Horticultural therapy and therapeutic gardens

1. Introduction

Version followed: the American Horticultural Therapy Association (AHTA) Definitions and Positions paper (June 2017 revision of the 1997 paper) and AHTA Standards of Practice for Horticultural Therapy (adopted March 2015, effective June 2015), with the UK Association of Social and Therapeutic Horticulture (ASTH) Practice Standards (developed by Thrive and Trellis) for UK practice and the chapter structure of Haller and Capra, Horticultural Therapy Methods (3rd ed., 2025). [source: AHTA Definitions and Positions; AHTA Standards of Practice; ASTH Practice Standards; Routledge/CRC Press book page]

Horticultural therapy is not a psychotherapy school but a goal-directed professional modality. AHTA defines horticultural therapy as participation in horticultural activities facilitated by a registered horticultural therapist to achieve specific goals within an established treatment, rehabilitation or vocational plan, and states that the process itself, not the end product, is the therapeutic activity. Therapeutic horticulture is the broader, wellbeing-oriented practice, facilitated by a registered horticultural therapist or another professional trained in horticulture as a therapeutic modality, using active or passive involvement with plants. A therapeutic garden, in AHTA's wording as cited by Oklahoma State Extension, is "a component of a treatment, rehabilitation or vocational program". In the UK the field is called social and therapeutic horticulture (STH); the ASTH standards describe an STH practitioner as "a trained professional who engages with people using plants" and name three routes to benefit: time in nature, meaningful activity, and a positive social environment. [source: AHTA Definitions and Positions; Richmond and Dunn 2023; ASTH Practice Standards]

Core idea of change: assessed, graded tasks with living plants give a person repeated success, purposeful routine, sensory engagement and social contact, and the therapist uses those tasks as the vehicle for measurable cognitive, emotional, social, physical or vocational goals. AHTA's stated core value is that people's relationships with plants relate to quality of life and support emotional, mental and physical health; this is attributed to AHTA as a value, not stated here as established fact. [source: AHTA Definitions and Positions]

Evidence status in one line: a meta-analysis of 22 studies found a positive overall effect of gardening on health outcomes with signs of publication bias (Soga, Gaston and Yamaura); a 2022 meta-analysis of 13 studies in older adults found lower depression scores with horticultural therapy but very high heterogeneity and a small, mostly Asian evidence base (Zhang, Wang and Fang). [source: Soga et al., Exeter repository record; Zhang et al. 2022]

For the psychotherapist this guide covers four roles: delivering horticultural therapy or therapeutic horticulture where you hold the training (AHTA registration or a UK STH qualification); integrating plant-based tasks into your own therapy; preparing, referring and debriefing a client who attends a programme such as Thrive's; and working with the meaning of gardening, gardens and plant loss in the client's life. Related guides: green social prescribing (015), blue care and open-water swimming (022), behavioural activation (II 040). [synthesis]

2. Framework

The AHTA Standards of Practice set out the treatment process as a cycle rather than a fixed number of sessions. [source: AHTA Standards of Practice, Standard 4]

Phase 1: Referral and assessment. Goal: decide whether horticulture fits the person's needs and collect what you need to plan safely. AHTA Standard 4 requires a confidential assessment covering diagnostic data, physical, social, mental and emotional aptitude, and current horticultural skills; Standard 5 requires the file to hold the referral documentation. ASTH asks practitioners to gather information from referral partners, carry out an initial assessment usually recorded in a written personal plan, and keep assessing the client and the delivery context on an ongoing basis. Move on when you have enough information to name precautions and goals. [source: AHTA Standards 4 and 5; ASTH standards 3, 4, 6]

Phase 2: Treatment or personal planning. Goal: an individual plan that lists precautions, restrictions, goals, objectives and discharge or transition goals, with goals written in observable behavioural terms and set with the participant (and family where feasible). ASTH adds considering how the individual plan works inside a group. Move on when the participant has agreed the goals and the risk assessment is complete. [source: AHTA Standard 4; ASTH 5.1-5.2]

Phase 3: Activity planning and sessions. Goal: select, analyse, grade and adapt horticultural tasks that serve the objectives, schedule them around the growing season and indoor alternatives, and run individual or group sessions. AHTA Standard 6 notes that programmes are seasonal and may depend on greenhouses or indoor light gardens; ASTH asks practitioners to plan for maximum engagement while staying flexible in the moment, and gives a typical staffing ratio of 1:4, ranging from 1:1 to 1:7 according to need. [source: AHTA Standards 3 and 6; ASTH 12, 25, 34.1]

Phase 4: Monitoring and review. Goal: record specific participant responses to activities, review the plan at set intervals, and revise goals with the participant. Criterion for change: objectives met, stalled, or no longer relevant. [source: AHTA Standards 4 and 5; ASTH 8-9]

Phase 5: Discharge and transition. Goal: a documented discharge or transition plan and, in AHTA's clinical standard, resources for continued involvement after treatment (for example garden clubs or community horticulture). ASTH covers ending mainly where a client's needs exceed the practitioner's competence: stop, refer to an emergency contact, GP or social worker, and support the client until the handover. [source: AHTA Standards 3, 4, 5; ASTH 1.2-1.3, 29]

