This article examines the use of adventure-based experiential therapy (AET) with child and adolescent psychiatry inpatients. AET environments, indications, practicality, therapeutic effects and research are outlined and clinical findings are reported. Activities such as rock-climbing, exploring a creek and caving are discussed and the limitations of AET in the hospital setting are addressed. AET activities range from leisure-time activities and activities that facilitate change to actual therapeutic work. Case studies showing the effects on individuals and groups, with and without specific processing of the activity, are surveyed and the similarities to mentalization-based psychotherapy are touched upon. Possible future research directions are suggested. As AET treatments are not commonly discussed in child and adolescent psychiatry, this article seeks to be a catalyst for further discussion and research.