Jan Hassink

Researcher Agriculture and Care

Wageningen University and Research Centre

The Netherlands

 

You are exactly right as you are. That is what nature is telling you. Your wish to improve your current life can be fulfilled. Nature helps you relax in the present moment, regain energy and practice new things.

Groen Team — Photo courtesy: Jan Hassink

 

Green care is a developing phenomenon in Europe and the Netherlands. Interesting examples are care farms and therapeutic gardens.

Care farms

There are more than 1000 care farms in the Netherlands. Care farms combine agricultural production with useful day activities for a broad range of user groups that need assistance. The production of vegetables, flowers, herbs and plants is an important and valued activity on many care farms. Clients on the farm express that they benefit from the (productive) farm context, meaningful tasks in the garden, space and quietness, rhythm of the seasons, meaningful processes and the possibilities to work alone or with others. Each client contributes in his or her own way and feels proud when a good quality product is produced. It contributes to the empowerment and self-esteem of users. Some users see parallels between the cycles in the garden and their own life. A nice example is the composting process where death material is transformed to nutrients for new life.

Vegetables — Photo courtesy: Jan Hassink

 

Therapeutic gardens

In therapeutic gardens the setting is different. Here plants are used for therapy. The number of therapeutic gardens is still limited. However, several interesting examples have started. We will describe the green time-out garden near Nijmegen. On an idyllic spot near Nijmegen in the eastern part of Holland Annette Beerens has created a therapeutic garden. The garden has been designed according to the Creationspiral, the natural path from wish to reality. Every step of this path is symbolised by a part of the garden. The first step is the wishing well. Here one can dwell on what it is he or she really wants in life at this moment. All wishes are welcomed as the start of a new path toward improving the capacities to deal with all types of challenges you encounter in your life. The twelve steps of the Creationspiral are not obligatory. You don’t have to go through all twelve to be able to be able to heal. Clients can work and relax in any place in the garden. We will end with an illustration how the therapy can work.

There once was a man with autism, he was very much focused on structure. His wish was to become more flexible toward new situations. As a therapeutic intervention, I asked him to cut back a Ligustrum hedge. The assignment was to not prune it in a straight line. He found that terribly difficult. This was a way for him to try to find if he could start to practice flexibility. (The hedge will grow, of course, so this task can be done at least twice a year.) In the end he succeeded in making a curved line in the hedge and one part he didn’t prune at all. He was surprised that he was able to let go of the idea that a straight line was not the only standard one could use when pruning.

 

 

For more information:

Jan Hassink

Researcher Agriculture and Care

Wageningen University and Research Centre

P.O. Box 16

6700 AA Wageningen

The Netherlands

[email protected]

 

Annette Beerens

Changing Colors

[email protected]

Annette Beerens and Marinus Knoope

I would like to share with you the underlying philosophy of my work as a horticultural therapist.

I work with all kinds of people who suffer from ‘knots’ in their lives. Burnout, depression or midlife crisis. All the issues these people encounter have to do with the core question ‘What is my role in this Life?’. 

I work with the Creation Spiral, this method was introduced by my friend, Marinus Knoope. He is physicist who discovered the natural way from wish to reality. I hope this introduction to the Creation Spiral will offer you food for thought and inspiration. 

When a gardener has grown a thousand apple trees, he will probably say, “Don’t make a fuss. Apple trees simply produce apples.” But if you were the apple tree, what would you think? You got through a harsh winter and made it through spring after a couple of frosty nights. Summer was quite dry but at the beginning of autumn, you do have a few magnificent apples on your tree. You would be proud of your achievement.

Every living organism has its own part and its own meaning in the whole story. Every cell, every plant, every animal and every human being has its own destination. That destination manifests itself as an inner drive. By following this desire, every organism plays its part in the incomprehensible whole of Nature.

From a higher point of view, human beings are just organisms that fulfill their wishes. Of course things do go wrong every once in a while, but that is also the case with apple trees. Not every blossom turns into an apple, after all.

