Fourteen wilderness and adventure therapy programs in England, Scotland, the United States, and New Zealand were studied to explore critical issues of practice. In view of differences in terminology among countries, various terms and assumptions are defined at length: adventure therapy; wilderness therapy; wilderness-adventure therapy; the continuum of adventure-based practice in terms of "depth" (encompassing recreation, enrichment, and therapy); and unimodal therapy versus multimodal therapy versus adjunctive enrichment. Most programs investigated were multimodal, typically combining wilderness and adventure therapy with parent or family therapy or other group therapies. Unimodal programs tended to be longer-term camping programs. Across countries, different historical, cultural, and social influences have lead to different values and attitudes among adolescent clients, particularly in relation to therapist authority and client autonomy, individualism, and group affiliation. These differences have significantly influenced therapeutic approaches and therapist expectations. Key findings and conclusions relate to trends in the development of the adventure therapy field, the relative importance of program design versus practitioner competencies, client factors associated with better outcomes, holism versus reductionism in therapeutic approach, client rights and ethical issues, consumer perspectives, and gender and power issues. Key elements for best practice are outlined. (Contains 19 references. Appendix outlines program characteristics.) (SV)