Horticultural Therapy and Caregiver Burden - Research Paper Example

? A Review of Horticultural Therapy and Caregiver’s Burden Horticultural therapy is the use of plants and gardening activities for healing and rehabilitating humans. A person’s engagement in therapeutic gardening is aided by a professional therapist to achieve specified objectives. Although the practice itself is ancient, the profession is relatively new. The benefits drawn by patients working with plants were first documented in the early 19th century by Doctor Benjamin Rush of the University of Pennsylvania. Since then, the practice has spread considerably in use. A growing number of researchers have attested to the unique attributes of horticulture when used as a therapy. This paper will review various literature on horticultural therapy for persons with social, emotional, mental and physical disabilities, as well as the caregivers’ burdens. Most of the literature available is in agreement with the success of the practice as a nonthreatening and non discriminating method. Regardless of the person’s age, religion or race, all plants respond well to whoever provides care. A Review of Horticultural Therapy and Caregiver’s Burden Introduction Within the past decade, awareness has grown among humans about the gains they can get from interacting with gardens and plants (Kimber & Richardson, 2006). The pronounced growth of interest in the interactions in recent times has facilitated the use of specially designed gardens known as healing, restorative or therapeutic gardens. They have defined differences suited to serve specific purposes and heal different conditions. The therapy is administered in various forms or programs. They include horticultural therapy, therapeutic horticulture, social horticulture and vocational horticulture (Simson & Straus, 2003). In horticultural therapy, a person actively engages in horticultural activities, within the perspective of an established plan of treatment, with the guidance of a trained therapist to realize specified and documented goals of treatment. The process forms the therapeutic activities rather than the final product. Therapeutic horticulture is the process in which plants and activities related to plants are used and those persons taking part endevour to make better their well being by passive or active involvement (Yalom & Leszcz, 2005). Furthermore, the goals here are not documented or defined clinically. Rather, the leaders possess training regarding horticulture’s use as means towards human well being. Social (or community) horticulture relates to activities in gardening for leisure. The treatment goals are not defined and therapists are not available and the activities emphasise on interacting socially. On its part, a vocational horticulture programs is designed to train people to engage professionally and commercially in horticulture and are available in rehabilitation or residential facilities and schools (Yalom & Leszcz, 2005). The influence of people’s interaction with plants in a relaxing and calming atmosphere as found in a greenhouse or garden positively affects both people and plants. The therapy takes place in various types of gardens including healing gardens, therapeutic gardens, horticultural therapy gardens, and restorative gardens (Resick, Monson & Chard, 2007). Healing gardens are dominated by flowers, green plants and natural settings. Generally, they are associated with hospitals and accessible freely to all. Designed as retreat centers, they aim to benefit most users. Therapeutic gardens are designed to be used as components of treatment programs like physical, occupational and horticultural therapy. Therapeutic gardens are designed to be part of multi disciplinary processes and may exist on their own or as extensions of in-house therapeutic program areas (Resick, Monson & Chard, 2007). Horticultural therapy gardens are designed to primarily support horticultural activities, but can also accommodate therapy causes. Restorative (or mediation) gardens could be private or public spaces that do not have to be associated with healthcare settings. Rather, they take advantage of the restorative and scenic value presented by nature as a conducive environment for emotional recovery, stress reduction and mental repose (Resick, Monson & Chard, 2007). The design of restorative gardens focuses on social, physical and psychological requirements of the patients. Literature Review 1. Horticultural Therapy According to the American Horticultural Therapy Association (AHTA, 2002), problems that can be alleviated through horticultural therapy treatment include sensory impairments, substance abuse, age related problems, physical and mental disabilities. In America, the therapy is mostly conducted in institutional environments where therapists work hand in hand with therapy and rehabilitation teams. They help the patients to enhance self esteem, lessen depression and improve their motor skills. This is supported by Simson and Straus (2003) who point out that most conditions and their associated treatments leave patients feeling dependent and passive, but when the same patients are placed in a situation where they nurture living plants, it creates a feeling of reversing roles. Haller and Kramer (2006) add to this point by saying that the patients’ social communication and interaction are improved when they feel in charge of living “things” that are flourishing. It also encourages and improves their adjustment to the working environment. Rothert (1994) suggests that the key role of horticultural therapy is that it provides the patients with an avenue to rebuild their confidence and give them a sense of purpose. 