A STEP TOWARDS HEALING - An evidence based designed therapy garden for drug addicts and alcoholics by Cristina Conciatu

A STEP TOWARDS HEALING An evidence based designed therapy garden for drug and alcohol addicts

CRISTINA CONCIATU and AMRA LJUBIJANKIC 30 ECTS MASTER THESIS

Authors: Amra Ljubijankic (cpb508) and Cristina Conciatu (sbm960) 30 ECTS Master Thesis in Landscape Architecture Supervisors: Ulrika Stigsdotter & Anne Dahl Refshauge Department of Geosciences and Natural Resources Management

Amra Ljubijankic

Cristina Conciatu

We would like to thank and show our appreciation to our supervisors Ulrika Karlsson Stigsdotter and Anne Dahl Refshauge, for a great and inspiring guidance along the way. A special thanks to JĂ¸rgen Maltesen, the Director and Manager at Alfa-Fredensborg, who made everything possible for us at the rehabilitation center, and therefore, helped us accomplish a dream. We would also like to thank our families and friends, for their endless love and support. Thank you, Tusind tak, Hvala puno, MulČ&#x203A;umesc!!

ABSTRACT This Masterâ&#x20AC;&#x2122;s Thesis proposes a renewal for the garden belonging to the rehabilitation center for drugs and alcoholics called Alfa, located in the city of Fredensborg. Literature research, the exploration and registration of the site, together with a thorough study of the target groupâ&#x20AC;&#x2122;s attributes and needs and the results gathered from the questionnaires and interviews formulate the design guidelines and the concept. The result of the thesis is developing an evidence-based design which materializes in a therapy garden.

TABLE OF CONTENTS Chapter 1

Introduction Introduction Aim and research questions Evidence-based design

Chapter 2

Methods

Literature study Site exploration Landscape analyses Target group analysis Questionnaire surveys and interviews Learning from a therapy garden: Nacadia An inspirational meeting with Fritzen

Chapter 3

Site and Location

Site Location Fredensborg and Facilities About Alfa, the rehabilitation center

Chapter 4

Target Group Addiction and its Consequences Common Symptoms Treatment Phases at Alfa CENAPS - a model for treatment Mindfulness - part of the treatment

Chapter 5

Theoretical Framework

The Mental Strength Pyramid The Attention-Restoration Theory Prospect-Refuge Theory Stress Reduction Theory 8 Perceived Sensory Dimensions Therapeutic Horticulture Hypothesis

Chapter 6

Landscape Analyses Site Presentation Lynch Analysis Applying the 8PSD for an analysis decode Existing vegetation; Functions and features Vehicle and Pedestrian Flow Entrances; Views to the garden Floor Plans SWOT

Chapter 7

Questionnaires and Interviews

Introduction Interviewing the clients Interviewing the staff Learning from a therapy garden: Nacadia An inspirational meeting with Fritzen

Chapter 8

Site programming

Design Guidelines

Chapter 9

102

Design Proposal Design proposal - a tour New proposed schedule The Courtyard The Back Garden The Horticultural Therapy area The Beech Forest The Wilderness Sections

Chapter 10

Discussion and Conclusion

140

Discussion Conclusion

References

144

Appendices

156

APPENDIX APPENDIX APPENDIX APPENDIX

A B C D

CHAPTER 1

INTRODUCTION

INTRODUCTION People and nature have always had a close connection. Nature created a home for humans to live in; whether it was a protected cave in the mountains, a cabin in the woods, or a village in the desert. Nature’s flora and fauna provided food, even though some had to hunt for it, the environment provided all the necessities for human beings to stay alive and thrive. But it seems like this connection is becoming disrupted.

(World Health Organization & UN-HABITAT, 2010). So people need to be encouraged to be healthier by having not only a healthy mental state, but also physical and social state. In this case nature can provide and serve as a good resource for healthier lifestyle patterns in all of these three aspects. Several research shows how nature or environments with vegetation, water features or wildlife elements can have several positive effects on people. Observing vegetation, wildlife, colors changing in seasons, hearing sounds of moving leaves in the breeze, birds chirping or feeling the warmth of the sun on your skin, these can have a restorative effect on people (Marcus & Sachs, 2014). People restore from stress by being and walking in nature, even restore from illness by looking at it (Marcus & Sachs, 2014), green environments facilitate social connections (Marcus & Sachs, 2014); finally it has been proved that green environments promote physical activity (Björk et al., 2007), which leads to a healthier body and mind.

Nowadays, half of the globe’s population live in cities, in these urban, dense, paved areas (World Health Organization & UN-HABITAT, 2010); our original environment is almost nowhere to be seen. In some cities, people don’t even have access to nature nearby. People have detached from their native environment, without realizing the repercussions. It is understandable that people evolve and always seek for opportunities, success and power and money, which has led to the growth of our dense cities. But cities lack in green open areas, wildlife and fresh air. People who are living the busy life in an urban environment might not realize of how great importance restorative areas can have for the physical and mental state of the human. For those that have sedative jobs in offices, or those who have too many unhealthy habits, these conditions are the reason why the humans are further away. The distance from nature, and the closeness to city, has been a large influential factor in this process.

Now that nature is not a big part of the daily life as much, feelings of stress, depression, anxiety, worrying are amplified. Looking for a solution to all the problems and feelings mentioned above, some might find it in drugs and alcohol. Studies show that people living in big cities, like for e.g. Greater Copenhagen, tend to use a larger amount of substances than the people from the outskirts and smaller cities (Sundhed.dk, 2014). Therefore, the city might have a negative impact on people’s general state of mind, influenced by the lacks in restorative environments.

The World Health Organization (WHO) define health as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”

Having a closer look at Denmark, we find out

there is a high consumption of drugs and alcohol, especially alcohol. About 500.000600.000 are heavy drinkers (they consume more than the limit - 14 drinks for women and 21 for men, within a week), 190.000 drink enough so it damages their health at a certain extent, and about 160.000 are what you would call alcohol addicts (Alkoholforbrug i Danmark, 2013). Alcohol causes 3000 deaths a year in Denmark, which represents 5% of the number of all deaths (Danskernes sundhed, 2013).

rehabilitation. Additionally, the costs of the treatment could probably be minimized and used for the maintenance of the gardens. Rehabilitation institutions might be tough and difficult for people to be in, especially for longer periods of time. For clients in physical or emotional pain, situated in an institution like this might be hard and stressful to deal with because they have to adapt and be aware, not only of themselves, but also of a new environment, new people and situations that they can not control. Following the treatment in a rehabilitation center for 3 months (in the case of this target group) could be quite challenging because of the long hours of therapy sessions, group meetings, workshops, individual written assignments; the workload is demanding, to say at least.

On the other hand, when it comes to drug abuse, there are 33.000 drug addicts in Denmark, from which 11.000 of these consume marijuana, 13.000 are injecting drugs, and the rest uses prescribed medicine (Narkosituationen i Danmark, 2014). The treatment for substance abusers in Denmark is financially handled by the municipalities, and every addict has the right to go into treatment at least 14 days after applying for it. Nowadays, the municipal expenses for the funding of social substance abuse treatment rise up to 874 million DKK, while the number in the year 1995 was only 294 million DKK. First, because the number of addicts has increased, and secondly because the government decided they want to invest in an even better treatment.

The previous facts bring us to out motivation, that leads to formulating the aim of this Master’s Thesis.

AIM AND RESEARCH QUESTIONS The scope of this Master’s Thesis is the development of an evidence-based design proposal for the outdoor area at the Drug and Alcolol Rehabilitation Center Alfa; by doing so, we introduce the effective use of a therapeutic garden, in order to improve the existing treatment and recovery for the clients. In our understanding, a therapeutic garden is “a garden which is deliberately designed with the intention to contribute to a positive development of health and well-being” (Konceptmodel, 2008).

Furthermore, there are 53 rehabilitation centers all over Denmark, from which 49 possess a garden that is not used for treatment purposes (danris.dk, 2015). If these rehabilitation centers would have, for. e.g. a therapy garden, that would be supportive for the treatment happening indoors, maybe the outcome of it would be better the clients could aim for a better and faster

The thesis is based on the study of the target group, in which 9 clients have been

interviewed at the center, while their stay for rehabilitation/treatment. The study was helpful because it revealed how the clients, as well as the staff perceive the restorativeness/benefits of the outdoor environment and how it could be changed in accordance with their needs.

aesthetic and practical skills a landscape architect has. As Stichler and Hamilton (2008, 3) were stating, “Evidence-based design is a process for the conscientious, explicit, and judicious use of current best evidence from research and practice in making critical decicisons, together with an informed client, about the design of each individual and unique project”.

Design guidelines and considerations are formulated based on the results of questionnaires and interviews, as well as the knowledge gathered about the target group and from literature. In formulating the design guidelines, staff and clients’ families are also taken into consideration.

Using the best research evidence and understanding the target group’s attributes represent the back-bone of the design. Finally, the design proposal in the end will be the result of our skills as landscape architects (together with the other two categories), looking for finding the best solution for each obstacle comes in the way, and trying to execute the best design possible for the target group.

In order to reach the aim of the Master’s Thesis and accomplish the results previously mentioned, the following research questions are formulated: 1. What are the characteristics and needs of the target group and how do they imagine /perceive an ideal outdoor environment for recovery?

target group’s attributes and special needs

2. How will the gathered information from research and practice evidence be used in the design process, in order to create the best restorative environment for the clients? 3. How would the design of the garden and the new treatment schedule benefit the clients in the recovery process, if the therapy would be happening outdoors?

aesthetic and practical landscape architect skills

EBD

best research / practice evidence

EVIDENCE-BASED DESIGN Evidence-based design is a powerful tool that binds together three important aspects: target group’s attributes and special needs, best research/practice evidence and the

Fig. 1 - Diagram showing the three pillars that together form the evidence based design model.

CHAPTER 2

METHODS

METHODS In order to realize an evidence-based health design, a few methods have been used along the way in the process. These will be presented and described in the following, in chronological order.

LANDSCAPE ANALYSES A landscape analysis was made after collecting all the information during our visits at the site. The focus was identifying different landscape characteristics, attributes. In order to evaluate the site in this sense, a number of specific analysis were made: Lynch analysis, an analysis of the existing vegetation, as well as of functions and features, vehicle and pedestrian flow, an analysis of the building floors (in order to show how the different rooms are displayed and how are these used), a SWOT analysis. The landscape analysis is of great significance as it provided us with a very good understanding of the site.

LITERATURE STUDY In order to get a good understanding of the field of health design and its practice, a literature study has been made in the first place. Books, scientific papers, articles in newspapers and online media were investigated. If in the beginning the focus has been made on health design on a general level, the study was narrowed down to much more specific literature related to: existing projects related to drug and alcohol abusers and literature describing the target group.

TARGET GROUP ANALYSIS At this point in our work, we have made a very thorough study of the target group: alcohol and drug abusers. Our aim was learning what an addiction means and what kind of challenges does this target group meet (psychical and physical challenges, behavioral, and how their abuse affects relationships with their families, friends or others), in order to understand what their needs could be. Each of the substances (different types of drugs and alcohol) was studied, so common symptoms were identified and evaluated. Talking with the clients - through questionnaires and interviews, was also part of the target group analysis, and it provided us with valuable information. The collected data helped us better understand their condition. The results of the target group study are to be later used in formulating the design guidelines, later on applied in the design process.

SITE EXPLORATION In order to get a good understanding of the site, a couple (consecutive) visits were made. During these visits the site has been explored by walking, capturing photographs and sketching, and at times observing possible interactions that could encounter in between the clients (or the staff) and the outdoor environment at the center. All the information gathered (photographs, sketches, written observations) was very valuable to our learning and working process, as it helped us understand the site: existing conditions, strengths and weaknesses, possible qualities, how the clients and the staff make use of the garden, appearance and general atmosphere, sense of place.

how the garden works, and how it is used by both, the staff and clients.

QUESTIONNAIRE SURVEYS AND INTERVIEWS

The talk with Djernis was enlightning, as she thoroughly explained how the garden is used for therapy. After the discussion, the garden has been explored, observation have been made and specific design features have been analysed.

Questionnaire surveys and interviews were conducted with both, the clients and the staff. The main reason for orchestrating this was gathering information about the usage of the garden: how it is used, when, how often, opinions about the garden, what features the users like/dislike, what activities they would like to have in the garden or not, personal needs. Both, closed and open questions have been used, in order to get complex answers that would cover all our interests.

AN INSPIRATIONAL MEETING WITH FRITZEN It was extremely valuable for this Thesis study to meet a former addict, in order to get even more information about the target group and its needs. And so, we met Martin Bødker Fritzen, a former drug addict, who was in the situation of living at a rehabilitation center more than three times.

The questionnaires and interviews took place at the center, during two visits. The first visit was focused on the clients mostly, while the second was focused on the clients as well as the staff. We were allowed to approach the clients and then interview them with their acceptance. Nine clients out of 16 staying at the center at that time were interviewed; and eight members of the staff (with different backgrounds) co-operated with us.

The outcome of the discussion resulted in valuable information based on his own perception and understanding of the treatment programmes in the rehabilitation centers and how he experienced the outdoor environments, and eventually how could they have been used in order to improve his physical and mental state.

All the information gathered from the questionnaire surveys and interviews is presented in detail later in this Thesis, in the “Questionnaires and Interviews” Chapter. (See page 72)

LEARNING FROM A THERAPY GARDEN: NACADIA A visit to Therapihaven Nacadia (Therapy Garden Nacadia) was made, in order to meet Dorthe Djernis - psychologist and therapist at Nacadia - and to understand

CHAPTER 3

SITE AND LOCATION

SITE LOCATION

Municipality of Fredensborg has 39.772 inhabitants (Wikipedia, 2015) and consists of the towns Humlebæk, Kokkedal, Nivå and Fredensborg, and a lot of smaller farm towns like Sørup, Asminderød, Brønsholm etc. It is well known for Fredensborg Slot, which is the summer residence of the Royal Family.

