Healing Through Nature

HEALING THROUGH NATURE

______

A Project

Presented

to the Faculty of

California State University, Chico

______

In Partial Fulfillment of the Requirements for the Degree

Master of Science

Kinesiology

______

James B. Satterthwaite

Summer 2013 HEALING THROUGH NATURE

A Project

James B. Satterthwaite

Summer 2013

APPROVED BY THE DEAN OF GRADUATE STUDIES AND VICE PROVOST FOR RESEARCH:

______Eun K. Park, Ph.D.

APPROVED BY THE GRADUATE ADVISORY COMMITTEE:

______Kevin G. Patton, Ed.D. Scott Roberts, Ph.D., Chair Graduate Coordinator

______David Swanson, Ph.D. DEDICATION

I dedicate this project to all those who are suffering with a mental illness or addiction, or both, and to all who counsel and help such individuals.

iii ACKNOWLEDGMENTS

I am grateful for and acknowledge Dr. David Swanson for his guidance with this thesis turned project. I thank Terri Todd for her advice and knowledge about how to write such a paper. A special thanks to Dr. Scott Roberts and Nate Millard who stepped in at just the right moment to help move this great work forward and out the door into nature.

iv TABLE OF CONTENTS

PAGE

Dedication...... iii

Acknowledgments ...... iv

Abstract...... vii

CHAPTER

I. Introduction...... 1

Background and Need ...... 1 Statement of the Problem ...... 6 Purpose of the Project...... 9 Significance to the Field...... 10 Definition of Terms ...... 11 Methodology Brief ...... 12

II. Literature Review...... 13

Introduction ...... 13 Improving Mental Health through Outdoor Activity ...... 14 Sunshine and Mental Health...... 15 Eco Psychology ...... 16 Restorative Environments ...... 19 Exercising in Nature and Mental Health ...... 22 Meditation in Nature...... 23 Wilderness Therapy as a Treatment Tool...... 24 Overcoming Addiction through Outdoor Activity ...... 27 Retraining the Brain ...... 28 Medicine from Nature ...... 29 Therapeutic Recreation in Natural Healing...... 30 Overcoming Addiction and Improving Mental Health ...... 31

v CHAPTER PAGE

III. Methodology...... 33

Introduction ...... 33 Information Sources ...... 34 Participants ...... 35 Materials...... 35 Data Collection...... 35 Specifications of the Final Product...... 36

IV. “Healing Through Nature” Recreation Guide ...... 40

V. Summary...... 41

References ...... 43

Appendices

A. Healing Through Nature Recreational Guide...... 51 B. Floral Essences and Their Roles in the Healing Process for Those with Addictions...... 111

vi ABSTRACT

HEALING THROUGH NATURE

James B. Satterthwaite

Master of Science in Kinesiology

California State University, Chico

Summer 2013

For the mentally ill and chemically addicted (the dually diagnosed), treatment programs are complex and intense. Nature is sometimes included as a useful tool in the program, but not as a key component. A review of the literature suggests that nature can play an important role in healing, recovery, and sustained healthy living for both the mentally ill and chemically addicted. Nature has always had a role in healing.

Now is the time to reintroduce it formally into treatment programs for the dually diagnosed.

The objective of this project is to help the clients of a particular dual diagnosis program in Monterey, California, to find greater levels of health in mind, body, and spirit by introducing nature into their healing process. Through the creation of a “Heal- ing through Nature” Recreation Guide, counselors and mental health professionals working with these clients will be able to select outdoor locations and activities for use

vii in their treatment program more easily. The guide will assist them in moving some of the existing treatment groups outdoors also. Nature becomes part of the healing process.

The methodology was to review existing studies on the benefits of using nature in the healing process. There are many such studies, both current and historical, which document the effects of nature on feelings of well-being, improved healing, and general strength of mind and body. In the literature review no programs were found that formally incorporated nature as a treatment tool. Interviews with local professionals supported the idea that nature provides benefits to those in recovery. In fact, the project was regarded as very important because it expands and enhances the approaches to treating people in a dual diagnosis program, by introducing nature as a tool.

The benefits of “nature as healer” will become evident as the Recreation

Guide is used at the particular facility in Monterey for which it was developed. Included in the guide are basic evaluation forms which should show over time the effects of outdoor activities and outdoor groups on the wellness of the clients. Although the guide is specific to this program and this area, it can easily be adapted for any program or any place in the world where there are programs treating the dually diagnosed, as well as for those treating the mentally ill or chemically dependent.

viii

CHAPTER I

INTRODUCTION

Background and Need

Nature has been both respected and feared throughout history. Nature as a component in the healing process has also been recognized throughout the ages. As modern medicine has advanced, nature as healer has often been regarded as less useful.

Hippocrates is perhaps history’s most famous physician. He earned the title of “Father of

Medicine.” He also gave the world the Hippocratic Oath, a code of ethics for physicians which is still taken by graduates at many modern medical schools. Perhaps his most famous quotes are, “The patient first; above all do no harm” (Herndon, 2013, p. 289) and

“Nature heals—not the physician” (Stoehr, 1998, p. 118). A less well-known but powerful statement by this man from Greece born in 460 B.C., “Walking is man’s best medicine” (Adams, 1891, p. 15).

Healing through nature has been around as long as humans have been on this planet so there is no single person who can be credited with the origins of this theory.

Healing the way nature intended should, in fact, be the first approach to healing for any disease, before introducing medications or attempting surgeries or even institutionalizing a patient. At the very least, nature should be a part of the healing process. Walking in natural settings, using nature’s gifts (herbs, oils, fresh food), even viewing nature in

1 2 pictures can focus the mind, quiet anxieties, and promote healing as will be seen in the literature review that follows.

There is a healing quality to nature which has been known for centuries be it taking time to smell the roses, meditating on a mountain, lying in a wildflower field, strolling by a meandering stream, or hiking in ancient redwood groves (Dyer, 2002, p. 2).

In several conversations with Chad Hammack, well-known counselor of the mentally ill on the Monterey Peninsula, some with addictions as well, I learned about the

“old ways” he has studied for many years. In addition to the books he referred to, he also described the following (as paraphrased by me): American Indians used to talk about the green ways. Originally, it referred to how Indians saw themselves in relation to their environment. When they were practicing the green ways, they were working with and in the natural world. They were in sync with their Mother the Earth and their Father the Sky acting and thinking and especially feeling green, like the leaves and the grasses and murmuring streams. It was a spiritual communion with the universe as they understood it.

Soon the green ways came to mean the opposite of the white man’s ways. The white man tried to compete with the Earth, tried to conquer and tame it, bend it to his needs and ultimately divorce himself from it. The white man even claimed that the Great Spirit made man the steward of the Earth. The Indian never saw it that way. He saw the Earth as having a soul. He referred to the Tree People, the Stone People. Everything was sacred in the natural world, and the Indian practiced his religion 24 hours a day. He wouldn’t chop down a tree. He would make wood with the tree. He wouldn’t ride his horse. He would share travel with his horse. He was always an equal among equals. Even when he farmed

3 and plowed a field, he referred to the long furrows of the soil as his Mother’s hair (C.

Hammack, personal interview, September 15, 2012).

Traditional medicines of the past are being re-introduced by naturopaths and homeopaths. Various healers who value aromatherapy are showing us their value. Native

American natural remedies tie the consumption of healing herbs with a social process that provides spiritual intervention through medicine men—shamans—formal ceremonies and family support. Because of Native Americans’ intimate relationship with nature, many of their therapies emphasize plants’ mind-body-spirit healing potential. Native American healers believe that:

 Plants possess spirit and intelligence, they are consulted to determine their best healing relationship with patients, and permission is obtained before and gratitude expressed after harvesting them.  Plant components affect bodily functions and bioavailability; the entire remedy is considered the active agent.  Harvesting herbs is an intricate procedure and factors such as plant part (e.g., flower, stem, root, etc.), time or season of harvesting, sun exposure, and much more obscure factors need to be considered.  Native herbalists use plants that appear in dreams, a form of communication by which the plant’s spirit can guide the healer.  The plant’s healing potential is empowered by ritual ceremony, prayer, song, or chants. This is because herbs can treat symptoms but to reach the deeper causes of the illness a combination of methods must be used. (Cohen, 2008, p. 2)

In her article entitled “The Therapeutic Value of Plants,” Paula Relf, Professor

Emeritus, Department of Horticulture, Virginia Tech University, confirms many of the historical beliefs in the healing power of plants. Specifically she examines medical databases containing data on gardening, horticulture therapy and healing gardens. In her paper, she credits Ulrich and Kaplan (discussed later in my literature review) with pioneering the study of the efficacy of plant-based therapy (Relf, 2005).

In another book on herbal medicines, researchers describe herbs that were used in pharmacological treatments until about 1930 when regulation became stricter in the United States than in other parts of the world. In 1994, the U.S. Congress passed the

Dietary Supplement and Health Education Act which classified botanical medicines as food supplements.

Nature has been thought to heal mental illness as well as physical illness. John

Muir, considered by many to be the Father of our National Park System, stated, “Earth has no sorrow that earth cannot heal” (Browning, 2009, p. 100). Muir recognized the importance of nature to the health of the nation, “Everybody needs beauty as well as bread, places to play in and pray in, where Nature may heal and cheer and give strength to body and soul alike” (Worster, 2008, p. 12). Some of the recent studies described in

Chapter II, the Literature Review, show that these revered men who were naturalists and adventurers had many ideas that are proving relevant to healing today.

Although treatment programs for the mentally ill and the addicted have been in existence for many years, the primary components of their treatment have been medications and counseling, and occasionally more drastic methods like shock therapy, surgery (lobotomy) and restraints (straight jackets). Rarely was nature or nature’s medicines used. There are a few programs, however, which include nature or wilderness as a formal part of their program: Naropa, Outward Bound, the Hazelton Center, and special programs within the National Outdoor Leadership School (NOLS). These programs which focus on activities and physical challenges outdoors expose the participants to the benefits, as well as the dangers of nature. I know this because I have been on three Outward Bound Programs and two NOLS programs. I was tested and I

5 came out stronger for all of it. Some of their programs address adolescents from the inner cities who know little about the wilderness, some address addicts, some build confidence in participants of all ages. Nature is a big part of the experience. Some call it therapeutic or healing. Others refer to confidence building. The testimonials abound on their websites.

In the world of the mentally ill who are also addicted, nature is not regarded as a tool in their treatment. I found no mention of this in the research I have done to date, perhaps because there is little data available on the treatment of the dually diagnosed in general. Dual diagnosis treatment programs and facilities are a relatively new development. Clients in a dual diagnosis program are trying to recover from both addiction and mental illness; it is a complex challenge for their counselors. Medication, hospitalization, and counseling are the traditional methods of treatment. Why are they not using nature, wilderness therapy, and walks in the woods? Often the reasons are as simple as not understanding the value of nature as part of the healing process, or limited knowledge of the availability of sites, or lack of sufficient time to arrange the logistics of moving treatment outdoors.

The “Healing through Nature” Recreation Guide has been developed to address these problems by developing the logistics of going into nature and tracking the effects. Certainly, clients in a dual diagnosis program are one special population that could benefit from the introduction of nature into the healing process. Details are found in the guide.

Statement of the Problem

The belief that nature heals is not widely recognized or addressed by the doctors, psychiatrists, and counselors who treat these dual diagnosis clients.The complexity of their problems already requires extensive counseling, medication, and assessment. There is only so much time in the day. Nonetheless, much of the research discussed in the Literature Review will show that bringing clients out of the facility where they spend most of their lives, out into nature that they seldom experience, may be one of the most important steps in their healing. With their counselors, they can do some of the therapy groups they already know, but they will do them in nature. They can go on walks in beautiful places. They may learn to identify plants, birds, and sea life. They may develop a greater connection with their natural environment.

Mental health professional, Dr. James Moran, explains that an open environment, free of artificial stimulation (e.g., noise/visual) can help to quiet the mind.

Explorations in nature can encourage movement and natural curiosity. Experiences in nature, outside one’s comfort zone, can promote distress tolerance (J. Moran, personal interview, June 2012).

