Journal of Therapeutic Horticulture 26.1 - 2016


Personality Disorder and Intellectual Disability: The Impacts of Horticultural Therapy Within a Medium-Secure Unit
Mark Alan Christie, MA, Michaela Thomson, MA, Paul K. Miller, PhD and Fiona Cole, MSc

This study was designed to explore the efficacy of a horticultural therapy intervention for the enhancement of subjective health and wellbeing in male service users1 with a dual diagnosis of personality disorder and intellectual disability in a medium secure unit in the north of England, UK. Service users (n=7) were involved in three focus groups; one just prior to a new garden facility opening, and then again at the nine and twelve month points, which explored the personal impacts upon service users’ health and wellbeing. The garden was itself an upshot of participant involvement; service users were involved in all aspects of the garden design and maintenance, and also assisted with dissemination of the research goals and findings. Service users reported numerous personal health benefits as a result of their engagement with horticultural activities, allied to personal development enhancements in respect of gardening knowledge, employability skills, personal achievements and positive changes in behavior towards self and others. Particularly, underlying these outputs, participants identified reduced stress, and a general “feel good” factor as key to their improved life-satisfaction. The mechanisms providing for these impacts included: interaction with a natural environment; enhanced intrinsic motivation derived from participation in a variety of tasks; and opportunities to develop specific horticultural skills. Immersion in horticultural activity may thus be an effective treatment modality in promoting positive health benefits to service users.

Personality disorder and intellectual disability: The impacts of horticultural therapy within a medium-secure unit
In recent decades a valuable body of literature has grown regarding the health benefits that can result from regular participation in green exercise. This phenomenon effectively involves exercise undertaken in active conjunction with natural environments, particularly gardening and conservation work (Christie, Miller, & Dewhurst, 2015; Coon et al., 2011; Pretty et al., 2007). The value of this form of exercise for addressing everyday somatic matters is, to some extent, already a germane concern within mainstream research; in this respect, one need look no further than illuminating work on cardiac rehabilitation patients (Wichrowski, Whiteson, Haas, Mola, & Rey, 2005), people with physical disabilities (Wilson & Christensen, 2011) and the experiences of older adults (Jackson, 2005). Conversely, there is rather less work available to date on the psycho-social impacts of horticultural therapy in general, and even less regarding its efficacy in what we might term “institutional settings.” The majority of influential studies in the psychological field emergent of the horticultural therapy paradigm have been largely laboratory-based (Pretty, Peacock, Sellens, & Griffin, 2005; Pretty, Hine, & Peacock, 2006). As Christie et al. (2015) note, however, it is important to reflect upon the ecological validity of taking thoughts and feelings out of the natural environment and into an artificial setting. Indeed, and as Erving Goffman (1961) emphasized well over a half century ago, in order to understand institutional behavior, one needs to first (a) qualitatively describe activity within the institution itself, and (b) make sense of what that means to the institutionalized.

With these points in mind, an increasing number of documented hospitals, care homes and prisons across Europe have, in recent years, used gardens for structured therapeutic purposes around a range of conditions (Sempik, Aldridge, & Becker, 2009). In short, it is taken as read by active practitioners in various forms of institutional facility that green activities have therapeutic value for a variety of psychological and somatic conditions. Nevertheless, there remains a lack of contemporary research investigating the influence of such horticultural therapy ( HT) in specifically custodial settings. This paper, thus, reports the impacts of a HT intervention on the subjective health and wellbeing of seven male service users, presenting with a dual diagnosis of intellectual disability ( ID) and personality disorder (PD), in a UK National Health Service ( NHS) medium-secure unit.

Case Study - Rebecca
Ciri J. Malamud, MA, CRC, CSW, LCADC

The following case study is based on observations of a 6-year-old girl during the 2015 Pediatric Summer Camp designed by the Pediatric Occupational Therapy Department at Rusk Rehabilitation/Hospital for Joint Disease (HJD), a division of New York University Langone Medical Center (NYULMC) in New York City. The children ranged in age from 5 to 8 years old, and were diagnosed with Cerebral Palsy, stroke or Guillain Barre syndrome. This 4-week summer camp has been operated by the Occupational Therapy Services Department (OTSD) at Rusk Rehabilitation during the past 6 years. The HTSD has been intricately involved in both the coordination and delivery of graded, age-appropriate one-hour HT group activities for the daily morning and afternoon summer camp sessions. Every day had a different summer-related theme, chosen by the OT staff.

Case Study - Sara
Jan Lane, HTR

The case study was conducted at Catholic Charities Gribbin Center, Perry Hall, Maryland, between June and September 2015. Gribbin Center serves approximately 60 adults with intellectual and developmental disabilities, including cerebral palsy, autism and Down’s syndrome. Programs at the center include “…pre-vocational and vocational training, supported employment opportunities, a supervised work environment, and habilitation daytime activities…” The center is located in a suburban setting, with a backyard that features ornamental flower beds, raised planters and a large gazebo.

Connecting to Self and Nature
Christina Sabra, MSW

The incorporation of alternative therapies such as Therapeutic Horticulture (TH) into clinical social work practice is an emerging discipline and one which has become my personal goal to achieve. The skills and awareness one learns caring for plants parallels the compassion, awareness and curiosity one needs to care for themselves and others, and to thrive. It also serves as an important vehicle for stress reduction and conversation about all manner of human emotion. Although my experience thus far with TH has been limited, there are many positive signs that it can be an effective tool in counseling clients, as it is accessible and useful for teaching and exploring one’s own awareness of themselves and their environment. The intervention that I have developed in a group setting is a form of Therapeutic Horticulture guiding clients to explore their feelings and improve their cognitive, social and physical well-being by caring for plants.

Book Review: Green Studio: Nature and the Arts in Therapy
Reviewed by: Matthew J. Wichrowski  MSW HTR