An Encyclopedia of Equine Therapy for Addiction Treatment

What Is Equine Therapy?

Equine therapy or hippotherapy is the practice of caring for and riding horses as a therapeutic endeavor1. This therapy is part of a larger umbrella of therapy types known as animal-assisted therapy. A person may complete sessions with a licensed therapist and riding instructor to learn skill development, mastery of tasks in caring for and riding the horse, and reflecting on their behavior2. Many people also find riding a horse to be a positive and stress-relieving experience.

Horses are pack animals. This means they thrive and work off the emotions and feelings of others. They rely on interactions with others to understand how to behave and trust another. In addition, horses are non-judgmental. This provides a therapeutic environment for a person in recovery.

A person in recovery will not usually participate in equine therapy as their sole form of therapy. Instead, equine therapy can be a part of a treatment plan that may include psychotherapy (talk therapy), medication management, and participation in a 12-step program.

History of Equine Therapy

Early History

Greek philosopher Hippocrates described early concepts of equine therapy somewhere between 460 and 377 B.C. Hippocrates is not the only author to have mentioned the therapeutic benefits of riding. These include in 1569, when Merkurialis wrote of horses and horse riding in his book “The Art of Gymnastics.”

Discussion Increases

The therapeutic and potential medical benefits of equine therapy were not significantly discussed until the 1960s. During this decade, the first therapeutic riding centers opened around the world, according to the American Hippotherapy Association. In 1969, riders established the North American Riding for the Handicapped Association (NARHA).

In addition to these advancements, Boris Levinson, a psychologist, published an article on his observations related to pets and how animals like dogs were able to have an effect on children even when his therapies did not. In the 1960s and 1970s, equine therapy was used more as an adjunct to physical therapy than for mental health rehabilitation.

In the 1990s, the number of equine therapy programs dramatically increased4. However, the scientific and therapeutic communities largely regard them as being a part of the evolutionary phase. This is because equine therapies do not currently have a framework or standardization with an evidence-based body of research for success.

Equine Therapy Today

As time has gone on, therapists and rehabilitation experts have studied the benefits of working with horses as a stress relieving method as well as a positive, low-risk behavior for those in recovery.

Much of the advances in equine therapy are due to those who ride horses and teach others to ride instead of from the scientific community creating certain protocols and programs. This means a lot of the research in equine therapy is in its infancy.

How Does Equine Therapy Work?

While almost anyone in recovery can participate in equine therapy, it may not be the most effective approach for everyone. A rehabilitation professional may start with an assessment to consider if equine therapy could be a beneficial approach.

A client does not have to have riding experience to benefit from equine therapy. However, a therapist may inquire as to allergies that a person has, whether to animals or outdoors. If a person cannot tolerate being outdoors for extended time periods, equine therapy would not be a good fit.

Detox should occur before beginning equine therapy. A person should not attempt to ride or care for horses when under the influence of drugs or alcohol. A therapist will also assess overall physical and mental health prior, as a person with active hallucinations or other delusions may have difficulty completing equine therapy.

Often, the first equine therapy session consists of a “bonding” time with a horse. At this session, a person will meet the horse they will ride and ideally foster a connection between horse and rider. A certified riding therapist is usually present at these sessions to help foster the bond and ensure a person is safe throughout the session.

In future sessions, a person may participate in individual or group therapy sessions. A person doesn’t always ride a horse in an equine therapy session. Instead, they may simply walk beside the horse or engage in grooming sessions. These interactions have the power to boost a person’s trust in themselves and others. It allows them to exhibit love, hope, and trust in a being who knows nothing about their past or present struggles.

Facilities may offer their unique take on equine therapy. Programs can range in length, the number of participants, and activities completed at each session. Sometimes the programs do not include the option to ride the horses at all. These programs may have horses that are either too old or unable to be ridden anymore due to a history of injuries.

Misconceptions About Equine Therapy

Fear

Most misconceptions surrounding equine therapy come from how people will interact with the horses. They may be afraid of horses for their large stature and fear they will be injured.

While it is true that horses do have the potential to injure and should always be treated with respect and regards to safety, often, horses are selected for their calm temperament and ability to interact in a positive manner with another person.

Dominance

Another misconception is that a person should act extremely dominant in order for a horse to respond to their training and interactions5.

However, this is not always true. A person does not have to be overpowering or aggressive for a horse to respond to them. Instead, therapists encourage the client to be their most authentic, open self when interacting with a horse.

Showing these traits when interacting with a horse will usually result in a greater degree of acceptance between the horse and rider.