When conditions are favorable, an apple tree produces many apples. There is a natural way for an apple tree to bloom and produce apples, with a number of optimal conditions in each season. For human beings there also are certain ways to fulfill their wishes, with optimal conditions in each stadium.

If you were aware of the different cycles on the natural path from wish to reality, and if you were to know how to use visualization, positive thinking, conscious observation and mindfulness, it would be a lot easier to fulfill your dreams. At the end of the day, that is what we all want.

We all more or less know how the creation process works for an apple tree. In winter the tree is bare. The focus is on the roots. At the beginning of springtime it is ready to take a leap. It starts to bloom. A short while later the blossom falls out and leaves start to grow.  Halfway through spring and summer it has a full coat of leaves. Then the buds that remained start to grow, until the tree is full of fruit. At the beginning of autumn, the fruit falls from the tree. A few weeks later also the leaves start to fall.

The tree thinks to itself “I hope I won’t die”. Anxiously the tree pulls back into its roots. That is exactly what it is supposed to do. If it just stays still and prepares itself, it will bloom again at the beginning of the next springtime.

This is what we call a natural cycle. It is about an ongoing process from winter to spring, from summer to autumn and then to winter again. It goes on and on, until the tree dies and becomes compost…

Anna María Pálsdóttir

The Alnarp Rehabilitation Garden, established in 2002, offers nature-based rehabilitation (NBR) for individuals with stress-related mental illnesses such as exhaustion disorder (ED) (ICD-10 F43.8).  ED occurs after many years of prolonged stress and the lack of sufficient recovery. The symptoms are severe tiredness and exhaustion, with low executive function and mental, physical and social impairments. The rehabilitation process has been described as vulnerable, and recovery can take months or even years. It is recognized that individuals with ED are in great need of rest and mental recovery, especially before they actively participate in a rehabilitation program. Therefore, to support rest and mental recovery, a specially designed garden, a select treatment team, and a specially designed activity program were developed at the Alnarp Rehabilitation Garden.

The garden and horticultural occupations were the base for the whole intervention. The two-hectare rehabilitation garden was designed according to theories on nature’s restorative effects and the theory of supportive environments and contains places for work, rest, and contemplation. It is divided into two major areas: the Nature Area (informal and non-cultivated) and the Cultivation and Gardening Area (formal and cultivated). It is further sub-divided into different smaller garden rooms, each with restorative properties that can enhance mental recovery.

The garden contains evergreen and deciduous trees and shrubs, as well as a vast variety of perennials and annuals; there is always something to look at or work with throughout the year. The color scheme is dominated by soft hues; strong hues are limited to certain areas in the garden where the clients can partake of them when they have developed the strength to handle strong colors. The size, height, form, texture, and fragrance of the plants vary in order to stimulate and awaken the senses, with an emphasis on seasonal variation. The connection to the seasons is important as nature has a rhythm of its own that cannot be sped up or forced as it switches between active and dormant phases. Many rehabilitation participants have lived stressful lives without regular rest. By working at the same pace as nature and the plants, the participants note the shift between the phases.

There are also specially designed garden rooms and greenhouses that facilitate meaningful horticultural and gardening occupations. Horticultural occupations capture the participants’ attention and help them be in the moment “right here, right now”, a somewhat diminished capacity for most participants. By working with their hands, they relax their focused attention. Their cognitive function rests and they switch from thinking to feeling – their hands in the earth, feeling and smelling it incorporates feeling in their bodies and their minds can rest, gaining mental recovery. The team works through the garden and the horticultural occupations to reach the rehabilitation goals. Nature is rich in opportunities for this purpose and it seems easy for everyone to find something to engage in as an active or passive (resting) occupation.

For further reading, please see:

Pálsdóttir, A. M., Grahn, P., & Persson, D. 2014. Changes in experienced value of everyday occupations after nature-based vocational rehabilitation. Scandinavian Journal of Occupational Therapy. Early Online, 1-11. DOI: 10.3109/11038128.2013.832794.

