The Profession of Horticultural Therapy Compared with Other Allied Therapies

Author(s): Candice A. Shoemaker

Source: Journal of Therapeutic Horticulture , 2002, Vol. 13 (2002), pp. 74-81
Published by: American Horticultural Therapy Association

Stable URL: https://www.jstor.org/stable/44025050

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 The Profession of Horticultural Therapy
Compared with Other Allied Therapies

Candice A. Shoemaker, Ph.D.

The 1950s and 1960s saw the beginnings of defining horticultural therapy as a profession and the need
for formally trained horticultural therapists. Historically, horticulture was used as an activity or diversion
for hospital patients, for vocational training, and in occupational therapy. Horticultural therapy continues
to be closely affiliated with these allied therapies such as occupational therapy, recreational therapy, and
activity therapy. Comparisons between these allied therapies can be a useful tool in understanding the past
and defining or identifying strategies for the growth and development of the profession into the future. This
paper provides a brief history of the profession and an in-depth comparison of the evolution of horticultural
therapy to the other allied therapies.

Introduction 1979). In 1936, the Association of Occupation

Therapists in England formally acknowledged the
Claims of the therapeutic value of horticulture can
of horticulture as a specific treatment for physical
be found as far back as ancient Egypt and through psychiatric
to disorders (McDonald, 1995). Milwau
recent times (Menninger, 1942; Burlingame, 1959; Downer College, the first college to award a degre
Black, 1971; Lewis, 1976; Simson & Straus, 1998).occupational therapy, was also the first institution
Historically, the use of horticulture in institutional
higher learning to offer a course in horticulture wi
settings has included having patients as field labor the
in occupational therapy curriculum, in 1942. A
farm settings (Tereshkovich, 1975), providing1940, garden therapy was considered a separ
diversions for long-term patients (McDonald, 1995),
treatment, and the first use of the term horticult
enhancing educational programs for mentally therapy was used by Ruth Mosher Place in 1
handicapped children (Lawrence, 1900), and as a
(Olszowy, 1978).
rehabilitative component to war veterans (Lewis,
1976). In 1952, the first week-long workshop in
horticultural therapy was offered at Michigan S
Development of horticultural therapy as a University by Dr. Donald Watson and Alice
profession has probably been mostly influenced by its Burlingame, a psychiatric social worker. This followed
role in occupational therapy and by volunteers from with the first master's degree program in horticultural
the National Council of State Garden Clubs and Master therapy for occupational therapists. The first Master of
Gardeners. The influence of volunteers in the Science degree in horticultural therapy was awarded
development of the profession began following World State University to Genevieve Jones, an
by Michigan
War II. Volunteers and members of the National
occupational therapist, in 1955. The first book in
Council of State Garden Clubs assisted occupational
horticultural therapy, Therapy through Horticulture by
therapists in using plants and gardening activities
Watsonin and Burlingame, was published in 1960.
their therapy and rehabilitation programming. In 1951,
the National Council of State Garden Clubs named The next significant steps occurred in the early
1970s with the establishment of university programs
horticultural therapy as one of the major objectives of
and creation
members clubs, which it remains today (Simson & of a professional association. In 1972,
Straus, 1998). Kansas State University, with the cooperation of the
Menninger Foundation in Topeka, Kansas, began an
Between 1920 and 1940, most books on undergraduate curriculum in horticultural therapy
occupational therapy mentioned gardening (Odom, 1973). This program was a partnership
(Sullivan,

