Introduction Summaries OF Equine Facilitated Psychotherapy (EFP)

Introduction Summaries OF Equine

Facilitated Psychotherapy (EFP)

Equine facilitated psychotherapy (EFP) has been researched as an

effective therapeutic alternative for the development of life skills and coping

skills, as well as the improvement of emotional and cognitive functioning

(Levinson, 1997; Rothe, Vega, Torres, Soler, & Pazos, 2005). EFP has been

explored as a beneficial therapeutic intervention for various mental disorders

such as depression, attentiondeficit/hyperactivity disorder, conduct

disorders, dissociative disorders, and eating disorders (Marx & Cumella,

2003; Tyler, 1994). Areas of behavioral modification, selfconcept,

confidence, anxiety, trust, communication, and self-efficacy have also been

explored when examining the effectiveness of EFP (Lentini & Knox, 2009).

Despite the research demonstrating EFP’s effectiveness, little qualitative

investigation has been done to capture the experiences of individuals after

their exposure to EFP. The potential for emotional growth related to self-

knowledge and interpersonal behavioral insights that derives from

participating in equine activities may yield new thoughts, feelings, and

alternative behavior patterns. Perhaps the longitudinal impact of EFP could

be strengthened if providers understood the experiences of individuals long

after their EFP ended.

Chapter 2 introduces a thorough review of results from existing

quantitative literature as well as quantitative studies that are most pertinent

to this study. Chapter 3 includes the research design, sample population,

methodology, and instrumentation of the present qualitative study.

Procedures for establishing the trustworthiness of the data are also

highlighted. Confidentiality and other ethical procedures conclude Chapter

3. Chapter 4 presents the results, including the development of key themes

from the interview data. Chapter 5 introduces the interpretation of the

results, limitations of the study, and recommendations for further qualitative

research regarding EFP. Chapter 5

concludes with social change implications.

Background of the Study

Scientific research in the area of animal-assisted therapy is abundant.

However, equine therapy is a relatively new area, and research is somewhat

limited concerning the scope of therapeutic benefits. According to Lentini

and Knox (2009), abundant literature is available on the practice of EFP;

however, more research on the theory of EFP needs to be conducted.

Supporting literature exists regarding the therapeutic benefits of EFP, but

studies describing the experiences of individuals and interaction with horses

as a therapeutic tool are limited. The literature on EFP is available for

describing the components of equine therapy, psychological approaches and

theories, and influences on self-esteem and behavior (Rothe et al., 2005).

Research in the area of EFP has increased in recent years; however, the aim

of this paper is to increase understanding of human experiences during and

after EFP and potential benefits in relation to long-term quality of

life.

Theory of Animal-Assisted Therapy (AAT)

The companionship between people and animals molds into a special

bond for many people. Research has explored the psychological and

emotional benefits for people who have developed a bond with animals

(Barker, 1999). Such bonds are said to have a special healing power.

Literature indicates that animal-assisted therapy (AAT) is a goaloriented

intervention that involves an animal as an integral part of therapy (Lentini &

Knox, 2009; Rothe et al., 2005). Prior to the inclusion of animals as part of

therapy, research existed on the benefits of pet ownership in relation to

general health factors and psychosocial development (Barker, 1999). AAT

emerged from the observation of the bond that exists between people and

animals and the correlated promotion of well-being. EFP is a form of AAT

(Lentini & Knox, 2009; Rothe et al., 2005). In EFP, the horses serve as a

catalyst to intervene and promote social interaction and serve as a bridge to

interpersonal communication. The objectives and components of EFP

involve activities with horses that require participants to apply certain skills

such as leadership, problem solving, nonverbal and verbal communication,

creative thinking, teamwork, relationships, confidence, assertiveness, and

attitude (Iannuzzi & Rowan, 1991). The combination of the equine

specialist, mental health professional, participant, and the horse allows for an

experiential opportunity for growth (Froug et al., 2013).

Theory of Equine Therapy

EFP is a type of AAT in which horses are used as an integral part of

the treatment process. In literature, various terms are used to describe the

use of horses for therapeutic modalities, including equine assisted

psychotherapy (EAP), equine facilitated therapy

(EFT), equine assisted experiential therapy (EAET), equine facilitated

psychotherapy

(EFP), and equine assisted learning (EAL; Lentini & Knox, 2009; Rothe et

al., 2005). Psychotherapeutic or therapeutic riding and hippotherapy are

often used in physical or rehabilitation therapy settings (Lentini & Knox,

2009; Rothe et al., 2005). For the purposes of this study, the term EFP is

used. The purpose of this research was to explore what participants’

experiences of the activities used in EFP were and what they did with them

in their personal lives.

Existing literature supports the notion that EFP leads to improvement

in nonverbal and verbal communication, problem-solving skills, and

confidence among participants (Iannuzzi & Rowan, 1991). EFP research

involving individuals with various mental disorders such as eating, mood,

and conduct disorders has indicated that this treatment has beneficial results

(Marx & Cumella, 2003; Tyler, 1994). In addition, studies on juvenile

offenders who have participated in EFP have demonstrated positive results

such as reduction in presenting problems involving disruptive behavioral

disorders such as oppositional defiant, attention deficit, and conduct disorder

(Ewing, MacDonald, Taylor, & Bowers, 2007; Mann & Williams, 2002;

Sapir, 2007; Trotter, 2006). Selfesteem is another area in which a large

collection of literature exists comparing EFP participants’ self-worth, self-

image, and self-evaluation after exposure to EFP (Bray, 2002; Tramutt,

2003). Processes, measures, and results of family therapy consisting of

parent(s) and child(ren) or couples therapy using EFP are also available as a

nontraditional therapeutic intervention (Russell-Martin, 2006). However,

research literature that focuses on the phenomenological experiences of EFP

participants is largely nonexistent. The research addressed this gap in the

literature.

Problem Statement

EFP helps participants develop accountability for their emotions while

recognizing the effects that their emotions and behaviors can have on others

(Marx & Cumella, 2003). The process of experiential learning through the

use of activities involving participants and horses leads to self-discovery,

and results suggest an increase in participants’ overall self-evaluation or

sense of self-worth (Marx & Cumella, 2003). In a review of the literature, a

gap in understanding the experiences of adults during and after EFP is

apparent.

Purpose of the Study

The experiences of individuals after exposure to EFP have not been

examined. In contrast to many quantitative reviews of EFP, a qualitative

study could investigate how individuals think and feel after exposure to EFP

and perhaps further understanding of psychological processes underlying

participants’ responses to this particular therapeutic approach. The potential

for emotional growth related to self-knowledge and interpersonal behavioral

insights that derives from participating in equine activities may yield new

thoughts, feelings, and alternative behavior patterns. Insights and

perspectives arising from individuals’ experiences after EFP may

supplement research in the areas of efficacy in skill building, emotional and

cognitive function, and overall mental health.

Research Questions

The following questions were addressed in this phenomenological study:

1. What are the experiences of adults during and after receiving

equine facilitated psychotherapy (EFP)?

2. What aspects of those experiences are considered by participants to

be most beneficial for their well-being?

3. How have participants been affected by the experience of EFP?

4. What did the participants do with their experiences after EFP?

Conceptual Framework

Theories such as animal-assisted therapy (AAT) and solution-focused

brief therapy (SFBT) support the application and effectiveness of therapy

between humans and horses. AAT research is abundant and reveals positive

bonds developed between humans and animals as well as benefits for

general health and psychosocial development. Selfesteem, one of the

emotional benefits of AAT, is a strong factor in interaction with the social

environment and its relationship to growth and development. Equine

therapy integrates the techniques of SFBT, which allows the therapist to use

a variety of solutions when working with participants.

Solution-Focused Brief Therapy (SFBT)

Solution-focused therapy can also be linked to brief therapy and

problem-focused therapy, in that these approaches emphasize brief, short-

term change through a series of small steps that may lead to bigger change

(Schieffer & Schieffer, 2000). EFT has roots in solution-focused therapy,

and the techniques of SBFT are used in equine therapy as a solution

focused/strategic approach to resolving psychological issues.

Part of effective therapy is increasing participants’ ability to problem

solve in personal and academic situations. These skills may lead to enhanced

self-esteem and to promotion of competence and a sense of empowerment.

Benefits of using SFBT are its practical application to current life

circumstances and help in assessing the degree of progress (Fernando, 2007).

Aspects of SFBT that are used in equine therapy include a focus on future

goals, a focus on solutions, a focus on what does or does not work for the

individual, and removal of any barriers that may hinder goal orientation and

well-being. The techniques of SFBT establish the groundwork for new

thinking and are designed to elicit positive behaviors (Nims, 2007). The

techniques of SFBT are goal setting, the miracle question, and solution

message (Nims, 2007).

A basic premise of SFBT is goal setting, which involves establishing

clear and concrete goals that are positive in nature and clearly behavioral

(Nims, 2007). The goals must be relevant and meaningful to the

participant’s situation (Nims, 2007). For instance, a couple attending EFP

might work together in EFP activities, with the mental health professional

helping the couple resolve issues through the use of skillful language and

appropriate goals for improving the relationship. While focusing on

problem resolution, the mental health professional in EFP may ask

participants to visualize how life would be different if the goal were

achieved, thus focusing on resolution and not interpretation of the problem

(Nims, 2007). In SFBT, this type of question is referred to as the miracle

question. During EFP activities, a couple might be asked what life would be

like if their problem were magically solved, thus promoting a vision for the

solution (Nims, 2007). Whatever has been blocking progress to finding a

solution could be paralleled with activities in EFP as the couple works

together through equine activities. A final step in SFBT is to reinforce

participants with a series of compliments and affirmations about effort. This

is referred to as the solution message (Nims, 2007). This technique might be

used by the mental health professional to communicate to the couple

(participants) and/or by each partner to communicate with the other. EFP

using SFBT techniques may create greater satisfaction for couples and

acknowledgement of effort through the use of language and open

communication.

In SFBT, subsequent sessions involve discussion of previous goals

and identification of any difference since the last session (Nims, 2007). The

principal skills of SFBT, active and reflective listening, can be applied to the

adolescent during equine activities in equine therapy. During engagement in

equine activities, goals and tasks are agreed upon based on the participant’s

experience, values, and beliefs. The therapist in equine therapy consistently

draws from the client’s point of view in each activity and guides the client

through the process of finding a solution, which enhances coping strategies

and psychological well-being.

In SFBT, focus is placed on the client’s strengths rather than

weaknesses. Less attention is devoted to how problems arose than to

solutions to problems and coping abilities to reach obtainable goals

(Fernando, 2007). Focus is also placed on continuing with what works for

the individual and discontinuing whatever it is that is not working. The

parallel between SFBT and EFP is the solution-directed and solution-

focused approach. For example, during an equine activity, a client may

become frustrated with not being able to get the result she or he wanted in

relation to the goal of the equine activity. Mental health professionals can

use this opportunity to intervene and discuss with the participants reasons

why a particular approach did or did not work. In alignment with the SFBT

approach, placing emphasis on what did work helps clients plan the next

small steps in equine activities. Opportunities for mental health

professionals to interject therapy depend upon the reasons that the

participants sought therapy (e.g., communication issues, leadership,

relationship, leadership style, anxiety, etc.).

Nature of the Study

Design

Phenomenology was chosen as the design for this qualitative study.

To gain an understanding and description of the experiences of adults after

EFP, the best qualitative approach is a phenomenological study. The

research described “what” these individuals experienced, “how” they

experienced it, and what they did with those experiences (Moustakas, 1994,

as cited in Creswell, 2013). To clarify, the research did not involve

explanations or analyses of reported experiences; rather, it involved

descriptions of adults’ experiences after EFP (Moustakas, 1994, as cited in

Creswell, 2013). Phenomenology also involves discussion of the essential

themes expressed within participants’ experiences (Creswell, 2013).

Participants and Site

Adult participants were located through a facility that provided EFP so

that all participants would have experienced the phenomenon being studied

and would be able to report their experiences. Participants had various

reasons for attending EFP such as bereavement, posttraumatic stress,

communication, behavioral, or relationship issues. Generally, when EFP is

provided, there is a focus group of participants aiming to improve areas of

their mental health. Permission to study at a particular site along with

consent to participate, when appropriate, was obtained for this study. The

consent form for participants included the following essential information:

(a) the right of participants to voluntarily withdraw from the study at any

time, (b) the purpose and procedures of the study, (c) measures to ensure

confidentiality of participants, (d) any risks associated with participation,

and (e) benefits of the study. The form concluded with space for the

signatures of the participants and myself (Creswell, 2013).

Data Collection

Structured in-depth phenomenological interviews served as the data

collection instrument. The interviews were structured around key questions

to ensure a systematic approach (Patton, 2002). I also used audio tapes and

transcriptions of the interviews. The data collection process involved

conducting one-on-one interviews with adult participants in EFP.

Interviews may include open-ended or close-ended questions

(Creswell, 2013).

This study involved the use of open-ended structured questions with a

sample of eight to 12 EFP participants. These questions allowed participants

the opportunity to reflect on thoughts, feelings, and experiences related to

EFP. The standardized open-ended strategy allowed in-depth exploration

and flexibility in probing discourse (Patton, 2002).

Data Analysis

Data analysis included organizing the interview questions and

examining insights and interpretations that occurred during data collection

(Patton, 2002). Participants’ responses to questions were grouped together

into meaningful units, and any significant statements or nonrepetitive

statements from participants were identified (Creswell, 2013; Patton, 2002).

Data were then organized into meaningful units, clusters, or themes

(Creswell, 2013; Patton, 2002). Data management began with making a list

of significant statements from participants and then grouping them into units

of information or themes (Creswell, 2013). I wrote a description of “what”

participants experienced (i.e., textural description), followed by a description

of “how” the phenomena were experienced (i.e., structural description); this

approach allowed me the ability to write a composite description of the

experiences of adults after EFP (Creswell, 2013). Data on what the

participants did with their experiences were also gathered and analyzed in a

similar manner. The resulting detailed description, known as a textural

description, used exact words from participants (Creswell, 2013).

The next step allowed delimitation to occur in identifying overlapping

or repetitive data (Patton, 2002). This step involved determining “how” the

experience happened, or the “bones” of the description (Creswell, 2013).

Structural description, as described by Patton (2002), captures what

participants experienced and how they experienced it in a phenomenological

analysis. A final step in phenomenological analysis is an integration that

captures the meanings and essences of described experiences (Creswell,

2013; Patton, 2002). This synthesis included the composite structural and

textural descriptions of the experiences (Creswell, 2013; Patton, 2002).

