Horses For Hope

Prepared for UnitingCare Cutting Edge by Lyn Shirley UnitingCare West

"When I look back, I can see how horse after horse carried me away from cruelty and towards kindness and understanding" (Monty Roberts, 2004, p.235).

"There is something about the outside of a horse that is good for the inside of a man"
~ Winston Churchill.

"A horse is the projection of peoples' dreams about themselves - strong, powerful, beautiful - and it has the capability of giving us escape from our mundane existence".
~ Pam Brown

"The essential joy of being with horses is that it brings us in contact with the rare elements of grace, beauty, spirit, and fire".
~ Sharon Ralls Lemon.

"Horses lend us the wings we lack"
~ Author Unknown.

This review aims to determine the role of qualitative research in health service evaluation, explore the use of horses as effective therapeutic adjuncts and their role as change agents, and examine the Monty Roberts "Join-Up" method. Finally the review will provide implications for community-based equine-facilitated support programs.

1]    The Role Of Qualitative Methods In Health Service Evaluation

The use of horses as therapeutic adjuncts is a relatively new and rapidly progressing field, therefore quantitative or scientific conclusions that support current research are limited.  Although quantitative techniques have traditionally been emphasized in the evaluation of health care programs Silverman, Ricci & Gunter (1990, p.57) claim that qualitative methods provide the "most appropriate or only means" to evaluate certain health services. A qualitative approach believes that as human judgement plays an integral role in every human act, the objectivity of science is questionable and science "is in fact, a delusion" (Burns, 1994, p.11).

However, it is imperative that qualitative methods employ appropriate strategies to ensure that rigour is maintained. According to Koch (1994), and Guba & Lincoln (1989), qualitative research should meet criteria of credibility, transferability and dependability in order to establish trustworthiness. In this manner, phenomenological qualitative research is able to challenge traditional empirical quantitative measures of internal validity, external validity, reliability, and objectivity.

An increasing amount of qualitative research has explored the link between adolescents, behaviour change and horses, and has evaluated the relevance of programs designed to address specific issues within these parameters.  This literature reviewed within will examine some of the research available from a qualitative perspective.

2]    The use of animals in psychotherapy with "at risk" populations

The use of animals as therapeutic adjuncts has a long and well-documented history.  In 1699 John Locke encouraged giving children "dogs, squirrels, birds or any such things" to care for as a means of developing responsibility and consideration for others.  During the late 18th century, the use of animals as therapeutic adjuncts began to be applied in treatment of the mentally and physically ill.  Florence Nightingale remarked in her nursing notes in 1880 of the benefits of a "small pet" for the sick and frail (Fine, 2006, p.12). 

In 1969 Levinson conducted research into pet-oriented child psychotherapy, concluding that the influence of animals was able to increase self-concept and decrease stressful responses.  Research has flourished in this field over the following forty years, as animals (generally cats & dogs) began to be utilized more often as therapeutic aids in a range of health services provided to children and adolescents.  Esteves and Stokes (2008) studied the influence of companion dogs on 5-9 year old children with developmental disabilities; the results showed an increase in positive initiated behaviours (verbal and non-verbal) and improved social responsiveness and a decrease in negative initiated behaviours. 

Bryant and Donnellan (2007) studied the influence of "pet provision" on one hundred and seven boys aged between 8 – 13 years to ascertain whether interaction with pets influenced anger retaliation and conflict resolution with peers.  The study found that the pet provision of "child self-enhancement" (the pet showing admiration and affection to the child) provided a "buffer" to boys with concerns in relation to their use of anger retaliation with peers.

More recently, research has concentrated specifically on the role of horses within the realms of cognitive-behavioural and other therapy modalities with adolescents who are considered "at risk".  Horses are now successfully utilised in working with anger management, "delinquent" behaviours (Foley, 2007), depressive and anxiety-based disorders, eating and attention-deficit disorders, abuse and trauma victims (Yorke, Adams & Coady, 2008). The role of horses as therapeutic adjuncts and "change agents" with "at risk" adolescents is now explained in further detail.

3]    THE ROLE OF HORSES IN PSYCHOTHERAPY WITH "AT RISK" ADOLESCENTS

It is significant to note that an enormous amount of research has specifically addressed the psychological needs of children and adolescents.  Children with conduct, developmental or learning difficulties or clinical diagnoses are ‘at risk’ of developing serious emotional disorders during adolescence. Severe emotional disorders which are not regulated and controlled during adolescence, often lead to "serious psychopathology during adulthood" (Ewing, MacDonald, Taylor & Bowers, 2007, p. 1).

