International Journal of Education and Research

Vol. 1 No. 6 June 2013

Healing Gardens Design

Dr. Hesham El Barmelgy

Associate Professor of Urban Design and Sustainable Development
Department of Urban Design
Faculty of Regional and Urban Planning
Cairo University

Cairo University - Main Campus

Giza, Egypt
barmelgy@staff.cu.edu.eg
+20-1001071231

ISSN: 2201-6333 (Print) ISSN: 2201-6740 (Online)

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Healing Gardens Design

(Offering a practical framework for designing of private healing gardens)

Hesham M. El-Barmelgy
Associate Professor Department of Urban Design
Faculty of Regional and Urban Planning
Cairo University

Abstract
The paper addresses a research gap dealing with landscape and health. Stress is
always a burden on our shoulders whether at work, on the street, or even at the house.
In a search to find a deep form of sustainable landscape that would act as a stress
reliever, the notion of healing gardens came into light. The paper offers a practical
case study for designing and formulating Healing Gardens (HG). It utilises the notion
of design patterns in composing a framework that would empower the achievement of
the therapeutic goals of the garden, thus providing the ability to label the garden as a
healing garden. The framework is to be presented, applied, tested and reported upon
by the author, who has experienced the challenge of creating Healing Gardens.

Keywords:
Health, Sustainable Landscape, Healing Gardens, Healing Gardens Design
1. Introduction
(Health, Landscape, Sustainability and the notion of Healing Gardens)
Health and well being have always been indicators for the quality of life,
while quality of life could be perceived as a method of measuring the degree of
community sustainability (Johnson, 1995; and Dave, 2011). World Health
Organisation defines health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (Vapaa, 2002:4). Vapaa
(2002) added that it [health] is this basic need for a connection with nature that keeps
us going (Vapaa, 2002:18). Investigating and proving the connection between nature,
healing and health a number of studies have been conducted (Kellert et al., 2008).
Three of which are mentioned below:
Gull Bladder Surgery patients were studied in their recovery rooms. Some
rooms had a view of nature while others had a view of a brick wall. It was
found that patients whose rooms overlooked trees and greenery have had a
faster recovery time, faster hospital departure, experienced fewer difficulties,
suffered less pain and used less medication than those patients facing a wall.
Michigan State Prison conducted a similar study between prisoners in cells
facing a courtyard and prisoners in cells overlooking farmlands. It was found
that 24% more sick calls existed among those facing the courtyard.
A school in Germany conducted another similar study, students were observed
in classrooms that contained plants and others in classrooms with no plants. It
was found that plants reduced student health problems, and helped reduce the
number of health complaints. This provided evidence that plants have a
positive effect on the students well being.
(Vapaa, 2002:22-26)
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Health studies and horticultural therapeutic programs prove that there is a relationship
between health and gardens (Wells, 1996; Kellert et al., 2008; and Haller et al., 2006).
Gardens are not only looked at as sources of physical healing but, as mental and
emotional healing sources as well (Wells, 1996). The subject of health is always
important as health is something we all strive for and hope to achieve (Kellert et al.,
2008). It is a positive state of life encompassing the entire life situation, and
environment (Morse et al., 2011). The notion of Healing gardens should not just be
restricted as a requirement for sick people, it is important for the healthy people as
much as it is important for those who are sick. The paper aims to study the various
types of healing gardens, targeting the most efficient form of healing gardens
identified by researchers as Private Homes Healing Gardens. Moreover, the paper also
presents a practical framework for the design and implementation of healing gardens
through a case study. The framework was adopted and implemented by a Healing
Garden Design Project Team which reports, through this paper, on the practical
experience in the field of designing, planning and creating private healing gardens.

2. The Notion of Healing Gardens (HG)

2.1. Sustainability and the notion of Healing Gardens
Greenery, as a sustainable form of landscape, has the potential of inducing
active living and public health; thus linking the importance of the natural environment
to the built environment and the citizens health. In the Western and Eastern
communities it has been noticed that greenery in the city is essential for the health of
the city dwellers. The brain is capable of two types of attention; directed attention
belonging to the higher cognitive centres, and soft fascination linked to the memorial
part of the brain. In a natural environment, the higher cognitive centres rest while the
old part of the brain is stimulated giving the sense of restoration, rest and healing.
It is vital for public green areas to be located near residential areas. Studies
have proved that natural environments outside a 50 meters radius from residential
areas would result in a decrease in the amount of visits to the gardens, and an increase
in stress levels. These findings reveal the significance of locating a natural
environment directly adjacent to dwellings (Stigsdotter, 2005). While designing a
healing garden it has been noted that sight is the most immediate physical sense that
reacts to a garden. Sight is important because a person only needs to open his/her eyes
to experience an ever-changing kaleidoscope of light and colour. Researches and
studies have proven the effect of colour on human thoughts, actions, health and even
relationships with others (Vapaa, 2000:64). The human scene of smell is also very
important in designing a healing garden. Scientists have discovered that sweet
essences produce alpha, theta, and delta brainwave patterns which leads to a state of
total relaxation. Other fragrances could stimulate beta brainwaves inducing a state of
alertness in the human brain. If the produced fragrances of a garden is disliked it
would block any effect upon the nervous system empowering the sense of alertness. It
would thus limit the chances of a garden to promote its healing powers. This
emphasises the importance of providing the garden with the proper scents.
If healing gardens are to symbolize health promoters, then they have to offer a
considered balance between the body, the mind, and the spirit (Vapaa, 2002). A
Healing Garden is to represent the ability to promote the sustainability status between
the three matters as presented in figure (1). Franke (1996) made it clear through his
statement that health is the core of the sustainable landscape, stating that "the only
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path to true sustainability is one which