Definition of Key Terms

Equine assisted psychotherapy (EAP) and equine facilitated

psychotherapy (EFP) are forms of experiential psychotherapy that include

equine(s) for emotional growth (Equine Assisted Growth and Learning

Association [EAGALA], 2010). It is a collaborative effort between a

licensed therapist and horse professional working with clients and horses to

address treatment goals. Because of its intensity and effectiveness, it is

considered a short-term or “brief” approach. EFP goes by several names,

and theories may vary, as may methods. For example, some therapists use

mounted activities, whereas other therapists use unmounted activities

(Lentini & Knox, 2009). An equine specialist (ES) “decides what

horses are used in each session, works with the licensed mental health

professional to structure the session, and keeps an equine log to document

horse behaviors in session. The ES remains aware of safety guidelines that

must be followed in interactions between participants and horses, securing

the welfare of participants and horses during equine activities.

A mental health professional (MHP) is responsible for treatment

planning, documentation of clients, and ensuring ethical practice. The MHP

builds on the ES’s horse observations, bringing in the metaphoric and

therapeutic/learning relevance of the session (EAGALA, 2010).

Solution-focused brief therapy (SFBT) is also referred to as brief

therapy. This approach focuses on issues of the present and how to explore

ways of goal setting to bring about a desired future (McCollum & Trepper,

2001).

Assumptions

For this study, I assumed that all adults who participated in interviews

after receiving EFP would answer honestly and to the best of their ability. I

entered the interview without any preconceived notion of what the lived

experiences of the adult participants would be. I also avoided interjecting

any personal experiences during the interviews. I also assumed that the EFP

processes and procedures were carried out in a way that met the prevailing

professional standards set by EAGALA.

Scope and Delimitations

This qualitative study was designed to capture the experiences of

adults during and after EFP. The qualitative approach taken to this study

was the opposite of a quantitative approach that would allow generalizations

about the effectiveness of EFP to be made. The significance of this study

resided in its effort to uncover what and how adults experienced EFP and

what they did with their experiences. This study did not uncover this

information at a single location. The sample in this study was not applicable

to any specific population and cannot be assumed to be generalizable to all

adults who receive EFP.

Limitations

The study was limited to a specific group of participants in one

location and their views based upon their own experiences during and after

EFP. Qualitative reviews of EFP are needed to further understand how

perceptions contribute to the therapeutic benefits of EFP. Qualitative

methods in this study were discussed with results in context and according to

the study’s purpose to lessen subjectivity. Qualitative interviews cannot

cover all important areas of adults’ experiences during and after EFP. Other

limitations on conducting interviews in a qualitative study include time

constraints and the researcher’s ability to obtain accurate information and to

ensure that participants provide complete answers. Standardized interviews

help to ensure consistency, and using probes during interviews provides a

level of comfort for the participant and minimizes influence from the

researcher. The researcher must be conscientious about noting any bias or

expectations of the outcome of the study to lessen threats to validity. The

researcher

must also identify and be aware of his or her own body language and convey

neutrality and acceptance while interviewing participants.

Significance of the Study

Many researchers have noted that research on EFP is not prevalent in

literature

(Klontz, Bivens, Leinart, & Klontz, 2007; Lentini & Knox, 2009; Russell-

Martin, 2006). This study contributes to the literature in its exploration of

cause-and-effect relationships in EFP. By exploring the lived experiences of

people who have participated in EFP, it may be possible to delve more

deeply into the curative factors that may be at work with this type of therapy.

The value of drawing on participants’ experiences is that specific curative

aspects of EFP may be identified so that mental health professionals can

better tailor their regimens as they carry out treatment. As a researcher

uncovers thoughts, perceptions, and feelings experienced by participants,

participants’ frames of reference and lived experiences emerge as unique

sources of insight to be valued. Continued maintenance of change may

occur as participants share their experiences, thereby further improving their

sense of self.

Dissemination of knowledge of the participants’ experiences may

occur across various branches of psychology, such as clinical, cognitive,

developmental, psychotherapy, and social psychology. This study may also

encourage the development of enhanced standards of practice among

providers of EFP. Dissemination of the findings from this study may occur

through EFP brochures and planning strategies for organizations that provide

EFP.

Summary

In this chapter, I have described literature on the therapeutic benefits

of EFP and have justified the need for more research on the experiences of

adults after EFP. In so doing, I have outlined several relevant theories,

including AAT and SFBT, to support the application and effectiveness of

therapy involving humans and horses. AAT research is abundant and

reveals positive bonds developed between humans and animals, as well as

benefits for general health and psychosocial development. Equine therapy

integrates the techniques of SFBT, which allows the therapist to use a

variety of solutions when working with adolescents.

There are few studies in the available literature regarding the

experiences of adults during and after EFP. More studies in this area of EFP

may assist therapists in using the horse as a vehicle to assist participants in

identifying problematic areas and attaining solutions through exploration of

their experiences during and after receiving EFP. Although quantitative data

have indicated benefits of EFP in relation to various aspects of mental

health, such as mood and anxiety disorders, communication, and behavioral

modifications, qualitative studies examining participants’ perspectives on

life experiences during EFP activities may assist in better understanding

what individuals find meaningful in their daily lives, as well as how they

find this meaning.

Chapter 2 provides a literature review that summarizes the current

state of knowledge about EFP, the gap in the literature that the study

addressed, and the areas explored through the phenomenological interview

process.

Chapter 2: Review of the Literature

Introduction

Literature has been published on incorporating horses as a therapeutic

aid in terms of its effects of self-esteem and behavior (Bray, 2002; Rothe et

al., 2005; Trotter, 2006), self-evaluation or sense of self-worth (Marx &

Cumella, 2003), mental disorders (Marx & Cumella, 2003; Tyler, 1994),

behavioral disorders (Ewing et al., 2007; Mann & Williams, 2002; Sapir,

2007; Trotter, 2006), and improvement in nonverbal and verbal

communication among clients (Iannuzzi & Rowan, 1991). Quantitative

studies have captured the influences and outcomes of the emerging

therapeutic intervention known as EFP; however, existing qualitative

literature in this field is insufficient. Some literature identifies the

importance of capturing the clients’ experiences (Bachi, 2012; Burgon,

2011; Masini, 2010) to enrich clinical practice of EFP. The benefit of this

phenomenological qualitative approach derives from the effort to explore the

experiences and responses of clients to this particular therapeutic approach.

In this chapter, I review and summarize current literature on EFP, strategies

used to search the literature, theoretical foundations as noted in the literature,

and other key variables and/or concepts.

Literature Search Strategy

The strategy for data collection used for this critical literature review

was an online search using several sources of information. Searches through

the Walden University online library included sources form PsycARTICLES

and PsycINFO databases using terms such as equine therapy, equine assisted

psychotherapy, and equine facilitated therapy. The literature review for this

study also included material related to components of SFBT. The databases

searched contain full-text, peer-reviewed scholarly and scientific articles.

Articles and books from the online digital library Questia were also used.

The literature search also identified published books relevant to this study.

Theoretical Foundation

EFP has derived techniques from various modalities, such as forms of

brief therapy and solution-focused therapy (Shultz, 2005). Generally, SFBT

focuses on problem resolution rather than problem interpretation (Russell-

Martin, 2006; Shultz, 2005). The model of brief therapy integrates and

focuses on the importance of the therapeutic process, doing something

different if problems exists when solutions are followed that do not work,

observing behavioral interactions, and identifying patterns of unwanted

behaviors (Russell-Martin, 2006; Shultz, 2005). In EFT, therapists observe

clients’ interactions with horses. Often, when a client experiences an

unfavorable response from a horse, it is assumed that the same behavior is

potentially causing problems in other areas of the client’s life (Shultz, 2005).

An assumption in EFT is that a horse will mirror or provide feedback to

clients during EFP due to the horse’s ability to be flexible in adapting to

persons or situations (their environment) and respond accordingly (Bachi,

Terkel, & Teichman, 2012). In EFT, horses are therapeutic facilitators, and

their role allows a window of opportunity for the therapist to address what

changes to undesirable behavior may be needed in other areas of the client’s

life, as well as discussion of solutions (Shultz, 2005). This technique in EFT

allows the therapist to transfer the learning-theory to other relationships

(Shultz, 2005). The ideology of problem solving is enhanced by clients

learning through participation and by action as well as the use of therapeutic

metaphors by the therapist (Shultz, 2005). Another brief therapy technique

is to find not only current solutions to problems, but also applicable

problem-solving processes for future problems (Shultz, 2005). During EFT

activities, a client may become frustrated or upset when trying to engage the

horse to complete an activity. This behavior would be applied to how the

client reacted to similar problems at other times, and solutions developed

during the session would be discussed as they might be applied to difficult

experiences (Shultz, 2005).

Conceptual Framework

Activities within EFP vary because some professionals use mounted

activities and others use unmounted activities (Lentini & Knox, 2009). Each

activity involves interaction between the client and the horse. Metaphors are

used for the therapeutic process of EFP. For example, some clients can

identify or relate with a horse’s fight-orflight instincts and natural

hypervigilance when threatened or frightened (Klontz et al., 2007; Lentini &

Knox, 2009). The use of metaphors and the therapist’s efforts to elicit

responses and interpretations of the horse’s movement and behavior from the

client provide a gateway for bringing forth any unfinished business or

transference reactions (Klontz et al., 2007; Lentini & Knox, 2009).

Transference refers to what occurs when a client may relate to the

therapist, or with the horse in the case of EFP, that emulate important

relationships or issues occurring in their lives (Weiten, 2005). During

transference, conflicting feelings within clients may be transferred onto the

therapist (Weiten, 2005). The client’s interpretation of the horse’s behaviors

allows for a portal for the therapist to address transference reactions

immediately during EFP (Klontz et al., 2007).

The theory of equine therapy posits that, through the interactions of

humans and horses, immediate therapeutic feedback is provided to humans.

Horses are known to mirror what they experience, thereby giving feedback

on human body language and other physical and emotional signals (Rothe et

al., 2005). Horses have the ability to give unbiased and accurate feedback

that mirrors the emotional and physical state of clients during activities; in

this way, EFP provides therapists with a way to assist clients in raising their

awareness about feelings and actions, thus practicing congruency between

emotions and behaviors (Klontz et al., 2007). Regardless of how much a

client may try to disguise inner feelings, horses respond to the internal state

of the client (Lentini & Knox, 2009).

One EFP activity is leading the horse. This activity may indicate how

the client feels about being led by others (Rothe et al., 2005). Some clients

portray their inner feelings by letting the horse go free instead of being more

restricted (Rothe et al., 2005). Leading a horse often brings up issues of

body placement in relation with others, the ability to notice potentially

dangerous situations, and the ability to ask for help (Rothe et al., 2005). The

variety of emotions and behaviors that clients exhibit during EFP offers the

opportunity for therapeutic metaphor and a method for awareness and

growth (Klontz et al., 2007). In a traditional setting, transference may

sometimes be difficult to address or may be easily dismissed when it appears

to the therapist as an inappropriate action. In

EFP, transference action may occur in relation to offenses or inappropriate

behaviors of a horse (Klontz et al., 2007). Working with horses during EFP

allows for opportunities for projection and transference; for instance, actions

such as a horse wanting to graze at an inappropriate time, biting, neighing,

walking away, ignoring the client, or being distracted by the herd may elicit

responses from clients (Klontz et al., 2007). Generally, due to biological

programming, clients can relate to the horse’s natural impulse to flee when

afraid—its instinctual hypervigilance. Horses offer immediate and unbiased

feedback to clients (Vidrine, Owen-Smith, & Faulkner, 2002). This

transference reaction to the horse during EFP can be addressed without some

of the confounding interpersonal factors that occur in traditional therapies

and may be easily dismissed (Klontz et al., 2007). While horses “mirror”

emotional states of the clients, it is difficult to attribute the clients’ reactions

of the unbiased feedback or inappropriate behaviors of a horse (Klontz et al.,

2007). The requirement of total attention to the present from clients and the

calming effects of horses elicit relational features and prospects for

metaphors (Klontz et al., 2007).

Psychosocial issues and mental health issues that influence

communication, cognition, behavior difficulties, social skills, and anxiety, as

well as mood disorders or posttraumatic stress, are addressed in EFP. Goals

in EFP can focus on group participation, development of social skills, speech

and language enhancement, organizing abilities, problem solving,

improvement in self-esteem, and resolution of inner conflicts (Rothe et al.,

2005). The human and horse bond may elicit trust, affection, respect,

empathy, confidence, and personal success through activities, assertiveness,

self-control, and responsibility (Rothe et al., 2005). This bond may also help

the client connect unconditionally with another individual and self-disclose

with feelings of safety and respectfulness (Rothe et al., 2005). The theory

also posits that if a client is behaving in a way that is inconsistent with her or

his thoughts or feelings, the horse will display unsettled behavior through

equine-facilitated activities until the client becomes internally consistent,

whereupon the horse responds when the client is congruently affective

(Lentini & Knox, 2009).

Activities in equine therapies are designed to promote trust, self-

knowledge, communication, teamwork, problem solving, and overcoming

obstacles as clients are engaged with horses and the therapist facilitates

change (EAGALA, 2010). Commonly used activities in EFP or equine

therapy include haltering activities, obstacle courses, and extended

appendages. These activities are discussed in greater detail in the section on

therapeutic benefits that follows.

Therapeutic Benefits

Greg Kersten, cofounder of EAGALA in 1999, provided the

following descriptions of key EFP procedures and methods (Kersten, 1997).

Haltering Activity

A haltering activity is an activity or method in which a halter and rope

is handed to the client and the client is instructed to go into the arena and

catch a horse. There is no right or wrong way of haltering a horse in this

activity, which is used as a metaphor for one’s approach to problem solving.

Clients have various reactions, as do the horses, depending on how clients

approach them; a horse may back away, run, or allow the individual to place

the halter over its head. How the halter is put on the horse can be a

determining factor in the client’s reaction and approach. The client may give

up or walk away, deeming the task impossible, or the client may be

consistent in his or her approach to the activity. The client may be forced to

re-examine the situation. Reactions of clients can be used metaphorically to

represent how they handle other difficult situations at home, work, or

elsewhere. Clients may be asked if their reactions represent their work ethic,

their ability to take on challenges, their reaction to negative communication

or body signals, and so on.