Esrum Lake

Fredensborg Municipality Baltic Sea

Zealand

Denmark Fig. 2 - Location of Fredensborg Municipality in Zealand, Denmark

FREDENSBORG AND FACILITIES

2 5

4 6 3

9 7

Fig. 3 City of Fredensborg and its main facilities identified.

Alfa - Rehabilitation Center

Fredensborg School

Fredensborg Palace and Gardens

Shopping Facilities

Fredensborg Golf Club

AsminderĂ¸d Neighborhood

Fredensborg Train Station

SĂ¸rup Neighborhood

Esrum Lake

ABOUT ALFA, THE REHABILITATION CENTER SHORT HISTORY Located in Fredensborg, North Zealand, Alfa is today a rehabilitation center for drug addicts and alcoholics. Serving as an orphanage from 1907 to the 1970â&#x20AC;&#x2122;s, it was transformed into a rehabilitation center in 2003, by JĂ¸rgen Maltesen, a Danish Addiction Counselor. Fig. 5 - Old picture of Alfa illustrating the group of young boys and their teachers, celebrating a form of an event.

Year 1917 was a very important moment as the orphanage extended its land to 8 ha and became a home to 40 young boys

GENERAL FACTS Due to its structure and division of space on the inside (such as a student dormitory) the place was easily transformed into a rehabilitation center for drug abusers, so it could accommodate 26 clients at a time. In the first phase of the treatment the clients spend 3 months at the center. In this time they all have a single room, which is fully furnished, with lock on the door and TV, and a window with a view to the garden (Maltesen, 2015).

Fig. 4 - Old picture of Alfa and the surrounding outdoor areas, while it was still an orphanage, back in 1926.

From a total of 26 clients living at the center, about 25% of them are women and 75% are men, from which 20% are alcoholics and 80% are drug addicts (Maltesen, 2015). The clients are aged 15-55, the center also accepts older clients, but this happens very rarely.

As years have passed, the institution was getting more facilities that helped improving the quality of life there (for the residents) and the quality of teaching and administrating the orphanage (for the staff and teachers): sports ground, gym hall, a room for arts and crafts, auxiliary rooms for residents, modern kitchen and offices, laundry facilities. By the time they were adults, the residents were either prepared to go to college, to be sent to work or to serve in the World War I (Eskesen, Beck & Knudsen 1926).

Alfa-Fredensborg looks to accommodating the clients in the best way possible, offering facilities such as a gym hall, fitness equipment, a music room, common living-rooms, smoking room, treatment rooms, rooms for group gatherings, not to forget the garden

surrounding the building, which measures 19.000 m2.

ing to their profession and skills. Each of the employees have their own role at the center. But the general tendency is that the staff is always ready to help the clients with whatever problem they might have, at anytime. Therefore their offices are open at any time during their working hours.

Most of the clients getting treatment at Alfa Fredensborg have had problems with crime, prostitution, violence and besides alcoholism or drug addiction (or both) they might suffer from depression, anxiety or irritability (alfa-fredensborg.dk, 2015). The thing all the clients have in common is the fact they cannot control and stop the addiction on their own, so they are in need for help. This is when Alfa Fredensborg intervenes, offering an opportunity for recovery with the suggested treatment scheme.

STAFF DESCRIPTION Alfa Fredensborg is a very challenging institution, where there is a need for employees with a wide range of skills for the daily responsibilities and tasks. Currently there are 22 employees at the center, from which 8 women and 14 men. They have different education backgrounds and different tasks and responsibilities at the center, accord-

Qualification

Nr.

Treatment assistant Psychotherapist Treatment Responsible Social Worker Psychiatrist Economist Anthropologist Secretary Deputy Head Clerk Cleaner Weekend Watch Caretaker/Driver

6 3 2 2 1 1 1 1 1 1 1 1 1

Total

Fig. 6 - List with the number of employees at Alfa and their specialisation.

CHAPTER 4

TARGET GROUP

ADDICTION AND ITS CONSEQUENCES DEFINING AN ADDICTION Signs of alcohol abuse:

Addiction is a disease, and it is defined as “a chronic, relapsing brain disease, that is characterized by compulsive drug seeking and use, despite harmful consequences” (National Institute on Drug Abuse, 2015).

hiding + denying your drinking loss of control drinking alone blackouts regular drinking routines day starts with a drink breaking promises + neglect become negative + unpleasant

ABOUT ALCOHOL ABUSE Consuming alcohol in Denmark is considered a normal and harmless act, the Danes drink more than 3-5 drinks in a week. 50% of the men and 41% of the women drink between 1-7 items in a typical week (Danskernes Sundhed, 2013), which means that half of the population does not let a week pass without having at least one drink. But Danes do not only consume alcohol often, but also in large amounts. It is estimated that about 860.000 inhabitants drink more items than what is recommended, which means the men in this category consume more than 21 drinks/week, and the women in this category more than 14 drinks/ week (Alkoholforbrug i Danmark, 2008). While some of the users can easily cut out on how much they consume, others need help getting rid of this very unhealthy habit. Alcohol addiction causes about 3.000 deaths per year in Denmark (Danskernes Sundhed, 2013).

Fact box - Summary of the most common signs of alcohol abuse.

and affects one’s relationships with family, friends and colleagues.

HOW IT STARTS AND WHY There is no obvious explanation for which causes lead people to alcoholism, but there could be a lot of different reasons that contribute to the development of an addiction like: social factors for example the family, work or society’s influence; or it could be mental factors like too much stress caused by daily situations at work or handling life in general, or depression, for these people alcohol can put a damper on their daily struggles. Some just don’t know how to deal with their problems and find alcohol as a solution. Of those who develop alcohol dependence, it is assumed that 1 out of 5 have an inherited or socially conditioned increased risk of dependence (Sundhed.dk, 2012). A childhood marked by drug and alcohol abuse among the parents increases the risk of developing addiction for children. The more use of alcohol at home, the greater is the risk that the children will

WHAT IT IS Alcoholism is a condition in which you have no control over your consumption. An addiction involves very unpleasant or even dangerous withdrawal symptoms if one individual stops drinking. The abuse can lead to mental as well as physical injuries

use or abuse alcohol at some point in their lives. It is also quite common to develop alcohol abuse after dealing with difficult life situations for example a separation or a divorce. All these factors can lead to an alcohol addiction. Once the addiction is there, it can easily be a different reason that is keeping the addiction present, than what causes the addiction to start.

Alcohol impacts on the body: Damages the liver Ulcer and stomach bleeding Pancreatitis Bleeding from varicose veins in the esophagus Cancer in mouth, throat or esophagus Nerve inflammation Heart disorder Brain damage and shrinkage Dementia Brittle bones /osteoporosis Impotence

A generalization amongst what types of people are alcoholics is not possible. Alcohol abusers are all different and come from very different environments. It is quite common nowadays to think of alcoholics as being the bums on the streets, but a study has shown that alcohol addiction is even more common within people with a higher education, a family and a steady job (Danskernes sundhed, 2013).

Fact box - Table summing up some of the most important alcohol consequences on the body.

Alcohol impacts on the mind: Hallucinations Dementia Delusions Disorientation Reality disruptions Anxiety Depression Lower awareness Reduces rational thought process Increase in reaction time

THE COURSE OF AN ADDICTION As described before, there can be a number of reasons leading to an alcohol addiction or dependence. Alcohol addiction can ruin many aspects of one’s life: the people around will also be highly affected. The damage caused by alcohol abuse becomes worse over time, meaning that the longer and the more alcohol one consumes, the worse is the take on the body and the higher the risk of potential damages and diseases. How alcohol affects the physical, social and psychological aspects will be presented in the following.

Fact box - Table summing up some of the most common impacts alcohol has on the mind.

The most exposed organs are the liver, the brain and the heart. The liver’s automatic reaction to alcohol is to grow, becoming a so-called “fat liver”. Continuing further abuse, the liver tissue begins to perish. The liver shrinks and will be functioning worse and worse. This is known as “liver cirrhosis” or simply “cirrhosis”, and

HOW IT AFFECTS YOU PHYSICALLY Once consumed, alcohol is distributed in all of the organs and will have different amounts of damaging effects on these.

it is often a fatal condition. The heart will also grow as a result of alcohol abuse. An enlarged heart cannot manage to pump all the blood around the body as well as it normally should. One can then develop heart failure, which is also a potential fatal condition.

for a long period of his life, he will probably have some type of mental disorders like: delusions, hearing voices, disorientation, and reality disruptions in general that make them see the world in a different way. Personality disorders in general are also common among abusers, along with anxiety and depression, even though these might occur for some, before an alcohol addiction, for others it happens because of the alcohol addiction.

The alcohol effects on the brain are many. The immediate effects are causing “slower” thinking and reflexes and impaired judgment. It can lighten ones mood, make him/her forget and lose control, reduce the concentration span and make users, in general, more impulsive or even aggressive. Consumed in large amounts, alcohol abuse could lead to losing consciousness, make one feel very ill, and eventually could lead to death. When consuming alcohol often and in large amounts, the body adapts to this intake, and after some time huge cravings for alcohol install, if the consume is stopped. This means that you and your body have developed tolerance. After the body got used to a certain amount of alcohol, the “high” or the rush will no longer be easy to get. A larger amount of alcohol will be needed. Alcoholics can, until the final stage, often burn alcohol faster than a person with a normal consumption and are less affected to the same amount of alcohol.

HOW IT AFFECTS YOUR SOCIAL LIFE In Denmark, more than half marriages in which one of the partners is addicted to alcohol, ends with a divorce (Sundhed.dk, 2012). It is obvious that when large amounts of alcohol are consumed, this affects the decision making skills and behavior, leading to neglecting the family and fail of your closest family and friends. The signs are also laziness, feeling burnt out, having bad sleeping patterns, stress and depression. Basically one will not be able to function properly in ones’ everyday life as they’re used to. And when this goes on for a longer period of time, it will be hard for the people around you, to deal with you. People from the social network will probably be the first ones to distance themselves. Abusers also have a hard time keeping up with their work, which could lead to conflict at the work place or losing the job completely. Some addicts get in trouble with the law by drunk driving or other criminal acts they do. These are just some of the examples of how addiction can affect you, for many abusers these are just the things that lead up to the real danger, where they are risking their lives.

HOW IT AFFECTS YOU MENTALLY Alcohol causes severe damage to the brain and its functions. Besides the physical damage, one will have an even harder time to deal with situations in the everyday life. Some severe cases are, for example, experiencing hallucinations and dementia. If an addict has been alcohol dependent

According to the same source (Narkotikasituationen i Danmark, 2014), there is a huge amount of drug users amongst the young population, aged 18-25. While 19% are marijuana users, 4% abuse illegal drugs; 4 out of 5 youngsters, or 75% from the ones in treatment centers are addicted to marijuana, 9% are addicted to methamphetamine, and 4% are addicted to cocaine.

ABOUT DRUG ABUSE In Denmark the most abused substances are marijuana, followed by ecstasy, cocaine and methamphetamine (Narkotikasituationen i Danmark, 2014). Nowadays, the number of drug addicts is estimated to be around 33.000, and for a nation with a population of only 5 million inhabitants, it is highly problematic. From the total number of 33.000 drug abusers, it is believed 11.000 are Marijuana users, and about 13.000 are injecting themselves with different drugs (Narkotikasituationen i Danmark, 2014), which leads to a high risk of developing serious injuries and illnesses and could finally lead to death.

WHAT IT IS Addiction is considered to be a brain disease because drugs change the brain â&#x20AC;&#x201C; its structure and how it works. It is something Signs of substance abuse: Bloodshot eyes Changes in appetite and sleep patterns tremors Slurred speech Impaired coordination Drop in attendance and performance at work or school Unexplained need for money Sudden change in friends, hobbies and favorites hangouts Frequently getting into trouble Unexplained changes in personality or attitude Sudden mood swings Irritability Angry outbursts Hyperactivity Agitation Lack of motivation Appears fearful, anxious or paranoid for no reason

In 2013, 213 narcotic related deaths were registered at the police department (Narkotikasituationen i Danmark, 2014). Most of these deaths occur because of an overdose, while some happen as a result of violence, accidents, suicide or illnesses caused by the psychical condition resulted from consuming drugs. In the same year (2013) 5.547 people have been enrolled in psychiatric hospitals because of a drug related diagnosis. In 1995 the government (the corresponding municipalities) was spending 294 million DKK for the treatment, the figure in 2013 went up to 874 million DKK, which means the number has increased almost 3 times first, because the number of addicts has increased, secondly because the government decided to improve the quality o f the treatment (Narkotikasituationen i Danmark, 2013).

Fact box - Summary of the most common signs of substance abuse.

that it can not be controlled by an individual, once the drug is taking over of the person in cause.

These are some of the most commonly met motives why people start using drugs (legal, illegal and prescribed medicine). The reasons why people start using drugs can be very different, and they are influenced by personal reasons and struggles and their interaction with the surroundings.

HOW IT STARTS AND WHY It is believed that people use drugs because they want to change something about their lives, there can be different reasons why. The logic behind why people use drugs is hard to grasp, but research in this subject reveals a couple of possible motives why people start using drugs.

HOW IT AFFECTS YOU PHYSICALLY Substance abuse causes lots of damages to oneâ&#x20AC;&#x2122;s health: it damages both the body and the brain. The health damages one can have after consuming drugs are multiple and depend on how much amount of drug is consumed, or how harmful the drug is.

While people suffering from anxiety, bipolar disorder, depression or other mental illnesses use drugs to ease their suffering, some see their family members, friends or role models using drugs and believe they can do it as well. Some become bored and think drugs will help, others think drugs can help them relieve stress. In some of the cases in which people are physically injured they might get hooked on prescribed drugs unintentionally. Sometimes using drugs is intended for covering memories of the past; or for helping people fit in different social contexts/groups (using the drugs socially). Simply because they want to get the high they once experienced. Or maybe because they are going through hard times and try to get over problems in their daily life.

