Carina Ribe Fernee

This qualitative case study examines how adolescents navigate their life course after experiences of abuse within the Norwegian welfare state. Drawing on a critical realist approach and two in-depth interviews, the study explores the concept of negotiated resilience, a relational and systemic perspective that shifts analytical attention from individual traits to adolescents’ interactions with the cultural and institutional structures surrounding them. Resilience is understood as a dynamic and situated process shaped by social conditions and institutional responses.The analysis identifies three dialectical tensions that characterise adolescents’ negotiated resilience: (1) Coping Alone versus seeking help, (2) Being Perceived as Reliable versus Unreliable, and (3) Future Orientation versus Stagnation. These tensions are interpreted as emerging from two broader discursive struggles present in the adolescents’ life-worlds: (1) The Capable Child versus the Deficient Child, and (2) Hope versus Despair.By foregrounding these tensions and discourses, the study offers a nuanced account of how resilience is actively negotiated in adolescents’ everyday lives following abuse. The findings highlight the significance of viewing victims as reliable and capable, and underscore the need for welfare-state institutions to recognise and support adolescents’ agency, even when structural conditions inadvertently constrain their opportunities to act.

Background: Recent research has demonstrated a multitude of ways in which exposure to nature enhances health and well-being. However, it is unclear whether this is true for neurodiverse children and youth, such as children on the autism spectrum and children with ADHD or Tou-rette’s syndrome.Objective: This scoping review summarizes the assumed mechanisms of change, explanatory theories, intended outcomes, and the results of studies examining the relationship between exposure to nature and psychosocial outcomes in neurodiverse children and youth.Design: We searched for peer-reviewed research reports on the relationship between exposure to nature and psychosocial outcomes in 0–18-year-old children and youth with a diagnosis of ADHD, autism or Tourette’s syndrome in six online databases with no language restrictions. The search included all years, and the final search was performed in April 2024. Animal-assisted stud-ies and studies on family outcomes were excluded. Results: This review covers 43 studies (1976–2023), primarily from North America and Europe, with 25 on ADHD and 18 on autism. Our systematic search did not identify any studies focusing on Tourette’s syndrome. The most commonly assumed causal pathways were restoring and building capacities. The most commonly mentioned theories – Attention Restoration Theory (ART) and Stress Reduction Theory (SRT) – were related to the restoring capacities pathway. Most studies adopted the medical model, viewing neurodevelopmental conditions as disorders. “Nature” was generally defined ostensively or operationally. Conclusions: Drawing on our analysis of assumed causal pathways, underlying theories, and varying definitions and conceptualizations of nature, we identify five critical research gaps to guide future studies. 1) Exploring diverse geographical and cultural contexts – more diversity is required; 2) Conceptualizing nature – what is it that provides the beneficial effects in nature? 3) A more nuanced view of pathways – it is important to align the assumed pathways with how neurodiversity is conceptualized; 4) Expanding theoretical frameworks – while most studies cit-ed ART and/or SRT, which relate to the restoring capacities pathway, explanatory theories relat-ed to the other pathways are needed; 5) Conceptualizing neurodevelopmental phenomena – there is room for building on more varied conceptualizations than the medical model, especially considering that restoring capacities and building capacities were the most commonly identi-fied pathways.

Human health and well-being are dependent on natural environments, which is the core foundation of the growing discipline of outdoor therapies. However, as with psychotherapy research in general, the field of outdoor therapies lacks descriptive process-oriented theoretical frameworks that precisely reflect this multi-faceted practice. Therapeutic work, whether this takes place indoors or outdoors, comprises numerous implicit relational and environmental dimensions. Implicit aspects are largely sensed, embodied and intuitive, and therefore hard to pin down and describe accurately. In this exploratory study, a survey mapped implicit guiding frameworks amongst outdoor therapy practitioners (n = 68) representing 18 nations. A constructivist grounded theory analysis resulted in the proposition of a practice theory, called the implicit ecosystem of outdoor therapies, made up of eight interrelated components: (1) joint engagement and co-creating agendas; (2) a foundation of safety and trust; (3) being in parallel and not fix; (4) awareness and attunement here-now; (5) the dynamic of outer and inner landscapes; (6) a constantly moving and meaning-making endeavor; (7) creativity, play, and whole-body activation; and (8) working through natural barriers and rewriting narratives. This grounded theory offers a preliminary blueprint of a practice-guiding framework developed from within the outdoor therapy discipline intended to advance theory, training, and research.

Introduction: Adolescents and Young Adults (AYAs) affected by cancer are at risk of experiencing late and long-term effects following cancer diagnosis and treatment. While structured interventions have demonstrated potential benefits for well-being during the intervention itself, little is known about how AYAs affected by cancer engage with and experience nature in their everyday lives beyond the formal program context. The aim of this study was to explore how a selected group of AYAs affected by cancer—who had participated in a nature-based intervention (the WAYA program)—experience nature and its role in supporting and managing late and long-term effects of cancer and its treatment, beyond the context of the program itself. Method: This qualitative study explored the experiences of nature following the WAYA intervention among AYAs affected by cancer. Data were collected by focus group interviews at a three-month follow-up, using participant-selected photographs as visual prompts to elicit reflection on how nature supports management of late and long-term effects of cancer. A photovoice-inspired approach guided discussion questions and facilitated individual and collective meaning-making. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Results: The analysis of this study showed one theme: Reconnecting with self and meaning through nature’s unconditional presence—beyond human connection. The theme comprises the two categories Nature as a resource for inner balance and Nature as a meaningful companion , and five sub-categories : Managing by being mindful, Managing by experiencing rest and being calm, Experiencing metaphoric recognition, Sparking comfort, hope and positive emotions, and Nature as a space without obligations. Conclusion: This study explored how AYAs affected by cancer engage with nature beyond formal programs, revealing its potential in better management of late and long-term effects. These findings can inform low-threshold, personal meaningful, and sustainable approaches to clinical practice, well-being, and rehabilitation for this vulnerable group.

