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Running head: EAP FOR VETERANS 1 Equine-Assisted Psychotherapy for Veterans
Melissa R. Amos
ENG122: English Composition II
Dr. William Carpenter
May 10, 2016 EAP FOR VETERANS 2 Although traditional medicine is used to a larger extent in the Western world, EquineAssisted Psychotherapy (EAP) provides hands-on exposure therapy which helps the Veteran
make significant progress in treatments, significantly more than the progress which is done
through conventional therapies and medication alone. ?There is something about the outside of a
horse that is good for the inside of man? is a quote by Winston Churchill. Emotional bonds have
been forged with horses, from times past, reaching from Ancient Greece, heroic tales of knights,
and cowboys riding into the sunset. Horses have come to represent freedom, spirit, adventure,
perseverance and drive (Sheehan, 2014).
Interaction with nature and animals helps many people rejuvenate their mind-body
connection. Due to the unique characteristics of the personality of a horse, they have the ability
to reflect human emotion (Brandt, 2013). The world has evolved into an excessively technical
and high demand environment, allowing individuals to separate themselves from authentic
experiences and feelings. Horses show a willingness to express emotion, as such, the use of
horses in a therapeutic setting, creates an effective medium for people to reconnect with their
authentic selves. In contrast, humans have become accustomed to rigidly controlling their
emotional expressions, especially within the military and Veteran population, which has
developed the incongruence between verbal and nonverbal communication. Unlike cats or dogs,
horses are prey animals and must be constantly attuned to their environment to ensure survival.
Horses are highly social heard animals, which depend on continuous communication between
members for safety, by which requires them to remain present in the moment as well as
accurately interpreting their environmental cues (Brandt, 2013). Through interaction and
observation between a human and horse, there are opportunities for a therapist to teach and
develop social and relational skills for a Veteran. Horses rely heavily on nonverbal EAP FOR VETERANS 3 communication and body language. When a human shows incongruence, horses instinctively
react, thereby, reflecting the person?s internal emotional state, regardless of outward expression.
The horse provides instant and direct feedback when they become confused and agitated, which
is non-judgmental, when the person presents unclear intentions or mixed verbal and non-verbal
cues (Brandt, 2013; Kuropatkin, 2013). The lesson that is learned through any equine assisted
learning (EAL) allows the therapist to see physical manifestations of any inner conflicts,
reflected outwardly by the horse?s ability to read and understand human body language. This
provides a learning tool as a pathway to change the ?inside? by changing the ?outside?
(Kuropatkin, 2013). The horse will respond exactly as the human body is communicating, and
will respond and react differently once the lesson of mindfulness has been learned.
EAP may be more readily accepted by those who are resistant to traditional therapeutic
interventions because it is held in a non-traditional setting. The stigma associated with receiving
treatment at a mental health clinic is removed, as the setting requires the Veteran to meet the
horse in its environment, conducting lessons in natural, outdoor settings, which provide more
relaxing and safe environment over a traditional office setting. Conducting therapy in a natural
and interactive environment alleviates some of the stigma related to attending therapy. Clients
often have fewer preconceptions attached to working with horses. This allows the client to
connect emotionally with the horse while their initial negative concepts of therapy are reframed
into an engaging, interactive, and positive experiences allow for deeper participation in the
therapeutic process, which facilitates change within the client (Brandt, 2013; Kelly, 2015).
Experiential learning is frequently more active than traditional ?talk therapy?. Mindfulness of the
body language of both themselves and the horse, being present in the moment, validation of the
non-verbal cues of the horse, all allow the client to gain a better awareness and understanding of EAP FOR VETERANS 4 their own bodies (Brandt, 2013; Kelly, 2015). A unique opportunity to elaborate on this
relationship takes place at a horse rescue, Dream Catcher. At this facility, abused and neglected
horses are rescued, bringing them to a facility which provides care, shelter, and nurturing. This
agency, in partnership with the local Veterans Center, assist Veterans who struggle with PTSD,
depression, anxiety, and issues with readjustment to civilian life. When incorporating with
treatment by a skilled and qualified mental health professional, equines bring qualities into
treatment which enhance this therapeutic modality. Helping rescued horses helps the horse to
?rescue? the person through therapy in a reciprocal relationship (Brandt, 2013; Kelly, 2015). The
Dream Catcher horse rescue provides this unique opportunity through no cost to those receiving
treatment or to taxpayers. Their program is self-funded, charging for boarding, riding lessons and
other services (McGhee, 2016).
