Nature-based creative activity

1. Introduction

Version followed: nature-based creative activity as Natural England's green care typology frames it ("nature arts and crafts", Bragg and Leck 2017, NECR228) and as UK green social prescribing delivers it ("outdoor arts and culture" in the National Academy for Social Prescribing toolkit); the clinical procedures are taken from Ronen Berger's Nature Therapy (Berger and McLeod 2006; Berger 2022), environmental arts therapy as Siddons Heginworth and Nash (2020) and Nash describe it, and nature-based art therapy as the Gulbe et al. (2025) scoping review maps it. Atkins and Snyder's nature-based expressive arts therapy (2017) is used only in outline, from its publisher's description.

This is not one manualised therapy. It is a family of activities: making art with natural materials, land art and sculpture, nature photography, nature writing and poetry, map-making, and ritual and enactment out of doors. It runs at three levels: community groups (nature-based health promotion open to anyone, such as land art, nature writing or photography groups), green care ("specifically designed, structured and facilitated for individuals with a defined need", Bragg and Leck 2017), and therapy delivered by an arts therapist or psychotherapist. [source: Bragg and Leck 2017; NASP green toolkit; Gulbe et al. 2025]

Core idea of change, as its authors put it: Berger adds nature to the therapist–client pair as a "live and dynamic partner". This makes a three-way relationship in which the client's contact with natural places and materials, the creative act, and ritual carry the work, and talking comes after embodied making. Environmental arts therapy anchors the work in the turning seasons, so that experiences are "reflected back at us in nature" (Nash). Natural England's green care model names three interacting ingredients: natural surroundings, meaningful activities and social context. These are the authors' frameworks and are attributed here, not stated as fact. [source: Berger and McLeod 2006; Berger 2022; Kopytin interview with Nash; Bragg and Leck 2017]

Evidence status in one line each: the 2025 scoping review found "the scarce evidence base for nature-based art therapy" and concluded that "further research is necessary to establish its initial effectiveness" [source: Gulbe et al. 2025]. The national green social prescribing programme reported statistically significant pre–post gains on ONS4 wellbeing measures across more than 8,300 participants, with no control group, and its activities were mainly horticulture, conservation and exercise rather than arts [source: NASP 2024].

Cross-references: VIII 183 ecoarts and nature-based expressive arts; VIII 195 arts on prescription; 015 green social prescribing; 022 blue care and open-water swimming; X 196 cold-water immersion.

2. Framework

No source gives a single phase model for this family of activities. The structure below combines the Safe Place programme's movement from the familiar to nature and back (Berger 2022), the sequence in Berger and McLeod's case examples, and the seasonal frame of environmental arts therapy. Where it goes beyond these, it is marked [synthesis].

Levels and formats

Community nature-arts groups. These are led by artists, rangers or volunteers and reached by self-referral or a social prescribing link worker. The therapist's job is to refer, prepare the client and debrief afterwards. [source: Bragg and Leck 2017; NHS England green social prescribing]
Green care groups. These are structured and facilitated for a defined need, with defined outcomes. [source: Bragg and Leck 2017]
Individual or group therapy outdoors. The therapist delivers it within their own training. Examples are the year-long Circle of Trees groups built around a different tree each month (Siddons Heginworth) and the Safe Place school programme of "12 weekly two-hour group sessions, indoors and outdoors", co-led by a programme facilitator and the class teacher (Berger 2022). Session counts outside these named programmes are not given in the sources. [source: Kopytin interview with Nash; Berger 2022]

Phases

Assessment and contracting (indoors or online). Goals: decide whether outdoor creative work suits the client, screen for health and access needs, and agree on confidentiality, weather and contact. Move on when consent is informed and a risk plan exists. [synthesis; risk categories from Gulbe et al. 2025]
Threshold: from the familiar into nature. Goal: a held transition. Berger's case work often begins indoors or verbally and then moves outside, for example walking from a school to a riverbank. Move on when the client can tolerate the open setting. [source: Berger and McLeod 2006; Berger 2022]
Choosing and building a place. Goal: the client takes authority over a site, which may become a "home in nature" they return to. Move on when the client has a place they can come back to, or chooses to work without one. [source: Berger and McLeod 2006]
Sensory contact and creative making. Goal: embodied, mostly nonverbal work with natural materials, land art, sand, photography or writing. [source: Berger and McLeod 2006; Gulbe et al. 2025; Kopytin interview with Nash]
Witnessing and reflection. Goal: talking follows making. Berger's client talked about childhood memories only after he had had "sufficient play time". [source: Berger and McLeod 2006]
Revisiting and working with change. Goal: return to the work over later sessions and treat what nature has done to it as material. [source: Berger and McLeod 2006; Berger 2022]
Ritual, return to the familiar, and ending. Goal: mark change with a ritual the client authors and take what was learned back into daily life. The Safe Place structure ends by returning to the classroom. [source: Berger 2022; client authorship is synthesis]