Physical

damages of abuse:

substance

Respiratory problems Pneumonia Increased heart rate Heart damage (all the way up to cardiac arrest) Heart attacks Convulsions Strokes Hallucinations Malnutrition Nausea Chills Sweating Blurred vision Dilated pupils Increased body temperature Hypothermia Skin abscesses Damaged blood vessels

For some, drug use is common in their families ever since they were children (source) and depending on how psychically stable they are, they usually have a tendency of starting using drugs at some point in their lives.

Fact box - Main physical damages caused by substance abuse.

Sometimes, the drug users are making abuse of more than just one drug at a time, a so-called “cocktail”, which is even much more threatening to one’s health.

poor performance when it comes to memory or cognitive abilities. Being addicted to methamphetamine, abusers exhibit symptoms that can include violent behavior, anxiety, confusion and insomnia. They can also display a number of psychotic features, including paranoia, hallucinations, mood swings and disturbances, and delusions (for example, the sensation of insects creeping on the skin, called “formication”).

Some of the damages the drugs cause (general valid) are: respiratory problems, pneumonia, increased heart rate, constriction of the blood vessels, heart damage (all the way up to cardiac arrest), heart attacks, convulsions, strokes, hallucinations, malnutrition, nausea, chills, sweating, blurred vision, dilated pupils, increased body temperature (can lead to organ breakdown), hyperthermia, damaged blood vessels and skin abscesses, and nonetheless death.

Drugs not only affect an individual physical condition. Drugs also significantly affect the brain – causing brain damage (nervous system and cells), which determines the users to develop other impairments/diseases.

These are just a few examples of how using drugs damages the brain. There is no doubt in time, the brain cells and the nervous system is so affected that in a short time the person/user would be no longer fully functional, mentally speaking. When treated, not only will they need to get rid of their addiction (which is a painful and stressful process) but they also need to be treated for their psychical conditions, from which the most significant ones are: anxiety, depression, irritability.

Being a marijuana user, irritability, aggression and anxiety could interfere after using the drug for a while.

HOW IT AFFECTS YOUR RELATIONSHIPS WITH OTHERS

HOW IT AFFECTS YOU MENTALLY

For those using cocaine for a long time, they can experience depression, anxiety, they can be agitated and nervous, tired and apathetic. Paranoia could also appear as one of the symptoms.

Using drugs causes behavioral changes, which eventually affect the relationships with others: family, friends, and work colleagues. What happens is, when a user becomes a heavy addict, he will do everything to obtain the drug. The addict will always deny his/hers problems and will do everything possible to hide this fact from the family and close friends. And nonetheless, will do everything possible to get the drugs they are using: manipulate, lie, steal, be aggressive, or violent.

Brain damage (or changes in the brain) takes place very quickly after a person starts to abuse ecstasy. These changes/ damages can result in depression, irritability, anxiety and confusion. Further symptoms include poor concentration span and

Soon the addict, once a normal person, will no longer be the same. Drugs are so powerful on oneâ&#x20AC;&#x2122;s self, they will take absolute control on their body and brain, and nonetheless soul. The drug becomes the only thing the addict wants.

er the addiction, the better. Because addicts can not control the addiction by their own, they can not stop by their own. They need professional help and families and friends need to look for signs of use first, and then be dedicated to help and support the addict.

Consuming a drug like marijuana, for example, could make one lose interest in health, life, school activities, friends or future goals. In other words, the users might become isolated, their social life and daily activities being highly threatened. The methamphetamine users have mood swings, could be aggressive, violent or have paranoid behavior. Cocaine users might experience being distressed about life without a particular reason.

Psychological damages of substance abuse: Depression Anxiety Irritability Aggression Tiredness Apathy Paranoia Brain damage Confusion Insomnia Hallucinations Mood swings Delusions

There is no doubt the relationships with the closed ones are to be lost, or at least neglected. One common thing all the drug addicts do is isolate themselves from their family and friends, and keep their addiction secret until maybe it might be too late. The sooner the families (or friends) discov-

Fact box - Main psychological damages caused by substance abuse.

COMMON SYMPTOMS As presented before in this chapter, alcohol as well as drugs (including prescribed medicine) have many consequences on one’s health. Being a user slowly destroys your body and mind, and not the least the relationship with the loved ones.

ple with a depressed mood can feel sad, lonely, anxious, hopeless, helpless, guilty, irritable, ashamed, restless. Anxiety is an emotion characterized by an unpleasant state of inner tumult, and it is often accompanied by nervous behavior. When referring to irritability it could be explained as a psychological reaction to stimuli, and it is usually referred to as frustration or anger. Depression and anxiety are two of the leading psychological affections that cause so many deaths already, fact that is is even more likely to happen in the case of an alcoholic or a drug addict, as the intensity of inner feelings is even higher.

Here are the most common met symptoms during the withdrawal period within all: alcohol, drugs and prescribed medicine: Common symptoms: Anxiety Insomnia Depression Irritability Nausea Sweating Tremor Muscle aches/pain Agitation Craving Vomiting All over body pain/aches Tachycardia

Added to the three mentioned above, other physical symptoms accompany: nausea, sweating, tremor, muscle pain, craving, agitation, vomiting, tachycardia, all over body pain or aches, and the list could for sure continue. A combination of psychological and physical symptoms could be disastrous for an addict. This is why they need to be helped by professionals in good time, until it is not too late. These withdrawal symptoms could eventually make the addict appeal to life threatening measures like suicidal thoughts giving up on everything around him/her.

Fact box - Common symptoms amongst alcohol and drug abuse.

These symptoms are very damaging to one’s body and mind: the experience of being an addict is certainly significant for the future coping with different life situations. Anxiety, depression, irritability (and insomnia) are the most common met symptoms and the most destructive to an addict’s inner peace, soul and mind. Depression is a state of low mood and affects the person’s thoughts, behavior, feelings and sense of well-being. Peo-

TREATMENT PHASES AT ALFA This information is gathered from Alfaâ&#x20AC;&#x2122;s website (www.alfa-fredensborg.dk, 2015).

relationships with family and friends. Written assignments are an important aspect of the treatment. Clients target different problems and issues that are standing in their way of having a normal life - without drugs or alcohol, by writing them down. The subjects of the written assignments could be: consequences of the addiction, anger, shame, fear, trust issues etc.

The treatment at Alfa-Fredensborg has three phases, each one lasting for 3 months. Each of these phases consist of different levels of treatment and some assignments and workshops that the clients need to participate in, combined with strict rules regarding drug and alcohol use during the treatment (Alfa-fredensborg.dk, 2015). In this Thesis, the focus is made on the 1st Phase of the treatment.

Workshops are part of the treatment as well. Their role is to educate the residents about addiction problems and the consequences of the abuse. It aims to give the residents the opportunity to compare their own abuse issues with a general pattern of problems/issues and reflect on their own situation. During these workshops, the residents have to share thoughts about addiction symptoms, their personality and feelings about the addiction and relapse.

Phase 1 - in which the clients live at the center (clients can also come everyday and keep living at home) Phase 2 - in which the clients come for the treatment at the center 2 days/week Phase 3 - in which the clients come for treatment at the center 1 day/week PHASE 1 is the first and the most intensive part of the treatment. The residents are part of group discussions, but also individual talks and work with the therapists. It is the most difficult phase because they now have to stop using (drugs and alcohol) and therefore are dealing with withdrawal symptoms.

One on one conversations between the therapist and the client are held regularly. The purpose of these conversations/talks is to clarify the clientsâ&#x20AC;&#x2122; problems and prepare for discussing these during the group meetings. A plan of action is being prepared by the resident and a social worker. An action plan in this case means planning the time after the treatment has been finished, with focus primarily on work opportunities, housing situation and finances.

Problem solving group therapy is used mostly to present some self-chosen problems or issues, and the residents need to write assignments along with the therapist. The group therapy is always adapting to newcomers, therefore the residents are in different stages of the treatment. During the problem solving group therapy the residents, together with the therapist, talk about emotional feelings, stress, drug cravings, their situation at home and their

PHASE 2 is meant to help the clients get a sense of control of their addiction and prepare for preventing relapse. The therapy in this phase takes place 2 days/week, for three months.

Relapse prevention therapy plays an important role at this point in the therapy process. First, clients learn how to identify their own individual signs of high risk situations (in which they might make abuse of drugs and alcohol). Afterwards they learn how to deal with these risky situations in a constructive way, so the relapse is avoided.

be submissive in relation to others, be the “underdog”, or be in control, or dominant, or the “top dog”. The clients learn how to deal with these aspects in relation to others. Reintegration. Here, the clients continue to work on integrating the tools from previous treatment phases, both in relation to personal development and in relation to the surrounding community. The following therapeutic methods are continued: problem-solving group therapy, stress management and awareness.

Group sessions continue the problem solving group therapy started in Phase 1, except now the primary topic is the everyday issues and challenges. Efforts are made so the clients maintain the skills acquired in the first phase. Considering the fact that many clients relapse because of stress or stressful situations, stress management and awareness exercises are being made.

CONCLUSION As described on the website, the treatment aims at providing the clients a greater sense of confidence, less stress sensitivity and a better foothold in relation to the social rehabilitation process. The changes of avoiding relapse will be, therefore, significantly reduced and improved.

The Healing Program is also an important aspect of this phase as it is network and action-oriented. The network can consist of family, friends, different communities and work. Clients learn to pursue structure and discipline in their daily lives. The plan of action started in Phase 1 is further developed at this stage. Most of the clients at this moment have already started going to work, or going back to school, or going to study different courses. PHASE 3 is the last of the treatment and at this stage, the therapy takes place 1 day/ week, for three months. Primary problems. Under the visible and manageable drug addiction, the clients usually develop inappropriate thinking and action patterns in contact with other people, as shown by the fact they could either:

Time 7:00 7:45 8:15 9:00 10:00

Monday

Tuesday

Wednesday

Thursday

Friday

Breakfast Responsibilities/Tasks (overview of the day program, discussing responsibilities and tasks in the house)

Walking tour Organizing the activities

(everybody sits together, clients are elected to make presentations and talks, dividing the clients in groups for the group meeting)

Group Meeting

Swimming at the swimming hall in Copenhagen

Group Meeting

Floor Meeting

Group Meeting

(they discuss administrative problems, general atmosphere in each floor, if there is something broken than needs to be replaced)

Lunch

12:15

Free time

14:00

Workshop

Free time

Workshop

(in which the clients have different tasks and exercises, for anger management, how to deal with their emotions and feelings)

(clients might go to AA meetings in Copenhagen, by bus)

(in which the clients have different tasks and exercises, for anger management, how to deal with their emotions and feelings)

Free Time

SMART RECOVERY

Free Time

Dinner Free Time

Free Time

1 1

Study Group

Free Time

Study Group

Free Time

Study Group

17:30 18:45

Free time

13:30

15:15

Sports

8 9

Sports

Free time

Workshop

(clients might go to AA meetings in Cph, by bus)

(in which the clients have different tasks and exercises, for anger management, how to deal with their emotions and feelings)

lecturers and other addicts from outside the center are invited to come and hold lectures, talks

19:00

(the clients have a book called “How to live again”; they are all sitting together and make different kinds of exercises from the book)

20:30

Night Meeting

23:00

Bed Time

2 2

group

ting

Time

8:30 9:00 10:00

Saturday

Sunday

Breakfast Responsibilities/Tasks

(overview of the day program, discussing responsibilities and tasks in the house)

Morning Meeting

Trip to HelsingĂ¸r Lunch

11:30

12:30

14:00

Visits start

17:00

Visits End

17:00 18:30

19:00

ients asks , for ment, h their elings)

a w to are all nd nds of he

Dinner Dinner

Free Time

Night Meeting Bed Time

20:30 23:00 24:00

fig. 7 - Existing schedule for the clients at Alfa (Phase 1). The table is made by the authors of this Thesis, after the information found on Alfaâ&#x20AC;&#x2122;s webpage (www.alfa-fredensborg.dk).

Bed Time 35

CENAPS - a model for treatment The CENAPS model was developed by the American Abuse Therapist and Psychotherapist Terence T. Gorski and has been used since the early 1970’s.

A core element in the CENAPS model is relapse prevention, and this is why Alfa-Fredensborg uses three different treatment phases, to structure this often life-long process. With cognitive restructuring of the addiction the clients learn how to be aware of how their thoughts, feelings, body sensations and actions play a key role in their lifestyle and thereby gain knowledge on how to restructure it.

The CENAPS Model of Relapse Prevention and Therapy (or CMRPT) as Gorski states it is “a comprehensive method for preventing chemically dependent clients from returning to alcohol and other drug abuse after initial treatment and for early intervention should chemical use occur”.

Relapse Prevention Counseling teaches clients to identify and manage high-risk situations that previously caused relapse. And finally, put the relapse-prevention therapy into practice, where clients try to get a deeper understanding about why exactly they have become addicted and how to maintain a healthy life.

It is based on a bio-psycho-social model of addiction, it is a development model for healing and relapse prevention, where each component has its therapies based on recognized cognitive, affective, behavioral and social therapies.

MINDFULNESS - part of the treatment Mindfulness is “the intentional, accepting and non-judgmental focus of one’s attention on the emotions, thoughts and sensations occurring in the present moment” (Zgierska, 2009).

meditation. Lund comes at the center and teaches these techniques. The scope of the workshops is to help the clients with managing their anger issues, help with stress relief and teach the clients how to relax.