Equine assisted psychotherapy is used along with a variety of therapeutic modalities, with
practitioners treating with a wide variety of theoretical practices. It is easily adaptable to
individual, group or family therapy sessions, in which the activities are tailored to the unique
treatment plans and goals of the client (Brandt, 2013; Mansini, 2010). EAAT programs are
diverse and offer concentrations in several different areas of need. All areas encompass specific
goals and techniques, which may be appropriate for certain individuals, which require different
professional personnel to facilitate. All areas complement and overlap, and the client receives
valuable physical and psychological benefits. Regardless of the area of concentration the client,
the horse (chosen for size and temperament), volunteers (trained as side walkers and horse
leaders), a certified therapeutic riding instructor and a licensed therapist work together as a team
to achieve individual goals (Kuropatkin, 2013). Ecopsychology and nature have allowed many
Veterans who otherwise would not have sought treatment through conventional means, due to the EAP FOR VETERANS 5 stigma in the military regarding post-traumatic stress, seek an alternative means for therapy.
Commonality between Veterans with PTSD and how their experiences through nature allow
them to feel as if they have regained their humanity following traumatic military experiences
(Westlund, 2015). Accreditation and certification of staff and establishments offering EAP
require control measures to establish consistency within future programs (Masini, 2010). Those
who have participated in studies report at the end of the session, significantly reduced posttraumatic stress symptoms, less severe emotional responses to trauma, less generalized anxiety,
and fewer symptoms of depression. Increased mindfulness strategies and decreased alcohol use
were all reported (Earles, Vernon & Yetz 2015). Results of those who participated in a residential
equine-assisted therapy program were maintained through a 6-month follow-up.
Clients and horses must be carefully evaluated prior to participation in any EAP sessions.
It is the responsibility of the therapist to establish if a client is fearful or has a history of animal
abuse or arson. This demographic is not an appropriate group for EAP. Those who have a
potential medical condition which may be a safety hazard to the client or horse, must notify the
Clients meet with a therapist in a traditional office setting to complete an initial
evaluation, establish a treatment plan and goals, and discuss the format for future sessions,
discuss with clients their past experiences and comfort level with animals. Brief check-ins prior
to and following each session, in addition to an occasional full session within a traditional
therapeutic setting. Safety considerations are discussed prior to EAP session and throughout the
treatment process. Therapists are also advised to frequently discuss their dual role during equine
activities. Protocols regarding safety and physical touch must all be implemented prior to any
sessions (Brandt, 2013). PATH has identified that social workers are the demographic which puts EAP FOR VETERANS 6 EAP into practice more than any other group of mental health professionals. PATH has stringent
standards to become an approved EAP facility. In these facilities, therapists must play multiple
roles, often being directive and firm with clients because of safety rules. They must occasionally
step in and act quickly to ensure that the horse and client are safe, including physically removing
one or the other from and area, or providing first aid. Credibility within the medical community
and general public, if more postsecondary and advanced degree institutions provided education,
training and certification (Brandt, 2013). Horses that are used for this modality are both
physically and mentally sound. Therapy cannot be effective and will potentially lead to setbacks
if the horse is not safe (Brandt, 2013). Each horse which is utilized in EAP must not be
overworked, and they must also be provided with ample down time with the heard, which helps
to re-cooperate and de-stresses the horse following an EAP session.
There are those who would refute the validity of EAP, stating that there are limited
continuity through the studies. There have been several research limitations identified, as EAP is
a newly studied therapeutic intervention. Equine facilitated and assisted psychotherapies have
only started to establish clinical trials and set standard criteria to compare results. Pilot studies
had small participation and have been limited to measured anger, depression, quality of life and
perceived self-confidence, in addition to mental health, age-related, cognitive-neurological,
behavioral, and other health risks and conditions (Selby & Smith-Osborne, 2013). Studies have
been initiated by the equine community and have not maintained the consistency within the
clinical community to become a valid therapy.
Clinical and equine communities have begun to work collaboratively to address the
deficit in research, as previous research has been conducted stemming from the equine rather
than the academic or clinical mental health communities. This developing therapeutic EAP FOR VETERANS 7 intervention must have more stringent reporting procedures to ensure the growth of this effective
technique in conjunction with various clinical populations. Isolating the effects of EAP through
multiple clinical diagnosis populations is time consuming and expensive and has yet to occur
(Brandt, 2013; Earles, Vernon & Yetz, 2015; Selby & Smith-Osborne, 2013). Future research in
equine assisted psychotherapy would greatly benefit from larger sample sizes and randomized
controlled trials, as they lacked a control group (Brandt, 2013; Earles, Vernon & Yetz 2015).