The warmth of the sun on your skin, the sounds of the birds in the trees— stepping outside can help anyone feel instantly better. But it turns out that the benefits of greener environs reach far beyond your mood: In their new book, Your Brain on Nature,

Eva Selhub, M.D., and naturopath Alan Logan explore the incredible physiological effects of being outdoors—including increased immune activity and less perceived effort during exercise (Selub & Logan, 2012).

Counselor to those with major addictions, often associated with mental illness,

Chad Hammack, states:

Many of the psychological and emotional ills of the world have come from our detachment from the natural world. It creates a soul sickness in us. The Earth always has a way of healing itself. And since we are part of the Earth, we have deep within us that same potential. The salt we taste in our tears is a residual memory that we began our existence in the oceans of the Earth. The Earth is our legacy, our future, and the natural world is home to our weary spirits. The more we partake of that legacy, the more often we return home to nature, the more likely we will be whole again. (personal interview, September 2012)

Historically, addicts attended meetings of Alcoholics Anonymous (AA),

Narcotics Anonymous (NA), Cocaine Anonymous (CA), etc. to treat their addiction.

These self-help programs have developed in response to a particular condition and persons dealing with multiple dependencies or with dual diagnoses situations have not always been welcome. Twelve-step patrons do not always welcome the mentally ill. I know because I have escorted clients to these meetings. Similarly, the organizations for the mentally ill often tried to exclude addicts. I heard a woman at a NAMI meeting complain that her family member might be mentally ill but certainly was not an addict— objecting to the talk being given by Interim’s director at the time. Dual diagnosis is now an accepted diagnosis, and the two problems are sometimes treated simultaneously in programs like those at The Bridge House, a part of Interim, Inc. located in Monterey,

California.

Interim, Inc. is a well-respected treatment program for those dealing with mental illness and/or addictions. Health professionals from all over the country come to observe Interim’s programs. One of their newest programs, Interim’s Dual Recovery

Services (DRS) Program, supports those living with mental illness who are also dealing with substance abuse:

The goal of the program is to guide and support individuals toward managing their mental illnesses and living a sober life in the community. Our staff works with clients individually and in group settings using a wide range of techniques. We helps clients to understand how drugs and alcohol have affected their brain chemistry, as well as how substance abuse interacts with their prescribed psychiatric medications. The goal is to help these clients discover their own strengths and dreams for the future and to identify issues that have proved troublesome for them in the past. (Interim, Inc., n.d.)

This project is important in general, and to Interim in particular, because it expands the approaches to counseling people in a dual diagnosis program. When dealing with both mental illness and addiction, counselors and their clients are often constrained within buildings. To fully recover and to successfully reenter the world, nature may add to the healing, to the sense of pride, to a connection with nature, and to the skill set needed for these people to live a more fulfilling life.

There are many ways to experience nature, many different types of walking programs, outdoor activities with various models and approaches. This project will describe activities in nature, specifically for clients in a dual diagnosis program, to maximize the effects of nature on their mental and physical health. Clients and their counselors will be introduced to nearby nature areas which have not yet been formally incorporated into the treatment process. Topics and activities appropriate to each outing will be described. Many people in dual diagnosis programs do not get to experience the healing benefits of being in nature. This project will introduce the concept of “Healing through Nature” to dual diagnosis clients and their counselors.

Although this project will focus on this unique population, those with a dual diagnosis of mental illness and chemical dependence, the benefits of their experiences and the observations of their counselors in using nature as a component in their treatment may also be applicable to other programs for either the mentally ill or the chemically dependent.

Purpose of the Project

To create a guide for the counselors of a dual diagnosis program in Monterey,

California, to help them include nature in their treatment. By augmenting existing therapeutic programs with nature, it is hoped that the clients can achieve greater levels of mental and physical health in mind and body. An outdoor Recreation Guide was developed for this group describing outings in the natural world around the Monterey

Bay. It was clear from the beginning that getting people outdoors is an important factor in their recovery, but it is not easily done, nor is the benefit well documented as yet because it is not being done. Some research has been done on the topic as I show in the Literature

Review, but not enough and none that I found for this specific population. The counselors involved in the preparation of this guide and ultimately those who make use of it will describe its usefulness. The staff at Interim, Inc. have given their full support to the project, per the following letter from the program director:

My program staff and I have talked with James about his proposal to add more outdoor components to our program. He is in the process of researching the effectiveness of nature in the treatment, and how this relates to the physical and mental health challenges of our consumers. We decided that the manual he is developing would be a great addition to our program because we currently facilitate most of our groups indoors, and an outdoor recreation guide would help us in moving some of these groups outdoors.

The counselors here are happy to work with James to create this manual for the benefit of our clients and program. Additionally, we have worked with James in the past and he is understanding of our needs and empathetic towards our consumers’ needs. He has a sincere interest in contributing to the success of our program. (Odegard, personal communication, May 9, 2012)

The purpose of this project is to provide clients of a dual diagnosis program greater levels of health in mind and body by walking in nature, by learning about nature, by feeling connected to nature and by experiencing the healing benefits of nature. The program at Interim now offers the clients about 25 classes each week and only one or two of these are conducted outdoors. After presenting this project in a large meeting with the managers, counselors, and clients of Interim, everyone agreed that more outdoor activities would be useful to the program. The staff asked for guidelines and suggestions for places in nature where they could take the clients for the groups they already have as well as new outdoor activities which could be added to the program.

Significance to the Field

Many of the medications prescribed to reduce symptoms of mental illness can cause serious adverse health effects. The seriously addicted have similar experiences; the side effects of some of their medications can be harsh. As this is not a review of medications, I will not discuss the many which are now available but their side effects are documented even in popular magazines. If clients can recover fully, perhaps with the help of nature, and can add enriching experiences in nature throughout their lives, it may not be necessary to put them on a life-long chemical regimen.

The “Healing through Nature” Recreation Guide is the result of a careful examination of the current research on the benefits of taking mentally ill, chemically

11 dependent, and dual diagnosis clients outdoors as part of the healing process. Although this project developed a guide for one unique population, those with a dual diagnosis of mentally ill and chemically dependent, the research and lessons learned should be applicable to other programs for the mentally ill or the chemically dependent. It is hoped that the final product is useful to all, a foundation upon which other programs can build a nature component into their treatment.

Definition of Terms

“Mental illness” (1998) is defined as a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. More technical descriptions of the many forms of mental illness can be found in medical volumes, but that is not necessary for purposes of this project. It is enough to know, sadly, that one in four people in the

U.S. over the age of 18 are estimated to have a mental illness. Mental illness is the leading cause of disability in the United States (Jans, Stoddard, & Kraus, 2004).

“Addiction” (1998) involves dependence on any mood-altering chemical.

Biological damage occurs to the brain, leading to psychological impairment, which causes social dysfunction, and physical neglect. Recovery requires that attention be paid to all these areas.

“Dual diagnosis” (1998) involves both mental illness and addiction. It is sometimes difficult to determine the order and interactions of each contributing factor.

Was there an underlying mental illness that the person tried to fix by self-medicating with alcohol or drugs? Or did the experimentation with alcohol or drugs result in an addiction

12 that caused a mental illness such as depression or psychosis? In some cases, the doctors and counselors have admitted that they do not know. More and more facilities are now treating “dual diagnosis” for this reason.

Methodology Brief

For this project, I reviewed literature and studies on the use of nature in the healing process by various groups and practitioners working with the mentally ill or the chemically addicted. I interviewed several health professionals, some several times. I examined many websites related to nature in the healing process. I compared the studies and summarized those whose findings were most relevant to the treatment of the mentally ill or those with addictions. (No research was found which addressed both problems.)

Finally, a Recreation Guide was developed suggesting the best options for including nature walks, outdoor experiences, groups meetings in natural settings, and related activities outdoors for the dual diagnosis population at Interim, Inc. A description of places to be visited, possible themes, and activities for the outings, and guidelines for the organizing these outings are described in detail. The guide has been kept simple so that the counselors at Interim can use it on a regular basis, and add to it as they incorporate nature into their plans.

CHAPTER II

LITERATURE REVIEW

Introduction

This project is intended to expand the approaches to counseling people in a dual diagnosis program by reviewing existing programs and studies on the use/value of nature in the healing process. Many people in the dual diagnosis programs do not get to experience the healing benefits of being in nature. The purpose of this project is to provide a “Healing through Nature” Recreation Guide for clients of a dual diagnosis program at Interim, Inc. in Monterey, California, by augmenting existing therapeutic programs with nature components.

The literature review will examine studies done with the mentally ill in outdoor therapy as well as studies focusing on those with addictions. Using the results, a recreation guide entitled “Healing through Nature” was written. It describes specific activities for the counselors in a dual diagnosis program to use in order to introduce nature into the healing process.

Some people have formulated simple theories about how visits to parks would yield restorative benefits, and they have used their theories in efforts to ensure that people would gain or retain opportunities to make such visits. The writings of Andrew Jackson

Downing (1815-1852), John Muir (1838-1914) and Frederick Law Olmsted (1822-1903)

13 14 exemplify the use of such theories in advocacy for public parks as means to promote the health and welfare of the public.

Olmsted provides a good example in this respect. Consider this quotation from his 1865 report on management of the land that eventually became known as Yosemite

National Park:

It is a scientific fact that the occasional contemplation of natural scenes of an impressive character, particularly if this contemplation occurs in connection with relief from ordinary cares, change of air and change of habits, is favorable to the health and vigor of men. (Olmsted, 1865/1952, p. 20)

Research over the past 20 years by psychologists, psychiatrists, ecopsychologists, naturalists, naturopaths as well as environmental advocates outdoor education specialists have continued to explore the effect of nature on the psyche and on wellness. As a treatment tool in programs for the mentally ill and chemically dependent, nature is being introduced formally into treatment programs by some professionals as the result of this research. The program for which I developed the recreation guide is one of those interested in doing just that. What follows is a summary of what I consider to be the most relevant writings on the subject to date.

Improving Mental Health Through Outdoor Activity

Current research shows physical activity improves mental health for the depressed adolescent as well as for the schizophrenic adult (Beebe et al., 2005). Outdoor therapy, often wilderness therapy, has been shown to help the addict, as well as the mentally ill (Slaght, Lyman, & Lyman, 2004). Breathing deeply of the fresh air, sitting in mediation on the beach, observing the beauty, the wildlife, the stillness in nature are all

15 tools which benefit the unwell, which benefit all of us. These observations are made regularly in outdoor magazines, regional public relations pieces and even women’s magazines. Introducing these benefits to the mentally ill is important.

Whenever there are outdoor wilderness activities or individual therapies, he would also feel more comfortable to talk and listen when exposed to nature. The ambiance gives them the sense of humility that they can never achieve within the walls of a typical rehabilitation center like a hospital. (Wilderness Drug Rehab, n.d.c)

Just looking at a natural scene activates parts of the brain associated with balance and happiness. In a study at South Korea’s Chonnam National University MRI scans showed that when subjects saw images of mountain, forests, and other landscapes, they experienced heightened activity in the anterior cingulate gyrus (which is linked to positive outlook and emotional stability) and the basal ganglia (an area that’s been tied to the recollection of happy memories) (Tudino, 2012). In addition to the images, nature also offers sunshine.

Sunshine and Mental Health

Not just getting outside, but getting outside in the sunshine, absorbing

Vitamin D, is beneficial to mental health concludes a recent study, “Vitamin D: A

Potential Role in Reducing Suicide Risk,” which examined the research on Vitamin D

(Tariq et al., 2011). Those individuals in the treatment group who were exposed to ultraviolet rays felt significantly less nervous, more balanced, and more satisfied with the way they looked. Those in the control group did not show any significant changes in these psychological parameters. Another study on Vitamin D and depression states unequivocally that getting the mentally ill into the outdoors to receive more sunlight may

16 help them overcome some of the problems in their life (Penckofer, Kouba, Byrn, &

Ferrans, 2010).

