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National survey on equine assisted therapy: An exploratory study of current practitioners and programs

Dissertation
Author: Patricia J. McConnell
Abstract:
Equine facilitated psychotherapy (EFP), a new field in psychology, is an alternative method of therapy that uses horses to facilitate therapeutic outcomes. There is minimal peer reviewed literature and few published studies examining efficacy. The conceptual lens of this study was grounded theory, as there is insufficient evidence of theoretical frame-works guiding equine assisted therapy. The purpose of this exploratory concurrent mixed methods study was to examine the theoretical foundation of practitioners; program make up; client populations; efficacy of program; and why the horse serves as the therapeutic catalyst of this model. A 43-item survey was sent to 800 programs, current members of the North American Riding for the Handicapped Association, Equine Assisted Learning and Growth Association, and the Equine Facilitated Mental Health Association who use equine assisted therapy. Twenty nine percent (n=232) of the surveys were returned. Chi square and cross tabulations were utilized to examine relationships between specific theoretical orientations of therapists and the therapeutic role served by the horses. Results illustrated that therapists who used experiential theory were more likely to use horses for development of confidence, development of self-efficacy, mirroring of behavior, and manner in which the therapist treats the horse. Open coding of qualitative questions was followed by axial coding into emergent themes were used to confirm and expand the quantitative results. Results illustrated the primary orientation within EFP was experiential theory; and that horses were universally considered essential aspects of the program because specific characteristics of the species facilitate key therapeutic processes. This study contributes to social change by providing the EFP field with a comprehensive analysis of current conceptual orientations and practice that can inform efforts to unify and extend this emerging therapy.

i Table of Contents List of Tables.....................................................................................................................iv  List of Figures......................................................................................................................v  Chapter 1: Introduction to the Study...................................................................................1  Introduction..........................................................................................................................1  Statement of the Problem.....................................................................................................3  Purpose of the Study............................................................................................................5  Nature of the Study..............................................................................................................6  Assumptions.........................................................................................................................7  Limitations and Scope..........................................................................................................8  Significance of the Study.....................................................................................................8  Conceptual Framework........................................................................................................9  Definition of Terms............................................................................................................11  Summary............................................................................................................................12  Chapter 2: Literature Review.............................................................................................14  Introduction........................................................................................................................14  The Beginning: Animal Assisted Therapy.........................................................................16  Equine Assisted Therapy...................................................................................................20  The Literature.....................................................................................................................24  Therapeutic Riding.............................................................................................................25  Equine-Assisted Therapy.............................................................................................25  Equine-Facilitated Therapy..........................................................................................26  Equine-Assisted Experiential Therapy........................................................................26  Equine-Facilitated Psychotherapy...............................................................................27  Equine-Facilitated Learning.........................................................................................28  Equine-Assisted Psychotherapy...................................................................................29  Equine Psychotherapy..................................................................................................30  Themes From the Literature...............................................................................................30  Human–Horse Bond.....................................................................................................32  Exchange Theory.........................................................................................................33  Biophilia Theory..........................................................................................................33  Anthropomorphic Theory............................................................................................34  Theory of Self-Psychology..........................................................................................37  Relational Theory.........................................................................................................38  Body-Language Theory...............................................................................................38  Gender Theory.............................................................................................................38  Summary............................................................................................................................39  Chapter 3: Methodology....................................................................................................41  Overview............................................................................................................................42  Research Design.................................................................................................................43 