Pálsdóttir, A.M., Stigsdotter, U.K. and Grahn. P. 2011. Preferred qualities in a therapy garden that promote stress restoration. Conference proceedings, 27-29 June. Research into inclusive outdoor environments for all. Open Space/People Space, Edinburgh.

Grahn, P., Tenngart Ivarsson, C., Stigsdotter, U., & Bengtsson, I-L. (2010). Using affordances as a health promoting tool in a therapeutic garden. In C. Ward Thompson, P., Aspinall & S. Bell (Eds.), Innovative approaches to researching landscape and health. Open Space: People Space 2. New York: Routledge; pp 116–54.

Adevi, A., & Mårtensson, F. 2013. Stress rehabilitation through garden therapy: the garden as a place for recovery from stress. Urban Forestry and Urban Greening, 12; 230-237.

Fung Yuen Yee, Connie

 Horticultural Therapist Registered (AHTA) 

 Registered Social Work

  President

 HK Association of Therapeutic Horticulture   

Population aging is a profound, pervasive and enduring storm sweeping across the world. Hong Kong is no exception. According to the HK statistics 2008, Hong Kong’s population has moved closer to seven-million and one out of eight Hong Kong people will be aged 65 or above. Department of Health and The Chinese University of Hong Kong conducted a study in 2005-2006 (Lam et al., 2008), and found the prevalence of dementia in adults over the age of 60 is 7.2%. It was also found that about 1 in 3 (32%) of the community-dwelling population aged 85 and above had dementia.

Dementia is a degenerative brain syndrome in which there is a gradual, insidious and relentless loss of cognitive functions. These cognitive deficits will further impair individuals’ social or occupational functioning and show a significant decline from previous level of functioning. Dementia can generally be classified into three stages: early, moderate, and severe. The early stage is characterized by the onset of deterioration in short term memory and cognitive abilities while in the severe stage, all intellectual functions breaks down and individuals with dementia will rely on caretakers to look after them in everyday lives. The most common form of dementia is Alzheimer’s disease. Yet, the causes of dementia are not yet known (Hong Kong Association of Alzheimer Disease, 2014).

Treatments for dementia include pharmaceutical and non-pharmaceutical methods. Horticultural therapy (HT) is one of the non-pharmaceutical treatments. HT has numerous advantages in treating dementia especially in fitting the needs of individuals suffering from different stages of dementia (Ebel, 1991).

“Smart Golden Age” HT project

“Smart Golden Age” HT project was held from Nov – Dec 2010 at 5 elderly centres in different districts of Hong Kong. Participants were community dwelling elderly who was suffering from mild to moderate dementia. Objectives of the groups were to provide cognitive training and facilitate social interaction among participants. Each group had 10 members and the program consisted of 5 sessions. Members propagated plants by cutting and division. Then they brought the propagated plants home and took care of them. They were required to bring them back to the centre for plant arrangement in the last 2 sessions.

  

Schedule of the groups

Date	Theme	Activities
8/11	New Hope I	Propagation: Cutting, Division
15/11	New Hope II	Propagation: Cutting, Division
22/11	Flower World	Flora Arrangement
29/11	New World I	Plant Arrangement: Foliage Plant (propagated in 1st session)
6/12	New World II	Plant Arrangement: Succulent (propagated in 2nd session)

Application of HT with community dwelling elderly with dementia in Hong Kong

Hong Kong has a dense population and the living spaces for most of the people are quite small. As the program required the members to bring the plants home to take care of, it is important for the therapist to consider whether members have enough space at home for the plants. Otherwise, they have to place the plant at the center.

Elderly with mild to moderate dementia can participate in most of horticulture activities. Detailed task analysis is necessary and hence modifications can be made in accordance with members’ needs and abilities. So they can follow the instructions and complete the tasks accordingly.