2. Benefits of Horticultural Therapy Miller (1992) urges people to consider gardening as more than just a refreshing way of producing their own food, but rather, embrace the benefits it brings forward in terms of improved diet, increased skills and knowledge, and increased physical exercise. Programs in horticultural therapy offer patients life enriching activities and engagement with nature and plants aiming at restorative benefits. In a research he carried out, Fieldhouse (2003) established that humans are able to benefit from horticultural therapy because they have an inherent fascination with plants. Mind (2007) also found that the gardening groups that participated in horticultural therapy achieved the best result when the leaders and therapists focused on the members’ aspirations and skills rather than deficits and symptoms. As offered by Johnson (1999), those who benefit from horticultural therapy include • Youth at risk • Clients of organisations of human advocacy and social services • Members of the public who seek connecting with nature • People who have developmental or physical challenges in day centers or hospitals • The elderly at retirement communities, senior centers or skilled nursing institutions • Those participating in programs of vocational training • People who live with illnesses in rehabilitation facilities, hospice agencies or hospitals • Military personnel and veterans in rehabilitation centers Although the general benefits of horticultural therapy are intertwined in the results of the exercise, some of the researched specific benefits are reviewed below. a. Physical Benefits Reflecting the words of a Kansas University professor, Richard Mattson, horticultural therapy provides children with activities that combat obesity, stress and youth violence (Yalom & Leszcz, 2005). These involve simple activities that are practical alternatives to competitive sports and can be done in the family backyard. As per Mattson’s opinion, physical exercise is necessary for children to feel better about themselves and that can be achieved through working in gardens. This thought is shared by Page (2006) who believes that the approach employed by horticultural therapy is interdisciplinary and incorporates horticulture with behavioral and social sciences. He opines that the relationship between plants and people built through gardening has the potential to improve an array of ailments like chronic pain, high blood pressure and depression. An example given by the National Institute for Mental Health in England (NIMHE, 2005) states that some children are prone to fits of anger. If they spend time and energy in garden chopping weeds, they also reduce stress and frustrations at the same time. Another researcher (Meiklejohn, 2003) points out that children that are too obese to participate in team sports end up developing low self esteem and eventual depression. Gardening provides the first step towards improved physical health and weight reduction for such children by increased body mechanics and muscular strength. Underused muscles are stretched and toned (Mind, 2007). Folkes (2002) contributes that horticultural therapy challenges and encourages participants to develop their strength and balance and promotes their coordination between the eyes and the hands. Their physical endurance and range of motion are also improved. Even for adults with no interest or ability in gardening, Burls and Caan (2004) were able to establish that being in touch with a green space in their neighbourhoods enables them to have momentary physical dissociation with their monotonous work offices or therapeutic institutions. The revitalizing and healing effects of staying out in nature, coupled by the scenic surroundings are ideal components for recovery from addiction (Johnson, 1999). As noted by Resick, Monson and Chard (2007), gardening presents the perfect way people in addiction recovery to develop new skills and abilities to focus and meditate. When they witness a garden they have nurtured and developed from an empty plot of soil to a flourishing ecosystem, they develop feelings of accomplishment and satisfaction. According to Folkes (2002), the gardening activities in horticultural therapy assists individuals struggling with addiction recovery to fill the gap left behind by the inevitable cutting off of contact with old friends. This is in view of the fact that keeping in touch with old friends who were associates in partaking of the addictive habits complicates the recovery program. A change in routine, as available in gardening, gives the participants new engagements that require energy and attention, driving them further away from their addictions (Haller & Kramer, 2006). In a comparison made by Gerlach-Spriggs, Kaufman and Warner (1998), there are striking similarities in the way patients carefully and slowly nurture life in a garden and the careful and slow path leading to recovery. In the same way the patients create ideal gardening environments for their plants, they also create one for their own recovery. b. Cognitive Benefits As presented by Kaplan and Kaplan (1989), patients engaging in horticultural