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April 11, 2013

The following article by Diana Ballon was featured in Cross Currents-The Journal of Addiction and Mental Health Autumn 2012 | Vol 16 No 1.

 

A Growing Concern

Horticulture therapy offers potent opportunities for healing and growth

By Diana Ballon

Work in the garden “takes priority over interacting with my symptoms,” says Toshio Ushiroguchi-Pigott. “It’s a kind of medicine in a way, to be outside,” caring for plants, harvesting, weeding and seeding in the greenhouse on days it’s too cold outside, says Toshio, who enjoys dropping by CAMH’s Sunshine Garden near his home to garden whenever he can. Run by FoodShare Toronto in partnership with CAMH, the Sunshine Garden uses horticultural principles to teach clients about food security, provide skills training and nurture self-confidence and healthy leisure activity.

“Going outside in a park is what I used to do when I was overwhelmed by symptoms,” says Toshio, an outpatient with CAMH’s Archway Clinic. He has found it’s even healthier to actively work in a garden; his involvement in gardening has since propelled him to enroll in a landscape design certificate program at Ryerson University.

Many people—like Toshio—have discovered the healing powers of horticulture therapy (HT), a formal practice involving the use of plants, the garden and horticultural activities to “promote well-being for its participant,” as defined by the Canadian Horticultural Therapy Association (CHTA). The benefits of horticulture therapy can take many forms, from physical and cognitive, to spiritual and emotional.

Gardening and surrounding yourself in nature have obvious therapeutic benefits that have been recognized for centuries: as far back as ancient Egypt, “mentally disturbed” royalty were advised by court physicians to roam in the palace garden as a means of relaxation and healing. Over the past 60 years, horticulture therapy has increasingly been recognized as an evidence-based practice. Horticulture therapy study has evolved to educational programs that offer assessment procedures, and concrete therapeutic goals for its participants, based on each person’s needs. The therapy is now practised extensively in a range of Canadian settings—in prisons, vocational rehabilitation programs, psychiatric hospitals, consumer-survivor businesses, community gardens, with mental health and addiction programs—and with almost any population group you can think of, from children and troubled teens to older adults with dementia and people with physical disabilities.

When I was first assigned this story, I thought, can I actually write 2,500 words on this topic? Aren’t the calming benefits of gardening and being in green space obvious, and the meditative, soothing effects of weeding and planting relatively predictable? What I found was a much more researched and sophisticated practice than I had imagined.

Countless studies attest to the success of horticulture therapy in everything from reducing recidivism in at-risk youth, to reducing aggression in adolescents who have been institutionalized, to reducing cortisol levels, improving self-esteem, helping people to feel less stressed and anxious, reducing the severity of depression and improving perceived attentional capacity and ability to concentrate in people who are depressed—the latter from an article published in a 2010 issue of the Journal of Advanced Nursing.

“In the past 25 years, horticulture therapy has really been given a whole lot of attention and research,” says Travis Slagle, a land supervisor for Pacific Quest’s Sustainable Life Skills program in Hawaii, speaking on LA Talk Radio about his program.

“You are in a restorative environment. As I tell the students, the garden will never judge you…. It places the client or student in a caregiving role, and gives them a sense of efficacy and purpose in being able to provide the care, rather than their being the ones that need the care,” he says.

The first registered horticultural therapist in Canada, Mitchell Hewson introduced horticulture therapy into psychiatry in Canada in 1974, with the opening of the horticulture therapy program at Homewood Health Centre, a mental health and addiction facility in Guelph, Ontario. It’s a program that he still manages almost 40 years later.

In this time, the program has burgeoned: about 230 patients participate in the program each week, with HT being used as an adjunct to other forms of treatment they will receive while they’re at Homewood. The program has three full-time horticulture therapists on staff, and about 40 volunteers and interns that come from as far away as Korea, Japan and China to train in how to use HT as a specialized tool in mental health/psychiatry. With a 47-acre property as backdrop, landscaped gardens, a state-of-the-art conservatory and teaching classrooms, it is an ideal setting for learning—and finding sanctuary in the process.

Hewson explains the seductiveness of the teachings, and the universal appeal of being in green space. “Most people can relate to nature in some way. You walk on it. You eat it. You breathe it. It’s all around you.” Whether you appreciate the smell of a rose, or the taste of mint, somehow we can all find a connection to nature.

“Where do you find a sense of peace? A sense of sanctuary?” he asks rhetorically.

Rather than having a preset program for patients, Hewson tailors the program differently depending on the person’s diagnosis—whether it’s anorexia, posttraumatic stress, a drinking problem or a combination of these or other mental health or addiction issues.

