Building Sustainability in Occupational Therapy Through Nature-Based Practices
Written by Hannah K. Burke, MS, OTR/L
“Occupational therapists are implicated – actually obligated in our view by virtue of our special knowledge of occupation, occupational injustice, and environmental forces – to enable ecological sustainability and justice through occupation” (Algado & Townsend, 2015, p. 184)
Human occupations are inextricably and reciprocally linked to the health of the natural environment (Lieb, 2020). Occupational therapists are positioned to facilitate human occupational engagement that is aligned with environmentalism. Looking at client health and well-being in conjunction with the health of the planet allows therapists to address occupational injustices that arise due to environmental degradation and lack of access to green spaces/activities. One way to work towards alignment between environmentalism and occupational therapy is through nature-based practice.
Nature-Based Therapy
“Nature-based therapy” is a broad term that crosses disciplines, including mental health and rehabilitation professions. Nature-based practices broadly involve the use of nature/the outdoors or natural elements (Harper et al., 2021); they are “place-oriented and relational: in nature, and with nature” (Harper et al., 2019, p. 31). These practices have existed within occupational therapy since the beginning of the profession in the form of gardening/horticulture interventions (Koch, 2019). Because of the strong connection between nature-based occupations and well-being (see for example: Chawla, 2015; White et al., 2017), occupational therapists now engage in nature-based practices across settings and with diverse client populations.
Impact on Sustainability
Integrating nature-based elements into therapy is a way to support sustainable occupational engagement for clients and communities. Spending time in nature is thought to help people develop greater appreciation for the fact that humans are a part of nature and that the health of the individual is tied to the health of the planet (Chaudhury & Banerjee, 2020). Increased time spent in nature as children is linked to later increased conservationist behaviors and environmental activism (Chawla & Derr, 2012; Deville et al., 2021; Ernst et al., 2021). When this activism reaches beyond the individual therapy context, it has the potential to spread to families and communities.
Supporting individual client occupational engagement in nature-based activities is therefore a way occupational therapists can address client well-being while also impacting larger systems.
Nature-Based Practices in Occupational Therapy
There are many general categories of nature-based practices used by occupational therapists. Here are just a few ways various nature-based occupational therapy practices can support environmentalism for clients and communities:
Horticulture therapy – “the use of plants as a therapeutic medium by a trained professional to achieve a clinically defined goal” (Kam & Siu, 2010, p. 80)
Provides connection to the land through occupational engagement
Teaches strategies for sustainable food production within communities
Animal-assisted therapy – supporting client goal attainment through human-animal connection and interaction (Winkle & Ni, 2019)
Creates caring relationships with non-human beings
Gives opportunities to appreciate the value of non-human beings
Adventure therapy – “commonly utilizes adventure-based activities [such as kayaking, rock climbing, etc.], experiential learning theory and outdoor environments to facilitate a therapeutic effect” (Jeffery, 2020, p. 109)
Provides access to activities in nature that may have been previously impossible due to systemic barriers
Demonstrates ways to find joy and accomplishment in nature activities that may be novel and highly motivating
More broadly, nature-based therapy is considered to be “intentional therapeutic processes that are (1) place-based, (2) feature active bodily engagement, and (3) recognize nature-human kinship” (Harper et al., 2021, p. 1). They invite a personal relationship with nature, as nature is the co-therapist, and give the opportunity for clients to explore how they fit into the natural world. Participation in this type of intervention teaches skills and ignites enthusiasms that can lead to valued leisure activities, friendships, or career paths.
Therapists can incorporate specific nature-based practices and sustainability into their work with clients even outside these specific treatment approaches. When building an occupational profile, therapists can investigate what role nature and nature-based occupations play in a client’s life and the life of their family. Evaluations should include assessment of contextual factors that limit access to engagement with nature.
Importantly, therapists should always consider that “nature” can have many meanings – for some it might be a weekly hike, for others it might be looking out of a window to see a tree or to hear birds singing. The expertise occupational therapists have in individualizing intervention to be client-centered is applicable in finding a nature connection that is relevant and personally meaningful. Even outside of a specific nature-based approach, therapists can still support clients in accessing, enjoying, and appreciating nature and nature-based activities that fit their interests and goals. This could include interventions that facilitate client activism to increase green spaces in their communities, that support client development of skills related to accessing valued nature activities, or that bring natural elements into clients’ preferred spaces such as through container gardening.
