Incorporating Nature Into Occupational Therapy

An Interview with Authors Amy Wagenfeld and Shannon Marder

KidsGardening recently chatted with Amy Wagenfeld and Shannon Marder, both occupational therapists with a deep love of nature who incorporate the outdoors into therapeutic practices. Amy and Shannon are co-authors of a new book Nature-Based Allied Health Practice, and they shared their inspiration for writing the book together and what they hope it offers therapists and educators working with kids.

Can you tell us about yourself and your work?

Amy: I am a lifetime devoted and passionate gardener and lover of nature. I have come to appreciate that I am my best self when outside, especially when I can feel the earth under my feet and dirt on my hands. I am calm, present, happy, and alive! Beyond my love of nature on a personal level, I wear several work and volunteer related hats that all pertain to nature. Through my therapeutic design organization, I consult primarily with landscape architects to create therapeutic and healing outdoor spaces for people across the lifespan. My design work focuses on incorporating all eight sensory systems into design, as they guide everything we do in our daily lives. I also teach in the landscape architecture program at the University of Washington (go Huskies!), am a master gardener, and of course, I write! My writing includes books, articles and professional presentations at conferences. 

Shannon: I grew up in Ohio and have since lived all across the USA (9 states, including Hawai‘i). And I’ve found that everywhere I’ve lived, there has been a unifying aspect of the outside world. It goes beyond small talk and the weather, but the fact that nature and the outdoors can be a leveling factor that helps people feel more united and a part of a community. I came to practice occupational therapy because I wanted to be helpful to people in a way that could make their lives not only better but also more meaningful. And now, I see helping people access nature as an essential part of my professional practice.

Can you describe some of your favorite personal experiences incorporating nature into occupational therapy?

Amy: Whenever possible, and long before I had any inkling about the benefits of being outside, I would bring my clients outside to do whatever therapy I had planned, just because it was my personal preference. If it was working with older adults, it might be deadheading flowers in a garden on the facility campus. It was literally a breath of fresh air for them. Or, if with children, using outdoor play spaces as my clinic was so much more fun for them and, yes, for me! But nature can also be experienced inside. One indoor nature experience happened in a pediatric group session. While most of the children were toddlers, one parent brought his 5-month-old daughter to the group. The toddlers were busily shredding buckets of dried herbs, smelling and crunching them to bits. Our littlest participant was not ready to do this activity, so I quickly grabbed several handfuls of herbs, gave them a little squish to release the aromatic properties, and invited Dad to remove his daughter’s socks and shoes and put her bare feet in the shallow bowl where I had placed the herbs. There was an abundance of lavender in the handfuls of herbs, and after several minutes of wiggling toes and feet, delighted gurgles, and smiles from the little girl, she peacefully dozed off in Dad’s arms. 

Shannon: My favorite nature-based experiences are the simplest ones. I most appreciate nature when it is seamlessly incorporated into the everyday routines or when our time outdoors is intentionally extended to include a few minutes of noticing what’s changing with the season. When working with teenagers at a high school, instead of taking the school van to the bus stop, we walked, and we’d have the best conversations on those 4-minute walks outside. When working with adults, instead of discussing patient education inside, I appreciate sitting on the porch and seeing the patient relax and come up with their own way to remember the routine (compared to feeling more rushed and distracted inside).

What was your inspiration for writing Nature-Based Allied Health Practice?

Shannon and Amy: We were invited to respond to a publisher’s query about creating a book based on a personal “passion project.” The book was born of two passions: therapy and nature. Being deeply committed to our profession and wanting to share how therapy can be enhanced when it is facilitated outside or when nature is brought inside, we quickly jumped at the chance to do the work to create the book. Our work is intended to inspire therapists such as OTs, PTs, speech and language therapists, recreational therapists, and mental health practitioners, to name a few, to “take it outside.”

What types of content have you included in the book?

Shannon and Amy: Great question! The book covers a lot of content. We start with a discussion about what the evidence-based research tells us, related to the holistic benefits of connecting or interacting with nature for ALL people. Because therapy outside comes with different privacy issues compared to inside, we spend a chapter talking about ethical practice and then move on to chapters that cover nature and health for all aspects of development for children and their families, adolescents, young adults, adults, and older adults. We cover the life course! There is a chapter on measuring the outcomes of nature-based therapy programs and how-to guides for setting up a program. Each chapter's content is enhanced with many compelling case studies of therapists taking it outside, personal stories from people who reap the benefits of being outside, and lots of how-to, fun activities, which we call “Nuggets of Nature.”

In what ways do you think garden educators will benefit from reading Nature-Based Allied Health Practice?

Shannon and Amy: The book’s content is spot-on and relevant for any educators learning about how and why nature positively influences children’s lives, which is a major theme of the book. Even if educators already know the benefits, based on their own observations or published research, the book will give them tools to translate that knowledge to the students and families. The life course chapters also include rich introductory materials that cover developmental milestones for each age group. Additionally, the case studies are chock full of good ideas, and an educator may want to reach out to the providers for mentorship opportunities.

Can you describe your favorite activity featured in the book and share why it's meaningful to you?

Amy: This is a tough question! I am very fond of a Nugget of Nature that focuses on doing yoga outdoors. As a self-proclaimed yogini and nature fan, my experiences practicing yoga outdoors are blissful. Yoga benefits the body, mind, and spirit and provides an opportunity for all people at all stages of life to take a much-needed moment in time to engage in self-care. But to be honest, I love all of our Nuggets of Nature!

Shannon: I am laughing because my current favorite activity from the book was something I was dismissive of when we started writing the book. I like the “Produce People” activity, which is designed for children and is a fun way to engage with food. When we created the activity three years ago, I thought, “Why is building people out of fresh produce included as a nature-based activity?” But now, I have two young children, and I volunteer at an early intervention clinic, and I totally see the value of seeing, feeling, smelling, touching, and tasting fresh, whole produce. It is such a great way to bring a bit of nature into an everyday moment (i.e., snack time), and we may already have all the pieces that we need in our kitchen.

Any last thoughts you’d like to share?

Amy and Shannon: We hope that the book will inspire therapists and educators to take it outside, and for caregivers to advocate for children to have ample opportunities, be it in their schools, therapy clinics, communities, or at home, to experience all the wonders that nature offers. We also hope the book inspires teens, adults, and older adults to think about ways to get outside more and to see the value in being outdoors. We hope it helps make therapy a little less stressful and a lot more meaningful.

Amy and Shannon in partnership with Jessica Kingsley Publishers are offering KidsGardening readers a twenty percent discount on copies of Nature-Based Allied Health Practice purchased through the JKP website. Jessica Kingsley also offers free shipping anywhere within the continental US. Here’s a link with the code automatically applied at checkout, or you can use the code “GARDENSTORY20” at checkout!