The Role of Equine Therapy in Mental Health Treatment

Equine therapy is a general term denoting an animal-assisted therapy (AAT) that covers hippotherapy, equine-assisted (or facilitated) psychotherapy (EAP or EFP), and equine-assisted learning (EAL).

Hippotherapy focuses specifically on physical disorders to improve balance, strength, and coordination, most often through learning horseback riding. Equine-assisted therapy and equine-assisted learning may involve some horseback riding, but for the most part, the horse is used as a therapeutic or educational assistant. Equine therapists state that horses only respond to participants when clients demonstrate cohesion between their words or commands, and their emotions; horses, therefore, train individuals in direct communication and better self-comprehension.

In equine-assisted psychotherapy specifically (sometimes referred to as equine-assisted therapy), horses are treated as a mirror for the individual undergoing therapy. Many equine therapists believe this quality in horses stems from horses being both prey and social animals. they need to be aware of their surroundings due to potential predators, and they typically run in packs, so they are more attuned to the emotions of other creatures, including humans. This is in comparison to less social animals like dogs or cats, which are often used as therapy animals in different scenarios.EAP also helps individuals learn to care for another creature, which helps with empathy, positive habit formation, routine, and endurance. The person learns to accept affection from another creature. In a Jungian therapy structure, symbolism of a horse’s strength, willingness to carry others, and endurance can reflect positive growth to the individual in the therapy sessions.

Types of Equine-Assisted Psychotherapy

There are two basic structures for EAP sessions.

  • Triangle: The individual, the therapist, and the horse interact in therapy sessions. The therapist observes the individual’s interactions with the horse and interprets the horse’s behavior (such as ears down or following) to the client, so the client can understand how behavior affects the animal.
  • Diamond: The individual, the therapist, the horse, and the animal handler work together in therapy sessions. The handler observes the horse’s behavior to interpret the animal’s body language, and to ensure the animal’s safety while interacting with both the individual and the therapist. The therapist observes the horse’s effect on the individual.

Applications of Equine-Assisted Therapy

Therapists have applied EAP sessions to nearly every age group – from young children all the way to older adults. Statistics gathered by the Professional Association of Therapeutic Horsemanship International (PATH Int) show that, in 2013, EAP was used to help children as young as age 2, to adults over 65 years old. For the most part, children 6-10 years old, teenagers 11-18 years old, and young adults 19-30 years old took part in EAP sessions.

Equine-assisted therapy has been used to treat numerous psychological and cognitive-behavioral disorders, according to PATH Intl, including autism, developmental delay/disability, ADD/ADHD, learning disabilities, speech impairments, as well as those suffering from head trauma or brain injury, post-traumatic stress disorder, and substance abuse. In addition, people with eating disorders such as anorexia or overeating disorders, at-risk youth, and violence and sexual trauma survivors have found help in EAP.

Techniques other than horseback riding in EAP include role-playing and reversal, grooming, walking or running with the horse, and mirroring.

Therapeutic Benefits of EAT

Although equine-assisted psychotherapy has become increasingly popular since the 1990s, researchers have performed very few large-scale studies to demonstrate EAP’s effectiveness. The majority of the evidence in favor of EAP is anecdotal or qualitative, but this does not mean it is not an effective therapy. It only means that, like other therapy techniques including talk therapy, outcomes vary in effectiveness based on the individual.

Many people who have undergone EAP report benefits, including:

  • Better communication skills, such as direct communication and assertiveness
  • Improved interpersonal relationships and stronger teamwork skills
  • Greater ability to build trust
  • Improved self-awareness and self-control
  • Stronger focus and concentration on tasks
  • Greater relaxation
  • Improved self-esteem
  • A sense of empowerment and leadership ability
  • Stronger sense of responsibility

EAP can be a good tool to help therapists whose patients have difficulty communicating, whether the problem is due to trouble clearly communicating intention from anxiety or depression, trauma-related communication problems, or a mental disability such as autism. Therapists and their clients are able to speak or interact without looking at each other directly, which can help reduce a sense of judgment or fear in the individual that might be an association about directly confronting another person. For nonverbal or preverbal individuals, EAP can help the therapist or caregiver see the person’s emotional state based on how the horse interacts with the individual.

Unlike other animal-assisted therapies, EAP requires the individual, and often the therapist, to go to the horse, which often requires an outdoor environment. Smaller animals, like therapy dogs, can be brought to the home or a therapist’s office, but horses are large animals that require a large space to traverse. This can remove an individual from a triggering environment and place the person in an entirely new situation, helping the person build new cognitive bridges.

Working closely with horses has also reportedly helped individuals overcome defensive behaviors and old emotional patterns, and see new ways to solve problems or, through empathy, to understand other perspectives. Therapeutic riding in particular has demonstrated an ability to help the rider enter an alpha meditation, in which the individual focuses on problem-solving in the present moment. EAP has qualitatively benefited both abuse survivors and juvenile offenders, giving them a greater sense of self-worth and power, along with a greater ability to empathize with others and work with them as a group.

EAP works well for individuals who dislike talk therapy, particularly veterans returning from combat situations who suffer from post-traumatic stress disorder. Jock Hutcheson founded Scotland-based HorseBack UK to help veterans who, he says, are tough patients because “they don’t want pity.” The horses used in EAP sessions reflect veterans’ emotional states back to them, while also offering them a new routine and structure to break out of the re-traumatizing military training that they fall back on when they feel vulnerable.

Adding EAP to other types of therapy can also, according to some qualitative studies, help reduce therapist burnout. Because the therapist often has support from a trained equine therapist in sessions, this allows the therapist to focus on the client in a new situation with more objective input.

Research on the Effectiveness of EAP

As mentioned, the vast majority of studies on the effectiveness of EAP involve either individuals in sessions reporting their own changes, or caretakers or therapists reporting changes in their clients. However, these qualitative studies suggest that EAP can be helpful for emotional and behavioral complications.

A 2006 study conducted for Governors State University called “Horses that Heal” examined 10 students with diagnosed emotional disorders who were involved in five EAP sessions. The study gathered surveys from the students’ teachers before and after the therapy sessions, examining behavioral changes in the students. Overall, the teachers reported positive changes to aggression, shyness or unassertiveness, boundary-setting ability and responding to others’ boundaries, and ability to listen and respond appropriately.

A report from 2006 examined rates of recidivism in juvenile offenders in Ohio in general, compared to a group of juvenile offenders who participated in equine-assisted psychotherapy at Stone Fox Farms. Recidivism is the rate at which offenders return to court for crimes. Ohio reports an average recidivism rate of 40 percent, with an occasional high of 50 percent; Stone Fox Farm therapy participants have a recidivism rate of 23.2 percent.

A study examining the effects of equine therapy on veterans who suffer PTSD and MST (military sexual trauma), conducted in 2013 as a joint effort between the PEACE Ranch and the Veterans Administration, shows that 72 percent of the participants self-reported an improvement in their symptoms.

Other small-scale studies involving individual self-reporting, as well as caretaker reporting, overwhelmingly support equine therapy to improve psychological disturbances ranging from depression, to PTSD to autism. Emotional and mental health disorders in both children and adults can be improved with this therapy, and it can be effectively used as a supportive therapy in conjunction with other types of therapy.

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