An Interview with Therapeutic Landscapes Expert Naomi Sachs

By Mark Ellison, Ed.D.

I recently had the opportunity to talk with Naomi Sachs, ASLA, EDAC, Founding Director of the Therapeutic Landscapes Network, and co-author of the recently published book Therapeutic Landscapes: An evidenced based approach to designing healing gardens and restorative outdoor spaces. Naomi received her MLA from the University of California at Berkeley and is currently pursuing a Ph.D. in architecture at Texas A&M University focusing on access to nature in healthcare environments through the Center for Health Systems and Design. Naomi is an informative and influential voice on the therapeutic use of gardens and nature for human health. Naomi took time to answer a few questions related to her new book, research interests and how to incorporate nature into the home landscape.

Naomi Sachs

Naomi Sachs

Hiking Research: What inspired you to pursue a nature/landscape focused career?

Naomi Sachs: I grew up in a rural town in northeastern Connecticut, and I think having nature all around me (and not much else!) instilled in me a deep appreciation for trees, plants, wildlife, water, and fresh air. My affinity with nature, combined with a love for art, photography, research, and writing made landscape architecture a good fit. I was thrilled to learn about healing gardens in the mid-nineties when I had started looking into graduate schools. This area of the field seemed like (and is) a way to make a positive difference in people’s lives while doing something creative.

Hiking Research: Talk about your new book Therapeutic Landscapes and why you chose to pursue this.

Naomi Sachs: A book on access to nature in healthcare facilities was long overdue. The last books on the subject were published in 1999 (funnily enough, three books related to the subject were published in the same year: Healing Gardens, edited by Clare Cooper Marcus and Marni Barnes; Restorative Gardens, by Nancy Gerlach Spriggs, Richard Enoch Kaufmann, and Sam Bass Warner; and The Healing Landscape, by Martha Tyson). Since then, much new research, and many new issues, have emerged that needed to be addressed – for example, sustainability; the participatory design process; restorative spaces in public places; and gardens for veterans and active duty military personnel with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The book, with practical design guidelines, case studies, and over 300 color illustrations, is user-friendly and accessible to designers, healthcare providers, students, and lay people.????????????????????????

Hiking Research: What research projects are you currently involved with?

Naomi Sachs: First, I’ll say that as hard as it is, I love being a PhD student. I do enjoy design, and still love being the Director of the Therapeutic Landscapes Network. But exploring new ideas and coming up with original research is extremely satisfying. As a student in architecture at Texas A&M University, I have the pleasure of working with incredibly smart, talented, and experienced faculty and students in the Center for Health Systems and Design  For my dissertation, I’ll be focusing on developing a standardized healthcare garden evaluation “toolkit” – a set of research instruments that will allow designers and clients to assess outdoor spaces in hospitals. Right now, no such thing exists and so designers and researchers end up reinventing the wheel with each new study; this makes it hard to compare findings from one study to another—too often, we are trying to compare apples and oranges—which undermines the credibility of the research and our ability to generalize from one scenario to another. The toolkit will not only enable the evaluation of gardens; it will also be used as a tool for research and evidence-based design. In testing the toolkit, I’ll be looking specifically at what design and programming elements influence garden use, and how that affects patient, visitor, and staff satisfaction.

Hiking Research: Describe the Therapeutic Landscapes Network, its purpose, and importance.TLN_homepage

Naomi Sachs: The Therapeutic Landscapes Network is an international, interdisciplinary knowledge base and gathering space focused on healing gardens, restorative landscapes, and other green spaces that promote health and well-being. The network is made up of designers, health and human service providers, scholars, students, gardeners, and nature enthusiasts. Though our focus is broad, our primary emphasis is on evidence-based design in healthcare settings. I created the TLN’s precursor, the Therapeutic Landscapes Database, in 1999 as a sort of online encyclopedia—a way to provide up-to-date information to people all over the world. With the advent of social media, through sites like Linked In, Facebook, and Twitter, we have become much more interactive, which is wonderful. Our vision, “Connecting people with information…people…nature” has become a reality.

Hiking Research: Are healthcare providers embracing nature as an important element in their facilities for patient and employee health and well-being?