Engaging in nature-based therapy practices has the power to connect our profession to a role in activism related to the health of the planet and its peoples on a larger scale. Protecting the planet becomes integral to working with clients and supporting ongoing occupational engagement in nature through the generations.
To achieve this large-scale impact, nature-based occupational therapy practices must be embedded within a community (Turcotte & Drolet, 2020) so that:
Land and natural resources are engaged with respectfully.
Communities themselves can be mobilized to address systemic issues around access to nature/green spaces locally.
Benefits of engagement with and connection to nature can be communal and go beyond the individual client.
Conclusion
Nature-based practices have always been a part of occupational therapy as a profession. Specifically, nature-based occupational therapy provides one route to addressing occupational injustices related to environmental issues by supporting clients’ access to personally meaningful engagement with the natural world. Engaging with nature as part of the occupational therapy treatment process will continue to move the profession towards a commitment to larger systemic changes that address the climate crisis.
Author Hannah Burke can be contacted on Instagram at @thenaturebasedot
References
Algado, S. S., & Townsend, E. A. (2015). Eco-social occupational therapy. British Journal of Occupational Therapy, 78(3), 182–186. https://doi.org/10.1177/0308022614561239
Chaudhury, P., & Banerjee, D. (2020). “Recovering with nature”: A review of ecotherapy and implications for the COVID-19 pandemic. Frontiers in Public Health, 8, 1–12. https://doi.org/10.3389/fpubh.2020.604440
Chawla, L. (2015). Benefits of nature contact for children. Journal of Planning Literature, 30(4), 433–452. https://doi.org/10.1177/0885412215595441
Chawla, L., & Derr, V. (2012). The development of conservation behaviors in childhood and youth. In The Oxford handbook of environmental and conservation psychology. (Issue August 2021). https://doi.org/10.1093/oxfordhb/9780199733026.013.0028
Deville, N. V., Tomasso, L. P., Stoddard, O. P., Wilt, G. E., Horton, T. H., Wolf, K. L., Brymer, E., Kahn, P. H., & James, P. (2021). Time spent in nature is associated with increased pro-environmental attitudes and behaviors. International Journal of Environmental Research and Public Health, 18(14). https://doi.org/10.3390/ijerph18147498
Ernst, J., McAllister, K., Siklander, P., & Storli, R. (2021). Contributions to sustainability through young children’s nature play: A systematic review. Sustainability (Switzerland), 13(13), 1–36. https://doi.org/10.3390/su13137443
Harper, N. J., Fernee, C. R., & Gabrielsen, L. E. (2021). Nature’s role in outdoor therapies: An umbrella review. International Journal of Environmental Research and Public Health, 18(5117), 1–13. https://doi.org/10.3390/IJERPH18105117
Harper, N. J., Rose, K., & Segal, D. (2019). Nature-based therapy: A practitioner’s guide to working outdoors with children, youth, and families. New Society Publishers.
Jeffery, H. (2020). Adventure therapy: Using adventurous activities as occupational therapy. Scope: Health and Wellbeing, 5, 109–115. https://doi.org/10.34074/scop.3005016
Kam, M. C. Y., & Siu, A. M. H. (2010). Evaluation of a horticultural activity programme for persons with psychiatric illness. Hong Kong Journal of Occupational Therapy, 20(2), 80–86. https://doi.org/10.1016/S1569-18611170007-9
Koch, L. (2019). The use of nature as a treatment modality in occupational therapy. Honors Theses. https://scholarworks.wmich.edu/honors_theses/3163
Lieb, L. C. (2020). Occupation and environmental sustainability: A scoping review. Journal of Occupational Science, 0(0), 1–24. https://doi.org/10.1080/14427591.2020.1830840
Turcotte, P.-L., & Drolet, M.-J. (2020). Les ergothérapeutes doivent déclarer l’urgence climatique / Occupational therapists must declare the climate emergency. Canadian Journal of Occupational Therapy, 87(3), 169–172. https://doi.org/10.1177/0008417420919557
White, M. P., Pahl, S., Wheeler, B. W., Depledge, M. H., & Fleming, L. E. (2017). Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing. Health and Place, 45(January), 77–84. https://doi.org/10.1016/j.healthplace.2017.03.008
Winkle, M. Y., & Ni, K. (2019). Animal-assisted occupational therapy: Guidelines for standards, theory, and practice. In Handbook on Animal-Assisted Therapy (pp. 381–397). Elsevier. https://doi.org/10.1016/B978-0-12-815395-6.00025-0