Archive for the ‘Healing Garden’ Category

What is a Healing Garden?

Sunday, September 11th, 2016
Legacy Meridian

Healing Garden at Legacy Meridian Park Medical Cntr, designed by Brian Bainnson. Photo by Naomi Sachs

My colleague, Dak Kopec, asked me to write a piece on healing gardens for his forthcoming book,  Environmental Psychology for Design, and he has graciously given permission to share it with you here on the TLN Blog. Dak is Director of Design for Human Health at Boston Architectural College and has written many books and other publications on the role of the environment in human health. Thank you, Dak!

Griffin Healing Garden

Healing Garden at The Center for Cancer Care at Griffin Hospital. Photo by Naomi Sachs

What is a “healing garden”?

A “healing garden” is a garden or landscape designed for a specific population, place, and intended positive health outcome. The garden’s design (physical aspects) and programming (activities that take place there) are informed by research. The majority of healing gardens, also referred to as “restorative gardens” and “healthcare gardens” are in healthcare facilities including general acute care hospitals, outpatient clinics, assisted living and skilled nursing facilities, mental and behavioral health facilities, hospices, and specialty facilities such as rehabilitation, pediatric, and cancer hospitals and clinics. Garden users include patients or residents, visitors, and staff. Positive outcomes, including stress reduction, are derived through both passive and active nature connection and can take place indoors (via indoor plants, or from viewing nature through a window) and outdoors. A “rehabilitation garden,” “therapeutic garden,” or “enabling garden” is a garden where physical, occupational, horticultural, and other therapies take place. A “restorative landscape” or “landscape for health” is any landscape—wild or designed, large or small—that facilitates human health and well-being (Sachs, 2016).

TIRR Memorial Hermann

Planter with patient-painted tiles, TIRR Memorial Hermann. Photo by Naomi Sachs

Why is access to nature important?

Access to nature promotes health through reduction in stress, depression, myopia, pain, fatigue, aggression, impulsivity, and symptoms of Attention Deficit Hyperactivity Disorder (ADHD); and improvement in immune function, bone strength, wound healing, cognition, concentration, emotional resilience, empathy, vitality, relaxation, mood, and satisfaction (Cooper Marcus & Sachs, 2014; Kuo, 2015). Why is nature good for us? Part of the answer can found in the theory of biophilia, “the innately emotional affiliation of human beings to other living organisms” (Kellert & Wilson, 1993, p. 31). Stephen and Rachel Kaplan’s Attention Restoration Theory (1995) is based on the concept that “positive distraction” and “soft fascination” through nature engagement lead to mental and cognitive restoration from the stress caused by “directed attention.” More recent research has identified enhanced immune functioning as a potential “central pathway” in explaining the connection between nature contact and positive health outcomes. Nature, in hospitals and elsewhere, plays a salutogenic role in both disease prevention and health promotion (Kuo, 2015).

Healing Garden at Houston Hospice.

Healing Garden at Houston Hospice. Photo by Naomi Sachs

What elements are important in healing gardens?

Safety, the perception and safety, and comfort are all essential in healthcare gardens. Good design and proper maintenance can address challenges such as climatic extremes, inclement weather, pollen, and harmful bacteria and insects. For example, a choice of sun and shade enables users to be outside throughout the day. Covered seating areas, especially at the garden entrance, allow even the frailest of users to venture out when the weather is not ideal. Gardens should be designed so that even when they are not physically accessible, they can be viewed from indoors and are a pleasure to see in all four seasons. According to Roger Ulrich’s Theory of Supportive Garden Design (1999), healing gardens should provide 1) nature engagement (plants, animals, water, fresh air), 2) a sense of control (for example, doorways that are easily navigable, and areas where people can find privacy), 3) opportunities for social support, and 4) opportunities for movement and exercise. While it may seem obvious that nature should be present in a healing garden, examples of nature-poor healthcare “gardens” abound. Stakeholders must work together to maximize the natural, biophilic elements that facilitate the best possible outcomes for all users.

Smilow Cancer Center

Betty Ruth and Milton B. Hollander Healing Garden, Smilow Cancer Hospital. Designer: Towers Golde. Photo by Naomi Sachs


Cooper Marcus, C., & Sachs, N. A. (2014). Therapeutic landscapes: An evidence-based approach to designing healing gardens and restorative outdoor spaces. Hoboken, NJ: John Wiley and Sons.

Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15, 169–82.

Kellert, S. R., & Wilson, E. O. (1993). The biophilia hypothesis. Washington, DC: Island Press.

Kuo, M. (2015). How might contact with nature promote human health? Promising mechanisms and a possible central pathway. Frontiers in Psychology, 6(1093).

Sachs, N. A. (2016). Gardens/Overview. Therapeutic Landscapes Network website. Retrieved from

Ulrich, R. S. (1999). Effects of gardens on health outcomes: Theory and research. In Cooper Marcus, C. & Barnes, M. (Eds.), Healing gardens: Therapeutic benefits and design recommendations (27–86). New York: John Wiley and Sons.

Book citation: Sachs, N. A. (in Press). In D. Kopec (author). Environmental psychology for design, 3rd Edition. New York: Fairchild Books.


