Nature-based family therapy can support family reconnection during emerging adulthoodYoung adults are increasingly facing mental health challenges. While individualistic cultural norms value autonomy during early adulthood—referred to as “the myth of independence” in this study—research shows that caregiver support can influence psychological health and well-being during this transitional period. This study is grounded in an understanding of interdependence within families, which views individual mental health as interconnected with family relationships. The study was conducted with the caregivers of emerging adults who were experiencing mental health concerns in a nature-based therapeutic setting. A mixed-methods approach was used to examine how a two-day, nature-based family therapy intensive affected caregivers’ perceptions of their relational functioning with their child. “By combining quantitative measures of relational functioning with qualitative insights into caregivers’ experiences,” the study aimed “to explore both potential effects on caregiver perceptions and how specific intervention elements might contribute to relational changes.”
The study was conducted at an outdoor behavioral healthcare (OBH) program for emerging adults (EAs) between the ages of 18 and 25 who were experiencing psychological distress in Hawaiʻi, U.S. A two-day nature-based family therapy intensive (FTI) was provided to EAs and their parent/caregiver, as part of the EAs participation in a 6–12-week residential program. Participants in this study included caregivers who participated in the FTI with their child between 2016 and 2020. The EAs were an average age of 20 years, and most had anxiety or depressive disorder diagnoses. The FTI aimed to support both caregivers and EAs through a sequence of activities based on systemic-relational theory. The first day of the intervention focused on facilitating reconnection through structured activities (such as therapeutic gardening and experiential learning), and the second day provided more open-ended opportunities to explore family dynamics. A modified self-report version of the Global Assessment of Relational Functioning (GARF) was administered to caregivers to assess relational functioning pre- and post-intervention. This survey included subdomains for interactional/problem-solving skills, organization/hierarchy, and emotional climate. Pre- and post-surveys were completed by 131 caregivers. Caregivers also completed reflection forms after both days of the FTI. The reflection forms included quantitative rating scales and open-ended questions. Data from the second day were lost, however, and only day one responses (completed by 96 caregivers) were analyzed. Data from the GARF assessment and quantitative section of the reflection forms were statistically analyzed. Open-ended question responses were analyzed using thematic analysis.
Statistical analysis revealed significant increases in relational functioning post-intervention. Large effect sizes were observed across each relational subdomain assessed by the GARF, including: (1) interactional/problem-solving skills (negotiating family goals, rules, and routines; adapting to stress; communicating; resolving conflict), (2) organization/hierarchy (maintaining boundaries; keeping “space”; caregivers working together; and distributing power), and (3) emotional climate (feeling free; showing of caring; sharing of values; and showing affection). These results indicate that, according to caregivers, the FTI had a large and meaningful impact on relational functioning. Additionally, caregivers reported positive ratings for all intervention components, with nature-based experiential group activities rated higher than other program components.
Qualitative results focused on caregivers’ perspectives of (1) the experiential, nature-based group activities and (2) the value of family therapy for EAs. Caregiver responses regarding the experiential activities indicated that the family sculpture activity was especially impactful and emotionally moving. Overall, the experiential activities were perceived as helpful in gaining insight into unspoken dynamics and facilitating connection and bonding. Caregivers also appreciated “the balance between depth and playfulness in the structure of the day.” Caregivers’ perspectives on family therapy revealed that this component was beneficial in recognizing the interdependence between caregivers and EAs, promoting effective communication and empathy, re-establishing emotional connection, and providing opportunities for caregiver role modeling and for supporting EAs’ self-understanding and development. Additionally, caregivers indicated that the FTI created “a nonjudgmental, emotionally safe environment that lowered defensiveness and opened the door to more honest dialogue.”
Findings across both quantitative and qualitative measures indicate that the FTI supported meaningful relational change within the areas of communication and conflict resolution (interactional/problem-solving), mutual respect and shared responsibility (organization/hierarchy), and emotional connection and empathy (emotional climate). The researchers contend that “the convergence of improved GARF scores, higher ratings for experiential components, and caregivers’ rich descriptions of pivotal moments in nature-based settings indicates that integrating ecological and family systems approaches may offer a particularly effective option for supporting the complex relational transitions of emerging adulthood.” Results especially call attention to the impact of therapeutic nature-based components which the researchers conclude “may catalyze relational shifts in ways that conventional verbal approaches alone might not achieve.” Overall findings support EA mental health programs that actively involve families and use nature-based, experiential activities as core therapeutic elements.
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