Plant selection is important in achieving the therapeutic goals. The plants selected have to be safe and toxic free. Since most people live in an apartment and lack outdoor space, indoor plants with small pot sizes are preferable. In addition, the plants have to be grown easily, gripped with ease, and with elements of sensory stimulation and symbolic meanings. Plants that are commonly used are listed in the table below.

Plant	Characteristics	Sensory Stimulation	Propagation	Plant Arrangement	Others
Chamaedorea elegans Mart	Easy growing, less pest…	Visual, tactile	Division Sowing	√	shade and humid environment
Fittonia verschaffeltii	Easy growing, less pest…	Visual, tactile	Division Cutting	√	shade and humid environment
Draceana sanderiana	Easy growing Easy grip	Visual, tactile	Cutting	√	Chinese name means “Rich”
Kalanchoe Blossfeldiana	Easy growing Easy grip	Visual, tactile	Cutting	√	Chinese name means “longevity”, “happy family
Chlorophytum comosum	Easy growing	Visual, tactile	Division	√	Have baby plant
Succulent	Easy plant care	Visual, tactile	Division Cutting	√

It is desirable for elderly with dementia to live in the community as long as they agreed. Community based services can provide enough supports for them and relieve the burden of their care givers. HT is a complementary therapy to incorporate into the services to enhance their quality of life.

Reference

American Horticultural Therapy Association, American Horticultural Therapy Association Definitions and Positions, retrieved on 4 Jan 2014 from http://ahta.org/horticultural-therapy

Census & Statistics Department, SAR., retrieved on 4 Jan 2014 from http://www.censtatd.gov.hk/home/index.jsp.

Ebel S. (1991). Designing Stage-specific Horticultural Therapy Interventions for patients with Alzheimer’s Disease. Journal of Therapeutic Horticulture, Vol. XI, 55-58.

Hong Kong Association of Alzheimer Disease retrieved on 4 Jan 2014 from http://www.hkada.org.hk/disease_02.php?lang=chi#.Usgf5nnxvIU

Jarrot, S., Kwack, H., & Relf, D. (2002). An observational assessment of a dementia-specific horticultural therapy program. Hortechnology, 12, 403-410.

Lam LC, Tam CW, Lui VW, Chan WC, et al. Prevalence of very mild and mild dementia in community dwelling Chinese older persons in Hong Kong. International Psychogeriatrics, 2008;20:135-48.

Suzanne E. Wells, 1997. Horticultural therapy and the older adult population. New York: Haworth Press

Donald Frisch gives us an inside look at how the Missouri Botanical Garden approaches the human dimension through therapeutic horticulture programming.  Mr. Frisch is a registered Horticultural Therapist, and the Therapeutic Horticulture Programs Coordinator at the Missouri Botanical Garden.  He has worked for the Missouri Botanical Garden for over seven years.

” Part of the mission of the Missouri Botanical Garden implores us, as employees of the [Missouri Botanical] Garden, to share our knowledge about plants and their environment in order to preserve and enrich life. The Garden achieves this in many ways through a variety of different avenues throughout the world. One of the avenues we use to share our knowledge within the St. Louis area is through our Therapeutic Horticulture program.

Zimmerman Sensory Garden: Raised beds – Photo courtesy of Donald Frisch

Therapeutic Horticulture, as defined by the American Horticultural Therapy Association, “is a process that uses plants and plant-related activities through which participants strive to improve their well-being through active or passive involvement. In a therapeutic horticulture program, goals are not clinically defined and documented but the leader will have training in the use of horticulture as a medium for human well-being.” By using horticulture in a therapeutic setting we are able to help the participants work toward their personal goals as they learn about and interact with plants.

We offer programming opportunities either at the Garden or at an offsite location. The therapeutic horticulture programs that are facilitated at the Garden have a combination of indoor classroom and the Zimmermann Sensory Garden, our outdoor growing space. In this garden space participants assist with the planting, weeding, watering, harvesting, mulching, etc…. as needed throughout the growing season. This garden space offers a variety of planting heights and depths such as raised beds, various sized containers, and ground level beds, to meet the needs of all ability levels of the participants.