promotes the importance of the health
of the local environment" (Franke,
1996: 246). Thus Healing Garden can
be considered as a deep form of
sustainable landscape where both
humans as well as the environment are
to mutually benefit from promoting it.

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Figure ( 1) The Notion of Healing

Gardens

Spirit

Body

2.2 History of Healing Gardens

The idea of Healing Gardens is
Healing
both ancient and modern. Following the
Gardens
Mind
beginning of human settlements and
erect of communities, local healing
places were nearly always found in
nature (Brown et al, 2010; and Marcus
Source: after Vapaa, 2002
and Barnes, 1999). The earliest
hospitals and infirmaries in the Western
world were dependent on plants, herbs and a cloistered garden as essential parts of the
healing process. For a long time the importance of health and well-being has been
noticed in the presence of urban green space, green ways, parks, green areas,
schoolyards, and house private gardens. All these factors are viewed as the health
creating elements of the city (Morse et al., 2011; and Stigsdotter, 2005). The great
gardens of Egypt were built to offer an escape from the external environment offering
a healing relief. Restorative or healing gardens for the sick have been part of the
landscape of healing since medieval times (Clark, 2004). Gardens were always
portrayed as a paradise that offered respite from illness to the healing of the soul and
the body. By the end of the 80s and the start of the 90s a decline of the concept was
witnessed all around the world. The connection between healing and nature was
gradually superseded by advancing treatment technologies and methods. By the late
twentieth century the idea of nature and healing was totally lost; nature landscaping
came to be merely portrayed as a green sort of decoration. Starting from the 1990s
the idea of healing gardens, once again, gained interest and began to appear in the
research field of sustainable landscape (Vapaa, 2002). Today the aspect of Healing
Gardens is gaining its popularity due to the harsh living and environmental conditions
that people are suffering from all over the world.
2.3. Defining Healing Gardens
A garden, in general, is portrayed as a heaven where people find a welcoming
escape from the everyday stresses of the outside world. On some level all gardens
have healing effects (Rawlings, 1998). Since this research focuses upon healing
gardens, a profound theoretical analysis is required to define the term. Vapaa (2002)
stated a very important definition explaining functions of a healing garden, he stated
that "instead of stressing the idea that they can cure a person, the benefits are related
more to the alleviation of stress and the abilities of the space to soothe, to calm, to
rejuvenate or to restore one's mental and emotional health" (Vapaa, 2002:4). In other
words healing gardens are not just for sick people, they serve the healthy and the
ailing. A healing garden is able to restore the natural balance in humans so that they
do not feel stress and other pressures. It is defined as a category that includes outdoor
or indoor garden spaces. Some scholars seem to think that those gardens belong to
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hospitals and health care centres (Stigsdotter, 2005), while others see that they are
very personal spaces that could be successfully located in private homes. Vapaa
(2002) concluded his study stating that, "a healing garden is one where the designer
pays close attention to the needs and likes of the user(s) or client(s) and is able to
provide therapeutic qualities in the space that addresses them" (Vapaa, 2002:73).
Stark (2004) has a vision of the healing garden as a microcosm of the larger world,
where each feature of the garden is to represent a larger feature in the landscape. He
argues that through this modelling healing has to be able to "stimulate the senses,
improve immune response, and promote recuperation from physical and emotional
illness .... a healing garden is a keeper of a sacred place. Its users can access higher
levels of spiritual power by their simple presence in its space" (Stark, 2004:3). Starks
sees the power of the healing garden in its ability to bring the human back to nature.
The nostalgic power of nature, which is embedded in each persons higher cognitive
part of the brain, can rest while the old part of the brain is stimulated, thus achieving
the healing power.
Based on literature analysis, the power of healing gardens lies in its ability to
bring humans back into connection with their private imaginative nature.
Accordingly, healing gardens is defined as the broad collective term that encompasses
various types of gardens that aim to promote health and well-being to the human life
and the adjacent environment.
2.4. Types of Healing Gardens
The positive health effect of staying in urban green spaces has been
recognized. If the goal of the community is to promote sustainable development, then
in the heart of the sustainability process is the ability to promote better health for all
city inhabitants. Studies proved that each dweller has the right to have free access to
an urban green space within a maximum radius of 50 meters from their residence.
Consequently, the types of healing gardens can be classified as follows: The first type
of healing gardens is like a sanctuary or a natural reservoir, where natural and wildlife
are preserved. This is presented by the citys green infrastructure elements,
encompassing the citys open spaces, green ways, nature parks and greenbelts. The
second type is a meditation garden within the premises of a hospital or a health care
centre. Finally, the third type is a privately owned garden. The third type is agreed
upon by most healing researchers to be the best type of meditation garden with
healing effect. This is based on the fact that the more time a human is in contact with
nature; the more profound the healing results will be (Hopper, 2007; Vapaa, 2002;
and Marcus and Barnes, 1999).
A residential or a private garden is the climax of the healing garden typology.
It allows the user(s) to gain the maximum benefit from the healing qualities of a
garden because it is their own personal space where they express their individual
identity, needs and level of engagement (Vapaa, 2002). The research will target the
private healing gardens for the case study, trying to investigate the healing reality of
such type of gardens. It presents a framework that would guide the landscape design
process to promote and create healing gardens.

