The three boys looked like typical kids as they strapped on harnesses and ropes to scale a 30-foot rock.

They joked around, laughed, spontaneously broke into song and occasionally acted goofy.

But they aren't typical. James, Jovian and James experienced something traumatic when they were younger - trauma that might come from a car crash, violence or the loss of a parent. Each has been diagnosed with symptoms of post-traumatic stress disorder, or PTSD, more often seen in soldiers returning from combat.

Helping kids battle PTSD and its symptoms - heightened anxiety, a quick temper, withdrawal, sleep problems - is a relatively new field. It wasn't until 1987 that the medical community officially acknowledged that children could have PTSD, too.

As the three took turns scaling the rock, they didn't acknowledge or perhaps even know they were in psychotherapy.

It's actually called adventure-based psychotherapy, said co-counselor Clifton Hicks.

Through his Urban-based Adventures, Hicks brings his young clients out to Glen Canyon Park in San Francisco to rock climb.

The concept is a little counterintuitive. Children with PTSD are already anxious. Sending them straight up a cliff would seemingly heighten their fears.

"We are increasing anxiety," Hicks said as he led the boys the half mile from the park's playground to the rock wall.

But in these kids, things like hope, trust or a feeling of safety have been damaged.

"Those are the things we're trying to repair here," Hicks said.

While many children experience some trauma, in the country's violent urban neighborhoods, an estimated one-third of children develop PTSD, according to the country's top child trauma experts.

That's the same rate as seen in Vietnam veterans.

Climbing to recovery

Jovian, 10, stood before the rock and looked nervous. His climbing shoes didn't feel right, he said.

"What if my shoe comes off?" he asked Hicks.

"Sometimes things don't work out the way we thought they would," the counselor told him.

Apparently, that answer was sufficient because Jovian started up the rock, his counselor acting as his rope anchor, or in rock-climbing terms, he was on belay.

He spent a nervous minute on a ledge about a third of the way up, contemplating out loud whether he should continue or come back down. Hicks waited quietly. And then, he smiled as Jovian found the next foothold and made his way to the top.

"That was good," Jovian said a few minutes later after he looped around a path back to the bottom. "It felt good."

It was the preteen's second week of climbing in the five-week program.

For the past two years, he has been going through the regular kind of therapy, in an office with Hicks.

"We talk about school, work and how I'm doing and stuff," the boy said. "It makes me feel better having somebody checking on me, seeing how I'm doing."

Stemming from 1960s

While adventure-based therapy is relatively new in terms of treating symptoms of trauma or PTSD, the concept isn't new.

It goes back to the 1960s when Outward Bound offered wilderness experiences to released prisoners and, later, adults with substance abuse and mental health issues.

The program was then used to increase self-esteem and confidence in youths. The general idea is the same as Hicks' program.

Trauma robs children of their sense of safety and security, said Ken Epstein, director of the Children, Youth and Families System of Care at the San Francisco Department of Public Health.

"I think when you think about adventure-based and other similar kinds of activities, you're really drawing on their competencies, on their resilience," he said. "In the face of trauma, they're able to achieve, be successful."

The adventure therapy offers unfamiliar physical challenges to participants, ones that feel risky.

In that new situation, the kids have to face anxiety and stress, but ideally develop more healthful ways to cope and ultimately succeed in the challenge.

As each of Hicks' clients scaled the wall for a second time, their confidence blossomed.

The first time that James, 12, went up, he had a moment of hesitation, saying he needed to come down.

"Mommy!" he said, scared, yet laughing.

"She's at home," Hicks said calmly, encouraging the preteen to find the next foothold.

James found a spot for his foot and then another and another until he pulled himself over the top.

'Spread my wings'

"I believe I can fly," the teen sang beyond the view of Hicks and his fellow climbing partners on the ground. "I believe I can touch the sky."

At the bottom of the rock, Jovian peered up the small cliff and smiled as one of them belted out the last lines of the chorus.

"I think about it every night and day," he sang. "Spread my wings and fly away."