There are four primary organizations, and numerous minor organizations, which provide training
and certifications for equine and mental health professionals who incorporate horses into their
practices. EAP is an experiential therapeutic technique that is brief and solution-oriented. The
collaborative effort between a licensed therapist and a horse professional working along with the
client and horse help to foster emotional growth and healing. Equine assisted psychotherapy
sessions are an effective modality for engaging in enjoyable activities while helping them to
develop social skills, coping mechanisms, and distress tolerance. Skills that are learned during
EAP sessions allow them to transfer skills over to other areas of their lives, fostering long-term
change and prevents relapse. Meta-analytic studies indicate that clients suffer from a wide range
of mental illnesses report psychological symptoms improve following participation (Brandt,
2013). Implementing control measures will respond to those who question the validity and depth
of study. Establishing a review board, comprised of members in an academic setting, such as
from a University, would ensure continuity within EAP programs. A research assistant, who
plays no role in the therapy, must administer all consent forms and questionnaires. A baseline
questionnaire must be administered within a few weeks before the first session, and the
posttreatment questionnaire must be administered immediately following the final session while
participants remain at the facility. A schedule must be established, which includes size of class EAP FOR VETERANS 8 participation (i.e. participants attend a program in three groups, ranging from five to six
participants; each attending once a week for six weeks; each session is 2-hours long and
conducted by the same Therapist) (Earles, Vernon & Yetz, 2015). All tasks that are completed,
must be individual, with the rest of the class mindfully observing and occasionally discussing the
process of the task with personal insights each gained (Earles, Vernon & Yetz, 2015).
A natural bond occurs between a person and a horse when traditional psychotherapy
techniques are combined with equine assisted psychotherapy. This helps to enhance the healing
process. The equine-human bond, in conjunction with the client-therapist relationship, allows for
the processing of painful emotions and experiences while developing intimacy, identity and
partnership. This dual process creates a successful and efficient therapeutic program. Traditional
medicine and therapies have been used for decades with Service Members and Veterans returning
from war. Alternative medicine has become more mainstream and accepted within the medical
community. Conjunctive use of both traditional medicine and alternative ideas, using this form of
animal assisted therapy (AAT), have been found to increase adherence to treatment, develop
coping resources, social skills and problem solving strategies for those who have special needs.
These Equine Assisted Activities and Therapies (EAAT) assist to improve quality of life and help
to influence the whole person (Brandt, 2013; Kuropatkin, 2013). Participants with PTSD
symptoms, emotional distress, anxiety, depression, and alcohol use significantly decreased
following program participation. Mindfulness also increased following treatments (Earles,
Vernon & Yetz, 2015). Mutual trust, affection, patience, assertiveness and responsibility are some
of the abilities which horses bring out in people. Increased mindfulness, being less burdened by
guilt and fear, in addition to becoming more independent and self-supportive are some of the
many attributes which benefit Veterans report as a side effect of completing EAP. This broadens EAP FOR VETERANS 9 the narrow use of cognitive-behavioral therapies, here-and-now therapies, and limited stages of
personality development to a more complete psychotherapeutic experience and involvement?
(Brandt, 2013). EAP FOR VETERANS 10
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McGhee, Tom - The Denver, P. (2016). Horse therapy helps veterans, soldiers. AP Regional State
Report - Montana, McClatchy Tribune Collection. EAP FOR VETERANS 11 Notgrass, C. G., & Pettinelli, J. D. (2015). Equine Assisted Psychotherapy: The Equine Assisted
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Modalities. Journal Of Experiential Education, 38(2), 162.
O?Brien, B. (2014). Impacts & Innovations. Nonprofit Charity Impacts Wounded Combat
Veterans And Children Facing Adversity. Nursing Economic$, 32(5), 270-274 5p
Selby, A., & Smith-Osborne, A. (2013). A systematic review of effectiveness of complementary
and adjunct therapies and interventions involving equines. Health Psychology, 32(4),
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recovery from stress and post-traumatic distress. Work, 50(1), 161-174 14p.
doi:10.3233/WOR-141934 . . EAP FOR VETERANS
Intro & Thesis
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