From left to right: Angela Fournier, PhD, professor in the Department of Psychology at Bemidji State University; Elizabeth Letson, MS, owner of Eagle Vista Ranch & Wellness Center; and Jennifer Laitala, BA, author, photographer, and equine specialist.
“This is just like my life,” the client[i] said, as she pulled on the lead rope in an attempt to get the horse to move with her through the obstacle course. The tall brown horse didn’t move. A few minutes later, she let go of the lead rope and stood quietly in front of the horse. “I’m stuck. I can’t get this horse to move. He doesn’t want to go,” she said as she looked toward the facilitation team.
The facilitators (a mental health professional and an equine specialist) stood in the outdoor arena during the client’s equine-assisted psychotherapy (EAP) session and held the space while she worked on her activity. At that moment, though, the client quietly stood next to the horse and looked toward the two facilitators like she was waiting for an answer to an unasked question. After a long pause, the mental health professional asked, “What’s happening?” The client responded by gesturing toward the horse and saying, “This is my courage.”
The client was a woman who came to the facility on a weekly basis to work through a traumatic event that had left her feeling anxious and depressed. A few months earlier, she had heard about a therapy practice that involved horses. She loved animals, but had never spent time around horses. In fact, she mentioned that the large animals scared her a little bit. Nonetheless, she was curious and wanted to give EAP a try.
The client spent a few of her first sessions outside in the pasture watching the horses from a distance. Anger. Fear. Triggers. All were present those days. A few of her goals were to be able to write or journal about the trauma, to work through triggers, and move forward with her life. As the sessions progressed, she spent more time out in the pasture, grooming the horses and writing in her journal. One day she shared her story with a horse, the tallest and biggest horse in the herd.
“This horse represents my courage, because I feel stuck and I can’t seem to get started,” she said in response to the facilitator’s question. The client stood next to the horse she named Courage. She held the lead rope in one hand and a crumpled piece of paper in the other. The client’s goal for the current session was to work on letting go. She had journaled about some past events in her life that she felt were preventing her from working through her recent trauma. She had torn that particular page from the journal, and was ready to “put it in the past.”
When asked what it might look like to heal from her trauma, she built an obstacle course with three barrels, a small wooden bridge, orange cones, and at the end of the course was an orange bucket (see Figure 1). She labeled the barrels trust, fear, and family; the bridge was healing; and the bucket was the past. Her task was to bring a horse along with her as she navigated through the obstacles and drop her journal entry into the past.
For several minutes, the client stood in silence. Behind her was a representation of her life and the past bucket. In front of her was Courage, tall and still. While the two stood “stuck” at the beginning of the course, a small brown horse and a small white horse walked through the course and in the direction of the past. They stopped at the fears barrel. Courage began moving through the course, stopping at the same barrel. Seeing all three horses at the barrel, the client began to cry. She explained that the two small horses were like her worries, always there, sneaking in, nagging at her, feeding her fears and holding her back. Specifically, she worried about being good enough – good enough at work and at home, good enough for her family and her friends. She looked at the small horses – her Worries – and noticed Courage had begun nudging at them. She started to smile and pointed out that Courage was larger than both Worries combined (see Figure 2); Courage could push the Worries away if he wanted to.
The client approached Courage, unclipped the lead rope, took off his halter, and dropped it on the ground. After a moment, Courage moved toward the Worries. The client stood with the crumpled paper in her hand as Courage nipped at the Worries, which moved quickly, and shuffled out of the course completely. Courage continued through the course to the past. He stuck his head into the past and tipped it on its side.
The client walked toward the past, moving steadily through trust, fear, and family. As she approached the past, she paused for a moment. She set the past upright, dropped the crumpled paper in, and walked away. When processing with the facilitation team, she noted that each time she had visited the ranch previously, she had focused on getting closer to Courage. She hadn’t even noticed the Worries in the pasture, even though they had always been there, following her around. She realized the Worries had been with her even before the trauma and were impeding her path to healing. She set a goal to spend time with the Worries in her next session, hoping to better understand them and get them under control. As she was talking, she looked at her course and noticed that from a certain angle, everything was lined up behind the family barrel, and she couldn’t even see the past (Figure 3). She smiled.