therapy benefit from enhanced cognitive functioning, stimulated memory, improved concentration and attention capacity and generally improved goal achievement. There is also an observed improvement in planning and problem solving skills as the memory and mind are exercised and positive thinking is promoted. These views are supported by Buzzell and Chalquist (2002) who give an example of children suffering from autism, a neurological disorder which interferes with the normal activities of the brain. A characteristic of those suffering from autism is a lack of display of affection, although they also have emotions. Although children suffering from autism are different (Jarrott, Kwack, & Relf, 2002), live plants provide an ideal alternative recipient of their affection. They learn to find joy in planting crops and watch them grow. The memory skills and concentration required in nurturing plants can gradually release such children from a depressing world that may have plunged them into developmental brain disorders from as early as three years of age. The socializing involved in the therapy also improves their self esteem, and alleviates communication problems and speech delays which are also characteristics of the condition. According to Pothukuchi and Bickes (2001), patients of autism are easily upset by certain smell and loud noises. Placing them in a controlled environment with specific sounds and smell is soothing and therapeutic to them, creating a suitable atmosphere for relaxing and concentration. Repetition of activities for a prescribed period and planned changes of the surrounding develop the children’s coping skills. Kimber and Richardson (2006) showed that horticultural therapy helps people suffering from cognitive challenges to increase and develop their observation skills, encourages their creativity, presents them with the ability and choices to make use of problem solving skills and gives them a way to let out emotions, anger and stress. Some facilities have created sensory gardens that stimulate sound, touch, sight and smell. The patients develop their cognitive skills by identifying and distinguishing different types of these senses. These senses are necessary components of the activities in the programs aimed at sensory stimulation. Pothukuchi and Bickes (2001) contributed that sensory stimulation can be achieved by interaction and use of plants with interesting textures and tastes, the colour and fragrance of flowers. The expertise of dirt therapists is also employed to give guidance on organizing thoughts as well as activities. Patients are able to learn new skills while regaining the lost ones. Kaplan and Kaplan (1989) note the development of courage and confidence in initiating new tasks and the ability to pay attention to details. The ability to arrange, for example, flowers, shows considerable positive results of the whole exercise. There is also a noted decrease on dependence on others to make decisions (Jarrott, Kwack, & Relf, 2002). c. Emotional Benefits According to the NIMHE (2005) some medical problems like high blood pressure and heart diseases are linked to suppressed emotions. While some people might be able to hide their feelings of sadness or anger, they will eventually feel agitated. In effect, they will be trading one set of negative emotions for another. Haller and Kramer (2006) believe that although such people must let go of negative emotions, it is equally detrimental to do so in heated confrontations or explosive outbursts. Horticultural therapy offers persons in emotional stress a positive option to responsibly release emotions (Buzzell & Chalquist, 2002). Programs in horticultural therapy help in creating strong senses of self esteem in situations where responsibilities and choices are taken away. The AHTA (2002) points out that horticultural therapists are able to design programs that deliver emotional gains in fields of anger and aggression management. Buzzell and Chalquist (2002) support this view by their contribution that energy consuming activities in horticulture can make use of the energies locked up in aggression or anger by channeling them into reproductive gardening activities. For example, in times of emotional turmoil, if patients put their energy into garden preparation by digging, raking leaves, weeding or washing of pots, they channel their emotions responsibly towards productive engagements Kaplan and Kaplan (1989). Emotional benefits and better outlook on life are enhanced as the patients are encouraged to observe daily change and growth. According to Meiklejohn (2003) the patients learn to accept and deal with both success and failure as they observe and monitor the propagation of their plants starting from seeds to the end product, with some flourishing and others dying along the way. Most of the patients in a research conducted by Gerlach-Spriggs, Kaufman and Warner (1998) reported improved relationships with their spouses and better communication. The most successful were those who took the therapy together. Their focus evolves together with their work beginning with changes and needs of seedlings, transplanting to the gardening and harvesting. It was interesting for the researchers to note that the same patience accorded to the plants was also found to exist in the relationship between the couples over time. Resick, Monson and Chard (2007) also reported a new development in the way the