In 2005, Homewood began using horticulture therapy to treat patients with concurrent substance abuse and posttraumatic stress disorders. “The premise of this program is to provide sanctuary, bereavement and reconnection through community,” says Hewson. The seven-week program may include what he describes as “psychological burials,” in which patients bury, burn or plant an object such as a letter or audiotape—something that physically connects them to the moment of trauma— as a ritual to help them move from being a victim to being a survivor.

In illustrating the power of this exercise, Hewson gives the example of a woman who expunged the trauma of an abusive father by crushing and smashing roses from her father’s coffin and putting them in Homewood’s memorial garden on the last day of her stay. She later describes her experience: “Since then I still have had painful memories of my father’s abuse, but I now feel surrounded by my higher power and I feel safe and comforted.”

In Homewood’s horticultural program for people with eating disorders, the focus is slightly different. With eating disorders, “they seek perfection” and control, says Hewson. Through the program, “we bring patients into a safe environment, and then work to help them replace their preoccupation with food with a healthier, creative focus,” he says. We offer activities where they can have fun, and feel joy, Hewson says, letting go of the intense focus they’ve had toward food issues. This may involve designing a miniature Japanese garden in a glass container, making botanical prints, going on nature walks or experimenting with herbology. They also use psycho- aromatherapy, in which they make or apply creams and essential oils with plant derivatives for massage, and as a way of self-nurturing. “Most people need to be nurtured,” says Hewson. Smells can also be strong triggers for trauma and other memories that can be replaced by more calming aromas created from these plant-based creams, explains Hewson, who is also a certified aromatherapist.

A horticulture therapy practice for dementia involves using the same client-centred Rogerian approach as is used for other populations, but adapting the pace of the program, so that clients are still challenged and stimulated by the work, without becoming overwhelmed. Hewson, who lost both his mother and mother-in-law to Alzheimer’s, says he finds this work particularly rewarding. Patients benefit from the social aspect of gardening, the physical work involved, and the “memory enhancer,” effect—recalling past skills they had in gardening, and gardens they’ve enjoyed. Therapists can assess patients’ cognitive functioning and build a rapport with them without the direct confrontation required in a more clinical setting. Working with plants also builds their self-confidence and improves their mood: activities range from group projects to dry herbs and make wreaths, to smashing pots and hoeing as a way to let out anger and aggression.

With patients with addictions, Hewson describes using various therapeutic plants—such as the dwarf orange tree, whose orange blossoms have antidepressant properties. Certain plants can be used to make creams, which can be self-soothing and nurturing to clients, and an alternative way of calming themselves, instead of using addictive substances. Clients who are in the program for 35 days will take a cutting from a plant, learn to nurture it, and bring it home with them.

Transplant yourself to the other side of the world, and you’ll find a program that draws on healing powers of the garden and rich metaphors of growth in its work with teens. Although not a registered horticulture therapy program, Pacific Quest is an intriguing outdoor therapeutic program where teens and young adults live for two to three months to learn what they refer to as a “sustainable life skill,” which includes elements of horticulture therapy as well as a wellness curriculum and rites of passage work. Students sleep in bunkhouses, and spend the bulk of their days in organic gardens where they tend plants, weed, harvest and then use the produce they’ve cultivated to cook for each other, and sell to a local farmer’s market, says Kathryn Kasenchak, one of the program’s psychologists.

“Growth of the plant can reflect growth of the self,” and transplanting can be a rich metaphor for the process students go through, says Kasenchak. “Like plants, the students’ roots can outgrow the environment they grew up in. They may need to temporarily leave home, as a way to recognize and then abandon maladaptive patterns that they’ve become familiar with. When they do, they—like plants—usually go through some shock. But they come to recognize that change doesn’t happen when you’re comfortable. They may not do so well at first, but it [leaving home] is necessary to achieve their full potential,” she explains. Students go through their own process of transplanting.

“I like to use the analogy of the soil,” says Kasenchak. “Soil is dirty, but it also nourishes.… Sometimes the work is dirty, because it involves dredging up difficult issues to then move forward.”

In the program, therapists give different roles to students based on therapeutic goals; for instance, they may assign a resident who has had a hard time addressing difficult things in his or her own life to work in composting. “Compost becomes analogous to these unaddressed issues. The longer it is unattended, the grosser and stinkier it can become,” says Kasenchak. Someone else who needs nurturing, and has family of origin issues, may be assigned to work in the nursery tending to baby plants, she says.

