Wilderness and adventure therapy (WT, AT) have employed cognitive or adaptive dissonance and involuntary treatment for decades. Cognitive dissonance occurs when people are faced with situations that do not confirm their expectations. Past WT participants have protested that involuntary, inescapable and harsh conditions harmed them through PTSD and dissociation. We compare dissonance and dissociation using a critical realist and argumentative research process using publicly available data. We argue that dissociation is a response, recorded both in the design of WT and in participant statement, that is mistaken for dissonance. Deliberate use of forced cognitive dissonance during involuntary treatments are also the conditions that may cause dissociation. Therefore, planning to enforce cognitive dissonance during coercive WT or AT is likely to be harmful and, knowing of this potential, may be regarded as malpractice.