Zimmerman Sensory Garden: Ground level bed – Photo courtesy of Donald Frisch

We also facilitate outreach programs in the St. Louis community for those people that may have difficulty visiting the Garden. At those locations, depending on the desires of the facility, we offer a wide range of indoor and outdoor programming.

Considering the public nature of our garden we have the opportunity to collaborate with a diverse group of participants. Some of the populations we have had the pleasure to work with include but are not limited to Senior living facilities, children and adults with developmental disabilities, children and adults with visual impairments or blind, women’s crisis center, and cancer support and recovery.

It is our hope that our continued plant and people focused Therapeutic Horticulture programs will continue to enrich the lives of the participants in our community and beyond. “

— Donald Frisch, HTR, Therapeutic Horticulture Programs Coordinator

 Have questions or want to learn more about the Missouri Botanical Gardens’ therapeutic horticulture programs?

Contact Donald Frisch at: [email protected]

In 2012, I had the privilege of serving as an Horticultural Therapy (HT) Intern for CooperRiis and their community.  Below I will introduce the CooperRiis mission, share a glimpse into my experience working within a Recovery Paradigm from the Garden, and provide a short summary on the ongoing growth of CooperRiis’ HT Internship program.

-Sarah Barmore Byrd

The CooperRiis Enhanced Recovery Model

CooperRiis: A Healing Community

North Carolina, USA

Road to CooperRiis Farm, 2012; Photo courtesy of Sarah Barmore Byrd

“Our healing community rests upon a rich heritage of therapeutic communities in the United States that began in the early 1900’s. The central concept of therapeutic community is to create a living environment in which staff, volunteers, and residents live, learn, recreate, and work together as a functioning community. To this model, CooperRiis has added the elements of modern psychiatry and psychology, with an emphasis on relationship-centered care, recovery, and a strong holistic approach that affirms and honors the whole person.

CooperRiis nurtures the whole person, rather than just the mind by utilizing comprehensive services and experiences such as:

• Therapeutic Community Support of Individual Recovery
• Individual and Group Therapy
• Family Education Program
• Medication Optimization
• Support for Individuals with History of Substance Abuse and/or Addiction
• Community Work and Service Program
• Scholastic Education and Career Assessment
• Integrative Health Counseling and Support for Optimal Health
• Recreational, Cultural, and Arts Experiences”

–The CooperRiis Enhanced Recovery Program: Summary of Philosophy, Program, and Practices— Introduction, p. 1 (2012)

Community Work and Service Program

In 2012, I had the privilege of serving CooperRiis and its residents as a Horticultural Therapy (HT) Intern. Before diving into the community and service, I attended a series of trainings. During this training, I was introduced to the Recovery Paradigm and CooperRiis’ unique Recovery Model built within the paradigm. Within this model Seven Recovery Domains were identified:

• Community/Connectedness
• Spirituality
• Physical Wellness
• Emotional/Psychological Health
• Purpose/Productivity
• Empowerment/Independence
• Intellectual/Learning/Creativity

The ‘Potting Shed’, Greenhouse #1 & 2, CooperRiis, 2012; Photo Courtesy of Sarah Barmore Byrd 

I initially presumed the work I would do in the garden would be mostly tied to one domain: Purpose/Productivity. It made sense to equate Community Work and Service to Purpose/Productivity. And, in truth, that may be how it was generally categorized– on paper. However, over the course of the summer I began to understand how the garden, in reality, fit within the CooperRiis Enhanced Recovery Program: it grew between all the cracks, and rooted the pieces together. And not by accident, but with deliberate thoughtfulness to design and intention.

The Garden Crew

My skill sets, intern’s purpose and needs led to my assignment within the Community Work and Service Program as a Garden Crew Staff Member and Life Coach. My main task was to assist the permanent Garden Crew Staff in the planning, facilitating and guiding of Garden Crew activities and work hours.

