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Systemic Wilderness Adventure Therapy


Title: Systemic Wilderness Adventure Therapy Author: Simon Crisp Last modified by: Simon Created Date: 4/10/2001 5:52:39 AM Document presentation format – PowerPoint PPT presentation

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Title: Systemic Wilderness Adventure Therapy


Fraser Island, Qld. 2003
A fresh approach to how we learn and grow. . .

Psychological First Aid in Adventure Therapy
Dr. Simon Crisp Clinical Child Adolescent
Family Psychologist Melbourne, Australia
Key Learning Objectives
  • Ability to DETECT mental health / behavioural /
    personal safety issues
  • Confidence in applying a RESPONSE (Psychological
  • Increased knowledge of resources, options and
    REFERRAL processes

Jahari Window - knowledge
What you know you know
What you know you dont know
What you dont know you dont know
What you dont know you know
Medical First Aid Analogy
First Responder Field staff, Outdoor Educator,
Paramedic Counsellor
Accident Emergency Team Program Coordinator,
Child Protection,
Surgeon / Physician Psychologist, Mental Health
Ways Adolescents Cope
  • Non-Productive Coping
  • Worrying about the problem
  • Using wishful thinking about the problem
  • Not coping and becoming ill
  • Letting off steam / tension reduction
  • Avoidance of the problem
  • Self Blaming
  • Keeping to oneself / not talking to others
  • Seeking spiritual support (ie. Praying to God to
    fix it)
  • Depending on a professional and not trying to cope

Ways Adolescents Cope cont.
  • Productive Coping
  • Seeking social support, talk to others (help
  • Actions aimed at solving the problem
  • Applying themselves to make changes
  • Spending time with boy/girl friend
  • Improve relationships with others
  • Join others with similar concerns
  • Focus on the positives of a situation
  • Seek relaxing diversions or leisure activities
  • Maintain fitness and health physical recreation

PREP D anger R eadiness Resources
A ct B
rainstorm C
onsult D ecide
Recap Follow-up
Psychological First Aid
Response gt approach engagement
  • P.R.E.P.
  • P rivacy discretion see how it might look
  • R eassuring manner and approach de-role
  • E ngage adolescent open up communication
  • P roblem define it as a shared concern,
  • normalise it, seek collaboration

Response gt approach engagement
  • Small group discussion
  • What are effective ways to PREP adolescents
    before responding with Psychological First Aid?

  • Private place how does this set the scene? What
    messages does this communicate?
  • Timing may compromise privacy
  • How will a private discussion be perceived?

  • REASSURING manner approach
  • De-role from your usual manner?
  • Approach at their level
  • Be aware of body language actions speak louder
    than words
  • Appear calm and confident instills trust
  • Humor to reduce anxiety?

  • ENGAGE - open communication
  • Be patient
  • Be an active and interested listener be
  • Wait until the adolescent is relaxed and more
    open with feelings and information
  • If still reluctant acknowledge it and validate /
    normalise it

  • PROBLEM describe normalise
  • Express your concerns simply and directly
  • Seek to learn how and if they see a problem
  • Be ready to acknowledge differing perspectives
  • Seek to find a shared concern
  • Outline implications of this concern why it
    deserves attention
  • Find leverage for how the client might
    collaborate on the problem

PREP D anger R eadiness Resources
A ct B
rainstorm C
onsult D ecide
Recap Follow-up
Psychological First Aid
Demonstration of Response
  • ? Presentation of all of the stages of Response
  • - 16 year old female student
  • - Teacher (Year Level Co-ordinator)
  • 25 minutes