Thinking Outside the Box in Psychotherapy
This is an example of EAP, following the model of the equine-assisted growth and learning association (eagala). A mental health specialist and an equine specialist partner with horses to help clients find their own solutions. Engaging with horses in ground-based activities results in metaphors; the horses, props, and surroundings become symbols in the client’s story (eagala, 2015; Thomas & Lytle, 2016). Rather than talking explicitly about internal factors (e.g., thoughts, feelings), the client engages authentically with the external environment and internal factors become evident. EAP is an out-of-the-box way to inform and engage the therapeutic process. Clients can become aware of influencing factors (e.g., the Worries) and enact change (e.g., reframe the Worries as much smaller than Courage). This treatment can be a powerful modality for the therapeutic process. The client in this story could be undergoing cognitive-behavioral therapy, with adjunctive eagala sessions aimed at identifying and working through maladaptive thought and behavior patterns. In this way, the client participates in an empirically-supported treatment (i.e., cognitive-behavioral therapy) supplemented with an animal-assisted component. EAP is an out-of-the-box way to inform and engage the therapeutic process.
Developing the Evidence Base
The evidence base for EAP is still developing. Reviews of the literature indicate equine-related treatments can result in positive outcomes (e.g., Selby & Smith-Osborne, 2013). Meta-analyses on animal-assisted therapies in general reveal moderate effect sizes, suggesting therapy incorporating animals has beneficial effects (Nimer & Lundahl, 2007). However, the research has a variety of limitations that must be addressed through more rigorous means (Anestis, Anestis, Zawilinski, Hopkins, & Lilienfeld, 2014).
While research has been conducted using experimental methods to test a specific EAP treatment with a specific patient population (e.g., Nurenberg et al., 2014), the literature is largely based on descriptions of applied research; investigators gather data on an EAP program happening in the real world (e.g., Kaiser, Spence, Lavergne, & Vanden Bosch, 2004; Trotter, Chandler, Goodwin-Bond, & Casey, 2008). Such real-world experiences offer limited opportunities for experimental manipulation and control. In fact, a recent meta-analysis found that most studies on EAP had no control group (i.e., Anestis et al., 2014). Furthermore, most studies to date have examined the outcomes of the treatment (e.g., did symptoms improve? did behavior change?). Concerns about developing the evidence base also call for theory development; we need to understand the therapeutic process itself. This requires looking more broadly, at human-animal interaction (HAI) in general, rather than focusing solely on the outcomes of anima-assisted therapies. Therefore, we are calling for researchers to get creative and think outside the box when studying animal-assisted therapies.
Shift toward basic research. We are studying the short-term effects of brief, unstructured interactions on healthy undergraduate psychology students. Yes, laboratory research with healthy adults is quite different than animal-assisted therapy with a real client and thus has certain limitations to external validity. But in return, we can control for some of the threats to internal validity that hinder research in our field. Once the basic phenomena are understood, we can test them in more generalizable situations. Figure 4 shows researchers observing and recording volunteer participants while interacting with a dog in the laboratory. The laboratory has worked well to study HAI with smaller companion animals; we’ve worked with dogs, cats, rabbits, rats, and even a hedgehog named Whimsy.
Pasture as laboratory. For larger animals, the confines of a traditional laboratory are inappropriate. So we’ve partnered with Eagle Vista Ranch & Wellness Center, a local private practice incorporating EAP. On days when there are no clients booked, we turn the pasture into a laboratory, studying the basic phenomena of HAI with horses. Figure 5 shows student participants in a pilot study being observed by a researcher. Using the pasture as a laboratory to study healthy student participants in their interactions with horses allows us to control for some of the myriad of variables that differ between an office session and an eagala session. Beyond interaction with horses, this therapy includes an outdoor setting, experiential approach, two facilitators, and novelty, each of which can contribute to any differences found between eagala sessions and traditional psychotherapy.