Depression in its own right is a disabling condition impairing all aspects of human function. In persons with a chronic medical disease, depression often makes the management of chronic illness more difficult. Recently, vitamin D has been reported in the scientific and lay press as an important factor that may have significant health benefits in the prevention and the treatment of many chronic illnesses. Most individuals in this country have insufficient levels of vitamin D. This is also true for persons with depression as well as other mental disorders. Whether this is due to insufficient dietary intake, lifestyle (e.g., little outdoor exposure to sunshine), or other factors is addressed in this paper. In addition, groups at risk and suggested treatment for inadequate vitamin D levels are addressed. Effective detection and treatment of inadequate vitamin D levels in persons with depression and other mental disorders may be an easy and cost-effective therapy which could improve patients’ long-term health outcomes as well as their quality of life. (Penckofer et al., 2010, p. 1)

Helen Keller faced life being both visually and hearing impaired; she shared her optimistic perspective on dealing with dark times: “Keep your face to the sunshine and you cannot see the shadow” (Dyer, 2002). Nature is more than sunshine, of course, and some psychologists are looking at the total experience and effects of being in nature.

Attention Restoration Therapy

Rachel and Stephen Kaplan (1989) originally introduced the theory and the term “Attention Restoration Theory” (ART) in their book The Experience of Nature: A

Psychological Perspective. Others have used this term and done research which supports the theory that nature has the ability to influence one’s psychological perspective, and specifically to influence one’s ability to function with respect to attention. The experience of being in nature repairs some of the damage done by the urban environment and by the many demands of modern living.

There is a hypothesis, biophilia, that believes people are instinctively drawn to nature, and when they are deprived of contact with nature, problems arise. Richard Louv

(2005) describes “nature deficit disorder” as the root of many behavioral problems in children. Whatever it is called, programs are increasingly focused on getting children outdoors—to improve their mental as well as their physical health. My brother and I attended the Outdoor Nursery School in Bethesda, MD, which has been operating for over 75 years and is recognized for its outdoor component in particular. My nephews attend the Tara Redwood School in the mountains of Soquel, CA, in the middle of the

“magical” forest. It too has been open for a long time, almost 50 years. Both were once considered out of the mainstream. Now they are models for other preschools.

As the mental health profession continues to research ways to recognize and treat various illnesses, Nature is being recognized by many to have a significant effect on mental health and mental functioning. Slowly the professionals are looking back at the

“old ways” whether they realize it or not. Much of the work done by Stephen Kaplan and his associates looks at “nature” and the functioning of the mind when expose to nature, and when deprived of nature. One of those articles, “The Cognitive Benefits of

Interacting with Nature,” was a joint effort with these colleagues (Berman, Jonides, &

Kaplan, 2008). Kaplan had previously used the phrase in articles and research as far back as 1995 when he first introduced “Attention Restoration Theory” (ART). Since then the phrase and the concept has been researched by several others in the field, such as Herzog,

Hayes, Applin, and Weatherly (2011) whose extensive studies resulted in the paper

“Incompatibility and Mental Fatigue.”.

What is ART? ART examines the many forces competing for an individual’s attention, and the often confusing results, that is, conflicting responses to stimuli and problems properly directing one’s attention. While such problems may not directly lead to mental illness, the restorative effect discovered in the research suggests that Nature plays an important role in restoring the sane person’s ability to focus and may play an even more important role in the treatment of the mentally ill.

The two experiments which resulted in “The Cognitive Benefits of Interacting with Nature” paper supported previous research which looked at how interactions with nature improved attention and memory. Without going into the specifics regarding subjects, measures and procedures, the final results did “demonstrate the restorative value of nature as a vehicle to improve cognitive functioning” (Berman et al., 2008, p. 1210).

Nature provides the peaceful environment that the mind needs to replenish itself in order to return to more demanding and complex environments. In summary, according to

Berman et al. (2008, p. 2011), “to consider the availability of nature as merely an amenity fails to recognize the vital importance of nature in effective cognitive functioning.” How can this not be even more important to the mentally ill and the addicted as they go through the healing process?!

In a similar article about mental fatigue, ART is examined as a treatment for loss of attention and direction associated with a life void of nature and its therapy. The sample in this study was large, 594 participants. Measurements were taken throughout the study on the six levels of “incompatibility: deception, difficulty, danger, distraction, deficit of information, duty” (Berman et al., 2008, p. 2007). The authors concluded that there is a positive correlation between incompatibility and mental fatigue. And what is

19 the treatment for mental fatigue? Attention Restoration Therapy. And what is a major component of ART? Nature.

Eco Psychology

Ecopsychologists document the benefits of Nature. They believe that there is an emotional bond between human beings and the natural environment out of which they evolve. At its most ambitious, ecopsychology seeks to redefine sanity within an environmental context. In simple terms, ecopsychologists believe that we cannot restore our own health, our sense of well-being, unless we restore the health of the planet.

Technology has given us an artificial universe which causes some to fill a lost sense of meaning and connectedness with substances like drugs or alcohol (Roszak, Gomes, &

Kanner, 1995).

Ellen Vincent, an environmental landscape extension specialist in the

Environmental Horticulture Department at Clemson University, hopes that her research in ecopsychology can stimulate awareness of the therapeutic benefits of nature.

At the heart of the environmental revolution is a change in values, one that derives from a growing sense of our dependence on nature. Ecopsychology brings together the sensitivity of therapists, the expertise of ecologists, and the ethical energy of environmental activists. It seems like common sense to believe, as they do, that human beings must live in a state of respectful give-and-take with the flora and fauna, the rivers and hills, the sky and soil on which man depends for physical sustenance and practical instruction. (Vincent, Battisto, & Grimes, 2010, p. 57)

Just being out in nature can provide healing. Vincent et al.’s (2010) research found that simply looking at photographs of nature could also ease the body’s pain. This led to her current research, which aims to uncover the most therapeutic landscape images for hospital surgery patients. Working closely with her students at Clemson and those in

20 the health care field, Vincent is helping others to become more aware of their surroundings—and the immense benefits that come along with doing so.

Some researchers are referring to nature as “restorative,” another way of saying “healing.” Some of this research relies on the earlier studies done by Kaplan and by Ulrich as described under Attention Restoration Therapy above. Much of the recent research on how access to open space promotes health has focused on activities, and in particular physical activities such as walking. Research on restorative environments focuses on particular psychological and social processes that occur as the result of access to open spaces. They are grouped under the rubric ‘restoration,’ which Hartig and Staats

(2006) defines as “the process of recovering physiological, psychological and social resources that have become diminished in efforts to meet the demands of everyday life”

(p. 220). Restoration involves beneficial changes. In that stress reduction and other aspects of restoration are sought-after benefits of physical activity, one could ask whether people in greater need of restoration consider physical activity in a green space more attractive than the same physical activity in a potentially less restorative environment

(Hartig & Staats, 2006).

A scene with moderate and ordered complexity, moderate depth, a focal point and natural contents such as vegetation and water rapidly evokes positive affect and holds attention, displacing or restricting negative thoughts and allowing autonomic arousal heightened by stress to sink to a more moderate level. The role of natural contents in this process has evolutionary underpinnings, according to Ulrich; humans are biologically prepared to respond rapidly and positively to environmental features that signal

21 possibilities for survival. Restoration becomes manifest in emotions and in physiological parameters such as blood pressure, heart rate and muscle tension (Ulrich, 1984).

Studies by both Ulrich and Kaplan have shown that looking at scenes of nature can more completely reduce blood pressure and other indicators of physiological arousal toward their pre-stressor levels within a brief span of time (Ulrich, 1984, p. 420).

Viewing scenes of nature can also quickly evoke more positive emotions and reduce negative emotions (Ulrich, 1984, p. 421).

Repeated instances of attention restoration supported by visual and physical access to greenery can have cumulative effects on behaviors of substantial consequence to individuals, families, and society. Taylor, Kuo and Sullivan (2002) tested a set of hypotheses with children living in the same low-income housing area. They reported that the greener the view that 7 to 12 year old girls had from their residence, the better they performed on tests of attention, and the better they could inhibit impulses and delay gratification.

Ulrich (1984) studied the records kept for patients who, after surgery, were placed in a room that had a window view of either trees or a brick wall. During the second through fifth days of their stay, those with the tree views used fewer potent painkillers than similar patients who had a view of a brick wall. Those with tree views also had shorter postoperative stays and fewer negative evaluations from nurses.

Cimprich and Ronis (2003) randomly assigned women diagnosed with breast cancer to either an intervention group or a standard care control group. Women in the natural environment intervention group performed better on a battery of attentional tests than did the women in the standard care group. Another study revealed the fact that

22 outdoor activities such as walking can often mitigate depression (Craft & Perna, 2004).

Yet another states “that pleasant activities such as taking a walk and looking at beautiful scenery, which can distract them from self-contemplation or rumination until their mood has lifted, opening the way for efforts to solve the reasons for depressed mood”

(Lewinsohn & Libet, 1972, p. 292).

Exercising in Nature and Mental Health

The value of exercise in attaining and maintaining good health is recognized by most people today. It is praised in the Sunday newspapers, the daily health shows on

TV, and of course in any magazine devoted to health or fitness. Is exercise in nature more valuable than exercise in a closed environment? Some think so.

According to a study done by researchers from the University of Essex and published in the journal Environmental Science and Technology, just five minutes of exercise in a natural place is enough to improve mood and mental health. Ten different studies were conducted on 1,250 participants; researchers compared the mental health effects of outdoor activities such as walking, cycling, gardening, fishing, boating, farming, and horseback riding. The results showed that within five minutes, people engaging in exercise in a green setting such as a park, garden or wilderness trail experienced significant improvements in mood and self-esteem.

“Exercise in green spaces was significantly more effective than exercise in urban surroundings. The effect was strongest in places that had water, and among those who were younger or mentally ill” (Gutierrez, 2011).

Green exercise refers to any physical activity that takes place in the presence of nature. It can be as simple as a walk through the park or time spent gardening. All that really matters is that the body is in motion and nature is in sight. A study recently published in Environmental Science and Technology has shown that

green exercise leads to improved mood and self-esteem. It is already well documented that exercise benefits both physical and mental health. It is also known that exposure to natural landscapes can enhance mood. Researchers at the University of Essex set out to determine whether a combination of the two could produce synergistic improvements in mental health. According to their findings, exercise and nature do complement one another. Another interesting aspect of this study is its recommendation that green exercise be viewed as a form of prescribed therapy to be administered in regular doses. (Barton and Pretty, 2010, p. 3947- 3948)

Meditation in Nature

Another of nature’s healing tools usually involves no movement at all— mediation is usually silent ant usually motionless. The first recorded use of meditation may have taken place many thousands of years ago with hunter-gatherers. In her recent book, Legacy on Stone, Sally Cole describes the artwork of the Colorado Plateau. Cave paintings (pictographs) have been found that may show people lying on the ground in a meditative state. These people are believed to be shamans who most likely were in trance in order to ask the spirits for help when they hunted animals for food (Cole, 2012).

During the 6th century BC, Hindu Prince Siddhartha Gautama was happy and wealthy. Although he was happy, he learned that not everyone else was satisfied with life. One day he sat down under a tree, folded his legs and began to look deep into his mind. After seven days of meditation, he awoke with newfound knowledge. He became known as Buddha. Buddha had learned how to quiet his inner thoughts and develop a strong form of concentration. Buddhism began to spread the religion and practices of meditation which eventually made their way to China and Tibet. Meditation gained popularity in the United States during the 1960s. This was at a time when many people were experimenting with methods to reach altered states of consciousness. The Beatles were also instrumental in spreading the

popularity of meditation, particularly Transcendental Meditation, after spending time with Indian guru, Maharishi Mahesh Yogi. After 15,000 years, various types of meditation have emerged, and meditation continues to grow in popularity bringing people a sense of peace and clarity. Meditation has the power to help heal physically and mentally. (Bodian, 2006, as cited in Meditation, 2010)

Mindfulness meditation is most actively and effectively practiced in Nature.

According to those practicing mindfulness meditation, there appears to be positive changes in the brain involved in memory, learning, and emotion. In mindfulness meditation, even in mindfulness walking or mindfulness eating, one focuses his attention on breathing (or the trail or the bite) in order to develop an increased awareness of the present.

Research suggests that mindfulness mediation may reduce symptoms of depression, anxiety, and chronic pain, but little was known about its effect on the brain.

