CHAPTER ELEVEN

FROM THE HORSE’S MOUTH: CASE STUDY OF A HANDLER’S PERSPECTIVE OF EQUINE-FACILITATED THERAPY

Christopher Hayes and Christopher R. Walker

Animal-assisted therapy (AAT) is a growing field and is quickly becoming an alternative to traditional therapies for cerebral palsy, postural impairment, language disabilities, multiple sclerosis, spinal cord injuries, and psychiatric disorders with varying rates of success. The efficacy of equine-facilitated therapy (EFT), also known as hippotherapy, is subjective in nature. Why it should be used and the outcomes expected differ from person to person prescribing the therapy. The purpose of this chapter is to elicit the perspective from an equine therapist who conducts EFT. Few research studies have documented the perspective of the equine therapist on the success of EFT, or what constitutes a successful application of equine-assisted therapy. A relatively new treatment for the aforementioned therapies, EFT has little research involving the equine therapist in general and fewer still with case study research involved.

PROBLEM STATEMENT

This research includes an extensive literature review of EFT for both the patients and the horse handlers. It also illustrates the theoretical background of the therapy including different references to the psychological perspective of different researchers. The chapter presents a discussion of the state of research using the available empirical studies and the reports on the topic. Finally, the literature presents reviews of the alternate application of the therapy in different situations.

There appears to be a deficiency in research focusing on the perspective and contributions of the handler. This research aims to identify what parameters and situations are helpful to conclude in successful application of EFT. The handler’s perspective is an often overlooked and a critical aspect of the success of EFT with patients selected for this type of therapy. Handlers are tasked with the responsibility to train the animal and match the animal with the participant. However, there is little history or research on how this relationship between the animal and the handler is established and maintained over the course of the animal’s time as a therapy companion. This research is significant because it can further help clinicians to appropriately identify, refer, and prescribe the correct patients for this type of therapy.

LITERATURE REVIEW

EFT represents a type of AAT. Notably, EFT describes the application of horses as an important part of the physiological and psychological therapy method. There are different methods that are applied in equine therapy including mounted, unmounted, and vaulting activities. Mounting activities include riding the animal itself or using a horse and carriage. The horse and carriage give EFT an option to those who otherwise may not be able to mount a horse because of weight, balance, fatigue, fear of heights, or the ability to sit astride. Unmounted activities use techniques such as teaching individuals how to interact with the horse and the equine environment. These behaviors entail safety, grooming, leading, and stall- and barn-related tasks. Unmounted activities also include experiences of handling and lunging a horse. This teaches the horse to walk in an enclosed circular pen that helps the horse to learn its correct bend. This helps the horse to understand that when carrying a rider, it learns to bend into the curves when turning so that the horse itself does not lose balance. Interactive vaulting is an activity in which the patients perform movements on and around the horse. These movements can be very simple such as sitting without holding onto the surcingle or a more elaborate compulsory move such as kneeling or standing on the horse (Gardiner & Frewin, 2005).

EFT presents literature that has a huge reliance on theoretical propositions leading to uncertainty of the results of the initial application. Many therapists are unwilling to try out the experimental therapies, instead relying on established protocols and treatments (Gardiner & Frewin, 2005). The longitudinal studies that apply biofeedback such as the varying heart rate, skin conductance, and alpha and beta brain activity could serve to provide viable results to measure the outcome of EFT. There are numerous propositions of biofeedback in different studies that propose the association of biofeedback to psychological parameters (Brandt, 2013; Drinkhouse, Birmingham, Fill-man & Jedlicka, 2015). Physiological parameters could be applied in the measurement of the variables after the application of EFT to patients.

Within the review of literature, all authors agree that their studies had only a small number of participants and that their work needs to be conducted on a large-scale population to see if the results would be replicated. The authors strongly agree that EFT should involve a minimum of two experts and the participant (handler, therapist, and participant/subject). There appears to be an agreement among the authors about the training the handler and therapist must have prior to becoming involved with equine-assisted therapy to include, partnership with Equine Assisted Growth and Learning Association (EAGALA), and North American Riding for the Handicapped Association (NARHA).

There also appears to be an agreement that AAT in general and equine-assisted therapy in particular can be conducted across a wide spectrum of conditions and can have positive outcomes for all of the subjects that are exposed to this particular therapy. They all agree that EFT should be further explored in large-scale research studies and followed over time to see if the effects of the therapy are long term in nature or only short term. There is also consensus among the literature that a particular goal should be set for each participant and the therapy should be geared toward achieving that goal.

Points of interest where the literature is not in agreement seem to be how long therapies should be introduced to the subjects. Some researchers felt that short therapy sessions with exposure as little as one to two times could make an impact on conditions. Others disagree and claim that the therapies should be for a continued period of time for weeks to months to have a true understanding if the therapy is beneficial. A short duration of exposure to the experimental treatment was mentioned as a limitation in several of the reviewed articles. Varying sample sizes were also mentioned as a limitation, whereas other researchers did not see this necessarily as a limitation or drawback to their research.

There is a gap in the literature from the perspective of the handler and their involvement with the research and day-to-day work with the animals. There does not appear to be any insight in the literature review to address this perspective and how the handler’s involvement shapes the therapy toward individualized participants. Because of this gap in the literature surrounding these aspects of EFT, this research is needed to provide this unique perspective related to research for EFT and addresses some steps necessary for patient-focused care.

METHODOLOGY

Design

A single case study was used to elicit answers to our research question: What parameters and situations are helpful to conclude in successful application of EFT? An interview was conducted with a single cultural participant, a horse handler that works in equine-assisted therapy. A participant was found who was willing to share her experience. Contact with the handler was made and she was interviewed over the summer.

