Members Articles – 30 October 2014

Horticultural Therapy or Therapeutic Horticulture?
Submitted by: Toni Salter

While it might seem like splitting hairs, the approach behind these two practices is actually quite different. This was the hot topic of discussion at this year’s 12th International People Plant Symposium, as part of the IHC 2014 in Brisbane, and should prompt the correct terminology to be adopted within the garden industry.

So what is the difference?

Let me try to explain using some of the definitions offered during the symposium. Horticultural Therapy (HT) is a gardening activity used specifically as a clinical treatment; it is an alternative medicine (just like art therapy or music therapy) for a diagnosed client receiving treatment. The treatment is delivered by a trained professional with both clinical qualifications as well as horticultural training. Outcomes are based on scientific assessment with measurable goals that can clearly show physical, social, cognitive and/or psychological improvement. Steps in a gardening activity are often broken down to fully reflect even small changes in such things as fine motor skills or a person’s ability to follow 2 or more instruction, in some cases.

A treatment goal using HT might look something like this:
“In 5 weeks, a client suffering stroke has depression reduced by 18 points on the GDS (Geriatric Depression Scale).”
A standardised program of sowing seeds of annual vegetables into containers might be the horticultural activity chosen and implemented for 30 minutes, 3 times per week.
Results would then be recorded, processes and goals reviewed and reset if necessary.

By standardising activities and processes, unknown variables can be reduced so that treatment results are clearly evident. If a success rate of, lets say, 80% is achieved then we can deduce that the therapy is worthwhile. Quantifiable results give weight to programs’ validity and future viability.

Therapeutic Horticulture (TH), on the other hand, is a more generalised approach offering someone enhanced wellbeing, whether they are in treatment, in a community setting or simply enjoying some gardening at home. Results are not necessarily measured. This is what we practice more in Australia, but is most often incorrectly termed horticultural therapy.

In Australia, for a person to be called a “therapist”, they need to have achieved at least a bachelor’s degree in an appropriate field. So horticulturists who consider themselves working in “horticultural therapy” should check whether they are indeed qualified to do so, or review the definition of what they are actually doing.

This highlights some deficiencies in our educational system here in Australia. There is no single course offered to become a recognised or qualified Horticultural Therapist. Instead, two separate qualifications are necessary: one in clinical therapy (such as Bachelor Occupational Therapy or Bachelor Psychology or Bachelor Nursing) as well as a qualification in horticulture (such as Cert IV Urban Horticulture). In contrast, countries like Japan, US and Korea all offer a registration process for degree qualified horticultural therapists.

We could expect that career prospects in this field would be promising because of our ageing population and need for such services, especially in the growing aged care sector. But still there is not enough current recognition of this in Australia.

A session presented during the Symposium showed some interesting comparisons in this field of work for Japan, US, Korea. All countries showed that the majority of HT’s were married women (71-82%) with an average age of 42-52 years and at least a bachelor’s degree (50%, slightly higher in US). The main areas of work were in schools, hospitals and rehabilitation centres. US and Japan employed HT’s in a full time capacity (62 and 81%) while Korea had only about half employed full time.

The challenges for Australia, like many of the other countries, are to improve our national presence and increase availability to training and resources. Recognition through standardised programs and definitions, along with appropriate qualifications, would improve the professional practice of Horticultural Therapy and give weight to applications for government funding to support programs offering this type of alternative therapy.

The remaining presentations at the Symposium offered some beautiful insights into how Horticultural Therapy is being effectively used around the world for many different projects while being supported by evidence based research.

“Roots to Freedom” is a nature based project within Kerava Prison in Finland, reaching inmates with a history of violent crimes. Many were typically experiencing high levels of depression and mental health issues, cognitive impairment due to drugs and alcohol, and lacked common every-day skills. After a program of vegetable gardening and general garden maintenance, the inmates showed an improved ability to develop perseverance, reduced levels of fear and stress in prison and were more hopeful of permanent change. More positive interaction between inmates was seen during the gardening program.

A Japanese study on gardening activities and their ability to reduce the incidence of dementia showed that watering plants had the most significant impact for older people. Sowing seeds, thinning seedlings, planting and weeding also showed positive results for preventing dementia and protection against further cognitive decline. Daily attention showed the best results, so it was recommended to include annual plants in gardens to encourage regular watering and care. Planting flowers and vegetables in aged care facilities had a positive effect on drawing clients outside while indoor plants for those people in locked dementia units were a good choice for garden activities because they were more visible.

Simple indoor garden installations using potted plants around some relaxed seating, posters of natural scenes, gnomes or other garden ornaments and bird songs piped through speakers showed a positive effect of those people living in aged care centres. The mood was significantly improved for residents for only a small outlay from a centre’s budget. Residents and staff both commented on the aesthetic appeal of the garden installation and how it helped make the centre feel more like a home than an institution. Residents tended to stay longer in the garden area over other areas.

Note: Toni Salter is a Registered Horticulturist and Member of Australian Institute of Horticulture. She also has a Cert IV in Leisure and Health and runs regular therapeutic gardening programs for adults with disabilities.

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