3. Healing Gardens a facilitator for the users horticulture and aesthetics needs
A healing gardens main role is to provide a sanctuary to allow for meditation
and, to fulfil other social and emotional requirements of its user (Johnson, 1995; and
Li and Mander, 2009). A talented designers main job is not only to fulfil the
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requirements and needs of his/her client but, to go far beyond client expectations.
Healing garden designers should use their expertise, knowledge and tools to create a
unique garden for the client. As previously deducted from studying the notion,
history, and definition of healing gardens along with the users intervention; one can
infer that the designers ability to integrate the user in the healing garden design
process is a key factor for the success of the design (Brown et al., 2010). There are
various means for achieving such integration between designer and client; the most
efficient are personal interviews, written surveys and questionnaires. During the first
session with the client, the designer should investigate some site ideas and have
feedback on them; a good designer should be a good listener. Following the first
session, a series of meeting and interviews with the client is a crucial step for
determining and fulfilling the clients social and emotional requirements. The client
should be involved in every detail concerning the design. When working on designs
for healing premises, the scope of the design capabilities should go far beyond the
utilization of the sense of sight to all the other senses. The designer should consider
what the client would like to hear, smell, taste and touch in their garden. The designer
should constantly pay attention to the client and if there is any reservation about a
certain element of the design it should be re-considered. It is always easy to reevaluate and to refine a design than to implement, demolish and re-implement. Design
elements and garden components should be selected thoroughly and according to the
users needs and opinions. This is done to maximize the healing effects on the
environment as well as the user, thus granting the garden with a healing label.
This study stresses the importance of being able to satisfy the needs and wants
of healing garden user(s) or client(s). Client satisfaction is the key issue that
determines the success of the design process. The user(s) have to be acknowledged as
effective members of the design team. The success of a healing garden is only
attained if the garden has managed to relate to its owner at the most achievable
personal level.

4. Healing Gardens Design Process/framework

The design process is essential for the health concept to be correctly integrated
in the garden (Ji, 2009). The design should be based on the users special needs and
requirements. Stigsdotter, (2005) noticing the importance of the design process in
achieving the required healing gardens stated that, "there is a great need for scientific
knowledge concerning how these gardens should be designed" (Stigsdotter, 2005:8).
McDowell and Tricia Clark-McDowell (1998) stated that, ''the key to a healing
garden is to honour and celebrate our broader human relationship with nature and
spirit, not just plants." As clarified from various resources a basic set of guidelines
would be very important for directing any designer through the design process (Ji,
2009). The design process of healing gardens differs than that of any normal garden in
that it has two layers of objectives. In the cognitive layer, lie the therapeutic
objectives such as the ability to provide stress relief, alleviation of physical symptoms
and improvement in the human overall sense of welfare. The physical layer includes
the designers objectives/principles for fulfilling the therapeutic objective of the
cognitive layer. Based on the former analysis and previous academic and professional
experience, figure (2) presents a proposed vision/framework for the healing garden
design process.

International Journal of Education and Research

Vol. 1 No. 6 June 2013

4.1 HG Design Framework

4.1.2. Developing Ideas.

Based on the former stage the
designer should start setting the
first layer of ideas and thoughts
regarding how to fulfil the
user/client needs. The designer
should keep their own vision
into consideration, the one that
has to be beyond the expectation
of the user/client.

Inventory Stage
(Site & Users/Visitors)

Developing Ideas

Setting Therapeutic
Goals

Setting &
Composing HG
Design Patterns

Formulating the
Design

Evaluation and
Assessment

Implementation
Stage

Healing Gardens
Client/Owner or User

4.1.1. Inventory Stage (Site and

Users Visits)
The inventory stage of the HG
design process differs from any
other garden design stage in that
this stage has to include the
user/client as one of the design
members. This is to be achieved
through a number of visits. The
visits should aim to investigate
and listen to the user/clients
own ideas. The design team
aims to identify clients needs to
be able to profoundly analyze,
categories and prioritizes them.