Obstacle Course Activity

An obstacle course activity takes place in an enclosed arena and

allows the horse to walk around unassisted (Kersten, 1997). Various

temptations are set up for the horse, such as grain and hay. Obstacles are

sometimes laid out that involve poles, jumps, and barrels. The activity for

the group is to lead the horse (haltered or unhaltered, depending upon the

therapist) through the obstacles without the horse eating anything until the

horse successfully completes the obstacle course. Rules are set up, and the

group of clients decides the consequences for breaking any of the rules. This

activity allows the professionals to observe clients’ interaction skills,

communication styles, and reactions to problem solving, thereby inferring

how they may react to consequences in the “real world.” Therapists may

also ask the clients what approaches worked and which did not and may

make inferences regarding clients’ daily decision-making processes and

reactions.

Extended Appendages

Kersten (2008) stated that horse activities can take place on the ground

or mounted on a horse. The extended appendages activity requires three

clients: two functioning as the left and right arms receiving direction from

the “brain,” and one functioning as the brain that gives instruction. The

mounted activity has one client mounted while the other two clients hold a

lead rope from both sides of the horse. The two clients are instructed to hold

the end of their lead rope with one hand (appendages), and the mounted

client, the leader, assumes the role of the brain and body. The “brain” (the

only one allowed to speak) instructs the appendages verbally on how to

successfully get through the obstacles that have been set up. When this

activity is used in family therapy and the client is placed in the leader

position, the “brain” can often set in motion the client’s underlying thoughts

and feelings. For instance, the client may demonstrate more trust toward one

parent than another. This activity may also lend clients a chance to be in a

position in which they feel that they can reveal their perspective on family

dynamics. In family therapy, the therapist is looking for communication

styles, relationship roles, and problem-solving styles (Kersten, 1997, 2008).

The EFP therapist looks for the confidence level of the “brain” in

giving directions and how instructions are received by “appendages.”

Giving the clients general instructions and allowing them to apply the

specifics within the activities reveals where clients are in the “here and now”

mentally and emotionally. The therapist applies therapeutic metaphors of

horses’ behaviors as well as the clients’ interaction with horses to daily

living and problem-solving skills. According to research, this activity has

been successful for individuals with eating disorders and behavioral issues,

and it can reveal various dynamics during family therapy through role

reversals and bringing parent/child perspectives out into the open (Marx &

Cumella, 2003; Russell-Martin, 2006; Tyler, 1994). Tyler (1994) also

supported equine therapy as a useful supplement to conventional

psychotherapy. According to Tyler (1994), equine therapy can be beneficial

to adolescents with oppositional defiant disorder. Defensive behaviors of

adolescents disappear due to attention being focused on a horse.

Additionally, adolescents with low self-esteem or the perception of having

little control in their lives feel empowered through activities used in equine

therapy (Tyler, 1994).

Review of Literature

Since the growth of EFP, few qualitative studies have documented

experiences of clients in EFP. The purpose of this study was to explore and

interpret the experiences of clients after EFP to add to limited knowledge of

EFP. EFP is being widely used, and research indicates that using horses in

the psychotherapy process has been beneficial (Nilson, 2004). The benefits

of including animals in the therapeutic process have been documented

(Lentini & Knox, 2009). Equine therapy methods are different from other

forms of AAT because horses are large animals that are less likely to be

household pets, and exposure to these majestic creatures provides clients

unconditional positive regard and has a calming effect (Lentini & Knox,

2009; Vidrine et al., 2002). Along with how EFP activities work, this

discussion presents reviews of both quantitative and qualitative research

articles on the efficacy of EFP through experiential learning aspects as it

applies to cognitive, emotional, behavioral, and other psychological

variables. Qualitative studies in EFP are often applied to attachment theory

within a human-animal context. Few qualitative studies have captured

clients’ experiences during EFP to gain an in-depth understanding of the

richness of their lived experiences. The following sections address

quantitative and qualitative studies of EFP and how the study contributes to

existing literature regarding the lived experiences of EFP clients.

Quantitative Studies of EFP

A study was conducted at Horse Sense of the Carolinas based in North

Carolina, which offers EAP outpatient services for individuals and families

(Sapir, 2007). The agency offers various therapy programs and

specializations and works closely with local courts and incarcerated youth.

Data on recidivism rates for juveniles were collected after the juveniles

received equine-assisted clinical practice (EACP) in order to assess

outcomes for juveniles receiving equine therapy. Pretest and posttest scores

from the Youth Outcome Questionnaire (Y-OQ) were used along with

follow-up three, six, and 12 months after receiving EACP.

Funding for this study was provided through the Juvenile Crime Prevention

Council (JCPC). In 2005-2006, 62.5% of JCPC clients completed treatment,

of which 20% had sufficient Y-OQ data (Sapir, 2007). Of the 20%, 100%

reported positive clinical change and 66.6% reported significant clinical

change based on Y-OQ scores (Sapir, 2007). The same data were collected

in 2006-2007, when 84.6% completed the program and 54.5% had sufficient

Y-OQ data. Of the latter 54.5%, 66.6% reported positive change, and 50%

reported significant positive clinical change based on Y-OQ scores (Sapir,

2007). Recidivism rates were collected from referrals in the 2005-2006 data,

of which 100% of JCPC had no referrals on the 3rd month follow-up, 80%

had one or fewer referrals on the 6-month follow-up, and 60% had no new

referrals on the 12month follow-up (Sapir, 2007).

A clinical study of equine-assisted experiential therapy (EAET) was

conducted on the treatment outcomes of 31 clients in a residential facility

with a 6-month follow-up. The study design was a 4 ½-day residential

program, 28 hours of EAET, eight clients per group over an 8-month period,

with a total of 31 clients in eight programs (Klontz et al., 2007). Clients

included nine men and 22 women, ranging from 23 to 70 years (M =

44.74), with an average of 15.77 years of education, covering 13 states, 90%

Caucasian, 39% married, 10% in a committed relationship, 35% previously

married or separated, and 16% were single (Klontz et al., 2007).

Groups were led by Master’s level licensed psychotherapists, along

with a Level

II certification in Experiential Therapy from the American Society of

Experiential Therapists (ASET). The horse specialist handled the safety

guidelines of between horses and humans and the activities involved in

equine therapy. A central hypothesis of this study was that clients would

report reductions in psychological distress and increased psychological well-

being (Klontz et al., 2007). Instruments used were The Brief Symptom

Inventory (BSI) and the Personal Orientation Inventory (POI). The BSI a

53item self-report, Likert-type scale was used to measure psychological

symptom patterns and the Personal Orientation Inventory (POI), a 150-item,

true/false self-report was used to measure constructs related to self-

actualization (Klontz, et al., 2007).

Results of the BSI measures included a multiple analysis of variance

(MANOVA) with repeated measures on the BSI Global Severity Index

(GSI) which showed significant reductions in overall psychological distress

from clients and an enhanced psychological well-being from pretest to

posttest (Klontz et al., 2007). The brief therapy approach of equine therapy

showed significant improvements in psychological functioning in which

future research in equine therapy is relevant/needed (Klontz et al., 2007).

The pretest vs. posttest vs. follow-up indicated a significant effect and

examined using repeated measures that indicated a decrease in GSI scores

from pretest to posttest (Klontz et al., 2007). There was no significant

difference between the posttest and the 6-month followup (Klontz et al.,

2007). Measures indicated that 60% of the clients had scores in the clinical

range on the GSI on the pretest, 20% of clients remained above the clinical

range at posttest, and an increase to 27% in the clinical range at the 6-month

follow-up (Klontz et al., 2007).

The prediction that clients would report an enhancement in

psychological wellbeing after EAET was further reported using the same

measure of MANOVA in relation to the POI (Klontz et al., 2007). An

increase of reported enhancements indicated a significant effect from pretest

to posttest; however, no significant change was reported from posttest to 6-

month follow-up (Klontz et al., 2007). Overall results of the study supported

the hypotheses that clients would report a reduction in psychological distress

and increased scores in psychological well-being from pretest to posttest and

follow-up

(Klontz et al., 2007).

Weaknesses in this study were the lack of experimental controls such

as the lack of a control or comparison group and utilization of a non-random

sample (Klontz et al., 2007). Due to the lack of comparison treatment

groups, it is difficult to generalize if the clients’ reports of changes were due

to treatment, other factors, or time alone (Klontz et al., 2007). Self-report

questionnaires also limit reliance on data collection due to some clients may

want to falsely report improvements in functioning (Klontz et al., 2007). A

strength of this study indicated significant improvements in psychological

functioning reported by clients immediately following EAET (Klontz et al.,

2007). Exploring the meaning of lived experiences of the participants could

have given some insight of the utility of equine therapy.

Mann and Williams (2002) conducted a research project for equine-

assisted family therapy (EAFT) treatment outcomes of eleven children and

adolescents who had received prior outpatient and inpatient treatment. This

study monitored juvenile delinquents on probation over a three-month period

using performance targets to measure the effectiveness of equine therapy

(Mann & Williams, 2002). Conduct disorders were the most prevalent

primary diagnosis followed by mood disorders and psychotic disorders.

This project provided information on a comparison of equine therapy with

other approaches and reflected the recognition and attention in the

therapeutic community that the effectiveness of equine therapy ought to be

explored and documented (Mann &

Williams, 2002). The research design consisted of a pretest and posttest

utilizing the Youth Outcome Questionnaire (Y-OQ) followed with posttest

parent survey measurements. The Y-OQ consists of 64 Likert scaled

questions with six separate subscales designed to measure behavioral

categories of children and adolescents with disturbances of mood and

conduct (Mann & Williams, 2002).

The client sample represented 11 youths, seven males and four

females age range from 8 to 17 years with a mean age of 12.5. Prior to

treatment, the clients were diagnosed with behavioral disorders (4), mood

disorders (3), and psychotic disorders (4) as primary diagnoses (Mann &

Williams, 2002). All clients had received previous outpatient patient

psychotherapy services, four of the 11 and previous in-patient psychiatric

admissions (Mann & Williams, 2002). Two of the 11 youth were on parole

with the division of youth corrections and two others on probation with the

division of juvenile justice (Mann & Williams, 2002).

The study posited that equine-assisted family therapy (EAFT) is an

effective intervention for the reduction of emotional and behavioral disorders

in high risk youths (Mann & Williams, 2002). The research questions were:

(a) What outcomes resulted from EAFT treatment as measured by the (Y-

OQ) composite and content area score differences between admission and

discharge?, (b) How did treatment outcomes vary according to client

presenting symptoms, diagnosis, and severity?, and (c) How did treatment

outcomes compare to other methods of therapy as measured by the Y-OQ?.

The study concluded that 90% of the participants had an increase in school

attendance. Eighty-two percent of the youth in EAFT demonstrated clinical

improvement from treatment for an average of five sessions at a cost of $800

per family (Mann & Williams, 2002). Results of the experimental group

indicated that 53% achieved the performance targets by the end of the

twelve-week program compared to 11% of the control group (Mann &

Williams, (2002). A control group was not used for comparison; however,

the study compared juveniles participating in the EAP program with office-

based therapy and showed a 43% increase in performance target for the EAP

group. During the first eight weeks of EAP, six of nine adolescents achieved

their performance targets (Mann & Williams, 2002). A one-year follow-up

of the six adolescents indicated that four of them were maintaining their

performance targets successfully (Mann & Williams, 2002). A comparison

of results with other Y-OQ studies was conducted and results concluded

receiving EAFT treatment had a larger score reduction as compared to other

non-EAFT treatments (Mann & Williams, 2002).

Upon discharge of the EAFT program, an open-ended parent

questionnaire was given to obtain qualitative data. Four open-ended survey

questions were given to parents and/or guardians upon discharge (Mann &

Williams, 2002). The term horse was chosen over the use of equine to avoid

any misunderstanding in the survey (Mann & Williams, 2002). The

following survey questions were: (a) What benefit (if any) did you and your

family receive from participating in the horse-assisted family sessions?, (b)

What are some of the specific differences (aside from the addition of horses

to the sessions) that you noticed between regular office-based therapy and

the horse-assisted approach?, (c) Describe what the horses may have taught

you about yourself and/or your family members., and (d) Please write any

comments that you would like the program staff to read, or for them to pass

on to other professionals and clients who may be interested in trying a horse-

assisted approach to family therapy (Mann & Williams, 2002).

Direct quotes:

(a) “My son accomplished goals and was ecstatic about it.” (mother)

(a) “The family learned that mom and dad work against each

other.” (mother)

(b) “This is a more down to earth and more relaxed way to do

therapy.” (mother) (b) “This is the only counseling that has worked in

over ten years of seeking help for our daughter.” (mother)

like our kids and we better do something to solve this problem.”

(parent)

following through with my kids.” (mother)

(d) “This is the best counseling I have ever had and it made me

look at myself and not just my kids.” (mother)

(d) “It is giving the three of us something in common to talk about.”

(mother)

Direct quotes presented were collected from five family sessions that

met three criteria: (a) equine activity targeted or was appropriate for specific

change needed within the family, (b) the opportunity for metaphoric

communication to occur through the interaction of client and horse in regard

to family dynamics, and (c) the therapist noted significant change during

therapy session (Mann & Williams, 2002).

Demographics of case example 1 include a mother and father both on

their second marriage and custody of their children from a previous marriage

(Mann & Williams, 2002). The mother has custody of her two daughters,

ages 14 & 16 and the father of his son and daughter, ages 12 & 11 (Mann &

Williams, 2002). The parents have also taken custody of two foster children

ages 9 & 13 (Mann & Williams, 2002). The identified clients are the

father’s 12-year-old son for reducing behavioral problems at home and

school such as opposition and defiance (Mann & Williams, 2002). The other

two identified clients are the two foster children, 13-year-old female for

behavioral symptoms of withdrawal and depression and nine-year-old (Mann

& Williams, 2002). The therapeutic team suggested that all members of the

family engage in equine-assisted therapy sessions (or equine session) (Mann

& Williams, 2002).

Case 2 included a mother, father, 10-year-old son, and 8-year-old

daughter both whom are home-schooled and had limited success in reducing

identified problems with traditional therapy (Mann & Williams, 2002). The

parents reported the son exhibiting oppositional and defiant behavior toward

the family, isolating himself from the family, and combative with his sister

(Mann & Williams, 2002). The daughter was silent during the intake and

was observed as being “clingy” with the mother (Mann & Williams, 2002).