ii Participant Selection..........................................................................................................45  Sampling............................................................................................................................46  Sample Validity.................................................................................................................46  Development of Instrumentation.......................................................................................48  Survey Content...................................................................................................................50  Procedures..........................................................................................................................52  Data Collection..................................................................................................................52  Statistical Treatment of Data.............................................................................................53  Qualitative Data.................................................................................................................53  Quantitative Data...............................................................................................................54  Compliance with Ethical Guidelines.................................................................................54  Methodological Limitations...............................................................................................54  Summary............................................................................................................................55  Chapter 4: Results..............................................................................................................56  Introduction........................................................................................................................56  Survey Method...................................................................................................................56  Missing Data......................................................................................................................57  Survey Structure and Response Structure..........................................................................58  Programs Represented.......................................................................................................58  Programs............................................................................................................................61  Population....................................................................................................................61  Program Data...............................................................................................................63  Effectiveness/Obstacles...............................................................................................66  Research Questions............................................................................................................67  Research Question 1....................................................................................................67  Research Question 2....................................................................................................69  Research Question 3....................................................................................................77  The Client Diagnosis and Contra-indicators......................................................................78  Research Question 4....................................................................................................78  The Relationship Between Client Diagnosis and Use of Horses.......................................80  Research Question 5....................................................................................................80  The Relationship between Theoretical Foundation and Use of Horses.............................85  The Benefits and Effectiveness of EAT.............................................................................88  Research Question 6....................................................................................................88  Triangulation......................................................................................................................89  Peer Reviewer....................................................................................................................90  Summary............................................................................................................................91  Chapter 5: Summary, Conclusion, and Recommendations...............................................92  Introduction........................................................................................................................92  Research Questions............................................................................................................92  Demographics....................................................................................................................93  Summary..........................................................................................................................103  Implications for Social Change........................................................................................104 

iii Limitations.......................................................................................................................106  Recommendations for Further Study...............................................................................106  References........................................................................................................................108  Appendix A: Survey........................................................................................................118  Appendix B: Invitational Notice......................................................................................131  Appendix C: Equine Assisted Therapy Invitation...........................................................133  Appendix D: IRB Approval Letter..................................................................................135  Appendix E: Follow Up Reminder..................................................................................137  Appendix F: Thank You Letter........................................................................................138  Appendix G: Horse is a Significantly Different Therapuetic Experience.......................139  Appendix H: Horse As Catalyst.......................................................................................146 

iv List of Tables Table 1 Frequency and Percent Measures on Open-Ended Responses to Primary Position......................................................................................................................59  Table 2 Frequency and Percent Measures on Categorized, Open-Ended Responses to Credentials of Therapist.............................................................................................61  Table 3 Frequency and Percent Measures on Categorized Diagnosis..............................62  Table 4 Frequency and Percent Measures on Categorized, Open-Ended Responses to Client Recruitment.....................................................................................................64  Table 5 Frequency and Percent Measures on Categorized, Open-Ended Responses to Obstacles in EAT Model............................................................................................66  Table 6 Frequency and Percent Measures on Name of Program......................................67  Table 7 Frequency and Percent Measures on Categorized, Open-Ended Responses to Name of Program.......................................................................................................68  Table 8 Gender of Therapist and Theoretical Foundation................................................70  Table 9 Theoretical Foundation and Reasons for Using Horses.......................................71  Table 10 Terminology of Program and Number Clients Riding......................................75  Table 11 Terminology of Program and Activities of the Program...................................77  Table 12 Frequency and Percent Measures on Specific Activities Involved in Therapeutic Program..................................................................................................78  Table 13 Frequency and Percent Measures on Categorized Diagnosis............................79  Table 14 Frequency and Percent Measures on Horse as Catalyst....................................89 

v List of Figures Figure. Frequency measures on selections within position category within gender..........60 

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Chapter 1: Introduction to the Study Introduction Equine-facilitated therapies are a type of therapeutic intervention with the goals of improved mental and physical health that uses horses as a therapeutic component. In the configuration of equine-assisted psychotherapy, a horse specialist, a psychological therapist, a horse, and a client are present (Bates, 2002). The horse specialist may also be the psychological therapist (Bates, 2002). The horse specialist controls the horse at all times (Christian, 2005). The therapist may introduce the client to the horse, have the client groom the horse, and/or complete a series of games with the anima (Donaghy, 2006). This model is considered ground work (Donaghy, 2006)). Equine Assisted Therapy (EAT) can also consist of the client riding the horse while the horse specialist and therapist guide the horse and rider in an arena/ring (Bates, 2002). Each program is unique (Frewin & Gardiner, 2005). In some programs the clients never ride the horse and only work with the horse on the ground (Hogg, 2003). Other programs have clients ride, and some have a mix of both procedures (Bates, 2002). What all programs have in common is using a horse as the catalyst or instrument to facilitate the therapeutic process. Currently, there are three organizations that offer membership and/or certification of programs providing a variety of therapeutic modalities: the North American Riding for the Handicapped Association (NARHA), Equine Assisted Growth and Learning Activities (EAGALA) and Equine Facilitated Mental Health Association (EFMHA). Certification from NARHA requires individuals from the programs to attend three