patients dealt with their emotions. They observed that some patients who checked into therapy with deep sadness occasioned by their relationship statuses, most notably women, learned to talk and share their feelings with friends. The garden setting and atmosphere augment spiritual connection to nature as the patients witness plants’ life cycles. Haller and Kramer (2006) opine that such settings rejuvenate the mind freeing people from their emotionally stressing relationships and work environments. The settings promote enthusiasm and interest in the future, especially for emotionally troubled or elderly people who no longer have interest in the future. The anticipation of a germinating seed or a flower budding open has the potential to rekindle interest. d. Social Interactive Benefits As stated by Mind (2007) the fundamental social benefit of horticultural therapy is the naturally occurring socialization that takes place when the exercise brings together different groups of participants in the sessions. The NIMHE (2005) also agrees that there is evidence of people known to have histories of being reserved or withdrawn starting to open up when they participate in projects. The blooming of plants is reflected in their character as they become more accessible and learn to share and appreciate other people’s experiences about common projects they are working on. In a group setting, people of different backgrounds enjoy the social benefits of conversation and laughter while they make new friends (Mind, 2007). Rothert (1994) observed that a higher degree of socialization takes place when sharing the happenings of the garden during family visits. People are more welcoming, and feel welcome themselves, when discussing activities that they both enjoyed a common participation. This idea is supported by Fieldhouse (2003) when he shares that the simple act of cooperating with team members in gardening projects, or creating a new session, brings people closer. Teaching new skills while learning others from the team enhances the social element. Many patients are motivated to get out of inactive lifestyles and interact with others in projects whose results they can credit to themselves. The physically disabled are a significant beneficial group of the social impacts of horticultural therapy. According to Resick, Monson and Chard (2007), the disabled find gardening to be a leisurely activity that reduces the stigmas associated with their conditions and daily life. Being of a leisurely nature, gardening provides the participants numerous opportunities to integrate into their communities by way of recreational activities. The NIMHE (2005) give examples of such activities. They include interacting with local garden clubs, touring horticultural facilities both in and out of their localities and taking part in community gardens or county fairs. As per contributions made by Meiklejohn (2003), the participants in horticultural therapy share a common binding force when they consider themselves as gardeners, rather than a group of unemployed citizens. Among themselves, they form a social entity that promotes their self confidence and, in turn, self esteem. Most of them, after leaving hospital or other rehabilitation facilities, are unable to get into employment immediately, and are easily drawn into shyness and loneliness because they cannot afford most of life’s pleasures. However, with the little allowances they earn from horticultural projects, they find a way of gradually getting back into society as a group (Rothert, 1994)). With continued participation in the gardening activities, the participants gain experiences that provide a platform for further growth as explained by Gerlach-Spriggs, Kaufman and Warner (1998). An added advantage of the socializing aspect is that horticulture may present employment opportunities in the community because the employers in the green industry, such as landscapers and nurseries, require people who have basic skills in horticulture (Gerlach-Spriggs, Kaufman & Warner, 1998). Such skills include planting specifications, watering or maintaining the garden, all learned during the therapy sessions. They, therefore, get to expand their social networks by working with different classes of people. For instance, as contributed by Page (2006), programs targeting people with traumatic brain injuries, developmental disabilities, at-risk youth and incarcerated individuals, offer training on the job while the participants work and interact directly with their clients in a job setting. e. Intellectual Benefits According to Buzzell and Chalquist (2002) individuals acquire new intellectual abilities and skills in the process of learning methods and techniques in horticulture including flower arrangement, gardening and plant propagation. New terms and concepts and terms are learned (Resick, Monson & Chard, 2007) as the patients improve their communication skills and vocabulary. In support of this statement, Fieldhouse (2003) says that the fascinating nature of plants arouses a sense of curiosity in the participants of the gardening activities. Many questions are aroused prompting them to experiment and find out why plants grow in the way they do. Their increased observation powers as they watch the interaction between humans, animals and plants develops in them deeper insights and the capacity to evaluate the relationships. Their abilities to plan procedures