Wilderness Therapy as a Treatment Tool

Wilderness therapy often uses both exercise and meditation, along with assorted adventure components. In the early 1900s, those working with the mentally ill began some outdoor therapy which included living in nature, specifically in tents. They began to call it “tent therapy” and some of the ideas behind “wilderness therapy” came out of these early experiments (Berman & Davis-Berman, 1994). Wilderness therapy is a form of mental health treatment that takes place outdoors and utilizes challenge and adventure, group work and other structured clinical interventions. Wilderness therapy has been shown to be an effective intervention for adolescent depression that can promote positive self-image and enhanced coping skills (Norton, 2007).

The lack of a significant relationship with the social and natural worlds is considered to be a primary cause of emotional and behavior disturbances. By introducing a personal relationship with the natural world, counselors may be able to improve the clients’ relationships with the social world and the natural world on many levels.

Emotional coping skills and self-image are just two possibilities (Gass, 1993).

Although wilderness therapy has been recognized as “a powerful intervention that promotes cognitive, affective changes” (Gillis & Bonney, 1986, p. 215), leaders in the field admit that more research is needed to understand the impact of wilderness therapy on specific emotional and psychological issues (Berman & Davis-Berman 1994;

Russell 2003). Furthermore, the rationale for introducing experiences in nature for therapeutic purposes has been well documented in the literature (e.g., Gillis & Bonney

1986; Kimball 1983; Kirkpatrick 1983; Mason 1987) but the empirical research documenting treatment benefits is scarce and almost non-existent for dual diagnosis clients.

Many theories have been developed to explain wilderness therapy; psychodynamic theory attends to the psychosocial, development and relationship aspects of the intervention (Bermann & Davis-Berman, 1994). Crisp and O’Donnell (1998) state that

wilderness therapy programs may involve an experiential reconstruction of developmental foundations as the individual corrects fundamental assumptions about himself or herself as well as assumptions about other individuals. Put succinctly, delayed, incomplete or un-mastered developmental tasks can be addressed by tangible corrective experiences. (p. 352-353)

In combating adolescent depression, there is a paradox between feelings of hopelessness and the need and will to survive as the adolescent faces the realities

26 associated with either wilderness travel or other adventure based activities (Handley,

1998). Lightfoot (1997) went so far as to say that “simply trying something new has its own rewards; regardless of outcome, it convinces him (the adolescent) of his own active participation, agency” and movement.

There are psychologists in this new field of eco-therapy who believe that spending time outdoors is important for everyone’s health. By connecting more with nature, we can fight depression, lower blood pressure, improve self-esteem, strengthen impulse control, decrease post-operative recovery time, and encourage improved social behaviors in patients with dementia, according to the book Ecotherapy: Healing with

Nature in Mind (Buzzell & Chalquist, 2009).

Eco-therapists are exploring the possibility that eco-therapy can benefit those with depression, anxiety, stress or other forms of mental illnesses. Depression is recognized as the most common psychiatric disorder, and the incidence of depression has been increasing every year. Now, one in six people will experience a depressive episode in their lifetime (Craft & Penna, 2004).

Traditional treatments for depression have focused on medication and individual or group counseling. In addition, recent research indicates that mindfulness practices, such as meditation or yoga, can help treat depression. Some eco-therapists suggest that there are additional benefits to be gained by supplementing these approaches with activities such as gardening, walking or other outdoor exercise, or spending time with animals (Buzzell & Chalquist, 2009).

Overcoming Addiction Through Outdoor Activity

Tools similar to those used in healing the mentally and physically ill can be used in treating the chemically addicted. Most 12-step programs are conducted indoors. A first step is to move them outdoors. Drug addicts often describe a strong desire to try new things. Finding positive alternatives for the clients in a dual diagnosis program such as

Interim is an extremely important component in their success if their recovery is to be complete, according to current counselors in the program.

When it comes to treating drug addiction, there is no such thing as “one solution” for all. There should always be alternatives to traditional treatment especially for those who have failed in prior rehab. “Apart from the conventional rehab programs, there is also the outdoor treatment as well. In this method, the patients are exposed to the nature and not confined in an establishment or center” (Wilderness Drug Rehab, n.d.a).

Wilderness drug rehabilitation programs that also offers a non 12-step approach provide a very high success rate.

The non 12-step treatment entices the drug addict to believe that he has full control over the situation. It also encourages them to think that they are not as powerless as they thought they were. . . . They have also learned to appreciate more by becoming closer to nature and usually experience a self-discovery of internal happiness. (Wilderness Drug Rehab, n.d.b)

Wilderness Therapy often requires a certain level of physical ability, and the participants are addressing mental illness or addiction. In the Wilderness Therapy milieu,

the role of the trip leader is an essential component of the healing process. Similar to the relational paradigm in social work treatment, the wilderness therapist functions as a participant-observer and provides opportunities for experiential learning and correction of negative relational patterns. (Borden 2000, p. 370)

The role of the therapeutic relationship in the context of Wilderness Therapy cannot be over-emphasized for it is this adult that provides the participant with an extra familial object/person with whom to work through past conflicts. Both the trip leader and the group act as “a safe base for the participant to come back to in between active phases of self and other exploration,” similar to the rapprochement mother in Mahler’s (1967) developmental theories.

Most importantly, Wilderness Therapy embodies the goals of treatment set forth in the relational paradigm of social work treatment in that it

seeks to help persons strengthen their ability to process subjective experience, deepen awareness of their own and other’s behavior, develop problem-solving skills and coping capacities, and enlarge understanding of self, others, and life experience. (Borden, 2000, p. 156)

Wilderness Therapy is a holistic intervention that may begin to address many aspects of the clients dealing with addictions, mental health, or both.

Retraining the Brain

“Old habits die hard” is an old saying. It is particularly true for addicts.

Outdoor activities in relation to addiction can have the ability to break old habits that were “hard-wired in the brain” and will contribute to creating new healthy habits that are considered plastic. Researchers have found that negative thinking and bad programming

“hard wired behavior” also affect a patient’s tendency to relapse into their old patterns of behavior. When patients are dealing with recovery from addiction they often think in the past; they have many triggers that can allow them to go back to substance abuse (Brown, personal interview, May 5, 2012).

Substance abuse causes the human brain to become “hard wired” to past experiences that control their lives today: past feelings of fear, anxiety, tension, anxious thinking patterns, the feeling of always being on guard, and paranoia. These feelings that patients have experienced in the past contribute to their current emotional thinking because they were living in that pattern for so long that it altered centers of the brain that are now overactive. They need to be rewired in order to change those old patterns so the recovering addict can neurologically change the pattern of addiction. People can literally change their brains and change their lives by engaging in regular brain-healthy habits, such as outdoor activities, correcting negative beliefs, and using meditative processes

(Amen, 2009).

Patients recovering from addiction do have the ability to change. Bringing awareness to patients regarding the neurology behind change is extremely important for their prognosis. They need to know the “why” behind outdoor activities and that Nature is extremely important in their recovery because it creates new neural networks. Clients will experience how being in the outdoors will help them break old patterns and will allow change to happen in their lives during their recovery process (Trivieri & Anderson,

2002).

Medicine from Nature

Mainstream treatment programs are looking at new tools to use in healing the mentally ill and chemically dependent. Some of those “new tools” are in fact “old tools.”

Native American natural remedies as well as those from the shamans of India and the naturopathic healers around the world are gaining acceptance in the world of healing.

Even the National Institutes of Health in Bethesda, Maryland now has a division entitled

National Center for Complementary and Alternative Medicine (CAM). According to the website:

Defining CAM is difficult, because the field is very broad and constantly changing. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine (also called Western or allopathic medicine), as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute. (National Center for Complementary and Alternative Medicine, 2012)

A table of floral essences and their roles in the healing process for those with addictions is presented in Appendix B. While the guide will not recommend any use of herbs or essences, it is an interesting area to explore while getting clients outdoors.

Therapeutic Recreation in Natural Healing

Therapeutic Recreation is a specialized area within the field of recreation that focuses specifically on providing leisure services, as well as recreation for persons with disabilities, or as a preventive measure for encouraging health and wellness in order to avoid developing disabling conditions. The literature includes everything from Kayaking to Hiking, from Tai Chi to Tai Kwon Do. It is important to know the population who will be involved when deciding which recreational activity to choose. Usually Therapeutic

Recreation focuses on people with physical problems and sometimes mental challenges, but not mental illness or addiction (Russell, 2001).

All of the consultants who were interviewed for this project recommended some form of outdoor activity, some introduction to nature, as part of the healing plan.

Nature is stabilizing in its predictable rhythms, ebb, and glows. It immediately connects the disabled, detached, self-obsessed, sometimes delusional human being with all those elements that are real, timeless, and centered. (Hammack, personal interview, June 10, 2012)

Henry David Thoreau (1854) reminds us of the importance of solitude in nature as the beginning of lucid thought. In Walden, he describes his own experience of going in to nature; it is a classic.

Being in nature” helps the mentally ill and the addicted recover by providing an open environment with less artificial stimulation, by encouraging movement and exploration, and promoting “distress tolerance” with respect to the elements and the terrain” (Moran, personal interview, June 10, 2012)

Overcoming Addiction and Improving Mental Health

After reviewing the above articles, as well as many more not cited, it became clear that attempts are being made to improve and expand programs for the mentally ill and the addicted. One such attempt was the request I received from Interim, Inc. to develop and outdoor guide for them to use in getting their clients out into nature.

Unfortunately, the literature is currently sparse about the potential benefits of wilderness or nature settings as tools for dual diagnosis clients. But they need healing just as surely as those who are “only” mentally ill or “only” addicted. Sometimes the plan for their treatment is different, or even more complex. For all who need healing, however, there seems to be an increasing interest amongst the various healers in looking to Nature.

Slowly and cautiously, with careful documentation and even testimonials, it appears that being in Nature, learning about nature, using existing techniques and healing modalities in a natural setting—all are being encouraged in the treatment of those with these problems. Studies regarding the use of Nature in the treatment of the mentally ill or

32 for those with addictions suggest that Nature can be used in the treatment of the dually diagnosed as well. It has been a potentially promising area to explore.

From the natural benefits of pure sunshine to the appreciation for the environment encouraged by the eco psychologists, there are ideas which can be used in the development of programs in nature for the mentally ill and chemically addicted.

Research by traditional healers involving restorative environments reinforces nature’s power to assist in the healing process, not just for physical injuries but also for mental ones. Exercise has always been recognized as a healing tool but now it is being introduced into treatment programs for the mentally ill. Wilderness therapy has been used for some time in the treatment of addictions, especially for the young in various camp settings (Outward Bound). From the time of the Buddha to today in the grade schools of

India (I attended one) meditation is taught as a beneficial tool for the mind. When even the National Institutes of Mental Health is funding research into alternative methods of treatment, it is obvious that nature is becoming a powerful tool in the healing process.

Research has shown and will continue to show that nature is one of the most powerful tools we have to heal.

CHAPTER III

METHODOLOGY

Introduction

The problem being addressed in this project is that dual diagnosis clients in treatment facilities are being counseled and educated in groups that meet indoors almost exclusively. This limits the healing benefits that nature can offer to these clients. By experiencing some of their groups or activities out of the closed doors of the facility, they may connect with nature and address their problems in a new way.

After sitting down with the clients and counselors at Interim, Inc. which has several treatment facilities in the Monterey Bay area, and proposing to get the clients outdoors for walks and nature therapy, unanimous agreement was expressed. Everyone agreed enthusiastically that adding outdoor components to their program would benefit

Interim and its clients. I was asked to create a Recreation Guide for the counselors that would describe locations for outdoor sessions along with recreational and other activities that would be suitable for the clients. We discussed “measureable tools” for counselors to assess the positive outcomes of these activities.

This “Healing through Nature” Recreation Guide will help the counselors become familiar with recreational activities and meeting sites that are available in the area for their clients and make it easier for them to get the clients of Interim to do more groups and activities out of the facility and into nature. This will allow them to include

33 34 more contact and connection with nature in their future programs, as a part of the healing process. This puts the healing benefits that nature offers at their fingertips. The

Recreation Guide will allow the clients to realize and experience what they can do in nature on their own and will suggest what the counselors can construct to take them outdoors while in recovery.

Information Sources

In addition to reviewing the literature, I interviewed several experts who recognize the importance of nature in the healing process. Some of them I interviewed several times. Some suggested further materials for me to read. They are listed below as well in the list of references and noted in the text when they are quoted.

