Running head: EQUINE ASSISTED THERAPY IN CHILDREN
Group Intervention: Equine Assisted Therapy in Children with
Emotional and Behavioral Disorders
Lindsay J. Nelson
University of Minnesota Duluth
Equine Assisted Therapy in Children with Emotional and Behavioral Disorders
People who consider themselves to be animal lovers may have at one point or another felt a connection to their animal. The work of animal assisted therapy (AAT) has emerged from those observations. Specifically, equine assisted therapy (EAT) is a particular type of animal therapy that uses horses in the therapeutic process. When a person can understand and be understood by a large animal, communication with people becomes easier and more rewarding. Whether it is with a life partner, a child, parents, co-workers, or friends, equine assisted therapy (EAT) can optimize interactions.
Equine assisted therapy (EAT) is for anyone who is experiencing a health issue, a work crisis, a family dilemma, or a general feeling of being stuck and blocked in their efforts to face life (Integrative Medicine Institute [IMI], 2003). It is an emerging field in which more research is needed. This field uses horses as a tool for emotional growth and learning. It is a collaborative effort between a therapist and a horse professional (“Be as Strong,” 2002). The EAT model can most easily be explained as an experiential approach to working with people. This means that the participants learn about themselves and others by participating in activities with the horses, and then processing these feelings, behaviors, and patterns. It is about life skills and development, not about symptom reduction (S. Smith, personal communication, November 19, 2004).
The focus of EAT is not riding or horsemanship. In fact, 90 percent of EAT takes place purely on the ground (“Be as Strong,” 2002). The focus of EAT involves setting up activities involving the horses which will require the client or group to apply certain skills. Nonverbal communication, assertiveness, creative thinking, problem-solving, leadership, work, confidence, teamwork, relationships, attitude, and taking responsibility are several examples of the tools utilized and developed by EAT.
Throughout history there has been much written about human relationships with animals. It is only within the last thirty years that it has been formalized as a viable treatment option. Research has shown that petting an animal can lower heart rate, and working with and riding horses can benefit people with physical/cognitive/emotional disabilities (DePrekel, 2002). It is not clear when the use of the horse became a specialized therapeutic treatment, but history records the physical and emotional benefits of horseback riding as early as the days of the ancient Greeks.
Hippocrates, Merkauialis, and Tissot all wrote about the therapeutic benefits of horses as early as 460 B.C. At the turn of Twentieth Century, England recognized riding for the disabled as a beneficial form of therapy and offered riding therapy for wounded soldiers of World War I. By the 1950’s, British physiotherapists were exploring the possibilities of riding as therapy for all types of handicaps (“History of,” 1999). Therapeutic riding centers developed throughout Europe, Canada, and the United States. This growing development started in the 1960’s in the United States and subsequently, the North American Riding for the Handicapped Association was founded in 1969.
Dr. Boris Levinson was one of the first to report and write about the psychotherapeutic value of animals. His dog, Jingles, accidentally met one of his young clients and seemed to aid in the communication work and healing process. Levinson came to believe that animals played an important role in developing relationships with clients and helped them work through issues in therapy. Levinson also believed that animals play an important role in maintaining emotional stability and that they gratify such human instinctual needs such as touch, grooming, and pleasure (Levinson, 1997). It is here that horses succinctly fit into the picture and it is in large part due to Levinson’s writings that the field has expanded.
Today EAT is practiced in some form in most countries throughout the world. The United States has seen tremendous growth in EAT since the 1960’s. Indiana has seen the number of EAT centers rise from three to fifteen in the past six years (Indiana Horse Council [IHC], 2000). Statistics for 1999 cite that there are 594 centers countrywide with 3,610 individual members (North American Riding for the Handicapped Association [NARHA], 1999). EAT has helped the growth of the equine industry, which now has a greater gross domestic product than the motion picture services, railroad transportation, furniture and fixtures manufacturing, and tobacco product manufacturing industries combined (Allen Financial Insurance Group [AFIG], 2004). The magnitude of the industry makes horses an abundant resource for EAT and children who have emotional and behavioral disorders (EBD).