and make decisions are also developed as their minds sharpen (Johnson, 1999). In America, the children’s gardening movement introduced in some schools is quickly gaining momentum (AHTA, 2002). Students who participate in the activities generally exhibit more composed personalities and are more attentive during academic lessons. Resick, Monson and Chard (2007) observed that such students are also of an inquisitive nature and ask probing questions. In a program under the sponsorship of the National Science Foundation, Page (2006) reported that students who have engaged in horticulture were able to initiate and organize their own projects to be exhibited in a fair with minimal assistance from their teachers. This is explained by AHTA (2002) that healthy flowers help students to maintain their emotional and intellectual balance. The emphasis lies in the ability of the students to approach life, and thus learning, in a patient, skeptical and observant manner. In that approach, they are able to understand more and at a faster rate (Haller & Kramer, 2006). Horticultural therapy has also been used to rebuild the intellectual capacities of people who have previously suffered traumatic brain injury. According to Resick, Monson and Chard (2007), methods like recognizing fragrances can be used to bring back fond memories from past experiences and help one recall or reconstruct events. This method has a wide overlap area with the cognitive benefits as well (Kaplan & Kaplan, 1989). 3. The Relationship between Horticultural Therapy and Caregiver’s Burden Pothukuchi and Bickes (2001) define a caregiver as a person who takes care of people with chronic diseases or illnesses. They communicate with nurses and doctors on their patients’ behalf and manage medications and take care of other chores including bathing and dressing their patients, preparing meal, shopping and settling bills. In other words, as put by Simson and Straus (2003), caregivers perform all the activities that their patients cannot manage on their own. That means being there to take up on others’ activities on their behalf, which is in no way simple task (Jarrott, Kwack & Relf, 2002). Both horticulture and the caregiver’s burden are aimed at taking a patient through the journey of a situation. With their essential purpose being to provide support to other, both the caregiver and horticulture draw benefits from positive responses of their patients. Burls and Caan (2004) provide that by being useful and helpful to other living things, the benefits are also shared by horticulture and the caregivers. Conclusion In conclusion, horticultural therapy programs enable participants to tend to their crops as well as their own spiritual, physical, mental, intellectual and social well being (Yalom & Leszcz, 2005). Through gardening, the participants’ qualities of life are tremendously improved. The activities involved may be as simple as viewing nature, taking a walk through nature, imagining nature, visiting healing gardens or hospitals, and actual gardening. Through interacting and working with the natural world, individuals with varying ability challenges are able to reintroduce purpose into their lives. Through horticultural therapy, individuals can maintain or relearn functions they lost because of illnesses or injuries they got in accidents (Jarrott, Kwack, & Relf, 2002). It is perfect way to enhance other forms of physical or occupational therapies already prescribed. The benefits offered by horticultural therapy vary between individual persons. But generally, they all exhibit improved social, mental and physical health. People of different ages facing different challenges can participate in the therapy. The activities are easily accessible to all with some specifically designed to meet the needs of people with, for example, limited mobility as for those in wheelchairs. All these conditions define a group of people who need to be encouraged to remember that they have a place within the human as functioning members (Jarrott, Kwack, & Relf, 2002). They are the ones faced with fear and uncertainty in their life and need assurance. Although the number of programs in therapeutic horticulture and horticultural therapy has significantly increased in the recent past years, they are presently not required to have registration or affiliation to any professional regulatory body (AHTA, 2002). This has made it a challenge to precisely establish the exact number and type of services offered, but documented evidence has shown that the therapy has actually led many patients to better lives. This can only be given more weight by the growing number of healing gardens. Awareness to the people is promoted by regular features in both national and local publications (AHTA, 2002). References American Horticultural Therapy Association (AHTA). (2002). American horticultural therapy association definitions and positions. Retrieved from http://www.ahta.org/ Burls, A., & Caan, A. (2004). Social exclusion and embracement: A helpful concept? Primary Health Care Research & Development, 5(1), 191-192. Buzzell, L., & Chalquist, C. (2002). Ecotherapy: Healing with nature in mind. San Francisco: Sierra Club Books. Fieldhouse, J. (2003). The impact of an allotment group on mental health clients’ health, wellbeing and social networking. British Journal of Occupational Therapy, 66(7), 286-296. 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