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conferences on using the horse to assist in a therapeutic program (NARHA, 2007). These agencies have a combined membership list of 800 individuals and programs committed to the use of horses as a therapeutic catalyst for intervention for both mental and physical illnesses (NARHA, 2007). A literature review showed that equine facilitated psychotherapy is also termed equine-assisted therapy, equine therapy, therapeutic riding, equine-assisted counseling, equine-facilitated therapy (EFL) and many other appellations. Although each peer- reviewed journal article has different terminology for using horses to facilitate therapeutic outcome, the commonality is using a horse therapeutically. For the purpose of this study, the term equine-assisted therapy encompasses all of these terms. Presently, literature in this field is scarce, with much of it being anecdotal. A current review of the literature showed a total of nine academic journal articles, with only one empirical study (Schultz, Remick-Barlow, & Robbins, 2007). EAT is little known in the mental health field. This study illustrated theory, foundation program, current uses, populations served, and effectiveness of using a horse to facilitate change with individual clients. No journal articles were found that illustrated the effectiveness of the horse, or different practices currently serving in various programs and populations. This study described demographics, foundation theory, specific practices, populations served, and how it is that the horse facilitates the therapeutic process. The following chapter focuses on further discussion of the available literature. This descriptive cross sectional study used a survey design to examine the current characteristics and status of these programs. T he researcher attempted to translate the phenomena and trends through descriptive statistical analysis to determine what is

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reported as EAT. Research questions focused on the specifics surrounding existing EAT programs, age and gender of therapists and participants, professional training and background of therapists and horse specialists, diagnoses of the population being treated, the theoretical foundations of the therapies used, and impact of the therapy on the clients. Program construction, comparison of various programs using horses, and the role of horse in these therapeutic programs were examined. Other phenomena and trends for future research may emerge from the results of this study. A descriptive cross sectional study of EAT has implications for social change. By exploring the animal–human bond, one can examine health and mental health issues that are improved through communing with animals and, in particular, with equines (Halm, 2008) One of the currently mentioned theoretical frameworks for EAT, experiential learning, can enhance self-efficacy, while empathy with animals can illustrate the ability for someone who has never experienced empathy to develop that trait (Hausberger, Roche, Henry, & Visser, 2008). These aspects of working with horses can foster change in people and allow learning that can be applied to clients and subsequently extended to the communities in which they live (Hausberger et al., 2008). Statement of the Problem There is little research published in peer-reviewed journals dealing with EAT (Karol, 2007; Porter-Wenzlaff, 2007). Additionally, there is no information on discrepancies in terminology and explanations of different uses of this therapy. There is little information and few statistics on the total numbers of programs, the populations being served, the criteria for treatment, or the determination as to whether it is truly the horse that is the instrument of therapeutic impact in this milieu.

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Currently there are over 800 programs employing equines in assisted learning, couples counseling, individual therapy, organizational leadership, addiction counseling, trauma counseling, at-risk behavior, and developmental and physical disabilities (EAGALA, 2009; EFMHA, 2007; NARHA, 2007). Published literature does not explain the theoretical foundations of these types of therapies/learning, nor does it point to the equine as a facilitator in accomplishing the therapy/learning. Peer-reviewed journal articles do not illustrate program construction or the specific role of the horse with clients. Such issues are valuable in laying a strong basic foundation for this milieu. In the EAT field, there are confusing and contradicting terms to describe specific programs. Formats of programs vary along with the terminology (Ewing, MacDonald, Taylor, & Bowers, 2007). There have been no descriptive surveys on what the programs specifically do or the terminology used by practitioners and clients. There are no data showing which populations are served, and, perhaps more importantly, there is no research on the theoretical foundations on which the programs are based. Specifically, the research lacks clarification as to why horses are used to assist in therapy. Further, there is a lack of clarity as to whether the professionals in the field believe that it is the equine that is the specific element that enhances therapeutic effect. All of these factors lead to the need for a greater understanding of EAT. Specifically, a foundation of applied knowledge about the programs that are currently using this therapeutic method will assist practitioners and researchers to develop and sustain the practice. Once a factual and descriptive foundation is established, the field of EAT can grow in both theoretical strength and overall applied success.