Mediation Stage

4.1.3. Setting Therapeutic Goals

One may argue that this design
Receiver
Dispatcher
stage should come before the
previous stage of developing the
ideas. It is arguable as the
Figure (2) Healing Gardens Design
framework is not rigid. Some
Proposed Framework
designers may find it more
appropriate to consider setting
the therapeutic goals before developing the design ideas. Others may argue that the
therapeutic goals should be hidden between the designers and their design. The
therapeutic effect on the receivers should be accounted on.
4.1.4. Selecting HG Design Patterns
The design patterns aim to assist the designer in achieving his/her therapeutic goals.
These patterns are already tested for their efficiency in achieving the therapeutic
objectives. Table 1, presents a list of HG design patterns. Each design pattern stands
for the elements of the language of design, they are the individual words or phrases
that when joined form the final story. Again this list is not compulsory and not a
closed list; on the contrary, it has to be a continuous updatable list based on designers
experiences and the special design conditions of each case (environmental, social,
and economic).
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Table (1) HG Design Patterns Proposed Open List

Pattern
Code
HG 01.
HG 02.
HG 03.
HG 04.
HG 05.
HG 06.
HG 07.
HG 08.
HG 09.
HG 10.
HG 11.
HG 12.
HG 13.
HG 14.
HG 15.
HG 16.
HG 17.
HG 18.
HG 19.
HG 20.
HG21.
HG22.
HG23.
HG24.
HG25.
HG26.
HG27.
HG28.
HG29.
HG30.
HG31.

Pattern Name
Garden Entrance
Garden Gates and Fences
Garden Walls (natural as possible using plants and earth materials)
Positive Outdoors Spaces (positive outdoors spaces functionally related to your
home or building)
Hierarchy of Open Spaces
Intimacy Gradient (space hierarchy, unfolding story, introduction spaces)
Anchor points at the heart (try to present interest points in the middle of the
spaces)
Connection with Nature (connect your garden with Mother Nature whenever it
is possible, through views from spaces)
Tree place (try to make them as natural as possible)
Vegetable and Fruit Garden
Raising Flowers
Supporting wildlife (colours, materials, and plants)
Shading Areas (natural as possible, pergolas or trees)
Arcades and Archways (providing interesting walking paths)
Paths and Goals (paths layout linking spaces together)
Path Shape
Paths smoothing roughly in the middle (the middle of the path should smooth
roughly to include an interest anchor/space or point)
Sequence of Sitting Areas
Connection with the Sun
Garden Seats (place, function, material and views)
Alcove (small sitting areas)
Sitting Circles
Seats Spots (location advantages)
Front Door Bench
Using Water (ponds and pools)
Fountains and Water drops
Water Falls
Activity Pocket (working, studying. )
Settled Work in the Garden
Waist High Shelf (sort of working areas)
Car Homes (caring and working areas)
(after, Christopher et al., 1977; Vapaa, 2002 and Tyson, 2007)

4.1.5. Formulating the Design (HG Design Stage)

The design formulation/creation is the heart of the design process of Healing Gardens.
A healing garden needs to express and present nature and its forms. It should escape
and avoid rigidity, conceptual thinking and preconceived notions of design. A
successful Healing garden design should be able to achieve the following design
objectives:
1. Maintain the spiritual character of the site
2. Accentuate the aesthetics values of the design
3. Create a variety of spaces
4. Encourage exercise
5. Minimise intrusion

6. Encourage vegetation and wildlife

7. Support the intention and care of its owners
8. Prevalence of green material
9. Provide positive destruction
10. Minimise ambiguity

(after: Stark, 2004; Vapaa, 2002; Cooper and Barnes, 1999; and Stigsdotter, 2005)

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Whilst designing, designers should avoid straight lines, volumes and planes and
excessive use of symmetry. Also, among the guidelines that would help in achieving
the required HG design objectives are:

Involve the user/client throughout the

process
Easiness to comprehend and navigate
Considering mobility in and around
Support all forms of wildlife
Promote reflection and self awareness
Maximum use of water elements
Special consideration for the garden walls
Providing working natural environment
Creative use of colour and light
Anchor points and creative nodes
The integration of art to support

Stimulating the users senses

Creative use of water elements
Offering contrast as a source of relief
Views from inside and outside
Utilise the cycle of life and seasons
Special entrance that would invite and
embrace users into the garden
Utilising white noises whenever
possible
Emphasis of natural features as
grounding points
Sitting areas

(after: Marcus and Francis, 1998; Foley; 2010 Stark, 2004; Vapaa, 2002; Cooper and
Barnes, 1999; and Stigsdotter, 2005)
4.1.6. Evaluating the Design (HG Certification Process)
The continuous evaluation of the process in every stage is a core for its success. The
evaluation is to be conducted merely by the client(s)/user(s) and the design team. The
evaluation should recognise two matters; the continuous evaluation of the targeted
healing objectives and the changes required to the targeted HG design patterns. The
creativity of the design team in designing the elements of the requested design pattern
is a determinant of HG success.
4.1.7. Implementation Process
The implementation process may differ than that of an ordinary garden in two main
points. First is the special need and consideration that has to be provided in selecting
the construction material. The material has to be completely related to earth. The
second point is engaging the user(s)/client(s) in the construction process. Every
construction detail of hardscapes and softscapes has to be done in consideration to the
clients needs and desires.
4.1.8. Mediation Process (HG users gardening)
A healthy plant is a main factor in a successful HG, where the impact of these healthy
plants is mediated to its user. HG is unique in its ability to engage its user in the
gardening tasks, through which mediation is maintained, and the therapeutic goals are
achieved. In other words, the extent to which a HG is successful in engaging its
user(s) in the gardening work is the expected extent of achieving a high level of
health, therapeutic and mediation effects.

