Géza Kovács Heerlen, 6th december 2013

1. Is aninclusion of a natural setting, horsesanddogs, beneficialfor a client in psychodynamicpsychotherapy? GézaKovács Heerlen, 6th december 2013

2. Whatis itabout? versus

3. Whatis itabout? EquestrianFocalPsychodynamicPsychotherapy (EFPP) • Stern’s affect attunement • Yalom’sexistential approach • McCullough’spsychodynamic • Psychotherapy • Fonagy’smentalization • Wallin’scombination of ment-alizationandmindfulness (nonverbal-somatic attachment) • 2nd order cybernetics • Wilson’s biophilia hypothesis • Brown’sdogsandhorses as selfobjects • Myers’s affect attunementbetweenanimalandchild • Panksepp’sneurologicalassessedaffect

4. Whatis itabout? EquestrianFocalPsychodynamicPsychotherapy (EFPP) • The EFPP program: • 7 day clinical treatment session (a ranch in Northern Spain) • 4 ambulant sessions (in the Netherlands) • diagnostic -, core conflict -, departing- phase and consolidating-phase. • A team of psychotherapists and equine therapists offer situations/exercises involving animals, dogs and horses in particular. • The helping factor in psychotherapy: • creation of intersubjectiverelationship. • therapist-client working alliance • We hypothesize that EFPP facilitates the forming of this intersubjective relationship easier and provides for a more optimal treatment. The goal: corrective emotional experiences by means of sensory experiences in a natural setting relatively far removed from the patient’s usual environment.

5. Resultsso far on EFPP • Study 1.: • Comparisonof clinicalpsychodynamicgrouptherapywithand without EFPP module, pre-post design • Cluster B, C, NOS personalitydisorders, N=51 • SCL90, BDI, PANAS • Both groupsshowed significant improvement, no significant differencebetween the groups. • Study 2.: • Pre-post design • patients bipolair disorder, dropped out of psychiatriccare, N=25 • SCL90, BDI, WHOQ • Significant improvementin particular on the BDI (t=5.532,df=20, p<0.0005) • Study 3.: • Pre-post mixed method design • patientswithvariety of axis 1 and 2 disorders,N=94 • SCL90, BDI • significant results SCL90, BDI: F(2,45)=29,210 p<.05, η2 =.565; SCL90: F(4,096)=18,000 p<.001, η2=.739 Strong correctiveemotionalexperiencescouldbedistinguished. • Study 4.: • Pre-post design withwaiting list as control • patientswithinsecure attachment representation, N=24 • SCL90, BDI, HSL • Significant improvement:(BSI) t (48) = -3.27, p <.05. and depression (BDI) t (48) = -2.91, p < .05 after EFPP

6. Preliminary results Client Change Interview (N=15)

7. Research objective Mainquestions Subquestionswillreferto: The moderators of effect in EFPP The intersubjectiverelationshipbetweenpatientanddogs, horsesandequinetherapist The enhancement of mentalizationandmindfulness skills The preverbal or non-verbalsensoryaspects The addedvalue of the setting To what extent could EFPP be a more optimal psychotherapy than the usual forms of psychotherapy for patients with mental health problems arising from inadequate attachment representation? What are the effects on psychological functioning in patients with mental health problems arising from inadequate attachment representation after EFPP? What are the discernible differences on psychological functioning in patients who have undergone EFPP compared to patients who underwent regular psychotherapy?

8. methods Mixed method design: • Quantitative : pre-post non-randomised (quasi) experimental design withrepeatedmeasures, TAU as control. Questionnaires on: • psychologicaldysfunction (BSI) • Depression (BDI) • Workingalliance (WAV) • Hope andselfconfidance (RL) • Attachmentrepresentation (HSL) andPersonalityproblems (SIPP-SF) (assessmentquestionnaires) • Qualitative: • Client Change Interview • Semi-structuredquestions Treatment report • Videoregistration of human-animalinteraction in EFPP

9. Thankyouforyour attention!