1. Reid Cross, Professor, California State University—Chico

2. David Swanson, Professor, California State University—Chico

3. Emyln Sheffield, Professor, California State University—Chico

4. Interim, Inc. counselors, Monterey, CA

5. Chad Hammack, counselor, Carmel Valley High School

6. Dr. James Moran, psychologist

7. Dr. James Lake, psychiatrist

8. Jan Odegard, Program Director, Interim, Inc.

9. Pamela Brown, Chiropractic Doctor

10. Nate Millard, California State University—Chico

Participants

The participants in the development of the guide have included the counselors at Interim and the professional consultants I interviewed. With their input, I created a

Recreation Guide for the participants, or clients, in the dual diagnosis program at Interim,

Inc. I have shared my research with the counselors and directors of this program as I developed the final product. The resulting “Healing through Nature” Recreation Guide will be of great benefit to the clients as well as to the counselors and directors.

Materials

 Historical beliefs regarding nature as a healer.

 Current research on wilderness therapy and nature as a healer.

 Brochures on state and national park areas.

 Maps and photos of trails and settings for group meetings.

 Accessibility data.

 Questionnaire regarding the clients’ satisfaction with each outing (given to them by counselors).

Data Collection

 Web research, journals, books.

 Interviews with my information sources.

 Reviews with the counselors and directors at Interim.

 Visits to parks and other outdoor settings.

 Talks with docents and rangers on site.

 Maps, photos, charts about the sites selected.

Specifications of the Final Product

Based on the research, a Recreation Guide entitled “Healing through Nature” was produced specifically for the dual diagnosis program at Interim, Inc. in Monterey,

California. The guide describes ideal locations for walks in nature, activities for enjoyment and enrichment in natural settings, and suggestions for traditional therapeutic groups that currently are held indoors which can be done outdoors.

The “Healing through Nature” Recreation Guide contains detailed information on:

1. Locations for outdoor activities and groups.

2. Assorted activities to complement the treatment program.

3. Interim’s existing groups (as defined by them).

It was clear from the beginning that the counselors think that getting people outdoors is an important factor in their recovery, but it is not often done. Some research has been done on these topics, but not enough and none for this population.

Many locations were identified in the Monterey area for introducing clients to

Nature. These locations were found, tested, photographed and documented as places in

Nature which could encourage and enhance healing: Lovers Point Park in Pacific Grove,

Monterey Peninsula Recreational Trail, George Washington Park, Berwick Park, Point

Pinos Lighthouse, Monarch Butterfly Sanctuary, Point Lobos State Reserve in Carmel, the Municipal Beach in Monterey, Del Monte Beach, Garland Ranch Regional Park, Ford

Ord National Monument, the Carmel Mission in Carmel-by-the-Sea, Jewell Park and

Caledonia Park in Pacific Grove, Jack’s Peak Regional Park, Elkhorn Slough Research

Reserve in Moss Landing. This list can continue to grow as the program develops.

Numerous activities in Nature, from walking to scavenger hunts, can be done with the groups to encourage feelings of well-being and to support the treatment program.

Some of these described in the manual include: Walks along the Beach, Hikes in the

Hills, Meditation, Tai Chi, Reading a Map, Using a Compass, Stretching, Breathing,

Frisbee, Croquet. This list too can grow as the counselors and clients become comfortable with the role of nature in their program. The critical component is getting clients out into nature, to feel the healing benefits of their environment; the activities are secondary although in many cases support healing as well.

The following groups are currently part of Interim’s treatment program. Some of them can be done outdoors, and some can be strengthened by outdoor activities. Here are the descriptions of the therapy groups directly from their brochure and the website:

 Building Healthy Relationships is weekly group to help clients better understand and practice interpersonal skills. Part of its emphasis is around learning how to set boundaries and how to overcome co-dependence.

 Anger Management is a group which helps clients identify the sources of their anger and their related emotions. It then helps them to process and express those emotions to release the anger without self-harm or harm to others. We encounter many interpersonal difficulties in a rehabilitation Program and this group helps clients to see how conflict resolution can be helpful.

 Process Group is a weekly group limited to five or six people in order to have greater intimacy so that people can share their deepest challenges in a psychotherapeutic container.

 Non-Violent Communications was developed by Marshal Rosenberg, Ph.D., and is a practice of learning to talk with people in order to effectively communicate of

“feeling, Needs and Requests,” to others. Clients with significant trauma or abusive backgrounds, or who have lived in a gang environment find it helpful in discovering more successful ways to express their anger or frustrations and get some badly needed relief.

 Women’s and Men’s Groups allow for each gender to talked about their specific needs and their needs of being understood by the opposite sex. The groups also discuss homophobia and how gender role restrictions discriminate against sexual minorities. Bridge House participates in the “safe zone” program for equality of sexual orientation.

 Fitness groups currently consist of Yoga each Friday with our staff person; two walks each week; a Friday outing to either the beach or a walk in the woods and our croquet matches. We are looking for more resources in this area and that is why your efforts art so important to us. But, primarily, what we have learned is that someone who is trained in this field is much better at motivating and educating our population.

 Goal Review is a weekly wrap-up of what the clients have achieved in the past week and what their list of goals for the next week—and long-term goals as well— will be. Many of our clients have had lives of chaos and confusion and this group helps them focus and start to realize that they can have small successes which later turn to larger success.” (Interim website, 2011)

The final product, “Healing through Nature” Recreation Guide, will be professionally printed for the use of the counselors at Interim, Inc. in Monterey,

California. A copy of the guide is contained in Appendix A.

“I only went out for a walk and finally concluded to stay out till sundown, for going out, I found, is really going in.” ~John Muir

CHAPTER IV

“HEALING THROUGH NATURE”

RECREATION GUIDE

As this is a Master’s Project, and not a Master’s Thesis, there is a Product.

That Product is the “Healing through Nature” Recreation Guide which is found in

Appendix A. It is the product of my research which included many interviews with mental health professionals as well as a continuing search of the literature on the subject of including nature in the healing process for those who are dually diagnosed with Mental

Illness and Addiction.

CHAPTER V

SUMMARY

This Master’s Project was conceived as a result of my direct experience with clients in a dual diagnosis treatment facility. They suffered from mental illness and addiction. As I worked through the Master’s Program in Kinesiology I saw how important nature was in the maintenance of good health and in healing. Nature as a part of the treatment program was only an after-thought, an occasional outing if time and the weather cooperated. But getting outdoors was more important than that. I began my research on outdoor therapy, wilderness therapy, the role of nature in our lives, past and present.

I proposed to my advisors and to the directors and counselors at the dual diagnosis facility that I create a manual which would assist them in formally including outdoor activities in their treatment program. If nature was experienced regularly, and a connection made to it, this could benefit the healing process. There were many more articles on this subject than I anticipated, and many fewer programs. The mental health professional and addiction counselors I contacted were eager to provide input and to explain their support. No one said, “Forget Nature.” It has been a long and exhausting journey to produce a useful product.

No quantitative data were collected for this project although the quantitative results of related studies were examined and always found to be supportive of the concept

41 42 of including nature in the healing process. Given more time and more access to groups of clients, perhaps quantitative data would have been useful. I have recommended to the counselors that they keep a record of the outings and activities and their perception of the benefits and problems, if any. They enthusiastically agreed. I have provided them with evaluation tools—basic forms and the more scientific data collection forms if they choose to pursue this follow-up.

In this area of “Healing through Nature,” there is much written, enthusiastic support from most, and great possibilities. All it takes is commitment, time, money, and someone to spearhead it. I plan to follow the program through as Interim, Inc. includes it in their treatment of the dually diagnosed.

The resulting Recreation Guide, while specific to the Monterey Peninsula area, should also be useful to other similar facilities and could be adapted to any city, state or country where there is an interest in adding an outdoor component to their treatment program for dual diagnosis clients, the mentally ill and/or the chemically addicted. This guide is in fact a template. With changes to the locations, and some modifications to the activities, it can be made useful to any similar program. As the data are collected to reveal the benefits of introducing nature to the clients, I am convinced that nature will no longer be an optional component of future treatment programs. It will be mainstream.

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APPENDIX A

Healing Through Nature

A Recreation Guide for the Monterey Peninsula

by James Satterthwaite

(All photos by author. Clipart from Microsoft online clipart collection. Maps from Google Maps online.)

52 53 Table of Contents

I. INTRODUCTION

II. INSTRUCTIONS for USE of this GUIDE

III. OUTDOOR LOCATIONS

Lovers Point Park, Pacific Grove Monterey Peninsula Recreational Trail George Washington Park, Pacific Grove Berwick Park, Pacific Grove Point Pinos Lighthouse, Pacific Grove Monarch Grove Sanctuary, Pacific Grove Point Lobos State Reserve, Carmel Municipal Beach, Monterey Del Monte Beach, Monterey Garland Ranch Regional Park, Carmel Valley Ford Ord National Monument Carmel Mission, Carmel-by-the-Sea Jewell Park, Pacific Grove Caledonia Park, Pacific Grove Jack's Peak Regional Park, Monterey Elkhorn Slough Research Reserve, Moss Landing

IV. OUTDOOR ACTIVITIES

Walk along the Beach Hike in the Hills Meditation Tai Chi Reading a Map Using a Compass Stretching Breathing Yoga

V. GROUPS

Building Healthy Relationships Anger Management Process Group Non-Violent Communications Women’s and Men’s Groups Fitness groups Goal Review

54 INTRODUCTION

This "Healing through Nature" Recreation Guide will help counselors at Interim, Inc. become familiar with outdoor locations throughout the Monterey Bay area, places where they can do therapy groups and lead outdoor activities for their clients. This will make it easier for them to bring the clients with whom they are working out into Nature, to have more groups and activities outside of the facility. This will allow them to introduce and utilize Nature as a part of the healing process. The healing benefits that nature offers are at their fingertips. This Recreation Guide will help the clients to realize and experience what they can do in Nature on their own long after recovery becomes a reality.

The guide is provided in order to expand the approaches to counseling people in a dual diagnosis program. It is the result of extensive research on existing programs and studies which currently use, or at least recognize, the value of using Nature in the healing process. The concept is old (Hippocrates said: "Nature heals, not the physician."), but the practice is often forgotten, or put aside as other methods of treatment overwhelm. As a result, many people in dual diagnosis programs do not get to experience the healing benefits of being in Nature because the groundwork has not been done to facilitate it. The process of treating mental illness and addiction is complicated and intense; introducing Nature into the healing mix must be done carefully without disrupting the elements already in place.

In the paper which preceded the development of the guide, recent literature on the subject of nature as a healer was reviewed. The paper is provided separately, but the most relevant studies examined in the literature review are listed in Appendix A of this guide. Specific topics which contributed to the guide were: overcoming addiction through outdoor activity, sunshine and mental health, eco-psychology, restorative environments, attention restoration therapy, exercising in nature for mental health,

55 meditation in nature, medicine from nature, therapeutic recreation in natural healing, and wilderness therapy as a treatment tool.

All of these studies are supportive of the concept of introducing Nature into the treatment programs. The research for this guide examined studies done with the mentally ill in outdoor therapy as well as studies focusing on those with addictions. None were found which addressed both simultaneously.

This "Healing through Nature" Recreation Guide has been written specifically for clients of a dual diagnosis program in Monterey, California, so that they may achieve greater levels of mental and physical health in mind and body by augmenting existing therapeutic programs with nature components. Mental health counselors were asked to review and comment. Mental health and addiction specialists were asked to review the final product.

Breathing deeply of the fresh air, sitting in mediation on the beach, observing beauty and stillness in Nature are all tools which benefit the unwell, which benefit most of us. Exercise, wilderness therapy, even the occasional walk on the beach, are not common components in the treatment of either the mentally ill or the chemically dependent, but the current research done for this Master’s Project, as well as the common perception, suggests that Nature could play a beneficial role in client recovery.