After introducing what equine assisted therapy is and how it developed, it can now be examined why it is effective with children who have emotional and behavioral disorders (EBD). First, however, it is necessary to talk about what characterizes these disorders, followed by what the children need, and then what type of therapy has been used to treat emotional and behaviorally disordered (EBD) children.
In recent years, “behavioral disorders” has gained favor over “emotional disturbance” as a more accurate label leading to a more objective decision-making process. It is important to recognize that states vary considerably in their identification, eligibility determination, and placement procedures for children with emotional and behavioral disorders (EBD). This tremendous variation from state to state, and sometimes district to district, makes it apparent that who is identified as EBD is more dependent on where they live, rather than any particular observed behavior (Panacek and Dunlap, 2003). Because there are differences in the definitions of EBD, the number of children who are classified as having EBD varies. One study suggests that as many as three million children in this nation suffer from serious emotional and behavioral disorders (Dwyer, 2004). Another study suggests that although teachers typically consider 10-20 percent of their students as having emotional or behavioral problems, a conservative estimate of the number whose problems are both severe and chronic is two to three percent of the school-age population. Currently, less than one-half that number are formally identified and receive special education services (Zabel, 1998).
A federal definition of EBD does exist. Public Law 94-142 defines emotional disturbance as “a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree, which adversely affects educational performance: an inability to learn which cannot be explained by intellectual, sensory, health factors, an inability to build or maintain satisfactory interpersonal relationships with peers and teachers, inappropriate types of behavior or feelings under normal circumstances, a general pervasive mood of unhappiness or depression, or a tendency to develop physical symptoms or fears associated with personal or school problems” (Zabel, 1998).
Children with EBD frequently display problematic behavior patterns characterized by aggression and disruption that contributes to serious difficulties in their peer relationships. Students with EBD are at greater risk for peer rejection. Such rejection is a major concern, given consistent findings that children who are poorly accepted by peers are at increased risk for a variety of concurrent and long-term negative consequences (Erdley and Asher, 1999). For example, these children are more likely to suffer from higher levels of loneliness, social dissatisfaction, and also experience problems with school transitions into kindergarten and junior high school. In addition, children who are rejected by their peers are more prone to experience long-term adjustment difficulties, more likely to display high levels of aggressive and disruptive behavior, be extremely withdrawn, nonresponsive, or submissive (Erdley and Asher, 1999).
To a very great degree, the social lives of children define their worlds and are essential to their healthy development. Children with EBD typically have a wide range of significant social skills deficits. These may involve problems in interacting appropriately with peers or significant adults in their social environment, difficulties in communicating their physical or emotional needs appropriately, inadequate knowledge of social rules or manners, inability to correctly appraise social situations, and even disruptive behavior such as violence or aggression (Quinn, Kavale, Mathur, Rutherford, & Fornes, 1999).
The types of treatments for EBD children are as widespread as the estimates of the number of children who have EBD. It is agreed upon by researchers that social networks have important roles in social adaptation, mental health, and development. However, there is little research that addresses the functions of networks in relation to EBD and the types of treatment for the disorder. Most programs focus on social skills training, but even within that type of treatment, wide variety exists and experts do not agree as to whether social skills training alone is effective. Less traditional methods of treatment are music therapy and animal assisted therapy, or specifically equine assisted therapy.
Social skills instruction has long been recommended as an intervention for improving the social competence of children with or at risk for EBD. One study found that social skills training was significant, especially if the instruction consisted of direct teaching using modeling, coaching, and effective reinforcement (Lane, Wehby, Menzies, Doukas, 2003). Quinn et al. (1999) conducted a study to determine how effective social skills training was in the treatment of EBD children. They used a quantitative meta-analysis to study the hypothesis under question. The researchers independently found research articles on this topic from the ERIC database. These articles were reviewed by three researchers knowledgeable in the area of EBD and social skills training in order to ascertain each study’s eligibility for the meta-analysis. Thirty-five studies ended up being included in the quantitative review. The researchers used statistical analysis to determine whether or not social skills training was effective. What they found was that social skills training produced less than substantial changes. In comparison, Walker et al. (1996) determined that social skills training is effective for EBD children when integrated across the child’s life.
