By Daniela Silva-Rodriguez Bonazzi & Alexandra Febles
Note: A Spanish version of this blog is available here.
“In the garden we cultivate your tranquility, we make your senses bloom”Daniela Silva-Rodriguez Bonazzi
Global estimates published by WHO indicate that one in three (30%) women in the world have experienced physical and/or sexual intimate partner or sexual violence by a third party at some point in their lives.
Physical or sexual violence results not only in physical injuries, but also psychological injuries, such as depression or suicidal ideation, or long-term injuries such as PTSD. Trauma from sexual violence can impact the long-term economic well-being of survivors and negatively affect their personal and community relationships.
The response to trauma is both physical and psychological. Traditionally the approach to addressing trauma has been through talk therapy, which is certainly still very important. However, holistic methods that include the body have been shown to be helpful in recognizing the physiological and nonverbal aspects of the survivor’s experience. For some survivors, traditional talk therapy may not be relevant due to cultural context, while the holistic approach may be more relevant to their traditions. Studies have shown that some survivors are more comfortable with interventions that involve movement of their body, rather than purely verbal interventions. Holistic healing methods that include body movement, energy intake, and connection to plants and animals empower survivors to interact with their immediate environment, create bonds of trust, and return to their bodies.
Traumatic experiences have the following impacts on survivors:
- Dysregulation of the autonomic nervous system and limbic system in the brain
- Affecting memory: the past becomes the present
|Catecholamines||Increased, affecting memory, rational thinking, hypervigilance, inability to identify danger signs|
|Corticosteroids||Decrease, affecting the immune system|
|Opioids||Increase, affecting affectivity|
|Oxytocin||Increases, affecting memory|
Why is horticultural therapy effective in addressing trauma?
“To plant a garden is to believe in tomorrow”Audrey Hepburn
Survivors of traumatic events (child/adolescent/adult) feel a deep sense of helplessness, lose problem-solving skills, lose the ability to move, and lose the ability to protect loved ones. The psychological impact includes high levels of anxiety and stress, behavioral disturbance, night terrors, emotional dysregulation, difficulty connecting with surroundings, and low self-esteem, among other impacts.
Working with plants, in the garden, offers relief from that sense of helplessness because the risk of making decisions is lessened. The space surrounded by plants/vegetation has a different rhythm, it’s a space free of judgement, a safe place; this is very important because the sense of safety allows survivors to experience it in their body without feeling overwhelmed, it is not blocked, and can continue to function daily; they regain hope, and painful memories of the trauma are unlocked. (Abby Tassel of WISE).
“The most effective neurobiological intervention is a safe relationship”Bruce Perry, MD, Ph.D., Psychiatrist
Plants respond to the care of the caregiver/survivor in a non-judgmental way, thus alleviating the feeling of helplessness. According to Bessel van der Kolk & Peter Levine: “The physical exercise of gardening gives the body the opportunity to redirect hyperarousal, to experience movement, heavy breathing, and even sweating, for good reasons. The sensory stimulation from fragrances, visual beauty, and physical contact with plants are powerful antidotes to the negative sensations that terrify and paralyze survivors.”
Robert Stolorow, a trauma expert, explains the psychological impact of a traumatic event as “a terrible sense of detachment and isolation,” producing in the survivor a loss of Self. Gardening is an activity that puts the survivor in a state of “flow”, allowing them to be in the present moment, redirecting their attention to the activity, and experiencing a Self beyond the pain or loss.
One of the attributes of horticultural therapy is its holistic approach. Unlike other therapy modalities, horticultural therapy seeks to improve the physical, psychological, social, and emotional state of the survivor through nature-based activities such as gardening or horticulture, active or passive, which can be used in conjunction with other traditional counseling techniques.
Currently, domestic violence or third-party violence programs are sought to economically empower victims (Goodman & Epstein, 2009) to reduce the likelihood that the victim will return to the abusive situation (revictimization) due to economic instability (Brush, 2011; Hamby & Bible, 2009; Moe & Bell, 2004). Vocational skills development is another focus of a horticultural therapy program. Participants can be trained in: seedling production; vegetable garden implementation; ornamental plant propagation techniques; green area maintenance; natural dyes; or floristry; which would enable them to become employed and financially independent.