Residents’ Reference Diagram of CooperRiis Farms, Color-coded, 2012; Photo Courtesy of Sarah Barmore Byrd

In addition to this task, I would also attend the weekly meetings of the Garden Crew Staff with Farmer Mike (the head guru of Farm operations) to discuss the constantly changing activity schedule in the garden and attend all extra company training. I would maintain my personal records of HT-related activities and documentation, and meet with my HT adviser weekly. Then, lastly, I would, after some shadowing, be slowly assigned to incoming residents joining the Garden Crew, as their Life Coach.

The Sunflower Group Reflection Circle–in Growth, CooperRiis, 2012; Photo Courtesy of Sarah Barmore Byrd

It was in this role that the compatibility of Gardening and the Recovery Model became the most apparent to me.

A Recovery Paradigm in the Garden

As a Life Coach you attend your assigned resident’s routine meeting with all of their case management support. During those meetings, the resident will identify ways each of their case management members can offer support towards their personal goals. The Life Coach’s capabilities to serve in this capacity are, for obvious reasons, mostly tied to their Work Crew roles. This resulted in Life Coaches giving support centered around aiding in their resident’s timely arrival to work hours, completing their work tasks, embracing their work and finding pride in their completed work. The work in this case meaning gardening, sweat and conversation, and the work output; harvest, health and beauty.

The ‘Red’ Field, CooperRiis, 2012; Photo Courtesy of Sarah Barmore Byrd

Yet, the support and work did not stay within the rows or beds of the garden spaces. Work and support ebbed and flowed from the morning breakfast, to community meetings, to drum circles, to flower arranging for the public eating areas. The blossom of recovery, that I believed would neatly occur at separate locations in different fashions–in truth seemed to spread all over and build on itself.

The garden, I realized, is a perfect vehicle for the kind of recovery process facilitated by CooperRiis’ Recovery Model. Gardening has long fingers that stir the spirit, fill your table, strengthen the body, induce kindness, tease out laughter, teach skills, bring peace, spur the mind to reason, and… can bring strangers close.

CooperRiis Vermiculture Bin Product, 2012; Photo Courtesy of Sarah Barmore Byrd

9 acres of the CooperRiis campus devoted to soil, vegetables and sweat, seemed to me, an effective mechanism to give those who felt kinship with the ground a chance to embrace the CooperRiis Recovery Program in a way that brilliantly interlocks all seven recovery domains.

2012 Onward: The CooperRiis HT Internship Program Bearing Fruit

Typically, my case included, HT Interns discover CooperRiis’ Internship program by a mix of good fortune and word of mouth.  However, due to CooperRiis’ recent showcase at the 2011 American Horticultural Therapy Association (AHTA)’s Annual Conference, their Mill Spring campus has had an ever steady stream of HT Intern applicants eager to work in the Garden. Some are attracted to CooperRiis because of its ability to board them throughout their internship–while others want a chance to gain the unique immersive community experience that CooperRiis offers.

In 2013, CooperRiis offered its campus, housing, food (delicious, nutritious, down-right awesome–and did I mention 10% [2012] of it all comes from their Garden??) and work experience to at least three different HT interns, each with a typical stay of a 3 month period, working full-time. Over the three month period, each intern is charged with managing their own internship needs and building on the internship’s experience before them.

Since I have been there, the internship program has keep pace with the evolving AHTA standards offering more opportunities for the HT Interns to work in formalized goal-setting groups and providing HT therapy-rich group experiences. In addition, HT Interns have improved the CooperRiis campus by redefining and building on outdoor places for recovery, and has added literature* to the growing body of outcome research from CooperRiis.

 

-A Glimpse into the CooperRiis HT Intern Experience, 2012, Sarah Barmore Byrd

 

*The PPC Newsletter Team is in the process of trying to locate information on the HT Intern projects… stay tuned.

For more information on CooperRiis’ HT Internship program, contact:  Lisa Schactman at [email protected].

For more information on CooperRiis and their mission you can visit their website or view their Outcomes Research Summary published in January 2013.