Session count and format. Neither AHTA nor ASTH fixes a number or length of sessions. Programme examples in sources: Thrive's Sow & Grow programme for people over 50 runs for 12 weeks; in the studies pooled by Zhang et al., sessions were mostly 60 to 90 minutes, usually weekly, and programmes most often 6 to 24 weeks, delivered in groups. Formats include individual, small-group and large-group work, indoors (greenhouse, community room, kitchen table, bedside) or outdoors. [source: Thrive Impact Report 2023; Zhang et al. 2022; Richmond and Dunn 2023; AHTA Standard 1]

Programme types named by AHTA. Clinical (goal-oriented treatment), vocational (work skills through pre-vocational to competitive employment), educational (skills for home and community, links to garden clubs and industry) and therapeutic horticultural services (quality of life through passive and active activities). [source: AHTA Standard 3]

Training and credentials. AHTA registers horticultural therapists as HTR (undergraduate degree, specified human-science, horticulture and horticultural therapy coursework, and a 480-hour supervised internship or equivalent experience) and therapeutic horticulture practitioners as THP (therapeutic horticulture coursework and at least 500 hours of work). NC State Extension (updated January 2026) states there is no US licensure for horticultural therapists and that certificate holders may not claim licensure or certification. An AHTA content outline for a Horticultural Therapist - Board Certified (HT-BC) examination, dated July 2026, lists six domains: horticulture; treatment plan; programme planning and activity design; managing human resources; business practice, safety and ethics; professionalism and scholarship. Check the current status of HT-BC with AHTA before relying on it. [source: AHTA Definitions and Positions; NC State Extension credentialing page; AHTA HT-BC Content Outline] [uncertain: HT-BC implementation date] In the UK, Thrive runs Higher Education courses accredited by the Open College Network London. [source: Thrive Impact Report 2023]

3. Guiding principles

Process over product. The plant, bouquet or harvest is the vehicle, not the goal; judge sessions by progress on the person's objectives, not by how the garden looks. [source: AHTA Definitions and Positions]
Goal-directed and measurable. Each task is chosen for a named objective written in observable terms; if you cannot say which objective a task serves, pick another task. [source: AHTA Standard 4]
Individual assessment first. Plan around the person's health, culture, economic, social and educational background; ask about these before choosing activities. [source: AHTA Standard 1]
Participant initiative and choice. Let participants choose activities, set personal goals and take leadership roles; offer two or three options rather than assigning one. [source: AHTA Standard 1]
Success at the optimal level. Grade tasks so the person works at their best level and succeeds; break a task down further when it fails, rather than blaming the person. [source: AHTA Standard 1; ASTH 25]
Use of the senses. Build in sight, touch, smell, sound and, where safe, taste; choose fragrant and textured plants for people with visual impairment. [source: AHTA Standard 1; Hazen, Therapeutic Garden Characteristics; Richmond and Dunn 2023]
Adapt, do not exclude. Modify tasks, tools and spaces (accessible facilities, raised beds, wide smooth paths, bedside work) so that disability is not a barrier. [source: AHTA Standard 1; Richmond and Dunn 2023]
Social and community connection. Encourage group work and, where feasible, contact with the public (plant sales, garden tours); plan at least one shared element in group sessions. [source: AHTA Standard 1]
Balance nature, social and occupational benefit. Use ongoing assessment to adjust the mix of time in nature, meaningful activity and social contact for each person. [source: ASTH 11]
Safety is planned. Keep a written safety plan for onsite and offsite work, safe tools and protective equipment, and safety data sheets for any products; brief participants at induction and refresh. [source: AHTA Standard 2; ASTH 15-16, 35-37, 46]
Know and stay within competence. Deliver only programmes you are suitably trained and experienced to run safely, keep up continuing education, and refer on when needs exceed your competence. [source: ASTH 1.2, 17-18; AHTA Definitions and Positions]
Safeguarding overrides confidentiality. Follow safeguarding procedures and report suspected abuse or neglect promptly; record your reasons when you share information. [source: ASTH 37.1, 50.1, 52]
Respectful relationships. Haller and Capra's text gives a chapter to respectful relationship with self, with clients and with plants; treat this as part of the therapeutic stance. [source: Routledge book page, chapter 4 by Jay S. Rice] [uncertain: chapter content not verified]
Therapeutic use of self. The horticultural therapist's own attending and responding skills are part of the method; training covers attending (SOLER) and responding to content, feeling and meaning. [source: Rutgers HT course syllabus; Routledge book page, chapter 5]
Rights and ethics. Design services to respect the rights of participants and families, follow disability and patients'-rights law and the AHTA Code of Professional Ethics. [source: AHTA Standard 7]
Dual roles are declared. If you are both the client's psychotherapist and the garden facilitator, or meet clients in a community garden you also use, agree boundaries in advance; the APA Ethics Code Standard 3.05 (Multiple Relationships) applies to psychologists. [source: APA Ethics Code] [synthesis]
The garden is a public-ish space. Outdoor work can be seen and overheard; contract about confidentiality, being seen, weather plans and touch before the first outdoor session. [synthesis]