Many theories have been developed about the positive impact of interacting with nature and its healing effect. Renzetti & Follingstad (2015) argue that it is due to a combination of “physical activity, the process of growing and producing vegetables, an attentional component, sensory experience in nature, skill development, and opportunities to develop informal social bonds”. They also identify 2 theories that explain the effectiveness of horticultural therapy:
- Attention Restoration Theory: postulates that working in a plant-based environment prompts survivors to engage in daily activities and be resilient, moving away from distractions and negative thoughts.
- Conservation of Resources Theory (COR): this theory suggests that traumatic events cause a loss of resources such as the Sense of Self, but participation in the horticultural therapy program has a positive impact on the recovery of resources such as self-sufficiency.
In addition to these 2 theories, from my point of view and experience, it is the “reconnection” with nature that helps people heal. Modern life has distanced us from nature, and medical and psychological therapies have ignored the fundamental role nature has played throughout the evolution of humans, for the mind, body and spirit. Horticultural therapy facilitates this people-plant connection. Plant caring helps survivors “rebuild” themselves, addressing disabling aspects of their existence, and affecting them physically and emotionally.
In nature, restoration and recovery are spontaneous, while human beings ruminate on worries, negative thoughts, or problems, delaying the recovery process.
Horticultural therapy is not only motivating, it also offers participants gardening strategies to help them cope with stressful situations. Nature-based activities are non-threatening, relaxing and stimulate all the senses, contributing significantly in PTSD symptom reduction. Strategies learned through the horticultural therapy program are carried over into daily life scenarios.
“No human being resists the pleasure of being in nature”Alexandra Febles
Horticultural therapists working with this population group would need to deepen their knowledge in:
- Therapeutic techniques and dynamics – age-related
- Use of Self
- Insights into the neurobiology of traumatic experiences
- Mental health first aid
Goals that could be addressed through horticultural therapy are:
- Trauma coping pathway: gardening skills for coping with trauma
- Recognizing the plant-based environment as a “safe place”
- Reduction of stress, anxiety, and negative feelings
- Reduction of self-injury behavior
- Reduction of cortisol level (related to stress)
- Increased dopamine production (improves judgement and controls impulsivity)
- Improve memory
- Create new habits to break the violent cycle
- Improve self-esteem, self-confidence, self-awareness, self-care, and self-regulation
- Learn to be in the present moment
- Recover a sense of control/decision making
- Alleviate depression
- Relaxation techniques
- Develop trust bonds – reduce isolation, improve communication skills (verbal & nonverbal)
- Belong to a support group
- Reduce violence
- Encourage creativity
- Perform a pleasurable activity
- Acquire vocational skills (employment)
Horticultural therapy program:
- Duration: 12 weeks
- Frequency: 2 times/week
Goal and activity chart (suggested)
|1||1. Recover Sense of Control||Heart shape topiary||1. Adopt a plant, and commit to its care – tangle the vine around the wire||1. I am responsible for my life’s path 2. I control my life, my body, and my mind 3. Express traumatic experience: from victimization to healing|
|2||1. Self-awareness||Journaling||1. Journaling helps with self-awareness – negative and positive emotions 2. Helps identify triggers and gardening strategies to channel them||1. Who am I?|
|3||1. Reduce stress (cortisol) 2. Recover a sense of Self /Self-care 3. Self-esteem||Hand scrub/strawberry face mask||1. Recovery of Self (helps with loss process – going from victim to survivor) 2. Self-care||1. I take care of myself – I love myself|
|4||1. Reduce stress||Lavander sachet||1. Lavender aroma is soothing 2. Having a sachet at hand offers security||1. Healthy body, healthy mind 2. I breathe peace|
|5||1. Self-awareness 2. Sensory stimulation 3. Self-esteem/Self-worth 4. Self-care 5. Responsibility||Plant maintenance||1. Plant maintenance helps in routine recovery 2. Compare plant needs to own needs||1. Cleaning plant leaves feels like: “washing out sadness or fear or pain” 2. What does a plant need? What do I need?|
