EQUINE PSYCHOTHERAPY

1. EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

2. The Problem • Substantial numbers of children witness family violence. • The prevalence is actually unknown but studies have suggested that 11%-20% of children have a childhood incidence of witnessing family violence. • There is evidence that family violence between parents has adverse effects on the children in the family

3. Problem (cont’d) • These children are at greater risks for behavioral problems, including aggression, cruelty to animals, truancy delinquency, mental health disorders, including anxiety, anger, depression and suicidal ideations, withdrawal, low self-esteem, attention-deficit disorder. • Family violence witnessed by children affects the developmental representations of relationships. Consequently, these representations may shape children’s perceptions and behavior in later life.

4. Problem (cont’d) • A therapy based in relationship-building may provide children with experiences that enhance trust, communication, and guidance to healthier relationships.

5. Equine Psychotherapy • EAP is a specialized form of psychotherapy using the horse as a therapeutic tool. • Horses have several characteristics that are similar to humans in their behavioral responses and social structures, thus providing a mirror for the client to gain insight in a unique and non-threatening environment.

6. Equine Psychotherapy (cont’d) • The horse is a large, powerful animal that commands respect and elicits fear. Overcoming these obstacles and building a relationship promotes confidence, relationship skills and problem solving skills.

7. Equine Psychotherapy (cont’d) • EAP is designed to address self-esteem and personal confidence, communication and interpersonal effectiveness, trust, boundaries and limit setting, and group cohesion .

8. Rationale • This type of therapy provides opportunities for the child to identify and understand personal emotions, develop empathy, develop a sense of responsibility, learn to problem-solve and to succeed in new undertakings.

9. Purpose of Study • Test the efficacy of EAP in a cross-sectional group of children referred to a psychotherapist for various childhood behavioral and mental health issues.

10. Methodology • Over an 18-month period children were referred to a psychotherapist for treatment of various conditions. • Each child and parent was interviewed by the therapist to determine the suitability for EAP. • The sample size was one of convenience in that it included all children referred to the therapist during that 18 month period (unselected consecutive sampling).

11. The Intervention • An equine specialist and a therapist work together to plan safe treatment sessions. • Interventions or activities are planned around the concept of the horse’s reflective behavior. • Interventions are tailored to each individual and their needs as assessed by the psychotherapist and the child and/or parent.

12. Examples of the Intervention • Grooming the horse is learned and practiced. The child becomes acutely aware that the horse will only lift their hoof for inspection if the horse chooses to. The child is unable to force the horse to do this. Children sometimes perceive resistance or an unwillingness from the horse to lift their hoof which may lead the child to have feelings of fear, inadequacy, and/or anger and frustration. At this time the opportunity for the therapist to help the child process these feelings is immediate and powerful. This is done by calling attention to the child’s feelings and encouraging them to talk about their feelings. The child soon learns that the horse is more likely to respond when the child is less fearful and/or angry.

13. Examples (cont’d) • Special attention to consciousness of one’s body is essential for safety, which is used as a demonstration of how it is in the rest of the world. Many times children are unable to understand their place in the world, they may feel themselves to be insignificant or invisible. By instructing them about how to approach the horse, for instance, remain in their line of vision, do not come upon the horse until the horse can see who is approaching, the child experiences their place in relation to others within their environment. While providing for the child’s safety the therapist helps the child to see how they fit into the world.

14. Examples (cont’d) • Children are able to make connections with the horse which facilitates vulnerability. They may be in a large enclosure with the horse and instructed to have the horse move using voice tone and body language. This allows the child to move from powerlessness to seeking support to feelings of success.

15. Evaluating the Intervention • The Children’s Global Assessment of Functioning (GAF) Score is determined by the treatment team before treatment starts and at 3 month intervals until treatment is concluded. • This is a 100-point rating scale measuring psychological, social and school functioning for children aged 6-17. It was adapted from the Adult Global Assessment Scale and is considered a valid and reliable instrument for rating a child’s general level of functioning in a health-illness continuum.

16. Description of the Sample • 63 children ages 4-16 years 59% males 41% females • Males significantly older than the females males = 11.5 + 2.6 females= 10.1+ 3.3 p = 0.05 • Ethnicity Anglo = 51% Hispanic = 46% Black = 3%

17. Psychiatric Diagnosis Category • Mood disturbances 57% • ADHD 16% • PTSD 8% • Adjustment disorders 5% • Disruptive disorders 5% • Other 5%

18. Diagnosis, Gender, Ethnicity • Females tended to be diagnosed with mood disorders more often than males • No ethnic differences in diagnosis

19. Violence in the Home • Interparental violence 40% • Child abuse and/or neglect 27% • Sexual abuse 20% children with a history of sexual abuse were significantly more likely to have had a parent with a substance abuse problem (75% vs. 22% , p < 0.001). children who were identified as having a history of abuse were significantly more likely to have witnessed interparental violence in the home (65% vs. 25%, p = 0.002).

20. GAF Scores • Pre treatment 54 + 3.2 • Post treatment 61.7 + 5.0 p = 0.001 • All children showed improvement in GAF scores • Females showed significantly greater improvement in GAF scores p = 0.02 • Younger children showed significantly greater improvement in GAF scores p = 0.01 • Children with a history of intrafamily violence tended to show greater improvement than those who did not • p = 0.01

21. Conclusions • EAP is an effective intervention for children with a history of mental disturbance and a history of intrafamily violence.