Effectiveness of Equine Therapy

Anecdotal Evidence

Very little research exists surrounding the scientific benefits of equine therapy for those in recovery. Most of the known benefits are related to anecdotal evidence, which means stories and narratives that people may share at certified training facilities. What is known is that people who have addictions to cocaine, heroin, alcohol, or other drugs have used equine therapy to stay sober and complete training programs. In addition, those who have experienced trauma and mental health disorders, such as depression and anxiety have benefitted from equine therapy.

Addiction Science & Clinical Practice

One study published in the journal Addiction Science & Clinical Practice studied 108 young adult patients who were participating in an equine therapy program as part of an 18-month time period. The participants engaged in 12 equine therapy sessions that lasted 90-minutes. The patients would typically start their treatments about two to three weeks after entering a rehabilitation program. Upon conclusion of the study, the authors found those who participated in horse-assisted therapies were more likely to participate in treatments and complete their treatment programs.

While the study was on a small scale, the authors concluded that horse-assisted therapies could be a method of encouraging those in substance abuse treatment to continue their rehabilitation pursuits. According to the journal, some of the reasons why horses may have an especially therapeutic benefit include the physical stature of the horses as well as their body language, warmth, and behavior.

Because helping clients find the motivation to stay in treatment can frequently be a significant challenge for therapists, this study further supports the value of equine therapy in helping a person become and stay sober.

A Growing Body of Research

The Addiction Science & Clinical Practices study did cite two previous meta-analyses that found equine therapy was “moderately effective” in helping those struggling with depression and mental illness. The article also cited a 2014 analysis that reviewed 14 previous studies that recommended a methodical approach to equine therapy that could help inform studies about the therapy’s effectiveness.

What Training Is Required for Equine Therapy?

Currently, there are two organizations that certify and accredit equine therapy instructors and the centers they run. These organizations include the Equine Assisted Growth and Learning Association and the North American Riding for the Handicapped Association. Several different personnel types may provide equine-assisted activities and therapies, which are also called EAAT. For example, sometimes a licensed mental health therapist will work with a riding instructor who is certified in therapeutic riding.

In this care model, a therapist will work with the client while the certified instructor will focus on the horse and ensuring the client’s safety. Sometimes, a person will work solely with a certified riding instructor who may also be a therapist.

Horse Selection

In addition to certifications for the therapists and riding instructors, many people wonder about the horses themselves used for therapy. Horses are typically selected for the temperament, training history, and their movement quality – they will usually have a steady, even gait that can feel therapeutic for the client3.

Recognizing the benefits of Equine Therapy

Currently, there are several organizations that recognize the benefits of equine therapy. These include the American Physical Therapy Association, American Occupational Therapy Association, and the American Speech and Hearing Association.

In some instances, insurance companies will reimburse for equine therapy as part of rehabilitation. However, a person should always check with their insurance company before assuming the company will pay for the cost of equine therapies.

Finding Equine Therapy

For those wishing to find a specific equine therapy training center with certified therapists, a visit to the two major equine therapy organizations’ websites is recommended. This includes the Equine Assisted Growth and Learning Association and the Professional Association of Therapeutic Horsemanship International. The Equine Assisted Growth and Learning Association website has a tab called “Find a Program” where a person can click to find a listing of certified professionals around the world. Contact information and company names are included in this listing for ease of finding the right person and contact.

The Professional Association of Therapeutic Horsemanship International also features a “Find a Center” link where a person can find more than 4,800 certified instructors and 881 member centers. While not all centers may specifically address substance abuse treatment, the organization can serve as a resource for those that do.

A person may also wish to contact local stables or rehabilitation facilities in their area to inquire if there are certified riding therapists who may be able to provide services.

Integrating Equine Therapy After Treatment

What many clients may find most interesting about equine therapy is that they are interacting with an animal that doesn’t have an agenda in the therapy session. While many people in recovery are constantly challenged by therapists, family members, and friends, a horse does not have this same knowledge.

Instead, a person is building a relationship with a horse and learning how to interact with another animal in a therapeutic fashion. One of the greatest learning experiences for a person in equine therapy is to observe how the horse reacts to their personality and energy. The horse can give clues into how a person’s emotions are reading to other people as well as animals.

Equine therapy will typically consist of four key elements. The first is herd behavior observation, which involves seeing how herds of horses, as well as people, interact with each other. The second is stable duties, which require a person to be physically active as well as working toward a positive outcome and result.

The third is groundwork, which includes leading a horse or walking beside one. This helps to relieve anxiety, promote trust, enhance communication, and promote a mastery of skills. The fourth is mounted work, where a person rides a horse and helps to improve their posture, balance, awareness of their body, and focus.

While some equine therapy programs are limited to a certain number of weeks, a person in recovery may find they have established a new pastime and friendship with horses. They may wish to continue riding and experience the anxiety relief and benefits that doing so can provide.