Non-systematic observations from a Prodigal Horticultural Therapist

It would seem that there are no registered horticultural therapists in France. I have this on a he said she said basis.

Strictly speaking, that is true. And this is simply because, to my knowledge, there are no specialized certifying, registering or licensing bodies in France.

In fact, Horticultural Therapy (HT), while represented in France along the spectrum from the wily nilly dabbler to the utmost seriousness by persons of various backgrounds (nurses, ergotherapists, gardeners, landscape architects, volunteers and doctors) is not even a recognized profession. While this may appear almost incongruent given some very unique historically french practices –such as homeopathic medicine or the advent of sophrology, a distinct mind-body intervention axed on relaxation and stress management–  ecotherapies in general and french horticultural therapy programming in particular lag far behind offerings in other European countries, namely northern europe (Germany, Netherlands, Denmark, Sweden) and the UK. Which is not to say that they are not present at all.

Because there is nary an educational opportunity in the domain of HT, practitioners in France come to exercise through a patchwork of experiences and short courses, coupled with great and heroic expressions of personal tenacity. Of this calibre precisely, we find the recognized pioneers in the domain, the buddhist inspired Ribes’, a husband and wife duo who have been poignant and combative and essential to the ongoing evolution of the fledgling field. And more recently, the academic Pringueys’, another dynamic duo at the forefront of evidence based research in order to garner credibility for this therapeutic modality. And there are many others. These dedicated reports are testimony to that presence.

Returning to France as an HT trained in North America at an accredited AHTA (American Horticultural Therapy Association) institution, having fulfilled the considerable and sometimes daunting number of internship requirements at NYU Langone, and having acquired my experience in New York city hospitals under the supervision of Rusk Glass Garden veterans , it remains interesting to observe the discussions and debates occurring in the French arena, albeit from afar and in non systematic fashion. I say this with careful intent because what follows are “impressions”, and not bona fide “research”.

Structurally, the difficulties on the ground here appear immediate. Culturally, the particularities can both inspire to a unique expression of horticultural therapy (Jardinotherapie, as it has been suggested) or remain challenging.

*For example, as in many countries, hospitals and dependent long term living facilities are strapped for public funds and so the competition between recreative type services is punchy, pun unintended. Many naissant therapeutic horticulture programmes depend on the pure good will, spare change and dedication of experienced to less experienced gardeners.

*The sacro-sanct team approach and patient centered care that has currency in Anglo Saxon hospitals is not the gold standard in France. From my casual conversations with a medical practitioner who advocates actively and nationally for patient rights, there is definitely a sea swell of change coming, but slow to pick up momentum since the hierarchical, deferential and technical bio-medical model is still the norm. Horticultural therapy stands to thrive best when welcomed by the institution and other staff as an equally valuable service provider that puts the complex individual at the center of the programme.

*The graduates of the Landscape architecture schools weigh heavy in the balance of voices heard concerning the therapeutic garden. And there would seem to be an unspoken divide between the designers and the social scientists. An enabling garden design might see the day of light but there will not necessarily be provisions made for animating the space or actively engaging users.

*More generally, holistic healthcare as a valuable complementary ally to the medical field is yet to come into its own. For the moment, integrative therapeutic approaches that might be offered in any large and well endowed, forward looking serious American, British or Northern European establishment (from guided imagery to mindfulness, from yoga in medical settings to reiki massage, from hypnosis to cranial sacral therapy) are still relegated to the corridors of hippy, baba cool, new age and alternative lifestyle professional conventions.  As a background note, the closest similar adjunctive profession, art therapy, was only recently recorded in the national register of professions, with an attendant masters degree recognised in the European community.  Art therapy, despite having being present in France at university level training, and practiced in its various usually competing complexions for over three decades, only gained officialdom in 2011.

