The deep scar etched into her bicep will never go away. Neither will the memories.

For Amy, a sensitive, Midwestern girl with a mop of wavy blonde hair, there are two distinct parts of her life. There’s the “before”: before her brother’s accident, when she was a carefree co-ed , studying neuroscience and psychology. (Her younger brother fell from a construction lift and became paralyzed.) And there’s the “after”. “I just kind of just lost it,” the 22-year-old says, describing the drug use, missing classes and and self mutilation that followed.

“I only ever cut in one place on my upper bicep because I didn’t want to have to deal with people asking questions, seeing it all the time,” she says. “Because of my neuroscience background, I was pretty anatomy conscious and that was one place I could go as deep as I wanted to and wouldn’t kill myself.”

Eventually, Amy’s parents caught wind of her problems and insisted she seek professional help. One visit with the shrink, another with a consultant, and within a week Amy was off to wilderness therapy, three months in the Oregon forests with no contact with the outside world.

What is wilderness therapy?
Wilderness therapy, in which patients typically spend 8 – 10 weeks backpacking in the woods with trained staff and regular visits from their therapists, is small, but growing. While there was a single program focusing on the immersive therapy in the 90s, there are about two dozen today, says Oregon-based licensed professional counselor Sean Roberts, who studies the topic. It doesn’t come cheap and participants usually have to pay out of pocket. (Amy’s parents paid for her therapy.) Roberts says programs generally run about $400 per day, so a 10-week program could cost $28,000.

For most of these patients, it’s a last resort. “It’s for people who have done a lot of four-walls therapy and haven’t responded to it,” he says. “It is an intensive intervention.”

What 14 weeks in the woods is really like
When Amy arrived at her Oregon-based wilderness program, she entered what looked like a storage building, where the staff took everything, including clothes, money, jewelry and books. “You have to take it all off,” she explains. In return, she got basic hiking clothes, a tarp and camping supplies — and a drug test. “It was intense, it was painful and hard.”

She then got into a truck and was driven for 2 ½ hours, deeper and deeper into the woods, with no idea where she was going. When she arrived at the group’s campsite, it was late and most people were asleep. Someone helped her tie her tarp to some trees. Amy says she didn’t sleep a wink that night.

But that was mild compared to what came next. “You’re on your own and you’re not allowed to talk to anybody for a few days,” she says. Someone brings you meals but then leaves you alone so you can write out your life story and what you want to get out of the program.

Even when she was allowed to speak again, things weren’t easy. Campers sleep underneath a tarp, don’t shower for weeks and have no communication with the outside world, with the exception of writing letters to friends and family. When you go to the bathroom, either someone comes with you, or “you yell your name or a number to let the field staff know,” she says. A staff member makes sure you put toothpaste on your toothbrush, that you wear sunscreen, that you rinse your cup out when you are done eating. Eagle-eyed staffers watch campers every move, taking notes so they can report back to the therapists who visit weekly.

Ultimately, though, Amy says the program helped her because of the intensive therapy. Campers must work on their issues each day. There are both individual assignments from a therapist that include journaling and meditations on your life, as well as weekly meetings with the therapist who might show you new ways to handle and cope with your emotions.

There are also group talk sessions, where participants openly discuss and work on their problems. One time, she watched as the group reenacted a scene from her life that was particularly painful for her: When her family was gathered around the dinner table and her sister “told me that I didn’t matter, that my opinion didn’t matter … and no one stuck up for me and said anything to help me out.” In another session, Amy had to read aloud a letter from her parents, in front of everyone. She had never read it before and listening to the sound of her voice as her parents detailed all the ways her behavior had impacted them was tough on her. “It is the most excruciating thing to expose all of the nasty parts of me to a bunch of people at the time I didn’t know that well,” she says.

But situations like that have a way of changing you — or at least of bonding you to the people helping and going through the with you. Amy, who is now in a transitional home and will finish her degree this summer, still stays in touch with her therapist.

Does wilderness therapy work?
If it all sounds like a lot, well, it is. But it also works, some research shows: A study published in the journal Child & Youth Care forum showed that symptoms of psychological disturbance were “significantly reduced” after people completed one of these programs; one year later those outcomes generally remained. Part of its effectiveness, experts say, is that it allows professionals to see clients behave in real time — and help them accordingly. Roberts pointed out that while someone prone to anger might not explode in anger on a therapist’s couch, he might do it while trying, unsuccessfully, to build a fire or do something else tough while in the woods.

Amy says it worked well for her. “It has changed my life completely,” she says. “I have a whole new approach on how I handle emotions.” The only thing better might have been the shower she got after 14 weeks in the woods. “That was like a life-changing, spiritual moment where I sat in the shower and cried for like 20 minutes,” she says. “It was like an ecstasy moment.”