Mindfulness is nowadays used in psychology to ease some of the health conditions (both mental and physical) including anxiety, and prevention of relapse in the case of depression, drug addiction or alcoholism. The cognitive therapy at Alfa-Fredensborg focuses on the clients’ thoughts, feelings, body sensations and actions and mindfulness is complementary. According to Maltesen, the founder of the rehabilitation center, mindfulness is a very important part of the treatment at Alfa-Fredensborg, as it is being practiced almost everyday by the clients, together with a therapist.

Fig. 8 - Jakob Lund during a meditation exercise.

The techniques he teaches are based on yoga exercises, special dynamic breathing techniques, meditation and an introduction to the so called “knowledge points”. (reference the website). These “knowledge points” are life stories and anecdotes that through reflection serve as means to handle feelings, thoughts and different life circumstances.

Sölvä, one of the therapists at the center, is a mindfulness instructor and one of the therapists at the center. She is in charge of teaching the clients relaxation techniques and breathing exercises at the beginning of each group meeting (see the schedule in the appendix). It is part, she says, of the cognitive therapy based on the CENAPS model, with the scope of focusing on the question “What do I choose to think of right now?”. (Solva, 21th. May, interview)

As stated on the website (breathesmart. dk), when people disclaim old habits and routines, there is often a gap. Meditation and breathing can, in this context, minimalize this gap and act as a substitute. For many substance users, such as cannabis users for e.g., the method is powerful be-

A couple of times a year, mindfulness workshops are organized at the center, where Jakob Lund is invited. Jakob is a “body and mind” therapist and teacher, specialized in breathing techniques and

cause it works on mood-altering and creates peace and space to accommodate emotions that arise when drug intake is minimized or terminated.

ity to solve conflicts should be increased, and should confer more self-esteem and self-confidence. Lund has been working with different target groups, but mostly with substance abusers and people engaged in criminal activities. Breathe SMART stimulates participantsâ&#x20AC;&#x2122; senses and give the experience of inclusion, community and proximity, without being influenced by alcohol or drugs, in this case.

All in all, Breathe SMART helps (with the methods and practices mentioned above), with handling negative emotions and thoughts in a much more constructive way. Sleeping should improve, the abil-

CHAPTER 5

THEORETICAL FRAMEWORK

RESULTS AND THEORIES AS TOOLS In order to find the best design solution for the target group (drug and alcohol addicts) we have chosen to research study results and theories. These will be described in the following, and will be used later on for formulating the hypothesis and in the design process.

• The outgoing involvement implies the highest mental power. The individuals, at this stage, are able to lead a group of people.

THE MENTAL STRENGTH PYRAMID When designing the therapeutic garden at Alfa Fredensborg, the focus is on the target group for whom the garden is intended for. Previous studies have shown experiences in nature affecting people in different ways, depending on their life situation, therefore it is crucial to observe the target group closely. Each person´s experience in nature is influenced by how much he can absorb from the environment and how strong his mental power is. For example, people dealing with stress, depression or loneliness would be characterized as having a low mental power.

Fig. 9 - Diagram showing different levels of the Mental Strength Pyramid.

The proposed evidence-based health design supports all the levels of the mental strength pyramid, as “a healing garden must be designed to suit visitors of all levels of mental power” (Stigsdotter & Grahn 2002).

THE ATTENTION-RESTORATION THEORY

As illustrated in the diagram (Fig. 9), the mental power can be represented as a pyramid with 4 different levels of mental power (from weak to very strong): • The directed inwards involvement is situated at the bottom of the pyramid. The mental power is very weak, which means, the individuals are mentally active, but not very willing to get new impressions. • The emotional participation is next in the pyramid. The mental power is greater – the individuals start to have an interest in their surroundings and tolerate people around them, but they do not have the strength to take part in what others do. • The active participation presumes even a higher mental power. The individuals, at this stage, take part in a group activity.

This theory, developed by Stephen and Rachel Kaplan, is about how we as humans perceive our environment and how we deal with this information. This study asserts that we have two systems of sorting information (Kaplan & Kaplan, 1989). It explains how humans function in an urban environment, based on the fact that there are two different types of attention: directed attention and soft fascination. The directed attention we use when we are in non-natural city environments, for example when one walks down a busy street, 11 million sensory distractions hit us every second (Peschardt, 2014) which forces us to sort out all the impulses

protection, while ‘Prospect’ is open views, expansive and bright areas. Two opposites that couldn’t seem further apart, but have to be present at the same time. In Appleton’s opinion, we still do this today, value space after this principal, we aesthetically look for a place where we have a view, but at the same time where we can withdraw and hide from others. (Marcus & Sachs, 2014).

we don’t need, so we can focus on those we really need. This might result in mental fatigue and stress, because it requires so much energy and concentration. Therefore, it is very important for the individuals to restore, by being out in nature, taking a walk in a forest or just looking at the sky or listening to waves from the sea. This system is called soft fascination, which does not require concentration and is unlimited, the amount of stimuli is not overwhelming but manageable. The environments considered restorative in this sense need to consist of:

STRESS REDUCTION THEORY Stress has become a widespread term in our urbanized environments, and one might use the term to describe oneself, often in demanding situations, but stress is a serious condition both short term and long term, which can have many negative impacts on people. Stress disturbs sleep, increases the feeling of depression and isolation, and it could also increase behaviors like smoking, alcohol consumption or disturb exercise habits. Research from Roger Ulrich presents how nature and gardens can restore people from stress (Marcus & Sachs, 2014). It is called the Stress Reduction Theory and consists of four characteristics, which have to be present in the garden.

- the feeling of being away: escape or withdrawal from the source of stress - a rich extent: a space with enough scope to actually feel that you are in a whole different world - fascination: a place that is interesting enough to hold ones attention, and distract one from worries. - compatibility: the setting should fit to ones intentions and what one would like to do there. This Thesis aims at providing the best restorative environment for the clients at Alfa,.

Sense of control. For most people in a rehabilitation process of any kind, they are not in control of many different small things, but small things that can be important to one’s stress levels. For example not being in control of what you’re doing through the day or what you eat. Ulrich states that gardens can help gaining a sense of control, here you can offer a setting and objectives that one can use as they pleases, an example is moveable seating where one can control where to sit and how to sit. More control equals less stress.

PROSPECT-REFUGE THEORY A theory developed by Jay Appleton, which attempts to explain the relationship between man and his original natural environment. It is explained why certain environments feel more secure than others. When man was still hunting for survival, it was crucial to be aware of ones surroundings and have the chance to look out for danger while still being in hiding. The need to observe (prospect) while not being seen (refuge) was key to survival. ‘Refuge’ is our concealment and

Social support: it’s hard to deal with loneliness and isolation for many people, especially if you’re in a life changing stage. Therefore a garden should facilitate social interaction and a variety of spaces to prevent loneliness and exclusion and therefore also stress. Physical movement and exercise can reduce stress. A garden that motivates physical movement with varying level of difficulties, a destination, views, places for game and play would be the optimal.

from stress. The eight perceived sensory dimensions were validated in 2009, based on surveys regarding people´s experiences, perception and preference of urban park or urban open space, and it is entirely based on users´ perspective. If a green area contains more of the dimensions, it is often more popular, more appreciated and visited than a green area, which only has one or a few of experience values. This is how people in general prefer the eight dimensions:

Natural distractions can reduce or block out worrisome thoughts. A garden should offer many opportunities to engage with nature, and contribute to fascinate you in the many sights, smells and sounds. If you’re not bored or distracted from your worries you will continue to experience stress.

1. Serene 2. Space 3. Nature 4. Rich in Species 5. Refuge 6. Culture 7. Prospect 8. Festive

8 PERCEIVED SENSORY DIMENSIONS

‘Serene’, ‘Space’ and ‘Nature’ are the most preferred of them all. People with stress have ‘Nature’, ‘Rich in species’ and ‘Refuge’ as the most preferred ones. The “8 Perceived Sensory Dimensions” tool will serve as an important aspect when designing the site, as it will result in creating different rooms with different characters, in order to be health supportive.

When designing a park or garden one should think about making it as attractive to as many people as possible, but it should also serve some different options in activity and type of space. There should be spaces where one can sit in private and undisturbed. But at the same time, it should invite people to be social and active somehow. A tool that is very helpful of exactly that, is the ‘’8 perceived sensory dimensions’’, this is a tool or guide that was developed from a Swedish study by Patrick Grahn and Ulrika Stigsdotter; ”The relationship between perceived sensory dimensions of urban green space and stress restoration” (Grahn & Stigsdotter, 2009). The overall hypothesis was that people perceive green spaces in terms of certain dimensions, where some dimensions are more important and preferred than others with respect to restoring people

THERAPEUTIC HORTICULTURE This is a practice that involves gardening on a level where the participants, their activities and outcome are the focus. It is officially by the American Horticultural Therapy Association described as: “a practice that uses plants and plant-related activities through which participants strive to improve their well-being through active or passive

Refuge is a room offering safety and shelter. Itâ&#x20AC;&#x2122;s a place where you can withdraw and watch other people.

Festive is a place for amusement, there is room for a lot of people to gather for socializing and concerts, it also offers plenty of seating and services like a cafĂŠ.

Rich in species is a space where you can experience a big variation of species both in plants and animals.

Prospect is experienced as a vast open space, where there is a lot of room for people to do sports and other activities.

Serene is the ultimate quiet place where you can be in peace, undisturbed and be one with nature.

Space feels like entering a new spacious room. It can be the room between the ground cover and tree crowns.

Cultural historic, here you can experience items from a lost time.

Nature offers the experience of a wild and free-growing area. Plants and animals live without being bothered too much by people.

Fig. 10 - Illustration addapted after Grahn & Stigsdotter 2010, showing images interpreting the 8 Perceived Sensory Dimensions.

involvement (American Horticultural Therapy Association, 2012).

mark, than the other cities. 42.157 people were stressed in Copenhagen compared to northern part of Denmark, which only had 20.176 people suffering from stress (Danskernes Sundhed, 2013). So it is clear that people in the capital city are more exposed and at risk than others.

So by engaging in gardening, growing and nurturing plants, is to accomplish some goals for the participants, who need some improvement in mood and physical well-being in general. Some of the outcomes that are hoped to be achieved from therapeutic horticulture, particularly for this target group is to improve goal achievement, sense of personal worth, concentration, quality of life, sense of well-being, increase self-esteem, sense of pride and accomplishment, reduce stress, decrease anxiety, alleviate depression, provide for healthier patterns of social functioning and promote physical health (American Horticultural Therapy Association, 2012)

Our intention is to design a therapy garden that can support the rehabilitation process - bringing the clients outside to do not only exercises within a restorative environment, but also make them aware of nature and to be present in nature, with the main objective in mind, that nature can only do you good in this difficult situation. So how can the outside (nature), support the therapy going on inside the rehabilitation center?

HYPOTHESIS

Our hypothesis is that the clients in treatment can benefit from nature. Rachel Kaplan and Stephen Kaplan suggest that nature restores one from mental fatigue (Kaplan & Kaplan, 1989), Ulrich proposes that nature recovers one from stress (Marcus & Barnes, 1999) and nature also serves as a resource for physical activities (Bjรถrk et. al, 2008), which promotes health and human well-being. If nature can do so much good for mildly stressed people, then one can only imagine how good it could do for people from this type of environment. This particular target group going through treatment, not only deals with the absence of the drug, but also anxiety, insomnia, depression and irritability etc. These are some sufferings that could be decreased or dealt with by peaceful mindfulness, walking in nature (soft fascination) and high energetic activities and nature serves as a resource for all of these.

So what can we derive from these study results and theories? Well, they create a theoretical framework, a foundation to what we build our hypothesis on. We argue for that man belongs and feel most comfortable in nature. It might be that cities are built entirely by humans and for humans, but this is not the place where we can unwind or turn down the pace. This is not the place we would automatically feel relaxed or at peace. Nature appeals to our ancient souls, in a way that no city can. Cities are the cause to our busy lives and our stress. Now people in rehabilitation need to get help, to get out of their abuse. But what they might not realize is that the cause to their abuse might be found in the big city and its temptations, fast pace or large pressure. Surveys show that people are more stressed in the big cities in Den-

CHAPTER 6

LANDSCAPE ANALYSES

residential area

Fredensborg Slot

Park Golf Club

eje

Ă¸j

rah

ALFA rehabilitation center

Flo

Train track

elderly homes

residential area

City Center

residential area

ĂŚ nv

se Ro et ng

residential area

AsminderĂ¸d

Fig.11 - Existing situational plan. Alfa situated in the center, and the immediate surroundings (residential areas mostly).

residential area

30 m

SITE PRESENTATION In this chapter we take a closer look on the site area, and analyze it further according to some selected theories and tools. These give us an idea about the existing environment and features on the area. The following will also help the reader to understand and comprehend the area.

When visiting the site, our impressions was that the space can be divided in 4 different areas. As shown in the illustration below, the garden, in our opinion, has 4 different parts: the front yard, the back garden, the hilly area and the wild area. All these have different qualities and characteristics that will be presented in the following.

Here we describe the area how it looks physically, via photos and describing diagrams.

The pictures used in the site presentation are all made by the authors.

The wild area The front yard

The hilly area

The back garden

Fig. 12 - Diagram showing the four districts identified in the garden.

0m 52

30 m

7 5 4 3 2 1 6

THE FRONT YARD

1. view to the courtyard in front of the house

2. bench and darts board (next to the shed)

3. parking lot

4. small pathway leading from the building to the shed

5. view from the green lawn to the house (see bonfire)

6. view to the south part of the garden

7. road dividing the garden

5 4 3 7 6 2 1

THE BACK GARDEN

1. panoramic view to the back garden

2. team-building exercise equipment

3. playground in the back garden

4. the only existing seating feature

5. petanque court

6. Magnolia tree in bloom right next to the house

7. view from the football terrain to the house and the hill.