5. Healing Garden Proposed Design Framework in action

The case study of creating a Healing Garden Design is to be presented on
three stages: the first is to report on the arrangement prior to the actual engagement of
the design process. The second stage is to report on the framework presenting the HG
design process. The final stage concerns the mediation process of the garden with its
user(s).
5.1 HG Pre-design Stage
The preparation prior to the start of the HG design process is of vital importance for
the success of the process and for achieving the required objectives. The main task of
the HG pre-design stage is composing the design team. The design team is to act as
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the tool through which the required design is to be formulated. The composition of the
right team (design team) is essential for the success of any design. There are some
factors that can guide the process of composing the required team. They include:
The technical head of the team should have the required knowledge of the HG
design process (to be identified based on the already developed fields of
expertise in each country).
Depending on the clients gender, age, norms, ethics and religion, a number of
design members should be included that have the privilege of being able to get
in close contact with the user(s). If the client is a family unit including
husband and wife, then the team should include at least a female and a male
member. The aim here is to establish a personal link with the clients.
The team should include a local softscape and hardscape designer.
The team should include a designer with the required lightning design
experience.
An assisting team, to the main HG design team, should include economic, soil,
agriculture, irrigation and construction experts.
The head of the team should be the client; he/she should be convinced that
they are to play an important role in the success of the HG design process.
In composing the team for the presented case study, the client was a business man.
His family had four members, his wife, daughter and two sons. The assignment was to
design a private and special garden to his already constructed new house. The client
already possessed a design prepared for him by a professional landscape firm. He
commented that, I am not happy with that design. I cant see myself in it.
Accordingly, the composed main team was set to include HG design
professional, a female internal designer (an architect, who is close in age, social,
economical and ethical class to the clients wife), a local landscape designer
(softscape and hardscape), an assistant landscape designer (a male member close in
age to the clients two sons). The composed team provided the required expertise in
the identified fields and ensured the maximum integration with the clients family. In
addition to the main team there was an assisting team which included lightening,
economic, agricultural, soil and construction experts.
In presenting this case study, if the design team is referred to without
mentioning the assisting team this addresses the main HG design team members only.
Also, the paper focuses on the exclusive requirements of the HG design process, thus
it skips the mutual points that are common for any ordinary garden design.

5.2 HG Proposed Design Framework Process

5.2.1 The Project Inventory Stage
The inventory stage of the HG design process should include:
1. Site Visit
Site visit(s) is the first step of the HG design process. The main team has to
accomplish the objective of getting to know the client and the project site very well.
During this stage the design team focuses on achieving maximum socialization with
the site and the client(s). A documentation plan of the healing gardens special
requirements includes documents inquiring: security issues, privacy issues, various
sources of pollution (health, sound and visual), prevailing wind, serene natural outer
views and all possible local environmental records.

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2. Defining the User(s) Needs

For any design to succeed it needs to meet the needs of its users. Thus the ability to
define the users needs is an essential task for the success of any design. For HGs
defining needs is not only essential, but is the core, and the fundamental, stem from
where the design of the HG should branch. Based on the first inventory socializing
stage included in the site visit, the design team was able to formulate a prime list for
each member of the clients family. These prime lists were finalised upon on a
number of meetings that were conducted with each member of the clients family.
These meetings consisted of one member from the clients family and members of the
design team. This allowed for a relaxed conversation where the design team was able
to understand the needs of each member. According to the results of those meetings a
final list of needs was written up to be implemented in the garden.
3. Studying the User(s) Regime
One of the basic requirements of the HG design process is the ability to set the
targeted therapeutic objectives of the garden. The therapeutic objectives should be set
to achieve the required healing effects on the family members. Therefore, to help set
the therapeutic objectives, the design team had to define the daily/weekly regime of
each family member. Finding out the daily/weekly routines was easily accomplished
as the design team had already formulated a degree of relation with the client.