It is not clear whether social skills training is more labor-intensive or costly than most other interventions used in special education. The cost of not teaching social skills however, is extremely high. There is abundant and consistent evidence that students who fail to develop desired social skills and strategies for dealing effectively in social situations are likely to develop long-term adjustment, mental health, and delinquency problems (Quinn et al., 1999). Adequate social skills are the foundation of personal and social adjustment in life. Few would argue that children with poor social competence are at risk for negative outcomes both within and beyond the school setting. However, it cannot be agreed upon that social skills training alone is effective, nor can it be agreed that other methods are effective.
The length of treatment for EBD is not agreed upon either. A study by Smyyrnios and Kirkby (1994) indicated that EBD children and their families who received the least contact with a therapist did just as well, and sometimes better, than those who received regular psychodynamically oriented treatment. This finding suggests that long-term therapy does not necessarily mean more effective therapy. Even minimal therapeutic contact can give clients a sense of self-efficacy, which can lead to positive change.
Contrary to the above finding, a different study suggests that longer term intervention is necessary in treating children with EBD. The earlier intervention begins, the more effective it will be and the less likely that secondary complications will arise. The persistence of early behavioral problems suggests that longer-term treatment interventions for EBD children are likely to be more effective than brief or episodic treatment (Hester, Baltodano, & Gable, 2003).
Music therapy has also been explored as an avenue for treatment of EBD children. However, like social skills training, there is no conclusive evidence to support whether or not it is effective (Quinn et al., 1999). In this type of therapy, children listen to music and interpret what they believe the music to mean. Their interpretations are indicative of their lives, much like the Thematic Apprehension Test (TAT). Children also are able to write and play music as an expression of their feelings. Much research has yet to be done in this area of treatment, as well as the area of equine assisted therapy (EAT).
In contemporary Western society, nonhuman animals play an extraordinarily salient role in the lives of children. For their first gifts, almost all infants receive soft toys manufactured in the likeness of animals. Throughout childhood, children continue to receive such objects. Animals predominate children’s toys, stories, clothes and room ornaments. Most cartoons are centered on an animal, as are children’s movies and books.
While how long animals have been used therapeutically is not exactly known, the extent to which animals are used for EBD children has been supported by Levinson since 1969 (Levinson, 1997). He believed that emotionally disturbed children who have experienced difficulty in their relationships with people relate more easily or quickly to nonhuman animals. The primary reason, he argued, was the animal’s ability to offer the child non-threatening, non-judgmental, and essentially unconditional attention and affection. This ability allowed the pet to serve as an adequate substitute companion and comforter when other relationships failed (Levinson, 1997). Levinson saw the relationship between the disturbed child and his or her pet as a sort of emotional bridge to access and reawaken the child’s enthusiasm for interpersonal relationships. Recent studies show that children with pets acquire an increased sensitivity to nonverbal communication and a greater ability to recognize feelings in others. As a result, these children often have an easier time making friends than children without pets (Gerstenfeld, 2000).
Programs for EBD children must be designed for the unique educational needs of the child and they must provide the child with some educational benefit. So for children that are especially fond of animals, it would seem natural then to use animals in the therapeutic process. But questions are raised as to why specifically horses, and what benefit does using horses have over other animals?
Those who are familiar with horses recognize and understand the power that horses have to influence people in incredibly powerful ways. Developing relationships, training, horsemanship instruction, and caring for horses naturally affects those involved in a positive manner. The benefits of work ethic, responsibility, assertiveness, communication, and healthy relationships have long been recognized. Horses naturally provide these benefits.
The benefits of horseback riding are as numerous as the types of disabilities and conditions served. Research shows that students who participate in therapeutic riding can experience physical, emotional, and mental rewards (NARHA, 1999). Many riders experience a connection to the horse that few sports can create. For individuals with mental or emotional disabilities, the unique relationship formed with the horse can lead to increased confidence, patience, and self-esteem.