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Psychotherapy practice has many modalities. Gordon (2000) reported that currently there are over 300 different psychological practices. New therapeutic practices need standards for their model; standards that are tested or measured by research studies. “The implementation of proven, well-researched programs is rapidly becoming standard practice today and required by most funding sources” (Waters, n.d., p. 1). Just as human beings are individually different with a myriad of psychological issues, so are the interventions. However the interventions or practices need research studies that illustrated their efficacy (Bohart et al., 1997). EAT is a new modality that needs standards as a solid foundation; studies on this issue illustrate the efficacy of this model. This research study was designed to examine the phenomena of EAT as it is practiced in the field today. Purpose of the Study Due to the lack of studies in this field of alternative therapy, there are currently no surveys or statistics existing on the potential impact of therapist or client gender, diagnosis of clients served length of program, or measurement of progress. The purpose of this study, therefore, was to provide this information to practitioners and researchers in the field. There are no unified standards and all programs in all three organizations are self-regulating. Because this is an emerging field, this type of research may be useful in implementing the ability of certifying agencies to support their positions about the effectiveness of this therapy. The research may also be helpful in the standardization of terminology. By providing concrete terms for specific applications, there could be a universal knowledge of the terms used in these types of treatment programs. An analysis of current terminology through a survey can assist in developing this universal terminology. Programs need to be surveyed for variables such as gender of client and

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therapist, education, theoretical foundations, and populations accessing this type of program (Yorke, Adams, & Coady, 2008). A foundation needs to be laid regarding the type of applications being used, the populations being served, protocols, and the efficacy of these programs. A survey can illustrate problem areas and describe specific issues. Horses are generally considered to be the main conduit of this alternative-therapy application (Tyler, 1994). Issues of the use and ethics of using horses should also be addressed, as animals are also vulnerable participants. Nature of the Study There is a significant need for a survey study in this area due to the lack of descriptive information and incongruence of the more than 800 programs using horses. These programs are based on little theoretical foundation, have interchangeable, confusing terminology, and no indication of how the horse effects therapeutic change (Klontz, Bivens, Leinart, & Klontz, 2007). I explored these and other issues to enable these alternative therapies to gain credibility in both the academic world and therapeutic fields. The specific research questions are as follows: 1. What terminology is currently being used by persons working in programs? 2. What trends, themes, or relationships in the equine-therapy field emerge from the data? 3. What methods of equine therapy (riding, on the ground, a mix of on the ground and riding) are used by most programs? How many programs use

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each method? The empirically based practices and their efficacy are compared. 4. What is the theory underlying the concept of using horses as a therapeutic modality base? 5. Is EAT beneficial? Specifically, is it a preferable or advantageous therapeutic method compared to those that do not incorporate the use of horses? 6. What diagnoses/conditions are appropriate for EAT? Are there any that are contraindicators? Assumptions This study evolved from the following assumptions: 1. The participants have a vested interest in answering the survey questions in a truthful and accurate manner in order to establish credibility for this type of therapy. 2. The survey questions elicited the information they were intended to elicit. 3. The terminology used in the survey was familiar to the person answering the survey. 4. The target population is suitable and sufficient to provide data that will answer the research questions. 5. The sample was derived through self-selection, thus the consideration of nonresponse bias is included in the discussion and implications surrounding the findings.

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Limitations and Scope Not all programs may be represented in the data, as respondents from the entire target population chose whether to respond. Sampling error and self-selection (nonresponse) bias are present. Some respondents did not answer all questions included in the survey, thus leaving gaps in the ability to analyze data. The discussion, conclusions, and recommendations were limited based on the descriptive and inferential analysis of the survey. This is a descriptive cross sectional, informational study, and no actual relationship with a criterion measure to indicate success of the therapeutic method is being investigated at this time. The respondents were a targeted population that is involved with EAT programs. Significance of the Study This field is not well known in academia and in therapeutic practices, although it is an alternative therapy. There is a significant gap in the literature with most of the literature being anecdotal, not evidence-based, grounded in research studies. This national survey of equine-assisted programs illustrated what theoretical basis programs are using for the benefit of clients, how horses affect therapeutic outcomes, specific demographics, specific design of programs, and various uses of the horse. It described other phenomena that arise in the study, and trends for future research. This study is an illustration and a cause of positive social change. Self-enhancing issues, empathy, independence, courage to face destructive issues, and more can be the outcome of working with horses that fosters such changes in people and allows the application to extend to the community in which they live. This survey helps to provide a clear picture of the programs that are instilling this change in people. Therefore, as a

