 2002, which examined the effectiveness of Catherine Freer’s therapy approach for treating incipient personality disorder characteristics in adolescents. His study used the Millon (MAPI), as well as the Youth Outcome Questionnaire (YOQ), with a sample of 70 clients. He concluded that the Catherine Freer program was effective in treating standard clinical syndromes such as depression and anxiety and, more importantly, was also effective in treating character disorders such as incipient borderline, narcissistic and obsessive personality disorders. Effect sizes for most character issues were large. It makes sense that wilderness treatment would be effective for working with character problems, but this is the first research Dr. Clark was able to find in the literature that showed any success in short-term treatment for these problems in adolescents.

Customer Satisfaction/Outcome Study, 1999
Jackie Cupples, M.S., a Catherine Freer wilderness guide, completed her internship project requirement for her M.S. by designing and conducting a questionnaire and telephone interview study. She found that 90 percent of parents said they would recommend a Catherine Freer program to others. On a three-point scale, the average satisfaction score for understanding admission information was 2.94, for their child being treated with dignity and respect, 2.84. On a four-point scale (an “extremely serious problem” to “not a problem”), parents rated their children on 13 behavior items with an average pre-trek score of 1.81, a one-month post-trek score of 3.38, and a one-year post-trek score of 3.45. Scores on particular items included:


Obeying rules
School Performance
Drug and alcohol use
Emotional Problems
Impulse control
Coping with ADHD		 Pre-trek
1.2
1.3
1.7
1.6
1.7
2.3		 One month
3.4
3.3
3.5
3.0
3.2
3.2		 One year
3.7
4.0
3.25
2.7
3.2
3.4

Scores on “child eating with family” (“never” to “often”) improved from 2.3 to 3.2 to 3.3 at one-year post trek. Parents reported 81 percent of their children in outpatient treatment or 12-step meetings at one month, and 90 percent at one year.

Wilderness Therapy Process Analysis, 1998 and 1999
Keith Russell, Ph.D., worked with Catherine Freer Wilderness Therapy Programs and Dr. Cooley, who served on his dissertation committee, to design a doctoral dissertation which would describe the theoretical bases and actual processes, along with results, of wilderness therapy. Dr. Russell spent a week in the field with each of four wilderness treatment programs, and additional time interviewing field staff and following up with clients after they graduated. He developed an elaborate database system for cataloguing client and staff statements about wilderness and treatment, and was able to tease out basic factors common to all the programs that help to define this form of treatment and explain its power to heal.

Depression Study, 1992
Steven Wall’s Ph.D. dissertation in clinical psychology used the Beck Depression Inventory to study the effects of wilderness therapy on adolescent depression. Of 27 students who participated, 15 scored as mildly to severely depressed before treatment, while only three participants scored in the mildly depressed range post-treatment. The effect size was approximately what is achieved by anti-depressant medications.

Current Research at Catherine Freer