In 1870 the Quakers’ Friends Hospital used greenhouses and acres of its natural landscape as integral parts of treatment for the mentally ill. At the turn of the century, Frederick Peterson, a neurologist and head of the New York State Board of Lunacy, did the same with a state asylum. Both the Quakers and Peterson believed involvement with nature through manual work would be healing. That proved to be true, but many such programs were abandoned later due to costs and legal issues about the exploitation of patient labor. Eventually, all were replaced by psycho-tropics and the sedentary joys of TV.
Although therapeutic work programs have mostly vanished from behavioral health care, manual work in nature is, nonetheless, inherently “therapeutic” as many of us know from personal experience. Based on 37 years of experience with work programs in Wellspring’s multi-modal, process-oriented residential treatment programs for children, adolescents and young adults, I am convinced that work, as a therapy in its own right, currently has more importance for behavioral health than ever, particularly for young people.
As a therapeutic medium, there are three aspects of manual work to consider: How direct involvement with nature, or the lack of it, affects mental health; how manual work can be instrumental for character building and personal growth; and how a work program can be developed into a therapy in its own right.
The basis of this “outdated perspective” is that the healing power of manual work is intrinsically connected to direct involvement with nature – with the physical matter of creation – wood, grass, rocks, dirt, plants and animals. In his book, The Last Child in the Woods, Richard Louv coined the phrase “nature deficit disorder,” a non-medical term used to describe the unhealthy effects on children of increasing disengagement from nature. Research shows that children – tweens and teens – now spend an average of 7.5 hours before screens and 90% of their time indoors. Attention, concentration, and cognition are being negatively affected in both direct and subtle ways, accompanied by measurable increases in stress, anxiety and depression.
These effects are clinically evident in the escalating numbers of children diagnosed with ADHD. Child obesity, a national concern, is indirectly related to nature deficit disorder through inactivity. As children stay indoors, fixated on the TV or computer, they tend to become couch potatoes. On the other hand, research indicates that direct involvement with nature in whatever form reduces stress, alleviates depression, and provides an effective alternative to medications used to counteract ADHD. While research about these positive and negative effects is mostly correlational in support of Louv’s argument, for the sake of our children, we need to take it seriously and find corrective ways to respond. From a therapeutic perspective, I propose that manual work on the land is especially suited to this task.
Children learn about the world first hand through their senses – touching, tasting, smelling, seeing and hearing. In this respect, a child’s withdrawal from the natural to the virtual world causes the sensory world to shrink. The plethora of electronic devices – the TV, computer, iPhone, iPad, etc. – may expand access to information, but sensory experience becomes restricted to the flat screen and the keyboard. Social networking presents itself as a tool for expanding relational contact, and it does that, but the actual experience of participants is more of isolation and containment than face-to-face contact and exchange. In the documentary film, Play Again, one boy says, “I’m in my own little world where I can control what’s happening.”
At Wellspring, work programs on the land are combined with adventure programming and animal care in an effort to restore healthy balance between virtual and natural reality. In this effort, a therapeutic work program confronts three major obstacles, which present both a challenge and a therapeutic opportunity: Body, Effort and Authority.
Manual work is a body-relational medium. You have to be in your body to do it. Manual work compels body presence because of its direct involvement with matter – with the soil, plant, animal and human levels of creation. Being present to a task in body also requires being in the here-and-now – a piece of work in itself. As Fritz Perls, the originator of Gestalt Therapy used to say, “Get out of your head and come to your senses.” Manual work challenges head trips and ways of escape through distraction, ways of disconnection typical of many disorders – nature deficit disorder perhaps most of all. Manual work also presses the body to be lived as an instrument – not viewed as an object – and body image concerns must give way to experience of the functional body – true even for anorectics who misuse it for over-exercise.
A second obstacle to work is effort. Manual work takes physical exertion and, consequently, draws upon all the qualities of personality and character that effort can engender – patience, persistence, endurance, focused aggression, care and attention, will and will power – the list is endless. These are all ego strengths, and as such they are the very stuff of personal growth and character building at the core of treatment. Surely, the development of a strength comes from its exercise. And as work requires the ability to do hard things, to expend oneself energetically and go beyond one’s sense of limitation, this builds self-confidence while accomplishment builds self-esteem.
A third obstacle to manual work is authority: Who or what am I working for or under, as the case may be? Authority comes from the Latin auctor, which means to author, to originate, to bring forth and create. At Wellspring, the authority of a work therapist is based on her ability to author the client into personal growth and healing through the medium of work. The authority of the client, on the other hand, comes from learning to exercise authority over herself, by directing energy into the work, and by learning how to take charge of a task from a sense of personal empowerment. Nowhere was this more evident than when Heather, a milieu counselor, directed a crew of adolescent girls in a series of landscaping projects one summer. Beginning with a sense of work as slavery typical of adolescents, what a potent force they became, so proud of themselves in what they accomplished!
