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.

Using Wilderness Therapy to Enhance the Quality of Life for Homeless People

Wilderness therapy has been used for personal growth, rehabilitation, education, and leadership development. Street-To-Trail (STT), a non-profit in Toronto, Canada is now using nature as therapy for the homeless in an innovative program. STT helps people living on the streets of Toronto rediscover their inner sense of worth using the healing power of the natural world. STT organizes wilderness hikes and other outdoor excursions including canoe trips that help homeless people experience the beauty and therapeutic calmness of nature. They believe that  getting homeless people away from the city to participate in a wilderness trip enables them to increase their self-confidence, experience a positive environment to overcome addictions, find new and meaningful relationships, and rediscover lost feelings of peace and hope.

Street-To-Trail Participants on a hiking excursion

Street-To-Trail participants on a hiking excursion
Photo courtesy Paul Mackle

STT activities involve more than a leisurely walk in the woods. Participants are required to demonstrate a commitment through training in skills, to be able to “graduate” to more advanced programs. The training STT offers prepares participants to go on overnight backpacking trips, bike trips, canoe trips, as well as cross-country ski and snowshoe trips. These activities help participants improve their health physically, mentally, emotionally and spiritually, while at the same time having fun. It is this integrated, whole form of “fitness” which is the secret to STT’s success. Paul Mackle, Executive Director of STT states, “We take over 275 people on activities each year. We supply everything needed on our journeys including tents, sleeping-bags, backpacks, food, cooking equipment, canoes, paddles, life-jackets, sleds, snowshoes, and other gear as needed.”

To better understand the impact of their program, STT collaborated with faculty and students from the University of Toronto Department of Occupational Science and Occupational Therapy  and the Canadian College of Naturopathic Medicine to conduct research on the program. A qualitative study conducted by the University of Toronto provided a glimpse into the contributions the program is making in the lives of participants. Findings of the study revealed that by escaping the pressures of the city, including its negative influences, participants were able to experience a discrepancy between their old ways of life and current novel experiences. STT appeared to be a major source of stability for all participants, both in a concrete manner, such as establishing structure and routine, and in a more abstract way by acting as a constant anchor of hope. A finding that the researchers thought was especially important was the theme of the STT program offering a source of engagement in meaningful occupation. Participants associated their engagement in wilderness occupations as adding value to their lives. Participants in the study also indicated that escaping the pressures of the city, including its negative influences had a positive influence. Many research studies have found that urban environments are stressful and negatively impact health. The exposure to unfamiliar situations also encouraged participants to question accepted beliefs and practices.

Street-To-Trail participants enjoying nature  Photo courtesy Paul Mackle

Street-To-Trail participants enjoying nature
Photo courtesy Paul Mackle

It is encouraging to see that occupational therapy faculty conducted this research. The OT field can make significant contributions to research and practice related to using nature to impact health. I have collaborated with occupational therapist Nancy Green, OTR/L, MHA, who is the Program Chair for the occupational therapy assistant program at Cabarrus College of Health Sciences and an alternative healer, to develop a course on utilizing nature for improved health. Nancy states,“the use of nature therapeutically is central to what occupational therapy is striving to accomplish-healing of the whole person.” Students in our course can participate in a research study looking at how time spent in nature impacts psychological well-being and stress levels. I have been contacted by graduate students at the Canadian College of Naturopathic Medicine who would like to collaborate with me to do a similar research study with the Street-To-Trail program. Research on the health benefits of time in nature must be an interdisciplinary endeavor, and the fields of OT and naturopathic medicine should be part of the conversation.

The results of this study provide an initial glimpse to an innovative approach to helping the homeless find stability in their lives. However, additional research is needed to support the findings of this study, which was based on a small sample. The innovative Street-To-Trail program should be replicated in other cities if the benefits of this study are any indication.