What is it? In a nutshell, therapeutic horticulture involves the use of garden environments as a therapeutic intervention. This can include the growth, care and maintenance of these environments as well as the simple act of spending time in gardens. Therapeutic horticulture is widely used across a broad range of settings; it can be used as a form of rehabilitation (physical or otherwise), a vocational tool, a way to foster community, and more. Those leading these interventions are called horticultural therapists, and they’re professionals with specific education, training and credentials.
Therapeutic horticulture has wide-ranging benefits befitting the wide-ranging populations it serves—mental, physical, vocational, and more. It can help participants learn new skills or regain those they’ve lost; it improves memory, language skills, cognitive ability and socialization; it strengthens muscles and improves balance, endurance and coordination; and it teaches people to work independently, problem solve, and follow directions.
Therapeutic horticulture or horticultural therapy?
Therapeutic horticulture and horticultural therapy are often used interchangeably, though they have slightly different connotations. For the purposes of this essay, I’ll be using the terms interchangeably, but I do think it’s important to note the slight difference between the two terms before we move on.
Horticultural therapy is defined as “participation in horticultural activities facilitated by a registered horticultural therapist to achieve specific goals within an established treatment, rehabilitation, or vocational plan.” It takes place within the bounds of an established treatment plan, and it’s an active process where “the process itself is considered the therapeutic activity rather than the end product.”
Meanwhile, therapeutic horticulture is pretty much the exact thing with a slightly different emphasis; it too is all about the “process through which participants enhance their well-being through active or passive involvement in plant and plant-related activities,” but it’s less yoked to an established treatment plan—meaning, those of us who haven’t been directly prescribed a horticulture-based treatment plan by our doctors but are still using the same basic tenets to feel better could be described as engaging in therapeutic horticulture.
Horticultural therapy and therapeutic horticulture are two sides of the same coin—the former more formal and the latter more informal. Think patients gardening as part of a program versus you in your backyard with your hands in the soil. In the end, both are versions of the same idea and have similar processes and end goals; one is just medically prescribed while the other is not.
The history of therapeutic horticulture
Like many other forms of nature therapy, therapeutic horticulture has a very long history. The use of gardens and gardening as a way to cultivate healing and combat stress is almost as ancient as society itself.
The use of horticulture to “calm the senses” dates back to at least 2000 BC in Mesopotamia. In 500 BC, the ancient Persians created gardens, combining beauty, fragrance, and running water, whose main intention was to soothe and calm those lucky enough to experience them, and ancient Egyptians used to prescribe garden walks for people suffering from “mental disturbance.”
In the Middle Ages, many monastery hospitals cultivated therapy gardens; many of the plants were used for medicinal purposes, but the gardens’ primary function was to brighten the spirits of the hospital patients. St. Bernard (the man from the medieval ages, not the dog!) was an early proponent of what would later become therapeutic horticulture, describing it thusly: “The sick man sits upon the green lawn… for the comfort of his pain, all kinds of grass are fragrant in his nostrils. The lovely green of herb and tree nourishes his eyes… The choir of painted birds caresses his ears… the earth breathes with fruitfulness, and the invalid himself with eyes, ears, and nostrils, drinks in the delights of colors, songs, and perfumes.”
The more modern iterations of healing gardens started in the late 18th and early 19th century with Dr. Benjamin Rush, who was often recognized as the “Father of American Psychiatry” and an original signer of the Declaration of Independence. He was serving as a professor at the University of Pennsylvania in 1798 when he noticed that field labor in a farm setting led to more positive outcomes for clients with mental illness. He began encouraging more and more of them to get their hands dirty as part of their recovery.
Rush wrote a book, Medical Inquiries and Observations Upon Diseases of the Mind, where he noted that “digging in the soil seemed to have a curative effect” on his patients; digging in a garden, he said, was one of the activities which distinguished patients who recovered from their mania from those who didn’t. His hospital, in response, created landscape-shaded paths through the grassy meadows on the hospital grounds.
After this, more hospitals in the western world began to turn to horticulture as a possible form of treatment, especially for clients with mental health issues or those with developmental disabilities. In 1817, the Asylum for Persons Deprived of Their Reason created an environment with a park atmosphere to help patients with their recovery, and in 1879 the same hospital—now renamed Friends Hospital—built the first greenhouse intended specifically for therapeutic purposes.
World Wars I and II spurred a huge leap forward for the field of horticultural therapy, due to the huge numbers of wounded servicemen returning home. Horticultural therapy was used as occupational and recreational therapy for these men, helping them improve the functioning of injured limbs and increase mental function while learning new, diverting skills.