Criteria for moving between phases are not specified in the sources. Use the client's regulation, consent and engagement as the guide, and step back a phase if the client becomes overwhelmed. [synthesis]

3. Guiding principles

Nature as partner. Practical meaning: the setting is not your furnished room. It "existed before the session and will outlast it", so plan to share control with it. [source: Berger and McLeod 2006]
The therapist's position moves. Practical meaning: at times you lead, with nature as backdrop and source of materials ("therapy in nature"). At times you step back as witness, container and mediator of the client–nature relationship ("therapy with nature"). Notice which one you are doing. [source: Berger 2022; Berger and McLeod 2006]
The client has authority over the site. Practical meaning: offer the client the choice of where to work, and build alongside them rather than above them. [source: Berger and McLeod 2006]
Embodied first, verbal second. Practical meaning: do not interpret during making; invite words afterwards. [source: Berger and McLeod 2006]
Unplanned change is material, not failure. Practical meaning: when wind, tide or animals alter the work, explore control, trust and loss rather than rescuing the piece. [source: Berger 2022]
Place and time matter. Practical meaning: choose habitat and time of day for the work. Berger notes that a midday beach "can be too intrusive for emotional work". [source: Berger 2022]
Seasons as a frame. Practical meaning: you may structure a longer group around the year's cycle. [source: Kopytin interview with Nash]
Safe, structured and accompanied. Practical meaning: outdoor freedom still needs a clear frame, a plan and a present facilitator. [source: Routledge description of Siddons Heginworth and Nash 2020]
Planning reduces anxiety. Practical meaning: tell clients in advance what will happen, where, and what the weather plan is. [source: Gulbe et al. 2025]
Three ingredients. Practical meaning: check that natural surroundings, a meaningful activity and a social context are all present, especially in groups. [source: Bragg and Leck 2017]
Feeling and meaning over facts. Practical meaning: prompts about emotion, meaning, beauty and care build nature connection better than nature-knowledge tasks. This finding comes from nature-connection research, not therapy trials. [source: Lumber, Richardson and Sheffield 2017]
Sustainability. Practical meaning: use sustainable, recycled or locally sourced materials. Leave rocks, plants and trees untouched where the Countryside Code applies, and "leave no trace of your visit". [source: Gulbe et al. 2025; Countryside Code]
Privacy is reduced outdoors. Practical meaning: contract in advance for being seen, being interrupted and what you will both say to passers-by. [source: Gulbe et al. 2025 lists privacy management; specifics are synthesis]
Competence and role clarity. Practical meaning: the review expects nature-based art therapy to be facilitated by a professionally trained art therapist. If you are not one, practise within your own training, train (for example on the environmental arts therapy courses at the London Art Therapy Centre, as Nash describes them) or refer. Keep therapist, artist and group-leader roles distinct (APA Ethics Code Standard 3.05 on multiple relationships, APA Ethics Code). Check that insurance covers outdoor and off-site work. [source: Gulbe et al. 2025; Kopytin interview with Nash; insurance point is synthesis]
The client is the author of meaning. Practical meaning: concepts such as the more-than-human world or nature's agency are the founders' frameworks. Offer them, do not impose them, and let the client name what the work means. [synthesis]

4. Intervention inventory

The sources name the creative methods but give few step-by-step protocols. The steps below follow the founders' descriptions where they exist, and therapist-side procedures such as screening, contracting, preparation and debriefing are marked [synthesis]. All example language is illustrative.

4.1 Suitability assessment and health screening

Purpose: decide whether outdoor creative work fits this client now, and at which level (community group, green care or therapy). Use it before any outdoor session. [synthesis; risk areas from Gulbe et al. 2025]
Steps: (1) Ask what the client hopes nature and making will offer. (2) Screen mobility and access, including terrain, toilets, shelter and travel. (3) Ask about allergies (pollen, plants, insect stings) and how they manage them. (4) Ask about medical conditions that the outdoors or exertion may affect, and agree that the client checks with their physician where needed. Do not set any exercise level. (5) Ask about fears and trauma linked to places, darkness, water, insects or animals, and about cultural meanings nature holds for them. Gulbe et al. note multicultural views of nature and varying nature connection. (6) Screen for eco-anxiety and climate grief. (7) Assess current risk; outdoor work is not a substitute for a crisis plan. (8) Record the decision and the reasons.
Example language (illustrative): "Before we take any of our work outside, I'd like to go through a few practical things: how your body manages walking on uneven ground, any allergies, and whether there are places or creatures that frighten you."
Watch for: a client agreeing to go out only to please you; undisclosed panic about open spaces; idealising nature as a cure. It is working when the client can say what they want from the outdoors and what would make them want to stop.

