Therapeutic Landscape Design
The evidence is clear: providing opportunities for people to interact with nature benefits their health
What is a Therapeutic Landscape?
There are many names that this intentional landscape design is called by: Healing Gardens, Healthcare Gardens, Therapeutic Gardens, Biophilic Landscapes are a few. Extensive research has confirmed that interacting with or simply viewing nature improves mood, provides stress relief, increases cognitive functions and improves pain tolerance, among many other benefits. In one study, walking in a forest was shown more effective at decreasing blood glucose levels than other forms of exercise, such as walking on a treadmill[i]. The long-respected research of Robert Ulrich and colleagues determined that visual encounters with nature provide measurable recovery benefits[ii]. Other researchers have demonstrated that children diagnosed with attention-deficit hyperactivity disorder (ADHD) were more able to focus in a natural setting than in either a built outdoor environment or an indoor one[iii].
Groundbreaking researchers and key advocates of the therapeutic value of nature include, but are not limited to:
Terry Hartig Ph.D., Uppsala University, Sweden
Stephen Kaplan Ph.D. & Rachel Kaplan Ph.D., University of Michigan
Peter H. Kahn Jr. Ph.D., University of Washington
Stephen R. Kellert Ph.D., Yale University (Biophilia)
Clare Cooper Marcus MA, MCP, University of California Berkeley
Susan Rodiek, PhD, NCARB, Texas A & M University
William C. Sullivan, University of Illinois at Urbana Champaign
Roger S. Ulrich Ph.D., EDAC, Texas A & M University
Landscapes specifically developed to promote health benefits for their intended users are typically classified as “therapeutic, ” “healing, ” or “healthcare” gardens. These type of landscapes are often associated with Acute Care Centers, Senior Living environments, Children’s Hospitals, Cancer and Hospice Centers, and Memory Care Centers. They may have a more passive intent, such as a respite garden at a hospital, or a more active purpose, such as a garden in an assisted living facility that performs horticultural therapy. In general, therapeutic landscapes have successfully integrated the following restorative elements:
• Engagement with Nature
• Exercise Opportunities
• Social Support
• Sense of Control (Choices)
Each of these elements requires significant design decisions based on the intended users of the spaces.
Evidence-Based (Informed) Design
Evidence-Based Design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes (definition from Center for Health Design). Design decisions influence the beneficial nature of outdoor spaces. For example, providing a door with a threshold that is easy to navigate can increase outdoor usage over 2.5 times in an assisted care facility[iv].
Gardens can be placed in a hospital, care center or senior living environment and not actually be therapeutic or “healing.” In some cases they can be detrimental to the over-arching intent of reducing stress. For example, a sculpture selected due to its interesting visual interest may cause a stress response due to its character evoking the pain or chaos a person is experiencing. Just because a garden is named as a healing garden does not make it so. It is informed design decisions that bring the layer of therapeutic value to an outdoor space. In many cases, this may not mean a “flashy” or cover-ready design, but rather a space that truly caters to the needs of those using it.
Below are a few examples of design details that can make the difference between a typical landscape, and a therapeutic one:
• Raised planters or pots raise the smell, texture and beauty of the landscape up to those who are in a wheelchair or cannot lower.
• For those traversing concrete in a wheelchair, sawcut joints are less jarring than tooled joints.
• Seating surfaces set higher for those with mobility challenges are much easier to get up and down from and can thereby also reduce the possibility of falls and injury.
• Pavement colors should not change dramatically or it could cause “visual cliffing” for those with visual impairment or sensitivity to light.
• Installing a bird feeder can dramatically increase the interest in using an outdoor space.
In order to acheive the most therapeutic benefit from the landscape and the site, it is critical to engage a designer that has a passion for this work and the expertise to develop thoughtful design solutions. Landscape can be foundation shrubbery, or it can be an integral part of care and healing; selecting the right designer can make the difference. Arkos Design has a Landscape Architect certified in healthcare garden design, We will work to ensure that evidence-based design principles are being implemented and the most benefits possible for patients and residents are brought to fruition.
[i] Ohtsuka, Y, N Yabunaka, & S Takayama. 1998, International Journal of Biometeorology 41
[ii] Ulrich, RS, & R Parsons. 1992. The Role of Horticulture in Human Well-Being and Social Development: A National Symposium. Timber Press.
[iii] Frances E. Kuo, PhD and Andrea Faber Taylor, PhD, September 2004, A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence From a National Study, American Journal of Public Health
[iv]Susan Rodiek, 2010, World Health Design,
Prepared by Darla Davidson Aldred, PLA, LEED AP, Certified Healthcare Garden Designer and Senior Landscape Architect at Arkos Design, Inc. in Mishawaka, Indiana.