Its role as rehabilitative care for veterans greatly legitimized the practice and allowed it to expand both in scope and credibility: “No longer limited to treating mental illness, horticultural therapy practice gained in credibility and was embraced for a much wider range of diagnoses and therapeutic options.” Since then, the practice has only grown, gaining more legitimacy and being used for a diverse variety of populations with a diverse variety of needs.
What does the research say?
As I mentioned above, the benefits of therapeutic horticulture are wide-ranging—from improved cognitive abilities, coordination, and endurance to decreased stress and pain—and nowadays there’s plenty of research to confirm this.
A 2011 study involved patients who performed a stressful Stroop task and were then randomly assigned to 30 minutes of either outdoor gardening or indoor reading. Both groups had a decrease in cortisol, but the effects were significantly more pronounced for the gardening group; furthermore, the study adds that “positive mood was fully restored after gardening, but further deteriorated during reading.” The study concluded that gardening can provide relief from acute stress.
Another study back in 2005 looked specifically at the effect of horticultural therapy on patients in an inpatient cardiac rehabilitation program, using a control group that went to class and another that went to the garden. It found that the group who went to horticultural therapy saw overall improvements in mood state and decreases in stress, suggesting that horticultural therapy could be an effective component of a cardiac rehabilitation program.
And a 2004 study, looking at 46 patients with brain damage who participated in group horticultural therapy, found that “horticulture therapy mediates emotional, cognitive and/or sensory motor functional improvement, increased social participation, health, well-being and life satisfaction.”
The research makes it clear that therapeutic horticulture is a medical intervention that can provide healing and relief to people with a wide variety of issues and illnesses.
What makes a therapy garden?
Not every garden can be technically classified as a therapeutic garden. A therapeutic garden is a garden that’s “specifically designed to address a variety of applications within healthcare, rehabilitative and other therapeutic settings.” The American Society of Landscape Architects even maintains a network for consultants who specialize in designing these therapeutic gardens!
It also should be noted that there are many sub-types of therapy gardens, such as healing gardens, enabling gardens, rehabilitation gardens, and restorative gardens, each with their own specific purpose. Some focus on passive interactions and others on active interactions, depending on the needs of the users’ and the gardens design. What they all do have in common is the fact that they’re plant-dominated environments that have been specifically and purposefully designed with healing in mind.
So what makes a garden therapeutic? Some basic elements include wide, gently graded, and accessible entrances and paths; raised planting beds; and a “sensory-oriented plant selection focused on color, texture, and fragrance.” The boundaries of the garden are often well-defined, and the emphasis is on creating “benign and supportive conditions,” which often means eschewing pesticides or poisonous plants. A therapeutic garden should have a universal design, meaning that it’s designed for the convenience and enjoyment of a wide range of people—from young kids to the elderly—and allows visitors to use the full range of their senses within its perimeters (including, ideally, taste!).
Oftentimes landscape designers collaborate directly with horticultural therapists when designing gardens like this to make sure the garden is accommodating to people with a wide range of abilities. But the gardens don’t need to be fancy or professionally designed; the emphasis is really on making sure the gardens are accessible and full of healing, sensory plants for the people using it to enjoy and benefit from. In fact, this pamphlet from the American Horticultural Therapy Association says therapeutic gardens function best when they are “simple, unified and easily comprehended places.”
Therapeutic horticulture in action
Therapeutic horticulture has been used to promote healing and stress-relief in a wide variety of populations with diverse needs. And luckily, therapeutic gardens and the programs that come with them can be found all around the country.
There are a number of more generalized programs whose goal is to provide a healing, beautiful space that everyone can enjoy—such as the Gardens on Spring Creek in Fort Collins, Colorado, or the Gardens at Heather Farm in Walnut Creek, California. Some are designed specifically to educate children about nature, such as the Elkus Ranch in the San Francisco Bay area, or the Bullington Center in Henderson, North Carolina.
And others still are directed towards aiding specific populations in need—like the Hospice and Palliative Care of Greensboro, South Carolina, which uses horticultural therapy as part of its mission to provide “compassionate, quality care for persons who are living with a progressive and life-limiting illness and their families,” or the Anchor Center for Blind Children in Denver, Colorado, whose goal is to provide “hope and a nurturing environment…[to] visually impaired infants, young children and their families.”
Some therapeutic horticulture programs are geared towards those with dementia, others towards children with behavioral issues, and others still to those dealing with mental illness. Because of its accessibility to a wide range of populations and its proven ability to decrease stress—which, as we know, exacerbates almost all other medical issues—horticultural therapy’s healing applications are almost endless.
There’s an ancient Chinese proverb that says: “If you want to be happy for a lifetime, be a gardener.” So many centuries later, science is finally proving these once idyllic-seeming words to be true. So make sure to get outside, get your hands dirty, and sniff a rose—it’s doctor’s orders!