OBH Research Findings: Engaging Resistant Clients

Most clients entering OBHC programs are resistant to treatment initially but research findings indicate the majority will become motivated to change and will benefit from the program.

Engaging Resistant Clients

While therapy is generally considered to be voluntary, most clients entering OBH Council programs are not doing so on their own will. External influences such as parents, mental health professionals, judicial systems, or schools typically bring clients into programs. A client’s desire to change is seen by many mental health professionals as critical, which presents a predicament for OBHC programs, who most often treat clients who do not want to be there. Through many anecdotal experiences, the field of outdoor behavioral healthcare has believed in its ability to engage resistant clients in the treatment process. Recently two studies also provide empirical support for this belief.

The first study in 2008 surveyed 774 OBH Council clients using the University of Rhode Island Change Assessment (URICA). Prior to entering an OBHC program, only 27% of adolescent clients were in a “motivated” stage of change. In other words, 73% were not engaged or participating in treatment, and were either ignoring or just beginning to recognize a problem issue. However, upon leaving their OBHC program, 90% of clients were in an action or maintenance stage of change. Though these clients were very unmotivated at admission, the majority had shifted to an awareness of their problem issues and begun to actively work on them. At a six-month follow up, about 80% of clients were still actively addressing problem issues and maintaining progress.

Another study in 2013, using the URICA, found that clients increased significantly in their motivation to change over the course of a wilderness therapy program. Additionally, this study found that unmotivated clients at admission made similar levels of improvements in overall functioning compared to clients who were motivated at admission. This suggests that resistance to treatment at admission does not reduce the effectiveness of a wilderness therapy program, and that motivation to change at the beginning of treatment may be unnecessary for positive therapeutic outcomes.

While both studies have limitations and further research is needed on this topic, these findings are encouraging to the OBH field and to parents who face placing their child in a program to which their child is adamantly opposed.



Bettmann, J. E., Russell, K. C., & Parry, K. J. (2013). How substance abuse recovery skills, readiness to change and symptom reduction impact change processes in wilderness therapy participants. Journal of Child and Family Studies, 22, 1039-1050. doi:10.1007/s10826- 012-9665-2

Norton, Tucker, Russell, Bettman, Gass, & Gillis (2014). Adventure Therapy with Youth. Journal of Experiential Education.

Russell, K. C. (2008). Adolescent substance-use treatment: Service delivery, research on effectiveness, and emerging treatment alternatives. Journal of Groups in Addiction & Recovery, 2(2-4), 68-96.


Lost your password?