Wilderness therapy is a growing treatment modality for adolescents presenting with a variety of clinical concerns, and wilderness therapy clinicians and referring mental health professionals must carefully consider the ethical issues that are unique to this modality. Following an overview of wilderness therapy as a mental health treatment, relevant ethical issues for mental health professionals are described and discussed, including the distinction between therapy and therapeutic experiences, the use of efficacious treatment, consent and confidentiality, therapeutic boundaries, a continuum of care and family involvement, and aftercare. A thorough reflection of the unique ethical issues faced by wilderness therapists is not only necessary, but will also assist in moving the field of wilderness therapy and outdoor behavioral healthcare forward in its establishment as both a recognizable and ethical treatment option.