Returning to France after training and experience in what is clearly a type of HT indebted to the MOHO (the model of human occupation) where the attendant concerns with therapeutic alliance, treatment planning, meaningful activity and outcomes are paramount, it is quite an understatement for me to say that I am like a bulb without the prospect of soil in a strange place.

That a horticultural therapist should be confident at challenging, reassuring, motivating and when resistance arises, able to offer alternate routes to accomplishing tasks, these teachable skills have been the bulwark of my North American exposure. With hours of prolonged engagement and observation, and hours of questioning, processing and supervised practical service came the understanding of how to provide opportunities for functional, cognitive and psychosocial growth. The type of thing that the horticultural therapists do so well and learn to do nearly as second nature, and this really is the thing that seems to set us apart  –adapting, modifying, shaping, or modeling compensatory strategies for skill performance– are the bread and butter of inclusive client participation. Trained to provide opportunities for maximizing benefits, there is certainly a unique skill set at work.

And yet from posts and articles and conversations I have followed this year in France, the focus remains the garden space as space. I am almost tempted to conduct a statistical analysis of the types of lexemes that appear in the forums or conferences I have had the privilege to attend, from casual conversation to the online group discussions, from the articles that are showcased on some websites to rapid fire encounters : all are primarily concerned with the “horticultural” half of our professional nomenclature, that’s to say with the material garden. We hear overwhelmingly about the garden design, what to grow, when to plant it, what gardening techniques are best, which pests are trending.

All information.

Is this beacause it is more easily quantifiable, justifiable, easy to post, and concrete to possible purseholders? Or is this simply this year’s fashion, that’s to say a reflection of the new acceleration towards real projects on the ground that seem to be mushrooming. Might this be a classic pull and push, the balancing act at work? An alternating pattern between practical issues and theoretical ones? If, a few years ago, in a rarefied space of manoeuvre, it was possible to rhetorically invest the french HT conversation with the spiritual and phenomenological aspects of engaging humans in gardening, such as toucher la terre illustrates, perhaps what I am sensing in the recent material garden focus is just indicative of a cycle of growth. In that case, care for issues of meaningful therapeutic alliance and patient complexity…and how, as a therapist, to best operationalize experience should predictably return to the forefront.

However, none of any of this would be problematic or awe inspiring if I did not worry that only one model, the Healing Garden School model (see Stigdottir’s distinctions) might come to reign in the end and alienate possible practitioners and approaches. I think that while horticultural therapy was planted in the garden, and depends on good design and gardeners, it has grown and matured and blossomed, sending its seeds afar to other fertile fields much like the dandelion. And so we must continue to ask how can we best articulate our multifaceted strengths.

In this year it has made me slightly uncomfortable to notice that I have rarely heard about populations (or the social cost of abelism) and how to engage persons of various capability horticulturally ; I never came across a discussion on how to analyse an activity for possible modification or adaptive tool use; and I can barely recall a frank discussion on the therapeutic counseling toolkit. Is it enough to assume that these things are obvious and implicit? Talents? rather than skills learned the hard way? I think that like task analysis and group process, there is a skill cluster that we would do well to appropriate through practicum, even in France.

A garden therapist (jardinier therapeute) is not simply a facilitator, an educator (educateur technique) or a group leader (animateur). Neither are we necessarily pure horticulturalists or landscape architects. In fact we are a little of all of that but certainly and moreover therapists (is that pompous? really?) who need to know how to conduct or provoke safe encounters in the triumvate: client, plant/garden, helping professional. So much more merits being said about the therapeutic competencies of the horticultural therapist as a helping professional and about what therapy, as a witnessing and accompanying support service dedicated to positive beneficial change, might look like.

The double conciousness or double competency which defines horticultural therapy, this inherent flexibility, while sometimes unusual, when it comes to justifying our presence in a landscape of competing presences, is the nature of the cultivar. Botany and horticulture yes, soil science and enabling design of course. But definitely occupational therapy sciences and counseling skills too. Wichrowski (2006) proposes interesting places to start. And we could certainly gain to read up on the likes of Jordan (2009).