Upon observation from the therapy team, the mother appeared to the

spokesperson for the family while the father appeared passive and they both

appeared to have incongruency with discipline and parenting of their

children (Mann & Williams, 2002).

The third case involved a father and his 17-year-old daughter, and his

wife (Mann & Williams, 2002). The daughter had been in at least five home

placements, long history of being a runaway, 10 scenarios of treatment

(Mann & Williams, 2002). The father is out of town a lot for work and the

stepmother homeschools the daughter (Mann &

Williams, 2002). The therapeutic team’s aims were to discuss the familial

structure and involvement/role of each parent along with assisting the 17-

year-old of appropriate skills to live independently (Mann & Williams,

2002).

The fourth case was referred by the Department of Social Services for

equineassisted family therapy (EAFT) in conjunction with traditional

therapy (Mann &

Williams, 2002). The mother and father, divorced for five years, have two

sons ages 16 & 17 that reportedly exhibit unruly behaviors in the home,

suspected substance use/abuse, and are prescribed antipsychotic medications

for psychotic disorders (Mann & Williams, 2002). The mother has primary

custody and the father remains involved with his sons and employs one in

his business (Mann & Williams, 2002). The last case involved a single

mother of a 16-year-old son and a 14-year-old daughter that were recently

diagnosed with psychotic disorders and prescribed antipsychotic disorders

(Mann & Williams, 2002). The mother indicated she would like to have

better communication with her children and denied any behavioral

difficulties with either child

(Mann & Williams, 2002).

No additional information was provided as it pertains to qualitative

inquiry. Further qualitative research could capture the process of youths’

experiences to understand meaning and provide explanations by analyzing

text and conceptualization. Additionally, the authors recommended

duplicating the research in other geographic locations with a larger

population sample, and more diversity (Mann & Williams, 2002).

A similar quantitative study conducted on 29 at-risk adolescents

hypothesized that EAP participation would increase positive psychosocial

functioning greater than or compared to adolescents who did not participate

in EAP (Shultz, 2005). The term at-risk entailed meeting three or more of

12 risk factors set by Rak and Patterson as cited in Shultz (2005); family

discord and disorganization, poverty, substance abuse, violence and abuse,

low birth weight, congenital defects, perinatal stress, parental alcoholism,

divorce, more than four siblings living in the home, parents with minimal

education, and parental mental illness (Shultz, 2005).

Twenty-nine adolescents, ages 12-18, were living in either in a

residential facility or enrolled in outpatient treatment (Shultz, 2005). Gender

was evenly dispersed in both treatment group and control group,

demographics of residential and non-residential enrollment, and participation

in individual or group EAP (Shultz, 2005). Informed consent for research

was obtained from the clients’ current primary caregiver.

Instruments given to the clients were the Youth Outcome Questionnaire

Self-Report (Y-

OQ-SR) before, during (sessions six & eight), and after treatment (session

10) (Shultz, 2005). Clients either received EAP along with traditional talk

therapy, traditional talk therapy, or no participation in any counseling

(Shultz, 2005). The Youth Outcome Questionnaire (Y-OQ) was given to the

client’s primary caregiver before and after treatment (Shultz, 2005). The

control group was also given the instruments again after six, eight, & 10

sessions (Shultz, 2005).

The author identified and discussed potential extraneous variables;

such as outpatient treatment, residential treatment facility, and receiving

other treatments (Shultz, 2005). Balancing was used for potential variables

or factors that could cause a potential affect and differences between the

treatment and control group (Shultz, 2005). The convenience sample

included participants that received EAP and those that did not and within the

two groups, some participants lived in a treatment facility and others did not

(Shultz, 2005). For example, three clients participating in EAP and also in

outpatient treatment, three clients in the control group did not live in any

treatment facility program, 12 participants in EAP lived in a residential

treatment facility which nine received traditional therapy such as talk

therapy along with EAP (Shultz, 2005). The control group had nine

participants who lived in a residential treatment facility while receiving

traditional therapy and three living in residential care in the control group

that did not receive any type of treatment (Shultz, 2005).

Results included statistical analyses of data on the Y-OQ and Y-OQ-

SR, changes in total scores, and changes on each subtest were computed

(Shultz, 2005). An independent-samples t test was conducted on the total

posttest score from the total pretest score and to analyze each of the

subscales on both instruments to evaluate the hypothesis that clients who

participated in EAP would experience greater positive therapeutic progress

in psychosocial functioning as compared to those clients who did not

participate in EAP (Shultz, 2005). The results for total score changes on the

Y-OQ supported the research hypothesis (Shultz, 2005). The results of the

changes on total scores on the Y-

OQ-SR were also significant which also supported the research hypothesis

(Shultz, 2005). One of the six subscales test (somatic) on the Y-OQ were

not significant while five (interpersonal distress, interpersonal relations,

critical items, social problems, and behavioral dysfunction) were significant

(Shultz, 2005). Clients that participated in EAP had an average change in

psychosocial functioning between 15.77 and 32.11 points greater than the

comparison group (Shultz, 2005). Three subscales on the Y-OQ-SR; critical

items, behavioral dysfunction, and social problems, did not report

statistically significant changes in scores (Shultz, 2005).

Although the sample selection was random, and selection was not

based on any inherent characteristic, it was a convenience sample which

could be a limitation of this study (Shultz, 2005). Inherent differences

between two treatment modalities, group and individual EAP, were not

discussed as well as which aspect of EAP influenced therapeutic benefits in

this study which may reveal another limitation (Shultz, 2005). Additionally,

this study identified demoralization which may occur in a control group

phenomenon in which clients lower their performance being denied access to

the experiential treatment, thus a possibility of threatening internal validity

in this study

(Shultz, 2005).

Future research could entail which aspects of EAP are correlated with

therapeutic benefits, what population would obtain the greatest benefits from

EAP, long-term effects of EAP for a particular population, duplication

including specificity on the number of risk factors in each participant, and

conducting an analysis of covariance identifying differences in a non-

random group (Shultz, 2005). The addition of the current phenomenology

study might identify and understand the essence of experiences from clients

and formation of client’s cognitive maps through phenomenological inquiry.

Cognitive maps are formed by how clients organize information from their

surrounds would help clinicians identify what clients notice and interpret

from participating in EFP. What, if any information is most readily

remembered by clients? Similarities and dissimilarities are vital factors in

gaining a deeper understanding how clients interpret information and

identify automatic thoughts and empowering clients to identify their own

belief system and whether they are rational or irrational and make changes

accordingly.

Understanding how clients form cognitive maps from treatment

experiences such as EFP and its effects, allows clinicians to understand what

inferences clients draw upon during and after EFP. This understanding of

thoughts, beliefs, and internal dialogue would enhance a clinician’s

knowledge about any potential maladaptive thought processes, thus

changing behavior patterns through participation in EFP. This information

could also be used to synergize EFP modalities with other treatment

modalities that include clients and address any identifying issues.

A quantitative pilot study tested the efficacy of EAP in a cross-

sectional group of children diagnosed with various behavioral and mental

health disorders (Schultz, Remick-Barlow, & Robbins, 2007). Of the 63

clients, 37 males and 26 females ranging from 4 to 16 years, 36 were

diagnosed with a mood disturbance, 10 with ADHD, five with PTSD, three

with adjustment disorder, three with disruptive disorder, three with other

disorders, and three without a diagnosis (Schultz et al., 2007). Fifty-one

percent of the clients were non-Hispanic white, 46% Hispanic white, and 3%

black (Schultz et al., 2007). Clients were referred from school counselors,

therapists, and pediatricians who were divided into three categories for this

study: (a) interpersonal violence, sexual abuse, and abuse/neglect (Schultz et

al., 2007). Clients who reported experience with a combination of sexual

and physical abuse were reported in one category such as abuse/neglect

(Schultz et al., 2007). Participation included a mean number of 19 EAP

sessions over an 18-month period and participation at least six EAP sessions

was included in analysis (Schultz et al., 2007).

The quantitative measure used was the Children’s Global Assessment

of Functioning (GAF), a 100-point rating scale measuring psychological,

social and school designed for children aged 6 to 17 years (Schultz et al.,

2007). Maximum functioning is indicated with a score of 100 (Schultz et al.,

2007). Administration of the GAF was given pre and post treatment. Three

age categorizations were used: (a) <8 years old, (b) 8 to 12 years old, and (c)

>12 years old and a univariate analysis indicated greatest improvement in

mental health promotion were in the youngest clients (F = 4.9, d.f. = 2, 46, P

= 0.01) (Schultz et al., 2007). All clients showed improvement in GAF

scores with statistically significant correlation between improvement of GAF

scores and number of EAP sessions (r = 0.73, P<0.0001) (Schultz et al.,

2007). Statistically greater improvement in GAF scores were indicated in

females (15% versus 10.3%, t = 2.46, d.f. = 47, P = 0.02) and no statistically

significant in pre and post scores between Hispanic and non-Hispanic white

clients (Schultz et al., 2007). Improvement in GAF scores and statistically

significant improvement occurred in clients with a history of physical abuse

and neglect in post scores compared to clients without a history of abuse and

neglect (Schultz et al., 2007). Another statistically significant improvement

in GAF scores occurred with clients who reported at least one parent with a

substance abuse problem when compared to the group whose parents did not

(mean + SD = 14.3 + 5.7 versus 10.8

+ 7.0; t =1.81, d.f. = 47, P = 0.08; Schultz et al., 2007).

Limitations of this pilot study included a biased sample that was self-

selected by me and it is unlikely that all children benefit from EAP as the

results indicated that all clients who had a history of neglect and physical

abuse showed an improved GAF scores (Schultz et al., 2007). A therapist

interviewed each client to identify suitability for EAP which could be

difficult to determine causation; any treatment effect could be due to

selection bias, and not applicable or representable for a larger population.

The limited number of instruments used to measure overall mental health

such as psychological functioning is an identified weakness as well as other

extraneous factors that may have contributed to improved scores (Schultz et

al., 2007).

Reporting of a study conducted at a residential treatment facility in

Israel for adolescents at-risk examined the influence of equine facilitated

psychotherapy (EFP) and comparing the treatment group with a control

group (Bachi et al., 2012). The at-risk variables measured were outcomes of

EFP on self-image, self-control, trust, and general life satisfaction (Bachi et

al., 2012). The hypothesis posited that clients in the treatment group would

report greater improvement as compared to those of the control group (Bachi

et al., 2012). Quantitative examination of the research hypothesis conducted

multi-variants with repeated measures analysis where the treatment and

control groups served as between-subjects factors and repeated measures

were within-subjects factors (Bachi et al., 2012).

Twenty-nine clients between the ages 14 to 18 were selected; the

treatment group was comprised of 14 and 15 were referred to the control

group (Bachi et al., 2012).

Participation included weekly 50-minute EFP sessions over seven months

with a total of 14 to 26 therapy sessions were received by the treatment

group excluding two participants that participated in nine sessions (Bachi et

al., 2012). Participants were similar in background demographics such as

being from socio-economic class, parents were divorced, referral to

residential treatment facility following a court order and supervision from

child protection services, police file records relating to drugs and/or,

property theft and/or, physical violence and/or traffic offenses (Bachi et al.,

2012). Pre and post questionnaire instruments were administered along with

a one-year follow-up of both groups (Bachi et al., 2012).

Quantitative measures in Hebrew versions were used to assess the

four parameters: (a) Offer self-image questionnaire (OSIQ) relating to

psychological, social, and coping types of “self”; (b) Rosenbaum’s (1980)

measure to assess self-control behaviors and tendencies to solve behavioral

problems; (c) seven items from the Children’s Interpersonal Trust Scare

written by Hochreich (1973) to identify reactions and interactions with

authority figures, friends, etc.; and (d) Student’s Life Satisfaction Scale

written by Huebner (1991) to evaluate general life satisfaction in connection

to domains such as family, friends, or school (as cited in Bachi et al., 2012).

Although results in the trust variant indicated a trend of increase in trust

among the treatment group (treatment group - M=2.714 before, M=3.071

after) and decrease among the control group (M=3.4 before, M=3.0 after),

results were not statistically significant between the measure effect (F=.005,

p>.05), the group effect (F=.993, p>.05), and between the measure and the

group (F=1.425, p>.05; Bachi et al., 2012). Results in selfcontrol indicated

an increase in both groups (treatment group – before M=2.734, after

M=3.081; control group – before M=2.96, after M=3.2) and neither results

of the group effect (F=.563, p>.05) nor the between measure interaction and

the group (F=.119, p>.05) were statistically significant (Bachi et al., 2012).

Similar results of self-control, self-image, and general life-satisfaction

indicated results that were not statistically significant; however, the

treatment group in all parameters did indicate an increase in scores when

compared to the control group, thus indicating a trend of increase scores

among the treatment group versus decrease scores among the control group

(Bachi et al., 2012). Absentee days and change in means were higher

among the control group than the treatment group (Bachi et al., 2012). To

evaluate the long-term influence of EFP, a one-year follow was conducted

and indicated a lower incidence of new police records among clients that

participated in EFP (treatment group 21% and control group 47%) and

incidence of reported drug use was lower among EFP participants

(treatment group – 71% had not used drugs and control group – 20% had

not used drugs (Bachi et al., 2012). The research hypothesis was not

statistically supported; however, the authors noted the data indicated a trend

of greater improvement in the at-risk parameters among clients participating

in EFP relative to the control group (Bachi et al., 2012).

Environment is noteworthy in terms of connecting therapeutic setting

to the therapeutic alliance of client, therapist, and horse in EFP which

generally occurs in a natural environment of pasture, barn, and

rinks/paddocks (Bachi et al., 2012). A benefit of this research is that it was

conducted with clients living in a treatment facility so the effects of EFP for

at-risk-inpatient adolescents could be assessed (Bachi et al., 2012).

This study also contained an experimental and control groups (Bachi et al.,

2012). The authors indicated a concern that the study of EFP occurred in a

residential facility and not a residential equine therapy program and

implications of systemic approach are noted (Bachi et al., 2012). Bach et al.

(2012) adds to the reliability data of EFP since different living conditions

(i.e., home environment and residential treatment) have now been explored.

