Healthcare and Therapeutic Garden Design PPN Field Session
by Sally Shute, Associate ASLA
ASLA Annual Meeting 2007, San Francisco, California

Part 1: Interview with P. Annie Kirk, ASLA, and Jack Carman, FASLA

For the 2007 ASLA national meeting, the Healthcare and Therapeutic Garden Design PPN sponsored a therapeutic garden “field session” (tour). The tour included The Sequoias Life Care Community as an example of continuity of care throughout one’s life (see; and several gardens at San Francisco General Hospital, including the Comfort Garden, Avon Breast Health Center, and the Psychiatric Services ward ( The tour sites were arranged by P. Annie Kirk, ASLA, and Jack Carman, FASLA. We thought it would be helpful to describe the decisionmaking process for selecting tour sites as well as the importance of feedback from PPN members regarding the success of these sites in meeting criteria that we perceive as therapeutic.

Shute: You have organized several tours now. What do you believe is the value of the tours to the PPN?

Kirk: There are a number of values that the tours provide. First, they provide a forum for our PPN members to share their perspectives and experiences through reviewing regional examples of healthcare and therapeutic gardens. Second, they further ASLA’s understanding, appreciation, and support for our particular specialty. And finally, our contacting of various facilities to coordinate the tour awakens the administrations’ interest in what is often the good work of a sole Horticultural/Occupational/Recreational therapist. In sum, we can all do better through careful and constant examination.

Carman: The tours are something that the members have expressed over and over that they find most interesting and educational to them and for their practice. The tours are a way to bring people together who share a common interest and to be able to collectively discuss the various aspects of the gardens they are visiting.

Shute: What are the criteria for selecting the tour sites?

Kirk: Site selection is a multi-faceted process that starts with referrals, research, and networking with others that have visited the sites or know of them. Jack and/or I visit selected sites the year prior to the annual meeting and evaluate the following: 1) the value of the site paired with the contribution of staff; 2) what lessons might be learned both on the micro and macro level; and 3) how such an event will complement the larger annual meeting, and how we coordinate with the local ASLA chapter.

Carman: Annie has expressed it well. One other consideration is luck. We try to find sites that we know exhibit the characteristics of therapeutic gardens. This is not always that easy, as some cities do not have a wide range of examples from which to choose. We have a good idea of what the PPN members expect and try to find a range of garden types to satisfy most everyone’s interests.

Shute: What attracted you to these sites in the San Francisco Bay Area?

Kirk: First, given the constraints placed by ASLA, we knew that we had to find sites within a five mile radius from the convention center. This narrowed the field immediately, particularly with several gardens in the Bay Area to explore. Second, we considered the commitment and good work done by the staff at each of the facilities and the diverse user demographics—culture, use, staff support, income, location within the larger “landscape” of the city, etc.—as key to the sites we chose. The difference in “infrastructure” was also a factor. For instance, all gardens at the Sequoias are on roof decks as well as three of the five at San Francisco General Hospital. This technically affords learning in its own right. Both sites were very welcoming of our visit, which helps tremendously. Both sites had a pre-existing appreciation for the value of nature within their facilities.

Carman: The first site that we visited was the Sequoias Life Care Retirement Community that had a roof top container garden. We were fortunate to have Robert La Rocca, the landscape architect who originally designed the project, walk us through the garden and explain the criteria for and design of the gardens. The second site, San Francisco General Hospital, offered a range of garden types and, again, we were fortunate to be able to talk with the designers—Joan Varney and her maintenance staff in the Comfort Garden, and our colleague, Topher Delaney, in the Avon Garden. The sites were very rich in educational opportunities that we knew the participants would appreciate seeing.  

San Francisco General Hospital Comfort Garden.
Photo Courtesy Sally Shute

Shute: What do you two have planned for the 2008 ASLA Annual Meeting in Philadelphia?

Kirk/Carman: As in the past, we have been working with the local ASLA chapters to organize a field session/tour entitled: “Therapeutic Gardens Tour of Delaware Valley.” We look forward to highlighting the good work of such sites as Medford Leas Continue Care Retirement Community in Medford, NJ; Pennsylvania Hospital in Philadelphia, PA; and Magee Rehabilitation Center in Philadelphia, PA. More details to come!

Part II Interview: Can We Get Other Tour Members’ Reactions to the SF Tours?

