Knowledge Database

An introduction to Therapeutic Horticulture

Angela Levine - Volunteer, Beit Issie Shapiro


Horticultural therapy – the employment of plants and garden activities in the rehabilitation of people with physical and mental disabilities - has its roots deep in history. In ancient times gardens were purely a source of aesthetic pleasure, a place for relaxation and meditation.  It was in Europe, in medieval times, that the concept of a ‘healing’ garden came into being. In a scientific treatise, Benedictine abbess Hildegard of Bingen (1098-1179), scholar, musician and visionary, referred to the connection between the ‘green’ health of the natural world and the holistic health of human beings. She viewed plants and elements of a garden as direct counterparts to the humors and elements within the human body, whose imbalance led to illness and disease (Sweet, V., 1999.)


In the early 19th century, Dr. Benjamin Rush, known as the Father of American Psychiatry, put forward the revolutionary opinion that gardens and gardening aided the recovery of the mentally ill. In his book Medical Inquiries and Observations upon the Diseases of the Mind (Rush B, 1812), he stated that laboring out of doors in a rural setting had curative effects. He had found, so he wrote, that ‘Digging in a garden” was an activity undertaken by patients who regained their mental health, as distinct from those who did not take part, and did not recover. From that time onwards, Influenced by Rush’s findings, gardens came to be increasingly included in the design of American psychiatric hospitals.


Awareness of the value of gardening practices – horticultural therapy (HT) – began in earnest in Europe after World War 11 when this restorative technique was offered to war veterans suffering from post-traumatic stress and other combat-related disorders. In the last two decades, it has become a professional occupation, a curriculum combining horticultural practice with a knowledge of social and health care is offered to students in colleges and universities worldwide. 


Ideally, the design of gardens in hospital and care centers takes into account the needs of the population they serve. For instance, safety and security is integral to the design of a Living Garden at the Family Life Center at Michigan, USA., for people suffering from Alzheimer’s disease and other forms of dementia. This is a secure environment where the residents can take gentle walks, rest, or meet with their families. Discreetly supervised through large windows in an adjoining building, it is entered and exited by a single gate. The walkway is in the form of a single loop, with no confusing turns or dead ends. At the Chemainus Health Care Center (BC. Canada,) catering for a similar population, landscape architect Edward Stillinger noted that most of the elderly residents had grown up in the prairies. As a result, prairie grass and other features typical of this region in Western Canada were incorporated into his design, as a way of bolstering the long-term memories of the residents. (Burton, A., 2014).


These are examples of ‘healing’ gardens that provide comfort and relief for patients, but cannot change the outcome of a disease. In contrast, therapeutic gardens are designated for the use of trained therapists whose aim is to improve the mental or physical health of their patients.  


Since the 197Os, many articles attesting to the value of HT have been published in medical and occupational therapy journals. Out of this wealth of material, three are briefly described here, with the intention of illustrating the range of possible interventions. The first example, theoretical in character, outlines a HT plan for pre-school children with autism spectrum disorders, while direct observation and assessment characterized the two other projects: the treatment of children with hemi-weakness; and an HT intervention to improve the well-being of ex-military personal with combat-related health issues. 


People with autism spectrum disorders may suffer from stress, incongruous responses to sensory stimuli and behavioral impairment. Thus, for them, a garden, a tranquil, non-threatening environment, is an ideal environment. One proposed TH intervention (Flick: 2012) aimed at balancing the hyper- or hypo-sensitivities of a group of children with ASD. Since people who are hyper-sensitive over-respond to non- threatening stimuli, it was suggested that the participating children should be exposed to  increasing amounts of stimuli - a technique based on the applied behavior analysis method of ‘fading’ one sensor stimuli into another. For example, they should first wear thick gloves while playing with soil, and then gradually don lighter ones, until they are ready to play with their bare hands.


In contrast, people who are hypo-sensitive crave all manner of sensations. Since their sense of judgement is often impaired they can cause themselves pain or injury. This intervention (proposes) proposed garden activities that would stimulate the senses of the children, but in a safe manner, such as shoveling sand or carrying water containers. In general, development of children with ASD is delayed because they lack motivation. A group-potting task was recommended for this group where various elements in Nature like the texture and scent of plants, the colors of the flowers might encourage them to complete their tasks. 