A drop-in participation in the control group fell from 15 to 10 during the

study in which findings should be read with caution and decreased results

from the control group in life-satisfaction could be attributed to clients that

reside in a treatment facility and do not participate in therapy may be a

contributing factor to decreased satisfaction (Bachi et al., 2012). Forty

percent of the clients in the control group had participated in other forms of

therapy and sampling was not random indicate concerns of this research

process (Bachi et al., 2012).

Future research could incorporate larger sample sizes to extrapolate

and contribute findings to a larger population concerning studies of EFP

(Bachi et al., 2012). This study suggested the use of qualitative data to

parallel to quantitative data to evaluate the development and occurrence of

change among EFP participants (Bachi et al., 2012). The benefits of

utilizing qualitative data could add descriptions from EFP participants to

provide rich data and details on their emotion, personality characteristics,

behaviors, needs, and desires. While examining therapeutic interventions,

relevant data such as the perspectives of clients are essential in assessing

areas/factors to gain access to the human experience.

Studies of EAP/EFP often involve findings on reductions in

psychological distress or and enhanced psychological well-being reported

from clients (Cumella, Lutter, SmithOsborne, & Kally, 2013; Kemp, Signal,

Botros, Taylor, & Prentice, 2014; Klontz et al., 2007; Schultz et al., 2007;

Shultz, 2005). Potential symptoms of psychological distress are suicide

ideation and suicide attempt rates among females (Bauducco, 2012). A

study investigated 17 suicidal females (ages 13-22) in a residential facility in

East of Sweden participating in EAP as part of examining complementary

therapies and prevention efforts to address females at risk for suicide

(Bauducco, 2012). The aim of the study was to examine significant changes

in female clients attending EAP sessions over time (Bauducco, 2012).

Intervening variables such as client and horse characteristics, previous

experience (riding experience), and number of sessions were also examined

(Bauducco, 2012). Comparison of the two groups (previous riding

experience and beginners) were analyzed to identify if any distinction exists

between the two groups and clarify if certain clients are more suited for EAP

(Bauducco, 2012).

A Likert scale (1-10) was used by a therapist to evaluate client’s

characteristics; active participation, motivation, willingness (predictors of

client outcomes), warm emotion, happiness, awareness, control, loquacity,

relaxation, and coordination (identified as client outcomes of EAP)

(Bauducco, 2012). An Individual Growth Curve analysis was used on three

main issues: (a) improved scores in happiness, warm emotions, awareness,

relaxation, control, loquacity, and coordination; (b) comparison between

riders and beginners; and (c) client-horse interaction and how client

motivation affected therapy outcome (Bauducco, 2012). Client-horse

interaction aims to extrapolate which EAP elements play a crucial

therapeutic role (Bauducco, 2012). Clients received

EAP as a complementary therapy to cognitive-behavioral therapy (CBT) at

this residential treatment facility (Bauducco, 2012). Equine assisted

psychotherapy sessions ranged between seven-16 sessions during a 12-

month-period and data retained findings from two females who committed

suicide during this study (Bauducco, 2012). The EAP sessions varied

between ground work as previously mentioned as components of EAP such

as grooming, longeing, leading, etc. or mounted work (riding) (Bauducco,

2012).

Data was collected after each EAP session in a protocol by therapists

with academia background in psychology, socio-pedagogy, and basic horse

riding and therapy that observed both individual and group change over time

(Bauducco, 2012). Informed consent was obtained along with fulfillment of

research ethical requirements for horses (Bauducco, 2012). Data of the first

research question on whether the client’s relaxation, control, warm emotions,

emotions, loquacity, and coordination changed over time was collected with

an Individual Growth analyses (Bauducco, 2012).

Results indicated significant change over time for coordination (Est.

= .11, p = .04, 95% CI [0.01, 0.22]), awareness (Est. = .13, p = .01, 95% CI

[0.03, 0.22]), and a small change for warm emotion (Est. = .10, p = .07, 95%

CI [-0.01, 0.20] and relaxation (Est. = .13, p = .06, 95% CI [-0.01, 0.26])

(Bauducco, 2012). Results for happiness, loquacity, and control indicated no

change (Bauducco, 2012). Analysis on the second question on the effects of

previous riding experience entered the variables 1 = rider and 0 = beginner

as covariates in the individual growth model (Bauducco, 2012). Results

indicated a small change for riders in relaxation as compared to beginners

(Est. = .13, p = .06, 95% CI [-0.004, 0.26] and (Est. = .26, p = .61, 95% CI [-

0.79, 1.31]) (Bauducco,

2012). Measure of control had a significant effect (Est. = 1.3, p = .03, 95%

CI [0.2, 2.4]) (Bauducco, 2012). The effect on the warm emotion measure

was small for riders (Est. =

.11, p = .04, 95% CI [0.003, 0.21]) and a significant change in coordination

(Est. = .12, p

= .03, 95% CI [0.01, 0.22]) and (Est. = .90, p = .02, 95% CI [0.2, 1.62])

(Bauducco,

2012). No changes were indicated on either loquacity or happiness

(Bauducco, 2012).

Significant results indicated change in awareness for riders (Est. = .13, p

=.006, 95% CI [0.04, 0.22] and (Est. = .74, p = .04, 95% CI [-0.2, 1.5])

(Bauducco, 2012). Thirdly, to examine the effects horse responsiveness and

effect on patient’s motivation outcome were examined by entering the horse

responsiveness characteristic in the model as the only covariate and results

indicated a significant effect on all outcomes; however, when both client and

horse characteristics were entered, horse responsiveness indicated no

significance on the client’s outcome (Bauducco, 2012). This indicated that

the client’s motivation had significance on each outcome in warm emotion,

happiness, awareness, control, loquacity, relaxation, and coordination

(Bauducco, 2012).

Overall results indicated that that the higher motivation in clients resulted in

higher scores in warm emotion, awareness, control, loquacity, relaxation,

and coordination and a small effect in client’s happiness (Bauducco, 2012).

Differences in scores comparing riders and beginners dissipated over time,

resulting in positive outcomes from EAP for both groups (Bauducco, 2012).

The study discussed the two suicides that occurred during the study and

other contributions other than mental disorders that contribute to suicide

along with the role of the ventral prefrontal cortex (Bauducco, 2012). This

study indicated that suicidal girls both beginners and riders receiving EAP as

complementary therapy was suitable (Bauducco, 2012).

Limitations of this study included a narrow sample and the

transferability to a larger population. An additional weakness may include

measures of this study being derived from direct observation of the therapist

which may lend to potential bias or positive trend by potentially recording

what they expect clients may do instead of what they are actually doing

(Bauducco, 2012). Future clinical research could include a wider population

including both females and males along with including a controlled

randomized research design to compare three groups receiving traditional

treatment, those receiving traditional treatment and EAP, and others

receiving another form of complementary treatment (Bauducco, 2012).

Residential centers treating inpatients diagnosed with eating

disorder(ED) often incorporate forms of equine therapy (EQT) into their

treatment plan (Cumella et al.,

2013). Standardized treatment among facilities adheres to the American

Psychiatric

Association’s Practice Guideline for the Treatment of Patients with Eating

Disorders, Third Edition (Cumella et al., 2013). Out of 250 meta-analysis

studies that utilized animal-assisted therapy in treating patients with ED, less

than10% involved equine therapy and according to a survey, 24% of ED

treatment facilities incorporated EQT (Cumella et al., 2013). This study

aimed in adding to literature the efficacy of EQT in the treatment of ED and

compare efficacy of treatment outcome of the standardized inpatient

treatment protocol to standard treatment with EQT among EQ inpatients

(Cumella et al., 2013).

Cumella and colleagues’ study (2013) had six hypotheses that

inpatients with ED participating in EQT with standard inpatient treatment

would produce statistically significant results and reduction in the following

symptoms: (a) drive for thinness, (b) impaired self-efficacy, (c) interpersonal

distrust, (d) impulse dysregulation, (e) depressed mood, and (f) anxiety

(Cumella et al., 2013). Demographic characteristics included 72 female

inpatients being treated at an inpatient facility for ED between2005 and 2008

(Cumella et al., 2013). The age ranged from 18-49 years; 92% White, one

AfricanAmerican, one Asian, one Native-American, and three identified

themselves as multiracial (Cumella et al., 2013). Diagnoses included

anorexia nervosa (32%), bulimia nervosa (33%), and ED not otherwise

specified (35%) (Cumella et al., 2013).

To measure areas four areas of the hypotheses (a) drive for thinness

(DT), (b) ineffectiveness (I), (c) interpersonal distrust(ID), and(d) impulse

regulation (IR), the Eating Disorder Inventory-2 was used (Cumella et al.,

2013). The Beck Anxiety Inventory (BAI) and Beck Depression Inventory

(BDI-II) are also self-report measures to measure symptoms associated with

anxiety and depression (Cumella et al., 2013). In addition to comparing self-

reported measures from inpatients who received standardized treatment

against self-reported measures from inpatients receiving EQT in addition to

standardized treatment, variables such as total equine minutes (TEM) time

spent in any EQT activities during treatment and length of stay (LOS) time

receiving standardized treatment were used as statistical controls for each

measure and regression models to identify relationships between these

control variables (Cumella et al., 2013).

Results of all six hypotheses were highly statistically significant and

there was a significance relationship between TEM in EQT (Cumella et al.,

2013). According to regression models, the more often inpatients were

receiving EQT the more self-reported symptoms decreased at discharge

indicating an inverse relationship between EQT and TEM (Cumella et al.,

2013). As predicted, inpatients receiving treatment for ED in addition to

receiving EQT had a decrease in drive for thinness, impaired self-efficacy,

interpersonal distrust, impulse dysregulation, depressed mood, and anxiety

(Cumella et al., 2013). Beta coefficients indicated a significant relationship

between the six models to TEM in EQT (Cumella et al., 2013).

Several limitations in the study were identified such as generalizing

the results due to whether the inpatients voluntarily sought admission or

were persuaded, grouping three diagnoses in one sample, and grouping all

horse activities under EQT (Cumella et al., 2013). An additional stated

limitation was allowing the inpatients immediate participation of EQT upon

a physician’s whereas an inpatient receiving EQT may need to be according

to specific symptoms (Cumella et al., 2013). Collection of results at the time

of discharge also presents a limitation in the study without outcome

measurements of long-term outcome (Cumella et al., 2013). Although most

facilities that treat inpatients diagnosed with ED generally report following

guidelines from the American

Psychiatric Association’s Practice Guidelines for the Treatment of Patients

with Eating Disorders, there will inevitable be variability among providers in

standardized treatment (Cumella et al., 2013).

Efficacy of EFP for children and adolescents that have experienced

sexual abuse was studied by Kemp et al. (2014). This study was conducted

in Australia that included 15 children (nine females and six males aged 8 to

11 years) and 15 female adolescents aged 12 to 17 years (Kemp et al., 2014).

Three of the child groups were identified as Indigenous and nine were non-

Indigenous and five adolescents identified as Indigenous and 10 as non-

Indigenous of the adolescent group (Kemp et al., 2014). Measures of

psychological distress for all clients were conducted in three-time intervals:

Time 1intake; Time 2-post tests after 6 weeks of traditional counseling (in-

clinic) and pre EFT; and Time 3-after 9-10 weeks of EFP (Kemp et al.,

2014). Two hypotheses: (a) fewer reported symptoms of trauma, internal

and external behaviors would be significantly less after Time 3 as compared

to results collected at Time 1 and 2 and (b) change scores on psychometric

measures from Time 2 to Time 3 would show significant improvements as

compared to change-scores from Time 1 to Time 2 (Kemp et al., 2014). The

research design of this study was a quasi-experimental, repeated measure

ANOVA, was utilized (Kemp et al., 2014).

Appropriate measures for both the child group and adolescent group

were used such as the Children’s Depression Inventory (CDI) and Child

Behavior Checklist

(CBCL) for the children aged 8 to 11 years and Trauma Symptom Checklist

(TSCC), Beck Depression Inventory (BDI), and Beck Anxiety Inventory

(BAI) for adolescents aged 12 to 17 (Kemp et al., 2014). To test they

hypothesis of the efficacy of EFP for psychological trauma, a repeated

measures analysis of variances (ANOVA) of the threetime intervals of the

CDI were examined and no significant change in reported symptoms of

depression between Time 1 and Time 2 were indicated with tests of within

subject (Kemp et al., 2014). In contrast, data collected at Time 3 showed a

significant improvement in depression symptoms with significantly lower

scores from Time 1 to

Time 3 (Kemp et al., 2014). Data collected from the CBCL internalized

behaviors had lower scores between the three-time intervals; however,

scores at Time 2 indicated a significant improvement when compared to

Time 2 (Kemp et al., 2014). The same analysis was conducted for

externalized behaviors and a similar overall difference between the three-

time intervals were collected and further analysis indicated significant

improvement of scores for Time 3 as compared to scores for Time 2 (Kemp

et al., 2014). Paired sample t tests indicated change scores between Time 2

and Time 3 were significantly greater than the change scores from Time 1 to

Time 2 (Kemp et al., 2014).

Similar analysis to test the hypothesis for fewer psychological

symptoms such as trauma reported by adolescents, ANOVAs were used to

examine the difference between Time 1, Time 2, and Time 3 score intervals

(Kemp et al., 2014). The first measure, TSCC, indicated significant

differences between all three-time intervals and change scores from Time 2

to Time 3 were significantly greater than scores from Time 1 to Time 2

(Kemp et al., 2014). Testing the hypothesis that adolescents participating in

EFP would report fewer depressive symptoms, the three-time intervals were

used as dependent variables in ANOVA analysis (Kemp et al., 2014). Non-

significant results in within subjects were indicated between Time 1 and

Time 2, while significant improvement between Time 2 and Time 3 scores

(Kemp et al., 2014). Additional data collected in change scores between

Time 2 and Time 2 indicated significantly greater improvement compared to

Time 1 to Time 2 change scores.

Levels of anxiety of repeated measures ANOVA of BAI indicated less

reported symptoms between Time 1 and Time 2 and significant reduction in

anxiety symptoms from Time 2 to Time 3 (Kemp et al., 2014). To further

test the hypothesis that clients would have significant improvement after

participating in EFP, a paired t test indicated significantly higher change

scores from Time 2 to Time 3 as compared to change scores from Time 1 to

Time 2 (Kemp et al., 2014).

Hypotheses that both groups, children and adolescents, regardless of

gender or ethnicity would show significant improvement in change scores in

data collected after EFP and a significant reduction in symptoms of anxiety,

depression, trauma, and undesirable behavior would show significant results

were supported (Kemp et al., 2014). Limitations of this study may be the

threat of confounding variables such as maturation, living arrangements, etc.

as potential factors influencing symptomology (Kemp et al., 2014).