4. Intervention inventory

The sources set out a process (assessment, planning, task analysis, grading, adaptation, documentation) and name activity types; they do not publish a manualised list of scripted techniques. The activities below are the ones AHTA, Oklahoma State Extension, the AHTA HT-BC outline and the trials pooled by Zhang et al. name; the step-by-step wording is written for a clinician and marked [synthesis] where it goes beyond the sources. Haller and Capra's chapters on session planning, therapeutic interventions and treatment strategies (Appendix IV) are the fuller primary reference. [uncertain: contents of those chapters]

4.1 Referral, suitability screening and preparing a client for a programme

Purpose / when: before you deliver horticultural work yourself or refer a client to an HT or STH programme (for example Thrive or a hospital HT service). AHTA requires referral documentation in the file; ASTH asks practitioners to gather information from referral partners and to signpost clients to a better-suited practitioner where practicable. [source: AHTA Standard 5; ASTH 1.1, 3]
Steps: (1) Ask what draws the client to gardening and what they hope will change. (2) Screen qualitatively for physical limits, pain, allergies (pollen, latex, plant sap), skin conditions, sun sensitivity (including medicines the client says make them sun-sensitive; check with their prescriber, do not advise on the medicine), mobility and fall risk, current risk of self-harm, and any history linked to land work or farm labour. (3) Ask about tetanus vaccination status and direct the client to their GP or physician if unsure. (4) With consent, send the programme a referral covering goals, precautions and who to contact in a crisis. (5) Tell the client what a first session is likely to involve (induction, tour, a small task), what to wear, and that they can sit out any task. (6) Agree how you and the programme will share information. [source: RHS health risks page for tetanus, allergies, sap; ASTH 1.1, 3] [synthesis: steps 1, 2, 4-6]
Example language (illustrative): "Before I send the referral, can we go through anything that might make garden work harder for you: your back, allergies, the sun, or anything about being outdoors with a group?"
Watch for: a client agreeing in order to please you; unrealistic hopes for a cure; fear of being seen by neighbours. Working: the client attends the induction and can name one personal aim.

4.2 Horticultural therapy assessment

Purpose / when: at intake and on an ongoing basis, to set precautions and goals. AHTA's assessment covers diagnostic data, physical, social, mental and emotional aptitude, and current horticultural skills; the Rutgers HT syllabus teaches assessment as its own unit. [source: AHTA Standard 4; ASTH 4, 6; Rutgers syllabus]
Steps: (1) Review the chart and referral. (2) Interview: gardening history, favourite and disliked plants, culturally meaningful plants or foods, interests, goals. (3) Observe a short standard task (for example filling and sowing a pot) and note grip, reach, balance, attention, following instructions, frustration tolerance and social behaviour. (4) Record current horticultural skill. (5) List precautions and restrictions (sharps, toxic plants, sun, standing tolerance, swallowing or pica risk in dementia). (6) Keep the assessment confidential and in the file. [source: AHTA Standard 4; Richmond and Dunn 2023 for dementia ingestion risk] [synthesis: steps 2-3]
Example language (illustrative): "I'd like to watch you pot up this seedling while we talk; it tells me which tasks will suit you. There's no right way to do it."
Watch for: performance anxiety in the observed task; over-reporting of skill; hidden pain. Working: you can write two precautions and two objectives from what you saw.

4.3 Collaborative goal setting and the individual plan

Purpose / when: after assessment and at each review. The plan states precautions, restrictions, goals, objectives and discharge or transition goals; the participant helps set goals and family is involved where feasible. [source: AHTA Standards 3 and 4; ASTH 5, 9]
Steps: (1) Turn the client's hope into a broad goal in their words. (2) Write two or three objectives in observable terms (who does what, under what conditions, to what standard). (3) Link each objective to candidate horticultural tasks. (4) Agree how progress will be measured (behavioural observation, the client's own rating, or a standard measure your service uses). (5) Set the next review point. (6) Record a transition goal from the start. [source: AHTA Standard 4; Rutgers syllabus on goal setting and behavioural measurement] [synthesis: steps 1, 4]
Example language (illustrative): "You said you want to get out of the house more. Could we make that: you arrive at the garden, choose a task and stay with it until the tea break, three sessions in a row?"
Watch for: goals that are the therapist's not the client's; goals measured by plant success instead of the person's behaviour. Working: the client can say the goal back and recognises progress.

4.4 Activity selection and task analysis

Purpose / when: each time you plan a session. Activities are chosen by participant need to address cognitive, affective, psychomotor and psychosocial functioning; task analysis is a core HT skill in the HT-BC outline and the Rutgers syllabus. [source: AHTA Standard 3; AHTA HT-BC Content Outline; Rutgers syllabus; Routledge book page, chapter 3 by Pamela A. Catlin]
Steps: (1) Start from the objective, not the plant. (2) List candidate tasks by goal domain, for example cognitive (planning a bed, sequencing sowing), physical (digging, weeding, fine-motor work with seeds), social (shared planting, making a bouquet for someone), emotional (calming tasks, bird watching). (3) Break the chosen task into steps and note the demand of each (grip, reach, attention, memory, decision-making, tolerance of mess). (4) Mark where the person may fail and plan the support. (5) Check the season and what plant material is available. [source: Richmond and Dunn 2023 for domain examples; AHTA Standard 6 for seasonality] [synthesis: steps 3-4]
Example language (illustrative): to a colleague: "Today's objective is sustained attention, so I've chosen pricking out seedlings: it needs care for one tray at a time and finishes with something visible."
Watch for: tasks that are busywork; tasks too long for attention span. Working: the task produces observable behaviour on the objective.

