Judge for your self

Below is a letter sent into March's edition of DDN in response to the article on Nature Awareness. I felt it only fair that the sceptics view should also be read. Below that is the article run in February's DDN news after a telephone interview was contacted with my self about some of the effects that Nature Awareness has had on people with addictions.

Drink & Drug News - Plan to succeed (09 March, 2009)

Bark at the moon

Upon opening my recent copy of Drink and Drugs News, I needed to do a double-take on your nature awareness article (DDN, 23 February, page 6) to check that 1 April hadn’t come round sooner than I thought. It appears that while Geoffrey recognises that there is no evidence for the programme’s effectiveness, it works on same principle as equine assisted therapy. While I have my own doubts over the effectiveness of EAP, using Geoffrey’s logic I’d suggest that hamster assisted therapy (HAT) would have the same impact as, like horses and trees, they are also part of nature. Would the NTA perhaps examine the opportunity to fund a study into cockroach assisted therapy (CAT)?

Geoffrey tells us that he doesn’t know how it works but it does. What does he mean by this? Does running blindfolded through a forest while someone beats a drum reduce the likelihood of re-offending? Does holding hands and behaving like a wolf reduce the trauma of childhood sexual abuse – although I must admit that I have little knowledge of the psychology of wolf behaviour. Perhaps Geoffrey has studied wolf behaviour and its similarities to human behaviour, and the lessons we can learn from wolves?

Geoffrey continues by informing us that the programme seems to work better with a younger age group. ‘Up to about 12’, he helpfully reports, continuing that after that it becomes a little bit more difficult. I wonder why? The programme also seems to have better outcomes with women ‘because they tend to be more organised’. This sweeping generalised statement based on absolutely no evidence whatsoever, sums up the whole basis of the article. Even if we accept the fact that women are generally more organised – although I’m not really sure what this means – how does it make them better at finding trees while blindfolded or acting like a wolf?

The whole article is frankly insulting to those of us who have spent many years offering service users robust evidence-based programmes that have demonstrable outcomes. The whole idea that the worldwide addiction field has missed a major treatment intervention is also offensive to those who have devoted significant portions of their lives studying and researching addiction. I’m disappointed that DDN sees fit to publish an article more akin to alchemy than science. As a practitioner and commissioner with nearly 20 years in the field, I subscribe to DDN to hear about programmes based on research evidence and best practice. I’m sorry Geoffrey, I don’t believe in fairies or the power of trees to assist in recovery from drug and alcohol problems.

Derek Wilson.

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Drink & Drug News - It's in the trees (23 February, 2009)

Recovery | Alternative therapy

Seeing the wood AND the trees

David Gilliver hears how nature awareness therapy has been helping clients with substance misuse issues not only re-connect with nature but also with themselves ‘I didn’t understand how trees and nature could be so powerful. I felt something I never felt before – I can’t really explain it. I felt happy, got in touch with my feelings for the first time. I started to feel spiritual as well – it was amazing.’ Lucy is talking about her experiences of nature awareness, an intervention for people with addiction issues using nature-based games. It’s designed to build trust, increase self-awareness and self-confidence, boost creativity and promote communication, problem solving and relationship skills. It is also based on the theory that connecting with nature – and stepping outside of your self – can help change established behaviours and encourage people to take responsibility for their actions.

Nature awareness therapist Geoffrey McMullan used the method with clients from Kent-based 12-step centre Promis, as well as a Christian rehab centre, as part of research for his MA in addiction psychology at Southbank University. ‘I’d been involved in nature awareness work for around 10 years, but when I ended up working in rehab I had no prior knowledge of working with addictions,’ he says. ‘It was like a blank sheet of paper.’ The games include ‘meet a tree’, the aim of which is to locate a specific tree while blindfolded, and ‘the drum stalk’ in which participants move through the trees to the sound of a drum beat. The games are based on Native American ideas, but have been modified through use with substance misuse clients – they also incorporate elements of ‘wilderness therapy’, which challenges people by removing them from their comfort zones.

So how does it work? ‘Nature awareness is very much about going into nature but allowing the events to unfold before you,’ he says. ‘There’s no set procedure other than the games I use. If a situation arises, we go for the intervention there – we sit down and work as a group.’ Rather than an alternative to traditional treatment methodologies, however, he sees nature awareness as a means of helping people get more from mainstream treatment. ‘I had a counsellor say she’d tried every possible way of intervening with a client with no success, until she went on nature awareness – it was an integral part of her recovery that focused on the here and now. A consultant psychologist told me it helped clients respond to more traditional treatment methods, and counsellors have also told me that it works on the spiritual side, which can be hard to deliver.’ He cites the example of equine assisted psychotherapy (EAP), which uses interaction with horses to boost emotional growth and non-verbal communication skills. ‘Nobody really understands how that works, but it does work,’ he says. ‘A horse is part of nature – we’re not separate from nature, we do have that connection, and it’s about firing that up. I say to people ‘I’m going to help you remember what you already know'.'

