Horseback riding, carriage driving and on-the-ground equine therapy are all methods that can help with PTSD or traumatic brain injury. (Getty Images)
Sitting within the confines of a traditional office, talking things out with a therapist between four walls, doesn't always work for kids and adults grappling with tough mental, emotional and behavioral health issues. For some people, adding equine-assisted psychotherapy may be an option. Hanging out with horses could feel more natural and nonthreatening – and you don't even have to ride.
Vulnerable Creatures
"I use horses to help folks heal," says Holly Hansen, an equine-assisted psychotherapist with Sabino Recovery, a residential treatment center in Tucson, Arizona. She's part of a team approach that uses a mental health professional, an equine specialist and horses to treat people with emotional trauma and addiction.
This on-the-ground therapy incorporates a connection between troubled humans and highly sensitive animals. "Horses, while they're very large animals, are very vulnerable," Hansen says. As prey animals, horses are hypervigilant, constantly scanning their environment for potential danger. "People who've experienced trauma can really relate to that," she says.
She recalls a client she treated at a previous workplace, a man with chronic relapses of drug and alcohol abuse. Along with receiving regular office therapy, he reluctantly agreed to walk out and sit in the adjoining pasture where horses grazed. After a couple of weeks, the horses came closer and closer. Finally, a single horse approached and got down near him. The trusting relationship that gradually developed led to a breakthrough for the man, Hansen says. Instead of temporary abstinence, he achieved real and lasting recovery.
Sabino Recovery is a private pay residential facility. However, Hansen says, outpatient equine therapy in the Tucson area costs about $225 for a two-hour session. "Depending on the insurance plan. If a licensed clinician is facilitating the equine therapy session, then the session may be covered the same way any other therapy session would be covered by insurance," she says.
Hansen is hard-pressed to name a type of client who wouldn't benefit from equine therapy – other than someone who's severely allergic to horses.
Equal Footing
Amanda, a 13-year-old student, shows up at the main barn in a state of frustration over backbiting friends and middle-school drama. Her session at the Project Horse Empowerment Center in Purcellville, Virginia, begins with a short walk to a nearby field alongside equine specialist Maria Kimble and therapist Heather Kirby. The adults, in T-shirts, shorts and caps, are dressed for horses and the heat on this August day.
About three-fourths of the center's clients are under 18, says Darcy Woessner, executive director of the volunteer-led nonprofit center and a certified equine specialist. Kids are dealing with issues including attention deficit and eating disorders, trauma and post-traumatic stress disorder, autism, and emotional and behavioral modification.
At the pasture area, the rest of the treatment team – two horses named Hope and Uncanny – awaits in two stalls within a small fenced area. All stand and interact.
"We refer to it as equal footing," Woessner says. Some clients don't even touch the horse, at least for a session or two, she says, because of extreme fear or anxiety. Some interact with horses over the fence. She recalls how one young boy with a history of horrible early neglect and abuse taught a horse how to kick a ball.
Uncanny, a thoroughbred quarter horse mix, is Amanda's favorite. Throughout the session, as the horses nuzzle Amanda's back or otherwise compete for her attention, Kirby and Kimble will help her draw parallels between the animals' behavior and situations among Amanda and her friends.
While petting Uncanny's mane, Amanda vents about school acquaintances who butt in. Hope continues to nuzzle Amanda, at one point forcing her to kneel and speak underneath the horse to her therapist. "Do you like her to do that?" Kimble asks. "No." "How would you tell Hope not to do that?"
As the humans talk about setting limits and learning social skills, the horses seem to be listening. Amanda, by simply standing with an air of confidence and assertiveness, wordlessly claims her own space as the large, pushy horse moves away.
Walking back to the main barn, Amanda appears happier and more relaxed. Her mother is waiting, and Amanda greets her with smiles, giving her a rundown of the session. ("Sort of role play," Amanda says.)
Afterward, as Amanda chats with the therapists, her grateful mother makes it clear these visits aren't just pleasant interludes. Amanda has been receiving equine therapy since March, following her latest of multiple hospitalizations for emotional issues including self-harm. Equine therapy is "beneficial," Amanda's mother says, and "an eye-opening experience."
Riding to Recovery
Horseback riding, carriage driving and on-the-ground equine therapy are methods used to help veterans with PTSD or traumatic brain injury, with sessions resuming this week in a peaceful Leesburg, Virginia, setting.
Carriage therapy, involving a horse-drawn adapted cart, is ideal for wounded warriors. "Veterans who are using a wheelchair and are participating at a wheelchair level can learn how to drive a horse and the skills involved in doing so," says Lucile Lisle, a nationally certified recreation therapist at the Washington DC VA Medical Center. Therapeutic horseback riding also addresses a variety of mental-health issues.
"I work with the veterans individually, along with their riding instructor, to help them formulate goals they'd like to work on," Lisle says. To cope with short-term memory deficits, for instance, veterans might learn strategies to help remember the chronological order of steps for securing the bridle and saddle on the horse, or the harness for carriage driving.
Soon, veterans are able to walk, then trot on the horse. "You're able to take control of that horse and be in charge as the rider," Lisle says, and self-confidence grows. Among veterans who have issues with anxiety or hypervigilance related to traumatic brain injury or PTSD, horse therapy can help them relax and feel more comfortable as they build trusting bonds.
The before-and-after difference is often vast. "Those veterans start out where they're just participating in in-house therapies, and they really aren't very independent or functional as much out into the community," Lisle says. "They may stay at home most of the time, and they don't have resources. Horseback riding also gives them those resources."
After 10 or so weekly sessions with horses, vets notice they're adjusting better to their disability or injury and are more relaxed in their daily lives. "Perhaps they're applying for a job," Lisle says. "Or they're out in the community in some other setting and they realize, 'Wow, this is really helping me.'"
As an emerging treatment, equine therapy lacks a robust body of supporting evidence from large, long-term or randomized controlled studies. If you're considering equine-assisted therapy, look for a balanced treatment team that includes a mental health provider with equine-therapy training and an equine specialist. The Equine Assisted Growth and Learning Association, or EAGALA, certifies professionals in its treatment model.
Used with permission from U.S. News & World Report. Lisa Esposito is a Patient Advice reporter at U.S. News & World Report. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.