LONG COVID FEATURE
The importance of outdoor and greenspace therapy has long been recognised in occupational therapy . Generations of occupational therapists appear to have instinctively identified this and sought to utilise whatever resources come to hand .
Examples range from the therapeutic gardening used in the treatment of First World War veterans , through the large therapeutic gardens that were a staple of the asylum system , to today ’ s more normalised , integrated and varied ( if sadly , less-well resourced ) patchwork of individual gardens , spaces attached to community centres , ‘ rurban ’ country parks , formal and informal small urban greenspaces , and of course the wider rural hinterland of towns and cities .
Past issues of this publication detail numerous creative initiatives carried out by occupational therapists that continue this tradition .
There is now emerging a coherent and convincing body of empirical evidence to demonstrate the efficacy of what are often referred to as ‘ nature-based health interventions ’. For example , a project recently carried out in the Gloucestershire wetlands effectively improved the overall scores of a group of patients experiencing depression and anxiety from below average on the Warwick-Edinburgh Mental Wellbeing Scale to average in just six weeks ( Maund et al 2019 ).
Some key mechanisms in such therapies appear to be gentle physical activity taking place within an unthreatening and naturally stimulating sensory environment , sometimes with water as a major feature .
The environment makes few cognitive or social demands at the most basic level of participation , although activities are likely to be on offer that allow social interaction and participation in horticultural or nature conservation activities .
In my own recent work in the field of more formal horticultural therapy , I have been privileged to witness children who have experienced trauma and loss begin to open up and heal , at least partially , through their engagement with the natural world , whether through seeing and gingerly touching the root system of a plant for the first time , making a rainbow of different leaf colours on a path in autumn , or sitting in a willow dome they have themselves helped weave , sipping a tea just made with freshly picked mint . Or being simply entranced by plants , animals , water , insects , logs to sit on , trees to run to and far-off skies to see .
In such therapy , the therapeutic alliance formed between therapist and client can allow the client to safely explore difficult feelings , often utilising play and metaphor , for example choosing the best and biggest plant , but being subsequently disinterested in it , versus choosing the smallest , but wanting to nurture it .
Horticulture skills are gained and are often a source of great pride and sense of achievement , but the goal of therapy is primarily emotional , not functional .
Over eight months in , and the experience of Long COVID has given me a further unique vantage point , a view ‘ from the other shore ’, as a person experiencing considerable difficulties who now needs these kinds of therapy myself .
The variety of Long COVID experiences have now been well-documented , so I will not dwell upon them here , but merely note that the most prominent symptoms for my wife Helen and I have been fatigue , cognitive problems , joint pains and sensory processing problems , with a very slow relapsing / remitting recovery pattern . Alongside these are the social isolation and worries about what the future may hold .
Nature-based health interventions are in many ways an ideal form of therapy for these kinds of problems . They can offer a full spectrum of levels of participation , from passive enjoyment of nature to active engagement with it through emotional , physical and mental activity . They can take place in a variety of spaces . Three examples below are drawn from our own informal experiences .
In open public greenspaces the fatigue can be experienced , not from the prison of ‘ sofa-and-TV ’, but on a pleasant bench , watching birds and squirrels feed , or watching the river snake under the viaduct and on past the long-abandoned mill site , while fishermen sit quietly by the now-repurposed ponds , watched by a solitary Heron .
The aches and pains of exercise , that did not lessen with the gently graded programme as hoped , are pushed to one side by an encounter with the wild garlic by the river path on the way to the next bench .
The cognitive self that will not be entirely quieted , and which can so often whip up a ‘ brain fog ’ by dwelling on illness , trying to make impossible life decisions or solve the problem of ‘ what is to happen to me ?’ can be more positively engaged by noticing the progress of the weather or the season , the behaviour of birds and animals , by deciding which way to go next , by solving the problem of the wet bench by drying it with a hat .
The active and sensory self can weigh the hazelnut in the hand and try to throw it just in front of that squirrel . If more activity is wanted , most public spaces now have a ‘ friends ’ group that organise communal litter picks and maintenance . In the garden , the need for action and sensation can be met by judging just how firmly to press in the soil either side of the newly-planted lobelia with finger and thumb to make good points of contact for the roots without over-compacting the soil .
Choices can be made about where to put which plants and where to put the chair today , and solve problems of colour balance and wobbly chairs by experimentation . For a moment , the aches and pains take second place to moving that pot to just the right place .
And when the fatigue returns , it can be experienced sitting and looking quietly , with pride – and often for longer and more contentedly than before Long COVID – at what has been accomplished .
© RomoloTavani via Getty Images
OTnews November 2021 37