4.5 Grading, adaptation and adaptive tools

Purpose / when: whenever a task is too hard or too easy, or a disability limits access. AHTA requires modified activities, adaptive tools, accessible facilities and accommodation for wheelchair users and bedside work; ASTH asks practitioners to select, adapt and grade tasks to support independence and progression. [source: AHTA Standard 1; ASTH 25; AHTA HT-BC Content Outline]
Steps: (1) Grade up or down by changing one variable at a time: number of steps, choice offered, size of plant material, tool, posture (seated, standing, raised bed), time pressure, independence of instruction. (2) Adapt the environment: raised beds or tables at reach height, wide smooth paths, shaded seating. (3) Adapt tools: lighter, longer-handled or thicker-gripped tools as your service supplies [synthesis]. (4) Fade support as competence grows. [source: Richmond and Dunn 2023 for environmental adaptations] [synthesis: steps 1, 3, 4]
Example language (illustrative): "Let's try this at the raised table so you can sit. If the small seeds are fiddly, we'll use the bigger ones today."
Watch for: adaptation that feels infantilising; under-challenge leading to boredom. Working: the person completes more of the task with less help over sessions.

4.6 Risk assessment, safety induction and the safety plan

Purpose / when: before the programme starts, at each new site and at induction and refresher points for clients. AHTA requires a safety plan for onsite and offsite programmes and accessible safety data sheets; ASTH requires documented programme-specific risks (client mix, site, public access), safe tools and PPE, inductions and refreshers, and attention to lone working. [source: AHTA Standard 2; ASTH 15-16, 43, 46-47; AHTA HT-BC outline]
Steps: (1) Walk the site for trip hazards, steps, water, shade and exits. (2) Check plants for toxic or irritant species (the RHS flags plants whose sap or hairs can blister or irritate, such as euphorbia, rue, ivy and fremontodendron) and remove or label those that are a risk to your group, especially people with dementia. (3) Plan for the RHS-listed garden risks qualitatively: dampen dusty compost and potting media and avoid potting in confined spaces (Legionella and bioaerosols), gloves and covered wounds (tetanus), rat hygiene and gloves around ponds (leptospirosis), latex-free gloves for allergy sufferers, handwashing before eating, and avoiding pesticides. (4) Add weather, sun, shade, hydration and tick checks to the plan [synthesis]. (5) Agree tool rules and, in secure or high-risk settings, a tool sign-out and count [synthesis]. (6) Brief participants in plain language and record incidents. [source: RHS Minimising health risks; Hazen on avoiding hazardous chemicals; Richmond and Dunn 2023]
Example language (illustrative): "Three things before we start: gloves on for compost and pruning, tools go back in the rack when you put them down, and if you feel unwell or too hot, sit in the shade and tell me."
Watch for: safety talk that frightens anxious clients; staff complacency on familiar sites. Working: no incidents, and participants remind each other of the rules.

4.7 Structuring a session

Purpose / when: every session. AHTA and ASTH require planning around objectives with flexibility in the moment; Haller and Capra's chapter 6 covers goals and documentation as the basis for sessions and session review and evaluation. [source: ASTH 12; Routledge book page, chapter 6] [uncertain: chapter 6 content]
Steps: (1) Arrival and check-in: who is here, how each person is, weather and site changes. (2) Orientation to the task and to the space (AHTA asks for orientation to the physical environment to support independence). (3) Demonstration and choice of tasks. (4) Task period with you circulating and using attending skills. (5) Clear-away, with tool return. (6) Closing: what was done, what people noticed, what will happen to the plants next week. (7) Record responses. [source: AHTA Standard 1 for orientation; AHTA Standard 5 for recording] [synthesis: overall sequence]
Example language (illustrative): "Before we go, let's look at what we've planted today. Who wants to say one thing they noticed?"
Watch for: the task swallowing the close; one voice dominating check-in. Working: participants anticipate the routine and settle more quickly.

4.8 Sowing and propagation (seed and cuttings)

Purpose / when: for hope, anticipation, fine-motor work, following sequenced instructions and a reason to return; propagation from seed and cuttings is listed in the HT-BC horticulture domain and sowing in the Oklahoma State and Zhang et al. activity lists. [source: AHTA HT-BC outline; Richmond and Dunn 2023; Zhang et al. 2022]
Steps: (1) Choose quick, reliable seeds or easy cuttings for early success. (2) Demonstrate filling, firming, sowing and labelling. (3) Let each person label their own pot with name and date. (4) Agree who checks and waters between sessions. (5) Next session, look at germination together. [synthesis: steps]
Example language (illustrative): "Nothing will show for a few days. What's it like to plant something and have to wait?"
Watch for: distress if seeds fail (have back-up trays); a client reading failure as personal. Working: the client asks about their pots and returns to check them.