4.2 Contracting for outdoor work: confidentiality, boundaries, weather and touch

Purpose: set up a frame for a setting you do not control. Gulbe et al. list privacy management in open settings among the challenges. [source: Gulbe et al. 2025; procedure is synthesis]
Steps: (1) Explain that you may be seen together. Agree what the client wants to do if you meet someone they know, and what you will say to passers-by (for example, nothing beyond a greeting). (2) Agree that sensitive talk pauses when others come within earshot. (3) Agree on a weather plan, including a named indoor or online alternative and how and when you will tell each other. (4) Agree on travel arrangements; do not drive clients unless your service and insurance allow it. (5) Touch: no touch by default. Any help over rough ground, or shared handling of materials, needs consent before and during, and either of you can stop at any point. Touch is never sexual. (6) Agree on emergency contacts and on carrying a phone. Tell someone at your base the route and the expected return time, as the Countryside Code advises. (7) Agree on what happens to artworks and photographs. (8) Put it in writing.
Example language (illustrative): "Out here, other people may walk past. If that happens we'll just pause, and you decide whether we carry on or move. If it rains hard we'll switch to video at the same time; I'll text you by nine that morning."
Watch for: discomfort at being seen that the client does not voice, and clients who later feel exposed. It is working when the client feels free to pause, move or go back indoors.

4.3 Preparing and risk-assessing the site

Purpose: make the place safe enough, and suitable for emotional work. [source: Berger 2022 on place; Countryside Code; UKHSA; procedure is synthesis]
Steps: (1) Visit the site beforehand, at the time of day you will use it. Berger notes that habitats and times of day differ in their impact, and that a busy midday beach "can be too intrusive". (2) Note the terrain, footing, exits, shelter, toilets, phone signal and the distance to help. (3) Check local rules about harvesting materials, fires and access. The Countryside Code says to leave rocks, plants and trees untouched and to light barbecues only where signs allow. (4) Ticks: in grassy and wooded areas, follow UKHSA advice. Keep to clearly defined paths, cover skin, use repellent, and check yourself and others afterwards. Seek medical advice if symptoms such as a spreading rash or flu-like illness develop after a bite. (5) Check the forecast and plan for heat, cold, sun and drinking water in qualitative terms. (6) If water is nearby: no entering the water as part of the work. Note the dangers qualitatively (cold-water shock, drowning, unstable banks, tides) and route to RNLI or national lifesaving guidance. Cross-refer 022 and X 196. (7) Carry first aid you are trained to use. Follow your organisation's lone-working policy.
Example language (illustrative): "I've walked this part of the wood already. There's a dry spot under the beeches and a shelter nearby if it turns wet."
Watch for: sites that become busy, have private sightlines or carry seasonal hazards. It is working when the logistics fade and the client can attend to the work.

4.4 Threshold: moving from the familiar into nature and back

Purpose: a held transition that contains the anxiety of the open setting. Berger's Safe Place programme moves "from the familiar (the classroom), to nature with its surprises, adventures and the need to cope", and then back to the familiar. [source: Berger 2022]
Steps: (1) Start indoors or at a meeting point and check in. (2) State the plan, the boundaries and the return time. (3) Walk out together, inviting the client to notice the shift. (4) At the end, walk back and close in the familiar setting. Briefly bridge what happened to the week ahead. [steps 2 and 4 bridging are synthesis]
Example language (illustrative): "As we walk out of the gate, just notice what changes, in the air, in your body, in your mood."
Watch for: mounting anxiety at the threshold. If it appears, shorten the outing or keep the work at the edge of the site. It is working when the client crosses the threshold with growing ease.

4.5 Client chooses the place

Purpose: give the client authority over the setting. In Berger's cases the client selected the site, for example a hidden spot under a willow. [source: Berger and McLeod 2006]
Steps: (1) Invite the client to wander within agreed bounds and find a spot that "calls" them or feels right. (2) Follow at a distance that suits them. (3) When they settle, ask what drew them. (4) Note the choice (hidden or open, high or low, near water or away from it) as possible material, without interpreting aloud too early.
Example language (illustrative): "Take your time and find a place that feels like yours for today. I'll follow; you lead."
Watch for: paralysis in choosing (offer two options); a choice of an unsafe or overlooked spot (renegotiate it). It is working when the client begins to return to the same place, or chooses with confidence.

4.6 Sensory contact: touching nature

Purpose: reach feelings and body sensations through direct contact with sand, mud, water at the edge, bark, leaves and other materials. Gulbe et al. list sensory interaction and grounding activities. [source: Berger and McLeod 2006; Berger 2022; Gulbe et al. 2025]
Steps: (1) Invite slow contact with one material at a time. (2) Ask the client to notice texture, temperature in general terms, weight and smell. (3) Allow play before talk. Berger's client moved from dry to wet sand and mud, and spoke about childhood only after "sufficient play time". (4) Let reflection follow. (5) Check hand hygiene afterwards, especially around soil and animal areas. [step 5 is synthesis]
Example language (illustrative): "Let your hands find out what this sand wants to do. There's nothing to make yet."
Watch for: disgust or sensory overload, which can be marked in autism or trauma; offer gloves or tools. Watch also for dissociation. It is working when the client's breathing slows and spontaneous associations appear.