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piece of foundational research in this field, this study will assist practitioners and researchers to further the practice of EAT and to ensure that the field grows and improves continuously. Conceptual Framework There is much literature available in examining the benefits of animal-assisted therapy. The same cannot be said of EAT. This study addressed the basic foundational issues in the field. It is descriptive and exploratory in nature with the purpose of examining the phenomenon of EAT to illustrate the constructs of the contemporary field. Concepts such as theoretical foundations, program dimensions, characteristics of clients, commonalities of therapists, programs, and horses help fill gaps in the knowledge base and enhance a growing field. The current EAT framework or paradigm illustrates views of the world, specifically the topics under examination (Botha, 1989, p. 49). The conceptual framework is a map for readers to follow, consisting of exploration, description, decision making, and explanation (Shields & Tajalli, 2006, p. 315). The conceptual framework of EAT varies with each individual program, but generally consists of a client working in some capacity with a horse; the horse, in turn, facilitates communication with the therapist (Ewing et al., 2007). What the client learns from the horse, the therapist, and the interaction of all 3 participants allows transference of new concepts/behavior to the outside daily life of the client (P. Robinson, 2003). Because this study is exploratory and descriptive in nature, examining the phenomenon of EAT and what is being done in the field today, a mixed-method approach to the research is appropriate due to the lack of literature and lack of common theoretical foundation. The mixed methodology is driven by sequential design. The lack of

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theoretical foundation and studies demands design that is complimentary. This enables readers to examine data gathered from those who actually work in the field being studied (Diers, 1979). Descriptive research depicts these phenomena and their characteristics to illustrate the presence of the phenomena, the lived experience (Giorgi, 2008; Holyroyd, 2001). Collecting this type of data can include statistics of populations, theoretical underpinnings, composition of programs, and basic demographics. This type of data gathering is quantitative. In this particular study, the survey contained questions on this subject matter (Diers, 1979; Payton, 1979; Stevens, 1984). Descriptive research shows the face or composition of the programs being studied; it is more comprehensive in mining foundational information (Johnson & Turner, 2003). Creswell (2003) noted that criteria for mixed methodology should consist of a two-pronged approach: a survey targeted to the population of EAT therapists, and interviews for additional data collection from participants. The mixed-method design starts with the quantitative component of a survey. The survey had qualitative open- ended questions with the expectation that the qualitative answers would compliment the quantitative data. The mixed-methods design, “involves the collections, analysis and integration of quantitative and qualitative data in a single study” (Hanson, Creswell, Plano Clark, Petska, & Creswell, 2005, p. 224). The theoretical lens and basis for the study in this mixed-methods approach is grounded theory, which is an enhancing component for the methodology (Gilgun, 2005). Grounded theory is applicable in this study as “the researcher attempts to derive a general, abstract theory of a process, action

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or interaction grounded in the views of the participants” (Creswell, 2003, p. 14). A more exact depiction of EAT is needed to allow for follow up studies to improve the field. In examining EAT, the microconceptual framework is exploration and description of contemporary EAT programs, the theoretical foundations of therapists’ models, and how and why EAT is used. The main components of the study are survey and content analysis of the qualitative data collected during interviews. Possible data examination may include descriptive statistics, median, means, frequencies, t-statistics, and or percentages (Shields & Tajalli, 2006, p. 318). The data assist in eliciting grounded theory. Grounded theory, posited by Creswell (2003), is derived from the data; as the data is interpreted an emergent theory arises. In order to attain such data the most appropriate vehicle is mixed methods, which can have complimentary data outcome. The framework can elicit phenomenon patterns, characteristics, and theoretical lenses, by way of consistent comparisons and correlational analysis (Botha, 1989; Creswell, 2003; Mills, Bonner, & Francis, 2006). Definition of Terms Equine-assisted therapy (EAT): EAT has many different appellations; however, these all have a client, a horse expert who controls the horse, a psychological therapist or licensed social worker as therapist, and an equine as part of the therapeutic process (NARHA, 2007). Equine Assisted Growth and Learning Association (EAGALA): An accrediting and licensing organization for people who wish to take courses. This organization specifically advertises horses helping in psychotherapy (NARHA, 2007).