4.9 Transplanting, potting on and routine plant care (watering, weeding)

Purpose / when: for routine, responsibility, gross and fine motor work and steady attention; transplanting, maintenance, watering and weeding appear in the HT-BC outline and Oklahoma State list (weeding and digging under physical goals). For depressed clients, routine plant care can serve as a behavioural-activation task (cross-refer II 040). [source: AHTA HT-BC outline; Richmond and Dunn 2023] [synthesis: BA framing]
Steps: (1) Pair the task with an objective (for example, completing a full row before a break). (2) Give clear boundaries for the work area. (3) Offer seated options. (4) Point out visible change at the end. (5) Where a client has care tasks at home, agree one small plant-care activity between sessions. [synthesis]
Example language (illustrative): "This bed looked overgrown an hour ago. Look at it now. What did it take from you to get here?"
Watch for: pain or overexertion; do not set exercise targets, and route questions about physical activity to the client's physician or a qualified exercise professional. Working: the client starts tasks with less prompting.

4.10 Pruning, deadheading and cutting back

Purpose / when: for decision-making, judgement and tolerating removal; pruning and training are HT-BC horticulture tasks and pruning appears in Oklahoma State's active-programme list. Some clinicians use cutting back as a conversation about letting go or making room [synthesis]; offer this only if the client finds the idea useful, not as an interpretation imposed on them. [source: AHTA HT-BC outline; Richmond and Dunn 2023]
Steps: (1) Brief on sharp tools and irritant sap (gloves, covered arms). (2) Demonstrate one cut and why. (3) Let the client choose the next cut and say why. (4) Review the plant together. [source: RHS for irritant plants] [synthesis: steps 2-4]
Example language (illustrative): "Which stem would you take out? You decide, and I'll tell you what I'd look for."
Watch for: impulsive cutting, perfectionism, and sharps risk with clients at current risk of self-harm (use a supervised, counted tool or a different task). Working: the client tolerates uncertainty about whether a cut was right.

4.11 Harvesting, cooking and sharing produce

Purpose / when: for completion, reward, nurturing others and social contact; harvesting and planning distribution are HT-BC tasks, and cooking and tasting, preparing a group lunch and nutrition education appear in Oklahoma State and in trials pooled by Zhang et al. [source: AHTA HT-BC outline; Richmond and Dunn 2023; Zhang et al. 2022]
Steps: (1) Agree who the harvest is for (self, group, a family member, a plant sale). (2) Teach harvesting technique and hygiene (wash hands; do not eat unwashed produce). (3) Cook or prepare together if facilities and food-safety rules allow. (4) Close with the giving or sharing. [source: RHS hygiene] [synthesis: steps]
Example language (illustrative): "You grew these. Who would you like to give some to?"
Watch for: food and eating can raise disordered-eating concerns; do not give diet, calorie or weight advice; screen and refer to a registered dietitian or eating-disorder service, and for eating-disorder support point to the National Alliance for Eating Disorders. Allergies and swallowing problems need checking. Working: the client takes pride in giving or eating what they grew.

4.12 Flower arranging, pressed-flower and plant crafts

Purpose / when: for indoor, bedside or bad-weather sessions, creativity, choice and fine motor work; bouquet making, dried or pressed flower cards, painting plants and decorating paper with dried flowers appear in Oklahoma State and in the Zhang et al. studies (one included study used a brief bedside flower-arranging programme). [source: Richmond and Dunn 2023; Zhang et al. 2022]
Steps: (1) Lay out material with enough choice but not too much. (2) Demonstrate one technique. (3) Let the client compose freely. (4) Invite them to name or title the piece and decide where it goes. [synthesis: steps]
Example language (illustrative): "You picked mostly yellow. Tell me about that, if you'd like to."
Watch for: perfectionism and self-criticism; allergies to pollen or plant material. Working: the client makes choices without seeking your approval at each step.

4.13 Garden planning and design with the client or group

Purpose / when: for cognitive goals (visual-spatial processing, decision-making, goal-setting, planning ahead) and shared ownership; Oklahoma State lists planning a garden space under cognitive goals, and AHTA asks for participant initiative and leadership roles. [source: Richmond and Dunn 2023; AHTA Standard 1]
Steps: (1) Walk or view the space. (2) Ask what the group wants from it (food, colour, scent, a quiet corner). (3) Sketch a simple plan with plant choices by season. (4) Assign roles. (5) Revisit the plan as it is built and adjust. [synthesis: steps]
Example language (illustrative): "If this corner were yours for the summer, what would you want to find when you came here?"
Watch for: plans that outrun the group's capacity; conflict over choices (see 5.6). Working: clients refer to "our bed" and follow through on roles.

4.14 Passive and sensory engagement: viewing, sitting, sensory and calm gardens

Purpose / when: for people with limited energy or mobility, high distress, dementia or bedside care, and for stress reduction and emotional regulation. Oklahoma State lists viewing gardens, plants in the room, meditating in a garden, listening to nature sounds and bird watching as passive or emotional-goal activities; AHTA's therapeutic horticulture includes passive involvement and its standards ask for use of the senses. [source: Richmond and Dunn 2023; AHTA Definitions and Positions; AHTA Standard 1]
Steps: (1) Choose a sheltered, shaded seat with plants within reach. (2) Invite attention to one sense at a time: colour, texture of a leaf, scent of a crushed herb, sound. (3) Allow silence. (4) Ask what the client noticed and how they feel now compared with arrival. [synthesis: steps]
Example language (illustrative): "Take a leaf of the lemon balm and rub it between your fingers. What do you notice?"
Watch for: check plants are non-toxic and non-irritant before inviting touch or smell; dissociation or rumination in silence; insect stings and pollen allergy. Working: the client reports or shows settling (slower breathing, longer engagement). Zhang et al. excluded mere viewing or visiting of green space from their definition of HT, so treat passive work as therapeutic horticulture rather than the whole of HT. [source: Zhang et al. 2022]

