A troubled youth steps into the pasture to meet a therapist, a horse specialist, and his equine partner. The teen has gotten in trouble with school, and he's been sent to therapy for anger management. But here in the pasture?far away from the clinical office he's just a kid with a horse, forging a bond and learning to deal with his emotions as the horse responds in kind.
This is equine-facilitated psychotherapy, and while the method is unique, the results are decidedly positive in cases that involve mental issues. It can be used for psycho-social and mental-health needs that include anxiety, psychotic, and mood disorders; behavioral difficulties; mental illnesses such as schizophrenia, depression, and post-traumatic stress disorder (PTSD); and major life changes that include environmental changes, divorce, grief, and loss.
Although the horse's value in physical therapy has long been acknowledged (see "Horse Therapy History," page 2), the psychotherapy branch is relatively new. We'll introduce you to it with explanations and insights from practicing therapists and counselors.
Equine Responses Hold the Key
The Professional Association of Therapeutic Horsemanship International (PATH International, which also incorporates the group formerly known as NARHA) defines equine facilitated psychotherapy as "an interactive process in which a licensed mental-health professional working with or as an appropriately credentialed equine professional, partners with suitable equine(s) to address psychotherapy goals set forth by the mental-health professional and the client."
"Horses sense what's going on underneath the surface with people," says Jody Enget, PATH International's president of the board of directors and executive director at Pikes Peak Therapeutic Riding Center in Colorado Springs, Colorado. "Someone might seem to be functioning on the outside, but if he or she has problems running deeper, the horse can unveil them."
Enget explains that the act of working with a horse and walking around a therapy center releases energy, encouraging clients to open up to their treatment. When a client needs to learn about empathy and anger management, a horse's physical responses can be a powerful motivator.
"People always say horses have unconditional love," Enget remarks. "I disagree?they're a fight-or-flight animal. If someone were working with an at-risk kid and said, ?You have anger issues,' the kid might not take any advice. But a horse will sense that client's anger and shy away. The kid will see that and say, What can I do, I don't want to hurt the horse.' This teaches a lesson about empathy and the effect anger can have."
Equine Therapists at Work
While an equine-facilitated psychotherapy session may vary, most include a certified therapist, a therapy horse, a horse specialist to monitor safety and the horse's behavior, and the client.
Pikes Peak Therapeutic Riding Center, the oldest, largest, and only accredited PATH premier center in Colorado, provides therapeutic riding and hippotherapy (see "Equine Therapy Defined," page 2). In 2008, the center implemented a Horses for Heroes program to provide equine-assisted therapy for local military.
Clients learn basic horse care and horsemanship skills while engaging in situations that encourage discussion about the problems they face. Enget says the center most often treats troubled at-risk youth and military veterans coping with PTSD.
"We're teaching people the relationship skills needed to work with a horse," Enget explains. "And those skills easily relate to their difficulty relating to people in their lives. You really just teach the clients horsemanship skills, and the issues will start to emerge."
Rocky Top Therapy Center in Keller, Texas, has provided therapeutic riding and hippotherapy to clients for more than 20 years. The center has aided school-age children through a program called Right Trail since 2001. In 2010, the center received a government grant to create a branch of the Horses for Heroes program that cares for military personnel and veterans. Rocky Top's executive director, Mike Hogg, says the program encompasses therapeutic riding, hippotherapy, and equine-facilitated psychotherapy for individuals, couples, and families of members of the military.
"It doesn't take long after meeting for the counselees to bond with their horse partners," Hogg says. "That helps the counselee relax and start talking about what his or her real problems are. The horse facilitates getting down into the areas where the hurt resides, and that's where the counselor can help the client to start piecing things back together and get that person to where he or she is living a higher quality of life."
A therapeutic riding session at Rocky Top Therapy Center typically takes place in one of the facility's pastures, and the sessions focus on groundwork.
"It's quiet in the pasture, the client is out there with the horse, and it makes for a conducive environment for counseling," Hogg says. "People feel very relaxed out there and are more likely to share what's disturbing them."
Hogg says the center treats clients suffering from depression, schizophrenia, and other disorders. The program doesn't include medication, but the counseling that's included as part of its overall treatment often has excellent results.
"People come here because it's different," Hogg says. "I had one colonel tell me all he knows is when he sends his people out here, they come back better."
Why Do Horses Help?
Horses provide a unique method for mental-health therapists to work with clients. Colorado's Enget says she sees results faster than she would with traditional therapy.
"In my experience, when you do office therapy, it takes a long time to engage a client in the treatment process if you engage the person at all," she reveals. "But it takes less than 10 seconds to engage someone in horse work. The clients come wanting to do it. They become way more engaged in the treatment process much quicker because of the enjoyment factor. People are motivated to work with a horse, even though you're having to talk about some of the heavy topics, too."
Sherry Butler is a certified therapeutic riding instructor at Colorado State University. She works alongside mental-health professionals at her facility, and she says the horse's inherent ability to accept people for who they are makes clients more likely to form a bond.
"Some of the changes I've seen include children and teens who come in with a history of having difficulty in school," Butler says. "You put them in therapeutic riding or equine-facilitated therapy, working with horses, and it tends to increase their self-confidence as they learn a new skill. That in turn helps their self-esteem. And because they're successful in the arena with the horses, parents often tell us that they're willing to try new things outside the arena."