D anger What are common dangers that need to be
Psychological First Aid
D anger - remove the student from danger or
danger from the student ( medical FA if
necessary) - secure the environment - ensure
supervision - anticipate how the student might
harm you, others or self-harm (in that order)
- risks medium long term
Psychological First Aid
D anger questions to ask - Do you feel
unsafe? Should I be concerned? - How much
control do you have over? - What could happen
that might reduce your level of control, or make
you less safe? - Can you easily talk to someone
about feeling unsafe? - Do you have thoughts
about hurting yourself or anyone else?
Psychological First Aid
R eadiness - Resources - What are common
reasons why you may be unready to respond? -
What are common resources you or your student may
be able to draw on?
Psychological First Aid
R eadiness - Resources ? Readiness am I the
best person? What is my mental state? Am I
adequately prepared? When is the best time for
me, when is the best time for the student? ?
Resources who, or what else can I access what
person or resources can the student access for
themselves (empowerment)
Psychological First Aid
R eadiness Resources questions - How do you
feel with me talking to you about this? - What
response do you expect from me? - Have you
spoken to anyone about this before? - Who else
can help you with this? - Who has tried to help
you with this in the past? Was it helpful?
Psychological First Aid
A ct within your limits / role / boundaries -
Is it ethical / legal /good practice for me to
intervene? - How far do I go? - What is the
best role for me to take on? - What does my
student expect of me? - Could I compromise my
relationship role with my student?
Psychological First Aid
A ct within your limits questions - What
are you expecting I would do in this
situation? - Often there are things that are
best talked about with a counsellor, is this one
of those times? - I wonder if you may feel it is
more private and easier to talk to someone less
involved with you everyday / in the way I am?
Psychological First Aid
A ct - How Receptive are you? (Johnson ,2000)
  • Receptivity
  • continuum of psychological closeness to
  • Continuum of Receptivity
  • Absent Objective Distant Empathetic
    Sympathetic Identified Fused
  • Destructive at risk OK Ideal OK
    at risk Destructive

A ct - Boundaries Self Disclosure
  • Self disclosure has the potential to confuse /or
    interfere with boundaries
  • Immediacy appropriate self-disclosure
  • The helping relationship will lead to feelings of
    imbalance for staff - this important
    asymmetry in relationship defines roles of helper
    and recipient of help
  • These feelings must be held, and the tendency
    to equalise the relationship must be resisted
  • Seek alternative responses to self-disclosure

A ct - Keeping Boundaries
  • Avoid
  • Acknowledging or discussing own mental health
    issues, family issues, drug use, school
    experiences - including telling client of own
    similar issue or problem and how you overcame it
  • Expressing personal rather than professional
    feelings about the client
  • Telling personal issues partner / spouse, sexual
    or relationship history, family, political or
    religious views

A ct - Keeping Boundaries
  1. Whose needs am I meeting by disclosing?
  2. Do they really want to know about me,
    or if I can understand their situation?
  3. Is their question really about themselves?
  4. Does a personal question about me, result in
    avoidance of own issues?

  • If I disclose, will the adolescent begin to worry
    about me (role reversal)?
  • Could I keep my own personal feelings about my
    issues contained and boundaried within myself?
  • Is a adolescent pushing disclosure about wanting
    to equalise or gain more power?

When asked a personal question, ALWAYS
  • Keep answer general, or in principle
  • Describe the concept or reasoning behind your
  • Broaden a question to a discussion about values
    and guidelines for behaviour or relationships
  • Remember it is always good to say That is
    personal and I want to keep that private

B rainstorm strategies - What can my student
do? - What can I do? - Take a collaborative
problem solving approach
Psychological First Aid
B rainstorm strategies questions - What has
worked in the past? - What havent you tired
that might help? - What do you think needs to
happen to take this in a more positive direction?
what do other people think? - If you had more
information, would that make it easier to deal
Psychological First Aid
C onsult - with peers / senior / parent /
expert - share responsibility with your
superior - utilize the resources of the parents
or an expert to your students benefit
Psychological First Aid
C onsult questions (to yourself) - Do I have
all the pertinent info? - How much do I know
about this type of issue? Have I dealt with this
type of problem before? - Is there something
unique to this situation that suggests I should
consult? - Do my reactions / confidence suggest
that I should get support? - Is specialised
assessment indicated?
Psychological First Aid
C onsult Who could you consult to
peer / senior / expert?
Psychological First Aid
D ecide - Monitor OR Manage myself OR Refer?
- Re-assess Danger (repeat DRABCD if necessary)
Psychological First Aid
D ecide questions (to yourself) - What might
hinder this student accepting referral? - What
can I do to ensure the student follows through?
- How can I ensure that the referee get all the
info? - What are my obligations to parents about
the referral? - What is the best way to review
this? make a plan
Psychological First Aid
Response gt termination
  • Re-cap Follow-up
  • Re-cap
  • Key points of information
  • Strategies to use
  • Plan of action
  • Follow-up
  • Who / what / when

Morning Tea? Something to eat?
Specific Problems Anxiety Disorders
  • Generalised Anxiety Disorder
  • Panic Disorder
  • Phobias Social Phobia / Agoraphobia
  • Obsessive- Compulsive Disorder (OCD)
  • Post-Traumatic Disorder (PTSD)