Having a global approach, learning about limitations and activities for daily living and treatment planning for performance and meaningful occupation are essential. Acquiring and exercising good listening and empathy skills is primordial. Continued supervsion or peervision, self reflection and continuing education –as is the expectation in many other therapeutic helping professions, are issues that need to get on the table and remain on the table, if only because there are studies that indicate that while the effects of exposure/contact to nature and gardens and wilderness or even pictures of bees on flowers are documented as being positive, it is suggested that the effects of guided exposure/contact are even more telling and more durable. For ethical reasons alone, we must ensure ourselves that the guidance is as excellent as possible.

So then the question becomes, what sort of guidance, what sort of alliance are we going to try and foster with our clients. And how are we to defer to our co-therapist, that’s to say Nature, usually in the form of garden and gardening, but also in nature crafting or ethnobotany, in this three way alliance. (Although I am avoiding the whole “what is Nature” question here, saving it for another time) Berger (2006) has a fabulous take on the co-therapist. And Jordan refers to Nature as a transitional object. All compost for thought.

To the extent that it has been seriously suggested in the past twenty years that not one specific theoretical framework or psychological orientation is substantially more effective than another based on its technical content,  but rather that a certain number of shared counselling traits and curative characteristics such as expectancy factor of the client and allegiance of the therapist to the efficacy of treatment can predict relative treatment success, what sorts of discussions should we be having? And here, my question goes out to HT in various traditions. And not just the naissant french profession.

Invariably, talk about safe therapeutic practice is essential. This goes hand in hand with unpacking psychological, sociological or theoretical occupational/rehabilitation orientations. Because, framework helps generate hypotheses about a client’s experience and behaviour but also helps formulate rationale for specific treatment activities and provide the context for evaluation of the ongoing therapeutic process. Framework helps us organize and listen to information provided to us by our clients as well as inform the specific steps of treatment planning. Add to this the ongoing interrogation around intentionality and consistency, professional self reflection and ethical effectiveness and HT can only flourish as a modality sharing common ground across the helping disciplines and across national borders.

In my training, and as a service provider, horticultural therapy has been about process. It is about presence and attending to the presence of another; it is about witnessing, rather than just intervention ( a word I take issue with anyhow, but I will come back to that in another post). There might not be anything to show for the process except positive beneficial change, something that will take a client further down the road, and it won’t necessarily take up precious space in a suitcase when one must vacate the premises. But it is about an experience. Not about a spot in the ground, a hole dug, or a harvest made. Horticultural therapy shares with Nature an ephemeral quality. We can tell stories about what happened, show how we have improved. Maybe, and sometimes there is a plant, or remnants of plants, or maybe a whole yard of plants. But they are not the testimony of transformation. The patient-client is. And so the journey with the patient, an enabling and empowering journey, demands that the horticultural therapist be continually attentive to building resilience through adaptive and adaptable activity.

The featured image is of Taraxacum officinale, an asteracea, the common dandelion.

I have used the words client, patient and participant invariably in this post.  And Nature, well, for now, let’s just assume that you know what I mean.

Next post, next month

Some references

Berger, R & McLeod, J. Incorporating Nature into therapy: a framework for practice. (2006). Journal of Systemic Therapies, Vol:25, No:2, pp: 80-94

Kass, Jared D., et al. Mindfulness and the arts therapies: Theory and practice. Jessica kingsley publishers, 2013.

Stigsdotter, Ulrika, and Patrick Grahn. “What makes a garden a healing garden.” Journal of therapeutic Horticulture 13.2 (2002): 60-69.

Wampold, Bruce E. The great psychotherapy debate: Models, methods, and findings. Vol. 9. Routledge, 2013.

Wichrowski, Matt. “Skills and Theories to Inform Horticultural Therapy Practice”. Journal of therapeutic Horticulture 17.1 (2006): 48-54.

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s