4.7 Found-object reflection

Purpose: use something the client finds as a projective and metaphoric focus. Gulbe et al. list found-object reflection among direct-engagement methods. [source: Gulbe et al. 2025; steps are synthesis]
Steps: (1) Invite the client to find an object that draws their attention: a stone, a twig, a feather, a seed head. (2) Ask them to describe it in detail. (3) Ask how it is like or unlike them or their situation. (4) Let them decide whether to return it to where it was found or keep it, where local rules permit.
Example language (illustrative): "If this stone could speak about what it's been through, what would it say?"
Watch for: feathers, bones and droppings (hygiene, and legal protections for some wildlife items); over-interpretation by the therapist. It is working when the client links the object to their own experience.

4.8 Building a home in nature

Purpose: a mostly nonverbal method for exploring security, self-coherence and boundaries. The client builds a protected, familiar personal space within a larger, unfamiliar landscape, which Berger links to the ritual idea of a sacred space, "a safe healing space". [source: Berger and McLeod 2006; Berger 2022]
Steps: (1) After the client has chosen a place, invite them to mark or build a space that is theirs, for example a circle of stones or sticks. (2) Build with them if invited; Berger builds alongside the client to flatten hierarchy. (3) Return to it across sessions and let the client maintain it. In Berger's case the circle was built over about three sessions, and tending it became a regular ritual. (4) When conflict arises, the client may revisit the space to check that it is still intact; work with what this shows about safety. (5) Use only loose natural materials and dismantle or leave them as local rules require. [step 5 is synthesis, Countryside Code]
Example language (illustrative): "Would you like to mark out a space here that belongs to you, using whatever you find around?"
Watch for: distress if the space is disturbed (see 4.11); the method can be powerful with children with attachment difficulties. It is working when the client uses the space as a secure base and begins to explore beyond it.

4.9 Land art and sculpture with natural materials

Purpose: a visual art response to an experience, mood or theme. Nash describes "a visual art response through sculpting, modelling, or land art"; Gulbe et al. list crafting with natural materials and environmental art installations. [source: Kopytin interview with Nash; Gulbe et al. 2025]
Steps: (1) Offer a theme or leave it open: a feeling, a relationship, a transition. (2) Invite the client to gather loose, fallen or abundant materials. (3) Make the piece in silence or with minimal talk. (4) Invite the client to walk around it and view it from different angles. (5) Reflect: what is it, what does it need, what would they title it. (6) Agree whether to photograph it and whether to leave it to weather (see 4.11 and 4.18).
Example language (illustrative): "Using what's lying around, make something that shows how this week has been for you. It doesn't need to look like anything."
Watch for: "I'm not artistic" (stress process over product); harvesting living plants; perfectionism. It is working when the client becomes absorbed and later finds words for what they made.

4.10 Sand map of one's development

Purpose: externalise a life story in a dynamic medium. In a training workshop Berger describes, participants shaped sand maps of their development and built sand forms. He calls sand "a dynamic medium" for exploring creation and destruction. [source: Berger 2022]
Steps: (1) On sand or soft ground, invite the client to shape the course of their life: its places, turning points and obstacles. (2) Ask them to show you the map and walk you through it. (3) Ask where they are now, and what they would add or change. (4) Let them decide whether to smooth it away or leave it for the tide or the weather. [steps 2 to 4 are synthesis]
Example language (illustrative): "Could you draw the path of your life so far in the sand? Put in the places where it bent or got stuck."
Watch for: traumatic material surfacing quickly; slow down and contain it. Watch also for grief when the map is erased. It is working when the client sees the pattern of their story and claims some choice about what comes next.

4.11 Working with change: revisiting the work

Purpose: use nature's own changes to the work as therapeutic material. For Berger, "the changes brought about by nature were part of the contract"; dried flowers and a breaking wave became prompts for new meaning. In one case a client built a sculpture and returned over several days to see how it changed. [source: Berger 2022; Berger and McLeod 2006]
Steps: (1) Agree in advance that pieces left outdoors may change or disappear, and make that part of the contract. (2) Return to the piece in later sessions. (3) Ask what has changed, how they feel about it, and what it reminds them of. (4) Explore control, trust and loss. (5) Offer choices: repair it, let it go, or make a new one.
Example language (illustrative): "The wind has taken half of it. What's it like to see that? Does it connect with anything else in your life right now?"
Watch for: destruction by other people rather than by nature, which can feel like violation rather than process; acknowledge the difference. It is working when the client tolerates impermanence with less distress, or finds meaning in it.