74 jļķ American Horticultural Therapy Association

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between the Horticulture and Forestry Department at compared to allied therapies such as occupatio
Kansas State University and the Activity Therapy therapy, recreational therapy, music therapy, and
Department of the Menninger Foundation. In 1973, therapy, a comparison between these allied therapi
Clemson University established a graduate degree can be a useful tool in understanding the growth a
program in horticultural therapy and a few other development of the profession.
universities began to offer horticultural therapy options
Definitions of
within their undergraduate degree programs in
horticulture throughout the 1970s. In 1981, eight Allied Therapies
universities offered B.S. and/or M.S. degrees or
options within horticulture in horticultural therapy Information on the growth and development of the
(NCTRH, 1981). According to the American professions of art therapy, music therapy, therapeutic
recreation, and occupational therapy was collected and
Horticultural Therapy Association (AHTA, 2002) there
are currently three universities offering degrees orcompared with horticultural therapy. A review of
definitions for each of these therapeutic modalities as
options and twelve others offering at least one course
in horticultural therapy. given by their professional associations shows many
similarities between them such as the populations
In 1973, the National Council for Therapy and served, locations where practiced, treatment purposes,
Rehabilitation through Horticulture (NCTRH) was skills required. Particularly, horticultural therapy,
and
formed to promote and enhance the profession art of therapy, and music therapy are comparable in many
ways.
horticultural therapy as a therapeutic intervention and The main difference is the modality used in
rehabilitative medium. It became the American therapy: horticulture, art, or music. The following
Horticultural Therapy Association (AHTA) in 1987. of each profession were taken from the
descriptions
Annual conferences began in 1973. Professional professional associations' Web sites and demonstrate
registration was established by the AHTA inconnection.
this 1975
based on a peer group review of qualifications. In
1985, the AHTA approved a core curriculum,Horticulturallargely Therapy
Horticultural therapy is "an adaptable and
modeled after the Kansas State University curriculum.
instrumental
Membership is currently 701, with 252 registered as therapy to help people of all ages and
mental/physical functioning to improve and grow.
horticultural therapists (AHTA, 2002, personal
communication). Horticultural therapy develops the social, educational,
psychological, and physical adjustment of persons to
nurtureare
Master Gardeners, another group of volunteers, their body, mind, and spirits. Horticultural
university-trained and serve as educators in theirare specially educated and trained members
therapists
communities with primary emphasis onofhome rehabilitation and therapy teams who involve the
patient
gardeners. When the Master Gardener program began in all phases of gardening" (AHTA, 2002). This
type of treatment
in the mid-1970s, its focus was primarily directed at is used "as a complementary therapy
along with doctors, psychiatrists, psychologists,
diagnosing plant problems and offering solutions.
While still a major focus, Master Gardeners nowoccupational
assist therapists, physical therapists, behavioral
in a variety of educational programs including vocational skills instructors, and others.
specialists,
programs regarding the welfare of youth, Horticultural
senior therapists are experts on the medical and
citizens, and persons with disabilities. Research on the benefits of gardening and facilitating
psychological
role and impact Master Gardeners have improvement
in horti- of the patients' physical, social, and
mental
cultural therapy began to be reported in the well-being" (AHTA, 2002).
1990s
(Flagler, 1992; Migura, Whittlesey & Zajicek 1996;
Art Therapy
Kafami, 1997; Larson, 1997; Marshall, 1997).
"Art therapy is the therapeutic use of art making,
within
If the activities of the late 1940s and early 1950sa professional relationship, by people who
are considered the beginning of the profession ofillness, trauma, or challenges in living, and
experience
horticultural therapy as a separate treatment by people who seek personal development. Art
modality,
therapists
horticultural therapy as a profession is now over 50are professionals trained in both art and
years old. Given that horticultural therapytherapy.
is oftenThey are knowledgeable about human
development, psychological theories, clinical practice,

Journal of Therapeutic Horticulture ^ 75

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spiritual, multicultural, and artistic traditions, and the Comparison of
healing potential of art. They use art in treatment, Allied Therapies
assessment, and research. They provide services,
individually and as part of clinical teams, in settings The development of the profession of horticultural
that include mental health, rehabilitation, medical and therapy is following a similar path to these other allied
forensic institutions; community outreach programs; therapies, although it appears to be moving at a slower
wellness centers; schools, nursing homes; corporate pace. The membership size, educational requirements
structures; open studios and independent practices" and opportunities, and credentialing all lag behind the
(AATA Inc., 2002). other comparable professions (Table 1). The American
Art Therapy Association (AATA) was founded only 4
Therapeutic Recreation years before the American Horticultural Therapy
"Recreational Therapy is a unique alternative Association (AHTA), yet has six times the number of
helping profession with a focus on recreation as a members. AATA established the educational
means to psychological and physical health, recovery, requirement of a Masters degree to enter the pro
and well-being" (NCTRC, 2002). "Recreational with 29 Masters Programs currently approve
therapists are health care providers using recreational AATA, and effectively supported legislative eff
therapy interventions for improved functioning ofthe state and federal level. There is an independe
individuals with illness or disabling conditions" Therapy Credential Board for registration
(ATRA, 2002). "Therapeutic Recreation uses certification that began in 1992, and in many stat
treatment, education, and recreation services to help therapists can become licensed as counselors or m
people with illnesses, disabilities, and other conditions
health therapists (ATCB, 2002).
to develop and use their leisure in ways that enhance
their health, functional abilities, independence, and The American Music Therapy Association
quality of life" (NTRS, 2002). (AMTA) was founded in 1998 as a union of the
National Association for Music Therapy, the first
Music Therapy music therapy association, founded in 1950, and the
"Music Therapy is an allied health profession in
American Association for Music Therapy founded in
which music is used within a therapeutic relationship
1971. This profession has clearly defined entry
to address physical, psychological, cognitive, and
requirements of a bachelor's degree and board
social needs of individuals. Music therapists arecertification, has established a curriculum and
usually members of an interdisciplinary team who approval process with 70 bachelor programs currently
support the goals and objectives for each client within
approved, and has significantly more members than
the context of the music therapy setting. Music AHTA. There is also an independent Credential Board
therapists provide services for adults and children with
for Music Therapy that began in 1983.
psychiatric disorders, mental retardation and
developmental disabilities, speech and hearing The history of the therapeutic recreation profession
impairments, physical disabilities, and neurological
may provide the best insights to the many parallels
impairments, among others" (AMTA, 2002). between therapeutic recreation and horticultural
therapy. Therapeutic recreation emerges from two
Occupational Therapy philosophical positions. One position promoted the use
"Occupational therapy is a health and rehabilitation
of recreation as a therapeutic tool for treatment while
profession that helps people regain, develop, and the other position held that recreation was an end in
build skills that are important for independent itself and simply met a specific human need for those
functioning, health, well-being, security, and persons who were institutionalized (Van Andel, 2002).
happiness. Occupational therapy practitioners work
Early terms such as recreation therapy and hospital
with people of all ages who, because of illness, injury,
recreation demonstrated the differences. The term
or developmental or psychological impairment, need therapeutic recreation was coined in the 1950s to
specialized assistance in learning skills to enable them
bridge this semantic gap.
to lead independent, productive, and satisfying lives"
(AOTA, 2002). In an effort to bridge the professional differences
within the therapeutic recreation profession, three
different professional associations merged in 1966 to
76 ^ American Horticultural Therapy Association