Labyrinths for Healthcare: Approach with Caution

Friday, May 29th, 2015
Labyrinth at St. Joseph Memorial Hospital. Photo by Clare Cooper Marcus

St. Joseph Memorial Hospital, Santa Rosa, CA. This labyrinth is appropriate for a healthcare setting since the walking route is relatively short (7-circuit); there are no overlooking windows, and vegetative screening ensures privacy; it is shaded; and a simple explanatory sign explains its use. Photo by Clare Cooper Marcus

This post might invite more invective or controversy than usual (which is usually none, so we’ll see), but it’s something important to discuss: Labyrinths are not always appropriate for healthcare gardens. When they are used, they need to be sited and designed to best benefit garden users. Clare Cooper Marcus and I discuss this issue in our book Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces and some of the text below is excerpted from Chapter 6 (p. 78).

Please understand: I have nothing against labyrinths per se. In fact, in the right place and context, I think they are wonderful and I very much enjoy walking them. The TLN has a page on labyrinths. In our chapter on Gardens for Veterans and Active Duty Personnel, we discuss how labyrinths are used in the therapeutic process (p. 210-211).

First, what is a labyrinth?
The classical labyrinth consists of a continuous path that winds in circles into a center and out again. This basic form dates from antiquity and is intended for contemplative walking. A labyrinth is sometimes erroneously referred to as a maze, which consists of a complex system of pathways between tall hedges, with the purpose of getting people lost. The aim of a maze is playful diversion, whereas the aim of the labyrinth was, and is, to offer the user a walking path of quiet reflection. See this earlier TLN Blog post for more on the distinction between labyrinths and mazes.

Labyrinth at St. Paul’s Anglican Church, Thunder Bay, Ontario, Canada

Labyrinth at St. Paul’s Anglican Church, Thunder Bay, Ontario, Canada


The healing garden down the street: Guest blog post by Joan Vorderbruggen and Lisa Overby-Blosser

Friday, August 22nd, 2014
Joan Vorderbruggen's garden patio. All photos by  Joan Vorderbruggen

Joan Vorderbruggen’s garden patio. All photos by Joan Vorderbruggen

I first met Joan Vorderbruggen at the Environmental Design Research Association (EDRA) meeting in 2013 in Providence, RI. She presented an expanded version of this lovely post, and I was very moved. Sometimes we researchers and designers get so bogged down in trying to analyze and quantify everything that we forget the more human and – dare I say it? – even the spiritual dimension. Joan’s and Lisa’s words, along with images from Joan’s garden, get to the heart of it. Many thanks to both of them for sharing here.

The healing garden down the street
By Joan Vorderbruggen and Lisa Overby-Blosser

The spring of 2012 held little hope for my neighbor, Lisa, wife and mother of four teenagers.  Lisa had just been diagnosed with stage four breast cancer and was given a year or less to live. Asking me if she could spend time in my backyard garden, she felt time in a peaceful setting would help her deal with the upcoming chemotherapy, radiation, surgery, and other stresses.

Over that summer, Lisa spent a great deal of time walking the 5-house distance to my yard, sometimes barely able to put one foot in front of the other.  Still, she persevered, settling in to journal, sketch, and just be in the moment.  While I encouraged her to come and go as she pleased, I was happy that at times, she would join me on my deck and, without any prompting, speak of how the garden and natural world supported her during that time. I asked if I could share her words with others.

Lisa’s words (italicized) fit neatly within the framework of Stephen Kellert’s Biophillic Design Elements (below). According to Kellert, these elements stem from an intuitive human-nature connection, where people feel that spending time in nature can help them heal mentally, physically and spiritually. The Biophilia hypothesis assertion is that because humans evolved with nature, they feel comforted by nature (Kellert and Wilson, The Biophilia Hypothesis, 1993).

The idea of prospect is primarily about being able to control your view, to scan the horizon and understand where you are in relationship to your surroundings.
In the garden you have control – of where you sit, where you look, what you choose to focus on – whether it’s a wide view or something really small…  There are so many choices available to you.  The fact that you can make a choice of something can be healing.

Prospect. Photo by Joan Vorderbruggen

Prospect and Refuge


Refuge allows us to feel safe, sheltered and protected.  In my garden, Lisa chose to sit under a grapevine trellis.  She speaks more in metaphor of her feelings of refuge.
The garden is always welcoming; no plants fall over or trees drop their leaves in disgust or empathy when I took my hat off exposing my baldness….  The garden accepts where your body and emotions are at that moment in time.


Healing garden for a veteran wins national award

Friday, July 25th, 2014
Harvest Home -  Julie Melear

The Wounded Warrior home, built for the Solar Decathalon, with its award-winning landscape design

George Washington University graduate students Julie Melear, Janet Conroy, and Mary Sper’s landscape design for HARVEST HOME, a Wounded Warrior home built for a veteran, has won the Gold Award in outdoor design from the Association for Professional Landscape Design (APLD). The house was designed and built by college students competing in the U.S. Department of Energy’s Solar Decathlon, which challenges collegiate teams to design solar powered houses that are cost effective, energy efficient, and attractive.


The first therapeutic garden in Romania!

Thursday, July 10th, 2014

Planting in Romania healing garden

Landscape engineer Nicsanu Marcela recently posted a photo on our TLN Facebook page with an image of raised flower beds and this caption: “First therapeutic garden in Romania!” That was pretty exciting. I emailed her to ask whether she’d like to do a guest blog post, and she agreed. Here is her post:

The first therapeutic garden in Romania opened its doors in June 2014, at Mocrea Psychiatric Hospital in Arad County. This first garden opened the way for horticultural therapy, a healing method used in almost some psychiatric hospitals in Western Europe and the USA.