Anxiety Process
  • Visual stimulus cues the person to appraise the
    situation as either safe OR threat
  • Physiological symptoms Perspiration increased
    respiration, blood pressure, etc.
  • Cognitive anticipating a catastrophe something
    bad is about to happen loss of confidence or
    self-efficacy memory disturbance attentional
    disruption (over-focus on threat)
    hypervigilance, etc.
  • Behavioural agitation restlessness

Gereralised Anxiety Disorder
  • Reassure the student things are OK and under
  • Be firm, supportive and directive take control
    for the student
  • Encourage the student to reality check their
    fears, bring things in to perspective use
    visual cues
  • Allow the student to talk through their fears if
  • Gentle distraction and humor can be useful if
    done supportively

Panic Disorder
  • Acute experiences of heightened anxiety
  • Difficulty breathing feelings of chocking or
    hyperventilation trembling or shaking racing
    heart beat dizziness abdominal pain fear of
    loosing control, etc.
  • Person may feel they are going to die
  • Hyperventilation may appear
  • as asthma
  • Usually transitory and will
  • abate after a few minutes

Panic Disorder
  • If unsure if a medical condition, treat as one
  • Move to quiet and safe location if necessary
  • Encourage slow, relaxed breathing
  • Reassure and explain what is happening to student
    get them to focus on reassuring using visual
  • Explain that attack will soon pass and they will
    fully recover
  • Assure them you will stay until it has passed
  • Dont restrict them from moving

Psychological First Aid Role Play
  • Managing acute anxiety
  • In groups of 3, role play the scenario described,
    especially focusing on management of anxiety
  • In a large group, discuss how to ensure you stay
    within the limits of your expertise

Extreme Anxiety Dissociation
  • Usually an adaptive response developed to cope
    with abuse, trauma or extreme anxiety, triggered
    by trauma related stimulus
  • Person psychologically disconnects from their
    physical body to avoid uncomfortable sensations
    of fear, anxiety or pain
  • Can experience feelings of derealisation and
  • May have very high pain threshold danger of
    accidental / deliberate self-harm or suicide

  • May be difficult to tell if it is happening can
    looks as if person is floating and indifferent
  • May report being OK or fine and have no
    awareness of their state
  • May refuse to move away from danger stay
    stuck or trance-like with fear
  • Usually occurs for seconds / minutes and usually
    resolves itself

  • Assess if person is orientated time/place/person
  • Ask how they feel may report nothing, or that
    they are fearful but not show congruent signs
  • Gently take charge simple, gentle, firm
    directions, but avoid appearing coercive
  • Have them maintain eye contact with you or fix on
    a reassuring visual point

  • Encourage them to talk about their fears
  • not tune out to what I happening
  • Move to safer / less stressful location
  • Encourage relaxation strategies breathing, etc.
  • Normalise their experience affirm their ability
    to put up with the fear

Specific problems Depression
  • Equally common in both sexes
  • Often first noticed
  • - fatigue, drop in general performance
  • - hopeless and nihilistic themes in verbal
  • - social withdrawal, failure to engage with
  • - friend reports that the student appears sad

  • Clinical assessment usually required
  • May be in denial that they have a problem, highly
    secretive, avoid interactions, may be expressed
    as irritability or anger
  • Hopelessness may make it difficult to motivate
    them towards solving the problem

  • Do
  • Take seriously
  • Persist in talking to adolescent about their mood
  • Assume the presence of suicidal thoughts
  • Attempt to find out about recent stressors,
    family/peer situation

  • Dont
  • Take their response that everything is fine on
    face value
  • Take sarcasm or anger towards you personally
  • Give glib advice snap out of it or list
    reasons why they dont have cause to feel sad
  • Raise concerns or comment in the presence of

  • Responds best to
  • Directness, patience, measured concern
  • Closed questions about their mood
  • Confidence about how you approach the situation
  • Empathy

  • When high priority
  • Any signs of suicidality, self-harm, high risk
  • If no professional involved (that you know of)
  • Prior history of depression/suicidality/self-harm
  • Recent stressor (especially loss)
  • Adolescent rejects help or denies a problem in
    the face of contradictory evidence

Suicide and Self-harm
  • Continuum of self-harming behaviour
  • Deliberate Suicide Attempt Suicide
  • Self-harm
  • Tension release, Call for help or failed
    Deliberate wish to
  • expression of anger serious attempt
    die or accidental etc. death