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Equine-facilitated learning (EFL): A subsection of the EFMHA that is educationally based on the experiences of clients working with a horse (NARHA, 2007). Equine Facilitated Mental Health Association (EFMHA): A subsection of NARHA that deals specifically with clients with mental health issues. This organization is an experiential psychological theory-based program. The clients may ride, vault, or do ground work (NARHA, 2007). Hippotherapy: A specialized program that uses a licensed occupational, physical, or speech therapist in conjunction with riding a horse for the benefit of the client (NARHA, 2007). Therapeutic riding: When a client is on top of the horse to ride the horse; it is not specific as to whether any psychological therapy is applied at the same time (NARHA, 2007). North American Riding for the Handicapped Association (NARHA): An accrediting and licensing organization for people who wish to take the courses given. Specific models allow clients who are physically handicapped to ride equines (NARHA, 2007). Vaulting: Humans performing acrobatic maneuvers on the back of a horse (NARHA, 2007). Summary This descriptive cross sectional study is the only national survey conducted that examines demographics, the horse as a catalyst, populations served, the theoretical perspective of practitioners, and other themes that arise from the survey regarding EAT. The contribution to this field is in basic demographic information, program descriptions,

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theoretical foundation, and explanations of how and why horses are the main factor in this therapeutic process. Further data that may be obtained from the survey may be populations best served, contraindicators, gender of therapists and of clients, difference in program use of horses, the role of the horse, and relationships between variables. The findings of this survey may aid in illustrating specific theoretical foundations, universal terminology, specific populations with which it is successful, populations for which this milieu would not be recommended, and possible reasons for using the horse as a therapeutic catalyst. This chapter describes contemporary programs and illustrates the purpose of and the need for this national survey. Chapter 2 exposits possible theoretical foundation, gives a history of the evolution of EAT, and describes the programs practiced today through a literature review. It also gives information regarding the domestication and use of equines. Chapter 3 reviews the methodology of this study and delineates the populations, sample, and ethics. Chapter 4 illustrates the results from the survey data, and chapter 5 summarized the results, with suggestions for further study.

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Chapter 2: Literature Review Introduction In a review of the literature, there were very few peer reviewed journal articles published in this field. Nine articles were found after an exhaustive search from Walden Library, Boston Public Library, the Internet, EBSCO, psychARTICLES, and other databases. The articles reviewed were available and published in peer-reviewed journals prior to 2009. This review covers available peer-reviewed journal articles that are currently available on any type of EAT, although most of the articles use different terminology to label the program studied. This literature review starts with the evolution and history of animals used in therapy; this is how EAT developed and remains under the umbrella of Animal Assisted Therapy (AAT). An analysis of AAT literature led to the evolution of EAT literature. The literature review on EAT examined the articles that have been published, noting any suggested themes and theoretical foundations. The researcher then examined literature on the horse, its role in history, possible explanations as to why therapeutic programs are based on the use of horses, and possible underlying theoretical foundations. Animals have always had a profound impact on human lives (Morrison, 2007). They continue to have varied and vital roles that allow humans to survive and live enhanced lives. The human species has relied on animals for its survival. Animals have been hunted for food, pelts for clothing, claws and teeth for ornaments, and bones for hunting weaponry, awls, needles, and spoons (Pettitt, 2008). To this day, humans use