Horses are large and powerful, which creates a natural opportunity for people to overcome fear and develop confidence. The size and power of the horse are intimidating to many, so accomplishing a task involving horses creates confidence and supplies powerful metaphors for dealing with other challenging situations in life. In other words, horses provide vast opportunities for metaphorical learning. Using metaphors in discussion or activity is an effective technique when working with even the most challenging individuals or groups (“Be as Strong,” 2002).
Horses are very much like humans in that they are social animals. They have defined roles within their herds; they would rather be with their peers. Horses have distinct personalities, attitudes, and moods. An approach that works with one horse does not necessarily work with another. They like to have fun. The sense of independence found on horseback benefits all who ride. Horses require work, whether in caring for them or working with them (DePrekel, 2002).
In a time when immediate gratification and the easy way are popular, horses require people to be engaged in physical and mental work to be successful, which is a valuable characteristic in all aspects of life. As people develop their ability, they can begin to respond to that ability by taking responsibility. Horses provide instant feedback when something a person is doing is not appreciated. Most importantly, horses have the ability to mirror exactly what human body language is telling them. Many people complain that their horse is stubborn or defiant. The lesson to be learned is that when people change themselves, horses respond differently. Horses are honest, which makes them especially powerful messengers (DePrekel, 2002).
Grooming and other experiential activities are therapeutic hands on learning that are used towards increasing self-awareness, self-control, bonding, trusting, communication, and personal skill development. This also improves strength, coordination, sensory processing, neuromuscular function, communication skills, and social skills (IHC, 2000).
The therapist acts as a catalyst for change and designs therapy sessions based on theoretical bias. The client takes emotional, cognitive, and psychological work from the therapy session back to everyday life and through a process of practice and reflection, change may occur. With EAT, clients have the opportunity to practice and integrate new ways of being because of the in the moment demands that horses require.
The most important need of the clients that will be served by the agency will be the opportunity to develop the life skills necessary through the use of horses in order to establish a healthy life and maintain relationships. By being in this group, members will be able to develop relationships with people who are experiencing similar issues as themselves. They will be able to develop better communication skills, higher self-esteem, learn to take responsibility, the ability to trust, and a higher sense of self-awareness, which are essential to EBD children. This group will provide members with the sense of support that they need by being willing to make changes and to take into account everyone’s ideas and opinions as well as providing feedback.
The group will meet the needs of the clients that will be served because the clients will be able to develop friendships with the horses and other group members. They will be able to work on communication skills, which will deteriorate social isolation. They will also have the ability to feel loved by allowing themselves to become close to the horses. The children will grow to trust not only the horse, but also the therapist. Trust is something that is lacking in children with EBD. EAT will assist in breaking down the barrier that keeps children from trusting others. The agency will work hard to ensure that the needs of the clients are being met by asking for feedback and assessing the progress of the group members.
Another need that the clients will have is riding equipment. While the tack for the horse will be provided, clients will have to be responsible for coming dressed properly, which includes wearing riding boots or some other form of boot with a heel to ensure safety. Helmets will be required, but only a minimal amount will be provided due to the high expense of safety headgear and also because of the differing head sizes. It would not be feasible for the agency to provide enough safety helmets in all the sizes necessary for the different clients.
The purpose of this group is to provide children who have emotional and behavioral disorders the opportunity to overcome the characteristics that accompany EBD and prevent them from becoming well adjusted and from functioning normally in society. Through direct observation, reflection, and metaphorical analysis, clients will be able to take what they learn in the “classroom” and apply it to their daily lives. This will enable them to deal effectively with situations that arise and allow them to develop lasting relationships.
Because of the unique nature of this group, the group size will have to be limited to less than eight children at a time as it is imperative that there is enough supervision to make sure the children and horses remain safe. It is also important that the group remain small enough in order for the therapist to be able to assess the progress of the members. Another reason that the number of children in the group needs to remain small is because there most likely will be a limited number of horses and equipment available and it is essential that each client be able to work consistently with his or her own horse and the same equipment.