5.2.2 The Stage of Developing Ideas and the Design Concept

In this stage, based on the former stage of the HG Design process, the design team
formulates and discusses a number of ideas. The proposed ideas from the team have
to go beyond the expectations of the client without undermining any of the clients
needs. Among the conceptual design challenges that the design team faced during this
stage was:
The need to establish a connection between the inner spaces of the house and
the outer spaces of the garden. Entrance and views from, and to the garden
play an important role in maximising the healing effect of the garden.
The other challenge was the need to achieve the family requirement regarding
a prestigious garden entrance; which directly falls under the category of a
formal entrance. A formal entrance usually has a negative effect on the healing
powers of the garden. Adding to that, the architectural designer neglected the
approach to the house from the garden gates.
Following a series of meetings between the team members and the family, the first
layer of the final design concept of the garden was formulated. The garden is divided
into two parts; the first part is regarded as a welcoming and introductory garden to the
house. The inner, main, garden was divided to a number of functional spaces to
achieve the maximum integration between the houses inner spaces and the gardens
space. Space articulation led to a successful garden design that achieved the needs of
the family.
5.2.3 Setting the HG Therapeutic Goals
Based on the former analysis of the inventory stage, regarding both the
environment and the users, the levels of stress facing the local environment and the
garden user(s) were identified. The environmental stresses were defined based on the
environmental analysis of the gardens local and adjacent environments. On the other
hand, the daily and weekly routines for each member of the family were studied,
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aiming to identify the types and levels of stress each member is exposed to.
Accordingly, the design team composed a list for the targeted therapeutic objectives
of the garden, taking into consideration and analysis of the site local environment.
The therapeutic objectives were classified into three levels: a. personal
client(s)/user(s) therapeutic needs, b. place physical environmental therapeutic needs,
and c. the achievement of maximum interaction (between the family member and the
gardens natural environment). Table (2), presents the personal, physical and
interaction targeted therapeutic goals for the case study. After setting the final
therapeutic goals, the design team added the therapeutic layer to the design concept
formulating the final HG design concept for the garden.
5.2.4 Selecting HG Design Patterns
After defining the list of therapeutic objectives, the next step would be the
selection of the required design patterns. These design patterns have the ability of
achieving the targeted therapeutic objectives. Studies by Christopher et al. (1977) and
Tyson (2007) regarding design patterns language and therapeutic achievements are
considered as a bible for the HG design process. Their works provided a method for
testing the healing effects of the garden. As presented in table (2), the case study
utilised 29 design patterns that coincide with the familys needs, the physical
environment of the site and the targeted therapeutic goals. Figure (3), presents the
HG design patterns chosen for the garden and the proposed functional design for each
of them. There is no limit for the number of selected HG design patterns. However,
designers should aim to utilise as many as possible since they are regarded as tools for
achieving the targeted therapeutic objectives. Therefore by increasing the number of
design patterns you are increasing the probability of achieving the therapeutic
objectives of the garden. The patterns can be classified into:
Entrances and wall patterns
Paths and spaces patterns
Anchor points and sitting areas patterns
Senses simulation patterns
Water, earth and wildlife patterns
Interaction patterns.
During this stage, the design team was proposing the idea of adding a swimming
pool as a sort of water design pattern (the symbol of the pool as a HG design pattern
stands for: activity, art, nature and view it has the ability to provide:
contemplation, purity and soul healing therapeutic effects). As the core of the HG
design process the family has to be involved in every decision. In discussing that issue
the family disagreed. The parents rejected the idea, the two boys supported the idea
and the girl was neutral. The design team adapted the utilisation of water as a design
pattern by changing idea of a swimming pool into a waterfall design with a small
pond. Also the team convinced the parents to construct the necessary installations for
a swimming pool, just in case their needs change in the future. This decision created a
sort of design flexibility in the final proposed HG design master plan, which defiantly
minimized any cognitive dissonance felt by the client. Furthermore, the decision
triggered the team into realizing that any proposed HG design should have the
required flexibility to change and adapt, on the long run, according to changes in the
users needs.

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Table (2) Healing Garden Therapeutic Program Formulation Matrix

HG selected design patterns

(after: Vapaa, 2002; Christopher et al., 1977 and Tyson, 2007)

HG 01
HG 02
HG 03
HG 04
HG 05
HG 06
HG 07
HG 08
HG 09
HG 10
HG 11
HG 12
HG 13
HG 14
HG 15
HG 16
HG 17
HG 18
HG 19
HG 20
HG 21
HG 22
HG 23
HG 24
HG 25
HG26
HG 27
HG 28
HG 29
HG 30
HG 31

HG Design Patterns

CASE STUDY: Selected design patterns

Familiar tasks (work, recreation & care)

Observation and relaxation

Attractiveness, Mystery and Enjoyment

Clarity and spatial orientation

Variety of activities and abilities

Creating interactive environment

Familiar Character and Earth

Supporting wildlife habitat

Compensate to Nature

Comfort Microclimate

Integration between indoor and outdoor

Ownership

Personal Privacy

Awareness, Beauty and satisfaction

Independence and Freedom

Safety and Security

Therapeutic Objectives

Therapeutic:
Human Needs
Therapeutic:
Environment
Needs
Interaction: Behavior

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Figure (3) Case Study Utilised HG Design Patterns

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5.2.5 Formulating the HG Design (master plan)

