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A Horticultural Therapist Shares Her Strategies

Those of us who love cosmos know one of the plant’s many amazing qualities is its willingness to bloom and rebloom all spring and summer. All it asks to keep this show going is regular deadheading. I gladly oblige until mid-fall or so. Then, as growth in the garden begins to wane, I’ll let some of the flowers age in place. By that time, each cosmos plant will have blossoms, a few buds and some flowers that have gone to seed.



In the garden where I work, I leave at least one or two of such cosmos for a few weeks. That’s because this garden serves a special population, and the simultaneous display of seeds, flowers and buds offers them something unique and important.

I work as the horticultural therapist at a 97-bed mental-health rehabilitation center outside of San Francisco. The facility serves clients with a history of severe mental illness, many with a dual diagnosis of substance abuse. The emphasis here is on recovery, using individual and group therapeutic experiences; pharmacology; prevocational and vocational training; and social-work support to help clients reintegrate into the community after a phase of acute illness. My work includes designing and installing therapeutic gardens and developing and implementing horticultural-therapy programming to help clients progress along their pathway to recovery.

Hanging on to the cosmos in the therapeutic gardens serves a specific purpose. Those plants offer clients a concrete way to understand abstract ideas like life, death, renewal and rejuvenation. These latter two concepts are often important aspects of recovery. As Clare Cooper Marcus and Marni Barnes write in Gardens In Healthcare Facilities: Uses, Therapeutic Benefits, and Design Recommendations: “People who are not well are emotionally vulnerable….(R)emember, the symbolic takes on increased meaning as we grapple with our own frailties.”

Using plants to illustrate various points in the life cycle isn’t limited to single plants, like cosmos, that have it all going on at the same time. For example, a bed in one of our gardens can show seed pods of love-in-a-mist (Nigella) next to a black-eyed Susan (Rudbeckia) that’s just about to blossom. Besides looking super-cool, the gray, dried nigella pods will soon be surrounded by seedlings ready to carry on—a lovely illustration of Round Two, second chances and beautiful, positive forces at work even when there seems to be little happening.

Encouraging Choice

In order to make life at the center function in an orderly and supportive way, schedules are set, leaving clients little room for decision making. When a client eats, when a client goes outside, when a client can use the art room are all decisions that are made by staff for clients. So in all my programming, I try to incorporate client choice.

In a micro sense, every session I facilitate includes options. If we’re planting seeds, I’ll bring six to eight kinds so clients can choose which they’d like to plant. In each group I organize, I offer an option for a tabletop activity, such as potting up rosemary or California fuchsia (Epilobium canum) cuttings, and a more physically demanding activity, such as adding layers of organic material to a sheet-mulched area or squatting down to plant tulip and daffodil bulbs in a prepared bed.

In a macro sense, I include clients in the gardener’s time-tested winter activity of planning the next season’s plantings. Every January, I devote a couple of client sessions to blending, brewing and enjoying herbal teas while we browse seed and nursery catalogs. Each participant gets to pick one plant that he or she would really like to grow. As long as it will work for our climate, we get it and nurture it.

One year, I encouraged clients to consider choosing plants that were chartreuse, the color of the mental-health awareness ribbon. This color represents solidarity and positive self-image for mental-health self-advocates and their supporters. Clients came up with a short list of lovely choices, some of which we planted from seed, others we bought as starts: Nicotiana alata ‘Lime Green’, Rudbeckia hirta ‘Prairie Sun’, Salvia Mexicana ‘Limelight’ and Zinnia elegans ‘Benary’s Giant Lime’.

Providing choice is a small offering, but as a therapeutic intervention it is powerful. All of this facility’s clients are adults, and during this period of their recovery journey, there are many choices that will need to be made for them, which can feel infantilizing. Giving decision-making power back to clients, even in a very circumscribed way, allows them to work that muscle and feel themselves capable. Modern life is a labyrinth of choices. We want clients to re-enter the community with some practice in making choices, as well as with confidence in their ability to make good ones.

Ensuring Success

Besides choice, I want all clients in my horticultural therapy groups to experience success. If I know there is someone in my group with fine-motor challenges and we are planting seeds, I make sure to include peas or beans as an option, so he or she will not be frustrated fiddling with tiny basil or viola seeds.

Planting beans

Planting beans

I’ve found that asking people who don’t self-identify as gardeners to plant seeds or transplants in a prepared planter or bed similar to handing a non-painter a blank canvas. Where do I start?, they wonder. What am I supposed to do? Am I going to mess this up?

I offer practical supports so clients don’t have to flounder. In our large, standing planters, I use a grid made of bamboo stakes lashed together. The grid creates a visual pattern of square-foot areas, which makes planting into them much more straightforward. Often, I’ll mark where to plant a seed or transplant with wooden clothespins that I stick into the ground before clients enter the garden space. It doesn’t matter if cilantro seedlings in a prepared bed are perfectly spaced; if planted more or less where the clothespins are, they’ll be fine. It matters that the client feels positively about the experience, and that the baby cilantro plants have found a good home.

Tenderly planting and caring for tiny seedlings gives clients an opportunity to address the human longing to nurture other living things. In a 2019 study published in Archives of Psychiatric Nursing, UCLA researchers, commenting on their observations of client reactions to gardening experiences on a psychiatric inpatient unit, wrote: “(T)he desire to nurture and cultivate life was important and lent itself beautifully to the metaphor of a patient’s own healing.”

Of Most Importance

My number one mission is to get clients noticing and appreciating the natural world that surrounds them. Many clients have not had much interaction with plants or nature in general. I try to address that. With every group, I point out what’s new in the garden: "Look! That Clarkia is flowering; another one was mowed down by snails who left a telltale silvery path; can you hear the bees buzzing around that bee’s friend (Phacelia tanacetifolia)?"

My hope is that some clients will leave with a new lifelong gardening hobby; a few may go on to work in the industry; and all will appreciate a flower or a butterfly and be nourished by the beautiful life that surrounds us.