|6||1. Strategy to channel traumatic experience 2. Decision making||Identify sick or damaged plant parts||1. Helps identify the “shadow” of our Self 2. Plant recovery activates innate healing capacity||1. We all have a shadow with which we have to learn to live. We don’t have to let that shadow disable us.|
|7||1. Channel negative feelings||Psychological burial||1. Identify negative emotion, write it down on a leaf and bury it on the compost pile makes the person feel lighter.||1. Symbolically get rid of pain or negative emotions|
|10||1. Recover Sense of Self 2. Stress reduction||Conscious breathing in nature||1. Conscious breathing improves attention span, focus, and memory. 2. Restores brain synaptic connections, thickens the cerebral cortex||1. Learn to listen to “silence” 2. Connect with Self or something bigger|
|11||1. Attention restoration 2. Reduce stress/anxiety||Flower petal mandala||1. Sensory stimulation 2. Hand-eye coordination 3. Attention restoration 4. Creativity 5. Self-esteem, self-worth||1. Regain control 2. The mandala represents my “journey” 3. I am a beautiful and colorful creation|
|12||1. Self-awareness (triggers) 2. Empathy||Identifying my emotions: look for plants in the garden with emotions or identify emotions in my body by putting colored flower petals on my body outline||1. Nonverbal activities help identify feelings 2. Identify triggers and strategies to channel negative feelings with garden activities||1. Knowing that other living beings have the same feelings makes me feel relieved.|
|13||1. Vocational skills 2. Resilience||Succulent propagation||1. Succulent plants are full of metaphors: adaptation and protection mechanisms, resilience; an easy group of plants to start a connection with plants||1. How do I protect myself, how do I adapt to different situations?|
|14||1. Creativity 2. Self-worth/self-esteem 3. Sensory stimulation||Flower arrangement||1. Break routine patterns 2. Sensory stimulation 3. Creativity 4. Self-esteem 5. Redirect attention 6. Fine motor skills 7. Restoration of Self||1. Beauty is within me|
|16||1. Creativity 2. Vocational skills||Pressing flowers or leaves||1. Sensory stimulation 2. Hand-eye coordination 3. Attention restoration 4. Creativity 5. Self-esteem, sense of worth 6. Vocational skills||1. Beauty is in the eye of the beholder|
|19||1. Self-awareness 2. Safe bond 3. Empowerment 4. Sense of time||Plant narrative: learn about different plants, choose one and relate and personalize the plant||1. Empowerment 2. Cultivate a relationship with a plant of choice||1. Knowing the plant’s narrative helps in the self-knowledge process (needs: light, water, companionship, nutrients, mood) -this empowers the participant|
|20||1. Self-awareness & needs||Plant anthropomorphization||1. Get acquainted with plant parts and their functions – compare them with human parts 2. Learn the biological cycles of plants vs human cycles (this will help the therapist work with limits)||1. Tending a plant serves as a mirror|
|21||1. Promote healthy eating 2. Physical activity (dopamine) 3. Vocational skills||Cultivating berries||1. Healthy eating choices 2. Take care of body wellness 3. Berry consumption regulates blood sugar levels, reduces mood swings, panic attacks, anger, or desperation||1. Healthy body, healthy mind|
|22||1. Channel negative emotions/anger 2. Recover a sense of control||Pruning||1. Physical activity which liberates endorphins, restores melatonin levels, and mood improvement (tryptophan production)||1. Prune anger or guilt 2. I establish my own limits|
|23||1. Set limits 2.Attention restoration (mindfulness) 3. Promote responsability||Sowing seeds in individual containers||1. Sowing seeds engages the participant in caring for another living organism and helps to redirect attention. 2. Promotes a sense of care 3. Multiple-step activity alleviates depression/anxiety (endorphins)||1. Sow with intention: make a big change in my life 2. Living organisms need boundaries|
|24||1. Channel negative feelings 2. Physical activity||Weeding||1. Channel negative feelings or overload||1. Don’t let trauma and abuse root and find a home in me 2. Remove negative thoughts from my mind – see the future with clarity|
|25||1. Cope with difficult moments (shadow)||Sunflower cultivation||1. Sunflowers turn towards the sun, as people do to move forward 2. Sunflowers are plants that follow their circadian rhythm (natural)||1. In my “shadow” moments, I search for the light 2. Sunflowers symbolize loyalty, and adoration (the myth of Clytie & Apollo 3. I feel as happy as a sunflower|
Strategies for horticultural therapists:
- DAY 1: Welcome the victim with the suggested words: “I am sorry for what you have gone through, I know I cannot change your experience, but I am here now to make you feel better”.