The proposed HG design framework adopted a number of design guidelines
that aim to maximise the HGs ability to fulfil its horticultural therapy program and
functional goals (Moore, 1989; and Simson and Straus, 1998). However, the design
guidelines cannot guarantee the efficiency or the output of the design process. The
formation of the design process has been widely portrayed as a spiral metaphor
that reflects the designers pattern of thinking. Translating notions, ideas and
abstracts into physical design requires certain design methods: knowledge, experience
and talent. These methods are used to bridge the gap between the scientific path of
thinking and the creative line of thought (Tyson, 2007).
The technical head of the design team, the one with the knowledge of HG
design, has a vital role in this stage. He needs to guide the design team in order to
maximise the healing ability of the garden. He is required to change colours,
materials, plant types and the position of HG design patterns. He should also keep inmind the design guidelines, work with his previous experience and be in full cooperation with the client.
Figure (4) Final Healing Garden Landscape Design

Figure (4), presents the final master plan for the garden. As explained in the
concept stage, due to architectural limitations, the garden is divided into two parts.
The design team decided to use the front part of the garden as an introductory space
for the main garden. Baring in mind the familys requirement of having a luxury
entrance, the entrance space was articulated using a soft fence which created a centre
of symmetry on the houses axis. Knowing that symmetry is to be avoided in the
design of healing gardens, the team started using a number of HG design patterns to
outdo this symmetry. Design patterns used include: motion water paths, a classic
fountain, a luxury gate and sitting areas overlooking the outer environment of the
garden.

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Surrounding the house there is a flower bed containing colourful flowers that create a
smell which stimulates the human senses. The bed is positioned above the basement
level, so the design team used that change of level to create a soft waterfall with
natural rocks. The selected recourses are all natural earth materials. The design team
integrated stone edges and marble paths in a unique design which emphasis the
importance of natural materials. A number of archways were constructed, in the plan,
to soften the entrance of the main garden where a change of level is overwhelming. A
number of seats and flower beds were added to further release the impact of
exaggerated level changing.
Figure (5) Art Work an efficient HG design pattern

To the left of the house there is a nine meter high wall. The wall is set up along the
side path leading to the main garden; the design team articulated the wall then
decorated it with artwork to release any sense of imprisonment (figure 5). The other
side of the entrance is to accommodate a number of evergreen mature trees providing
shade for the car parking area, screen for the house kitchen and shelter for wildlife.
Through this area we can reach the path to the right of the house that contains some
family activity areas.
The main garden is at the back of the house. For family members, the main
entrance to the garden is from the living area. The living area overlooks the main
terrace; this provides a natural and visual extension to the houses inner space as the
terrace flooring is made from the same material. The material is integrated into a
coloured gravel and marble plaza as a form of earth material. The width of the terrace
was designed to fit the clients weekly routine of having family and friend gatherings.
The terrace was elevated above the garden level to insure scenic views of the different
garden elements. To the right of that terrace there is a shaded sitting area. The sitting
area is sheltered with dense erect evergreen plants to provide the required privacy
from the neighbours. This sitting area may also be a quiet space for sitting alone
reading or just recovering and enjoying the healing power of nature. Beside the sitting
area we can find the familys activity zone. Flower beds are located near the activity
zone and sitting areas to enrich the human senses with sweat scents and views. The
terrace also functions as an entrance plane to the garden. Access is gained from the
terrace plane to the gardens main footpath which overlooks a wide and expanse of
lawn, carpeted by the natural shade from trees, leading all the way to an adjacent
field. These aesthetic views are beyond of the garden premises; however, it forms a
HG design pattern as it softly connects the garden to the outer natural premises.
The main part of the path is made from random shaped marbles and fine
gravel divider. The path connects the various parts of the garden together and moves
to one of the garden corners where a lovely pergola (a circular sitting HG design
pattern) is located. The sides of the path are defined by natural stones and whenever
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possible plants are allowed to creep on the path. The left and right walls of the garden
are to host a number of planting groves. These groves provide the garden with a sense
of wildlife habitat, fruit and vegetable vegetation to add to the sense of taste and
texture. Also, flower beds and seats are provided as soft anchor points. These areas
provide the garden with activity pockets, ones that stimulate the interaction between
the users and the natural environment of the garden. The main footpath steams to a
natural stepping stone path that circulates the garden joining its different parts
together. On the inner right corner of the garden, there is a natural waterfall utilising
water and natural rocks aiming to achieve maximum stimulating powers of nature to
the cognitive human brain, and thus triggering the healing power of nature. The
waterfall is to provide the garden with a source of white noise and to stimulate the
hearing sense. Attached to the waterfall is a small shallow pond, acting as a great
source of light reflection, and a couple of stone seats, where users can sit and enjoy
the healing power.
Knowing the green colour to be the colour of peace, the rest of the garden is
covered with lawn adding the green cover and colour to the garden growth.
Surrounding the lawn are pockets of shrubs and flowers, providing wildlife and
adding various colours to the garden. Through the analysis of the family regime, the
colours which best complimented the regime were found to be orange (colour of
motivation, activity and passion), purple (symbol of mystery, deep love,
contemplation and unconscious) and blue (a source of spiritual release, calmness,
sincerity and rest). Also the garden contains a central anchor point that is to contain
three erected palm trees providing an internal and external landmark for the garden
and a scenic point of interest. The location of the planting pockets and the various HG
design patterns of the garden were defined in respect to the internal views from the
house spaces and furniture.
5.2.6 The Design Evaluation Process
The evaluation stage should be regarded as a continuous adjacent process to
the HG design process. Every step of the HG design process was evaluated by the HG
professional, by the design team and finally by the members of the family. The HG
design professional has two very important evaluations to continuously conduct and
measure. The first of which is the evaluation of the expected healing capabilities of
the garden, while the second would be the ability to design and create successful HG
design patterns. The design team is to evaluate the healing elements of the design
patterns. Finally, the family is to perform the final evaluation of the HG design
concerning its, elements, materials, colours, and plants. It has to be clear that it is
always easier to adjust or even change a design than to construct the garden, and then
demolish part of it simply because it does not satisfy its users needs.
5.2.7 Implementation Process
Private Healing Gardens implementation process is unique in that it involves the
users in the construction of their garden. The process can be considered as a start
towards the mediation stage or the healing process. The users should be involved in
the various implementation stages. This sort of engagement is the core upon which
the healing abilities of the garden are boosted.
5.3 The Mediation Stage of the Healing Garden
Healing gardens provide a new way of living, a regime change, for its users. It urges
its users to engage in more activities. The mediation process of the garden starts
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during the implementation process of the garden and thrives after its construction. The
HG design team should apply continuous monitoring and observation of the garden
elements and their affects on the users over a period of two years. An evaluation of
the HG therapeutic program should be conducted and the required adjustments should
be carried out.
6. Case Study Findings
Listed below are the findings the design team reported.
1. The user gained appreciation and satisfaction in being part of every step in
creating the garden. Being involved in every detail created a sense of
belonging between the user and the garden, even before the final construction
stages were achieved.
2. Giving the family members the chance and freedom to create the views they
wish to see from their windows or chairs initiated a sense of comfort or
healing that directly associated itself with the garden.
3. The ability of the design team to identify the daily/weekly regime for each
family member helped in personalizing the garden to uniquely fit each
members life. This allowed each user to self reflect and feel familiarity with
the garden details. However, the team has recognised the need to hire a
professional therapist (as a member of the assisting team) to conduct the study
of the clients daily/weekly routines, and to help in setting the therapeutic
program of the garden.
4. The integration of natural art in the garden design helped in creating pride and
care towards the garden.
5. The evaluation process is always highly subjective; this highlights the need for
an objective tool that would help to certify the healing powers of a garden.
6. The stimulation of the users senses can be recognised all around the garden.
There are: different attractive views, various colours, sounds of water and
birds, smell of flowers and fragrances, a variety of feelings from various
textures, and finally, but not yet achieved, the ability to taste.
7. The design team did not announce their target of achieving a healing garden to
the family. Nevertheless, the clients family expressed their deep satisfaction
with the garden. This supports the notion of creating healing gardens as a deep
form of sustainable landscape rather than creating a normal garden with a
shallow form of landscape that lacks sustainability and focuses only on decor.
8. The implementation and construction costs of healing gardens are similar to
that of any ordinary garden; and sometimes even lower. Nevertheless, the
efficiency of the garden is highly beyond that of any ordinary garden. This
proves that promoting a deep form of sustainable landscape is a matter of a
design quality and knowledge rather than economic potentialities and budgets.

