Salmon Arm and Williams Lake, British Columbia, Canada
What is Animal-Assisted Therapy?
People have observed the healing and supportive power of animals since time immemorial. However, the first formal documentation of animals incorporated into a traditional therapeutic setting wasn’t until the 1960’s. Animal-assisted therapy (AAT) involves the use of one or more animal, which may range from dogs and horses, to birds and dolphins, alongside the use of a specific theory of psychotherapy to meet the wellness goals of the client. Animal- assisted activities are any activity, recreational or therapeutic, that involve animals. Therapies are defined by facilitator training and specified objectives geared towards therapeutic outcomes. Therapies are offered by a licensed mental health professional, like a counsellor, while activities may be offered by coaches, teachers, volunteers, or even be un-facilitated. Interventions are “goal-oriented and structured interventions that intentionally incorporate animals in health, education, and human service for the purpose of therapeutic gains and improved health and wellness” (Delta Society). While activities are less-structured and without specific objectives, they may still be healing and supportive nonetheless. Generally, practitioners focus their work with one species of animal, most commonly dogs and horses. I, of course, have chosen to focus my work and research on horses (you can read more about this on the Practice page of this site). Because mental health professionals and coaches alike have been incorporating animals into their practice with great success, we will use the term equine-assisted learning (EAL) to encapsulate both equine-assisted activities and therapies.
Therapeutic riding emerged in the 1950’s as the first use of equines in a therapeutic context, fostering psycho-social skills within people with specific development needs through horsemanship and riding. Activities include horse husbandry, general care, ground work, and riding with common objectives like improved self-esteem and self-efficacy, self-awareness, self regulation and emotional intelligence, and leadership and communication skills. Hippotherapy, a well-regarded branch related to physical therapy, predates therapeutic riding and focuses on the physiological effects generated by the rhythmic movement of the horse that is recreated in the rider’s body. It was not until the 1990’s however, that the first equine-assisted psychotherapy organization was officially inundated in the United States. Today, there are countless centres across North America offering some type of equine-assisted learning and many regulating bodies such as EAL Canada, EAGALA, PATH, and EFW.
Why Horses?
Horses are non-judgmental and non-critical. Because horses do not hold grudges and live in the present moment, we can consider them to posses unconditional positive regard. Horses mirror the emotional states of the people with which they work by attuning to their emotions, regardless of attempts at masking or avoidance. This attunement is similar to the process of empathy in people. Empathy creates a perception of social support that is mutually beneficial. Emotional attunement, or mutual empathy, is one of the primary functions of incorporating horses into personal development processes since they promote this skill building. These are important common factors affecting positive change.
Horses, highly perceptible prey animals, also have the capacity to develop emotional and social intelligence. In fact, it is this social and emotional intelligence that helps them to thrive in large and complex herd systems, keeping them safe from predators. When we work with horses, we become part of their herd, and must also develop emotional and social competencies required to partner with these animals. EAL utilizes bi-directional co-regulation: the client’s emotional state is reflected in the horse, and the horse, conversely, has the ability to emotionally influence the client. By navigating these highly activating experiences in partnership with a horse, EAL participants may learn to recognize and regulate their emotions. Again, it is through the horse's own emotional intelligence that the capacity is built in those that work with them.
The horse acts as a medium for metaphor and/or transference. Transference may occur when clients choose animals that reflect beliefs about themselves, and/or project their feelings onto the animal. Metaphors are used to connect in-session phenomena with real-life situations and validate client experiences. By using metaphor and transference, clients may externalize their experiences, increasing safety by depersonalizing their experiences.
How Does it Work?
Within an EAL session, it is the relationship between the client, equine, and practitioner that facilitates positive change, rather than specific equine characteristics or qualities. Some practitioners believe that while some animal characteristics are well-suited for specific symptoms, some characteristics may exacerbate those issues. In my experiences, however, this is both true and untrue and completely dependant on the individual and their equine partner. For example, a person who experiences symptoms of anxiety might experience positive change with both a calm horse and an anxious one. The calm horse might provide a stable support in a new or difficult situation, thereby helping to build confidence and self-efficacy. While an anxious horse might need help in regulating, requiring that the client utilize a process of co-regulation, thereby strengthening their own skills. And so, practitioners must be client-centred and attune to the unique needs and affect of both horse and client.
Positive change happens with increased motivation, strong therapeutic relationships, empathy, and emotional safety. These are common factors that promote positive change, regardless of theoretical orientation. The therapeutic relationship is at the forefront of the common factors dialogue and is an important predictor of change. The therapeutic bond is strengthened because horses are non-judgmental and non-critical, which are key factors in feeling accepted. As a result, attachment to the horse may come before attachment to the human because of the emotional safety that is generated by the animal. With this initial trust and a foundation of safety, the human-animal bond bridges the gap from client to practitioner. This is important since a strong therapeutic alliance predicts better outcomes. The EAL space is made safer too by reducing pressure often felt in a traditional or institutional office setting, does not require people to work face-to-face but rather alongside one another, and neutralizes some of the power imbalances sometimes felt in a traditional therapeutic setting.
EAL practitioners generally incorporate a variety of frameworks (see practice section for more info) with equal success. Theoretical integration is not only appropriate within EAL, but fundamental since there is no clear prescription for this model. Because an integrative framework is both practical and effective for EAL work, attunement and collaboration between practitioner, client, and equine is imperative to determine a meaningful and appropriate approach to positive change. However, practitioners should be aware of theories of attachment in order to understand how the human-animal bond concept impacts certain components of change within AAT. Just as the therapeutic relationship is essential to the change process, attachment processes are fundamental in operationalizing change in AAT.