4.12 The journey: a walk as an inner process

Purpose: treat a physical walk as parallel to an inner process. Berger's group work included personal journeys and solo walks. [source: Berger and McLeod 2006; Berger 2022]
Steps: (1) Set a question or intention for the walk. (2) Walk together, or walk separately within sight on a known, bounded route. Any solo time must stay within the agreed bounds and safety plan, with no solo time in remote or hazardous terrain. (3) Invite the client to notice what draws them or blocks them on the way, and to collect one image or object. (4) Debrief the parallels with their inner journey. Cross-refer the walk-and-talk guide in this family. [safety bounds are synthesis]
Example language (illustrative): "As we walk this loop, keep your question in mind and notice where your attention goes. We'll compare notes at the gate."
Watch for: physical fatigue (adjust the route; set no exertion targets) and fear of being alone. It is working when the client's account of the route carries personal metaphor.

4.13 Shared practical tasks

Purpose: build relationship through doing rather than talking about the relationship. Berger used building a fire and making tea with a boy with pervasive developmental disorder to create "a real relationship through engaging in these practical tasks". [source: Berger 2022]
Steps: (1) Choose a simple shared task the site permits: a shelter, a path, a planting or brewing tea. (2) Light a fire only where landowner rules and the Countryside Code allow, and only if you are trained in fire safety. (3) Share the steps and let the client lead some of them. (4) Notice relational patterns as they emerge: taking over, deferring, cooperating. (5) Reflect on them later if it is useful. [steps 2 to 5 are synthesis]
Example language (illustrative): "Shall we make tea together today? You choose where we set up."
Watch for: burns and fire rules; the task becoming an activity with no therapeutic frame. It is working when trust and spontaneous talk grow during the task.

4.14 Creating a ritual from natural elements

Purpose: mark a change or transition. Berger creates rituals for each group from its own culture and from natural elements such as water, wind, fire and earth, rather than borrowing from existing traditions. He uses natural cycles (dusk, dawn, tides) as symbols of change, so that clients can connect "their personal to their cosmic stories". [source: Berger 2022; Berger and McLeod 2006]
Steps: (1) Name with the client what is being marked: an ending, a loss, a new start. (2) Let the client design the ritual: the place, the time, the elements, the words and any witnesses. (3) Rehearse it if helpful. (4) Hold the ritual, with you as witness. (5) Debrief. Use only biodegradable natural objects; in Berger's case a client threw an object into a river, so check local rules and do not put anything into water that harms it. Do not borrow content from living religious or Indigenous ceremonies; cross-refer the secular ritual and therapeutic ritual guides in this domain. [client authorship and limits are synthesis]
Example language (illustrative): "If you could mark this ending out here, what would you want to happen, and where?"
Watch for: rituals that become performance for you; spontaneous ritual in groups. Berger describes one group spontaneously turning a sand channel into a birth-canal ritual, which needs careful containment and consent around touch and closeness. It is working when the client experiences the transition as owned and marked.

4.15 Seasonal and cyclical structuring

Purpose: frame longer group work around the turning year. Environmental arts therapy gives "attention ... to the natural cycles and seasonal changes". Siddons Heginworth's year-long Circle of Trees groups focus on the qualities of one tree each month, combining visual arts, drama, movement, voice-work and ritual outdoors. [source: Kopytin interview with Nash]
Steps (in outline; the full monthly scheme is in Siddons Heginworth's books and trainings, not reproduced here): (1) Plan the group across the seasons. (2) Introduce each month's theme through what is happening in the land: growth, fruiting, decay, dormancy. (3) Invite creative responses through art, movement, voice or story. (4) Link the season's theme to the members' own life processes. Seek training before running such groups. [steps 2 to 4 are synthesis]
Example language (illustrative): "The leaves are coming down this month. What in your life is asking to be let go of?"
Watch for: imposing seasonal metaphors that do not fit, and clients from other climates or cultures. It is working when members bring their own seasonal metaphors unprompted.

4.16 A framework story for children's groups

Purpose: hold a children's group within a shared story. Safe Place used a story about the "guardians of the forest" who rebuild a "safe place". It was co-led by a facilitator and the class teacher over 12 weekly two-hour sessions, indoors and outdoors. [source: Berger 2022]
Steps: (1) Agree aims, consent and assent, and safeguarding with the school, parents and children. (2) Introduce the framework story. (3) Alternate classroom and outdoor sessions in which the children act within the story through building, making and ritual. (4) Return to the classroom to close each session. (5) Coordinate with the teacher throughout. [steps 1 and 5 are synthesis] Do not name or photograph children without consent from parents and the school.
Example language (illustrative): "The guardians need help to build a safe place in the forest. What should it have so that everyone feels protected?"
Watch for: distressed children who need individual follow-up; your safeguarding duties. Berger reports benefits for group cohesion and reduced aggression but gives no effect sizes. It is working when the children use the story to talk about safety and help one another.