7 2 1

5 3

6 4

THE HILLY AREA

1. view from the hilly area to the house and the garden

2. view to the tall, majestic trees

3. improvised sitting place

4. image capturing the atmosphere

5. view to the neighborhood from the hilly area

6. bench located next to the hilly area, where individual therapy sessions take place sometimes

7. view to the hilly area - entering another dimension

5 3

THE WILD AREA

1. view to the wild area (from the road)

2. pathway as an edge to the North

3. pathway leading into the garden (South)

4. pathway as a connection to the oth- 5. pathway leading into the garden (North) er parts of the garden

LYNCH ANALYSIS Kevin Lynch is recognized as a leading urban design educator and researcher. His publications brought a huge contribution to the fields of environmental psychology and environmental behavior, influencing generations of professionals.

1. Pathways. The diagram shows all the channels the people at the center use in order to move around (customarily or occasionally). The plain line shows the road crossing the site, physically dividing the site into two different parts; while the dotted lines show small pedestrian pathways. The pedestrian pathways always start from the road, going the forested area (up North) and to the building (to the South).

Lynch argues that people understand and perceive the form of cities through recognizing some key physical elements. Recognizing these (key physical elements) helps people to orientate and better understand the structure of a city, and also distinguish familiar places, which would give people a sense of place-based ownership. In The Image of the City (1960), Lynch identifies five key elements that provide urban image ability: paths, edges, districts, nodes and landmarks.

Pedestrian walkway

Based on these five key elements Lynch identified, an analysis was conducted. The objective here is to identify these five key elements in our site, Alfa Fredensborg, and doing so, uncover the role of form itself and get a better understanding of the place.

Driveway Pedestrian walkway

The figures used to symbolise the five key elements are made by the authors of this Thesis, derived from Lynchâ&#x20AC;&#x2122;s initial illustrations.

30 m

Fig. 13 - Diagram showing the pathways identified, according to the Kevin Lynch analysis.

3. Districts. The diagram shows different sections of the site, each of them having a different character. There were four districts identified on site. The dark toned areas show two forested areas, characterized by being enclosed and diverse in vegetation. The lighter toned areas show two districts characterized by openness, while the light toned area shows a district where socializing and organizational activities take place.

2. Edges. The diagram shows the edges of the site, as being linear elements that are not considered to be paths. The line surrounding the site represents the physical edge, and it consists of the main road, the nearby neighborhood and the park nearby. Two boundaries that create edges inside the site were identified, represented with a dotted line: the forest hill on the right and the road, which creates an edge and a barrier.

The Wild Area The front yard

The hilly area

The back garden N

30 m Fig. 15 - Diagram showing the districts identified on site, according to the Kevin Lynch analysis.

Fig. 14 - Diagram showing the edges of the site (symbolized with dotted lines), according to the Kevin Lynch analysis.

4. Nodes. The diagram shows the nodes identified on site, illustrating either junctions or intersections of roads and cores, defined by social interactions that take place. Two nodes have been identified, located on the main road, where they meet the smaller pathways going to opposite directions. The two cores identified, one in front of the building and one in the back of the building, are signals for where the socializing takes place. The clients meet there for having a coffee, smoke or just sit in the sun and talk.

5. Landmarks. The diagram shows the lanmarks identified on site. These serve as physical objects that are points of reference while orientating. One of the landmarks is the main building, due to its large volume and due to its location, right in the middle of the area, which makes it easy to orientate to. The forested hill was also identified as being a landmark, due to its dense volume and due to its terrain elevation, which makes it stand out.

The Hill Building

30 m

Fig. 16 - Diagram showing the nodes identified on site (symbolized with a purple circle), according to the Kevin Lynch analysis.

Fig. 17 - Diagram showing the landmarks identified on site (symbolized with a star), according to the Kevin Lynch analysis.

APPLYING THE 8PSD FOR AN ANALYSIS DECODE The 8 perceived sensory dimensions tool is used in this analysis chapter to uncover how the existing nature characteristics at the site are organized and perceived.

by other people. We also find the dimension of Rich in species present in this area (weaker than the dominant - Nature), because of the variation in vegetation and also in birds and insects. Serene is also a part of this area (weaker than the dominant), because it’s so withdrawn from the building and road.

The first sensory dimension Serene is not identified as a main dimension in any of the spots on site. But is present in some of them. For example in the Space and Nature area, because it is a bit enclosed and retracted from the more public areas.

Rich in species is really a self-explanatory dimension; there can be found vegetation and animals in vast species, forms and colors. This dimension is not found as a dominating dimension in any of the parts of Alfa’s plot. But it is present in the Nature area and also a little in the Refuge area, because of the flowered and evergreen trees (see picture on page 52).

Space is a dimension which is characterized as a place when you enter it, it’s experienced as a different setting and a whole for itself. This dimension was identified in the hilly area with the tall trees (see picture on page 53). This specific area differs so much from the rest, and is experienced as a total different milieu and atmosphere. First of all the terrain is steep, so in that way it differs from the flatness of the surroundings. Secondly, the tallness of trees creates a wall and encloses the space. There is a couple of entrances into it – you cannot enter from all sides because of the dense vegetation and shrubs. When inside the wall of the trees you feel protected and sheltered both from rain, wind and surrounding noise. There is also a presence of Serene (a quiet and enclosed space, one with nature) and Nature (preserved therefore untouched vegetation and long grass) in this part of the site, but these have a weaker character.

Refuge is a space categorized as the retreat area, where you can be sheltered and at the same time have a view of other people doing activities. We find that as the main dimension in the spot between the hilly forest (Space) and the open lawn area (Prospect). Physically this space consist of two benches, with the tall trees protecting the back and not much else. Also we find it present along the main buildings’ back side all the way to the playground, here you can sit and have a view of the playground and the football field and there a couple of trees there which you feel sheltered from. Cultural historic is a place consisting of some kind of decorating items, for example a statue, sculpture or water element. None of these elements or characteristics are present on this site.

A dimension characterized by its wildness and uncut vegetation is Nature. This dimension is present as a dominant in the North part, obviously where the forest is. This area is rather uncut, it grows how it pleases, and there are a few paths going through, so you can stay there without being too disturbed

Prospect is a place with big open lawn areas and views, this dimensions is dominating in

Here we characterize the different parts of the site according to the 8 perceived sensory dimensions. Some parts are easier to characterize than others, because these could be labeled with more than just the one perceived sensory dimension.

NATURE Serene Rich in Species PROSPECT Festive

FESTIVE Refuge

SPACE Serene Nature

REFUGE

REFUGE N

30 m

Fig. 18 - Diagram showing the 8 perceived sensory dimensions identified on site.

PROSPECT Festive

the front and the back of the garden. These areas are somewhat empty and bare, but they offer some activities like football and petanque because there is enough space for many people to run around; Festive was also identified here, but weaker than the dominant, Prospect.

to sit in sun and shade - offers shelters so Refuge is also present, with a weaker character. There are benches and the driveway is made out of gravel. It also offers fun features, like a dart table and a barbeque. So now we have described the area specifically in relation to existing theories and tools, we will therefore continue analysis of the site, in relation to our own observations and notes.

Festive. This dimension should offer many activities and services. We find this dimension to be dominant in the courtyard in front of the building. Here there are some places

Existing Vegetation This diagram highlights the raised vegetation on the site. Here we get an idea of where one can walk, where there is shade and shelter. It also gives us an overview of where there is a lot of space for design and where itâ&#x20AC;&#x2122;s more narrow. We use this to create our subspaces of the garden and to see where more vegetation is needed.

Parking

Building

Existing trees Existing bushes

30 m

Fig. 19 - Diagram showing the existing vegetation (existing trees- dark green and existing shrubs light green).

Functions and features Functions diagram displays the physical items on site. As it could be observed some of these facilities could be used for potential recreational or interactive activities. It also illustrates the delimitation of the parking area.

bonfire parking barbeque

darts

garbage bins

tent/cover shelter carpet drying poles

petanque

playground

bench

football goals N

30 m

Fig. 20 - Diagram showing the existing functions and features identified on site.

Vehicle and pedestrian flow The traffic on site and around it, is what this diagram shows. The dotted blue lines show where vehicles are allowed to go and the purple lines show where we have observed the residents walking around. The variations in the thickness of the blue lines illustrate how heavy the traffic flow is, for e.g. the line furthest to the left is the thickest because of the many cars driving by, and produce noise disturbing the area.

Drive way

Garbage disposal

Parking Bench to have a talk or smoke

Playing petanque

Garden tent

Bench to have a view

Playing football N

30 m

Main road

Fig. 21 - Diagram showing the vehicle and pedestrian flow happening on site.

Entrances

This diagram shows the main and secondary entrances to the building. The building on the left is the new building that is currently being built at Alfa.

New building under construction Head entrance Entrance to the offices

10 m

Main exit to the garden

Terrace

Fig. 22 - Diagram showing the entrances to the building.

Views to the garden Illustrating the fact that nearly all of the client rooms, offices and common rooms have a view to either the courtyard surrounded by the building, the backyard or the west and east part of the garden. In the following - in this chapter - it becomes even more clear, because all of the rooms on all the floors are being shown/ visible.

10 m

Fig. 23 - Diagram illustrating the views from the clients rooms to each side of the garden.

Ground floor

In the following pages, each of the floor plans of the bulding at Alfa are presented, with a focus on how the different rooms are displayed.

Gym hall Group meeting room Client room Common room Office Office meeting Kitchen Toilet

10 m

Fig. 24 - Diagram illustrating the ground floor plan (including the new building - green).

First floor

Attic Bathroom Toilet Client room Kitchen Common room Deposit room

10 m

Fig. 25 - Diagram illustrating the first floor plan.

Second Floor

Attic Client room Deposit room Common room Toilet

10 m

Fig. 26 - Diagram illustrating the second floor plan.

SWOT analysis The SWOT analysis is a very useful tool in this phase of the project. It is used in order to identify and understand the sitesâ&#x20AC;&#x2122; strengths, weaknesses, opportunities and threats. This analysis was considered to be important (in the process of analyzing and observing) as it gives a good over-all picture of what qualities the site has, where it could use improvement, as well as threats or possible opportunities for its future development and use.

Summing up, our approach is that the strengths and the opportunities are going to be used in order to balance sitesâ&#x20AC;&#x2122; weaknesses, and eliminate possible threats. It is obvious the site has some strengths - it consists of a large space, it has a lot of green cover, most of the clients have a view to the garden from their rooms, which all provide a very good work base for developing the evidence-based designed proposal.

STRENGTHS

WEAKNESSES

- Large space - Most of the clients have a view to the garden - Many entrances/exits to the garden - Historical value - A lot of green cover

- Lack of shelters in the garden - No structural order or division of space - Lack of private areas for the individuals and family visits - The playground is worn down - The driveway creates a physical barrier, dividing the garden in two - Lack of seating and recreational features - No pathways

OPPORTUNITIES

THREATS

- Large area that could be structured - Creating more enclosed areas - Improving football field and playground - Creating shelters and seating areas - Space for bringing therapy outside

- High maintenance costs - Driveway is dividing the area - Traffic noise - No fencing between the site and the elderly homes - Parking area can not be removed

Fig. 27 - Illustration showing the SWOT analysis, which identifies the strengths, weaknesses, opportunities and threats.

CHAPTER 7

QUESTIONNAIRES AND INTERVIEWS

Questionnaires represent a very significant research tool in our project. Conducting questionnaires helped us with gathering valuable information that is used, later on, in the design process.

INTERVIEWS AND TALKS WITH THE RESIDENTS Nine clients were interviewed in total. One important aspect we need to understand when conducting questionnaires with substance abusers and alcoholics, is that they might perceive the outdoor area (the garden) differently than we do, due to their condition. And so, pictures with different landscape features were brought along with the questionnaires, in an attempt to stimulate their imagination and creativity. This way they were more cooperative. Along with the pictures, we have also used a map of the site when asking questions, so they could indicate different activities or places, depending on the question.

The first session of questionnaires and interviews was organized on the 21th of April, while the second session took place on the 5th of May. Both the clients and some of the staff members (therapists and social workers) were interviewed. During our visits at the center, we were able to approach the clients while for e.g. they were sitting on the bench outside, having a coffee or a smoke, or approach them inside of the building, in one of the common areas (informal). Interviews with the staff took place whenever they had some time to talk to us during the day.

The following charts are all made by us.

The purpose of the questionnaires and interviews is, first, to get a sense of how much the clients use the garden, how they perceive it, and what their wishes are. Then, use all the information while designing. Secondly, to understand if the garden is used in a specific way during the therapy program and how, trying to find out if some of the therapy parts could be eventually brought outside, and apply the knowledge we have got in the design as well. The outcome of the questionnaires and interviews will be presented in the following, describing the results from the clients first, followed by the results from the staff.

In which part of the day do you spend time in the garden?

8 7 6 How often do you spend time in the garden?

y ek ek ek da ver we we we a a a ery s s e v e e c E tim tim On 2-3 4-5

How important is it for you to have this garden here?

5 4 3

rni

o ern Aft

nin

Eve

rt po t im

ant

nt nt al rta rta utr po po Ne m Im i y Ver

Fig. 28, 29 and 30 - Charts showing the results of the questionnaires with the clients.

How often do you spend time in the garden? This question was for some difficult to answer, because of the short amount of time they have been living at the center. Most of them liked to be outside - first of all because they all smoke, (even though they have a small smoking room inside the building, but preferred to go out to smoke), also to get out for a while, but they all go out for different reasons. They would all stay outside for some time if the weather would be dry and nice.

Does the weather keep you from being outdoors? They all agreed about the weather having a large influence on whether they felt like going outside or not. They only have one sheltered place, which is just outside the front door - here they smoke or talk when it’s raining. There was only one resident that didn’t mind going outside in all kinds of weather. He felt too trapped inside, and therefore preferred to go out as soon as he got up in the morning.

