Combining Trauma-Focused Treatments with Horticultural Therapy

Theresa Hasting PQ

Theresa Hasting, LMHC

By: Theresa Hasting, LMHC

Working in the garden alongside students and seeing the benefits it yields students (and, of course, myself) has left me asking “How do we integrate additional evidence based treatments with our practice of Horticultural Therapy?”  The garden offers so many options for regulating the nervous system and calming the mind and body.  Having specialized in working with students with trauma histories, it seemed only natural to fit the pieces together.



Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence based, manualized, psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. It incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques. Students learn new skills to help process thoughts and feelings related to traumatic life events; manage and resolve distressing thoughts, feelings, and behaviors related traumatic life events; and enhance safety, growth, parenting skills, and family communication. The first stages of TF-CBT involve learning relaxation skills and emotional regulation skills.

Trust Based Relational Intervention (TBRI), also an evidence based model, is designed for working with students who have suffered from relational trauma. It focuses on the tenets of Empower, Connect, and Correct. Through empowerment, students learn effective means for regulation and gain a sense of felt safety. Connection, or relationship, focuses on re-establishing trust in others and in one’s self. The tenet of correct looks to give students alternative and appropriate methods for cognitive and behavioral expression of needs.

Melding the above treatments within Horticultural Therapy model of PQ has been a seamless process. Before a student can work through the 11 session manualized TF-CBT model, they must first have access to the parts of their brain in charge of reason. To do this, regulation and connection must exist. Through nature and the garden, students are able to customize their regulatory techniques- whether it be mulching banana trees, working the compost pile, weeding, or using the garden to create an individualized 5 sensory meditation practice. The gardening experience also allows for experimentation in life and death, promotes teamwork, and a nonjudgmental environment for students learn; thereby starting the process of connection to nature and to others. As students start to feel more connected to nature, others, and themselves and are functioning in a regulated fashion, they can then start to engage in rest of the TF-CBT process; examining their cognitive processing and exploring their trauma narrative.

A Client’s Perspective

But don’t listen to me, hear a student in her own words about her experience at PQ where she engaged in trauma focused treatment:

“The garden here is a lot different from the small garden I had at home.  At home, I never learned much about gardening of the processes  that made the flowers bloom and the lettuce grow.  There was no relationship between nature and me. Here at PQ, I learned about something called Aloha Aina, it refers to the deep connection between humans and the land.  It is sacred to the native Hawaiians and it is sacred to me as well.

“The garden means a lot to me. It is where I can be myself. I can weed, plant, mulch, and no matter what, I feel good and do good, which is my essential goal and personal legend in life.

“Usually when plants are transplanted they a little in shock when they are pulled out of the soil and taken away from what they are use to; however, with a little help, love and care they can blossom and grown. This is in direct alignment with what I am going through at this time.  I am being transplanted.  In order to cope, I will utilize EFT, coloring, cane grass meditation,  rock thingy, ocean breathing, and lavender- sniffing just as plants utilize chicken poop, water, sunlight and the soil that they have.

“I am quite like the banana trees. Each time I harvest a rack, I must cut down the tree in order for a new banana tree to grow in its place. I have been cutting down my inner banana trees.   During Nalu, I cut down the banana tree of thinking that I didn’t deserve love and support.   During Kuleana and Ohana, I have been cutting down shame and depression and anxiety.  When I leave PQ, I will continue cutting down bad habits so good habits can form. I love the garden and I love myself!”

Connecting the Dots

As a therapist, I’m passionate about creating meaningful relationships in a healing environment for our students to step into the power of redefining their story.  Pacific Quest provides a unique experience for the combination of these therapeutic modalities.  Relationally based TBRI emphasizes felt safety in a therapeutic relationship, allowing the body and  brain to be regulated enough to utilize TF-CBT, all the while giving space for HT to access and reprocess trauma on the level it was experienced- in the body.

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