Tour members in San Francisco had lively discussions both on the tour buses and in small informal groups while touring and at lunch. For our next newsletter this year, we would like to highlight their responses to the questions listed below. Please email sashute@astound. net if you would like to contribute to the discussion (please include PPN in subject line).

Please respond to any of the following questions for which you feel strongly. Also, please address any issue not included below:

1. What specifically made these sites “therapeutic” or “healing” to you?
2. Which elements of specific sites may have been nontherapeutic?
3. It may seem obvious to some, but why include so many staff as discussants?
4. What were highlights for you?
5. What was the most significant “take home lesson” for you?
6. What was the most rewarding part of the day?
7. What do you consider the greatest accomplishment from the tour?
8 What was the most challenging or controversial element for attendees and hosts?
9. For those of you familiar with the San Francisco Bay Area, which other sites would you have recommended for our tours and why?
10. What value did you get from Topher Delaney’s participation in the tour, as well as the controversy she generated about the promotion of therapeutic garden design?

As a means to generate further discussion amongst the PPN members, please find the following reflections from Annie Kirk, provided following the October 2007 event: 

“At the end the day, no matter the appearance of capital invested in a garden, I take pause of use as a determinant in whether a garden is successful, in terms of ‘healing’ or ‘therapeutic benefit.’ We heard feedback that the Sequoias, although lovely with obvious large capital investments, didn’t appear to be ‘used’. I wondered what kind of use attendees meant. Daily?  

Sequoias Life Care Retirement Community. Photo Courtesty P. Annie Kirk

Active? Programmed? Passive? Viewing? Immersed? As we review sites, it appears that appropriate and applicable ‘use’ needs to be defined. What are evaluators expecting the use to be in a garden versus the goals for the facility and the tolerances and preferences of the specific resident culture and population? With the Sequoias, one might ask, ‘What type of use did the Administration determine was desirable as a result of the establishment of the extensive garden areas?’ Many attendees remarked that the only areas at the Sequoias that were being used were the raised planters—that this area appeared to be the only ‘therapeutic aspect’ of the site. Interesting are two things: 1) During our tour of the facility on an average day in November 2006, Jack and I noted all the garden areas a-flurry with ‘users’—walking, socializing, playing cards, etc.; and 2) I noted that, as soon as our tour group proceeded out, many residents left the gardens on both levels. I take pause that perhaps our large tour group presence deterred ‘typical’ use that day.  

“Additionally, the question of use brings up the long-had discussion/debate on a definition of ‘therapeutic.’ Based on comments made during the tour, it was suggested that, because the use in the garden areas other than the raised planters is ‘passive’ and residents do not ‘dig in the dirt,’ ‘cultivate,’ or ‘harvest,’ in other garden areas, these other garden areas are not ‘therapeutic?’ What of the social interaction that occurs in these areas? What of the physical exercise that occurs in these areas? These are instigative questions, as the Comfort Garden is a place noted primarily for solace, social interaction, talk therapy, and physical exercise, not unlike most of the gardens at the Sequoias. Yet, the Comfort Garden received potentially greater preference by tour attendees. Why? What were attendees ‘looking for’ that goes unmentioned when discerning the therapeutic value of one garden over another? What makes one more ‘preferable’ than the other? Is it an intuitive rating we give? Is it our own predisposition? Do we move too quickly to compare two sites without examining context, population, administration?

“What would be the outcome if Ulrich’s ’supportive garden theory’ criteria or Cooper Marcus’s POE criteria was used to rate these two spaces independently? What makes one ‘seem’ more therapeutic than another, beyond these evaluation tools?

“All in all, what makes these good gardens to tour is that, ultimately, we challenge some perceptions, we rattle some cages, and we spark discussion—all to further discern what we as a collective advocacy group describe as ‘therapeutic garden design.’ There is obviously something explicit in our discussion, yet I ask, what is it that we are trying to get to? And how do we express this among our colleagues and beyond in order to further the good work we know needs to be done?”

Sally Shute, Associate ASLA, is the Principal at SAS Enterprises, and can be reached at: sashute@astound. net. P. Annie Kirk, ASLA, is the Founder and Director of Acer Institute, LLC, and is Principal of Red Bird Design, a residential design division of Acer. She can be reached at: Jack Carman, FASLA is President of Design for Generations, LLC and can be reached at:
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Steve Mitrione, ASLA (2012-2013)

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