Equine-Facilitated Psychotherapy for Trauma
Developing safe relationships is crucial for the treatment of trauma-related disorders. In The Body Keeps the Score, van der Kolk asserts that “traumatized human beings recover in the context of relationships” (van der Kolk, 2014, p. 212). He further states that relationships provide “physical and emotional safety” (van der Kolk, 2014, p. 212). Individuals whose traumatic experiences occurred in the context of a relationship find it more difficult to develop safe and healthy relationships with other people. For these individuals, animal-assisted therapy provides an opportunity to build trusting relationships with animals. Equine-facilitated psychotherapy is a form of animal-assisted therapy that utilizes horses to help individuals recover from symptoms of traumatic stress. In The Body Keeps the Score, van der Kolk shares the case of fifteen-year-old Maria, who has an extensive history of childhood abuse and behavioral problems (van der Kolk, 2014). When traditional treatment approaches didn’t work for Maria, the residential treatment center she was staying at tried equine therapy. Maria credits this unique therapeutic approach for marking the turning point in her recovery. The safety and “visceral connection” Maria felt with her horse helped her open up to her counselor (van der Kolk, 2014, p. 153).
Equine-facilitated psychotherapy (EFP) is a novel approach for the treatment of trauma-related disorders. In EFP, an individual is paired with a horse and learns how to interact with and care for the horse over several weeks. Participants stay with the same horse for the duration of the treatment, if possible. A mental health professional leads group sessions where an individual learns skills ranging from “basic caretaking tasks, such as grooming and feeding…to horse handling skills, such as leading a horse around the arena” (Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side, 2020). In order to accomplish these caretaking tasks, participants need to develop trust and safety with the horse. Horses are particularly suited for addressing traumatic stress in humans because of their predictable and responsive nature. According to Dr. Neria, Director of Trauma and PTSD at the New York State Psychiatric Institute, horses are “naturally hypervigilant and sensitive to verbal and nonverbal cues” (Fisher, 2021). When humans engage with horses, horses give them immediate feedback. This helps participants adjust their behavior in response to the horse’s feedback. Horses are also “patient and nonjudgemental,” which gives participants space to learn caretaking tasks and communication patterns without fear of retribution (Equine Therapy Helps to Heal PTSD, n.d).
Although there is no standard protocol for equine-facilitated psychotherapy, sessions generally last three months. There are three objectives of EFP: “1. safety 2. attachment 3. regulation” (Naste, 2017). Participants learn how to “recognize and respect boundaries” with the horse, as well as how to set their own boundaries and engage in safe physical contact with the horse (Naste, 2017). Participants also learn how to attune to the horse’s “non-verbal cues” and respond appropriately (Naste, 2017). This strengthens the attachment bond between the participant and the horse. Participants are able to apply the skills they’ve developed in EFP towards building safe relationships with other people. Equine-facilitated psychotherapy is a bottom-up regulation strategy. Similar to techniques such as meditation and yoga, EFP can decrease the activity of the sympathetic nervous system. Participants with trauma-related disorders are in a state of hyperarousal due to an overactive fight/flight system (van der Kolk, 2014). EFP can help these individuals regain the ability to feel safe in their bodies. Since EFP is a bottom-up regulation strategy, it doesn’t involve talking about traumatic experiences directly (Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side, 2020). However, EFP can help individuals regulate their nervous system so that top-down approaches, if used later, are more effective.
Initial research shows that EFP can decrease symptoms of traumatic stress, including hypervigilance and dissociation. In a study of 63 veterans with PTSD, equine-assisted therapy was shown to decrease PTSD symptoms; these results were maintained three months post-treatment (Fisher, 2021). Case studies of children and adolescents with complex PTSD who underwent equine-facilitated therapy also show reduction of trauma-related symptoms and “behavioral dysregulation,” as well as improvements in “interpersonal skills, communication strategies, and overall social functioning” (Naste, 2017). There are several limitations to equine-facilitated psychotherapy. First, there is no standardized approach for conducting this therapy. More research is needed to develop EFP into an evidence-based treatment for trauma-related disorders (Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side, 2020). Second, the high cost of horse maintenance and lack of insurance coverage for EFP decreases the accessibility of this treatment for the general population (Naste, 2017). Despite these limitations, equine facilitated therapy has the potential to help individuals learn to develop safe and healthy relationships. Establishing safe relationships is a pivotal step in an individual’s recovery from trauma-related disorders.
References:
Equine Therapy Helps to Heal PTSD. (n.d.). NewYork-Presbyterian. Retrieved December 9, 2024, from https://www.nyp.org/newsletters/prof-adv/psych/equine-therapy-helps-ptsd
Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side. (2020, January 22). McLean Hospital. Retrieved December 9, 2024, from https://www.mcleanhospital.org/news/equine-facilitated-psychotherapy-facing-trauma-horse-their-side
Fisher, P. W., Lazarov, A., Lowell, A., Arnon, S., Turner, J. B., Bergman, M., Ryba, M., Such, S., Marohasy, C., Zhu, X., Suarez-Jimenez, B., Markowitz, J. C., & Neria, Y. (2021). Equine-Assisted Therapy for Posttraumatic Stress Disorder Among Military Veterans. The Journal of Clinical Psychiatry, 82(5). https://doi.org/10.4088/jcp.21m14005
Naste, T. M., Price, M., Karol, J., Martin, L., Murphy, K., Miguel, J., & Spinazzola, J. (2017). Equine Facilitated Therapy for Complex Trauma (EFT-CT). Journal of Child & Adolescent Trauma, 11(3), 289–303. https://doi.org/10.1007/s40653-017-0187-3
Van Der Kolk, B. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. Penguin Books.