Natural surroundings and biophilic design may enhance therapeutic work with children and youth

Hauge, A. L., Lindheim, M. O., Røtting, K. ., & Johnsen, S. A. K. (2023). The meaning of the physical environment in child and adolescent therapy: A qualitative study of the Outdoor Care Retreat. Ecopsychology, 15, 244-258.

Research on factors impacting therapy usually focuses on the therapist, the client, and/or the relationship between therapist and client. This study considers an often over-looked factor in therapy – that of the physical environment.

The physical environment in this study was a cabin in a natural setting on the grounds of the Oslo University Hospital in Norway. This cabin – referred to as the Outdoor Care Retreat (OCR) – is used for conducting therapy sessions with hospitalized chronically ill children. The intent of therapy in the OCR is to give children nature experiences despite being hospitalized. The aim of this study was to compare “the experience of the meaning of the physical environment in therapy in the OCR” to traditional hospital environments. The study also aimed “to propose a general theoretical model of the meaning of the physical environment in child therapy.” A total of 17 individuals participated in the study through either group or individual interviews. Seven leaders of the program participated in group interviews focusing mainly on background information. Six therapists (psychologists, social workers, and medical doctors) and four parents of hospitalized children participated in the individual interviews, where the primary focus was on the experience and use of the cabin. Individual interview participants were also asked to compare the OCR with the traditional hospital setting.

Interview responses indicated that “the OCR influenced leaders, therapists, children, and parents in many similar ways.” There was a general agreement about the affordances of the OCR positively influencing the therapy. Specific ways in which this occurred were through natural bodily reactions, multifaceted role activation, situational understanding, restorative emotional reactions, therapeutic alliance, and valuable expectations. Findings also indicated that the OCR creates “a holding environment” – that is, a psychological space that is experienced by the child as safe and welcoming. A benefit of the OCR frequently mentioned by the therapists relates to how it offers an external focus, either in a view of nature or in nature-based activities. A shared external focus contributes to the therapeutic flow by providing a positive distraction, which is generally lacking in a more typical hospital setting. The therapeutic flow in a holding environment was identified as the main focus of this study, with the other categories serving as a base for understanding how the physical environment impacts the therapeutic work.

This research highlights the importance of place and nature for therapy with children. Findings show how the therapeutic setting can influence therapeutic intervention. The starting point of a model based on these finding may be natural surroundings and biophilic design.

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