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animals in a similar manner for food, decorations, and clothing. As humans and animals rely on each other for survival, it is not a large step to have some animals who have taken the place of human companions and helpers in human lives (Morrison, 2007; Pattnaik, 2004). Tracing the evolution of human relationships and the importance or reliance on animals can be found on cave walls and in paintings in Lascaux, La Marche, Chauvet Caves, with over 350 caves illustrating animals and their role on Paleolithic life (Pettitt, 2008). The drawings from these caves date back 12,000 to 30,000 years. In these paintings hunts of the people of the time are illustrated, as well as mysticism attributed to the animals (Valladas et al., 1992). Throughout the world are ancient signs of the importance of animals in prehistoric life: petroglyphs depicting metaphysical animal beings, hunt scenes, excavation of funeral pits with animal and human remains, and petroglyphs at Arches National Park in Utah depicting hunters on horse, (Goring-Morris & Horwitz, 2007). Illustration of the beneficial relationships between human and animals can be seen through the art in caves, petroglyphs of prehistoric times, to the current role of hands, eyes, and ears of humans with animals working in various capacities to improve human lives (Parshall, 2003). AAT is a therapeutic modality that continues to use the beneficial relationship between humans and animals. Today, this relationship is geared to positive therapeutic intervention (Nimer & Lundahl, 2007). Documentation of animals assisting humans goes as far back as the 1700s, with Quakers using rabbits, birds, and farm animals to assist in psychological treatment of people (Hooker, Freeman, & Stewart, 2002). Florence Nightingale used caged birds for

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the benefit of her patients (Heimlich, 2001). In 1919, dogs were used in psychiatric units in Washington, DC. In 1942, the military hospital in New York used animals therapeutically for recovering veterans (Hooker et al., 2002). In the 1960s, Levinson described results of using AAT to have “found that pets function as transitional objects with which patients can bond. … This bonding could eventually expand to include a therapist” (as cited in Hooker et al., 2002, p. 18). Mallon (1992) took Levinsons’ work with small animals further, by using farm animals as “therapeutic aides” (p. 471) in a residential program for children. The farm animals used in the program consisted of cats, cows, roosters, pigs and horses. This was the first published study of therapeutically using nonpet animals; a precursor to EAT studies (Berget, Ekeberg, & Braastad, 2008). The Beginning: Animal Assisted Therapy An animal that facilitates therapy falls within the realm of AAT. The Delta Society (n.d.) is an international organization that certifies and registers pets that provide AAT. The Delta Society is a nonprofit organization, uniting people who have mental and physical disabilities and patients in healthcare facilities with professionally trained animals to help improve their condition. Krueger and Serpell (2006) reported the Delta Society's definition of AAT is A goal-directed intervention in which an animal that meets specific criteria is an integral part of the treatment process. AAT is directed and/or delivered by a health/human service professional with specialized expertise and within the scope of practice of his/her profession. (p. 23) The Delta Society (n.d.) posited that any domestic animal may be used to facilitate therapy, if the animal has been tested and certified. Animals such as dogs, cats,

Full document contains 168 pages
Abstract: Equine facilitated psychotherapy (EFP), a new field in psychology, is an alternative method of therapy that uses horses to facilitate therapeutic outcomes. There is minimal peer reviewed literature and few published studies examining efficacy. The conceptual lens of this study was grounded theory, as there is insufficient evidence of theoretical frame-works guiding equine assisted therapy. The purpose of this exploratory concurrent mixed methods study was to examine the theoretical foundation of practitioners; program make up; client populations; efficacy of program; and why the horse serves as the therapeutic catalyst of this model. A 43-item survey was sent to 800 programs, current members of the North American Riding for the Handicapped Association, Equine Assisted Learning and Growth Association, and the Equine Facilitated Mental Health Association who use equine assisted therapy. Twenty nine percent (n=232) of the surveys were returned. Chi square and cross tabulations were utilized to examine relationships between specific theoretical orientations of therapists and the therapeutic role served by the horses. Results illustrated that therapists who used experiential theory were more likely to use horses for development of confidence, development of self-efficacy, mirroring of behavior, and manner in which the therapist treats the horse. Open coding of qualitative questions was followed by axial coding into emergent themes were used to confirm and expand the quantitative results. Results illustrated the primary orientation within EFP was experiential theory; and that horses were universally considered essential aspects of the program because specific characteristics of the species facilitate key therapeutic processes. This study contributes to social change by providing the EFP field with a comprehensive analysis of current conceptual orientations and practice that can inform efforts to unify and extend this emerging therapy.