4.15 Reminiscence and life-story work through plants and memory gardens

Purpose / when: for older adults, people with dementia and grief work; Oklahoma State lists talking about past gardening as a passive activity and names memory and meditation gardens and memory stimulation. [source: Richmond and Dunn 2023; Hazen on sensory design stimulating memory]
Steps: (1) Offer a familiar plant, herb or flower from the client's era or culture. (2) Ask an open question about where they knew it. (3) Follow the story and reflect feeling and meaning (responding skills in 4.18). (4) Where wanted, plant something linked to the memory. [synthesis: steps]
Example language (illustrative): "Does this smell remind you of anywhere?"
Watch for: sudden grief or loss of a garden or home; hold it rather than redirect it. Working: richer recall and positive affect.

4.16 Group horticultural projects and public contact

Purpose / when: for social skills, collaboration, conflict resolution, reducing isolation and community integration. AHTA asks for group participation and, where feasible, public interaction such as plant sales and garden tours; Oklahoma State lists growing a garden as a group; Zhang et al. found group delivery at the same time and place in their pooled studies and describe sharing experiences as a key element. Group work stages and dealing with difficult behaviour are taught in the Rutgers HT course. [source: AHTA Standard 1; Richmond and Dunn 2023; Zhang et al. 2022; Rutgers syllabus]
Steps: (1) Choose a task that needs more than one person (carrying, planting a bed, a shared sale stall). (2) Assign complementary roles. (3) Build in a shared break. (4) Close with group reflection. (5) For public events, prepare clients for being seen and agree what they will share about the programme. [synthesis: steps 1-4; 5 from outdoor-confidentiality rules]
Example language (illustrative): "We need two people on the trays and one keeping the labels in order. Who wants which?"
Watch for: exclusion, scapegoating, a client's discomfort at public exposure. Working: unprompted helping between participants.

4.17 Vocational horticulture and work-skills training

Purpose / when: for clients working towards employment or structured occupation; AHTA describes vocational services that teach work skills and monitor progress through pre-vocational, vocational and competitive employment, with productivity and job skills tracked for paid participants. [source: AHTA Standards 3 and 5]
Steps: (1) Define the target job behaviours (punctuality, following instructions, task completion, working alongside others). (2) Use real tasks with a work standard (for example, potting a batch to a set quality). (3) Record performance against the behaviours. (4) Plan a link to supported employment or volunteering. [synthesis: steps]
Example language (illustrative): "This week let's see whether you can run the potting bench on your own for the first half hour."
Watch for: pressure that recreates workplace trauma; exploitation of unpaid labour [synthesis]. Working: steady performance across sessions and readiness for the next step.

4.18 Therapeutic use of self: attending and responding during tasks

Purpose / when: throughout every session; the Rutgers HT course teaches attending skills (SOLER) and responding to content, feeling and meaning, paraphrasing and personalising, and Haller and Capra include therapeutic use of self, facilitation and motivation and behaviour-management techniques. [source: Rutgers syllabus; Routledge book page, chapter 5] [uncertain: chapter content]
Steps: (1) Work side by side; let the shared task carry silence. (2) Paraphrase what the client says. (3) Reflect feeling when it shows (for example, frustration at a broken seedling). (4) Reflect meaning when the client links the task to their life. (5) Offer specific praise for effort and process, not for plant success. [synthesis: steps]
Example language (illustrative): "You've gone quiet since the seedling snapped. It sounds like it matters to you to get things right."
Watch for: over-interpreting; turning every task into a metaphor. Working: the client brings up concerns while working.

4.19 Observation, documentation and progress review

Purpose / when: after each session and at set reviews; AHTA requires specific recording of participant responses, a file with referral, assessment, plan with measurable objectives, progress notes and a discharge summary, and compliance with health-privacy law; ASTH requires periodic review of personal plans and programme evaluation, with client feedback taken into account. [source: AHTA Standards 4 and 5; ASTH 8-9, 14, 31; Routledge book page, chapter 7]
Steps: (1) Note observable behaviour against each objective. (2) Note the client's own words about the session. (3) Record precautions or incidents. (4) At the review point, compare with baseline and revise the plan with the client. [synthesis: step detail]
Example language (illustrative): "Looking back over the last few weeks, you've stayed for the whole session each time. How does that compare with where you started?"
Watch for: notes that describe the plants and not the person; group notes that miss individuals. Working: notes allow another clinician to see the change.