A therapeutic work program has many objectives: To learn how to work, to gain satisfaction from accomplishment, to increase self-esteem, to develop a positive work ethic, to acquire basic work skills, to learn how to work with others for a common good, and to learn skills of relationship with co-workers and staff. A work program directed toward these goals can accomplish much therapeutically. However, for a work program to become a therapy in its own right, the work must be related to the individual’s treatment process and become an integral part of treatment planning. This involves the subjective side of work, where the work experience is focused on specific issues of individual growth – where work becomes a way of working on oneself. To the degree that a work program does this, along with general goals, the legal problem of exploitation can be resolved. It can also answer questions from clients such as, “Why should I work? What does this have to do with me? I’ll never have to muck stalls or mess with animals, dig a ditch, plant flowers, whatever. Wellspring should be paying me to work.” This is where a work program that is therapeutic develops into Work Therapy as an art.
The first requirement for a work therapist is to know the work task intimately from personal experience. This knowledge is both external and internal, both physical and psychological. By experiencing and reflecting on each task – weeding, raking, digging, lifting, shoveling manure – the work therapist gains an understanding of the qualities of personality, the particular ego strengths, required of the worker. These strengths (or weaknesses) are revealed by the internal demands a task makes on a worker through its physical demands. Tasks can then be chosen to address relevant issues relevant for an individual, whether to utilize and build upon an existing strength, or to address a weakness in need of development. This allows the work therapist to articulate why she assigns a particular task to an individual and invite the person to take on the task’s inner work as a way of self-development. The trite generality – “this work will be good for you” – becomes re-defined into a specific opportunity for personal growth.
To fit the task with the person in terms of specific treatment issues and objectives, the work therapist has to know the individual both clinically and as a worker. Work histories are intertwined with clinical and relational histories that can have a determining effect on a client’s attitudes toward manual work. Information about parenting is particularly important in determining the client’s expectations about work and relationship to authority. By assessing this personal dimension, the work therapist will be aware of reaction and response patterns emerging in work that may be unconscious to the client. They can also affect how the individual relates to different kinds of work and different kinds of matter, like soil, leaves, rocks, wood and manure, their various smells and textures. As these response patterns emerge in various tasks and contexts, they can be addressed, reframed, re-decided and changed in the treatment process.
Assessment of the individual as a worker – her actual functioning in work – can only be obtained through close observation with different kinds of work. As various ego strengths and weaknesses are revealed in response to the demands of different tasks, the work therapist reads the body of the worker – the non-verbal language of energy, movement, breathing, posture, alertness and alacrity. It is this language that guides assessment and intervention.
For example, Corinne was a teenager who was negative toward everything, especially work of any kind, when she first arrived at Wellspring. Although she was distinctly overweight and preferred sitting around and griping to doing anything active, something about her underlying physicality belied that. Personal history revealed that when her father, whom she looked up to, abandoned the family for another woman, Corinne became depressed and began using drugs. In revenge, Corinne quit Karate where she had excelled, and rejected the male coach she had admired much like her father. In her anger, she became destructive to the very physical nature with which she was gifted, as well spewing her anger at everyone around. Within the context of multi-modal treatment with intensive individual and family work, Work Therapy was the key experiential element of her treatment that literally gave Corinne a way to work out her problem. As she understood the nature of her predicament, she was focused on directing the energy of her anger into the work. By doing so, she was able to replace her external father with the development of an interior “masculine” capacity that found expression in her ability to work. Corinne came alive and became both a model worker and a leader in work program and the community. Work Therapy, in combination with other modalities, provided the ideal context and instrument for this to occur. It literally saved her “life.”
As an “outdated perspective” for behavioral health, a therapeutic work program is able to combine involvement with nature, with character building, and experiential interventions in treating core issues. Context is important, because residential treatment at Wellspring is able to provide direct involvement with nature in a rural setting, within a framework of multi-modal, process-oriented, relational treatment. Although these elements may not be available in every circumstance or to the same degree, effective therapeutic work programs can be designed to fit different circumstances and take advantage of the natural surroundings in some way – if there’s the will to do that. Community gardens in urban settings are a case in point. The greater challenge is to develop a mindset based on values that grasps how truly important this perspective is, now more than ever, for the behavioral health of young people.
Richard Beauvais, Ph.D. and his wife, Phyllis, are co-founders of Wellspring, a multi-service mental health agency in Bethlehem, Connecticut. Richard is now the Director of the Wellspring Institute, a vehicle for training and consultation, and is also Chairman of the Board.