An Alternative Therapy: Equine-Facilitated Psychotherapy

1. An Alternative Therapy:Equine-Facilitated Psychotherapy Nadia Moheisen & Roya Leavitt

2. Description: • Equine-Facilitated Psychotherapy – “Experiential psychotherapy that includes equines.  It may include, but is not limited to, a number of mutually respectful equine activities such as handling, grooming, lunging, riding, driving, and vaulting.” This must be accompanied by a licensed mental health professional and an equine professional. • Equine Assisted Learning/Therapy – “Includes equine activities incorporating the experience of equine/human interaction in an environment of learning or self-discovery.” • Goals: usually related to self-improvement, social interaction and/or education. • Often used in group team building exercises

3. Equine Facilitate Psychotherapy (EFP) can be used to alleviate the effects of psycho-social issues and mental health needs such as: Posttraumatic Stress Disorder Eating Disorders Trauma due to Sexual or Physical Abuse Mood disorders such as Depression and Mania Attention Deficit Hyperactivity Disorder, Autism, Personality Disorders Anxiety Disorders Environmental trauma (natural disasters), divorce, grief, and loss. Uses:

4. How/Why it works: • Horses are large and powerful animals, which can incite fear or intimidation. Accomplishing a task involving the horse, despite their fears, creates confidence, and a sense of self-efficacy in the client • Horses mirror the emotions and read the body language of the people around them • Horses don’t lie – they will convey to you exactly what’s going on • Use these as metaphors for understanding the emotions the client is experiencing or avoiding. “Working with horses provides the therapist with an object in the space (other than self) on which to promote projection and identification. Disclosure of abuse and expression of feelings can be integrated into story-telling. Children will tell stories from the animal’s point of view which are metaphorical or are actual details of the child’s life (Reichert, 1998). “ • Congruency: Allow therapist to discover unacknowledged emotions or get to issues faster • Develop problem-solving skills

5. Can address fear and empowerment issues (example: For dependant personality disorder can help discover how to establish boundaries and respect through self-empowerment) • Example – (person hiding emotions, horse picks up on that) • Creates a more nurturing and comforting setting for client and therapist • Riding rhythm and beat can help get through highly charged moments (adults usually revert to fetal position or a rocking back motion when overwhelmed with emotions or fear)

6. History: • 5th century Greek soldiers used horses to rehabilitate their injured • 1969 North American Riding for the Handicapped Association (NARHA) started • Some believe the theoretical underpinnings of EFP originate from Gestalt Therapy (1950’s) which is an existential and experiential psychotherapy that focuses on the individual's experience in the present moment, the therapist-client relationship and the environmental and social contexts in which these things take place • Not until 1996 that Equine Facilitated Mental Health Associated started as a branch of NARHA • Last four years become more widely recognized

7. Case Study • Children: Cross-study analysis (Schultz N.P., Remick-Barlow G. A., 2007): • Main Measurement: GAF ( Children's global assessment of Functioning) • Secondary info: demographic information, physical health history, medication history, mental health history, mental examination, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis. • Participants: 63 total, half Hispanic, age range 4-16, disorders: family abuse, PSTD at-risk for mental disorders, ADHD, and mood disturbance diagnosis • Found significant improvement in GAF, did not test against other therapies

8. Case Study (Karol 2007)  • Case study approach: one example mood disorder (manic and depressive episodes) • “She was able to close her eyes and imagine the horse’s rhythm as her own when she felt herself either out of control or falling toward depression. This did not cure her of these states, but lessened the severity of them, she was able to calm her body and her thoughts which helped prevent most of her manic outbursts from getting out of control.” (example use of metaphor and effect of stable rhythm) • “The horse is a potent object for the child to join with. The child can borrow the power and grace of the horse while he or she is riding and so experience his or her body and, thus, ‘self’ differently. Also the child can join his or her experience of powerlessness and vulnerability with the vulnerable nature of the horse, because of the unique and disparate characteristics of the horse the child can find a friend in both his or her need for an enhanced sense of self and a companion in the lonely and painful experience of limitation and helplessness.” • Helps facilitate trust and communication between client and therapist

9. Organizations • Equine Facilitated Mental Health Association (EFMHA) which is a newly established (1996) branch of the North American Riding for the Handicapped Association, Inc. (NARHA),(est.1969) • Provides workshops, network, guidelines, ethics, certification if eligible to take exam • A growing field (2003-2006) • EAGALA • Horses and Humans Foundation (HHF)

10. Certification • Eligibility for examination to get certification (EFMHA): • A copy of a current license to practice mental health services (counseling, social work, substance abuse counseling, pastoral counseling, psychology, etc.) in the state where you will be providing services. (In some states a Masters is required, in others a bachelors degree with proper training will qualify) • At least 1,000 hours must be in equine facilitated mental health or learning (EFMH/L) • i. At least 550 hours of the 1,000 hours must be in delivery of mental health services that incorporates equines and would include all face to face work with clients, supervision, planning, meetings, and evaluation, etc. • ii. As many as 450 of the hours could be in seminars, coursework, workshops, academic courses, etc.

11. Organizations (cont.) EAGALA (founded 1999) certifies team of: • Mental Health Practitioner: must be under a governing board/association that can hold him/her accountable for any practice violations relating to mental health practice. • Equine Specialist/Professional The person we interviewed (Susan Hice) had become certified in this way and is currently working towards establishing a non-profit status for their practice.

12. In this area… • There are a number of organizations in Virginia which focus on psychotherapy, team-building, and physical therapy… • Horses Healing Hearts in Suffolk, VA • Susan Hice, Equine Specialist in Warrenton, VA (EAGALA Certified Instructor) • Horse as Teach Programs – Charlottesville, VA

13. Sources: • http://www.naropa.edu • http://www.narha.org • http://www.eagala.org • http://www.blackwell-synergy.com – Equine-assisted psychotherapy: a mental health promotion/intervention modality for children who have experience intra-family violence • http://ccp.sagepub.com - Applying a Traditional Individual Psychotherapy Model to Equine-Facilitated Psychotherapy (EFP):Theory and Model