Tina Bexson discovers the benefits of equine assisted psychotherapy for Mental Health Today magazine
People with mental health problems, and especially those who find it difficult to benefit from the talking therapies, can be helped to address their needs by non-verbal interaction with horses. This is the central tenet of Equine Assisted Psychotherapy (EAP), an emerging field which involves the collaborative effort between a licensed therapist and a horse professional working with patients and horses to help the former address specific treatment goals. It is experiential by nature with patients learning about themselves by participating in various activities, such as set tasks and role-playing games with the horses, and then processing and or discussing their feelings, behaviours, and any repeated patterns. The role of the therapists is to act as guides through these processes, effectively involving the horses as teachers.
EAP addresses a number of mental health needs including depression, eating disorders, substance abuse, anxiety, communication needs, and abuse issues and EAP providers are increasingly keen to encourage the NHS to recognise the benefits for patients on their path to recovery.
Ruth McMahon, a former senior occupational therapist who worked with Community Mental Health Teams in Norfolk and Waveney Mental Health Care Partnership, developed her Equine Assisted Therapy Programme along with riding instructor Nicky Welton. They operate from Croft Farm Riding Centre in Filby, near Great Yarmouth where their clients are a mixture of referrals from both the Trust, other Mental Health Care Trusts, charities, local private mental health organisations and from organisations like Independent Living Norfolk where people with enduring mental health problems can apply for government money to fund things that they feel will be of therapeutic value to them.
McMahon first worked with patients and horses back in 1990. ‘To begin with, people with mental health problems were encouraged to attend a local riding school to try ‘therapy on horseback’. The focus at the time was on understanding horse welfare, learning to ride and confidence building,’ says McMahon.
‘A sense of ‘feeling better’ after the sessions was consistently reported by patients and so we decided to explore more work on understanding and communicating with horses, and developing the human-horse bond without riding.’ (Traditionally the focus of EAP is not riding since 90 percent of it takes place on the ground.)
Today a typical session with clients involves the setting up of activities and creating cause and effect situations with the horses which will require them to find coping strategies, and build up trust, self confidence, self esteem and problem-solving techniques that can all be transferable to many other areas of day to day life.
‘For example,’ explains McMahon, ‘some people need to develop a sense of caring so the process of feeding, watering, grooming the horse can be very therapeutic for them as these things can be transferred and help them to think about how they need to care for themselves to stay healthy and well.’
The task of leading a horse around the arena can illustrate many examples of how the patient engages the horse in EAP. ‘Do they just pull the rope, or do they try and engage the horse in eye contact and try to get it to willingly walk with them? This can be quite difficult for some of our patients because they don’t feel they have the right to ask the horse to do this or they don’t think the horse will come with them so often the first step is for the patients to believe the horse will follow them by changing their pattern of thinking then their contact with the horse can be a motivating factor to get them to address their problems which may be those involving communication with other people.’
The benefits of working with horses as opposed to other animals, says McMahon, centre primarily around the horses’ ability to mirror what human body language is telling them. ‘They like clear open communication and see through to falseness and so work well with patients whom they sense are congruent within themselves,’ she says.
A frustrated patient will not find the horse co-operative. ‘The horse mirrors back to the client how they themselves are behaving and so their interaction can also act as a metaphor for the difficulties the client may have with people.’
The very size of horses is also significant for some patients. ‘The therapy provides an opportunity for them to overcome any fear and develop confidence. And accomplishing a task despite these fears provides useful metaphors when dealing with challenging situations in life.’
Most of McMahon’s clients tend to have enduring mental health issues and so after an initial batch of around six weekly sessions most are likely to come back again and again for a further six sessions each time. ‘We tend not to use it as a short-term treatment. Though used on a short-term basis, because of its intensity, it can be very powerful in helping people to start the process of recovery by having their various issues highlighted so they can go on to explore them deeper.’