3.1  Self-concept and self-efficacy
According to Maslow’s (1970) "hierarchy of needs", each individual has basic biological and psychological needs which must be filled before reaching one’s true potential.  Basic physiological needs include the need for food, shelter and security, while basic psychological needs include the need for acceptance and affection, the need to "belong" and self-esteem (Bourne & Russo, 1998).  Many "at risk" young people have difficulty fulfilling both their basic biological and psychological needs.

Adolescence is a time of self-definition and multiple transitions; young people must manage stressful physiological, educational and social changes and pressures, whilst constantly re-negotiating their status within their social and familial circles.  The perceived inability to deal behaviourally, cognitively or emotionally with the challenges which confront young people during this time often results in decreased perceptions of personal efficacy and frequently manifests as depression and anxiety-based disorders.  Poor self-concept, low self-efficacy, depression and anxiety during adolescence often accompany suicidal or self-harming thoughts and behaviours (Bandura, 1997: Joffe, 1995).

Interaction with horses provides companionship, empathy and affection.  It helps give young people a sense of ‘belonging’ whilst strengthening self-efficacy and increasing coping, conflict resolution and anger-management skills. Schultz (2008) studied the effectiveness of equine-assisted psychotherapy with forty children deemed "at risk of mental dysfunction" and referred with anxiety, depression, anger and disruptive behaviour issues.  Using the Beck Youth Inventory Scale pre and post research, the study found significant improvement in anger management and self-concept among the participants.

In 2004 MacDonald explored the effectiveness of equine-facilitated therapy with one hundred and twenty-six at-risk adolescents aged 8 – 17 years in five different programs.  Each program focused on self-esteem, depression, locus of control, loneliness, empathy and aggression.  These constructs were measured pre and post research.  The results indicated significant increases in self-esteem and internal locus of control along with considerable decreases in hostility and aggression (MacDonald, 2004).

3.2  Building ‘individual resilience’
The capacity to overcome challenges and to progress and develop despite exposure to risk factors is known as resilience.  Protective factors in childhood resilience include individual disposition, supportive familial relationships, community support and personal self-efficacy (Garmzey, 1993 and Werner & Smith, 1992, in: Hayden, 2005). Horses are extremely challenging, sensitive and unpredictable animals; working with horses provides numerous opportunities for facing challenges and overcoming adversities. Interaction with horses in a program which utilizes both family and community support presents many real opportunities to increase resilience in children and young people who are at-risk (Hayden, 2005; McCormick & McCormick, 1997; Mandrell, 2006).

3.3  Cognitive, behavioural and emotional regulation; how horses change behaviours
Due to their sensitive and intuitive natures, horses are innately able to detect anger, aggression, hostility and anxiety.  In order to establish a positive relationship with a horse, the individual must learn to regulate internal feelings and external behaviours.  The degree of control exerted by the individual over their cognitive, behavioural and emotional conduct will determine the success of the horse-human relationship.   Several studies have demonstrated that interaction with horses promotes self-regulation of cognitive, behavioural and emotional states, enabling the participant to apply this self-regulation in ‘external’ family or social environment (Ewing et. al., 2007; Hancox, 2005; McCormick & McCormick, 1997).

In a recent study of equine influence on the self-efficacy of five adolescent females, the participants reported the need to consciously control their behaviours and emotions while working with their horses, and claimed that this experience helped them to control and change their behaviours in relation to their families and peers (Hancox, 2005).  In this way, horses act as a catalyst for behaviour change; they become the "change agents".

3.4  Case Studies
Ewing et. al., present a number of case studies attaining to the success of equine-facilitated therapy, although quantitative results showed little change in variables such as self-esteem, empathy and depression, qualitative data tells a different story: of an eleven year old girl with multiple diagnoses of Behavioural Disorder (BD) and Educational Mental Handicap (EMH) with poor hygiene, low social functioning and defiant, disruptive behaviours, who progressed from attending a special-purpose day school to a successfully functioning adolescent accepted back into mainstream education.

A 13 year old boy, diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), whose common behaviour was to crawl on the floor and attempt to climb the walls of the classroom and who tended toward pyromanic tendencies began to model positive behaviour, slow down his responses and began to learn well.

McCormick and McCormick (1997) discuss several case histories in their book "Horse Sense and the Human Heart: What horses can teach us about trust, bonding, creativity and spirituality".  One example is of a 12 year old girl, who had been abandoned by her parents at two years of age and had spent her life in institutions.  She presented to the McCormick program with hallucinations, bed-wetting and several other dysfunctional and disruptive behaviour patterns.  After some time of working with the horses, the girl was able to positively change her behaviour patterns, the bed-wetting and angry behaviour diminished, and the girl’s self-concept and locus of control flourished.  She was later successfully accepted into a foster family and commenced mainstream schooling.

4]    OTHER APPLICATIONS FOR EQUINE-FACILITATED THERAPY.