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become the National Therapeutic Recreation Society recognized by the Commission on Accreditation of
(NTRS), the fourth branch of the National Recreation Rehabilitation Facilities (CARF) as members of the
and Park Association (NRPA) (Van Andel, 2002). The comprehensive core treatment team in the acute brain
NRPA with a membership of 15,000 at that time injury, the post-acute brain injury, and the inpatient
promised greater visibility and potential for growth. rehabilitation standards. The Health Care Financing
However, the treatment aspect of therapeutic Administration (HCFA) includes recreational therapy
recreation did not receive the support from NRPA that in the mix of treatment and rehabilitation services used
those in NTRS felt was critical for the advancement of
to determine compliance with the federal government's
commitment to quality care in rehabilitation, skilled
the profession. During this same period, the health care
industry was changing rapidly and although members nursing, and long-term care facilities (ATRA, 2002). In
of NTRS saw the importance of interaction with the addition to active participation in JCAHO and CARF,
the American Therapeutic Recreation Association
health care industry for the profession, they could not
convince NRPA of this (Van Andel, 2002). Thus, in actively participates in the national legislative arena
1984 a new association, the American Therapeutic and at the state level.

Recreation Association, was founded. Currently there

are two member associations for professionals in Occupational therapy as a defined profession is the
therapeutic recreation. oldest of these four allied therapies, having been
founded in the early 1900s. The National Society for
Even with these different philosophies andthe Promotion of Occupational Therapy was founded
in 1917, changing its name to the American
associations, the profession of therapeutic recreation
has become recognized and successfully established asOccupational Therapy Association in 1921 (AOTA,
an important component of medical treatment. This 2002).
is Although occupational therapy emerged as a
evidenced by the fact that a minimum of a bachelor's profession considerably sooner than the other
degree is required to enter the profession and it hastherapies, studying its role in the medical profession
become more and more critical to be credentialed as and how it got there may prove useful.
well. The United States Department of Labor projects
As the American Occupational Therapy
that there are over 38,000 recreational therapists in the
United States (U.S. Department of Labor, 1998).Association
Over grew its membership and expanded its
17,000 of these professionals are professionally services during the 1920s and 1930s, the role of the
certified by the National Council for Therapeutic occupational therapist in medical care became more
Recreation Certification, which began in 1981 clearly defined. The Association began holding annual
(NCTRC, 2002). Credentialing as a certified meetings and publishing an official journal in 1922. In
1923 a national registry of qualified occupational
therapeutic recreation specialist is rapidly becoming
therapists was started. Also in 1923, accrediting
essential for employment (Wenzel, 2002). Through the
educational programs became a stated function of the
efforts of the NCTRC, the credentialed therapeutic
AOTA and basic educational standards were
recreation practitioner has greater standing in the
healthcare and human service arena (NCTRC, 2002).developed. A joint effort between AOTA
Council on Medical Education of the American
Forty-one bachelor's programs are currently accredited
Medical Association began accrediting education
by the National Recreation and Park Association/
American Association for Leisure and Recreation programs in 1935 (Punwar, 1994). Currently there
Council. more than 300 programs at colleges and univers
accredited by the AOTA Accreditation Council
Occupational Therapy Education (AOTA, 2002).
Recreational therapists are recognized as one of the
physical rehabilitation services in the Joint
Commission on Accreditation of Healthcare There are three different levels of occupatio
Organizations (JCAHO) standards (ATRA, therapy personnel. The registered occupation
2002).
therapist (OTR) is a graduate of a baccalaure
Recreational therapists are standard treatment team
certificate,
members in psychiatric rehabilitation, substance abuseor an entry-level master's degree prog
(beginning
treatment, physical rehabilitation, and long term care in 2007 will be master's degree prog
services in both in-patient and out-patient only)settings
(AOTA, 2002). The OTR evaluates and trea
(ATRA, 2002). Recreational therapists are also deficiencies in occupational performance areas