Gardening work is also used to teach students skills that can be directly applied to their own lives, such as executive functioning, Kasenchak says. “A lot of students who have gone through the mental health system have trouble with planning, task initiation and completion,” Kasenchak says. “The garden helps them to break down different tasks in life into more manageable pieces.” They learn math skills involved in portioning out food, and gain information on nutrition, diet, cooking and time management. “We also encourage and teach mindfulness practices and suggest certain activities, such as weeding, be done silently, so they can see what arises for them.”

Weeding is another interesting metaphor, she muses. “With weeds, you have to keep tending the garden. You get the weeds out, but then they come back next week…. Some weeds are deceiving because they can look really pretty.”

The program has a community focus, in that each resident’s role is interdependent, and proceeds from sales of their produce at the farmer’s market goes to community organizations. As Slagle comments in the radio interview, their approach reflects a whole new paradigm, a shift from the “rugged individualism of our culture to a more collective approach of what we give versus what we take.”

In offices overtop PARC—Toronto’s Parkdale-Activity Recreation Centre—HT is an activity that people can make a living off. Here at Parkdale Green Thumb Enterprises, employees are hired to plant, water, prune, fertilize, mulch, weed or do other landscaping services to beautify Toronto streets and businesses. Employees at this consumer-survivor business all have mental health issues, and struggle with poverty—plights that are common in Parkdale where substandard rooming houses, boarding homes and a psychiatric hospital have been home for many people trying to rise out of difficult conditions.

“A lot of people have been isolated, and told they can’t work or shouldn’t work, or when they tried to work, there was no accommodation, so they’re afraid to work,” says Green Thumb’s business manager Maggie Griffin. “You have to understand the culture of people with mental health and addiction issues,” she says. Many have experienced extended abuse, some have come from small communities, are recent immigrants or refugees, or may have lived on the street or couch surfed.

At Green Thumb, employees are given a chance to succeed, rather than being further stigmatized and alienated for the problems they are trying to cope with. And they can do this work within the often meditative and nurturing environment of plant life.

“We’re here to support, but we’re not social workers,” says Griffin. If someone needs accommodation, to take time off, they can do that without getting fired or being asked for a reason why they can’t work. Staff are paid to participate in staff meetings, paid for their training and can take part in different staff outings. They work three hours per day for as many days a week as they can manage, and are paid between $10.50 and $15 per hour for their work.

One employee has been at Green Thumbs for almost 11 years. “I feel a lot better about myself,” she says of her work there. “I can keep a job.” After leaving an abusive marriage, coming to Green Thumb meant that she could get back on her feet, and even afford a shared apartment near the program.

Of course, the seductiveness of green space and the power of not just observing, but participating in the plant world around us keep many of us sane. I rely on daily walks with my dog in High Park to bring stillness to an often overengaged mind. Thoughts slow down. I feel the same breeze that brushes against the leaves, that nudges the bushes, that sweeps past the trees.

On Hewson’s homepage, he quotes Thich Nhat Hanh, who writes, “Walk as if you are kissing the Earth with your feet.”

Hewson himself comments on the “magical and curative powers of nature… Nature is forgiving; if a plant dies, another can be grown in its place.” While gardening may be dirty, the effects can be restorative. And the experience of caring for an other, rather than being cared for, has potent benefits.

Diana Ballon is an editor at CAMH, and a freelance writer specializing in mental health issues.

Horticultural Therapy and Its Benefits

Lea Tran is the horticultural therapist at the Guelph Enabling Garden in Guelph, Ontario. In addition to running inclusive, imaginative and lively programs and the garden, she blogs about all the events and takes photos too. She and Trina Alix, a fellow registered HT, put together this list to show just how many benefits can be found in HT. Read more at http://guelphenablinggarden.blogspot.ca

  • Cognitive benefits
  • Promote memories
  • Learn and share skills
  • Communicate ideas
  • Make choices and plan
  • Use the imagination
  • Maintain/improve attention span
  • Emotional benefits
  • Increase self-esteem
  • Relax in a beautiful setting
  • Discover interesting new hobbies
  • Feel like an important part of the community
  • Feel empowered and independent
  • Express oneself creatively
  • Physical benefits
  • Hands-on work
  • Sensory awareness
  • Nutritious organic herbs and vegetables
  • Fine/gross motor skills
  • Eye/hand co-ordination
  • Strength and balance
  • Exercise, fresh air and sunshine
  • Spiritual benefits
  • Sense of purpose and meaning
  • Life review
  • Motivate and inspire
  • Acceptance
  • Sense of interconnection with wildlife
  • Presence
  • Heal with energetic properties of plants
  • Social benefits
  • Get outside, meet new people and network
  • Teamwork-building skills
  • Make a difference in the community
  • Improve supportive relationships

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