The Role of Equine-assisted Psychotherapy in Treating Trauma

The field of clinical psychology is vast and diverse. Over the years, treatment of mental health has evolved in many forms, subject to the patients needs and response. This has expanded the field into treatment in the arts, sciences and everything in between. A common realm that has been developing over the years is that of animal psychotherapy. This summer, I worked with a psychological clinic called ECS Psychological specializing in equine assisted psychotherapy and opened my eyes to the endless possibilities of therapy and its effectiveness in aiding trauma amongst veterans and children of all ages. This research ended up being the focus on my internship and having spent days on the horse farm with the clinicians, I was introduced a whole world of psychotherapy I didn’t know existed until my time there.

During my time at this internship I was exposed to nature of trauma patients, especially scars it leaves on people of all ages. Brain imaging techniques such as functional MRIs have further supported this by providing evidence that traumatic experiences changes particular functions and developments in the brain including the amygdala, corpus callosum, cerebellum, hippocampus and prefrontal cortex. Furthermore, the constant stress within a trauma victim leads to high levels of triggers within the limbic system, affecting a persons overall muscular and skeletal system (Baker et al., 201; Bourne Mackay, & Holmes 2013). Due to the complexity of this condition, The Substance Abuse and Mental Health Services Administration collaborated with the National Center for Trauma Informed Care and Alternatives to Seclusion and Restraint to compile a list of “Six Key principles of a Trauma Informed Approach” in order to create a uniform approach to treatment. These principles include safety, trustworthiness and transparency, peer support, collaboration and mutual, empowerment, voice and choice and cultural, historical and gender issues sensitivity (Frei, Rynearson-Moody, Christy, & Clark, 2012). Utilizing this list, it is anticipated that various forms of treatments can be developed to treat trauma. Among them is psychotherapy.

The field of psychotherapy primarily revolves around the relationship between therapist and client. The intended outcome of the treatment is to help the patient overcome demoralization and mend it with a sense of hope. In addition, they treatment anticipates to in place solid pillars of social and emotional support that will in turn bolsters self-esteem and independent coping abilities (Frank and Frank 1991). This alliance in itself fosters a collaborative nature that will eventually lead to attachment, a vital element in treatment. Attachment resulting in strong emotional connections are at the very core of healing and are usually one of the goals of psychotherapy (Haugaard 1994). A specific form of psychotherapy that places emphasis on attachment is animal assisted psychotherapy. Prior research has shown that relationships with animals such as dogs and cats have had positive effects on conditions such as depression (Odendaal 2000), blood pressure (Katcher et al.1983) and coronary heart disease (Friedmann et al 1980).

More recently, a larger scale of animal psychotherapy has come to light called hippotherapy. Hippotherapy, also known as equine assisted psychotherapy utilizes horses for therapeutic uses since the animals possess valuable characteristics such as patience, cooperation and a high level of self-awareness (Hayes 2015) . Due to their distinct personalities and hierarchal structures mirroring that of human families or workplaces, they are often relatable for patients who are seeking support and treatment through therapeutic riding programs that involve grooming and riding the horses. Past research indicates riding provides a ground for patients to socialize as well as be exposed to physical contact with an animal that leads to the development of a relationship that is in some ways, deeper than a human bond, establishing rapport, intimacy and collaboration (Edgette 1996). Upon further research conducted by Yorke, Adams and Coady 2008, this relationship fosters under two main areas- personal and socio-emotional. Personal levels of treatment include fostering feelings of intimacy and nurturing, resulting in mutual liking, trust and compassion fostered in the patient. Riders found that horses were easier to work with because of their “accepting and nonjudgmental nature” that could be found in humans. Moreover, riders said they were able to create a stronger bonds through the exchange of physical affection with the horse, an act that cannot be ethically administered in human-client interactions (Yorke, Adams and Coady 2008). The socio-economical area consists of the systematic and task oriented goals that focus on rebuilding discipline, training and trust in the patient, providing them with a sense of routine an consistency that is often lacking when a patient undergoes trauma. The goal oriented behavior that arises from this further builds confidence and gives the patient control over their own progress (Yorke, Adams and Coady 2008). Overall, the impact of animal therapy has been praised for decades but the power of equine psychotherapy has come to light only recently and must be acknowledged for achieving what modern day human-client therapy cannot.