A wealth of studies demonstrate the associations between nature contact and well-being, and gradually, nature-based solutions are becoming more widespread in mental health care and recovery. While emotion-focused therapies generally show promising results, evidence of nature-based family therapy is still scarce. In a forthcoming clinical trial at Sørlandet hospital in Southern Norway, we will compare indoor and outdoor provision of emotion-focused multi-family therapy. The foundation of emotion-focused therapeutic work with families is a deep belief in the healing powers of families, where resources within the “ecosystem” of a given family can be reactivated and nudged towards establishing a greater sense of harmony and connectedness over time. According to a Gibsonian understanding of affordances, humans respond to possibilities and limitations within an environment, where affordances in the context of this article arise from a systemic interplay between nature, participating families and facilitators. In this exploratory inquiry, we are particularly interested in the myriad ways nature may influence four core principles in emotion-focused therapy, including (a) emotion awareness, (b) emotion regulation, (c) reflection on emotion, and (d) emotion transformation. In this perspective article, we propose hypotheses and working metaphors in relation to everything from emotions’ multiple purposes to the delineation of facilitators’ accepting, empathic and curious stance. First and foremost, we attempt to generate a preliminary account of nature’s potentiality to tug at our heartstrings and offer a supportive environment for the novel provision of emotion-focused family therapy in the outdoors.

Outdoor therapy and family-based therapy are suggested to be promising interventions for the treatment of mental health problems. The aim of the present scoping review was to systematically map the concept, content, and outcome of combining family- and outdoor-based therapy for children and adolescents with mental health problems. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible qualitative and quantitative studies were screened, included, and extracted for data. Seven studies were included. Findings from these studies indicated that family-based outdoor therapy programs have a positive impact on family- and peer relationships, adolescent behavior, mental health, self-perceptions (self-concept), school success, social engagement, and delinquency rates. However, participant characteristics, study design, and content and mode of delivery of the interventions varied substantially, hence preventing detailed comparison of outcomes across studies. In addition, most of the studies included few participants and lacked population diversity and comparable control groups. Although important ethical concerns were raised, such as non-voluntary participation in some of the programs, there was a lack of reporting on safety. This review indicates that a combination of family- and outdoor-based therapy may benefit mental health among children and adolescents, but due to the limited number of studies eligible for inclusion and high levels of heterogeneity, it was difficult to draw firm conclusions. Thus, future theory-based studies using robust designs are warranted.

Mentalization-based family therapy and family rehabilitation represent a rich variety of approaches for assisting families with difficult interaction patterns. On the other hand, adventure therapy methods have been successfully used with families to offer them empowering experiences of succeeding together against difficult odds and to improve communication between family members. Further, the health promoting qualities of spending time outdoors are now well established and recognized. The Nordic approach to mentalization-based family rehabilitation combines adventure, outdoor, and systemic therapy. We provide three examples of nature-based family rehabilitation practices that are delivered as brief, multi-family psychological interventions taking place in nearby nature and aiming to support sustainable, systemic change. The current contribution is a description of clinical practice, not a systematic review or a formal evaluation. We propose that recontextualizing mentalization-based family rehabilitation to the outdoors can not only provide added health benefits, but also strengthen intra-familial attuned interaction and emotional connectedness. The outdoor adventure provides the families with embodied, multisensory experiences of verbal and, especially, non-verbal interaction that can be usefully examined through the lens of theory of mentalization. The concreteness of adventure experiences is particularly beneficial for families that have difficulties in verbal communication and/or utilizing executive functions, perhaps due to neuropsychiatric traits, intellectual disabilities, or learning difficulties. Furthermore, outdoor adventure can support the participants’ connectedness to nature.

Objective: To report on the role of nature in outdoor therapies through review and summary of existing systematic and meta-analytic reviews in an effort to articulate a theoretical framework for practice. Materials and methods: An umbrella review was conducted following systematic protocols PRISMA guidelines. Results: Fourteen studies met the inclusion criteria and represented five self-identified approaches: nature-based therapies, forest therapy, horticultural therapy, wilderness therapy, and adventure therapy. Clear and comprehensive descriptions of theory, program structure, and activity details with causal links to outcomes were mostly absent. Conclusions: A rigorous and determined program of research is required in order to explicit in-depth theories of change in outdoor therapies. Conversely, or maybe concurrently, a holistic theory of integrated relatedness may be developed as a parallel expression of support for nature in therapy while the explanatory science catches up.

This paper is a twelve-month follow-up study that explores perceived outcomes from participation in a Norwegian wilderness therapy program. Through a critical realist approach, the authors performed an in-depth analysis of individual interviews with ten adolescent participants. Long-term outcomes included the transfer and adaptation of calming and nature-supported strategies to the participants’ home environments, improvements in mood and emotional regulation, and increased social interaction. Overall, the adolescents seemed to exert greater independence and agency in their lives at twelve months post-treatment. This ability appeared to be facilitated by underlying processes that entailed insight, awareness, and acceptance of oneself and one’s situation. The authors suggest that these emerging stories are fragile, yet conditioned by a fundamental (re)connection with the self and address this cautious proposition in the discussion. Finally, a more precise theoretical framework should be developed to support future in-depth explorations.