The background of the clients that are in this group will be ones that are riddled with trouble. Since the children that will be in the group have EBD, they have most likely been in trouble in school and at home. Some may have even been placed in foster care or other residential settings. Most of the children probably are not in mainstream classes, but rather in special education classes.
The personalities of the children will differentiate as personalities of all people do. However, what these children will have in common is that they will most likely be unable to interact with each other in appropriate ways. These children will probably be withdrawn for the most part, except for when they are having behavioral outbursts or showing aggression. They will have poor social skills and lack the ability to trust each other.
It is anticipated that some of the children will have much experience with horses while others will have none. Some of the children will be excited to be around the horses while others will be apprehensive or even negative about the experience. The children will most likely differ in their educational level as well as their family situations. It is the hope of the program that the children will learn to accept their background as well as that of others and in doing so will not only learn from others, but also develop friendships.
Time and Space
The group will go for ten weeks, with one session each week. The sessions will be held on a weekend, as that seems to be the time where children get into trouble because they do not have enough to do (Gerstenfeld, 2000). Each session will run for three hours, as it is important that the clients not only get enough time to work with the horse, but also have enough time to reflect upon the experience with themselves, the other clients, and the therapist.
The group will be a closed group. It will be closed for several reasons. The largest reason is that children with EBD have trouble establishing relationships. It will take them time to learn to communicate with and trust each other. Having group members coming and going on a regular basis would be disturbing to the children and they would not allow themselves to get close to anyone for fear that the person may not be there the next time. This group’s intent is to provide a supportive environment for the clients and in order to do so the group must remain closed.
The physical arrangements for the group are not traditional. The setting will be an equine facility with a barn, tack room, a riding arena, and pastures. The setting is complicated as it is necessary to have a large enough facility to not only accommodate so many horses, but also so many clients. The grooming of each horse can be done in the individual stall of each horse. The observing can be done by watching the horses in their pasture as well as in the riding arena. The clients will also be able to work with the horses in the arena, which will teach them personal space boundaries, as there will not be an abundant amount of room. Each client will have to keep enough space from the next to remain at a safe distance.
Minimal refreshments will be provided, as it is a sanitation issue to consume food or drink in the presence of animals. A water cooler will be available located in a clean, distant area away from the horses. Fruit and other such snacks will be provided after the work with the horses has been completed.
The basic structure of the group will remain constant throughout each session. Each group will start with an opening activity followed by contracting for the session. After that is completed, each client is responsible for properly grooming his or her horse. When the grooming gets completed, an activity will follow in which the clients will either observe or participate in the activity. Afterwards, clients will reflect on what they have learned. During this time refreshments will be provided. The sessions will end with a closing activity. While there will be times when the therapist lectures, the majority of the group will be client discussion as it is one of the goals of the group to strengthen communication and social skills in the clients.
Supplies that will be needed include the horses as well as the properly fitting tack for each horse and rider. A proper riding facility will also be needed that includes an indoor riding arena to accommodate for inclement weather. Paper and pencils will be needed to allow the clients to write their reflections.
Group Recruitment and Screening
Members will be recruited by advertising the service not only in mental health clinics, but also in medical clinics, schools, state hospitals, and at appropriate equine related events. Information that will be included is whom the group is appropriate for as well as the benefits of the group. The flyers will specifically state that the group is for EBD children and that the purpose of the group is to help children develop life skills through the use of horses to enable them to function better in society.
Any therapy starts with assessment, but with EAT that assessment includes the client’s ability to interact with the horse and the environment in which the work is to take place. It is necessary to fully explore each client’s experiences with animals. An initial session to assess appropriateness would lessen the possibility of the client experiencing a sense of rejection or abandonment if the therapy was not right for him or her. The client’s history of mental health will need to be obtained as will an opinion from the EAT therapist as to whether or not the group may be beneficial to the client.