4.20 Integrating plant work into office-based psychotherapy

Purpose / when: when you are not delivering HT but a client's interest in plants can serve therapy goals (behavioural activation, routine, mastery, care for something alive). [synthesis]
Steps: (1) Ask about plants, gardens and green space as part of activity scheduling. (2) Agree a small plant-care activity as a between-session task where it fits the client's goals (cross-refer II 040 behavioural activation). (3) Review it next session: what was done, mood before and after, obstacles. (4) If plant work grows into a significant resource, consider referral to an HT or STH programme (4.1) or green social prescribing (015). [synthesis]
Example language (illustrative): "You mentioned your windowsill herbs keep you going. Could looking after them be one of the small things we schedule this week?"
Watch for: a dying plant becoming evidence of failure; reframe as information about conditions, not character. Working: the client keeps the activity going and links it to mood.

4.21 Working with the meaning of gardens, plants and plant loss

Purpose / when: when a garden carries grief, identity, migration, family history or a lost home; when a client grieves a lost allotment, a parent's garden or a homeland's plants. [synthesis]
Steps: (1) Invite the story without assuming meaning. (2) Explore what the garden gave and what its loss took. (3) Ask whether the client wants a way to honour it (planting something, keeping seeds, visiting a similar place); the client decides. (4) Where grief is prolonged or complicated, assess as for any bereavement and cross-refer the Domain XV death and mourning guides. [synthesis]
Example language (illustrative): "What was your mother's garden like? What did you do there together?"
Watch for: ecological or spiritual meanings (for example, a felt kinship with living things) are the client's to hold; neither endorse nor dismiss them. Working: the client can speak about the loss with less avoidance.

4.22 Discharge, transition and continued involvement

Purpose / when: as objectives are met or a programme ends; AHTA requires discharge or transition planning and, for clinical services, resources for continued involvement after treatment; its educational services connect participants with garden clubs and horticulture industries. [source: AHTA Standards 3, 4, 5]
Steps: (1) Mark the ending ahead of time. (2) Review progress against the plan with the client. (3) Identify where gardening can continue: community garden, allotment, volunteering, a garden club, home growing. (4) Plan the first step and a back-up for winter. (5) Write the discharge summary. [synthesis: steps 1, 3-4]
Example language (illustrative): "We've got four weeks left. Where would you like to be growing things next spring?"
Watch for: loss of the group and the garden can feel like a bereavement; plan for it. Working: the client has a concrete next place to go.

4.23 Therapeutic garden design consultation

Purpose / when: when a service asks you to help plan a garden for clients. AHTA-published guidance by Teresia Hazen lists seven characteristics of a therapeutic garden: scheduled and programmed activities; features modified for accessibility; well-defined perimeters; a profusion of plants and people-plant interactions; benign and supportive conditions; universal design; and recognisable placemaking. Oklahoma State adds wide smooth aisles, raised beds, shaded benches, fragrant and textured planting, water or wind chimes, and dementia-safe design. Cooper Marcus and Sachs's Therapeutic Landscapes is the main design text [uncertain: content not verified]. [source: Hazen, Therapeutic Garden Characteristics; Richmond and Dunn 2023; Berkeley catalogue record]
Steps: (1) Identify who will use the garden and their needs. (2) Check the plan against the seven characteristics. (3) Advise on refuge, shade and enclosure for anxious or trauma-affected users, avoidance of hazardous chemicals, and safe planting for people at risk of ingestion. (4) Recommend a landscape architect with healthcare-garden experience. [source: Hazen; Richmond and Dunn 2023] [synthesis: steps 1, 4]
Example language (illustrative): to a manager: "A garden people can't find their way around won't get used. Simple loops, clear edges and seating in shade matter more than rare plants."
Watch for: a garden designed for show rather than use. Working: clients use the garden outside programmed sessions too.

5. Handling problems

The AHTA and ASTH standards address competence, safety, safeguarding and referral; most of the responses below are clinical synthesis and are marked as such.

5.1 Low motivation, non-attendance and withdrawal

Lower the demand: a smaller, seated or passive task (4.5, 4.14), or a single plant that is the client's own responsibility. [synthesis]
Offer choice rather than instruction, which AHTA names as a principle (participant initiative). [source: AHTA Standard 1]
Give the client a reason to return (seeds to check, a role in the group). [synthesis]
Repeated non-attendance: review goals with the client and referrer and ask what gets in the way (transport, weather, cost, social anxiety); ASTH asks that clients and referrers be told when a programme is no longer suitable. [source: ASTH 29] [synthesis: rest]

5.2 Plant failure, perfectionism and self-criticism

Keep back-up trays and quick-growing material so no session ends in total failure. [synthesis]
Name process over product, as AHTA's definition does: the work done counts whatever the plant does. [source: AHTA Definitions and Positions]
Use failure as a chance to explore the client's beliefs about failure, without forcing a metaphor. [synthesis]
Example (illustrative): "Seeds fail for lots of reasons: cold, old seed, too much water. What story did you tell yourself when you saw the empty tray?"