With some clients, the therapy also seems able to put them back in touch with aspects of their character they may have lost touch with. He describes how a woman with an eating disorder felt intense frustration after becoming caught up in brambles during one game. She persevered, however, and later said that the frustration she felt was the same as when she started to binge, but the fact she had managed to get out meant there was hope for her.

Another said that for the first time in her life she listened to what her body was telling her. ‘That could only be achieved by being outside in nature,’ he says. ‘You couldn’t achieve that within four walls. So it’s not a stand-alone intervention, it’s very much a complementary one.’ Another client, now a counsellor himself, described the ‘drum stalk’ game as being like steps one, two and three of the 12 steps. ‘The person being blindfolded was him in his addiction, going through the forest blindfolded was him recognising that he’s powerless over that situation, his sight guide represented his sponsor and the drum beat was the higher power calling out to him,’ he says. ‘That was a good analogy.’

Established behaviour patterns are challenged through asking clients to ‘become’ animals and completely lose themselves in the role. ‘I had a group of guys blindfolded, holding hands, who took on the role of a pack of wolves,’ he says. ‘They were hunting someone who was a rabbit, and one of the guys broke away from the group. We challenged that, asking him why, and he suddenly realised that that’s what he does when he wants to go and use. That wasn’t picked up within the four walls – it wouldn’t be he’s not breaking away from the group there. When you get them to take on the role of an animal, after a while people drop the barriers they’ve put up – there’s no need to hide anymore. It’s quite amazing what comes from that, because they’re not them, they’re the animal.’

He’s now used nature awareness with around 100 clients with substance misuse issues, covering a broad range of addictions. Does it work with certain age ranges better than others? ‘Nature awareness works from a very young age all the way up,’ he says. ‘Children up to about 12 respond very well to nature-based activities. After that it becomes a little bit more difficult and for me that’s where the wilderness aspect kicks in – taking them out of their environment and into a wilderness where they can’t just pop down to McDonald’s. You’re putting them in a challenging situation where eventually they have to do something about it.’ As yet no one else seems to be using this in substance misuse treatment. Are people usually open to the concept or are they likely to be suspicious or cynical to begin with? ‘Cynical, totally,’ he says. ‘But I kind of encourage that. I give them very little information because I want to challenge them. Some people will claim that they know everything about nature and there’s nothing I can teach them, some will be suspicious but curious and others will use it as a reason not to go to group or counselling sessions. But then they take part in the game and suddenly get challenged. It doesn’t work with everyone – I’ve had one or two people just walk away and not engage at all.’

Once clients have overcome their initial reservations the feedback is usually positive. So does any one group seem to get more out of it than another? ‘What I did find with the research is that women tend to perform better than men because they tend to be more organised. Nature awareness is about getting people into that ‘heart’ space, rather than the ‘head’ space, which is all factual and statistical, and once men do that they perform just as well as women. One man who was on Detox came back a year later and said it was still having a profound effect on his life.’ He’s now in the process of setting up a workshop to teach nature awareness to other counsellors. Clearly, however, a lot of people will take a good deal of convincing – what would he say to the sceptics? ‘A consultant psychologist asked me if she could come and observe and my answer was the same as always – ‘yes you can, but only by taking part. If you want to stand on the sidelines you’re not going to have that experience.’ She came and was very cool about it, looking at it from a professional point of view, and at the end she told me that it created a bridge that traditional methods couldn’t. I’m more than happy for anyone to challenge me. You can get lulled into a false sense of security about what you’re doing, and that’s wrong – I’m always open to change.’

And would he like to see nature awareness ultimately becoming a part of mainstream treatment? ‘That’s in my heart of my hearts,’ he says. ‘I’d love to see it used throughout the country and for the evidence to be built up. Ultimately I want to set up my own wilderness centre working with people from all different backgrounds, not just addictions, and I’d also like take the research further if anyone’s interested. One of the problems with the alternative or spiritual-based side of things is that there’s not enough evidence, because the other side – the scientists – don’t want to go there. I do believe that nature awareness can close that gap – not entirely, but a little bit. I’ve had real sceptics come along and I’ve just thought ‘great, the more sceptical you are the better.’