7. Conclusions and Recommendations

The paper presents a practical research for promoting a sustainable form of

landscape labelled as Healing Gardens. The proposed HG design framework
aims to guide the landscape profession for promoting healing gardens. The
framework utilises the therapeutic design patterns (table 1) as a method for
ensuring the achievement of the gardens targeted therapeutic objectives.

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The paper composes a genuine therapeutic manual (table 2), through which any
landscape designer can compose a healing program for their garden.
The proposed framework is designed to provide a friendly guiding tool rather than
a compulsory systematic process. It is better portrayed as an open learning process
where professionals are invited to perform any adaptations based on their
expertise and knowledge.
The practical application of the case study has proven the need to include a
professional therapist as a member of the HG assistant design team.
The paper proposed three stages for designing and promoting of HG. Starting with
the pre-design stage, the HG design framework stage, and the HG meditation
stage.
Healing gardens have proved to be a deep from of sustainable landscape, a form
that would benefit both human-beings as well as the natural environment.
Landscape professionals have an obligation to further contribute to all forms of
deep ecological landscape rather than being involved in the shallow decor form of
landscape practised nowadays.
Although this paper has contributed to the field of healing gardens (health and
landscape); the field is still considered as a research gap area. Researchers should
target such field knowing the great benefits different communities could gain.
Health and healing are the core of any sustainable form of landscape. A number of
issues have been raised during the research that could be identified as points for
further studies. The most highly rated priority is the ability to develop a
sustainable tool that would test and certify the healing power of any landscape
design.

Notes
1. In presenting this case study, if the design team is referred to without
mentioning the assisting team this addresses the main HG design team
members only.
2. The paper focuses on the exclusive requirements of the HG design process,
thus it skips the mutual points that are common for any ordinary garden
design.
3. Frameworks presented are not compulsory or rigid. They many differ
according to the different sites, and customer needs.

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