This has proven to be the case for people with addiction problems and eating disorders. A number of treatment centres use it as part of their wider addiction treatment programmes, including the Priory’s North London Clinic and STEPPS, a residential rehabilitation clinic in Gloucester which has recently formed a subsidiary LEAP to purely concentrate on EAP.
Most EAP programmes used with these patients are based on the belief that those who are susceptible to addictions often have a history of unresolved trauma which creates an untolerable level of anxiety. This in turn leads to self-medication with alcohol, drugs, food, sex, and other types of behaviour. Such clients are also often distanced from themselves and the use of EAP helps them to become engaged with the self.
Wendy Powell, previously provided EAP at LEAP, and now runs her own private practice in Surrey offering out patient and day programmes as well as training BACP recognised therapists in EAP. ‘It has been very difficult to get the NHS to recognize EAP as an incredibly useful and valid form of therapy with all types of mental health problems but particularly with addictions and eating disorders,’ she says.
Powell explains that eating disorder clients can be manipulative in ‘one to one’ and group therapy settings but whilst engaging in EAP, they quickly become aware that they need to communicate non-verbally with the horses in order for the tasks to be carried out. ‘This’, she says, ‘tends to bring real emotion to the fore much faster as a result.’
‘We have also found in EAP that the use of a horse allows these clients to express themselves and to feel comfortable and safe enough to physically embrace such a powerful animal. This may be one of the rare occasions that such a patient gets to experience non-threatening touch with a sentient being and this raises genuine feelings and emotions which you are unlikely to get in the normal therapeutic settings.’
’Often eating disorder clients are particular about which horse they work with. One client I had was a man weighing 26 stone who did not want to work with a small but very rotund pony because he said the horse was fat and therefore lazy. He would not even approach the pony and said that just being around this pony made him feel uncomfortable. We were able to get him, over a period of several sessions, to recognise that he was projecting onto the horse how he felt about himself. He subsequently did a lot of work around stereotypes and what they meant to him.’
Powell has also found that anorexic patients often only want to work with horses that look perfect and have no scars or obvious physical defects. ‘When challenged with having to work with a horse that may have what these patients perceive as a defect, the initial instinct appears to be to avoid that horse, even if it is desperate for attention. This opens paths to physical appearance issues and body image perceptions and allows the therapists and clients a very real opportunity to challenge these beliefs and perceptions and to use these observations as a mirror of how they see themselves.’
There is a substantial body of evidence for the benefits of physical activity for mental health, and research focusing specifically on EAP looks promising. Research into the use and efficacy of EAP is predominantly qualitative, and, less commonly, quantitative.
Dr Helen Spence, part-time Teaching Fellow in Animal Behaviour at the School of Psychology, Queens University Belfast, and Equine Behaviour and Training Consultant says that the qualitative research into the use and efficacy of EAP is, on the whole, very positive about the benefits of the use of horses in a therapeutic setting and is drawn from the reports of participants and therapists. ‘EAP can provide well being and improvement in the quality of life of children with mental health problems (Rothe, Vega, Torres, Soler and Pazos, 2005),’ she says. ‘Participants in another study benefited from increased confidence and improvements in social stimulation which in turn led to transferable skills being acquired (Burgon, 2003). Also students with special needs were found by Brouillette (2006) to have improved abilities to participate and be responsible, building self control, emotional insight, behavioural awareness, relationship skills and coping skills as a result of interactions with horses.’
Spence insists that practitioners of EAT/EAP should not be disheartened by the lack of statistical evidence. ‘The quantitative research of this area is still in its early days, and improvements in the selection of measurement tools, decisions on what to measure, and controlling for confounding variables may yet lead to significant findings in support of the use of horses in the field of mental health therapy,’ she says.
It is now widely accepted that animals are beneficial to human physical and mental health, with much documentation of the ameliorating effects that pets can have on stress, the ‘social lubricant’ effect and the improvements in physical health arising from pet ownership. It seems likely that equines could be beneficial when introduced to the therapeutic setting.
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Tina Bexson 