The setting must be relaxing, free of judgement, and emotionally safe. The victim has to know that “he/she is not guilty nor worthy of the traumatic experience”
- The first (2 or 3) sessions are fundamental to establishing a warm and empathetic rapport
- ACTIVITIES DAYS 1-3: a) play and read in the garden; b) identify garden tools – explore them freely; c) sensory exploration with plants (touch, smell, taste them); d) make soil “bombs”, throw them, channel anger. These activities motivate participants to go back to the HT program.
- Start the session with aromatherapy to calm the mind
- Offer conscious breathing exercises during the session, preferably at the beginning of the session
Suggested documentation for the program:
|Complete evaluation (initial and final)||Provides information about the physical, cognitive and emotional state of the participants, as well as their interests, hobbies, habits, and horticultural skills. It serves as a baseline on which the horticultural therapist will design the program.|
|Rosenberg Self-Esteem Scale (initial and final)||Measures the participant’s self-esteem at the beginning and end of the program. Validates the effectiveness of the program.|
|Beck Depression Scale (monthly)||Measures the presence of depressive symptoms and assesses the severity of depression in participants|
|Participant self-evaluations (monthly)||Participant feedback is very important to the success of the program (Person-Centered Care)|
|Observation Chart (each session)||Recording the participant’s behavior or performance in each session allows evaluation of progress toward established goals.|
|Program evaluation (biannual)||Demonstrates: 1. Goals can be addressed through HT 2. Importance of including horticultural therapy in traditional programs for survivors. 3. Compare the economic empowerment of the horticultural therapy program vs other strategies. 4. Evaluate the therapeutic impact of the program.|
- Participants must work at their own pace
- Touch and boundaries
- The rapport between therapist and participant
“Gardening is a great ally to identify past situations, be conscious about the present, and start to cultivate a resilient future.”Alexandra Febles
- Van der Kolk, B, MD – book: “The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma” -Penguin Books, 2014
- Poore,T, Shulruff,T, Bein, K – November 2013 – Holistic Healing Services for Survivors – National Sexual Assault Coalition
- D’Anniballe, J, Ph.D. – Understanding the Neurobiology of Trauma: Implications for Working Effectively with Adults and Adolescents – 2011 – SASP National Forum
- Campbell, R – Neurobiology of Sexual Assault – Webinar – National Sexual Violence Resource Center – 2012
- Fisher, J. Ph.D. – Transforming the Living Legacy of Trauma – PESI Publishing & Media, 2021
- Phillips, S.B., Psy.D., ABPP – “5 Reasons Gardening can Help to Heal Trauma”- Psychology Today, March 28, 2021
- Renzetti, C. M, PhD, & Follingstad,D, PhD. Violence and Victims; New York Vol. 30, Iss. 4, (2015) – “From Blue to Green: The Development and Implementation of a Therapeutic Horticulture Program for Residents of a Battered Women’s Shelter”
- Goodman, L.A., & Epstein, D. (2009). Listening to battered women: A survivor-centered approach to advocacy, mental health and justice. Washington,DC: American Psychological Association.
- Brush, L.D. (2011). Poverty, battered women, and work in U.S. public policy. New York, NY: Oxford University Press.
- Hamby, S., & Bible, A. (2009). Battered women’s protective strategies. Harrisburg, PA: National Resource Center on Domestic Violence.
- Moe, A. M., & Bell, M.P. (2004). Abject economics: The effects of battering and violence on women’s work and employability. Violence Against Women, 10, 29-55