In which part of the day do you spend time in the garden? They all stay outside during the afternoon, usually before lunch and after. One of them was really dependent on being outside so he had to go out as soon as he got up in the morning with a coffee and cigarette. None of them stayed outside during the night - they have group meetings after dinner, so probably that’s one of the reasons, also they are supposed to go to bed at the same time every night so they would develop a routine.

How important is it for you to have this garden here? Almost all of the clients consider it being important or very important to have a space outdoors and a garden where they could stay. For two of the residents it wasn’t so important to have a garden to stay in (they were not interested in doing anything active, but they did use the garden pretty often though). Which activities do you do in the garden, and for how long? They all use the benches

outside to sit and smoke, talk with the other residents and socialize. Denmarkâ&#x20AC;&#x2122;s cold seasons are the reason why they donâ&#x20AC;&#x2122;t eat lunch outside, also they have much more seating in their cafeteria area. Most of them like to go out for fresh air and sun. Some only go out to talk on the phone quickly, while some use the garden for several activities only for 20 minutes or less. Others like to be in the garden for several hours doing active things, like sports and socializing with the other residents. Some clients have children and relatives that come in the weekends, and they would use the garden to spend time together there. None of them do actual garden work or go running (only two of them do gardening, which we didnâ&#x20AC;&#x2122;t interview). The center has some weights that some of the men bring outside to exer-

cise with. In general, they all agree that the garden can provide a sort of escape from what is going on inside (discussions, talks, written assignments, feelings, struggles). What else would you like to do in the garden? The male residents are especially the ones who would actually like to do more in the garden, for example they would like a paved area or multi-functional court to play sports or do exercise. On a scale from 1 to 5, how well do these characteristics fit the garden? This next question asks the clients how would they describe and characterize the garden. Most of the clients believe that the garden is not so welcoming, while some classify the garden as being a 5 on the scale, others classify it between 1 and 3. They all agree

Which activities do you do in the garden and for how long?

31-60 min

21-30 min

11-20 min

< 10 min

4 3 2 1

ave

> 1 hr

s x ls y s e ir d ily e lk ple ork ela den ma ch alk run sport cise ent wa ries un Walk phon Rea ha lun Smok ick ta and t and r e fres me s gar d ani t wor Get a Exer resid ds/fam e peo en w for a e e h Do u h d t r o v t e o t n an n r r s e Q m g Si Sit a e G n e y t r i h o s g r t o Fo ts ko Ge Ob Do ho th f Enj garde Ge Tal wit Be wi Be the e v ser Ob

Fig. 31 - Chart showing preferred activities the clients do in the garden, and for how long.

9 4

1 (not at all)

5 4 3 2 1

g l min efu lco Peac We

l en sed Socia Op Enclo

y y g ful en rey oring ful zed Empt restin Nois uti Stress G Gre B ani e g t r Bea In O

Fig. 32 - Chart showing how the clients characterize different characteristics of the garden.

that the garden is somewhat peaceful. In their opinion, the garden is open (too open), and not so much enclosed. On a general level they characterize the garden as not being social, most of them think of the garden as being partially social (neither social nor non-social). 4 out of the 9 think that the garden is boring; opinions about the garden being beautiful are very different: the clients have chosen different answers, from 1-5. The back garden is considered to be beautiful because it’s green and because of the beautiful large magnolia tree, which they find fascinating to look at, especially in the blooming period. The clients agree there is nothing special about the front yard, but they would still hang out there because it is easily accessible. None of the clients find the garden stressful, but they mention the noise from the main road as being disturbing at times. All of them agree the garden is definitely not interesting to look at or be in (except for one of the clients, which found everything very positive and beautiful). When asked if the garden is organized, the

residents were a bit confused about what the word “organized” refers to; after explaining, they said they believe it is not so organized. Out of 9 clients, 5 find the garden to be empty, lacking of activities and features. How satisfied are you with the garden? When asking the clients about their satisfaction with the garden, most of their answers were “neutral”, and others said they are pretty satisfied; but they all think there is room for improvement. They feel this is how the garden looks like and no one is going to listen to their wishes about the garden. What do you like about the garden? The residents mostly agree that they found the back garden the most appealing because it is so green, and because of the blooming magnolia tree. The women didn’t seem to find or be paying much interest in the back garden, because they are staying in the front yard most of the times, but they did like the thought of having more flowers and colors to look at. All of them liked that they have mov-

able benches so they could sit wherever.

so-called bonfire in the front garden. They would really like to have a real one (no diagram shown for this question).

How do you like the existing conditions in the garden? They especially thought there could be some improvement on the seating arrangements (the benches), the vegetation, the structure of the place, the football area and the playground. Features that they like are the hill with the trees, the forest and the atmosphere. Oddly enough, the area they find the most appealing, they didn’t actually spend most of their time in (chart not pictured for this question).

Which part of the garden do you use the most? When asking this, the answers were divided in between the front yard and the back garden (both areas are close to the building entrances/exits). This is where they all go when they are having a smoke, having a cup of coffee, talk on the phone or just sit and relax in the sun. They use the existing benches in these areas for the activities mentioned above, but also for writing their individual assignments sometimes.

Which part(s) of the garden are you not satisfied with? The playground and the football field are very criticized amongst the residents – because most of the times, they say, it is wet and muddy. One more feature they do not like is the

Do you feel safe in the garden? All nine of the clients feel safe in the garden, even though they talk about the fact that it is really open to the main road and

How do you like the existing conditions in the garden? 9 I like it very much

I like it

Which part of the garden do you use the most?

It’s okay

I dont like it

n as st rde are ore kga wn ill/f c a l h a b n The op e The The

ard

nt y

fro The

I don’t like at all

s d st ill on lace rea ound re yar he h k fore sphe p che tati r la T o c ont Ben vege of the otbal playg r a f m b at The The cture he fo The The The T tr u s The

Fig. 33 and 34 - Charts showing the clients favourite part of the garden (first), and their preferences regarding the existing conditions in the garden (second).

Which of these features do you think the garden needs?

Do you need more places to sit alone, one on one or in groups?

7 6 5

1 s ne one roup Alo g on e n I On

s s ers as ent rea eas ing ure ree eas eat ore t Flow Seat ved a te ar cial ar ful are uipm f r a q M y te Pa So Pla rcise e Priv Wa e x E

Fig. 35 and 36 - Charts showing the clients preferences of sitting in the garden (alone or in groups), and what kind of features they would like to have in the garden.

they would like more fencing and closing off (chart not pictured for this question).

pavement, or more areas where you could be alone in nature. They all thought that the garden could definitely benefit from having more features, even just something to look at would be great for them.

Do you want places to sit alone, one on one or in groups? Most of them feel that the area is lacking in private areas where they could sit alone and be unbothered, relax or just write their individual assignments.

Would you like to use the garden more if it had some of these features? They all answered yes to this question, of course they would really like to see some of the features mentioned, to being brought into the garden so it would be less boring during their stay (chart not pictured for this question).

Which features do you think the garden should have? In general residents all feel that the area could use more features mostly water features, walking trails, shelters, sport or exercise areas where there is

ents, but with slight changes to the questions. They definitely used the garden much differently than the clients (as expected). All of the employees take really short breaks, for 10 minutes or less. In general they are very busy when they work, because they have to be available to the clients all the time - when they need something or somebody to talk to, when they need advice or medication. They are sometimes busy even in their lunch breaks, which they might use for introducing new residents to routines and talking about the center.

INTERVIEWS AND TALKS WITH THE STAFF The interviews with the staff were conducted on the 5th of May. We were able to interview 7 employees of the center, which gave us the opportunity to gather valuable information that will be presented in the following. How satisfied are you with the garden? The staff at Alfa seemed in general satisfied with the garden, but they all agreed that some improvement could be done, for example more features for the clients. They believe the garden has good space and plenty of opportunities, and they consider it green.

The staff use the garden for activities such as: going out for a smoke, get some fresh air and sun or make a phone call. But in relation to their work, they would use the garden for longer periods of time, for example to go have a talk or walk with the clients, or do some sports activities together.

Which activities do you do in the garden, and for how long? We asked what the staff uses the garden for, as we did for the cli-

On a scale from 1 to 5, how well do these characteristics fit the garden? Some of the employees describe the existing garden as being pretty welcoming, while others think itâ&#x20AC;&#x2122;s far from welcoming. As for being peaceful, most of them classify the garden

3 2 1

It â&#x20AC;&#x2122;s

oka

Fig. 31 and 32 Which activities do you do in the garden and for how long?

> 1 hr 31-60 min

5 21-30 min

11-20 min

< 10 min

2 1

ve Ha

x ir ts n k le ay ients ues en imals rries e lk nts ela ch ts one Read un ha op wor nts g l aw a ru e clien ard lun Smok ick ta . clie and r e fres me s clien he ph e g nd an et wo Get e w. c collea th clie rve pe rden o for h w u h t t o e t i t s k i s Q tal m et S h G n th n a Forg oy rci ith Be w Obse o ga wit t so ko G with D Enj garde Exe Be w Ge Tal rts and lk e Sit spo h Wa t o D ve ser Ob

Fig. 37 and 38 - Charts showing the staffâ&#x20AC;&#x2122;s satisfaction in relation to the garden (first), and which activities are they doing in the garden and for how long (secondly).

7 6 5 4

1 1 (not at all) g l min efu lco Peac e W

en sed So Op Enclo

l cia

y y g ful en rey oring ful zed Empt restin Nois uti Stress G Gre B a ani e e B Int Org

Fig. 39 and 40 - Chart showing how the staff characterizes the existing situations in the garden.

as being a 3 on the scale. The staff consider the garden too open, and believe the place could need more enclosed spaces. They describe the garden as being a little social, but they think the garden could definitely be more inviting. The staff consider the outdoor area at Alfa as being very green, as they have classified it with a 5; but later during the interview they mention it could be even greener. In the same time, the garden is believed to be a bit boring and grey. However, 4 out of 7 find the garden beautiful, while the others would not call it beautiful at all. None of them think of the garden as being stressful. But they do find it empty (6 out of 7 employees think that), and all of them agree the garden is not an interesting place. Lastly, 3 out of 7 found the garden noisy, because of the main road situated right next to the site. The next step in the process was to find out more about the rehabilitation program, and determine if nowadays the therapy schedule is related to some extent to nature or being outdoors.

Could you imagine some parts of the therapy could be brought outside? And so, we have asked the employees (therapists and social workers) if they could imagine some parts of the therapy taking part outdoors. The feedback was very positive, as they confirmed it could be possible, so all of them answers yes. That is, of course, because they have been experienced the clients have a better mood and feel much more energetic after spending some time outside. The therapists we have interviewed are also aware of the fact that being outdoors in nature is so beneficial for every human being, so they believe the clients should definitely spend more time in the garden (chart not pictured). How do you use the garden in relation to your therapy with clients? Therapists use the garden for having a walk and talk with the client, or just sit and talk, as a part of their treatment (chart not shown for this question). Have you noticed any difference in their mood while being outdoors? All the therapists say they have noticed the clients

are much more relaxed and peaceful after spending some time outdoors. They truly believe the residents could spend even more time outdoors during the therapy (chart not shown for this question).

discussion led to talking with the therapists and social workers about the visits the clients get during the weekend (family or friends) and possible influences on their rehabilitation process, mood, changes in their attitude after the visits. Most of the clients have a family and a social life. Some have neglected their loved ones, other have lost their loved ones because of their addiction, some of them might be orphans and have no one. According to the staff, most of the clients get visits each weekend, either from families or friends. But a visit, as they say, can influence the clients tremendously, depending on what kind of relationship they have with their family members (or friends). A good relationship with a parent will always turn out to have a good effect on the clientsâ&#x20AC;&#x2122; attitude and behavior. While a bad status of a relationship, either with a family member or a friend, could be so damaging for the client â&#x20AC;&#x201C; that would determine him/her to lose confidence in the program and in themselves (chart not shown for this picture). The employees notice that the week follow-

What do they suffer from besides the addiction? What about their background? Asking this question helps us reveal with which kind of problems the clients deal with during rehabilitation, others than the addiction itself, and helps us find out what kind of background the clients have. As the employees mention, clients have struggled with depression, anxiety, stress grief or loneliness for a long time; many of them have had problems in the past with being violent or involved in some kind of crime or prostitution activities. Some of the clients also suffer from schizophrenia, which apparently might occur among the abusers. How many clients get visits from their relatives and friends? Does the support and visits influence the recovery process? The 7

Do you use the CENAPS model for treatment?

6 5

Yes y n sio nxiet res A p e

ess

Str

ry ry ss ef on ni a isto Gri t histo u ti line t h hre i e l t n s a n op o o n z e i r i l L P m Vio Sch Cri

Fig. 41 and 42 - Charts showing different kinds of problems the clients deal with (left) and how much does the staff uses the CENAPS model (right).

How stressed do you feel after treating your clients on a scale from 1-5?

Yes

No 1

( no

se res t st

3 5

sse tre ys r e (v

Fig. 43 and 44 - Charts showing staff’s wish to have a place just for themselves (left) and their level of stress after being at work (right).

On a scale from 1 to 5, how stressed do you feel by dealing with the clients? Another important aspect was finding out information about the employees emotional state at work: how stressed they are, how they feel after treating the clients and dealing with different situations at work. None of the employees feel stressed because of their jobs, saying “I am more busy than stressed, and I get a good feeling knowing that I might help people here” (Sölvä, therapist).

ing the visit could be quite hard to bare for the ones who never get a visit (because they have no one) or for the ones who have a really bad relationship with their family members/ member. As the staff accentuates, the worst case is for those that have nobody to talk to, so their feeling of loneliness creates doubts and so their recovery could last longer. Do you use the CENAPS model? How does it work? The next step was gathering information about the CENAPS model of treatment they use at the rehabilitation center, so we have asked how they use it with the clients, so we could get a better understanding of the treatment.

