The document discusses the evolution and practice of client-directed adventure therapy, emphasizing the importance of the therapeutic relationship and client engagement in achieving effective outcomes. It critiques the medical model of mental health treatment and highlights evidence supporting client feedback's role in therapy's success. Additionally, it defines adventure therapy as the use of experiential activities in natural settings for therapeutic purposes, calling for a collaborative approach between therapists and clients.

1. Will Dobud MSW
Charles Sturt University

2. “The therapist is a co-adventurer, exploring the
landscape and encountering multiple vantage
points while crossing the terrain of the client’s
theory of change. When stuck along the way,
we join clients in looking for and exploring
alternate routes on their own maps. In the
process clients uncover trails we never
dreamed existed.”
(Duncan, Miller, & Sparks, 2004, p.
136)

3. Client Directed Adventure
Therapy
• Relational vs. Medical Model
• What works in therapy
• What is Client-Directed, Outcome-
Informed?
• The Adventure Therapy Experience

4. A Bit About Me
BSW – University of Maryland – Baltimore
County
MSW – Charles Sturt University
Phd (Cand.) – Charles Sturt University
-Run a small program True North Expeditions,
Inc.
-South Australian Representative for AABAT

18. Over the Last 50 years…
• 275% increase in mental health workers since
1980
• Evidence-Based Treatments from 60 to 250+
• Number of Disorders from 24 to 297+
• Psychotherapy down 35%, Pharmaceuticals up
75%

19. Here’s why…
• National Conference of Charities and Corrections
(1915)
• National Institute of Mental Health (USA) says “no
diagnosis, no research”
• Competence of service deliver vs. Outcome

20. The View of the Medical Model
Proper Diagnosis + Prescriptive Intervention =
Effective Treatment
Targeted Diagnostic Groups + Evidenced
Based Treatments = Symptom Reduction

21. The Killer D’s
• Mental Disorders to not have the boundaries of an
illness like diabetes or the flu
• Homosexuality was a “Mental Disorder” until 1973
• Attribution Creep…
• No correlation between diagnosis and outcome

22. Which Treatment Works Best?
• Human Affairs International Study
• Wampold et al. (1997)
• Elkin et al. (1989)
• Lambert (2013)
• Miller, Hubble, Duncan (2008)
Specific Factors vs. Common Factors

24. Who Are The Supershrinks?
• What do the best therapists in the world do?
• Eliciting Feedback on Outcome & Success
• More time doing “Deliberate Practice”

26. The New Equation
Client Resources and Resilience +
Client Theories of Change +
Client Feedback about the Fit & Benefit of the
Service
= Client Perceptions of Preferred Outcomes

28. What is Client-Directed?
• Clients are critics of therapy performance
• Therapeutic Relationship is an ongoing process
• Accepting the client’s goals
• Tailor fitting the tasks (procedures) of therapy

30. What is Outcome-Informed?
• Product Oriented vs. Consumer Oriented
• Tracking Outcome
• Bringing Results to Light
• Failing Successfully

33. 0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 12 13 14
Outcome Rating
Session Rating
2015 ORS/SRS Results
SRS Cutoff
ORS Cutoff

34. 0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 12 13 14
Outcome Rating
Session Rating
A Less Than Romantic Outing
SRS Cutoff
ORS Cutoff

35. Feedback Informed Treatment
(FIT)
• Privilege the client’s voice (even when we don’t want
to)
• Tailor our service to their unique feedback & situation
• Use the client’s creativity and strengths to solve
problems
• Ongoing measurement to see the FIT

36. “…clients whose therapists had access to outcome
and alliance information were less likely to
deteriorate, more likely to stay longer, and twice as
likely to achieve a clinically significant change.”
(Miller, Mee-Lee, Plum, & Hubble, 2005,
p. 47)

38. Definition of Adventure Therapy
“the prescriptive use of adventure experiences
provided by mental health professionals, often
conducted in natural settings that kinesthetically
engage clients of cognitive, affective, and behavioral
levels”.
(Gass, Gillis, & Russell, 2012,
p. 1)
“Bush Adventure Therapy is a diverse field of practice
combining adventure and outdoor environments with
the intention to achieve therapeutic outcomes for
those involved.”

39. Quality of Participation
• Tailored Facilitation Focussing on Engagement
• “Connection Before Correction”
• Increase relationship through collaboration
• Debriefing: What can I do better next time?

48. References
Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcomes of psychotherapy: Historical excurus, measurements, and
prospects for research. Frontiers in Psychology, 2, 1-11.
Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors of therapy: Quantitative findings. In M. A. Hubble,
B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33-56). Washington, DC: American
Psychological Association.
Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-
directed, outcome-informed therapy. San Francisco, CA: Jossey-Bass.
Duncan, B. L., Miller, S. D., & Sparks, J. A. (2007). Common factors and the uncommon heroism of youth. Psychotherapy in
Australia, 13(2), 34-43.
Duncan, B. L., Sparks, J. A., Murphy, J. J., & Miller, S. D. (2007). Just say 'no' to drugs as a first treatment for child problems.
Psychotherapy in Australia, 13(4), 32-40.
Duncan, B. L., Miller, S. D., Sparks, J. A., Claud, D. A., Reynolds, L. R., Brown, J., & Johnson, L. D. (2003). The session rating scale:
Preliminary psychometric properties of a "working" alliance measure. Journal of Brief Therapy, 3(1), 3-12.
Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: Therapeutic relationship problems and other reasons for
ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70(2), 439-443.
Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York: Routledge.
Lambert, M. J. (2013). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield's handbook of
psychotherapy and behavior change (6th ed., pp. 169-218). Hoboken, NJ: Wiley.
Madsen, W. C. (2009). Collaborative helping: A practice framework for family-centered services. Family Process, 48, 103-116.

49. ReferencesMiller, S. D., & Duncan, B. L. (2000). Paradigm lost: From model-driven to client-directed, outcome-informed clinical work. Journal
of Systemic Therapies, 19(1), 20-24.
Miller, S. D., Hubble, M. A., & Duncan, B. L. (2008). Supershrinks: What is the secret of their success? Psychotherapy in Australia,
14(4), 14-22.
Miller, S. D., Duncan, B. L., Brown, J., Sorrell, R., & Chalk, M. B. (2006). Using formal client feedback to improve retention and
outcome: Making ongoing, real-time assessment feasible. . Journal of Brief Therapy, 5(1), 5-22.
Miller, S. D., & Duncan, B. L. (2000). The outcome rating scale. Chicago, IL: Authors.
Miller, S. D., Mee-Lee, D., Plum, B., & Hubble, M. A. (2005). Making Treatment Count: Client-Directed, Outcome-Informed Clinical
Work with Problem Drinkers. Psychotherapy in Australia, 11(4), 42-56.
Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy - noch einmal. In A. E. Bergin & S. L.
Garfield (Eds.), Handbook of psychotherapy and behavior change. (4th ed., pp. 270-378). New York: Wiley.
Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: A comprehensive review
of controlled outcome research. Psychological Bulletin, 30-49.
Rodwell, M. K. (1987). Naturalistic inquiry: An alternative model for social work assessment. Social Service Review, 61(2), 231-246.
Rogers, C. R. (1961). On becoming a person. Boston, MA: Houghton Mifflin Company.
Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070), 250-258.
Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: A comprehensive review
of controlled outcome research. Psychological Bulletin, 30-49.
Wampold, B. E. (1997). Methodological problems in identifying efficacious psychotherapies. Psychotherapy Research, 7(1), 21-43.