4.17 Nature photography

Purpose: frame and attend to the natural world, and work with the resulting images. Gulbe et al. list nature photography (direct engagement) and working with nature photographs (indirect engagement). [source: Gulbe et al. 2025; steps are synthesis]
Steps: (1) Give a prompt, such as "something that feels like how you are" or "something you'd like to protect". (2) The client photographs on the outing or between sessions. (3) Choose a few images together. (4) Ask what was outside the frame, what drew them, and what title they would give. (5) Agree consent and storage: no identifiable people, especially children, without consent.
Example language (illustrative): "Take three pictures this week of things that caught your attention outside. We'll look at them together."
Watch for: the screen replacing contact (suggest putting the phone away for part of the time); privacy of passers-by. It is working when images open up feelings the client could not easily name.

4.18 Documenting, keeping or releasing the work

Purpose: decide with the client what happens to impermanent work, and protect confidentiality. [synthesis]
Steps: (1) Before making anything, agree whether work will be photographed, who keeps the images and where they are stored. (2) Ask the client's permission before photographing. (3) Offer choices for each piece: dismantle it, leave it to the weather (see 4.11), or keep a small part, where rules permit. (4) Keep images as clinical records under your record-keeping policy, and use them in supervision or publication only with consent.
Example language (illustrative): "Would you like a photo of this before we leave, or would you rather it just stays here and does what it does?"
Watch for: clients who want to keep everything (attachment and loss), or who refuse any record (privacy). It is working when the choice itself becomes meaningful.

4.19 Nature writing and nature-inspired poetry

Purpose: give language to an encounter with place. Gulbe et al. list nature-inspired poetry and journaling about nature experiences. Atkins and Snyder's appendices include a writing-centred structure for a nature-based expressive arts session, alongside body-centred and ritual-centred structures; its contents are not reproduced here. [source: Gulbe et al. 2025; JKP description of Atkins and Snyder 2017; steps are synthesis]
Steps: (1) After sensory contact or making, invite free writing from what the client noticed. (2) Offer a simple form, such as a list of what is seen, heard and felt, or a letter to or from a place, tree or creature. (3) The client reads it aloud if they wish. (4) Reflect on resonances with their life. (5) Between sessions, a nature journal is optional.
Example language (illustrative): "Write for a few minutes, starting with 'In this place I notice...', and keep going without correcting."
Watch for: literacy and language barriers (offer voice notes or drawing); shame about writing. It is working when the writing carries feeling and personal metaphor, not just description.

4.20 Map-making and ecological identity

Purpose: explore the client's relationship with places across their life. Gulbe et al. list map-making and art-based exploration of ecological identity among indirect-engagement methods. [source: Gulbe et al. 2025; steps are synthesis]
Steps: (1) Invite the client to draw a map of places that mattered to them: childhood landscapes, places lost or longed for. (2) Mark feelings and memories on the map. (3) Explore themes such as belonging, displacement, migration and loss of land. (4) Consider which places are reachable now, and what the client might do with that.
Example language (illustrative): "Draw the places that have shaped you, whatever they are: a street tree, a grandmother's garden, a coastline."
Watch for: grief about migration, or about places damaged or no longer accessible; trauma connected with land. It is working when the client links their history to present resources.

4.21 Bringing nature indoors

Purpose: offer nature-based creative work when going outdoors is not possible, because of mobility, institutional rules, weather or the client's readiness. Gulbe et al. list miniature ecosystems and terrariums, making art materials from nature, nature-inspired colour palettes and metaphors, and working with photographs. They note access barriers in prisons, medical settings and lockdown. [source: Gulbe et al. 2025; steps are synthesis]
Steps: (1) Bring in natural materials gathered responsibly, or ask the client to bring their own. (2) Choose an activity: a small arrangement, a terrarium, collage or colour work from natural pigments, or images. (3) Follow the same make-then-reflect sequence as outdoors. (4) Check for allergies, mould and hygiene, and follow ward or prison rules on materials.
Example language (illustrative): "We can't go out today, so I've brought some of the outside in. Is there anything here you'd like to work with?"
Watch for: losing the living, changing quality of the setting; materials not allowed in secure settings. It is working when the client engages and the work can later move outdoors.

4.22 Nature-connection prompts: emotion, meaning, beauty, compassion

Purpose: deepen connection with nature during creative work. Lumber, Richardson and Sheffield found that contact, emotion, meaning and compassion predicted nature connection, with compassion working through engagement with natural beauty. Knowledge-based activities did not predict connection. [source: Lumber, Richardson and Sheffield 2017; application to therapy is synthesis]
Steps: (1) Replace naming and identification tasks with prompts about feeling, beauty and meaning. (2) Pair making with noticing beauty, for example "choose the most beautiful thing you can find and respond to it". (3) Invite care, such as tidying litter or protecting a plant, where appropriate.
Example language (illustrative): "Don't worry what it's called. What do you feel when you look at it?"
Watch for: clients who use facts to keep distance from feeling; respect that as a defence and go gently. It is working when the client expresses care for, or kinship with, the place.