There may be limitations to the extent to which a client can participate in these nature walks or recreational activities due to age, physical problems, or fears. The selection for participation will be left to the mental health professionals and addiction counselors at Interim. Since travel to parks or other venues requires transport and time, the number of participants may be limited. In addition, participation may be limited due to their mental state at any given moment, their medication level or their attitude. The "Healing through Nature" Recreation Guide suggests the best options available in the Monterey Bay area for nature walks, outdoor experiences, and group meetings outside of the treatment facility for the dual diagnosis population at Interim,

Inc. The places to be visited, possible themes for the outings, and guidelines for organizing these outings are all described in detail. There are photos and maps. Even supplies are suggested. Two useful charts area provided as help in planning the outings: on show activities best done at each location, the other shows groups most easily done at each location.

The purpose of this guide is to provide the clients with greater levels of health in mind and body by walking in nature, by learning about nature, and by feeling connected to nature and to their environment. The program at Interim now offers the clients about 25 classes each week and most of them are conducted indoors. This is the same scenario used in most recovery programs. The managers, counselors, and clients of Interim all agreed that moving some activities outdoors would be helpful. They asked for guidelines. It was clear from the beginning that getting people outdoors is an important factor in any recovery, but it is not easily done, nor is the benefit well- documented. Some research has been done on the topic, but not enough and none for this group.

While this guide has been developed specifically for the Interim Program on the Monterey Peninsula, the concept can be used by other recovery and treatment programs and guides can be developed for their specific locale. As the counselors in Monterey work with this guide, their feedback will provide useful data on the benefits of working in partnership with Nature.

57 INSTRUCTIONS for USE of the GUIDE

This guide is intended for the use of counselors in a dual diagnosis program, specifically for the program developed by Interim, Inc. in Monterey, California. It is intended to complement their existing programs and methods by introducing a new element into the healing process. Nature as "healer" is a relatively new concept. Nature is increasingly recognized as not only "healer" but also as a valuable component of any healthy lifestyle.

It is hoped that this guide will enable counselors to easily select sites for holding their group sessions outdoors occasionally. It also suggests themes and activities which can add to the experience in nature. The sites and the activities can be used together as the counselor sees fit. Locations are easily identified by the color green in each title. Activities identified by blue and Groups identified by purple.

While beautiful natural sites abound on the Monterey Peninsula, the locations in this guide were selected for ease of access, general safety, and available facilities. All are open to the public. Some of the parks have entry fees which may be waived if Interim calls in advance. Permits are not required for the use of any of these locations unless the group size is larger than 50. (Interim’s groups are rarely larger than 12.) A reservation may be required for the volleyball courts, basketball courts and sometimes for picnic tables, if these are needed for a specific time. When such fees and reservations are required, that is noted on the location description. Whether or not permission is required, there is contact information provided for each location.

Ecology Considerations

All of the locations selected are public lands and are protected by California and/or federal laws. In grade school children are taught, “Leave nothing behind, take nothing out.” regarding use of public places. This means – no harm to the plants or living creatures, no litter left behind, and no damage to the location. Needless to say, no fires except where grills are provided and permits are in hand. If Interim intends to have a picnic or snack, those are carried in by the participants and all refuse is carried out by the participants, or deposited in trash containers provided by the location. Some spaces, like Toro Park even provide various recycling bins. Environmental concerns are an excellent topic of conversation on these outings with the clients.

In most cases, in the parks, there are trails which are well-maintained. Signs state “Please stay on the Trail/path.” This caution is for the protection of the plants and animals in the natural setting. It also protects the visitor from the occasional wild creature and from the poison oak which thrives on the Monterey Peninsula. Identification of poison oak as well as other potential hazards is another topic for discussion.

Information provided on each Location

For each location included in this guide, there is a one-page summary: a photo, physical description, suggestions for activities best suited to the site, and some historical data. On the flip side of the summary, there is a Google map, contact information, and specific access/fee requirements, if any.

In all cases, these locations were selected because they are settings where nature can be experienced, can be enjoyed and can contribute to the healing provided by the program. In the research paper, also entitled “Healing through Nature”, which is provided to the counselors along with this guide, the specific literature reviewed is discussed and referenced. This literature review contributed to this guide by supporting the idea of nature as healer.

The most important studies are listed in Appendix A, along with those books and manuals which describe the plants, sea life, and animals of the Monterey Bay area. In most cases there are also some very informative brochures on the specific locations. These are provided in a packet in the back of the guide. It is recommended that these brochures are replaced by new ones from the locations as they are available. Many can be collected from The Monterey Visitors’ Bureau located on El Estero Avenue.

Information provided on each Activity

The activities in this guide were selected based on the literature review, meetings with Interim staff, and my own experience and exploration of the locations as well as my training in some of the activities. Each activity is briefly summarized on one page. References to books, articles, and experts are provided in Appendix A if the counselors or clients choose to go beyond the basic activities. This is especially relevant to yoga poses, breathing exercises, and Tai Chi.

The activities may include information on the beauty, the dangers and the ecology of the location. Part of the overall goal of the activities is to inform the clients about nature in order to encourage a healthy connection with it. For that reason,

59 identification of flora, fauna, marine life, physical formations, and even poison oak, is important. If the client is to enjoy and pursue a connections with Nature throughout the healing process, and afterwards, a familiarity with nature is necessary. As activities in nature grow, more advanced training can occur – mapping, use of the compass, and even survival skills.

Information provided on the Groups

Formal treatment groups as defined by the staff of Interim can sometimes be conducted, I whole or in part, out in nature. They have expressed an interest in this and that is why the guide was developed. The staff will decide which groups, which clients, which locations, and which groups suit their immediate needs. The “Healing through Nature” Guide is just that, a guide.

In addition to the descriptions of locations and activities, the guide provides Reference Charts suggesting which activities are best for each location, and which groups can most easily be done at each location. Sometimes the trips into nature are independent of a formal group activity. The benefit is a pleasant experience in nature and that is all.

Suggestions for supplies and information materials are just that – suggestions. The outdoor experience can enrich the healing process with or without a "theme". The activities, or themes, are suggested in order to strengthen the clients' connection to nature and to give them tools for enjoying nature after they leave the program. Some of the activities teach valuable "life skills" to the clients.

When planning an "activity" and choosing a "location", the counselor can remove the relevant pages from the guide along with a checklist of supplies and a map. These can be Xeroxed for each of the clients if the counselor chooses to do so. After an outing, the counselor and possible the clients can be asked to evaluate the experience. Forms for comments and suggestions are found in the Appendix.

60 OUTDOOR LOCATIONS

Lovers Point Park, Pacific Grove Monterey Peninsula Recreational Trail George Washington Park, Pacific Grove Berwick Park, Pacific Grove Point Pinos Lighthouse, Pacific Grove Monarch Grove Sanctuary, Pacific Grove Point Lobos State Reserve, Carmel Del Monte Beach, Monterey Garland Ranch Regional Park, Carmel Valley Ford Ord National Monument Carmel Mission, Carmel-by-the-Sea Jewell Park, Pacific Grove Caledonia Park, Pacific Grove Jack's Peak Regional Park, Monterey Elkhorn Slough Research Reserve, Moss Landing

61 LOCATION: Lovers Point Park, Pacific Grove

DESCRIPTION: The park with the disputed name. Sixty years ago it was called "Love of Jesus Point” by the Methodists who built their summer camps on the peninsula. Great views of the entire bay. Large lawn area, rocky outcrops, stairs to a sandy beach on one side and to a rocky beach on the other side of the point. Picnic tables, bathrooms, sandy volleyball court. Note the sculptures!

DIRECTIONS: The park is located on Oceanview Boulevard and 17th Street, next to the new Beach House Restaurant.

SUGGESTIONS: Set up for picnics, walks along the shore, photos. Good space for practicing Tai Chi or sitting in a group on the grass. It is a quiet place as long as there is no event, such as a triathalon, taking place, in which case it is interesting to observe the crowds in action.

DETAILS: This special park is well-patrolled by Pacific Grove police. Litter is not allowed so there are very many trash bins. Parking is plentiful. Many tour buses on the weekend. Not a place for quiet meditation.

LOVERS POINT PARK - Map location A

ADDR: Ocean View Boulevard at 17th Street, Pacific Grove, CA

PHONE: (831) 648-3130 – Pacific Grove Recreation Department

WEBSITE: www.ci.pg.ca.us

Contact PG Rec Dept, listed above, for reservation if group is to be > 50. Fees apply for large groups planning formal functions like weddings, else no fee.

63 LOCATION: Monterey Peninsula Recreational Trail

DESCRIPTION: A walking trail along the coastline of Monterey Bay from Marina all the way to Pebble Beach. Sections can be addressed separately. There are open spaces (small park areas), beaches (of course) and sites of historic significance.

DIRECTIONS: This path runs the whole length of the shoreline. There are parking areas along the way as well as street parking. See map in the Appendix.

SUGGESTIONS: Perfect for a long walk, many green spaces available to sit and meditate or talk. Good for groups wishing to discuss issues with some privacy. Excellent place for a bike ride. Many areas of the path have groups of picnic tables also for lunch or snack time.

MONTEREY PENINSULA RECREATIONAL TRAIL

ADDR: A long stretch of coastline on the Monterey Bay

PHONE: (831) 649-2836

WEBSITE: www.parks.ca.gov

No reservations, public access all along the coast, no fees.

65 LOCATION: George Washington Park, Pacific Grove

DESCRIPTION: A large city park that offers an important wildlife habitat and a butterfly habitat from October to March. Picnic tables, barbecue grills, restrooms, baseball field. This is the largest of Pacific Grove's beautiful city parks. This wild forest is popular with hikers and dog walkers and is an important wildlife habitat. While not officially a Butterfly Sanctuary, they do crowd the skies overhead in October.

DIRECTIONS: Located in Pacific Grove, from Short Street to Sinex Avenue, between Melrose and Alder Streets.

SUGGESTIONS: Good walking trails through the forest, beautiful sightings of Monarch Butterflies in season, set up for picnics.

DETAILS: No charge for usage unless you require a special table or grill; contact the Pacific Grove Rec Dept for a permit. It is possible to have a charcoal grill cookout. GEORGE WASHINGTON PARK, Pacific Grove, CA

ADDR: From Short Street to Sinex Avenue, btwn Melrose and Alder Streets, PG

PHONE: (831) 648-3130

WEBSITE: www.ci.pg.ca.us

Call in advance to reserve the baseball field or a grill, no fees.

67 LOCATION: Pacific Grove, Berwick Park

DESCRIPTION: This one acre park on the coast has views of the Monterey Bay. There is a well-maintained lawn as well as native vegetation. Often a site for weddings. A special bronze sculpture of an otter distinguishes the spot.

DIRECTIONS: This special park is located on Oceanview Boulevard, between Carmel Ave and 9th St.

SUGGESTIONS: Quiet setting for groups, for meditation, for Tai Chi. Also can be set up for picnics on the grass or used as a great open space for Frisbee, allowing client to interact as a team.

DETAILS: Always open. Reservation and permit required for groups which intend to set up chairs and have more than 50 people.

BERWICK PARK, Pacific Grove, CA

ADDR: Ocean View Boulevard at 9th Street

PHONE: (831) 648-3130

WEBSITE: www.ci.pg.ca.us

Permit and fee required for groups larger than 50 planning a special event.

69 LOCATION: Point Pinos Lighthouse, Pacific Grove

DESCRIPTION: Historic Point Pinos Lighthouse is located on the tip of the Monterey Peninsula. The U.S. Congress appropriated funds for six lighthouses on the coast soon after California became a state – one of these was at Point Pinos. It was completed in February, 1955, and it is the oldest continuously operating lighthouse on the West Coast.

DIRECTIONS: The lighthouse is located on Asilomar Avenue just off of Ocean View Boulevard in Pacific Grove. Across from the lighthouse is Point Pinos Beach which has restrooms as well as quiet sandy beach for strolling and sitting.

SUGGESTIONS: A walk around the very small but nicely restored lighthouse, followed by a brief discussion of the history of the place, and lighthouses in general. A brief walk, past the restrooms (if needed) brings you to a private sandy beach for reflection or discussion. It is a perfect setting for tai chi or meditation.

DETAILS: The lighthouse is open from 1-4 p.m. Thursdays-Mondays. A $2 donation per person is suggested, but not required. Call for more information: 648-5716 or check out www.pgmuseum.org.