Implications for future clinical work could include methodologically robust

research including adults that are survivors of sexual abuse. The addition of

qualitative research used in conjunction could produce or be used as a gauge

to providing therapy for clients across various age, gender, and ethnicities.

Identification of themes that are collected in qualitative research could link

an in-depth understanding of patterns from clients’ reaction/responses to

situations and outcomes, thinking, reactions within a group of other clients

or family that occur during EFP Kemp et al., 2014).

Mixed Methods Studies of EFP

A three-year quantitative and qualitative study hypothesized that

equinefacilitated psychotherapy and learning (EFP/L) would enhance

traditional therapy for youths with severe emotional disorders (SED) (Ewing

et al., 2007). Severe emotional disorders consist of moderate to severe

behavioral or conduct disorders and/or learning disorders with an average IQ

score of 86 (Ewing et al., 2007). The youth were given pretest questionnaires

prior to the nine-week session and posttest after completing the nine-week

EFP/L session (Ewing et al., 2007). Twenty-six of the thirty-six students

that were tested included both females and males with various ethnic

backgrounds and ages from 10-13 years from an alternative school (Ewing et

al., 2007). The experimental group consisted of students of similar age and

IQ as the control group (Ewing et al., 2007). Participation was voluntary and

guidelines for ethical treatment of research according to the American

Psychological Association (APA) were followed (Ewing et

al., 2007).

Five quantitative measures used were: (a) Self-Perception Profile for

Children, (b) Empathy Questionnaire, (c) Locus of Control Scale, (d)

Children’s Depression Inventory, and (e) Children’s Loneliness

Questionnaire (Ewing et al., 2007). Administration of pretests and posttests

evaluations were given during the same time for both the experimental and

control group with each item of the measures read aloud to the students and

answers recorded (Ewing et al., 2007). Results of the quantitative measures,

analyzed individually with paired t-tests, between the pretests and posttests

did not show statistical significance. Five hypotheses were not supported by

quantitative results; however, qualitative analyses compiled from interviews

and observations were illuminating (Ewing et al., 2007). Qualitative data

were collected from the special education teacher, therapeutic riding

instructor, and volunteers (Ewing et al., 2007). Four case studies were

chosen to demonstrate the positive effects exhibited by the students. Case

study 1: The Victim, “V” is a 10-year-old girl diagnosed with posttraumatic

stress disorder (PTSD) with a family history of mental illness, emotional,

and physical abuse (Ewing et al., 2007). Living with her mother that

exhibits sexual promiscuity and all her siblings have different fathers, “V” is

anxious, distrustful, and fearful of men. “V” was paired with a female horse

and during the program; “V” began discussions with her horse about issues

of fatherhood and personal worries including safety and trust (Ewing et al.,

2007). “V” related aspects of her life to her horse’s life in terms of horses

having a family together regardless of having different fathers as is true in

her own family (Ewing et al., 2007). The avenue of working with a horse

through the therapeutic intervention of EFP/L, allowed/enabled “V” to open

up and discuss her fears and anxieties and smile again (Ewing et al., 2007).

The Feral Child, “FC” refers to an 11-year-old girl with multiple

diagnoses that include behavioral disorder (BD) and educational mental

handicap (EMH) along with a speech impediment (Ewing et al., 2007).

Teachers referred to her as the feral child due to her out of control behaviors

of mimicking the bad behaviors of other students, lying on the floor in

defiance, poor personal hygiene, and avoidance of eye contact (Ewing et al.,

2007). Her background includes a poverty-stricken family, sexual abuse,

and a low functioning mother (Ewing et al., 2007). Due to the history of

sexual abuse, “FC” was paired with a female volunteer (Ewing et al., 2007).

The first equine activity was grooming her horse and paralleled with her own

self-care. “FC” soon insisted that she would not ride her horse until her own

hair was brushed and away from her eyes so that she could see while riding

(Ewing et al., 2007). Eye contact between “FC” and the female volunteer is

essential during riding instruction and riding appear to instill confidence in

“FC” (Ewing et al., 2007). Teachers were impressed by “FC’s” positive

social skills and behavior that they requested she repeat the EFP/L program

(Ewing et al., 2007). By the end of the school year, “FC’s” improved

progress allowed her to be back in a traditional middle school (Ewing et al.,

2007).

Similar in revelation, the other two cases presented a 13-year-old

male, “R” The Runaway that shadowed his instructor and modeled positive

behavior which resulted in building trust with his instructor and horse that

carried over into the classroom where he no longer ran away (Ewing et al.,

2007). Another male, 10-years-old diagnosed with behavioral disorder (BD)

with an average IQ with an explosive temperament is called The Boost

Needed “BN” (Ewing et al., 2007). Areas of interest in developing for “BN”

were social skills and self-esteem. Through interaction with instructors and

his horse, the message of how to be “up front” were demonstrated (Ewing et

al., 2007). Observed confidence and boosted self-esteem were exhibited by

“BN” through EFP/L and he was eventually mainstreamed into middle

school (Ewing et al., 2007).

Over the three-year period, situational factors such as changes in

parental custody, placement in foster care, and the death of one parent that

may have taken away benefits of EFP/L in terms of increased self-esteem,

self-worth, depression, and increased feelings of internal locus of control as

compared to other studies in EFP (Ewing et al., 2007). Other reasons for

unexpected results besides the disrupted family lives may be the duration of

the participation in EFP/L and changes in medication (Ewing et al., 2007).

Implications for future clinical work could include qualitative results to

capture positive outcomes that are not reported on quantitative self -

measures. Duration of time or more frequent sessions may also provide

additional information in empirical studies on EFP/L.

Additional empirical studies including case studies and meta analyses could

provide information if life skills learned through the participation of EFP

carries over into clients’ daily lives. According to Kemp et al. (2014), the

location and aim of this study was conducted in an educational setting with

goals of behavior management and learning versus therapy so measures of

depression, self-esteem, and loneliness are not surprising.

A phenomenological study of six clients in equine psychotherapy after

experiencing trauma, physical and/or psychological, was conducted to

explore the interpretations of the clients’ lived experiences and relationships

with their horses during therapy (Yorke, Adams, & Coady, 2008). The study

aimed at gaining insight into the clients’ bond with the horses and its

contribution to recovery from trauma (Yorke et al., 2008). The method

combined semi-structured, audio-taped interviews and observation of clients

during equine psychotherapy. Interviews were divided into two parts; the

first interview explored the trauma experienced by the clients and their

relationships with the horse (Yorke et al., 2008). The second part of the

interview consisted of videotaping the interaction between clients and horses

such as grooming and riding that provided data in a natural setting to gain

insight into the horse-human bond relationships (Yorke et al., 2008).

Purposive sampling of clients in equine therapy was chosen to discuss their

experiences with horses during therapy and progress of healing (Yorke et al.,

2008). Four women and two men, ages 18 to 51, had all experienced trauma

within the timeframe of 10 months to 11 years prior to equine therapy and

sample selection (Yorke et al., 2008).

The open coding process in data analysis utilized transcripts, notes,

videotapes, and clients’ input based on quotations, and authors’ input. The

notes were then entered in a qualitative software NUD*IST (Non-numerical

and Unstructured Data* Indexing Searching and Theorizing) that contained

over 1600 individual codes (Yorke et al., 2008). Two dimensions, emotional

and task fell under the therapeutic process that resulted in four horse-human

bond themes: intimacy and identity bond (emotional dimension) and

partnership and utility bond (task dimension) and the relationship to healing

(Yorke et al., 2008). The nature of the therapeutic alliance was also

analyzed when two categories horse-human bond (intimacy/nurturing bond,

identity bond, partnership bond, & utility bond) and trauma experience and

recovery come together (therapeutic value) (Yorke et al., 2008). Yorke et

al. (2008) suggest that therapeutic alliance in EFP is comprised of two

primary components which are the equine-human bond and the therapeutic

value of equine human bond. The equine human bond has 4 main

components: (a) two emotional dimensions and two task dimensions. The

therapeutic value of the equine-human bond had three sub categories: (a)

feelings, (b) proximity/touch, and (c) behaviors relevant to healing and

recovery (Yorke et al., 2008). Further results of the horse-human bond

themes, intimacy/nurturing bond and identity bond were identified with

emotions, which emphasized the clients’ feelings about the horse (Yorke et

al., 2008). The two themes, partnership bond and utility bond, were labeled

under task dimension (Yorke et al., 2008). The task-oriented or partnership

bond emphasized communication and teamwork during EFP (Yorke et al.,

2008). This study paralleled the impact of the client-horse relationship as a

therapeutic relationship as between the therapeutic impact of the therapist-

client relationship (Yorke et al., 2008). Descriptors of how participants’

relationships with horses contributed to their healing from trauma parallels

what the psychotherapy literature describes about how therapeutic alliances

contribute to client change. Therapeutic alliance occurred when the

equinehuman bond (relationship between riders and horses) and the

therapeutic value of the equine-human bond were clearly described by

participants. The relationship participants had with their horses contributed

significantly to their healing from trauma.

Furthermore, clients who have experienced trauma and how they

began to diminish defense mechanisms and build trust during equine

psychotherapy can be examined through exploring and interpreting the

feelings and descriptions of the bond clients experienced toward their horses

(Yorke et al., 2008). The authors reported that clients began to speak to their

horses as they would speak to a loved one (Yorke et al., 2008). For

example, expressions of the horse-human bond were expressed in the

following: (a) “We both want to be close”, (b) “They don’t try and analyze

you”, (c) “It has a lot to do with his innocence [horse], he’s completely pure,

who he is. There is no second guessing what he is thinking”, (d) I can

remember standing with my arms around [her horse], and crying on her

shoulder, literally tears running down onto her fur, and it was like her saying

‘It’s okay, you can tell me your story..I won’t tell anyone else there were

tears in your eyes.’ You just kinda get it [emotion] out and they seem so

accepting of it”, (e) “This was a way to get back on my feet again”, and (f)

“I’d have no means of finding it myself [without riding her horse]” (Yorke et

al., 2008).

Results of the second broad category, therapeutic value of equine-

human bond, and the sub-category of feelings were expressed in the

following: (a) “It’s like we’ve known each other for over 20 years”, and (b)

“Going to the barn and mucking out, and turning out, and feeding, being out

in the country, being at one with nature, there’s a whole warmth to it, and

it’s very healing, positive warmth” (Yorke et al., 2008). The second sub

category, proximity/touch related to the physical contact between horse and

human, touch, and closeness were expressed in the following: (a) “To me it’s

a safe zone,

I just want to be there”, and (b) “There’s the physical contact, which is

therapeutic” (Yorke et al., 2008). The third sub category of behaviors as it

related to healing and recovery were described by the acts of grooming and

training techniques and using equipment that were expressed by participants

as feelings of competence (Yorke et al., 2008). An example of how

behaviors were relevant to healing and recovery was expressed in the

following: “I think the emotional part that helped me was in the barn,

playing with [my horse]. You know, grooming him, playing with him,

talking to him..because with a horse, you’re not alone, he’s always

responding to what I do, whether it’s the grooming aspect I’m doing to him,

or talking to him, he’s always talking back” (Yorke et al., 2008). Not only

could larger studies explore meanings from clients in equine psychotherapy,

but also how the horse-human bond may lend understanding in how it relates

to trauma recovery (Yorke et al., 2008). My study complemented this study

by exploring the essence of clients’ experiences during and after EFP

thereby providing the meanings and views on the relationship between them

and the horse.

According to Bachi (2012), knowledge and existing literature in EFP

is insufficient and recommends the application of attachment theory to the

client-horse relationship and bond. Identification and exploration of the

bond that clients experience are discussed as relevant in the transformation

process of clients, but lack in empirical methodology and reporting (Bachi,

2012). Furthermore, Bachi (2012) suggested a need in conducting

qualitative studies to examine the experiences of clients to fill a gap between

indications from research and observations from the therapist during EFP.

Qualitative studies could lead to a level of conceptualization factors to

introduce relevant factors and new constructs in the practice of EFP (Bachi,

2012). The complexities of the client-horse relationship could be revealed

through qualitative methodology (Bachi, 2012).

Literature in equine assisted psychotherapy (EAP) relate the

importance of understanding clients’ experiences during horse activities and

often refer to observations of clients during EAP; however, through self-

reports these studies generally gather data as it relates to improved self-care,

positive attitude, improved social skills, improved communication and

behavior, etc. (Masini, 2010; McCormick & McCormick, 1997; Schultz et

al., 2007; Tyler, 1994). The format of equine therapy consists of activities

between clients and horses which are most often followed by discussions

about clients’ experiences during this process without documenting the deep

meaning that clients ascribe and interpret their experiences (Masini, 2010).

Major themes in quantitative studies of equine therapy examine

reductions in psychological distress and improvement in psychological well-

being. Inferences of equine clients are noted throughout literature; however,

existence of literature capturing the lived experiences described by clients

during and after EFP is essentially nonexistent/limited. Exploration to this

insight may lead information on what psychological changes people

experience when they participate in EFP. Anecdotal evidence would be

made available in exploring the deep meaning that clients experience during

and after EFP, therefore, this study hopes to add to the existing literature.

Chapter 3 follows with a description of the research design, clients,

methodology, and instrumentation of the present qualitative study.

Procedures for establishing the trustworthiness of the data will also be

highlighted. Confidentiality and other ethical procedures conclude Chapter

Chapter 3: Methodology

Research on equine therapy allows for exploration of the use of

metaphoric and experiential experiences of people through engagement in

horse-related activities. The purpose of this study was to investigate and

define the direct experiences of adults after EFP. This phenomenological

study aimed to identify significant statements and themes among adults’

described personal experiences of EFP. This qualitative phenomenological

research incorporated both textural (what) and structural (how) descriptions

to add to existing knowledge, practice, and theory on equine therapies.

Chapter 3 contains descriptions of the research design, clients, methodology,

and instrumentation of the present qualitative study. Procedures for

establishing the trustworthiness of the data are also highlighted. A

discussion of confidentiality and other ethical procedures concludes Chapter

Research Design

I sought to answer the following questions through this

phenomenological study:

1. What are the experiences of adults after receiving equine

facilitated psychotherapy (EFP)?

2. What aspects of those experiences are considered by participants to

be most beneficial for their well-being?