Hogg, of the Texas center, says horses are intuitive to humans and respond to signals the client may be unconsciously emitting.
"Among other things, horses can sense your heart rate," Hogg maintains. "If you're anxious, they can sense that and they'll demonstrate a response. They'll either move their ears or position their eyes or breathe differently. They're a one-ton lie detector."
Brooke Knox is Rocky Top's clinical director of education and counseling services. She says counselees often respond better at the center than they would in a sterile office setting because the environment is a positive place where people feel comfortable. Instead of dreading their therapy sessions, clients look forward to coming to them. "The bond our clients make with these horses is incredible," Knox says. "Oftentimes, they pick each other out. We have some horses in this pasture that actually have PTSD they were involved in trailer accidents or were abused by their owner. It's amazing, we'll take a soldier who's closed and tight with PTSD, and the horse will come over and pick him out. It happens all the time."
Could Your Horse Help?
If you've ever thought about donating or loaning your horse to a therapeutic center, you may be wondering if he'd qualify for assisting with this form
of treatment. Therapeutic and hippotherapy horses are required to possess specific traits, including symmetrical movement, ultimate calmness, and a great deal of patience. But according to Butler, horses used for equine-facilitated psychotherapy require a different set of personality traits. Even if your horse wouldn't be suited to traditional equine physical therapy, he could be perfect for a mental-health therapy program.
"With mental-health therapy, we look for a horse that's well trained and has some curiosity about things," Butler says. "The horses need to be open to working with participants and explor- ing with them."
"With equine-facilitated psychotherapy, you don't really have to worry about soundness and movement quality like you do for hippotherapy, and you want horses with a variety of behaviors," she says. "You want horses that are used to people, but you want them to be keen to their environment. It's another way for horses to go back to work."
The Future of Mental Health and Horses In the last decade, PATH International has implemented a set of specialty standards that pertain to providing mental-health services. The organization provides training for equine specialists to work in the mental-health field. Quantified research in this particular field is limited, but an organization called Horses & Humans Research Foundation is working to support, promote, and fund scientific research on the benefits of equine-assisted activities and therapies.
"This field is emerging," Enget says. "There's more and more need for research, and there's more of it happening. In the future, I see the field becoming more professional. The requirements to facilitate will become tougher, and all mental-health professionals will know this is an option for individuals who may need it."
Equine Therapy Defined
Therapeutic riding teaches adaptive riding skills to a client with disabilities that include physical, cognitive, and mental-health issues. Hippotherapy uses the movement of the horse to elicit some change in the client; this therapy could encompass physical therapy, occupational therapy, and language therapy.
Therapeutic driving employs a horse and cart; patients are taught to drive a horse-drawn cart with a therapist.
Therapeutic or interactive vaulting uses vaulting activities to teach teamwork and cooperation, behavioral lessons, and speech and language. Equine-facilitated psychotherapy includes a mental-health therapist working with an equine specialist and a client to treat mental illnesses and issues. Equine-facilitated learning develops skills that clients use in the classroom.
Horse Therapy History
Horses have been known to have a healing influence on humans for thousands of years. Ancient Greeks were recorded as having used horseback riding to treat people with disabilities. In 1875, a French physician named Cassaign prescribed horseback riding to his patients for treatment. At Oxford in England, doctors used horses to rehabilitate soldiers injured in World War I. In the 1960s, several equine therapy organizations were formed, including the North American Riding for the Handicapped Association (NARHA) in 1969. NARHA became known as Professional Association of Therapeutic Horsemanship International (PATH International) in 2011.
As the mental-health field has evolved, experiential approaches in therapy also have developed. In the 1990s, mental-health practitioners began discovering that using horses as a vehicle for psychotherapy is a unique way to get patients out of a clinical setting to achieve results in a different way.
Initial studies surrounding equine-facilitated psychotherapy, published in the 1990s, touted the benefits of incorporating horses for mental therapy. The Equine Mental Health Association was formed in 1996 as a special interest group of PATH International, and the two organizations recently merged.
PATH International's equine-facilitated psychotherapy literature says that in a therapeutic setting, the horse acts as a large biofeedback machine, providing the client and therapist with information regarding the client's moods and changes within these moods. The horse's responsiveness provides information and skill-building opportunities for both the client and the therapist.
Horses and Corporate Team Building
The Horse Institute, which has a variety of locations, is an innovative training program that focuses on equipping corporate employees with leadership development, team development, and improved nonverbal communication skills, among other goals, through working with horses in a group setting.
Participants observe and work with horses at liberty using three to five specific exercises designed to bring out certain skills. After each session with the horses, the group members discuss what they observed and practiced. The Horse Institute's executive director, Marie-Claude Stockl, says horses are ideal for corporate training because they react but don't hold grudges.
"The patterns we observe in some situations with horses are often the same ones we have at work," Stockl says, "so we use the horses as a metaphor for those situations to discuss them."
For more information about The Horse Institute, visit thehorseinstitute.com.
For More Information
To find information for a family member suffering from mental illness or other issues, or if you're interested in becoming a volunteer, you'll want to check out PATH International's Web site at pathintl.org. The site is a great resource for finding riding centers in your area, and you also can learn about certifications available. If you'd like to talk to an individual, you can also contact Jody Enget, PATH International's president of the board of directors, at firstname.lastname@example.org.