4.23 Working with eco-anxiety and climate grief in creative work

Purpose: hold distress about environmental loss when it arises in the work. Gulbe et al. say art therapists should be prepared to handle eco-anxiety and environmental grief. [source: Gulbe et al. 2025; Climate Psychology Alliance North America]
Steps: (1) Validate the feelings without pathologising them or rushing to solutions. (2) Use the creative work to give the grief a form, for example a piece that honours something lost. (3) Assess for depression, hopelessness or suicidal thinking in the usual way; climate distress does not replace a risk assessment. (4) Consider peer spaces. Climate Psychology Alliance North America runs workshops for people hosting climate cafés, group conversations about thoughts and feelings that it states "are not therapy groups". (5) Support action that has meaning for the client, where they want it. [steps 1 to 3 and 5 are synthesis]
Example language (illustrative): "It makes sense to grieve what's happening to places you love. Would you like to make something for what's being lost?"
Watch for: spiralling despair, or a therapist's own climate feelings shaping the session (take this to supervision). It is working when the client can hold grief alongside connection and agency.

4.24 Referral, preparation and debriefing for community nature-arts and green social prescribing

Purpose: connect a client with community provision and integrate it with therapy. In green social prescribing, link workers take referrals from GPs and other agencies and work through a "what matters to you" conversation. Referral routes run from GPs, practice staff, social care, public health and specialist mental health services, and voluntary groups; people can also self-refer. [source: NHS England green social prescribing; NASP green toolkit; Bragg and Leck 2017]
Steps: (1) Discuss with the client what they want: company, making, being outside, structure. (2) Find local provision through link workers or local directories; Bragg and Leck recommend that providers register with these. (3) Check that the group suits the client: who leads it, accessibility, cost, transport and safety arrangements. (4) Rehearse first-session worries. (5) Debrief in therapy: what it was like, what it stirred, and what it shows about the client's patterns. (6) With consent, coordinate with the link worker or facilitator, and keep confidentiality clear: community facilitators are not therapists. [steps 3 to 6 are synthesis]
Example language (illustrative): "There's a nature-art group on Thursday mornings. Shall we look at what would make it easier to go the first time?"
Watch for: drop-out after the first session; groups that are not ready for distress; cost and transport barriers. It is working when the client attends, connects socially and brings the experience back into therapy.

4.25 Ending outdoor creative work

Purpose: close the work in a way that honours the client's places and pieces. [synthesis]
Steps: (1) Plan the ending in advance. (2) Revisit significant places or pieces, or photographs of them. (3) Offer a closing ritual the client authors (see 4.14). (4) Plan how the client can keep their own nature and creative practice going: community groups (4.24), personal places, a journal. (5) Review what changed.
Example language (illustrative): "For our last session, would you like to go back to your place by the willow, or somewhere new?"
Watch for: losing a place as well as the therapist (a double ending). It is working when the client leaves with their own ongoing relationship to nature and making.

5. Handling problems

The sources treat unplanned change as meaningful, and Gulbe et al. list practical barriers. Most of the responses below are [synthesis] unless a source is given.

