There are as many wilderness approaches as there are wilderness programs. What binds them together is not simply their innovations in the area of recreation therapy, but in their common orientation toward helping their clients build greater self-efficacy. Self-efficacy is a mindset that one can handle challenges in front of them. Called also “self-belief” by its progenitor Albert Bandura, we at Ellenhorn believe this mindset is central to a person’s growth and recovery, and especially for the clients we work with, who have often been injured in their ability to believe in themselves, due to often long histories in treatment. This is also a central element in wilderness work, with the strengthening of a person’s self-efficacy as a kind of aid to their treatment if not the central goal.
There are a myriad of reasons why a focus on self-efficacy is integral to a person’s growth and recovery, but at Ellenhorn we see two prime areas in which this powerful mindset is the main player. First is their ability to engage in treatment. We work with individuals typically called “difficult to engage,” and we believe the reason they resist treatment is because of social losses they experienced due to their psychiatric or addictive experiences and the general way individuals are treated within behavioral health systems. At the base of this problem is a series of experiences in which they feel they have failed, or that they are broken by their illness. For us to help them try again, and accept care, they need to believe in themselves again. This leads to the second area: hope. As our Founder, Ross Ellenhorn describes in his book How We Change: And they Ten Reasons Why We Don’t, hope is the mindset that pushes us through uncertainty toward something we yearn for. And to take the risk of hoping requires that one has faith and belief in oneself in order to take that walk into uncertainty. In fact, the central psychological measurement for hope, largely measures just this. Or to put it another way, hopeful people are also self-efficacious people. All treatment is about hope since in all treatment an individual must face the uncertainty that they will get anything out of it, or the chance that their hopes for change will be dashed.
These are our two main areas of concern when it comes to self-efficacy and why we often think that the recovery of this mindset is really what most of our treatment is trying to achieve. From our perch, we also believe these are the central elements of wilderness therapy. We differ, however, from wilderness therapy in two important areas that we believe a referring party should consider when making decisions about treatment placement. These differences are also often exclusionary criteria for Wilderness programs, with Ellenhorn filling a couple very important gaps in treatment that places self-efficacy as a prime goal.
- Severity of experiences: Ellenhorn is a “hospital without walls” and the most robust community integration program in the United States. We provide care for individuals who often require intensive psychiatric help, people who often do poorly in wilderness programs because of invasive psychiatric experiences, and are typically thought of as needing supervised residential services. With psychiatrists and nurses working daily on our multidisciplinary team of clinicians, we attempt to help people who are experiencing very difficult and complex symptoms work on their self-efficacy in managing their daily lives, from making meals for themselves and attending events in the community, to going back to school or work. In this way, we turn the concept of “readiness” on its head. Where most programs consider a person ready to return to the community once they are considered “stable” by clinicians, we believe that people don’t get well without self-efficacy and so we create care that can sustain them in the community while they build their self-belief. This leads to the second difference between Ellenhorn and Wilderness programs.
- Environment of Care: Up to eighty percent of Ellenhorn’s services are provided outside our offices and in people’s homes. Our work is conducted “in-vivo.” Not in the woods, on a river or in the mountains, our clients build self-efficacy around the behaviors of daily life. To put it another way, they recover their sense of autonomy and independence by becoming more autonomous and independent. That makes their movement out of our care seamless, since they have not only built greater belief in themselves while working with us, but have built the skills needed to function independently.
In this, Ellenhorn works counter to central trends in behavioral health in which the most intensive resources are spent on helping individuals in locations away from daily life, while less resources are spent on helping people manage things when they are home.
Our ability to serve people this way, which is formed around our belief in what is called “the dignity of risk,” reflects the model of care we use, called the Program for Assertive Community Treatment. This model is designated by both the National Institutes of Mental Health (NIMH) and Substance Abuse and Mental Health Services Administration (SAMHSA) as the evidence-based method for serving individuals who are “difficult to engage,” people who are resistant for any number of reasons to engage in treatment. This makes Ellenhorn a prime source of self-efficacy oriented care for individuals who are unwilling to take the leap of entering a wilderness program.
Certainly, Ellenhorn is not for everyone: we work with often highly complex cases, one’s that would do poorly in most wilderness programs and with individuals who are often unwilling to accept other treatments. But we do believe that we swim in the same waters (or climb the same mountains, scale the same cliffs or live in the same tents) as wilderness programs, and we see ourselves as our family in our joint pursuit of building greater self-efficacy for our clients.