Do you need a relaxing place outdoors for you and your colleagues, where you can be together? This brings us to the final question for the staff. 5 out of 7 believe it would not be possible or it would not work well for this facility. Because they really spend most of their time doing therapy with clients or helping them with their needs, and when they are not with the clients, they do computer work in their offices, when they also need to be available for clients. The reality is that they have a lot of work to do treating and doing different tasks, so they really do not have time to relax or take a break from clients and work. Therefore they feel that a separate place just for staff wouldn’t work or function at this facility (chart not shown for this picture).

All of the therapists we have interviewed (4) use CENAPS for treating the clients, and as they have explained, it is based on cognitive therapy. As it is a relapse prevention treatment model, they talk with the clients about their feelings and behavior, teaching them to be aware of their inner thoughts (first step); secondly, they are trying to help the clients figure out how the addiction has started and why. Afterwards, they try to help clients to reach their goal, which is rehabilitate without relapsing after the treatment had come to an end.

84 Fig. 45 - Serene dimension - Nacadia. Picture taken by the authors of the Thesis.

LEARNING FROM A THERAPY GARDEN:NACADIA It was late May when we made a visit to the Therapeutic Garden Nacadia, to meet Dorthe Djernis (psychologist and therapist at Nacadia) and to explore the garden, in order to understand how the garden works and how it is used by the staff and by the clients. To get to Nacadia, we passed through the Arboretum. All the flowers were blooming, the trees, all in all there was a harmonious and peaceful ambiance. As we approached Nacadia, the atmosphere became more and more calm and serene. Dorthe welcomes us in the green house where we get some tea and we start talking. The main reason for visiting the Terapihaven Nacadia was to get a full understanding of how the garden is used for therapy, and to get a feeling of the restorative place there. Djernis talked us through the therapy schedule at Nacadia, and we were asking questions for further explanations along the way.

Fig. 47 - Nacadia - a view to the garden house.

Djernis explains that the therapy at Nacadia is based on three pillars: nature (the therapy happens almost always outside), mindfulness (every activity, part of the program is built on mindfulness) and individual sessions (the client/participant has to be convinced that â&#x20AC;&#x153;what he/she is doing is good for his/her process); all of these three pillars have the same importance. In order to get to Nacadia, the clients need to take the same walk as we did to get there, through the Arboretum; and so, they leave their car at the entrance, leave problems and worries behind and proceed to the garden. This way, they already feel a bit more relaxed and peaceful by the time they reach the garden, being detached from real life and worries.

Fig. 46 - Entrance to Nacadia, guided by a beautiful pergola.

Every morning, the therapy day starts with coffee and tea, nuts, crackers and peanut butter in the green house, followed by gathering at the fireplace, located just outside. The group gathering starts off with a mindfulness exercise – the participants are guided through the exercise by the therapist; the main point is they could totally relax and focus on the present moment, being aware of their own bodies’ energies and being aware of what happens in that specific moment.

-mindfulness – a good starting point for making the schedule for Alfa Fredensborg, as all the activities should be organized having a connection with that; as we know already, Alfa Fredensborg also considers mindfulness very important, but it is not practiced as much though.

Djernis made it clear from the very beginning that mindfulness is such an important aspect of the therapy. According to her, every activity is based on the individuals’ experience of being in the present, being aware of their own body, sensations and the five senses. Yoga exercises are made along the way, as well as some horticultural activities (tasks that need to get done in the garden – for e.g. cutting wood for the fire).

DISCUSSION & RECOMMENDATIONS Visiting Nacadia was an inspiration and an eye-opener. Comparing our target groups and having a discussion about the therapeutic garden was very useful, as we could imagine some of the aspects being used in our project, with slight changes: -quiet time on your own in the garden – should be longer than in Nacadia (25-30 minutes); Djernis also considers the time the clients have for the “quiet time on your own in the garden” is too short; -yoga – more active that in Nacadia’s case, because the substance abusers and alcoholics need much more physical activity;

AN INSPIRATIONAL MEETING WITH FRITZEN Martin Bødker Fritzen is a motivational speaker, currently traveling around the world and Denmark, giving lectures and talks about how to fight an addiction. He used to be heavily addicted to drugs, prescribed medicine and alcohol for 14 years (1995-2009). When his addiction was at its peak, he used to take a dangerous mixture of 40-60 pills, alcohol, cocaine and amphetamines.

he could interact with others (but not talk that much), to a small enclosed space from where he could sit quietly, be in peace, observe others doing different activities. The necessity of having silent places where the clients could sit on their own is absolute. He recommends these spots (where the clients could sit alone) should not be placed too far from the building, as substance abusers could take advantage of it and hide away using drugs (he explains substance abusers often find ways of stealing drugs and hide the abuse from others).

Martin is clean since 2009. Finding his book accidentally (“From Drug Addict to Role Model”), convinced us that he is definitely a person we should talk to, because of his openness when it comes to sharing his experiences and thoughts, feelings. Martin agreed to talk to us, expressing his interest in our work.

When it comes to physical exercise equipment, Martin considers it should be present, and suitable for those who are in a good shape, but also for those who are not in such a good shape; the equipment should probably be challenging for the clients, motivational. He mentions physical exercise could also mean just having a walk up on a small hill, or through a curved, mysterious pathway.

The discussion we had with Martin was very useful and inspiring. Right after starting the talk, we got the feeling we are talking the same language, but using slight different terms. Many aspects that we have learned from theories were confirmed by Martin as we proceeded with our discussion. He was willing to share his own feelings from when he had experienced being in a rehabilitation center (more than 3 times). Main points of our discussion will be presented in the following.

Being in a rehabilitation center for a couple of times, Fritzen has experienced mindfulness exercises and yoga. He says mindfulness helped him to relax and focus on the present moment, and yoga was a good, challenging physical exercise. He believes both could be eventually implemented in the therapy program.

In his opinion, the garden is a very important element while being at a rehabilitation center, and it should be used at its maximum.

But, he says, “the garden should also be interesting, inviting for exploration, stimulating for the 5 senses”. Martin further explains that he always used to choose the most interesting pathway systems, and he always used to appreciate the wild-looking spots of the garden. But in the same time, his advice is the clients should not feel they are too

First thing Martin starts talking about is the fact that himself as a former addict felt the need of variation in space, so he could choose from an open space, where

far from the building, also because of their physical condition during withdrawal. He narrates himself as a client of one of the rehabilitation centers had to make use of the building many times, because of different side effects of the medication and his general state of mind. And, shortly, he always needed to feel that the building and other clients are close by, because this would offer him a feeling of safety.

cause being around the fire and looking at it is very relaxing and not demanding psychically. He mentions that the clients might be

Fritzen is of the opinion that the fencing around the site is important, but it should probably be made out of vegetation and other elements from nature, and in general should not confer a feeling of being trapped. When it comes to sheltered places for sitting, Fritzen believes the clients should have both the opportunity to sit alone (in a sheltered place) but also sit with others and socialize (in a sheltered place). Being aware of the short summer and the large number of rainy days in Denmark, he thinks a heated place outdoors could be a good feature to have.

Fig. 48 - Martin BĂ¸dker Fritzen .

Fritzen narrates a very important reason for why the garden should be inviting is that the clients need to desire to go explore it from their own initiative, and for e.g. not from the therapistsâ&#x20AC;&#x2122; initiative. And so, the garden should be green and beautiful all year round, have many flowers and vegetation in general, maybe some herbs or fruits. It should offer opportunities for walking (pathways that have curved, interesting shapes), and of course all the 4 elements of life should be present: water, fire, earth, air. Having a bonfire where clients could gather would be a very good idea, he believes, be-

involved in cutting the logs for the fire. Our talk revealed Martinsâ&#x20AC;&#x2122; thoughts about how to make them use the garden more and more. He imagines the schedule should include some small tasks the clients could make on a daily basis, like cutting the logs for the fire (for men), picking up flowers for further use (for women mostly); or implement an activity they have to do somewhere in the garden in a way that they would walk the garden in order to reach the place (for e.g. they could walk through the garden so

they can put their name on a tag and then write the number of days they have been in the rehabilitation center, and maybe reflect/ think about it), and then getting back to the building for breakfast. Fritzen believes women are more sensitive than men. He says women in rehabilitation have problems with guilt, low self-esteem, they feel ashamed, therefore they might be more reserved and they might want to be left alone, and maybe not interact with others that much, and probably not be that interested in using the garden as much as they guys. In this sense, Martin mentions maybe there could be something they can do in the garden related to flowers, plants, going out to read or have a short walk; the same goes for small tasks in the garden, tasks that make sense and will make them feel important doing it. Last but not least, Fritzen mentions hope. Hope, he says: â&#x20AC;&#x153;It is something that should be present in the garden, somehowâ&#x20AC;?. Either if itâ&#x20AC;&#x2122;s a symbol, a quote, or a clear idea about what could happen after being clean (a new life, a new beginning, a life with many opportunities) this should certainly be present in the garden to help the residents be positive about their future lives.

CHAPTER 8

SITE PROGRAMMING

PROGRAMMING THE SITE

This chapter presents the design guidelines formulated after all the knowledge acquired in the previous chapters, synthesized here in different categories, presented in the following. TARGET GROUP CONSIDERATIONS This is a complex group of people, who all experience treatment and withdrawal symptoms differently. Drug abuse has a strong impact on people and change them as a person. In the withdrawal phase of the treatment everything will be upside-down for these people, and they all cope with it differently. Therefore some clients need to be private, others socialize and find comfort in their roommates who are experiencing the same things they are. The garden must fit to all these different moods and needs, be appealing, supportive to the treatment program.

CONCEPTUAL GUIDELINES WHAT: therapy garden HOW: bring the treatment/therapy from indoors to outdoors; design so the garden accomodates for different activities in the treatment schedule WHY: so the clients benefit from the restorative outdoor environment

WHAT: all of the 8 perceived sensory dimensions should be present in the garden HOW: create different rooms with different characters WHY: so the clients have different opportunities for gathering, socializing, or being on their own (Grahn & Stigsdotter, 2010)

WHAT: mental strength HOW: divide the garden into different areas that correspond to each of the levels of the mental strength pyramid WHY: each of the clients has a different mental strength, so they have to have possibilities for choosing the place in which they would like to be in (Stigsdotter & Grahn, 2002)

WHAT: remove the driveway going through the site HOW: provide an alternative route for driving to the rehabilitation center WHY: the garden should have a sense of unity, so the clients could move around in a natural flow, without being disturbed by traffic

PATHWAYS

WHAT: organize pathways that go through the garden HOW: so they facilitate access to different destination points WHY: so the clients can access places with different functions - places for socializing, places for sitting alone exercise equipment gathering places etc. (Marcus & Sachs, 2014) WHAT: provide curvilinear pathways throughout the whole garden HOW: build curvilinear pathway made of wood, that create a feeling of walking in a natural flow WHY: their naturalistic form invites for exploration and it creates a very interesting experience of place; as the clients are hard to convince to use the natural environment; (Marcus & Sachs, 2014; Staff interviews) WHAT: seating places HOW: placed along the pathways WHY: as the clients might experience mental fatigue and physical exhaustion (Marcus & Sachs, 2014; Target group study; Staff interviews)

SEATING PLACES WHAT: provide a variety of seating places HOW: single chairs, benches, tree benches, hammocks, swings, tables with chairs, chaise-longues WHY: as the clients are all experiencing the treatment differently, as the clients to have a range of possibilities to choose from (Marcus & Sachs, 2014; Clients Interviews, Talk with Fritzen) WHAT: provide movable furniture HOW: use single chairs and benches WHY: as the clients might want to gather in smaller groups, for socializing or other interactions, this aspect is really important (Marcus & Sachs, 2014)

WHAT: provide places for sitting alone, in private and semi-private areas HOW: use hammocks, swings, chairs, chaiselongues, tree house, tree bench WHY: as the clients need moments for individual reflection and relaxation/meditation (Marcus & Sachs, 2014; Clients Interviews; 8PSD) WHAT: provide seating close to the building HOW: place tables and chairs close to exits/entrances WHY: as the clients experience physical pain and disturbances because of their withdrawal (nausea, diarrhea etc.) and they have to access the facilities (Talk with Fritzen; Target group study, Staff Interviews) WHAT: provide plenty of seating HOW: benches, tables with chairs WHY: for the family visits that happen during the weekends (Staff and Clients Interviews; Marcus & Sachs, 2014) WHAT: provide sheltered places HOW: use gazebo, pavilion, sheltered bonfire, glasshouse WHY: as the group meetings could take place outdoors, where the clients feel closer to nature (Marcus & Sachs, 2014; Staff and Clients Interviews, Talk with Fritzen) WHAT: provide sheltered outdoor constructions HOW: build constructions that could be used all year round WHY: as some clients stay for the treatment program in the cold winter seasons only (Marcus & Sachs, 2014; Staff Interviews) WHAT: provide places for sitting one on one HOW: place a couple of chairs in a private/semi-private area WHY: so the individual therapy sessions could happen outdoors; as the clients experience the therapy session more calming in the garden (Staff Interviews, Talk with Fritzen, Talk with Djernis)

WHAT: provide sheltered/covered seating HOW: use umbrellas, textile WHY: so the clients have a possibility to stay and write their individual assignments outdoors in all types of weather (Marcus & Sachs, 2014; Clients Interviews, Talk with Fritzen)

PLANTING WHAT: provide planting that confers an interesting experience all year round HOW: use evergreen and deciduous trees, shrubs and alternate perennials that bloom in different times of the year WHY: as the garden needs to be inviting and interesting to use and be in for the clients in all seasons (Clients Interviews; Marcus & Sachs, 2014) WHAT: provide planting that offers fascination and sensory engagement HOW: use ornamental grasses that move in the breeze, trees with beautiful foliage, flowers with beautiful and calm colors WHY: as this would provide a peaceful and appealing atmosphere the clients need (Marcus & Sachs, 2014; Talk with Fritzen) WHAT: provide planting that dictates the shape of different types of rooms (private, semi-private, enclosed) HOW: use dense shrubs and perennials WHY: as this make the clients feel safe, secure, intimate, without any disturbance from other users (Marcus & Sachs, 2014; Talk with Fritzen)

