Journal of Rehabilitation Research & Development (JRRD)

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Guest Editorial

Volume 48 Number 7, 2011
   Pages xi — xii

Author
Barbara MacLean, LCAT, MT-BC

Equine-assisted therapy

Since 2008, the Samuel S. Stratton Department of Veterans Affairs (VA) Medical Center in Albany, New York, has offered the Equine-Assisted Therapy Program for veterans with posttraumatic stress disorder (PTSD). The first year, the program ran for 7 weeks, and in 2009 and 2010, we were able to run 12-week programs in the summers and a 9-week program in the fall of 2010. Also in 2010, veterans from the VA's Adaptive Sports Program enjoyed a 3-hour "sampler" afternoon. In 2011, we are holding two 10-week sessions.

EQUINE-ASSISTED THERAPY PROGRAM

Six veterans from various mental health programs are enrolled in each round of sessions. Each veteran identifies one or two goals on which he or she would like to focus; some of the more common goals are improving verbal and nonverbal communication, decreasing anxiety, handling frustration, building confidence and self-esteem, completing tasks, and becoming more aware of feelings.

Arriving at the facility early in the afternoon, the veterans groom their horses and do groundwork, a training process for establishing communication with the horse, for about an hour and a half. Grooming is important for bonding and building a relationship with the horse and is one form of "Friendly Game." Friendly Game is one of seven games played with the horses as a way to train the horse. The other six games establish the veteran as the leader and teach both the veteran and the horse skills that will be used when the veteran mounts the horse. These games invite the horse to move in various ways: forward and backward, sideways, in a circle, moving just the head, just the hind quarter, head and shoulders, etc., and to walk, trot, and stop when asked. The program is not considered a riding program, but if the veterans are ready, they may do some of these games while mounted. Using a bareback pad or saddle, they tack up their horse and mount. All the skills learned on the ground can be applied to the mounted work. Afterward, they remove and put away the tack, give their horses a carrot or apple treat, and return them to their stalls. Group discussion and processing follow each session. The psychologist and recreation therapist guide the processing to important issues and help the veterans communicate (with humans); acknowledge their feelings, frustrations, and successes; focus on their goals; and provide and receive feedback and suggestions. If needed, some veterans may meet individually with one of the therapists between equine sessions.


Figure 1. Figure 1. Stroke Rehabilitation System.
Figure 2.
HORSES AND PTSD

People with PTSD often isolate themselves, have difficulty connecting with others, and have difficulty trusting others. Many people connect more easily with animals, who can be more accepting of them, do not talk back, and enjoy being touched. This is the reason that pet therapy is so popular. Horses are larger than the average pet, so veterans with PTSD who have problems controlling their impulses realize immediately that, if they express their anger violently or make sudden unexpected motions, the horse is big enough to cause them significant harm.

As prey animals, horses are hypervigilant until they learn they are not in danger. Unlike with many dogs, who trust unconditionally, horses require humans to work to gain their trust. Because of their own hypervigilance, veterans with PTSD easily understand and can relate to the trust and hypervigilance in a horse. Other symptoms of PTSD are emotional numbness, a feeling of "not being in one's body," and a lack of awareness of body language. Horses understand communication primarily through body language, so the veterans with PTSD learn to become more aware of their bodies, their body language, and expression of emotion through their bodies. They must become aware of the body language of the horse, which helps them become aware of others' body language, too.

Horses are also herd animals and look for a leader to follow. Some horses want to be the herd leader. A horse and its human are a herd of two. One of them will establish itself as the leader. If it's not the human, it will be the horse. The veterans must be assertive without becoming aggressive and show confidence to gain the respect of the horse and become the "herd" leader.

NATURAL HORSEMANSHIP AND PTSD

The Equine-Assisted Therapy Programs are conducted at the Every Body Counts (EBC) Therapy Center in East Berne, New York, a facility that prior to 2009 provided services mainly to children with physical impairments and autism. Although the staff at EBC (two physical therapists and a nurse) had no experience with adults and very little with the psychiatric population, they are very intuitive and work extremely well with our veterans. This facility also employs a natural horsemanship technique, which endorses appealing to a horse's natural and herd instincts, which proved to be perfect for our veterans with PTSD.


Figure 4.

Natural horsemanship is a method of training and interacting with horses that differs from traditional methods. Rather than using force and teaching a horse "who's boss," natural horsemanship keys into the language of the horse. Instead of forcing the horse to do something, the handler helps the horse to understand what is wanted and to be willing to do it. Handlers use the body language and herd behaviors of horses to develop a partnership with the horse. Gentle but firm pressure applied in place of fear, pain, and defeat invite the horse into an understanding and trusting relationship. Because of the use of this method and the lessons learned from the horses, amazing things are accomplished that could never have occurred in a simple talk therapy session.

FROM THE VETERANS

The following comments were collected from veterans who participated in the program:

"I learned there is another way of doing things besides `kicking them in the ribs.' This is another way to communicate, and I can use it when communicating with my wife."

"Being with the horses helps me relax. I learned to be more patient."

"I can feel the ground under my feet. I haven't felt that in a long time. I feel present in the moment."

"I was able to be assertive without feeling guilty."

"I learned the difference between being assertive and being aggressive."

"I feel good about myself and what I've been able to do."

"I've learned patience, which I never had, and I've learned trust, which I never had."


Figure 5.
FUTURE PLANS

VA staff, veterans, and the staff and volunteers at EBC are very happy with the success of the Equine-Assisted Therapy Program, and we hope to expand it. To that end, in 2010 one VA staff member and one EBC staff member attended a 3-day training session in Tucson, Arizona. They learned horsemanship from a wheelchair and more about PTSD, spinal cord injury, and finding and training volunteers and also had an experiential lesson in which they simulated being blind and working with the horses.

We are hoping to join forces with another facility that teaches similar techniques, endorsed by the Equine-Assisted Growth and Learning Association (Santaquin, Utah), and that specializes in treating substance abusers.

Barbara MacLean, LCAT, MT-BC
Lead Therapist Recreation/Creative Arts Therapy New York VA Medical Center
This article and any supplementary material should be cited as follows:
MacLean B. Equine-assisted therapy. J Rehabil Res Dev. 2011;48(7):ix-xii.
DOI:10.1682/JRRD.2011.05.0085
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Last Reviewed or Updated  Thursday, August 18, 2011 12:50 PM