The client won't go outside, or freezes at the threshold. Bring nature indoors (4.21). Work at the edge of the site, or on a short, familiar route. Explore the fear itself, which may be about being seen, open space or trauma linked to places. Do not push exposure without consent and a plan. [synthesis]
"I'm not creative." Shift from art product to process and play. Start with sensory contact (4.6) or found objects (4.7). Berger's sequence lets play come before words. [source: Berger and McLeod 2006 for the sequence; the rest is synthesis]
Stuck, or only intellectualising. Move from talking to making. Use emotion and beauty prompts rather than facts (4.22). Change the place or the time of day; Berger notes that different places and times have different effects. [source: Berger 2022; Lumber et al. 2017]
Overwhelm, flashbacks or dissociation outdoors. Stop the activity. Ground the client using their senses and the immediate surroundings. Move to a sheltered, quieter spot or back indoors. Debrief, and adjust the plan. Places, smells or darkness can trigger trauma. Strong group rituals and enactments, such as the spontaneous birth ritual Berger describes, need careful containment, and any touch or closeness needs consent before and during. [source: Berger 2022 for the example; responses are synthesis]
The work is destroyed. Separate natural change, which Berger treats as part of the contract, from destruction by other people, which can repeat experiences of violation. Acknowledge the feelings, and offer to repair, remake or let go (4.11). [source: Berger 2022; distinction is synthesis]
Passers-by, being seen, or meeting someone the client knows. Follow the contract (4.2): pause, change place, or greet briefly. Afterwards, check how exposed the client felt. Choose quieter sites and times. [synthesis; privacy as a challenge from Gulbe et al. 2025]
Weather. Use the agreed alternative, such as shelter, indoors or online. Treat sudden change as possible material only once everyone is safe. The Countryside Code notes that conditions can change quickly in hills and at the coast, and that turning back early is sensible. [source: Countryside Code; Berger and McLeod 2006 on seasonal adaptation]
Physical incidents: tick bites, stings, allergic reactions, falls. Follow first aid within your training, your organisation's procedures and UKHSA tick advice. Seek medical help as needed and record the incident. Review the site risk assessment. [source: UKHSA; the rest is synthesis]
Water nearby. No one enters the water as part of creative work. Keep back from unstable banks and incoming tides. Cold-water shock, hypothermia and drowning are real dangers, so route clients who want to swim to RNLI, Swim England, the Outdoor Swimming Society or national lifesaving guidance, and to medical advice about conditions such as heart disease, epilepsy, pregnancy or medicines. Cross-refer 022 and X 196. [synthesis]
Non-attendance or non-adherence (journals, photos, group sessions). Make any between-session tasks optional and small. Explore barriers such as cost, transport, shame or depression. Use behavioural-activation framing, without setting activity targets (cross-refer II 040). [synthesis]
Ruptures. Ruptures can come from a therapist who takes over the making, interprets too early or chooses the place. Return authority to the client: Berger builds alongside the client and treats the client's choice of site as central. Name the rupture and repair it. [source: Berger and McLeod 2006; repair is synthesis]
Group difficulties. Conflict over materials or space, or members who dominate or withdraw. Use clear ground rules, enough materials, and individual space within the group (each member's "home", 4.8). Co-facilitate where possible. Safe Place used a facilitator and a teacher together. [source: Berger 2022; the rest is synthesis]
Harvesting and environmental harm. Use fallen, loose or abundant material, or bring sustainable materials. Leave rocks, plants and trees untouched where the Countryside Code applies. Do not take protected wildlife items. [source: Countryside Code; Gulbe et al. 2025]
Eco-anxiety escalates, or the therapist's own climate feelings intrude. Assess risk. Hold grief with connection and agency (4.23). Take your own reactions to supervision. Peer spaces such as climate cafés are "not therapy groups", so do not refer a client in crisis to them in place of treatment. [source: Climate Psychology Alliance North America; the rest is synthesis]
Risk and crisis outdoors. Carry the client's crisis plan and emergency contacts, and know the route to help. Suicide-risk assessment follows standard practice wherever the session takes place; in the US, 988, and in the UK and Ireland, Samaritans 116 123. [synthesis]
Children and young people. Follow safeguarding procedures, and obtain parental consent and the child's assent. Keep ratios and staffing per the setting's policy. Do not photograph identifiable children without consent. Coordinate with teachers. [synthesis; co-delivery with teachers from Berger 2022]
Scope, dual roles and referral both ways. Many community nature-arts groups are run by artists or volunteers who are not therapists. If a member's distress exceeds what the group can hold, the facilitator should refer them to clinical care, and you refer clients to such groups for connection, not treatment. If you are both the therapist and the group's artist-facilitator, think through multiple relationships (APA Ethics Code Standard 3.05). Get training before delivering environmental arts therapy, for example the London Art Therapy Centre programmes as Nash describes them, which now run in Devon. Check that your insurance covers off-site and outdoor work. [source: Kopytin interview with Nash; APA Ethics Code; the rest is synthesis]
Access and inequality. Barriers include cost, transport, disability, urban access and cultural meanings of nature. Gulbe et al. list budget, travel, mobility and multicultural views of nature among the challenges. The national green social prescribing programme reached participants from deprived areas and ethnic minority populations. Choose accessible sites and co-design activities with the people who will use them, as the NASP toolkit recommends. [source: Gulbe et al. 2025; NASP 2024; NASP green toolkit]

Sources

Web sources:

Books and papers cited:

Atkins, S. and Snyder, M. (2017). Nature-Based Expressive Arts Therapy: Integrating the Expressive Arts and Ecotherapy. Jessica Kingsley Publishers.
Siddons Heginworth, I. and Nash, G. (eds) (2020). Environmental Arts Therapy: The Wild Frontiers of the Heart. Routledge.
Berger, R. and McLeod, J. (2006). Incorporating nature into therapy: a framework for practice. Journal of Systemic Therapies, 25(2), 80–94.
Berger, R. (2022). Theory and practice of Nature Therapy. Ecopoiesis: Eco-Human Theory and Practice, 3(2).
Bragg, R. and Leck, C. (2017). Good practice in social prescribing for mental health: the role of nature-based interventions. Natural England Commissioned Report NECR228.
Gulbe, E., Ozola, A., Vītola, B., Akmane, E., Pacek, J. and Mārtinsone, K. (2025). Exploring nature-based art therapy: a scoping review. Frontiers in Psychology, 16, 1522629.
Lumber, R., Richardson, M. and Sheffield, D. (2017). Beyond knowing nature: contact, emotion, compassion, meaning, and beauty are pathways to nature connection. PLOS ONE. doi:10.1371/journal.pone.0177186.

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