Cone Health TH participants use pressed flowers to create art

Online Therapeutic Horticulture Certificate alumna Ali Brown joins us to share her TH program on two hospital campuses. Thank you, Ali, for inviting us into the Cone Health Healing Gardens!

About the Program:

Cone Health Cancer Center (CHCC) in Greensboro has been offering Therapeutic Horticulture sessions for patients, survivors, and caregivers in partnership with the Wesley Long Healing Gardens since summer of 2023, and the Alamance Regional Medical Center Healing Garden in Burlington since summer of 2024. The program is designed to meet participants’ wellness goals of coping with fear and uncertainty, engaging with others with a shared experience, learning new skills, and finding calm in nature. Some sample activities include collecting and starting seeds that are later transplanted into the gardens; designing and planting flower pots for the infusion suite balcony where patients may receive their treatments outside overlooking the gardens; creating nature journals using pressed leaves and flowers; making terrariums for succulents; seated yoga and mindfulness walks at the labyrinth; and gathering garden objects to create a nature mandala outside.  Sessions are 1-2 hours in length and occur weekly during the growing season.

The size of each group varies depending on the site and time of year, and typically ranges from 3-10 participants per session. The program is part of Alight’s support services and is free to all CHCC patients, survivors, and caregivers.

These groups are led by Healing Gardens Manager Ali Brown, who has a Certificate of Mastery in Therapeutic Horticulture from the North Carolina Botanical Garden at UNC & NC State Extension Gardener Program and is pursuing her master’s degree in social work in a joint program at UNCG and NCA&T. Ali is also an Alight Program Coordinator for CHCC’s Patient and Family Support Services department.

Spring container planting at Alamance Regional Medical Center Healing Garden

About the Therapeutic Approach:

The Therapeutic Horticulture (TH) program focuses on common concerns and goals for those who are in active treatment for cancer or who have completed treatment. Caregivers are also invited to participate, and many of these issues apply to them as well. Whether newly diagnosed, living with long-term cancer, or well into survivorship, most of these individuals must navigate shifting priorities while facing fear and uncertainty, and may feel isolated within their experience. Participants have consistently expressed that their involvement in the TH program offers a much-needed respite from the stress and mental fatigue associated with a cancer diagnosis and treatment, and has helped redefine their relationship to the cancer center, as they now look forward to coming to the gardens. Through observing and engaging the cycles of the natural world, participants gain greater perspective regarding their own rhythms and seasons of life.

The TH program offers opportunities for social connection with others who “get it”, without having to caretake or over-explain what they’re going through. Each session is facilitated to provide formal and informal opportunities for discussion, whether through group conversation prompts or simply chatting with another group member during an activity. Mindfulness practices are often incorporated, including the Five Senses Walk which helps participants slow their minds and bodies and notice their surroundings. Each activity accommodates different physical needs, like using raised beds or designing tabletop activities that can be done while seated. Even when moving about the gardens, participants are encouraged to move at their own pace and rest when needed.

Designing the planters at Wesley Long Healing Garden

About the Facilities and Resources:

Both campuses provide an indoor classroom to gather that also serves as a secure location to leave valuables during outdoor garden activities. Bathrooms are easily accessible from the classrooms. Programs occur indoors only when weather prevents the group from taking place in the garden, and the scope of indoor activities is somewhat limited since soil and other organic materials are not allowed within the hospital. 

Both sites have a Healing Garden where most of the programming takes place. Each garden site is different, but some common features include paved walkways and benches, plant identification signs, outdoor tables and chairs, a garden shed for storing tools and supplies, protected wetlands, native and ornamental trees, shrubs and perennials, water features, and many birds and other pollinators. Both gardens are wheelchair accessible from inside the hospital, although you need a badge for re-entry and therefore must coordinate with a staff member.

Many existing plants in the garden are used in programming, for example: collecting seeds from perennials such as stokesia, aquilegia, liatris, asclepias, and bee balm, and later replanting them. Other propagation methods like separation and division are demonstrated using swamp sunflower, rudbeckia, and Tatarian aster. Flowers and leaves are collected and pressed for a variety of creative purposes. Compost produced in the garden is incorporated into new plantings and seed starting. Occasional purchases of annuals and herbs are made specifically for program use and take-home activities. Common gardening tools are provided for use during sessions, such as hand trowels, pruners, watering cans, wheelbarrows, and gardening gloves.

Cone Health coneflowers

About the Therapeutic Relationship:

While there are some common experiences that connect participants, each individual comes to the TH program with unique needs and goals for their participation. Attendance for the duration of a series is not required, to better accommodate individual schedules, which means it takes longer for participants to get to know and feel comfortable with each other and the facilitator. Similarly, taking time as a facilitator to get to know participants and understand their needs happens gradually. Creating a warm, inviting atmosphere by welcoming each person by name upon arrival, making sure all participants are introduced on a given week, and thanking them for their participation, are some simple ways to set the tone and begin building rapport. Starting with brief introductions that include a prompt to get to know each other, such as “what is something you enjoy about nature during the winter months?”, and a short mindfulness practice or grounding exercise, can help orient participants to one another and the space. Some participants appreciate having a break from talking about cancer, while others are eager to share their experiences, so providing space to share without expectation is important. Being flexible as a facilitator and honoring each person’s unique physical and emotional needs without judgment helps to create a supportive environment. This includes being willing to change course due to weather, physical or emotional fatigue, or participant’s request. Soliciting and applying participant feedback about the program is another way to demonstrate care and build trust. Providing informational handouts on the day’s activities, links to additional resources, and materials to take home are a few ways to encourage ongoing engagement in nature-based activities in whatever way best suits individual’s needs.

Learn more about the Cone Health Healing Gardens

Contact Ali Brown at alexis.brown@conehealth.com