Why Does it Work?
Through emotional and social competency, improved attachment mentalization, and positive self-regard, EAL may address symptoms of insecure attachment styles while simultaneously building more secure internal attachment models. Attachment theory outlines an internal working model that is developed in infancy as a behavioural system important for survival. A person’s attachment style influences they way they view themselves and others, and informs how they feel about their relationships. EAL is fundamentally aligned with attachment theory since healthy attachment outcomes mirror the most common EAL outcomes: emotional development, attunement and mentalization, improved distress tolerance, enhanced social and emotional skills, and improved self-esteem. Both the practitioner and/or the equine may act secure base from which to explore interpersonal patterns and mental health concerns since attachment to practitioner, and attachment to equine are two main attachment processes informing EAL sessions
In EAL, the processes for relationship building with the horse are non-verbal and the experience is based on internal working models (mentalization). Or rather, your values and beliefs about yourself and others, based on your attachment style and bi-directional attunement: how in-tune are you with the horse, and the horse with you, and why is this? This is part of the normal process of socialization, but can act as re-socialization process for those with insecure attachment styles and/or interpersonal or emotional regulation difficulties. Bringing to light the mentalization processes can highlight attachment information, which can then be targeted and positively influenced through EAL.
Insecure attachment styles are connected to low self-esteem. However, positive self-esteem can be generated by improved independence and interdependence, as well as overcoming obstacles, and problem-solving. Affecting positive change with the animals through caregiving or animal husbandry has a positive effect on participant perceptions of self-worth.
Mentalization is also an important factor in improving distress tolerance as it improves a person’s ability for containment. Meaning, a person with secure internal working models is better able to separate and depersonalize distress, increasing their ability to self-regulate. Secure attachment models are shown to increase distress tolerance, or a person’s capacity to self-regulate and problem solve during stress and/or adversity. One of the primary reasons for this is emotional development, which can also be understood as emotional intelligence, or the capacity for emotional regulation.
Who Does it Work For?
Specific empirical emphasis has been placed on EAL for high-risk youth, persons on the autism spectrum, persons experiencing symptoms of depression and anxiety, and Indigenous populations. Some programs working with Indigenous youth find that the unique setting and less-directional nature of the EAL programs work to de-institutionalize traditional therapy programs through a (re)connection to nature and a de-colonized approach to learning and/or therapy. Indigenous ways of knowing and being argue that in order to combat modern ailments we must reconnect with the natural world, which can be expedited by working with animals.
Most of the research used to inform this page focused on Euro-centric populations. However, many countries outside of North America and Europe have histories with, and reverence for, animal-assisted interventions aimed at personal development including countries in Asia and South America. While attention to the human-animal bond is universal, cultural and religious groups interact with this concept in unique ways, resulting in varying attitudes towards animals in general. International interest in AAT has been growing at a rate consistent with that in North America, which indicates a need for culturally safe approaches. A culturally responsive framework for AAT includes practitioner self-awareness of cultural location, knowledge of client’s sociocultural backgrounds, and continued development and application of cultural competencies. With these concepts in mind, and client-centred approach, EAL could be appropriate for many population groups.
References, Research, and Suggested Reading
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Ceatha, N. (2020). Learning with dogs: Human-Animal bonds and understandings of relationships and reflexivity in practitioner-research. Aotearoa New Zealand Social Work, 32(4), 77. https://doi.org/10.11157/anzswj-vol32iss4id795
Chandler, C. K., Portrie-Bethke, C. L., Minton, C. A. B., Fernando, D. M., & O Callaghan, D. M. (2010). Matching animal-assisted therapy techniques and intentions with counseling guiding theories. Journal of Mental Health Counseling, 32(4), 354–374. https://doi.org/10.17744/mehc.32.4.u72lt21740103538
Delta Society (n.d.). Industry terms. Retrieved May 19, 2023 from https://petpartners.org/learn/terminology/
Flynn E., Zoller, A. G., Gandenberger, J., Morris, K. N. (2022). Improving engagement in behavioral and mental health services through animal-assisted interventions: A scoping review. Psychiatric services. 73(2):188-195. https://doi.org/10.1176/appi.ps.202000585
Haig, L. & Skinner, K. (2022). Use of equine-assisted services to improve outcomes among at-risk and indigenous youth: A scoping review. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.730644
Hanrahan, C. & Boulton, A. (2021). Animal-assisted interventions in Canada: AAI as potential field guide in/to alterity relations. Human-animal interaction bulletin. CABI International. https://doi.org/10.1079/hai.2021.0003.
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Schlote, S. (2019). Integrating somatic experiencing and attachment into equine-assisted trauma Recovery. In Trotter, K. S., & Baggerly, J. N. (eds) Equine-Assisted mental health for healing trauma. Routledge
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Serpell, J., A. (2019). Animal-Assisted interventions in historical perspective. In A.H. Fine (Eds.). Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice (pp. 13-22). Amsterdam: Elsevier. https://doi.org/10.1016/B978-0-12-815395-6.00002-X
Stern, C. & Chur-Hansen, A. (2013). Methodological considerations in designing and evaluating animal-assisted interventions. Animals, 3(1), 127–141. https://doi.org/10.3390/ani3010127
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 14(3), 270–277. https://doi.org/10.1002/wps.20238
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