POINT PINOS LIGHTHOUSE, Pacific Grove, CA

ADDR: 90 Asilomar Avenue btwn Lighthouse Avenue and Del Monte Blvd

PHONE: (831) 648-3176

WEBSITE: www. Pgmuseum.org or www.ci.pg.ca.us/lighthouse

Open 1 – 4 p.m. Thursdays – Mondays; $2/per person suggested.

71 LOCATION: Monarch Grove Sanctuary, Pacific Grove

DESCRIPTION: Winter home of the well-traveled orange and black butterflies. On Ridge Road, off Lighthouse Avenue, in Pacific Grove. Every October, many thousands of butterflies visit this eucalyptus grove. The Monarch butterflies are migrating to warmer climates. You can watch them hang in clusters from the eucalyptus branches; the resulting effect is stunning.

Monarchs stay in the Monarch butterfly grove from October until February.

DIRECTIONS/MAP: The Butterfly Sanctuary is just off Lighthouse Avenue on Ridge Road. The pathway to the Butterfly Sanctuary is located right next to the Butterfly Grove Inn's property with a white picket fence on one side.

SUGGESTIONS: Come for a walk, admire, and take Monarch butterfly photos. Just don't touch. A great place to walk and to learn.

DETAILS: Admission is free and the park is always open. Bathroom facilities and drinking fountain. Butterfly etiquette includes quiet, no disturbing of the Monarchs, even on the ground, and no litter. No picnic space.

MONARCH BUTTERFLY PRESERVE

ADDR: 250 Ridge Road, off Lighthouse Avenue, behind the Adult School

PHONE: (831) 648-5716

WEBSITE:www.pgmuseum.org

LOCATION: Point Lobos State Reserve, Carmel

DESCRIPTION: Point Lobos aka "the greatest meeting of land and sea in the world" and "the crown jewel of the state park system." It is a large rocky area on the coast suitable for great hiking, easy strolls, perfect picnics, photos, etc. There is even an old whaler's cabin.

Point Lobos is home to sea lions, elephant seals, harbor seals, sea otters, and is a year-round stopping point for orcas. Gray whales migrate past this area from December to April, and can be seen from shore. You may also encounter deer, rabbits, badgers and bobcats. Nocturnal creatures include raccoons and coyotes.

DIRECTIONS: From Carmel, go south on Highway 1 for about three miles. There is parking on the roadside outside of the park, but if you have a park pass, there are parking lots on site.

SUGGESTIONS: This large and diverse park is great for walks, picnics, and groups. There are places to sit on the rocks, the beach and even on picnic benches which the rangers and guides will help you find. The literature and maps provided at the entrance signage will help you identify flora and fauna. Migrating gray whales are visible in the winter. (www.pointlobos.org)

DETAILS: Entry fee is $5 per vehicle without a pass. Hours: 9 a.m. – 5 p.m.

Point Lobos State Reserve, Carmel, CA

ADDR: 62 Highway One, south of Carmel

PHONE: (866) 338-7227, or 624-4909

WEBSITE: www.ptlobos.org

DETAILS: Entry fee is $10 per vehicle without a pass. Hours: 9 a.m. – 5 p.m.

75 LOCATION: Municipal Beach, Monterey

DESCRIPTION: This is a very long stretch of sandy beach.

DIRECTIONS/MAP: Off Del Monte Avenue, across the street from El Estero Park which is also a peaceful place to watch birds. Street and lot parking area available.

SUGGESTIONS: Volleyball court for activity, beach for walks, also picnic tables.

MUNICIPAL BEACH, Monterey, CA

ADDR: A public stretch of coast, called "windows on the bay"

PHONE: (831) 649-2836

WEBSITE: www.parks.ca.gov

Reservations required for groups >50 or those wanting to use the volleyball court, no fees.

77 LOCATION: Del Monte Beach, Monterey, CA

DESCRIPTION: Yet another long stretch of sandy beach, less populated than most. Native plants abound. Bring a book to identify them or a sketchbook to record them.

DIRECTIONS/MAP: Across Del Monte Avenue from the Naval Postgraduate School. Parking is on Tide Avenue which is perpendicular to Del Monte.

SUGGESTIONS: There are picnic tables for lunch. Shell collection, native plant identification. Because it is quiet and less populated, it is good for some stretching and yoga.

DETAILS: No entry fee. No permit required for usage. No fires allowed.

DEL MONTE BEACH, Monterey, CA

ADDR: A long stretch of coastline on the Monterey Bay

PHONE: (831) 649-2836

WEBSITE: www.parks.ca.gov

No reservations, public access all along the coast, no fees.

79 LOCATION: Garland Ranch Regional Park, Carmel Valley

DESCRIPTION: This beautiful park is sometimes crowded on the weekends but almost deserted mid-week. Garland Park has many walking trails. The higher you go the better the views. Keep an eye out for the wildlife to include bobcats and turkeys. A pleasant walk is alongside the river to Waterfall Trail which leads to a beautiful waterfall. From the top of the ridge you get fantastic views of the Monterey Bay and the Santa Lucia Mountains.

DIRECTIONS/MAP: This very large regional park is located on Carmel Valley Road, about five miles west of Route 1. Parking is plentiful.

SUGGESTIONS: The trails provide many levels of physical activity. There are places to sit and relax near the Visitors' Center and at the top of the hill. Good for singing while you hike as well as identifying flora (and avoiding poison oak).

DETAILS: No entry fee. Rangers on site to answer questions. Be sure to grab a map of the many paths at the Visitors' Center.

GARLAND RANCH REGIONAL PARK, Carmel Valley, CA

ADDR: 700 West Carmel Valley Road, Carmel, CA

PHONE: (831) 659-6065

WEBSITE: www.mprpd.org

No entry fee, no reservations, Rangers on site at Visitors' Center.

LOCATION: Fort Ord National Monument

DESCRIPTION: A large part of what was once the Fort Ord military base is now a National Monument. It contains some of the last undeveloped wildlands on the Monterey Peninsula. There are more than 86 miles of trails open to the public to explore on bike, foot or horseback. Also, there are 35 species of native plants and animals thriving in this habitat which is protected by the Bureau of Land Management.

DIRECTIONS: Enter via Gigling Road off Route 1 or via Reservation Road just west off Route 68.

SUGGESTIONS: Very good for long hikes and observation of flora and fauna. It is also an opportunity to discuss the origin and history of Fort Ord. Flyers as well as maps are available.

FORT ORD NATIONAL MONUMENT

ADDR: Off Route 1, Salinas

PHONE: Bureau of Land Management, (831) 394-8314

Access to Fort Ord National Monument is FREE. Open from 30 minutes before sunrise to 30 minutes after sunset. CAUTION: obey signs, stay on paths.

83 LOCATION: Carmel Mission, Carmel-by-the- Sea

DESCRIPTION: This mission is an important part of California History. It was here that Father Junipero Serra oversaw the mission system which eventually gave way to the religious and social structures that would become the “Golden State.”

The Carmel Mission is one of the most authentically restored of all the missions in California, and is still functioning as a neighborhood parish.

DIRECTIONS: Just south of Carmel-by-the-Sea, it is located on Rio Road just off Route 1. Parking is free and donations are accepted for a tour of the museum; suggested donation is $7 but it is not required.

SUGGESTIONS: In the basilica itself, it is a place for silent meditation an reflection. Inside the courtyard, it is possible to sit and have a quiet group meeting. A call ahead would ensure some private space: (831) 624-1271.

CARMEL MISSION BASILICA

Open 8 a.m. to 5 p.m.

Donation of $7/person suggested but not required for Museum only.

ADDR: 3080 Rio Road, Carmel

PHONE: (831) 624-1271 (church), 624-3600 (museum office)

WEBSITE: www.carmelmission.org

85 LOCATION: Jewell Park, Pacific Grove

DESCRIPTION: Well-maintained lawn area, small gazebo, benches, and picnic tables. Across the street from the Pacific Grove Natural History Museum. On Monday afternoons there is a small Farmers' Market.

DIRECTIONS: This small urban park is on the corner of Central, Grand ave.

SUGGESTIONS: Walk through Natural History Museum to identify local birds and wild animals. Discuss while sitting in the park, or even in the gazebo!

Jewel Municipal Park, Pacific Grove, CA

ADDR: Forest Avenue & Central Avenue in Pacific Grove, CA

PHONE: PG Recreation Department, 831-648-3130

WEBSITE: www.ci.pg.ca.us

No fee for usage.

87 LOCATION: Caledonia Park, Pacific Grove

DESCRIPTION: Open-space free-play area with basketball court, close to beach, three picnic tables, restrooms. Park equipment for young children. Also a kickball on a post if you want to get some extra activity. It is most quiet during the week days when children are in school.

DIRECTIONS/MAP: Located in the center of Pacific Grove just behind the Post Office.

SUGGESTIONS: Play basketball or kickball. Watch holiday activities (Fourth of July). A group meeting could be held on the picnic benches. Very funny pictures could be take near the assorted playground structures.

CALEDONIA PARK, Pacific Grove, CA

ADDR: Central Avenue and Caledonia Street

PHONE: Pacific Grove Recreation Department, 831-648-3130

WEBSITE: www.ci.pg.ca.us

No fee for usage

LOCATION: Jack's Peak Regional Park

DESCRIPTION: This special "peak" has almost 8.5 miles of hiking and trails in difficulty from easy to moderate. Fantastic view from the top.

DIRECTIONS/MAP: Located off Highway 68 near Monterey, just before the Airport.

SUGGESTIONS: Serious hiking, picnics, photography. At the top, a group meeting could be conducted while basking in the sunshine, drinking water and enjoying incredible views.

JACK’S PEAK REGIONAL PARK

ADDR: 25020 Jack's Peak Park Road off Route 68, Monterey, CA

PHONE: (888) 588-2267 or Parks Department (831)755-4899

WEBSITE: www.co.monterey.ca.us/parks

Reservations suggested as a limited number of visitors are allowed; fee/car is $4/day Monday to Friday, $5/day Saturday, Sunday & holidays.

91 LOCATION: Elkhorn Slough Estuarine Research Reserve

DESCRIPTION: There are five miles of trails, as well as a visitors' center with intriguing exhibits, and plenty of waterbirds, crabs, and other critters to observe and photo graph as you are out walking around the slough. Boat tours are available at a price.

DIRECTIONS/MAP: Enter off Route 1, just past the Whole Enchilada Restaurant in Moss Landing.

SUGGESTIONS: Walks, tai chi, meditation, identification of the inhabitants.

ADDR: 1700 Elkhorn Road, Moss Landing, CA, just off Route 1

PHONE: (831) 728-2822

WEBSITE: www.ElkhornSlough.org

Visitor Center and regular reserve open Wed – Sun, 9 a.m. to 5 p.m.; $2.50/car.

OUTDOOR

ACTIVITIES

Walk along the Beach

Hike in the Hills

Meditation

Tai Chi

Reading a Map

Using a Compass

Stretching

Breathing

Yoga

ACTIVITY: Walk along the Beach

DETAILS: A quiet stroll along the beach, observing the sights and sounds of the waves, the wild life and the occasional plant or shell can be relaxing. It can also open the mind to new and pleasant thoughts. A formal group session can follow this walk, sitting on logs or benches or even the sand. An informal session about the sights and sounds can provide enjoyment. A speedy stroll , about 15 minutes, can burn a few calories and cause healthy sweating.

EQUIPMENT NEEDED: Hats and sunscreen, water, notepads, possibly cameras. Need blankets or towel if wading in the water or sitting on the sand. Baggies are useful for collecting shells.

ACHIEVEMENT EXPECTED:

 A sense of peace in the setting,

 A renewed interest in nature,

 A momentary escape from one's own problems,

 A healthy dose of Vitamin D, and

 Positive interaction with peers.

"I only went out for a walk

and finally concluded to stay out till sundown,

for going out, I found, is really going in."

-- JOHN MUIR, Father of our National Forest System

96 ACTIVITY: Hike in the Hills

DETAILS: A hike may be of varying degrees of length and difficulty. It can involve simple strolling in a beautiful location, or heavy exertion climbing hills and navigating the woods. The site should provide places to rest, and places to sit and discuss the activity and/or a healing topic.

EQUIPMENT NEEDED: Hats, sunscreen, bug spray. Water and power bars. Walking sticks may be found along the way. Maps and pictures of flora and fauna to spot.