3. How have participants been affected by the experience of EFP?

4. What did the participants do with their experiences after EFP?

Central Concept(s)/Phenomenon of Interest

Consistent, empirically supported data on equine assisted therapies are

lacking; however, researchers consistently report positive outcomes of

equine assisted therapies. Moreover, qualitative research is even less

available within the realm of documented experiences of adults after equine

assisted therapies.

The Research Tradition for the Study

The phenomenon of lived experiences after EFP defined the

qualitative philosophy underlying the study. The empowerment of EFP

participants to share their experiences was a fundamental goal of this

qualitative research. This qualitative approach allowed themes among

participants to be identified, thus providing rich descriptions of the

phenomenon (i.e., the experience of EFP).

Rationale for the Chosen Tradition

As previously mentioned, studying the phenomenon of the lived

experiences of adults after EFP was the key goal of the project because little

research is available on this topic. According to Creswell (2009), four

qualitative strategies or approaches are viable for conducting qualitative

studies: (a) ethnography, (b) grounded theory (case studies), (c)

phenomenology, and (d) narrative research. Given that the lived experiences

of participants in EFP cannot be easily measured, exploration of how they

derive meaning from the phenomenon may be best conducted through

qualitative inquiry. Collection of data were accomplished through the

traditional phenomenological approach to gain a deep understanding of EFP

participants’ experiences (Patton, 2002).

Role of the Researcher

Role, Relationship, & Biases

In my role as the primary instrument in this study, I sought to adhere

to the ethical standards and principles set forth by the Walden Institutional

Review Board (IRB). These standards include ensuring the safety of

participants by maintaining their privacy and minimizing exposure to risks

by following consistent procedures in phenomenological research. Second,

participants for this study were selected equitably, and research benefits and

burdens were distributed fairly. Third, full disclosure was provided to

participants concerning the study, and informed consent was obtained and

tailored to this study. Informed consent was documented by me, as indicated

by the signatures of participants, and interviews were audio-recorded.

Coercion was avoided by acknowledging my own facial expressions and

gestures during interviews. I avoided leading questions, did not push

participants to answer research questions that they might not want to answer,

and restrained myself from sharing my own stories as well as other

participants’ stories.

Ethical principles and considerations included justice for participants,

not only in terms of equitable selection, but also in terms of fair treatment to

avoid exclusion. Adherence to the principle of beneficence minimizes risk

to participants while maximizing research benefits. To minimize risks, I

ensured that participation in this study occurred after EFP treatment had

been completed, that I was not affiliated with clients in any role other than

the role of researcher, and that I made it clear to the participants that they

were involved in a research project, not a treatment. If the interviews had

occurred at a site that provided equine therapy, then I would have offered

clarification on the facility’s role in therapy intervention and liability, and a

letter of cooperation would have been required for IRB approval. I aimed to

avoid collecting data from a vulnerable population. If any risks existed,

they were reasonable in relation to phenomenological research methods. I

used an epoche process through which I identified any biases I held for or

against EFP so that I could set aside prejudgments in order to be receptive

and unbiased during interviews (Moustakas, 1994). Additionally, respect for

participants from me ensured that participating in this study was purely

voluntary.

Interviewing requires patience, skill, and the ability to deal with

sensitive issues; I prepared myself to exhibit these qualities in the research

context (Creswell, 2013). I also needed to identify my agenda in data

collection and interpretation in order to gather truthful data and avoid

withholding information (Creswell, 2013). Other ethical considerations

included the need to convey the purpose of the study and the participants’

roles in the study without deception about the nature of the study (Creswell,

2013). Awareness and acknowledgement of potential biases that may arise

during data collection and interpretation can help a researcher to prevent

these biases from having any effect on qualitative analysis and interpretation

(Creswell, 2013). In writing, researchers may also use the fundamental

method of phenomenological reduction and bracketing prior to research to

record their own personal experiences, biases, or perceptions so that they

may be analyzed separately and not influence the study. Recorded

interviews can be bracketed and analyzed to show commonalities that can

later be related to other studies and integrated with other phenomena (Patton,

2002).

Evidence of quality and credibility in a qualitative research plan

develops through a writing strategy (Creswell, 2013). It is now common

practice for qualitative researchers to be more self-disclosing and open with

their position or stance within the constructs of writing (Creswell, 2013).

Writing involves reflection and interpretation of the writer’s experience,

gender, social and cultural factors, and personal politics because the impact

of these experiences cannot be separated from any individual (Creswell,

2013). Being forthright and acknowledging potential influences enhances

credibility and thus the quality and trustworthiness of a study. It is

suggested that qualitative researchers disclose in writing their own

experiences related to the phenomenon being studied as well explore any

connections of these experiences with past experiences involving family,

work, and so on (Creswell, 2013). In this regard, being a conscientious

researcher means bringing one’s biases, experiences, and values to the

writing table (Creswell, 2013). The skill of writing along with filtering

one’s biases requires practice and continuous evaluation (Mack, Woodsong,

MacQueen, Guest, & Namey, 2005). Identifying one’s own body language

and conveying one’s own biases is important in interviewing; however,

awareness of whether one is conveying neutrality and acceptance while

observing is also an essential skill (Mack et al., 2005). Researchers must

identify any connections they have with participants and/or the research site

(Creswell, 2009). If any factors that may compromise the researcher are

identified, multiple strategies should be used to ensure validity and accuracy

of results (Creswell, 2009).

I did carefully reflect, deal with, and report any potential biases

(Patton, 2002).

Strategies included rigorous preparation, systematic data collection

procedures, an

epoche process, phenomenological reduction, member checking, and an

audit trail. According to Patton (2002), the concept of the hermeneutical

circle or situation indicates that research is not free from the preconceptions

and interpretations of the researcher.

However, a researcher can identify biases and perceptions before conducting

research (Patton, 2002). To adhere to epoche, a researcher can balance

analysis and interpretation with synthesis of findings, impartiality, and

confirmability, remaining cognizant of the purpose of the study and its

audience (Patton, 2002). This process is also part of the audit trail to verify

the rigor of a researcher’s fieldwork and confirmability.

The interview questions in this study were based on sound content that

was similar across qualitative studies in the literature. I did not use an expert

panel or outside (second) rater, but I benefited from the quality work and

feedback of my dissertation committee in making sure that the style of the

interview questions was in line with the qualitative method. I did have one

external person who is an expert in EFP look over the interview questions

for appropriateness. In dealing with biases during interviewing, the same

open-ended questions were used to ensure my neutrality as the researcher

and noesis from participants. A standardized open-ended interview format

allowed participants to answer questions without implied choices. All

participants were asked the same questions, in the same way and in the same

order, to ensure consistency. This approach may also reduce the need for

interviewer judgment and allow the same order of organization of research

questions be asked of participants (Patton, 2002). According to Patton

(2002), a strength of standardized open-ended interviews is reduction of

interviewer effects and bias when used among several interviews. The

overall interview protocol (Appendix B) was reviewed by the dissertation

committee to manage biases for or against EFP, as well as by an external

reviewer who was an expert in EFP. Probing questions were not used to

gather more understanding of participants’ experiences.

I had bias in favor of EFP due to my background, upbringing with

horses, and frequent involvement in equine activities. Although I had

experienced favorable outcomes with EFP, the theory of EFP and my own

beliefs indicated that this therapy might be inappropriate for various

populations. With this orientation, I did not aim to prove or disprove the

effectiveness of EFP, but rather to understand the depth of experiences and

perceptions of the phenomenon (EFP) regardless of the outcome (i.e., pro or

con). Member checking allowed the participants to review the accuracy of

the determined themes. Validity was increased through receiving feedback

from participants on my conclusions.

Other Ethical Issues

This study required the informed consent of participants. The consent

form included researcher information, the sponsoring institution, how

participants were selected, the purpose and benefits of the research, benefits

of participating, the type of participant involvement, confidentiality of the

participants, a statement indicating that the participant could withdraw at any

time during the study, and names of persons to contact with questions

(Creswell, 2009). The process of informed consent allows participants to

make balanced choices among various options in their perceived best interest

(Beahrs & Gutheil, 2001). Informed consent affords protection to both

researcher and participant during research, assessment, therapy, counseling,

or consulting services (Fisher, 2012).

Consideration of appropriate language use, cultural accommodations, written

versus electronic consent, best interest of the child or adult with cognitive

impairments, HIPPA requirements, and exemption activities is essential

when obtaining informed consent

(Fisher, 2012). Familiarity with APA Standards 3.10, Informed Consent;

8.02, and Informed Consent to Research; 9.02, Use of Assessments are

essential ethical considerations in conducting research (APA, 2012; Fisher,

2012). I disclosed the purpose of the research to participants without

deception in order to adhere to ethical guidelines for research (Patton, 2002).

Signed consent forms were obtained prior to research.

Participants’ understanding and consent were verified prior to interviews.

Other ethical procedures included gaining permission from the

gatekeeper at a potential EFP site to discuss recruitment of participants from

a physical location. A recruitment letter (Appendix A) was written outlining

the purpose of the study and anticipated time commitment (Creswell, 2009).

I was cognizant of potential disruption of the setting while discussing the

study onsite with potential EFP providers (Creswell, 2009). The purpose of

the study (Appendix A) was sent to potential participants whom I recruited

via blogs and/or professional networks, and the process of sending and

obtaining consent was similar to the process used for participants recruited

from an EFP facility. I aimed to avoid any conflict of interest or dual

relationships in research. If a participant had become emotionally upset or

had experienced an adverse reaction during the interview process, I would

have stopped the interview and referred the participant to a national mental

health hotline number. The participant would have been reminded that she

or he could withdraw consent at any time. I would have reported this

incident(s) to

IRB as well as the dissertation committee.

Participant Selection Logic

For this retrospective study, I recruited participants who had

completed EFP at a facility that provides this service. In selecting a sample

size of 10 participants in EFP, I aimed not to generalize the information

collected, but to investigate and define the experiences of participants

(Creswell, 2013). A researcher’s section of a sample size and strategy is also

influenced by which unit of analysis the researcher seeks to study (Creswell,

2013). My focus on data collection with a group of EFP participants

determined the unit of analysis (Creswell, 2013). These data would not be

used to compare individuals, groups, demographics, or programs as units of

analysis (Creswell, 2013). The focus of this study (unit of analysis) was

description of the lived experiences of EAP participants (Creswell, 2013).

This sample size seemed logical to yield data about the phenomenon being

studied. Interviews and follow-up sessions with participants to conduct

member checking ensured that themes were fully developed, also known as

saturation.

There were 10 participants willing to participate in in which data were

collected. I aimed to meet sample size criterion to cover the phenomenon

given the purpose of the study (Creswell, 2013; Patton, 2002). Factors that

influence sample size are consensual validation, judgment, and peer review

(Creswell, 2013). This study included the sampling strategy and process as

it relates to interpreting the results (Creswell, 2013).

Recruitment of a sample and participant selection require an

investment of time and energy, along with participants’ disclosure of

personal feelings (Hill, 2012). Trust from participants toward the

investigator is also essential when a researcher is asking participants to

volunteer their time (Hill, 2012). Studies have indicated that novice

researchers have to work harder at being credible, especially when

participants do not know them (Hill, 2012). Participants are more willing to

volunteer when trust has been established (Hill, 2012). Trust entails an

understanding that the researcher will be honest, fair, nonjudgmental, and

compassionate (Hill, 2012). Picking the right time to ask for participation

and interview participants is also a vital factor in the process, but it is often

hard to achieve (Hill, 2012). Interviews were conducted with clients who

had completed

EFP, and the research project was clearly described as not involving therapy.

Sampling Strategy

I used purposeful sampling in an effort to provide rich information on

how adults described their experiences after exposure to EAP (Creswell,

2013). This sampling strategy allowed me to develop an in-depth, detailed

understanding of how EAP participants defined experiences and was not

chosen for the purpose of generalizing from this sample to another

population (Creswell, 2013). Purposeful sampling is a common sampling

strategy that typically involves preselected criteria pertaining to a particular

research question (Mack et al., 2005). A sample size of 10 was deemed

adequate, in that there are no rules for a specific sample size in qualitative

inquiry (Creswell, 2013; Patton, 2002). I accepted that during the process of

study and recruitment, a change in sample size may occur (Patton, 2002).

According to Patton (2002), as new information emerges, changes in a

sample could occur which is indicative of a need for flexibility in following

emerging data and aim of research questions.

The criterion for participation in this study is that each participant

must be an adult, aged 18 or older and have completed equine facilitated

psychotherapy (EFP). After IRB approval, sites that provided EFP were

contacted by me, upon approval, a recruitment letter (Appendix A) was sent

outlying the purpose of the study and procedures along with my contact

information. Sites were asked to post an approved flyer, the recruitment

letter, (Appendix A) at their location, place an announcement on their

website and/or newsletter about participation in a dissertation research. I

provided contact information such as email to potential interested

participants. Interested participants were contacted by their preferred

method stated; email, mail, Skype, or phone. Participants that volunteered

for the study were sent consent forms and obtained prior to collecting data.

Interviews were conducted via telephone, in-person, or Skype depending on

the preference of the participant.

Recruitment

I contacted and gained permission to conduct research from facilities

that conduct equine facilitated psychotherapy (EFP), through blogs and

professional networks related to EFP such as the Equine Assisted Growth

and Learning Association (EAGALA). After interested participants

contacted me, a recruitment letter (Appendix A) was sent allowing for

contact. Upon receipt of the recruitment letter (Appendix A), an informed

consent was sent stating the purpose and estimate length of the interview.

After this time, an arranged date and time for the interview was arranged.

Instrumentation

First-person recorded interviews were conducted among participants

directly related to the phenomenon; equine facilitated psychotherapy (EFP).

The interview questions did not present any bias and consists of questions

that can be answered from EFP participants. All participants received the

same research questions. The development of interview protocol (Appendix

B), process of selecting, and refining questions was conducted through

comparison of content compared to other qualitative studies and review by

the doctoral committee. Questions provided were clear and concrete terms

and relevant to the topic of EFP (Moustakas, 1994). Additionally, the

interview questions sought to reveal the meanings and essence of

participants’ experiences and void from predicting any casual relationships,

and accurate renderings of human experiences (Moustakas, 1994).