Equine assisted psychotherapy has come to aid for trauma victims of all ages. When looking at its effectiveness for youth, a study conducted by Kemp et al 2014 sought to observe effects on children and youth who have experienced sexual abuse. It was hypothesized that participants would show significant reduction in symptoms of depression and anxiety that came with the trauma. The results supported this hypothesis in showing that both, children and adolescents showed a significant improvement in their trauma symptoms (Kemp et al 2014). Similar results were shown for children holding PTSD symptoms from car crashes and natural disasters, particularly decreasing levels of reported anxiety and depression. A case study conducted by Johansen, Wang and Binder observed a woman named Anna who had social anxiety and depression as a result of PTSD. This case study highlighted how specific activities conducted in an equine psychotherapy session aided in treatment of this patient. The first target of the session was to improve assertiveness and communication through body language. This was achieved by making Anna move the horse back and forth and to the side without any physical contact. At first the horse was uncooperative and Anna tended to adapt to the horses needs and simply followed it When this did not achieve her goal she recognized that adaptive behavior, stemming from PTSD and a past of trauma and abuse, was ineffective and instead she should express her needs through her actions more constructively. The second target was reduction of anxiety and avoidance and this was achieved through physical tasks such as cleaning the hooves and riding the horse without a saddle. These tasks were seemingly daunting to Anna at first but once she became close to the horse and began trusting that it would not hurt her and that she had control of the situation, her confidence began to build and she started to develop functionality in the presence of anxiety and fear. The last goal was to improve attachment and be comfortable with tough and this was achieved by starting each session by touching the horse with fingertips and eventually hands, arms, face and body. This was a slow and tiresome process but eventually Anna was comfortable in approaching the horse and later, people, to be able to make steady eye contact and communicate. Horses tend to sense discomfort and accommodate for this, thus allowing the patient to take their time to accustom themselves to physical touch. Overall, this case study provided an intriguing lens into an equine assisted psychotherapy session and presented how seemingly complex goals could be achieved in collaboration with the nature of horses (Johansen, Wang and Binder 2016).

The aforementioned studies and research provide ample support for the benefits of equine assisted psychotherapy. Yet this field has a wide room for improvement. For one, the cost of maintaining a barn and taking care of horses is extremely high, especially for clients situated in urban areas. My time at ECS Psychological provided me with statistics of the farm in Saratoga Springs indicating that the cost to keep one horse is about 6,570 dollars a year which is approximately 18 dollars a day. Also, the horses at ECS eat over 3,000 bales of hay per year which costs approximately 15,000 dollars a year. Finally, the average vet cost per year for a healthy horse ranges from 4,500 to 6,000 (Christopher-Sisk, 2018).These numbers begin to add up and can be difficult to maintain. Moreover, a lot of the research conducted on the effectiveness of this treatment collect qualitative data in the form of self-reported levels of anxiety and depression. While qualitative data is beneficial in order to gather detailed evaluations on treatment effectiveness, it is difficult to quantify and use to identify future patterns or limitations. Therefore, if more studies are conducted on this topic in the future, I would definitely recommend gather quantitative data such as galvanic heart rates and cortisol samples to monitor stress and anxiety levels. I believe this will allow us to explicitly identify areas that need to be strengthened for this form of treatment.

Overall, equine facilitated psychotherapy is a leap in the right direction for trauma therapy. Providing patients with the opportunity to rebuild their trust and attachment with an animal broadens the horizons of possibilities that can be achieved in the field of clinical psychology. Not only is the daunting expectations of working with another human eradicated but animals have shown to have a heightened sense of compassion and security that can result in a mutually beneficial relationship. My time at ECS Psychological truly opened my eyes to the endless possibilities of clinical psychology and the healing and changes I saw in patients in the short time I was there proved to me that this line of work is one that requires dedication and patience that will come with time and belief in the treatment itself. I look forward to doing more work in this field and learning more about various forms of therapy that can aid not only trauma victims but anyone undergoing mental or physical turmoil.