Journal of Therapeutic Horticulture 77

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their components and manages occupational therapy
service programs (Punwar, 1994). The certified
occupational therapy assistant (COTA) is a graduate of
a certificate or associate degree program of technical
education and is prepared to collaborate with OTRs in
providing occupational therapy services. This level of
practice began to be recognized through certification in
1958 (AOTA, 2002). The occupational therapy aide
usually has no formal education in the field but
receives on-the-job training that equips him or her to
assist with routine procedures in occupational therapy
programs (Punwar, 1994). The National Board for
Certification in Occupational Therapy (NBCOT) is the
certifying body for the OTRs and COTAs. More than
140,000 practitioners have obtained credentials
through NBCOT (NBCOT, 2002).
health care relations; stating and promoting standards
of clinical practice and code of ethics for professional
conduct; defining and communicating entry level skills
and educational attainment; developing and
implementing systems for approval or accreditation of
educational programs and clinical practice sites; and
having independent credentialing boards. Based on
this historical review of the development of the
profession of horticultural therapy and its comparison
with other allied therapeutic professions, the
profession of horticultural therapy and the AHTA have
seen many successes since its inception but this
comparison suggests there is much yet to be
accomplished.
Discussion

Currently AOTA membership consists of more It should be suggested that for the profession
than 50,000 occupational therapists and occupational of horticultural therapy to grow and thrive, the
therapy assistants. As an advocate for the profession, practitioners, researchers, and educators of horticultural
AOTA is a founding member of CARF, serves on the therapy must come together to clearly define what it
Liaison Network of JCAHO, and is active in the means to be a professional horticultural
therapist
National Committee for Quality Assurance, which is and, perhaps more importantly, to then
communicate it effectively to all constituent groups.
dedicated to improving the quality of healthcare
(AOTA, 2002). Through AOTA and NBCOT, close
relationships with federal and state agencies for health The founding name of the horticultural therapy
care are maintained, which are reflected in the professional association, - the National Council for
Therapy and Rehabilitation through Horticulture -
certification process and their assistance in state
licensure requirements for occupational therapists. recognized two philosophies of horticultural therapy in
the early 1970s. Rehabilitation was part of the title since
many horticultural therapy programs in the early 1970s
The American Horticultural Therapy Association
were found in vocational training and rehabilitation
has significantly less members than the other allied
therapy professional associations. Currently, centers
the for the developmentally disabled. Therapy was
AHTA Web site lists no educational requirement part for of the title since many programs were found in
psychiatric
entering the profession. Based on the author's review hospitals (Mattson, R., 2002, personal
of horticultural therapy position announcements communication). This philosophical difference is also
evident
received at Kansas State University and the results of in discussions from the 1970s to current times
regarding the use of the term therapeutic horticulture
mailed surveys of practicing horticultural therapists
(data not published), some entry-level positions versus horticultural therapy to distinguish between the
require a high school diploma and others require general use of horticulture with any population in any
a bachelor's degree. The AHTA does provide a setting to promote well-being and the use of horticulture
credential, but since it is a voluntary peer review for treatment of a disease or disability. This distinction
process, it is not a recognized credential in health care. is evident in the United Kingdom where the association
AHTA has developed a core curriculum for Thrive was formed to promote grassroots programming
horticultural therapy but does not have an accreditation focusing on gardening for all without an emphasis on
system in place. the medical aspects while the medical basis of
horticultural therapy exists within occupational therapy
The professional associations for music therapy, art
training at Oxford University.
therapy, and therapeutic recreation were all founded to
represent the interests and needs of their constituency. Given that the act of gardening, doing other plant-
This has been done through building government andrelated activities, and even the passive experience of
seeing, smelling, or listening to plants and nature can

78 ^ American Horticultural Therapy Association

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be therapeutic (Kaplan & Kaplan, 1989; Lewis, 1996;
Simson & Straus, 1998), the profession of horti-
cultural therapy is then challenged to define itself since
if this is the theory behind horticultural therapy, then
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Journal of Therapeutic Horticulture ^ 81

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