Naomi Sachs: I think healthcare providers are really starting to embrace nature as a critical element in the environment of care. As Clare and I often say, it’s no longer just “the icing on the cake.” This is not just true of access to nature. The concepts of patient- and family-centered care; evidence-based design; and “salutogenic design” – design for wellness rather than illness—are all gaining acceptance by designers and clients. Beyond common sense and intuition, there is solid research to validate the profound health benefits that can be derived from contact with nature. Healthcare settings (and by this I mean not just general acute care hospitals but also hospices, assisted living facilities, mental and behavioral health clinics, and so on) are some of the most difficult places for people to be. The patients, visitors, and even the staff are under an enormous amount of stress. Gardens are an excellent way to reduce that stress and provide a life-affirming experience. People in the industry now see the social as well as economic value of providing gardens and other ways to connect with nature.

Hiking Research: What are five suggestions you have for people who want to incorporate nature into their landscape at home?

Naomi Sachs: Well, it’s very personal, especially when it comes to landscape for the home. As with all landscapes, a big part of the design process entails practical issues, like how much space there is, how much time and money the client wants to put into the garden, etc. So it’s hard to suggest five specific elements. Some critical considerations:

  1. The garden must be safe. I know this isn’t very sexy, but whether it’s at home or in a healthcare facility, safety is paramount – especially if the garden is for small children, people with physical or developmental disabilities, or the frail elderly. So, for example, a garden for young children shouldn’t have poisonous plants. A garden for frail elders should have walking surfaces that are smooth and easy to walk on (or roll on with a wheelchair or walker). The garden should also feel safe, and comfortable.
  2. The garden should be a source of fascination, and inspiration. Back when I was doing more design work, I would ask my clients, “What makes your heart sing? What inspires you? What do you really want to do in this garden?” Some people love to entertain; they should have a big space for that. Some people want space for their kids to play, or to do yoga, or to meditate…some people want it all! Creating a healing garden—rather than just a back yard—at home takes some more reflection, some careful thought about what is going to really touch and nurture that person or that family.
  3. The garden should engage all of the senses. We mostly think about sight, but how can the garden delight our sense of smell, sound, touch, and even taste? In a small space, plants that can do “double duty” by engaging more than one of the senses are best. For example, lambs ears are soft and fuzzy and are also a beautiful silver color. Lavender flowers and foliage look beautiful, feel soft to the touch, and are deliciously fragrant. The flowers can be harvested to used for cooking, baking, drinking, or even for medicinal purposes.
  4. Decide what you can and can’t do (or do and don’t want to do). . If you love to garden—to dig in the dirt, plant seeds, pull weeds, harvest flowers, herbs, or food—then that should be a big part of the garden. If you work 60 hours a week and commute a long way and have kids, maybe you want a garden that needs less maintenance, where you and your family can just be in the free time that you have. It’s rather counter-productive to worry about a garden that you don’t have the time, or the funds, to maintain!
  5. Consider how you can enjoy the garden in all of the seasons. If it gets cold where you live and you can’t use the garden in the winter, what can you plant that gives it interest in the off season? Evergreens; plants with berries, or colorful bark, or interesting form; or even elements like a pair of really colorful chairs that stays outside…these can all brighten up the garden and give us something to look at in those dark days. I love to plant things with berries that attract birds, and I put out birdfeeders and heater bird baths. Well, I used to, before I moved to Texas. For people like me who endure hot summers, and mosquitoes and other insects, it’s important to make the garden usable in those times. A big tree, or a screened-in porch or gazebo with a ceiling fan, allows you be partially outdoors, or to feel outdoors, even on beastly days.
  6. And a bonus idea: A healing garden (or any type of garden, really), should be good for the earth. We get so much—physically, mentally, emotionally—from nature. The least we can do is treat her with love and respect. So, avoid pesticides and herbicides; conserve water; use native plants, and plant the right plant in the right place so it thrives. The wonderful thing about most of these strategies is that they also encourage birds, butterflies, and beneficial insects; these creatures can really bring a sense of magic to the garden.

Hiking Research: How can we promote more interdisciplinary collaboration among researchers and practitioners on the links between nature and health?