ACHIEVEMENT EXPECTED:

 Delight in the natural setting,

 Strength in following the path and encountering nature,

 Recognition of poison oak and poison ivy,

 Learning some survival skills,

 Camaraderie!

97 ACTIVITY: Meditation

DETAILS: Meditation is a method of quieting the mind, centering your thoughts removing distraction. Practiced properly, and frequently, meditation allows a person clarity awareness and clarity. In certain forms of Buddhism meditation is seen as a way of dropping away from the illusions of civilization and re-entering a relationship with the authentic reality of the natural world. To be in nature is to remind yourself that you are part of nature. It is not something that is alien to you.

The easiest way to begin meditation is to take three steps:

1) Sit comfortably ,

2) Breathe,

3) Observe.

EQUIPMENT NEEDED: A rock to sit on or perhaps a towel.

ACHIEVEMENT EXPECTED:

• Clarity of mind,

• Sense of calm,

• Sometimes a nap.

98 ACTIVITY: Tai chi

DETAILS: Tai chi originated in ancient China. It is one of the most effective exercises for health of mind and body. Although tai chi is an art with great depth of knowledge and skill, it can be easy to learn. Soon after your practice begins, it delivers health benefits. For many it continues as a lifetime journey. Most people practicing tai chi enjoy themselves.

Start with simple stretching, breathing, and enjoyable poses such as the Standing Bear or movements such as Changing Clouds.

EQUIPMENT NEEDED: Open space, flat ground or sand

Tai chi is also a form of meditation; it fosters tranquility and a sense of living in harmony with Nature. It is recognized as a powerfully holistic approach to better health and longevity.

99 ACTIVITY: Reading a map

DETAILS: Present a map of the location and its relation to home base. Plan route to the location as well as along the beach or through the woods. Always note compass on the map.

EQUIPMENT NEEDED: Local maps, site map

ACHIEVEMENT EXPECTED: Understanding of locale, directions, planning.

100 ACTIVITY: Using a compass

DETAILS: Discuss the origin of the compass, the directions, the importance of knowing your location. Point out direction of sun rise and sunset, stars, if applicable. Follow a map using the compass.

EQUIPMENT NEEDED: Some small compasses, drawing paper.

ACHIEVEMENT EXPECTED: Ability to orient oneself in the world, in the community.

101 ACTIVITY: Stretching

DETAILS: Discuss the importance of stretching muscles especially on long walks or climbs. Present a series of simple stretches to do before and others to do after the activity.

EQUIPMENT NEEDED: Level ground

ACHIEVEMENT EXPECTED: Some flexibility and comfort

102 ACTIVITY: Breathing

DETAILS: Discuss the value of deep breathing, the gift of clean air, and the practice of centering while breathing. Breathe together . . . for 3- 5 minutes initially.

EQUIPMENT NEEDED: Stand on flat ground viewing Nature, or sit on a tarp or rock watching the waves come in. Soft voice of group leader leads the breathing.

ACHIEVEMENT EXPECTED: Breathe in the clean air, breathe out the toxins. Clears the body and the mind. With regular practice (daily!) a feeling of wellness results.

103 ACTIVITY: Yoga

DETAILS: There are many different forms of yoga. For the beginner, some simple poses will introduce him/her to the form. One of the most widely practiced routines (popular on many campuses) is the Sun Salutation. It is shown below.

EQUIPMENT NEEDED: Flat ground. A mat is needed only if extensive groundwork is being done, but not necessary for the Sun Salutation.

ACHIEVEMENT EXPECTED: Flexibility, focus, and a great sense of accomplishment.

104 OTHER ACTIVITIES and TOPICS

Finding a walking stick (prepare with sandpaper & duct tape)

Conservation considerations: take nothing, leave nothing

Survival considerations: water, shelter, wounds

Recognizing poison ivy & poison oak; treatment

Exploring aromatherapy: rosemary, sage, mint

Caution with mushrooms and berries: some are tasty, some are poison

Flying kites, paper planes; discuss wind and currents

Scavenger hunt in woods: bark, rock, feathers, berries, etc.

Scavenger hunt on beach: shell, hermit crab, drift wood, seaweed, etc.

Sandcastles

Healthy foods: good choices, bad choices

Running

Laughing Circle (a la New Delhi)

Singing

Frisbee

Kickball

105

GROUPS

(as described by INTERIM)

Building Healthy Relationships Anger Management Process Group Non-violent Communications Men's and Women's Groups Fitness Groups Goal Review

106

Building Healthy Relationships is weekly group to help clients better understand and practice interpersonal skills. Part of its emphasis is around learning how to set boundaries and how to overcome co-dependence.

Anger Management is a group which helps clients identify the sources of their anger and their related emotions. It then helps them to process and express those emotions to release the anger without self-harm or harm to others. We encounter many interpersonal difficulties in a rehabilitation Program and this group helps clients to see how conflict resolution can be helpful.

Process Group is a weekly group limited to five or six people in order to have greater intimacy so that people can share their deepest challenges in a psychotherapeutic container.

Non-Violent Communicationswas developed by Marshal Rosenberg, Ph.D., and is a practice of learning to talk with people in order to effectively communicate of “feeling, Needs and Requests,” to others. Clients with significant trauma or abusive backgrounds, or who have lived in a gang environment find it helpful in discovering more successful ways to express their anger or frustrations and get some badly needed relief.

Women’s and Men’s Groups allow for each gender to talked about their specific needs and their needs of being understood by the opposite sex. The groups also discuss homophobia and how gender role restrictions discriminate against sexual minorities.

Bridge House participates in the “safe zone” program for equality of sexual orientation.

Fitness groups currently consist of Yoga each Friday with our staff person; two walks each week; a Friday outing to either the beach or a walk in the woods and our croquet matches. We are looking for more resources in this area and that is why your efforts art so important to us. But, primarily, what we have learned is that someone who is trained in this field is much better at motivating and educating our population.

107

Goal Review is a weekly wrap-up of what the clients have achieved in the past week and what their list of goals for the next week---and long term goals as well—will be. Many of our clients have had lives of chaos and confusion and this group helps them focus and start to realize that they can have small successes which later turn to larger success.

SUPPLIES for OUTINGS

___ A Plan

___ Hats, suntan lotion, bug spray

___ WATER

___ Proper clothes for site

___ Tarp or blanket for sitting

___ Folding chairs

___ POWER BARS or bag lunch

___ First Aid kit: Bandages, wipes, Neosporin or bacitracin

___ Bird book

___ Tree book

___ Flower book

___ Water's edge book

___ Baggies for trash & treasures

___ Personal ID

108 APPENDICES

A. Selected REFERENCES FROM THE Master’s PROJECT

B. ACTIVITY REFERENCE BOOKS

C. SUGGESTION/EVALUATION FORMS

For Client

For Counselor

D. CONTACT INFORMATION

Emergency: 911

INTERIM: (831) 649-6399

D. MAPS & BROCHURES (in attached packet)

Monterey Peninsula

Garland Park

Point Lobos

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APPENDIX A - Selected REFERENCES

Barton, J., & Pretty, J. (2010). What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environmental Science & Technology, 44(10), 3947–3955. doi:10.1021/es903183r

Berman, D. S., & Davis-Berman, J. (2005). Reconsidering post-traumatic stress. Journal of Experiential Education, 28(2), 97-105.

Brealey, E. (2004). The spirit of meditation. London, England: Cassell Illustrated.

Buzzell, L., & Chalquist, C. (Eds.) (2009). Eco-therapy: Healing with nature in mind. San Francisco, CA: Sierra Club Books.

Google Maps. (n.d.). Various maps. Retrieved from maps.google.come

Kimball, R. (1983). The wilderness as therapy. Journal of Experiential Education, 5(3), 6– 9.

Lam, P. (2007). Tai Chi for health programs. Burlison, TN: Tai Chi Productions.

Microsoft. (n.d.). Office clip art. Retrieved from http://office.microsoft.com/en- us/images/??Origin=EC790014051033&CTT=6

Penckofer, S., Kouba, J., Byrn, M., & Ferrans, C. E. (2010). Vitamin D and depression: Where is all the sunshine? Issues in Mental Health Nursing, 31(6), 385-393. doi:10.3109/01612840903437657

Roszak, T., Gomes. M. E., & Kanner, A. D. (1995). Ecopsychology: Restoring the Earth, healing the mind. San Francisco, CA: Sierra Club Books.

Russell, K. C. (2001). What is wilderness therapy? Journal of Experiential Education, 24(2), pp. 70-79.

Selhub, E., & Logan, A. (2012). Your brain on nature. Mississauga, Ontario: John Wiley & Sons Canada.

Selhub, E., Logan, A. (2012). Your Brain on Nature, Wiley Press.

Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224(4647), 420-421.

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APPENDIX B - ACTIVITY REFERENCE BOOKS

Benson, H. and Klipper, M. (1975). The Relaxation Response. HarperCollins

Forey, P. and Fitzsimons, C. (1986). An Instant Guide to Wildflowers. Random House.

Leatherman, S. and Williams, J. (2011). Field Guide to the Water’s Edge. National Geographic.

Peterson, R. (1961). A Field Guide to Western Birds. Houghton Mifflin Company.

Zim, H., Martin, A., and Irving, J. (1952) Trees: A Guide to Familiar American Trees. Simon and Schuster.

APPENDIX B

FLORAL ESSENCES AND THEIR ROLES IN THE HEALING PROCESS FOR THOSE WITH ADDICTIONS

Flower essences, the subtle liquid preparations made from the fresh blossoms of flowers, plants, bushes, even trees, may make it easier to break the cycle of addition, according to Patricia Kaminski and Richard Katz, co-authors of Flower Essence Repertory and founds and directors of the Flower Essence Society, in Nevada City, California. Flower essence therapy, an approach pioneered by British physician Edward Back in the 1930s, addresses the emotional, psychological, and spiritual components of health and well-being. In the case of additions—cigarettes, alcohol, drugs, or emotional codependency such as addictive behavior in personal relationships—flower essences can help overcome the underlying cause of additive behavior, state Kaminski and Katz. They recommend the following flower remedies to address psychological and emotional causes often associated with additions: California Poppy (Eschscholzia californica)—This flower encourages inner stability in those with escapist tendencies or a need to experience things from outside themselves. It is particularly helpful for users of hallucinogenic drugs. Morning Glory (Ipomoea purpurea)—This flower is often recommended for thrill-seekers who rely on stimulants to compensate for perceived dullness in everyday life. By encouraging increased awareness of personal surroundings, Morning Glory helps with addition to stimulants, such as nicotine, cocaine, and amphetamines. Chrysanthemum (Chrysanthemum morifolium)—For those who use drugs or alcohol to avoid confronting painful circumstances, flower essence practitioners often suggest Chrysanthemum. Milkweed (Asclepias cordifolia)—Milkweed is commonly prescribed for substance abusers who use alcohol, opiates, or other sedatives to stupefy their consciousness. Nicotiana (Nicotiana alata)—Flowering Tobacco, or Nicotiana, is strongly indicated for those who smoke cigarettes for comfort and relaxation. Bleeding Heart (Dicentra formosa)—Essence of this flower address feelings of pain and loss in personal relationships, especially for people whose emotional connections are motivated by possessiveness or fear. Bleeding Heart is often prescribed for emotional dependency. Black Cohosh (Cimicifuga racemosa)—Useful for people caught in a patter of abusive or threatening relationships, Black Cohosh helps provide courage to confront abusive situations rather than to retreat from the abuser.

112 113

Five Flower Formula—This blend, containing essences of Cherry Plum, Clematis, Impatiens, Rock Rose, and Start of Bethlehem, has a stabilizing effect that is particularly useful as a first step toward healing addiction. Walnut (Juglands regia)—Essence of walnut provides general support in times of change, including the transition between addictive and non-addictive behavior. Self-Heal (Prunella vulgaris)—This flower essence provides healing support and inspires confidence in one’s abilities to break an addictive habit. (Trivieri & Anderson, 2002, p. 482)

REFERENCE

Trivieri, L., & Anderson, J. (Eds.) (2002). Alternative medicine: The definitive guide (2nd ed.). Berkeley, CA: Celestial Arts.