Mentalization-based treatment is a form of psychotherapy which integrates different aspects of cognitive-behavioral, systemic, and ecological approaches. This form of therapy is sometimes used with families to enhance communication and minimize unhealthy interactions between family members. In Finland and other Nordic countries, mentalization-based treatment with families sometimes combines adventure, outdoor, and systemic therapy. This theoretical paper, with case examples, presents an evidence-based rationale for the Nordic approach to mentalization-based treatment with families. The rationale is based, in part, on research demonstrating distinct benefits of outdoor nature-based activities. Assumed causal pathways underlying some of these benefits are discussed.
The paper outlines similarities and differences between indoor and outdoor mentalization-based family therapy. It also describes three versions of the outdoor approach as used in Finland. Each version involves brief, multi-family interventions taking place in nearby nature with the aim of supporting and/or enhancing sustainable intra-familial connectedness. Each version is based on a framework referred to as “systemic, mentalization-based outdoor therapy” or “SMOT.”
“Fathers and sons up in the trees” – one of the versions of SMOT with families – is designed for boys between 10 and 16 years of age with neuropsychiatric symptoms and their fathers. After participating in the program, both fathers and sons reported positive changes in their relationships and quality of their interactions. Sons also seemed to make positive changes in self-regulation of emotions and social conduct. Another version of SMOT with families is referred to as “Girl, You Are a Pearl!” This program was designed to support the relationship between teenage daughters with mental health issues and their mothers. Goals of the program, as determined by the mother-daughter dyads, focus on increased emotional connection, communication, and time spent together. Most (90%) of the participants over a three-year period indicated that the program helped them meet these goals. The third version – referred to as “Out Into the Woods With Grandparents and Grandchildren With Special Needs” – provides rehabilitative adventure experiences to grandparent-grandchild dyads or triads in nearby nature. Preliminary results indicate that positive outcomes of this program include grandparents gaining a better understanding of, and having greater compassion for, their grandchildren.
While this paper provides “a description of clinical practice, not a systematic review or a formal evaluation” it does support the idea that mentalization-based family therapy in outdoor settings may be effective in assisting families with difficult interaction patterns. The effectiveness of this approach is attributed, in part, to the concrete, embodied nature of the outdoor activities. According to the authors, this concreteness “is particularly beneficial for families that have difficulties in verbal communication and/or utilizing executive functions.” In addition to promoting family connectedness, SMOT with families in an outdoor setting may also support the participants' connectedness to nature.