A medical doctor’s opinion as to the appropriateness of each client for EAT is necessary. They would screen for deficits in balance, allergic reactions to animals, medications, heart conditions, hemophilia, hypertension, migraine headaches, medical instability, circulatory system disorders, respiratory compromise, skeletal injuries, substance abuse, and weight control disorders need to be addressed from a medical point of view (NARHA, 1999).
The client will have to have a history of EBD for at least one year as well as currently still exhibiting characteristics. The child can be no younger than ten years old because it is important that the child be able to think critically and reflect upon learning. No child over sixteen will be accepted. The client will have to have a medical doctor’s approval as well as a letter of reference stating that the child has no past history of being abusive towards animals. This letter can be from a parent or guardian, or a mental health professional. While undoubtedly some of the letters will be fabricated and untrue, having to obtain a letter will discourage those who have history of animal abuse from applying. This is important as the safety of the horse will not be compromised and it is within the social work ethical guidelines to keep clients safe. In this particular case, horses can also be seen as clients in a sense.
For those individuals who are not appropriate for the EAT group, information regarding alternative services will be given to them. While these services may not necessarily be provided by the same agency, it is important that the child have access to treatment that could benefit him or her, no matter where it is offered. Referrals to mental health professionals who can provide individual counseling as well as referrals for other programs will be given to these clients as deemed necessary.
Staffing the Group
All models of EAT that certify a therapist to perform this kind of therapy require that there not only be a mental health practitioner, but also an equine professional. While the equine specialist is obligatory, this person is not necessarily a co-leader as the purpose of this person is to help ensure the safety of both the clients and the horses as well as assist with any horse related problems that may arise. The equine specialist will be used as a reference if students have questions and will also be able to give insight as to horse’s behavior. However, this person does not have to be and most likely will not always be a mental health professional and is therefore not licensed to provide any sort of therapy. Consequently, this person’s role in the actual therapeutic process will be minimal.
The advantages of having two people is that by having another set of eyes, it will be easier to keep track of all the kids and horses. Another set of hands will be able to assist with the horse related activities such as “tacking a horse up.” The therapist and the specialist can work together to come up with creative activities for the clients to do. A disadvantage to having this additional person is that he or she may intimidate the clients. Also, this specialist may overstep his or her boundaries and try to heal the clients, which is not part of the job for that person.
In order to work effectively together, each needs to be clear about what role they will play. Clear goals need to be established right away in addition to creating a plan for attaining those goals. The two professionals need to be open and clear with each other and address conflict as soon as it arises. The professionals will have ongoing discussion as to how each sees the group progressing and ideas on how to make the group more effective.
In order to start and maintain this group, permission is needed from the executive director of the agency. Because most mental health institutions do not have an excess of money, funding will have to be attained through grants. If the grants are not received or for some reason are taken away, then the group will not be able to maintain itself.
Space is going to be the largest issue of this group. Equine facilities are extremely expensive, especially the sort that this group would need. It would require hard work to find a facility and an owner who would be willing to allow the use of his or her horses for this purpose. This person would also have to be willing to donate his or her time, as funding would be limited enough as it is already. The funding would go to pay for the sessions as well as the use of the facility including the horses.
The support from a certified equine therapy group such as the North American Riding of the Handicapped Association would be needed to certify the therapist and the equine professional in order for the grants to be obtained and for insurance companies to even consider paying for the service.
Group Session One (Saturday Week One)
2:00-2:10 Introduction of Therapist as well as Presentation of Agenda for Approval
2:10-2:30 Introductions and Opening Activity
2:30-3:00 Contract Development
3:00-4:00 Choosing a Horse, Grooming, and Turning Out
4:00-5:00 Reflection and Closing Activity
- Refreshments will be provided at this time.
Group Session Ten (Saturday Week Ten, Last Session)
2:00-2:30 Agenda Approval and Opening Activity
3:00-4:00 Teamwork Activity
4:00-5:00 Reflection on Activity and Group and Closing Activity
- Refreshments are served at this time.
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