Naomi Sachs: Healthcare design cannot happen without multidisciplinary collaboration. It just doesn’t work. Research on healthcare design must also be interdisciplinary. I think that the world, in general, is heading in this direction. It’s more challenging for people to step outside of their own bubble, to try to understand and speak someone else’s language, but it is so much more rewarding for the people involved and for the end users. I chose, at least for now, to focus my attention on access to nature in healthcare. Many talented people are doing other fantastic work—Richard Louv with the Children & Nature Network; Robin Moore and Nilda Cosco with the Natural Learning Initiative; Sharon Danks and the International Green Schoolyards Movement; Richard Jackson and Howard Frumkin with issues of urban planning and public health; your work with the International Society of Nature and Forest Medicine…many organizations working with community gardens, urban farming…the list goes on (check out the TLN’s related organizations page for some of these). Part of what excites me about my work with the TLN and as a PhD student is pulling people, research, and ideas from different disciplines together and seeing what grows from that rich mixture.

Kalevi Korpela Discusses Finland’s “Power Forests” for Well-being and Emerging Research

I had the opportunity to meet Dr. Kalevi Korpela at the joint conferences of the Society of Outdoor Recreation Professionals and the International Union of Forest Research Organizations in May 2013. It was at this conference that we had the initial meeting of the North American Chapter of the International Society of Nature and Forest Medicine. Dr. Korpela, Professor of Psychology at the University of Tampere in Finland, is on the board of (INFOM) based in Tokyo, Japan. Dr. Korpela’s research has made significant contributions to the understanding of how nature impacts human health and well-being. He took time recently to answer several questions about his research and the “Power Forests” for wellbeing in Finland and other European countries.

Dr. Kalevi Korpela, Professor of Psychology, University of Tampere Photo courtesy University of Tampere, Finland

Dr. Kalevi Korpela, Professor of Psychology, University of Tampere
Photo courtesy University of Tampere, Finland

Hiking Research: What inspired you to pursue psychology as a career and to research how nature impacts well-being?

Kalevi Korpela: I remember being interested in psychology already in high school. After matriculation, I was thinking about architecture or psychology for university studies but only went to psychology exams. I did like and still like this Dostoyevski quote: “A human being is a mystery: if you spend your entire life trying to puzzle it out, then do not say that you have wasted your time.” At our department of psychology in Tampere University we had a tradition of environmental psychological studies dating back to early seventies. In my master’s thesis I found myself being interested in environmental psychology and writing a thesis on cognitive maps of the city.

Hiking Research: What research projects are you currently involved with?

Kalevi Korpela: The project “Urban Diversity” 2010-2013 is ending. We have tried to figure out how to combine building and the possibilities of nature in fruitful ways in process planning. The research consortium includes the Tampere University of Technology (School of Architecture), Departments of Regional Studies and Psychology at the Univ. of Tampere.

The project “Recovery from work stress: integrating perspectives of work and environmental psychology”, 2012-2016, investigates the relationship between “green exercise”, indoor plants, window views and recovery from work stress in a 3-year longitudinal survey. We also carry out interventions during the lunch break (relaxation, park walks) to investigate short-term recovery from stress during the workday.

The project “Outdoor recreation 2009”, 2010- , is a survey study of outdoor recreation and well-being using a representative sample of Finns. A recent paper about this data is Korpela, K., Borodulin, K., Neuvonen, M., Paronen, O., & Tyrväinen, L. (2013). Analyzing the mediators between nature-based outdoor recreation and emotional well-being. Journal of Environmental Psychology. doi: 10.1016/j.jenvp.2013.11.003. (An earlier paper is also available online through the journal Health Promotion International). The research consortium includes the Finnish Forest Research Institute (FFRI/METLA), Statistics Finland, University of Tampere, The National Institute for Health and Welfare, Centre for Health Promotion Research (UKK Institute), and MTT Agrifood Research Finland.

