November/December 2016 Issue

Mental Health Monitor: Equine-Assisted Therapy — Horses, Humans, Healing
By Sue Coyle, MSW
Social Work Today
Vol. 16 No. 6 P. 8

A medic from the Gulf War struggling with what it means to have been a part of a seemingly forgotten war, a nurse who saw the front lines and their immediate aftermath in Vietnam, a veteran who witnessed his friends and colleagues die in a helicopter crash during a rescue mission, and a marine who returned from Vietnam changed, as they all had been—what do they have in common? The obvious answer is military service.

The less obvious is the path they've chosen for assistance and healing. Each of the individuals listed above has received services at A Helping Hoof, PLLC (AHH) in Utah.

"AHH was started with the idea of engaging active military and veterans in a healing process using horses," explains Laurie Sullivan-Sakaeda, PhD, a licensed psychologist and director of AHH. "The work is based on a premise that horses are very intuitive and will provide feedback to the veterans about their moods, energy levels, and presentation style. While people are also able to give this feedback, the horses are unbiased, so their feedback is harder to deny."

AHH is one of a growing number of organizations throughout the country providing equine-assisted psychotherapy (EAP).

EAP
As Sullivan-Sakaeda states, EAP is a form of treatment based upon the relationship and interactions between a horse and an individual. There are, within the scope of EAP, differing models. One of the primary variations is riding vs on the ground.
"They're both good, but for different reasons," Wanda Whittlesey-Jerome, PhD, LMSW, an associate professor at New Mexico State University School of Social Work, says of the two variations. "The relationship on the ground is about establishing trust, building trust. Once you put a halter on a horse, that horse is paying attention to you and you are directing it. On the ground you're trying to negotiate the power relationship. They [the models] complement each other."

AHH began with only on-the-ground work but evolved to include riding as well, where there is a focus on teaching the concept of "soft feel."

"In the horse training world, 'soft feel' is an approach toward the horse in which the least amount of energy required to get a response from the horse is used," Sullivan-Sakaeda says. "Many of the people, veterans and nonveterans, who seek treatment at A Helping Hoof have a history of being critical of themselves, what could be called a 'hard feel'. The goal is trying to teach them to apply a soft feel to themselves.
"The soft feel concept as applied here includes learning to give themselves positive feedback more than negative to create positive change in their functioning," she notes.

In contrast, the EAGALA (Equine Assisted Growth and Learning Association) model is 100% on the ground. "There is no riding at all," Whittlesey-Jerome says. "It's very humanistic, very experiential," she explains. "We might give the clients the opportunity to do something. There are tools available such as PVC pipe, pylons, boxes, and buckets, and all kinds of things that can create certain obstacles or a path. They can wrap a hula-hoop around a horse's neck and get the horse to move. [But] the horses are left to be horses. It's about negotiating a relationship with an animal who weighs three to four times more than you. The horses are pretty quickly sizing us up. They are quick to sense if someone is in trauma or having incongruent behaviors."

One of the most challenging aspects of EAP is the need for the social worker to take a step back. "Everything in our education teaches us to be experts and interpret what we hear, but the EAP model I am studying is a noninterpretive model," Whittlesey-Jerome says. "You have to put aside your training of learning how to judge and interpret and diagnose.

"The goal is for the clients to have an experience that allows them to explore their anxieties and fears," she continues. "Through their experiences with the horses, the clients build self-efficacy and feelings of control. They walk away feeling like they were heard unconditionally and given an opportunity to be themselves in a safe place."

She notes that a treatment plan is commonly developed but not regularly followed to a T. This is due to the fact that the social worker and equine specialist do not remain in the foreground of a session. Rather, they allow the client and the horse to take the lead. Thus, sometimes a specific goal will not be accomplished as planned.

"If you have all day, it will take five minutes. If you have five minutes, it will take all day," Whittlesey-Jerome says, paraphrasing a quote made famous by noted horse trainer Monty Roberts. "That is an amazing truth about working with horses. When you don't have control over them and they're on their own, they do what they want when they want to do it. As a social worker, I would say that this is the most rewarding, humbling, and physically stimulating activity that I can participate in as a therapist."

Horses
But what exactly is it about horses that make them ideal for healing?
"I have a big bias toward horses," Whittlesey-Jerome cautions before saying, "There's something about the horse—the smell, the beauty, the power, the delicate nature, the fear. They're majestic, [and yet] they don't realize how much power they have.

"There is this immediacy of life. Every moment, they are aware. They are very keen to changes in the environment," she continues. "They like having something to do. When people come out, the horses get excited."

Sullivan-Sakaeda agrees, adding, "They often know what's going on with a person before the person does and provide feedback in a way that people can often 'hear.' The horses also have a steady rhythm, unlike people with anxiety and depression. They eat, walk, breathe in a rhythm and having people join in the rhythm can help the person calm down and feel more grounded. People often relax just being in the presence of the horses without even touching them.

"There is also new research, which has come out recently, exploring the benefit of contact with the horse on the vagus nerve in humans. The vagus nerve is seen as central in the action of PTSD and anxiety, and certain types of contact with the horses are thought to calm the nerve," she says.

Military
What then is it about active and veteran members of the military that make them ideal for EAP?

"Many veterans have a low-level ability to trust anyone. Their communication skills may be troubled, and they have limited experience with positive feedback. The pressure of the military to always succeed, with everything being mastered 'yesterday,' leaves people with little real room to experiment with learning or to have any flexibility in their assessment of themselves," Sullivan-Sakaeda says.
"Often," she says, "the participants are better able to give themselves a break in making changes when they see that the horses need time."

Additionally, it can be difficult for some in the military to admit that they need services. The uniqueness of EAP can be an opening for these individuals. "They don't need therapy, in their opinion," Whittlesey-Jerome says. "They don't want the shame and stigma associated with it. But we don't call it therapy; we call it 'group with horses.'"

And what happens during this "group with horses" can be as simple and powerful as a gesture of connection. "There are stories of veterans with PTSD who have a hard time even leaving their home," Whittlesey-Jerome recalls. "The horses will just go up and put their head on [the veteran's] shoulder. It's an instant connection."
And a necessary one. "Being in a limbo is one of those things that happens to folks when they come back because they aren't who they were. They're very different, and they have to come back into a world that they had to say goodbye to," Whittlesey-Jerome says. "Social workers really need to have specialized training and understanding of the military culture."

Research
Though EAP is still a growing sect, there is research being done about its benefits and applications. Many of these studies are in the pilot stage but appear promising. "People have been studying this since 1999," Whittlesey-Jerome says. "But only since 2004 or 2005 have there been some really concerted efforts."

She notes that the Horses & Humans Research Foundation is a leading funder of research, though they tend to focus on riding therapies. However, there are others such as Whittlesey-Jerome studying on-the-ground models, working to ensure that there is an evidence base behind the practice. "It's just a matter of time," she says.

As EAP continues to evolve and take hold, Whittlesey-Jerome wants social workers to remember one thing: "This is an intervention that we as a profession should be extremely proud of. A lot of different therapy groups are using it, like counselors and psychiatrists. But it really was created by a social worker with the values and beliefs of the social work profession.

"It's ours."

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs and a frequent contributor to Social Work Today.