WATER FEATURES WHAT: provide water features HOW: use water installations that engage more than just one sense WHY: as water has a soothing and calming effect, and it creates a destination point for the clients to reach (Marcus & Sachs, 2014; Clients Interviews, Talk with Fritzen)

WHAT: provide water features for children HOW: use interactive water installations - that would allow them to water the plants for e.g. WHY: as they often would like to engage with water (touch it, play in, put things in) (Marcus & Sachs, 2014; Clients Interviews)

HORTICULTURAL THERAPY WHAT: provide opportunities for horticultural activities HOW: raise planting beds, provide tools, provide opportunities for watering the plants WHY: as this helps decrease anxiety and depression, increases self-esteem (this is especially important for the women) and mood (Marcus & Sachs, 2014; Staff Interviews, Talk with Fritzen) WHAT: provide planting beds in different heights HOW: build planting beds in different heights, that would allow working under different circumstances WHY: as some of the client might not be capable of standing for a longer period of time, due to their physical condition (Marcus & Sachs, 2014; Target group study; Staff Interviews) WHAT: provide planting that engages several senses HOW: use scented and colorful plants, herbs, fruit trees, plants which are pleasant to touch WHY: as it will stimulate their sensorial experience, improve memory and cognitive functioning, which might be impaired after a long term abuse (Marcus & Sachs, 2014; Clients and staff interviews, Talk with Fritzen) WHAT: provide tools for the gardening activities HOW: use shovels, rakes, water hose, scissors, table for cutting WHY: so the clients can do the horticultural activites in good conditions (Marcus & Sachs, 2014)

UTILITIES AND OTHER GARDEN ELEMENTS WHAT: provide guidance on how to navigate in the garden

HOW: use signs for teaching and guiding the users on how to utilize the garden - the signs should be used for both adults and children, with differences in appearance WHY: so the clients find it easy to orientate and get familiar with the garden early in their stay at the center (Marcus & Sachs, 2014; Talk with Fritzen) WHAT: provide the garden with motivational quotes HOW: use signs with different quotes WHY: so it motivates the clients for accomplishing goals in the future (related to their addiction) (Talk with Fritzen) WHAT: provide opportunities for exercise outdoors HOW: use outdoor physical exercise equipment and multifunctional court; the equipment should be suitable for both, users in a good shape and users in a bad physical shape WHY: as the target group requires a lot of physical activity; the exercise releases the bodyâ&#x20AC;&#x2122;s neurotransmitters (dopamine, endorphins) which would make the clients feel better physically and psychologically (Talk with Fritzen)

WHAT: provide opportunities for play HOW: use different constructions and installations: tree-top walking, rope to climb on, water features, swings, tree-house WHY: so the children could make use of it, possibly together with their parents, as this reestablishes good relationships (clients and children) (Marcus & Sachs, 2014;)

WHAT: provide spaces where sports group activities could take place HOW: open spaces WHY: for social interactions that gives the clients healthier social interaction patterns and increases group cohesiveness (Clients and Staff Interviews; Talk with Fritzen; Talk with Djernis) WHAT: provide lightning all around the garden HOW: use garden lights and tree lanterns WHY: so the clients and the staff coul safely enjoy the garden at night (Marcus & Sachs, 2014) WHAT: safe and secure environment HOW: fencing the garden using vegetation WHY: so the clients feel safe in the garden, but not trapped (Marcus & Sachs, 2014) WHAT: places for alone meditation HOW: use wooden meditation platforms WHY: so the clients could meditate while being outdoors, for a better restorative outcome (Talk with Fritzen; Clients Interviews) WHAT: facilitate being outdoors in all types of weather HOW: use water-proof suits and blankets for keeping warm WHY: so the clients could be in the garden in colder or rainy weather (Visit to Nacadia; Talk with Djernis) Fig. 49 - Design guidelines, divided in different categories.

APPLYING the MENTAL STRENGTH PYRAMID and the 8 PERCEIVED SENSORY DIMENSIONS

Fig. 50 and 51 - Illustrations of the proposed mental strengths areas (left) and the perceived sensory dimensions (right).

In the following, the Mental Strength Pyramid and the 8 Perceived Sensory Dimensions will be described, as they are proposed in the new design.

so they would surround all the area, like a shield. This specific placement was made in order to provide users a place where they could retreat no matter where they find themselves in the garden. As the users would like to benefit of places to sit alone in quiet areas, these places serve as a great opportunity for doing so.

THE MENTAL STRENGTH PYRAMID The first step in the design process was dividing the garden in 4 different types of areas, according to the Mental Strength Pyramid. Each of the four types of areas are in relation to different levels of mental strength (power). The four areas in the garden will be described in the following.

2. Emotional participation areas are placed in the buildingsâ&#x20AC;&#x2122; immediate surroundings. These areas are accommodating users with a greater mental strength, which would have an interest in the surroundings and would, for e.g. observe other people and nearby places, without engaging in any sort of group activity.

1. Directed inwards involvement areas (the lowest mental strength in the pyramid) are placed close to the margins of the site,

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3. Active participation areas are even more demanding than the first two described above. These are places where users could engage in different group activities (for e.g. group meetings, individual therapy sessions with the therapists, talks and interactions with other clients or their own families).

Space is a room with a unique feeling, as it gives the users the impression of entering a whole new other spacious dimension. The Space room is represented here by the protected area, where the tall trees create a beautiful space with a great atmosphere. In this case, it overlaps one of the areas corresponding to the directed inwards involvement.

4. Outgoing involvement areas are the ones which accommodate users with the strongest mental power in the pyramid. These are meant to be open spaces, that allow active group activities to take place (yoga, mindfulness, different team sports) as well as social interactions in between the clients, the clients and their families, the clients and the staff.

Prospect is experienced in the garden as a vast open space, where there is enough room for clients to do all kinds of activities (from sitting on the grass or observing other people, to doing sports like for e.g. yoga or mindfulness exercises, team sports). This room overlaps two of the mental strength areas: active participation and outgoing involvement. Prospect has quite a strong social character.

THE 8 PERCEIVED SENSORY DIMENSIONS After dividing the space according to the Mental Strength Pyramid, the next step was establishing where would the perceived sensory dimensions should be placed. Seven out of eight sensory dimensions are considered to be most relevant for the studied target group, and will be presented in the following.

Nature is combined in the garden with one of the directed inwards involvement areas. The second dominant character/room in there is Rich in Species. This room is characterized as a wild looking, free-growing area. Festive is placed close to the buildings, and it overlaps one of the active participation areas. This room is inviting for socializing, as there is room for clients to gather for talks or for having lunch together, as well as for spending time with visitors.

Refuge is a room that offers possibilities for shelter and safety, and it is placed in the same spot as the areas corresponding to the directed inwards involvement and emotional participation.

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CHAPTER 9

DESIGN PROPOSAL

3 The Wilderness 2 Bonfire

4 Horticultural

therapy Parking

1Courtyard

7 The Beech Forest

Building

5 The Back Garden 6 The lake

N Scale 1:1000 Fig. 52 - Masterplan proposal - the therapy garden for drug and alcohol addicts.

30 m

DESIGN PROPOSAL - a tour The Masterplan represents the final proposal for the evidence based designed therapy garden at Alfa, and it illustrates defined rooms and spaces, together with the pathway, which connects these throughout all the garden, and facilitates accessibility as the road going through the garden has been removed (from the building throughout the garden). The rooms are all of different character and have their own function and facilities.

ue down the main wooden pathway, where a natural looking scene leads the clients out in the garden. Pergolas and beautiful vegetation follows the main pathway as we come out in the garden. The pathway leading to the bonfire is meant to make the clients feel secure, at peace, to make them aware of their surroundings and initiate them for the group meeting that is going to take place. And so, the first stop we make is at the bonfire, where all the clients together with a therapist gather at the beginning at the day, when they all make a mindfulness exercise. At the bonfire, the clients split into smaller groups and each proceeds to a special designed place for this activity (gazebo, pavilion), deeper into the wild growing part of the garden (3). This part of the garden is characterized by being dense, varied in vegetation. Private rooms offer the possibility of having a quiet, peaceful moment; furnished with hammocks, chairs, swings, chaise-longues, these rooms are meant to offer the possibility of sitting in a peaceful setting. The area also provides a tree-top walking feature, which starts on a sloping ramp, leading up to a walkway of about 3 meters high, up in between the tree trunks. This provides a couple of places to sit (for one or two people) with a view to different parts of the garden. Family and children visiting clients at the center – during the weekends – would have plenty opportunities for play and exploration in this part of the garden.

In the following, we would like to invite the reader for a “walk” through the garden, starting from the courtyard, surrounded by the building. (1) Coming out from the building’s head entrance, one can step out and have an overview of the garden before going further out. A beautiful courtyard, with vivid vegetation which seems like it’s spreading to the building (from the garden) set the scene and accommodate the user for further exploration intentions. Sheltered seating places are situated all around the courtyard, where high perennials (ornamental grasses) create small semi-private spaces. The courtyard is thought as a flexible space, where the clients (users) could have a break, have lunch outside, meet the visitors, write assignments, make a phone call or interact with staff members; that is why it is important to have a good arrangement of smaller spaces for 1-5 people to sit together (the courtyard could accommodate 26 people in total). From the parking lot, pergolas guide the user to enter the courtyard, and wooden signs announce the pathway that leads to the garden.

(4) Moving further south, the horticultural therapy area emerges. It is a great place for bringing the clients together via horticultural activities. Fruit trees, planting beds full of herbs and flowers, all surrounding a glass house, that can be used all year-round

(2) As we emerge in the garden, we contin-

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make this part of the garden truly unique. This area is to be maintained by the clients, as they will be responsible for planting the herbs, collecting flowers for tea, watering the plants, or other horticultural activities.

tion that defines smaller intimate individual spaces. (7) Continuing on the main pathway, you are guided up to the eastern part of the building. Alongside, the beech forest appears on the right side, where stepping stones (made out of wood) intrigues you for further exploration. Tall beech trees create a fascinating setting where one could walk around having an overview over the entire hill; possibilities for stay are offered which function both as seating or meditation spots.

(5) Walking down to the back garden, a large prospect area is to be observed. Here group activities and large events could take place (yoga, football, socializing, reunion party). Different trails lead the users to different destination points. Closest to the building, in the middle of the garden, dense vegetation made out of perennials, evergreen and deciduous shrubs and trees create rooms for the clients to sit in a quiet atmosphere, observing the immediate surroundings.

In the following, further explanations of the design will be presented, together with an illustrative journey (visualisations, collages, sections, detailed plans). A new schematic treatment schedule is proposed, adapted after the existing schedule at Alfa, but with new activities incorporated in the therapy schedule.

(6) From here, the main pathway leads you further south, where a small lake is dominating this particular area. The surroundings are characterized by evergreen vegeta-

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NEW PROPOSED SCHEDULE The new proposed schedule (draft) is adjusted after the existing one and it introduces some new features. First of all, the group meetings and individual therapy sessions have been moved outdoors, as the facilities proposed make it possible in all types of weather. Furthermore, individual assignment writing, physical exercise is now possible outdoors, together with horticultural activities, opportunities for socializing but in the same time places for clients to sit alone are possible, team sports, mindfulness, yoga exercises; free time in the schedule is still respected, as the clients might not be in the best physical/mental shape to follow a full scheduled day of treatment.

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Time

Monday

Tuesday

Wednesday

Thursday

Friday

7:00

Breakfast

8:00

Walking Tour in the garden – mandatory, the therapist reminds the clients of being mindful, aware, new day is about to begin

Responsibilities/Tasks + Organizing the Activities

8:30 9:30

(overview of the day program, discussing responsibilities and tasks in the house)

Group Meetings in the garden -where: bonfire, gazebo, pavilion, glasshouse, open spaces -all the clients gather at the bonfire; there, together with a therapist, a mindfulness exercise is being made (15 minutes); afterwards, the clients split in 3 smaller groups and go to the; gazebo, pavilion and one of the groups stays at the bonfire.

11:30 Individual

Horticultural activities -where: horticultural activities area and the rest of the garden (small tasks - if needed) -maintenance of flowers and herbs, collect flowers, collect flowers for tea, collect herbs for the kitchen, collect seeds, prepare plants for planting, mow the lawn etc.

-where: bonfire, gazebo, pavilion, glasshouse, open spaces -all the clients gather at the bonfire; there, together with a therapist, a mindfulness exercise is being made (15 minutes); afterwards, the clients split in 3 smaller groups and go to the; gazebo, pavilion and one of the groups stays at the bonfire.

Horticultural activities

Group Meetings in the garden

-where: horticultural activities area and the rest of the garden (small tasks - if needed)

-where: bonfire, gazebo, pavilion, glasshouse, open spaces

-maintenance of flowers and herbs, collect flowers, collect flowers for tea, collect herbs for the kitchen, collect seeds, prepare plants for planting, mow the lawn etc.

-all the clients gather at the bonfire; there, together with a therapist, a mindfulness exercise is being made (15 minutes); afterwards, the clients split in 3 smaller groups and go to the; gazebo, pavilion and one of the groups stays at the bonfire.

Individual sessions

-5/6 clients have an individual therapy session in the garden, together with a therapist (in 5 different places)

Individual sessions -5/6 clients have an individual therapy session in the garden, together with a therapist (in 5 different places)

Lunch

13:30 - Quiet time in nature/Reflection - Individual assignments writing

14:00 - Outdoor

Workshop (in which

- Quiet time in nature/Reflection - Individual assignments writing

-Quiet time in nature/Reflection - Individual assignments writing

- Quiet time in nature/Reflection - Individual assignments writing