The project “Green infrastructures for health in the future living environments (GreenHealth)”, 2013-2014 has carried out the walking experiments in Helsinki city center, an urban park and urban woodlands. The first results are in press in Journal of Environmental Psychology. The research consortium includes The Finnish Forest Research Institute (FFRI/METLA), The National Institute for Health and Welfare (THL), Dept of Psychology (Univ. of Tampere), and the Japanese team who has carried out tens of walking experiments in Japan: Forestry and Forest Products Research Institute, (Prof., Dr. Takahide Kagawa, Dr. Yuko Tsunetsugu, and Dr. Norimasa Takayama); Nippon Medical School (Dr. MD Qing Li) and Chiba University (Prof., Dr. Yoshifumi Miyazaki)

LEADER- project “Forest Project – Network of densely wooded regions in Europe”, 2012-2013 has created awareness-enhancing / engagement-based forest trails to four countries. Forest trail partners are Finland (Finnish Forest Research Institute and University of Tampere), Sweden, Luxembourg and France. The project partners and funders also include LAG (=Leader action group) Växtlust, Sweden; LAG Müllerthal, Luxembourg; LAG Pays de la Déodatie, France; Aktiivinen Pohjois-Satakunta ry, Finland. Funders include EU, several municipalities, and some private funders.

A view from a trail in the "Power Forest" in Finland.  Photo courtesy Finnish Forest Research Institute

A view from a trail in the “Power Forest” in Finland.
Photo courtesy Finnish Forest Research Institute

The first trail (of this kind, ever; according to our knowledge) was opened on May 20, 2010 near Ikaalinen Spa, Finland (view brochure). We developed the trail in the “Health from the Forest” project 2008-2010 in co-operation with the Finnish Forest Research Institute (Parkano Unit) and Ikaalinen Spa. The project was funded by the European Regional Development Fund (ERDF) and the Council of Tampere Region.

The idea is that the awareness-enhancing psychological tasks along the trail may allow even less ideal environments to be experienced in stress-alleviating ways and help people to be physically active. The tasks were written by K. Korpela and their ideas draw from several lines of research: a) experimental research results on the onset of psychological, physiological and behavioral changes in restorative natural settings, b) studies on people’s everyday favorite places and their restorative qualities, c) studies on the effects of cognitive sets and role-taking on human perception and environmental attitudes d) studies on psychology of suggestive information.

Thus, the tasks aim to i.a. induce relaxation, improve mood, induce cognitive reflection and attentional restoration, and enhance the search for a favorite place which can be socially shared.

In the LEADER-project, identical tasks were used in all four countries and the wordings were translated from the original Finnish trail signposts. User surveys are presently collected from each country to investigate people’s attitudes in these trails and tasks.


Hiking Research: What needs to happen for the use of “forest therapy” to become more accepted by healthcare providers? Is nature often used by psychotherapists in European countries?

Kalevi Korpela: We need more solid and causal evidence of the effects of forest therapy and nature’s restorative effects, in general. For example, the Finnish Current Care Guidelines are very strict and require good scientific evidence for any procedure to be accepted as care. Current Care Guidelines are independent, evidence-based clinical practice guidelines.

The guidelines are intended as a basis for treatment decisions, and can be used by physicians, healthcare professionals and citizens. The guidelines are developed by the Finnish Medical Society Duodecim in association with various medical specialist societies.
We also need more co-operation, and need to provide more informing and PR work for healthcare providers. I do not know the European situation but know that there are perhaps half a dozen psychologists in Finland who use nature in their practice.

Hiking Research: What are your suggestions for using nature to help people cope with work stress? Have you worked with organizations that are utilizing nature to help employees improve health? If so, describe what they are doing?

Kalevi Korpela: I will be wiser on this after our research project (see above). But indoor plants and window views might be important in workplaces as well as possibilities for being in a greenspace during the lunchbreak. Our forest trail project has shown that spas might include these trails in their activities.

Hiking Research: Do you collaborate with forestry researchers? If so, how? How can we promote more interdisciplinary collaboration focused on how nature impacts health?

Kalevi Korpela: Yes, I have co-operated a lot with the Finnish Forest Research Institute In Finland as well as in Europe (the COST system), we have funding systems for collaboration and for creating networks for interdisciplinary collaboration. Societies like the International Society of Nature and Forest Medicine are important.