Suicide and Self-harm
  • Signs
  • Depressed, anxious, angry, agitated, mood swings,
    concentration or memory problems
  • Often high risk-taking behaviour
  • Poor coping, may have eating disorder,
    personality problems
  • May be aggressive towards others
  • Sometimes have difficulty being assertive

Suicide and Self-harm
  • Do
  • Always take seriously, regardless of frequency
  • Gently persist in talking to adolescent about
    self-harming behaviour / suicidal thoughts
  • Assume even fleeting thoughts can be deadly
  • Affirm telling someone is best thing to do

Suicide and Self-harm
  • Dont
  • Avoid or put off investigating the issue, or hope
    it will subside with time
  • Convey anger, disgust, or a punitive attitude
  • Believe you can tell the students real
    motivation, ie. just trying to get attention

Suicide and Self-harm
  • Remain non-judgmental
  • Encourage verbalisation of feelings
  • Affirm your role is to keep student safe from
  • Set clear limits about not tolerating self harm
    in your presence (if necessary)

Suicide and Self-harm
  • Dont reinforce/reward the behaviour accidentally
    give a neutral response
  • Dont attempt to physically restrain if actively
    self-harming move away, avoid watching, but
    remain in close proximity
  • Ensure student is directly supervised at all
    times if suicidal
  • Seek expert consultation as soon as possible

Psychological First Aid Role Play
  • Managing suicide / self-harm risk
  • In groups of 3, role play the scenario described,
    especially focusing on engagement, building
    rapport and direct questions about mood and
    suicidal thoughts
  • In a large group, discuss how to ensure you stay
    within the limits of your expertise

Psychological First Aid Role Play
  • Key points
  • Develop sufficient rapport to allow student to
  • Normalise the adolescents experience
  • Ask direct, closed questions to determine risk
  • Ensure you have a clear plan student adherence
    to it
  • Plan for follow-up or monitoring

Acute Stress PTSD
  • Definition of Psychological Trauma
  • An adverse psychological reaction to a stressful
    and extraordinary event
  • Eg.s
  • Accident, near accident, injury, death
  • Assault, threat of harm, extreme behaviour
  • Self harm, threats of self harm, suicide
    gestures, completed suicide
  • Natural disasters and extreme environmental
  • Observing or in any way being a witness to any of
    the above

Comfort Zones Trauma
  • Typical (normal) Stress Response Symptoms
  • Shock, disbelief
  • Heightened arousal, fear
  • Hopelessness, abandonment
  • Flight or escape behaviour
  • Protective postures
  • Holding others
  • Family oriented behaviours
  • Heroic behaviour
  • Time distortion brief, suspended
  • Emotional shutting down
  • Panic is rare

Acute Stress Disorder PTSD
  • Acute Stress Disorder
  • Occurs within 2 days to 4 weeks post incident
  • lt20 of people are likely to experience it
  • 75 of ASD continue onto PTSD

Acute Stress Disorder PTSD
  • Acute Stress Disorder - Features
  • Persistent dissociation
  • Re-experiencing of the event (e.g. flashbacks)
  • Avoidance of being reminded of the traumatic
  • Regressed behaviour
  • Increased arousal startle response,
  • Derealisation, depersonalisation, dissociative

Acute Stress Disorder PTSD
  • Post Traumatic Stress Disorder
  • Post Acute Stress Disorder gt 4 weeks
  • lt 15 of all survivors develop PTSD
  • Symptoms may worsen with time
  • Likely to seriously effect functioning school,
    family, peers, adult relationships
  • Can be foundation to depression, substance
    abuse, self-harm, suicide

Managing Critical Incidents
  • Ensure physical safety
  • Take personal inventory
  • Take charge
  • Seek and give personal support
  • Develop a routine
  • Balance activity and restore normalcy
  • Establish links to social supports ASAP

Trauma Reactions of Adolescents
  • Withdrawal
  • Depression
  • Less responsible, more demanding - regress
  • Rebellious, competitive
  • Frustrated angry
  • Physical complaints

Traumatic Events
  • Needs of Adolescents
  • Education about the crisis what happened and why
  • Talk about their feelings / frustrations
  • Encouragement to re-engage in activities and
  • Encouragement to become actively involved in
    getting things back to normal

Traumatic Event Hypothetical
  • Managing a traumatic incident
  • In groups of 3, discuss how to manage the
    scenario described. Plan your response in points
    and chronological order.
  • In a large group, discuss what action you
    planned, what order you would apply them and why?

Round Up
  • Hows your Jahari Window?
  • Outstanding questions?
  • Most helpful thing?
  • Where to now?