HAI as a continuous variable. In both Figures 4 and 5, the researchers are recording human and animal behavior using the Human-Animal Interaction Scale (HAIS) (Fournier, Berry, Letson, & Chanen, 2016; Fournier, Letson, & Berry, 2017), which is connected to a second limitation of HAI research to date – the field is limited by HAI being studied as a categorical variable. Clients or patients who receive animal-assisted therapy are compared with those who do not (e.g., Klontz, Bivens, Leinart, & Klontz, 2007). But perhaps there can be varying quantities of HAI and those varying quantities could have differential effects. The HAIS is an instrument designed to measure the amount of interaction that occurs in a given time period. We have used it to determine whether there are particular kinds of interactions that are associated with outcomes (e.g. do participants who pet an animal leave in a better mood than participants who just watch an animal?). We have also tested whether an overall amount of interaction is associated with outcomes (e.g., do participants who experience a greater quantity of interaction with the horses leave in a better mood than those who experience less interaction?). We can distinguish between human behavior toward the animal (e.g., the human petted, groomed, and fed the animal) and animal behavior toward the human (e.g., the animal sniffed and licked the human), as well as whether one is more closely associated with outcome variables than the other (e.g., which has a greater effect on human mood – what the human does during the interaction or what the animal does?).
There are many questions to be answered about HAI and its effects. The field will benefit from researchers studying this construct from multiple perspectives. This may mean measuring it as a continuous rather than categorical variable. Our certainty about HAI’s effects will rely in part on our ability to move beyond correlational or quasi-experimental design and use rigorous experimental methods. The field needs explanatory theory, which requires investigations of the process, not just outcomes. Understanding the interaction between two or more complex organisms is challenging and developing the evidence base is a tall order. We need to be both creative and curious when studying HAI. It’s critical that we understand, with certainty, if and how interacting with a horse named Courage impacts human health and well-being.
Anestis, M. D., Anestis, J. C., Zawilinski, L. L., Hopkins, T. A., & Lilienfeld, S. O. (2014). Equine-related treatments for mental disorders lack empirical support: A systematic review of empirical investigations. Journal of Clinical Psychology, 70 (12), 1115-1132.
Equine Assisted Growth and Learning Association (2015). Fundamentals of the EAGALA model: Practice untraining manual (8th ed.). Santaquin, UT: EAGALA.
Fournier, A. K., Berry, T. D., Letson, E., & Chanen, R. (2016). The human-animal interaction scale: Development and evaluation. Anthrozoös, 29 (3), 455-457.
Fournier, A. K., Letson, E., & Berry, T. D. (2017). HAIS: Human-Animal Interaction Scale and manual. Bemidji, MN: Angela Fournier.Nimer, J., & Lundahl, B. (2007). Animal-assisted therapy: A meta-analysis. Anthrozoös, 20(3), 225-238.
Kaiser, L., Spence, L. J., Lavergne, A. G., & Bosch, K. L. V. (2004). Can a week of therapeutic riding make a difference?—A pilot study. Anthrozoös, 17(1), 63-72.
Klontz, B. T., Bivens, A., Leinart, D., & Klontz, T. (2007). The effectiveness of equine-assisted experiential therapy: Results of an open clinical trial. Society & Animals, 15(3), 257-267.
Nuremberg, J. R., Schleifer, S. J., Shaffer, T. M., Yekllin, M., Desai, P. J., Amin, R., Bouchard, A., & Montalvo, C. (2014). Animal-assisted therapy with chronic psychiatric inpatients: Equine-assisted psychotherapy and aggressive behavior. Psychiatric Services in Advance, October 1, 1-7.
Thomas, L., & Lytle, M. (2016). Transforming therapy through horses: Case stories teaching the EAGALA model in action. Santaquin, UT: Equine Assisted Growth and Learning Association.
Trotter, K. S., Chandler, C. K., Goodwin-Bond, D., & Casey, J. (2008). A comparative study of the efficacy of group equine assisted counseling with at-risk children and adolescents. Journal of Creativity in Mental Health, 3 (3), 254-284.
Selby, A., & Smith-Osborne, A. (2013). A systematic review of complimentary and adjunct therapies and interventions involving equines. Health Psychology, 32 (4), 418-432.