As discussed above, EFT has been highly effective with anxiety, depression, anger, hostility, aggression and behavioural disorders, ADD/ADHD and educational difficulties.   Post Traumatic Stress Disorder (PTSD), substance abuse, chemical dependency and eating disorders are additional areas where EFT has proven beneficial (Mandrell, 2006, Ewing et al., 2007). 

Ewing et al. (2007) describe the case of a 10 year-old girl who presented to a nine week, thirty-six hour "Horse Power" program with severe PTSD and an extremely disturbed and abusive background.  The relationship that the young girl formed with her horse allowed her to feel secure enough to discuss her family situation and "talk out" her concerns about safety and trust; she was soon able to discuss her fears and anxieties and began to regain some control and happiness.

The cognitive and behavioural skills which are developed during interaction with horses also has many positive implications for the use of EFT in substance abuse programs (Mandrell, 2006). McCormick & McCormick (1997) offer the "Equine Experience" program to residents of a residential drug and alcohol rehabilitation program. 

The skills taught during the program, in conjunction with the relationships formed with the horses, has successfully helped many young people change the self-destructive behavioural patterns associated with their past drug or alcohol abuse. 

Mandrell (2006) also claim that drug and alcohol abuse and problems, depression and eating disorders all decreased significantly as a result of participation in equine-facilitated psychotherapy.  A client of Mandrell’s EAP program, "Amy", was so malnourished when she arrived for her first session that she was confined to a liquid diet.  Through her interaction with the horses, Amy began to understand and discern what she had control over and what was beyond her control.  After three months of EAP, Amy left the centre and has not had a relapse of anorexia (Mandrell, 2006).

EFT has also been used effectively with children who have experienced intra-family violence.  Violence between parents has adverse effects on the children within the family; these children are at an increased risk of behavioural and mental health disorders such as anger, depression, anxiety, low self-esteem, suicidal ideation and ADHD (Schultz, Remic-Barlow & Robbins, 2006).  Schultz et al. studied a group of sixty-three children who had all experienced or witnessed family violence.  Results of tests administered pre and post treatment indicated a significant improvement; especially in the younger participants.

Another form of equine-facilitated therapy is Hippotherapy, where the horses are ridden or used for acrobatic vaulting.  This approach to EFT has shown great promise when used with children who are mourning the loss of a family member. A recent study of a summer riding program for school age children who had recently lost a family member, found increases in the children’s confidence, trust and communication skills.  The increased skills and confidence gained by participating in the horse-riding program enabled the children to communicate about the deceased and increased their levels of self-confidence and esteem (Glazer, Clark & Stein, 2004).

Hippotherapy is also used very successfully with young people with special developmental or physical needs. Benda, McGibbon & Grant (2003) studied the effect of hippotherapy on fifteen children diagnosed with spastic cerebral palsy.  The results indicated significant improvement in symmetry in muscle activity due to the movements of the horse rather than passive stretching exercises.  Hippotherapy has also been credited with statistical increases in self-concept, improvements in emotional and behavioural problems and increased social acceptance (Vidrine, Owen-Smith & Faulkner, 2002).  Research by Macauley and Gutierrez (2004) into the effectiveness of hippotherapy for children with language-learning disabilities found that hippotherapy increased the motivation to attend and stay in therapy and produced significant improvements in speech and language abilities.

Although equine-facilitated therapy is often applied on an individual basis, this form of therapy is also easily adapted to group situations.  Group therapy may be used as an adjunct to individual therapy or as the complete treatment plan.  Mandrell (1996, p.86) claims that group therapy is of particular benefit to adolescents due to the strong influence of "peer interactions and opinions".  When working in a group situation, adolescents learn to communicate with their peers, openly express their concerns and values and accordingly, modify those which need to be changed (Mandrell, 2006).

Family groups provide an ideal interactive, therapeutic experience in which family members are exposed to different ways to communicate, negotiate and rationalize. The value of teamwork, co-operation and positive support brings many special benefits to families who have participated in EFT (Taylor, 2001, Mandrell, 2006). 

Groups may also be constructed according to age, gender, developmental level, emotional, mental or behavioural issues or personality types.  Corporate groups, club, association, company or church groups are other examples of EFT group work. 

Skills applied during group work emphasise stress management skills, teamwork, communication, cooperation, creative thinking, conflict resolution and problem solving.  Trust, respect, consideration, assertiveness, self-expression and confidence are other aspects of a productive EFT group session.

5]    Monty Roberts and his "Join-Up" method: The REAL Horse-Whisperer

Monty Roberts was born in 1935 in Salinas, California.  His father was a horseman and operated a large riding school and agistment facility.  Roberts’ early childhood was spent traveling across the country riding rodeo horses, a talent he embraced early; at four years of age he competed on the professional rodeo circuit, and at age 5 years was working as a professional stunt-rider in Hollywood productions.  At the age of thirteen, Roberts spent many weeks living in the Nevada wilderness with a herd of wild horses which he was to capture.  It was here that Monty discovered the technique he was later to make famous: Join-Up.