Rebecca, an alert six-year old child with cerebral palsy, but with no apparent cognitive defects, attended a month long Pediatric Summer camp in New York for children with hemi-weakness (Malamud, C. M., 2016).  It was organized in 2015 by the Pediatric Occupational Therapy Department, Rusk Rehabilitation/Hospital for Joint Disease, a division of New York University’s Langone Medical Center. Weakness on the right side of Rebecca’s body had affected both her gait and upper body strength. While her left arm and hand moved freely, she held her right arm and hand stiffly and close to her body.  The goal of this HT intervention was to increase their strength and dexterity by means of plant-related Right Extremity exercises. To hold the interest of Rebecca and the other participants, activities in the camp were linked to different themes. The ‘Summer’ theme, for example, included shoveling sand into buckets, tossing a beach ball in a circle, and repotting flowers, grown from seed prior to the opening of the camp.


A temporary restraint was placed on Rebecca’s dominant hand for the first two weeks of the intervention. It served as a visual and physical reminder to reach, grasp and pass objects using only her weaker arm and hand. For the second half of the camp, the restraint was removed, and she and the other participating children were asked to pass pots, soil and plants using both hands, so extending the reach of their affected arms (gross muscle exercises.) In addition, fine muscle exercises were carried out by grasping flowerpots, patting soil with their fingertips, or guiding the spout of a watering can. In Rebecca’s case, the aim being that her affected hand would do all the work, with the dominant one acting only as a stabilizer.  By the end of the third week she was passing objects with both hands 85% of the time, eventually without prompting from the therapist. By the end of the camp, Rebecca had attained the goals set by the therapists in conjunction with medical staff which were to markedly increase the movement of her right arm and hand; and, in addition, to relax her affected hand in order to stabilize objects that she wanted to hold. (Malamud, C.M., 2016).


Gardening Leave was the name given to a HT pilot project aimed at helping war veterans suffering from a wide range of mental health problems to rebuild their lives.  It was hosted by Combat Stress, the UK’s ex-services mental welfare society at Hollybush House, Ayre, Scotland. The sessions took place in the gardens of a nearby agricultural college. Veterans resident at Hollybush House for treatment were free to attend the course on a whole or half-day basis. Those not in residence, but living within commutable distance, were also welcome to participate.


An essential design feature was the high stone wall at the back of the gardens. This gave the veterans the feeling of safety for which they craved. Garden tasks offered to them included planting seeds, growing flowers and vegetables and constructing plant and bird boxes, They also cared for a field of poppies, that formed part of the National Collection of this flower, a poppy being a remembrance symbol for Commonwealth soldiers who fought and died in battle.


In order to estimate the success of this HT intervention project, 44 participants in this project were interviewed. Most of them spoke of the fact that working in the open air had had a positive impact on their mood, stress and concentration levels. Additionally, they mentioned a renewed sense of pride and achievement in their work, that gave structure and meaning to their day - – a feature now generally missing in their lives at home. Important to them, too, was the fact that they were working alongside men with similar experiences to their own, and to whom they could talk freely. During the sessions, the veterans also learned to trust the ‘civilian’ staff running the course whose background and training enabled them to empathize with the veteran’s issues, in a way that they had found that most people in the outside world were not able to do. (Atkinson, J., 2009).


Despite many impressive results like these, the time has yet to come for a significant number of hospitals or medically related facilities to invest readily in gardens specifically designed for therapeutic interventions. As science writer Adrian Burton points out money is required to create and maintain them. “If they are understood as only pleasant amenities, gardens are unlikely to spread deeply into the health systems. But if they can be shown to shorten hospital stays, reduce the need for pain medication or other drugs, hasten and therefore reduce the cost of the rehabilitation process, financing bodies might look upon them favorably” (Burton, A., 2014).




  1. Atkinson, J. (2009). An evaluation of the Gardening Leave project for ex-military personnel with PTSD and other combat related mental health problems. Glasgow: The Pears Foundation.
  2. Burton, A., (2014). Gardens that take care of us. The, 13, 447-448.
  3. Flick, K. M. (2012). The application of a horticultural therapy program for preschool children with autism spectrum disorder. Journal of Therapeutic Horticulture, 22 (1), 38-35.
  4. Malamud, C. M. (2016). Case Study-Rebecca. Journal of Therapeutic Horticulture, 26(1), 19-23
  5. Sweet, V. (1999). Hildegard of Bingen and the greening of medieval medicine. Bulletin of the History of Medicine, 73(3), 381-403  
  6. Rush, B. (1812). Medical inquiries and observations upon the diseases of the mind. Kimber, Richardson.


  • Disabilities:

    All disabilities

  • Topics:

    Therapeutic Methods

  • Keywords:


  • Audience:

    General public, Professionals

  • For additional information:


Get in Touch