Sample

Only one participant was interviewed. The participant was recruited by an informal referral from a known associate. The participant was selected because of her profession of being a handler of horses for a company that provides EFT. Asking the participant to use an alias, instead of using her real name, protected her identity. Informed consent was obtained with a written contract with the participant. Although conducting research, all measures were taken to maintain the privacy of the participant. Data were stored on a personal computer that was password protected.

Setting

The interviews were conducted at a small equine therapy facility located in a large metropolitan area in the southeastern United States and has been participating in and providing equine-assisted therapy for more than 15 years. The program has over 45 participants involved in therapy each week. There are six staff members and over 30 volunteers that help out each week on a rotational basis to help serve as many clients as possible. The handler was comfortable with conducting the interview at her place of employment so no other venue was necessary to conduct the research.

Instruments

The data collected were in the form of answers to the questions regarding the perspective of the handler in relation to AAT in general and equine therapy in particular. The procedure for eliciting the answers in the case study was a question and answer semi-structured interview with a single cultural participant. We asked each question and gave the participant the opportunity to interpret the question and answer each question with no time limits. This provided time for impromptu questions and answers. The following questions were used during the interview:

Data Analysis

The interview of the handler helped to elicit insight into the gaps of information. It was anticipated that two interviews would take place. The first interview was to go through the primary questions and receive feedback. A second interview was scheduled and conducted to answer questions that emerged from the analysis of the first interview. There was also use of participant observation and observation with patients during the first interview. The researchers met to analyze the data together to verify that they both agreed on the understanding of what was said during the interview. This was done to come up with a consensus and to help identify ongoing themes and concepts.

Rigor

The data were content analyzed and the answers were accepted as true and honest answers as the researchers had no reason to believe that the participant lied during the interviews. If another researcher asked the same questions, it is anticipated that the answers would be the same.

RESULTS

Handler

Our handler, “Margaret” (pseudonym), is a Professional Association of Therapeutic Horsemanship (PATH)-international certified therapeutic riding instructor. Margaret has been around horses all of her life and has been riding horses for 19 years. She has a bachelor’s degree in psychology. She currently owns a horse ranch, where she offers riding lessons. She also works at a facility that offers EFT to all patient types. She has been working at this facility since she became certified in November of 2014, but has been teaching riding lessons as a subcontractor for about 10 years. Margaret tells us, “Horses are my life.” PATH International is the certifying organization. PATH is the leading organization, around the world, for certifying and supporting these types of therapeutic riding instructors. In 1969, PATH was founded by the NARHA to help promote horsemanship and riding, as an alternative avenue of therapy for people with special needs (PATH International, 2015).

Equines

The horses implemented at this site are chosen and applied after careful consideration. Choosing the correct horses is critical to creating bonds and relationships with the individual participants. Quarter horses and Welsh ponies are the two breeds that are usually selected at Margaret’s facility because of their calm nature. She told us that they “typically don’t have thoroughbreds or warm bloods, they are too hot headed.” These breeds typically need someone like a trained professional who knows how to handle them. Per the interview, mild-mannered horses are the best. She describes a good horse as, “where sirens could go off and the horse could care less. It’s really the horse’s personality more so that’s most important.” The normal process of selecting a horse has different avenues. Ads are placed in search of a therapy horse and ads are responded to if a compatible breed is up for sale. Many times older, retired horses are bought because of availability. She told us that “purchasing retired horses could benefit the horses as well as the patients.” Usually, they “can no longer jump or do competition, but they need to keep moving and keep some level of fitness.” Some people are willing to donate horses as well. The trainers and handlers evaluate the horses to determine their compatibility and demeanor. Based on the evaluation, the determination is made to see whether to purchase the horse and implement into therapy sessions or if the horse does not meet the criteria. Once purchased, the handler trains the horses to learn the possible maneuvers and typical strategies used during therapy. If all criteria and training are met, the horse interacts with patients.

Observations

Observing clients during their session was the validating factor for all the information obtained during the interview. On the day of the interview, we had an opportunity to observe participants and their interaction with the horse, the handler, and her two assistants. Each participant had a different condition and a couple had multiple conditions. The different diagnoses observed were numerous. Autism, cerebral palsy, attention deficit hyperactivity disorder (ADHD), and others were being treated. EFT is not only limited to treating patients with physical or mental disorders. Psychological and emotional disabilities can be treated with EFT as well. Although each session had very different conditions/disorders, many of the therapy sessions started similar and became more specific moving forward in the session, as to individualize toward the strengths and likes of the participant. The main focus of each session was to ensure that all parties were involved. The parent(s), volunteers, and patient are all part of the session and need to be included to help create a cohesive and happy environment for the participant to maximize the benefits from the therapeutic session. Mounting, vaulting, the motion of the horse, communication, and other aspects of riding allowed for improvement in most of the impairments that brought the patient into therapy initially.

One observation, in particular, was an overwhelming success each time the participant had a session. He is a 25-year-old patient with cerebral palsy (CP) and mitochondria disorder. He weighed about 20 pounds and was only 26 inches tall with no verbal speech and very limited movement at the beginning of the session. When we first met him, we had no idea how the handler was going to be able to put him on a horse. His body was stiff and his legs were unable to separate. It was a challenge, but the handler put him on a bareback pad (a pad that lies on the horse’s back and straps under the belly of the horse to secure) and laid him on his back. The motion of the horse’s back and hind end was so soothing for him that his muscles eventually relaxed. After his muscle relaxed enough, they were able to put him into a chair position. As the session progressed, the handler and her assistants started to introduce stuffed animals and played music that he enjoyed. He became more responsive to voice and he would point and say “go” to get the pony to walk forward. Margaret would later tell us:

Stay updated, free articles. Join our Telegram channel

Join