5.1 Join-Up
"Each significant horse was a stone in my life’s necklace.  I used the lessons they taught me and gained strength from the relationships formed with them" (Roberts, M. 2004, p.8).
As a young child, working alone for weeks at a time, Monty spent much time observing the natural behaviours of the wild horses.  He noted that dominant mares would drive "problem" colts away from the herd, keeping them at a distance until the colt exhibited specific submissive behaviour, signaling his acceptance of the dominant matriarchy. This done, the mare would allow the colt to return to social grazing with the herd.

Roberts’ technique, Join-Up, is based on these same behavioural principles; the human takes the role of the dominant horse and sends the "problem" horse out and away.  When the exiled horse exhibits particular submissive responses (such as chewing, licking, tilting ears etc) the horse is allowed to return to the herd (per se) and is rewarded with praise and physical affection.

5.2  Why use Join-Up?
In their 1999 paper; "The Man Who Listens To Behaviour: Folk wisdom and behaviour analysis from a REAL horse whisperer", Farmer-Dougan and Dougan explored the Join-Up method from a behavioural-analystic perspective.  The authors concluded that Roberts’ methods indicated a "deep understanding of behavioural principles including positive reinforcement, timeout, species-specific defense reactions, "learned helplessness", and the behavioural analysis of language" (Farmer-Dougan and Dougan, 1999, p.139).

The Monty Roberts Join-Up method is based on creating a relationship with horses which is based on trust, respect, collaboration, communication and leadership.  As explained earlier, horses are innately sensitive animals; they respond immediately to anger, aggression and anxiety.  Learning and applying the Join-Up method with these sensitive animals creates the necessity for individuals to a) become more aware of the impact of their behaviours on themselves and their "external" relationships, b) learn how to change negative behaviours, c) achieve desired outcomes without using violence or aggression, and d) learn how to maintain positive relationships and behaviour change.

5.3 Joining-Up and changing lives; Join-Up in practice
Kingshurst Junior School is located in a deprived area of Solihull, Britain.  At the time of Monty Roberts initial involvement with the school, forty per cent of its student population were deemed "special needs".  Within months of using Join-Up, the ethic at the school began to change; the students became more respectful and began to enjoy their time at school.  "If you can save one horse’s life it is wonderful," says Roberts, "but to save one child? That’s like saving all the horses in the world" (Elsworth, 1995, p.2).

At the Priory Hospital in North London, a horse named" Guinness" is changing the lives of people battling with alcohol and drug issues, helping them to overcome their addictions and lead functional lives. Equine-assisted psychotherapy is primarily used in addiction group therapy and with eating disordered patients.  The local riding school works with the hospital to provide a number of horses and ponies for use in the therapy sessions.

"We find working with horses can provide a very solid base for recovery … in an era when immediate gratification and the easy way are the norm, horses require people to be engaged in physical, emotional and mental work – a valuable characteristic in all aspects of life"." (Dr. Neil Brenner, Medical Director of the Priory Hospital, in Hall, 2006).

6]    Implications FOR community-BASED  "EQUINE-FACILITATED" support PROGRAMS

Previous evidence supports the effectiveness of equine-assisted and facilitated learning and therapy. Effective provision of this treatment requires the utilization of mental health and equine specialists.   It is recommended that the equine specialist and mental health professional are in constant contact and collaborate fully to provide a safe, enjoyable and potentially life-changing experience.

6.1 The importance of community support
As discussed earlier, several variables are associated with resiliency, these are; individual disposition, supportive familial relationships, community support and personal self-efficacy (Garmzey, 1993 and Werner & Smith, 1992, in: Hayden, 2005).  As has been discussed above, interaction with horses is capable of increasing perceptions of self-efficacy and improving self-concept, however, individual dispositions and family dynamics and relationships may be difficult to monitor, influence and change.  Conversely, community-based interventions and programs are more easily supervised and adapted and  "appropriate to introduce at any developmental stage" (Wolkow & Ferguson, in; Hayden, 2005, p.7).  Constant evaluation and monitoring of programs will reveal their effectiveness and their deficiencies.

7]    CONCLUSION

Learning is more effective when the participant is interested in the subject and is able to actively participate in their education (Ewing et. a., 2007).  Equine-facilitated learning and therapy provides an opportunity for young people to become actively and consciously engaged in the development of their behavioural and social skills.  "At-risk" adolescents with developmental or behavioural dysfunction often have difficulty identifying with and finding their place in society – it is suggested that the life and social skills accumulated during participation in an equine-facilitated program will transmit into the lives of these young people and assist them in finding their place in society and becoming effective, functional adults.