5.3 Overwhelm, sensory overload and distress in the garden

Have a quiet, shaded refuge spot agreed in advance; Hazen lists a protective setting that offers refuge as a design feature. [source: Hazen]
Reduce choice, noise and group size; ASTH's ratio range allows 1:1 work where needed. [source: ASTH 34.1] [synthesis: rest]
Use grounding through a single sense (4.14). If distress points to acute risk, follow your risk-assessment procedure and, under ASTH, stop, refer to an emergency contact, GP or social worker, and stay with the client until handover. [source: ASTH 1.2-1.3]
Crisis resources to give clients: 988 Suicide and Crisis Lifeline (US); Samaritans 116 123 (UK and Ireland). [synthesis]

5.4 Physical limits, pain, heat and weather

Adapt posture, tools and task (4.5); offer shade and seating; plan indoor alternatives (greenhouse, indoor light gardens, crafts) since AHTA notes programmes are seasonal. [source: AHTA Standards 1 and 6; Richmond and Dunn 2023]
Gardening is physical activity; do not prescribe amounts or intensities. Route questions about how much activity is safe to the client's physician or a qualified exercise professional. [synthesis]
Have a written weather plan (cancel, move indoors, shorten) agreed with clients before outdoor work, and a hydration and shade plan. Check for ticks after work in long grass, and route clients with concerns to their doctor. [synthesis]

5.5 Allergies, infection and plant toxicity incidents

Prevention as in 4.6 (gloves, latex-free gloves for allergy sufferers, damp compost, hand-washing, toxic and irritant plants removed or labelled, tetanus status). [source: RHS Minimising health risks]
If a client is cut and soil gets into the wound, the RHS advises seeing a GP for vaccination advice; follow your service's first-aid and incident procedures and document the incident. [source: RHS; AHTA HT-BC outline on documenting incidents]
Suspected ingestion of a plant (dementia, learning disability, pica): follow your service's emergency procedure and contact poisons advice or emergency services. [synthesis]

5.6 Group conflict, difficult behaviour and ruptures

Group stages and difficult behaviour are part of HT training; give each person a defined task and space, separate tasks if conflict persists, and repair in the closing round. [source: Rutgers syllabus] [synthesis: responses]
If the rupture is with you (for example, the client felt criticised over a task), name it, take your share and return to the client's goal. [synthesis]
Example (illustrative): "I think I took over the planting just now, and it felt like I didn't trust you with it. Let's go back to doing it your way."

5.7 Confidentiality, being seen and boundaries outdoors

Gardens, community plots, botanical gardens and plant sales are public or semi-public. Before the first outdoor session, agree what you will each do if you meet someone the client knows, what can be discussed within earshot of others, and how the client wants to be introduced. [synthesis]
Touch: hand-over-hand help with a tool or plant needs consent before and during, with a right to stop at any time; it is never sexual. Ask, demonstrate first, and offer a non-touch alternative. [synthesis]
Travel: agree whether you travel separately, meeting points, and what happens if the session is cancelled en route; follow lone-working policies, which ASTH asks practitioners to apply. [source: ASTH 43.2, 47] [synthesis: rest]
Insurance and liability: check that your professional indemnity and the site's public liability cover outdoor and horticultural work and the activities you will lead; ASTH places facility safety duties on the organisation. [source: ASTH 37] [synthesis: insurance]

5.8 Dual roles and competence

If you are both the client's psychotherapist and their HT facilitator, or a fellow allotment holder, decide in advance whether the dual role could impair objectivity or exploit the client. For psychologists, APA Ethics Code Standard 3.05 (Multiple Relationships) applies. [source: APA Ethics Code]
Do not call yourself a horticultural therapist without the training; in the US there is no licensure, AHTA registers HTR and THP, and certificate holders may not claim licensure or certification. In the UK, ASTH asks practitioners to deliver only programmes they are trained and experienced to run safely. [source: NC State Extension credentialing page; ASTH 17]
Without HT training, refer to a registered horticultural therapist or STH practitioner and keep your work to preparation, integration and debriefing (4.1, 4.20). [synthesis]

5.9 Self-harm risk and tools

In secure, inpatient or high-risk settings, use the service's tool control policy: sign-out, counting, supervised use of sharps, and alternative tasks when risk is raised. Do not discuss methods of harm; manage means through storage and supervision. [synthesis]
Reassess risk if the client's mood changes during or after sessions. [synthesis]

5.10 Eating, food and body concerns

Harvest, cooking and nutrition education sessions can stir disordered eating. Give no diet, calorie, weight or supplement advice; screen and refer to a registered dietitian or eating-disorder service; for eating-disorder support point to the National Alliance for Eating Disorders. [synthesis]
Never advise starting, stopping or changing a medicine (for example, a client who wants to swap a prescription for garden herbs); refer them to their prescriber. [synthesis]

5.11 Trauma linked to land, farm work or forced labour

For some clients (for example people with histories of forced agricultural work, displacement or rural abuse), soil, fields or certain tasks can be triggers. Ask at assessment, offer choice of task and setting, and do not push exposure. [synthesis]

5.12 Seasonal gaps, programme endings and loss of the garden

Plan winter work (indoor propagation, crafts, planning) as AHTA's scheduling standard expects; prepare clients for endings early and link them to continued involvement (4.22). [source: AHTA Standards 3 and 6] [synthesis: rest]
Treat loss of a garden, allotment or programme group as a real loss and work with it (4.21). [synthesis]

5.13 Safeguarding

Follow safeguarding procedures and report suspected abuse or neglect promptly; confidentiality can be overridden for safeguarding, and the reasons and outcome are recorded. Raise poor or unsafe practice under organisational policy and, if it continues, escalate to a senior manager, trustee, ASTH or an external body. [source: ASTH 37.1, 41, 50.1, 52]

Sources

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