Procedures for Recruitment, Participation, and Data Collection

Upon approval from dissertation chair and IRB, location and selection

of research participants was obtained through bulletin boards, blogs, contact

to facilities that provide EFP, newsletters, and organizations that provide

guidance on EFP were contacted to obtain sampling pool. The researcher

contacted potential participants and provided appropriate documentation

such as informed consent, confidentiality, permission to record as stated in

the informed consent and selection criteria. Approved formulated research

open-ended questions was used in interviewing participants. Interviews

occurred in a safe and secure environment. Interviewing process engaged in

establishment of rapport (Moustakas, 1994). Interviews were recorded,

reviewed, transcribed, themes identified, and results synthesized. Due to the

possibility of noshows or cancellation of participants, the researcher planned

on an initial larger pool of participants to account for dropouts. For

example, 10 participants may be selected; however, 14 responses for consent

to participation may have been received, then I would have the additional 4

participants as a back-up for data collection. Data completed were

organized, analyzed, and synthesized to assist with identifying textural and

structural descriptions (Moustakas, 1994). I conducted member checks to

confirm the themes determined for each participant. An audit trail was

established by archiving transcripts and recorded interviews. This study

provided actions and protocol discussed by researcher with notation of

establishing rapport with participants and lists of the research questions. The

audit trail also consists of audio recordings, files of the transcripts, how the

study was conducted, and information collection strategies along with

justification if any emerging or changing of process of data collection or

analysis occurs.

Data Analysis Plan

I listened to the audio recordings of the interviews and transcribed the

data. Strategies utilized for this data analysis consisted of organizing the

data, printing the responses from interviews, and circling keywords to help

establish themes/categories (Gibbs & Taylor, 2005). This process allowed

me to identify abstract themes, attempt to broaden specific themes, and

perhaps use a hierarchical tree diagram (Creswell, 2013; Gibbs & Taylor,

2005). According to Creswell (2013), classifying data into codes should be

less than 25-30 categories and combined into five or six themes.

Interpretation began when attempting to narrow the keywords and

combining them into five or six themes as suggested by Creswell (2005).

These themes were included in the narrative analysis (Creswell, 2013).

Interpretation of data included several forms of data such as intuition,

hunches, or insights (Creswell, 2013). There were also two processes in the

coding activities according to Patton (2002); these are segmenting and

metadata activities. Segmenting is dividing up chunks of interviews or

words in interviews that are similar and establishing a theme or code. I

conducted member checks so that participants may confirm the themes.

A binder was kept of the transcribed notes from participants’

responses to the research questions. After all participants had been

interviewed, responses were grouped together into any existing themes and

verified by a repeated process by me prior to member checking. The cluster

of information constituted of the experiences participants expressed and

broken down and grouped into meaningful units and themes. I hand coded

the detailed descriptions using the exact words chosen by participants. I

avoided overgeneralization and added specific information of the group such

as the nature of the group. The overall process of the data analysis plan

included the following: (a) each statement was treated with respect as a

description of the essence of a phenomenon, (b) all statements were be

recorded, (c) each nonrepetitive statement were broken down into units,

(d)meaning units were clustered into themes, (e) meaningful units and

themes were synthesized, (f) reflection of the researcher did occur, and (g)

textural-structural descriptions were constructed to capture the essences of

participants’ experiences

(Moustakas, 1994).

Issues of Trustworthiness

Validation strategies in qualitative inquiry and research design may be

enhanced by focusing on eight strategies suggested by Creswell (2013): (a)

prolonged engagement and persistent observation by building rapport and

trust with participants, and check for misinformation; (b) triangulation, by

using multiple sources of data to have a complete evidence of participants’

experiences of the phenomenon and code or theme in multiple sources of

data; (c) peer review which entails a check and balance of the research

process; (d) negative case analysis identifies that not all of the data will fit

into a theme and is necessary in reporting; (e) clarifying researcher bias

ensures the reader that the researcher has identified any biases or prejudices

that may influence interpretation; (f) member checking allows the

participants to view the interpreted data prior to conclusions; (g) rich, thick

description entails a descriptive alternative of shared characteristics so the

reader may decide to transfer the findings; and (h) external audits allows an

outside party to assess accuracy of interpretations and summary are

supported by data. Utilizing at least two strategies is suggested by Creswell

(2013).

This study utilized the following strategies (e) clarifying researcher

bias in which I, at the outset of and throughout the study identify and share

any biases or position, or assumptions that may impact the study; (f)

conducting member checking as previously discussed to allow participants

to reflect and verify the accuracy and credibility of themes identified; and (g)

the researcher aiming to provide rich, thick descriptions from the data

collected and possibly allow the audience to transfer the findings to other

settings

(Creswell, 2013).

Results of this study are not meant for the use of generalization, but

the possibility of transferability (Patton, 2002). This concept is better used

when findings are in depth, rich, and with thick description (Patton, 2002).

Because the researcher in qualitative inquiry is the primary instrument, the

role and biases of the researcher need to be explored (Creswell, 2013;

Patton, 2002). Confirmability may be established through awareness and

acknowledgement of any personal bias and dependability established when

the process of the interview and research processes are verified. Through the

process of confirming meaningful patterns and themes during organizing,

analyzing, and synthesizing data, this process will ensure the researcher is

moving toward confirmability.

Ethical Procedures

I sought approval from Walden University by submitting appropriate

documents for institutional review board (IRB) approval. Local permission

from site and participants was also obtained after IRB approval. A

disclosure statement about purpose of the study was given a site that

provides equine facilitated therapy (EFP) or related equine therapeutic site to

post on site. Recruitment of potential participants began after approval from

IRB and interested participants contact the researcher with consent to contact

and consent to participate. Proper documentation and informed consent was

given to participants in a professional and respectful manner. After I was

contacted by potential participants, a recruitment letter (Appendix A) was

sent thanking them for the interest in participating in the dissertation

research investigating and defining the experiences of adults with equine

facilitated psychotherapy (EFP). Both the informed consent and recruitment

letter (Appendix A) entailed information about confidentiality of the study,

privacy and anonymity of findings. During documentation, the identity of

participants was changed to a coded format and original copies of recordings

was kept with the researcher’s residence in a locked compartment.

Beneficence ensured that I maximized research while minimizing any

possible harm to participants. Participants were treated fairly and equally.

Participants were also given as much information about the study as possible

prior to participation and researcher will ensure the participants understand

the purpose of research. I took all necessary steps to ensure no harm comes

to the participant; however, in the event of emotional upset from a

participant, I would have stopped the interview. I also asked if the

participant wished to postpone or withdraw from the research. Research

design was examined and approved to identify any potential risks to

participants and adherence to rules set forth for research on human subjects.

Collection of data were the least disruptive while building trust with

participants with informed purpose of the study, and devoid of any leading

questions and participants could respond freely to the research questions.

Data analysis included multiple perspectives, any report of contrary findings,

and the use of fictitious names assigned to participants.

Summary

This chapter restated the purpose of the study, research questions, and

research design and rationale. The role of myself was defined and explained

along with ethical issues that may arise during collecting data. Participant

selection criterion and instrumentation were discussed in methodology. A

follow-up of procedures for recruitment, participation, and data collection

were discussed concluding with data analysis plan. Issues of trustworthiness

such as credibility, transferability, and ethical procedures finalized Chapter

Chapter 4 begins with the study, setting, demographics, data collection

and analysis, and conclude with the findings of my study.

Chapter 4: Results

Introduction

This study used interviews to explore the experiences of 10 adults

during and after EFP. Goals of this research were to capture and understand

the lived experiences of participants, explore the curative factors of EFP, and

integrate the essences of described meanings into themes, thus providing

rich descriptions of the phenomenon, i.e., the experience of EFP. Chapter 4

presents the demographics of the participants, the data collection and

analysis, emergent themes from the data, evidence of trustworthiness, and

the overall findings of the study.

Research Questions

1. What are the experiences of adults during and after receiving

equine facilitated psychotherapy (EFP)?

2. What aspects of those experiences are considered by participants to

be most beneficial for their well-being?

3. How have participants been affected by the experience of EFP?

4. What did the participants do with their experiences after EFP?

Description of the Participants

Participant 1 (P1) was a female veteran who had been diagnosed with

PTSD, anxiety, and social issues. She described herself after EFP as having

had a valuable experience and as someone who was better able to self-

regulate, who had learned to be in the moment, who had conquered some

fears in areas of her life, who was more selfaware, who was empowered to

make positive changes, who was equipped with tools to work through

relationships, who had reconnected with society and was socializing, who

was reflective, who had discontinued all medications for PTSD, who was

interested in helping other veterans, who wanted to continue coursework in

equine therapy, and who had started a nonprofit for women veterans working

with equine therapy. Participant 2 (P2) was a male veteran who had

been diagnosed with PTSD and had extreme suicidal thoughts, relationship

issues, extreme depression, and outbursts of anger. He described his

experience after the 8-week period of equine therapy as a process of

rediscovering himself and his place in the world, as giving him a sense of

accomplishment, as enabling him to redefine perfection and take positive

steps to better control his anger, as an opportunity to change his demeanor,

as a catalyst that changed his perception for the better, as an immense mood

enhancer, as a means for strengthening his familial relationships, as a

motivation for him to participate in community outreach and raising

awareness about equine therapy for veterans and others, as an impetus for

him to volunteer with the program he participated in, and as a motivator for

him to become a certified facilitator for EAP programs helping women

recovering from substance abuse and abusive relationships as well as

children and adults with various issues, including those on the autism

spectrum.

Participant 3 (P3) was a 52-year-old female who had been sexually

abused from the age of 2 to the age of 16 by a family member. During

middle age, she reported having intimacy issues and experiencing anxiety

and dissociative symptoms and was arrested for shoplifting. She attended a

5-day intensive retreat for female survivors of sexual abuse that incorporated

equine therapy and described it as the most incredible experience of her life.

She described the experience with EFP as healing due to the physical and

emotional contact with the horse; the opportunity to observe the emotional

work of other women with their horses as soothing; the feeling that she was

not being judged by the horses; and the ability to release internal sadness,

trauma, and anger. She reported an improved relationship with her husband

as well as a broadening of her social circle and being the mentally healthiest

she had ever been in her life. She had become certified in equine therapy

and hoped to incorporate it into the school system to help children who had

not responded to traditional therapeutic approaches such as talk therapy. She

wanted to collaborate with other professionals and provide equine therapy

for survivors of sexual abuse.

Participant 4 (P4) was a female veteran who reported being very

stressed and stated that being around people or being touched by people

could trigger her PTSD. She also referred to her inability to drive long

distances and explained that soft textures such as her bedding and clothes

could provide comfort and destress her. She paralleled the comfort of soft

textures to petting horses, which also helped her feel at ease. She described

her experiences of touching the horses as putting her in a place that was

extremely happy and calming, indicating that this experience was more

intense than petting her cat or retired service dog, though she adored them as

well. The size of the horse allowed her to hug it and have physical contact,

which was difficult for her to do with people, as well as a chance to get close

enough to another heartbeat without the fear that she experienced with

people. Time with the horses was emotionally fulfilling and allowed her to

be outdoors, which she was not often. She also applied the tools she learned

in EFP to parenting her son and reported having a better relationship with

him as a result. She added that she wished to have more individual, private

EFP sessions rather than what was currently provided in groups that

contained male participants.

Participant 5 (P5) was a female veteran who reported working on

significant issues during EFP such as relationships, past marriage and

previous romantic relationships, fear of men, and suppressed anger.

Through horse activities and obstacles, the participant reported

understanding where her fear of men originated, and she was able to resolve

issues related to that. She also came to understand the dynamics of her

relationships and stated how participating in equine activities became

“iconic, a life lesson,” while also accepting fear as a natural emotion and

learning that there is an appropriate way to express anger.

Participant 6 (P6) was a female who reported being afraid of horses

due to being bitten as a child. She reported that through EFP, she learned

that she could face her struggles and that there is more than one way to face

one’s challenges. Additionally, she felt empowerment, increased self-

awareness, and a sense of accomplishment and achievement through

working with the horse and following through with equine activities and

obstacles. She stated that even though she had been a victim of sex abuse

for most of her life, she did not always have to be in that role. The

experience of EFP was a positive one that increased her sense of self-worth.

She reported that when she started to feel sad or depressed, she thought back

to her time during EFP and found strength, hope, and optimism to move

forward.

Participant 7 (P7) was a female who experienced increased self-

confidence, worked on relationship issues, became more assertive, and

learned to set better boundaries. She also stated that EFP helped her sense of

self-esteem, and that experiencing EFP had made a big difference for her, so

much that she became certified in

EAP to share this therapy with others.

Participant 8 (P8) was a female who participated in a 12-week equine

therapy program while dealing with feelings of guilt and shame, negative

thinking processes and behavior patterns, and triggers in dealing with family

members. She reported that equine therapy helped a lot in terms of learning

tools and applying knowledge of EFP to recognize that she could form new

habits, such as mindfulness to approach triggers with family members and

grounding, which is often used in equine therapy, to form new thinking

processes and behavioral patterns. She recognized that her self-confidence

was enhanced, that she had become more aware of her body language and

when to surrender thoughts that did not serve her, that she was trusting her

intuition more, and that she was applying knowledge and tools developed

through equine assisted therapy (EAT) to experiences and situations in the

real world.

Participant 9 (P9) was a female who participated in EFP at an

inpatient facility. She reported that equine therapy was an empowering

experience that enhanced her selfdetermination, helped her to learn coping

skills and set healthy boundaries, and enhanced her sense of inner strength

and self-assurance. Furthermore, she recognized and accepted that she and

other female participants were similar in facing their own challenges. EFP

helped her to accept herself and not compare herself with others, as well as

to deal with situations in ways that were best for her. She shared that her

experience with EFP was great and that she would recommend that anyone

take advantage of an opportunity to participate in EFP.

Participant 10 (P10) was a female who participated in EFP at an

inpatient facility. The participant reported that EFP was a profound and

powerful experience that had empowered her with a sense of maturity.

Connecting with the horse felt nonjudgmental and allowed her to let her

emotional guard down and get in touch with her emotions; it was an

uplifting experience that paved the way for self-identity and affected how

she viewed her relationships. She continued with equine therapy by working

with her family’s horses, which provided her with mental and emotional

stimulation.

summarizes the demographic information available on participants.

Information on participants’ age, education, race/ethnicity, and relationship

status were not requested for this study. It was a requirement of this study

that participants were 18 years of age or older and had participated in a

minimum of 6 hours of EFP.

Data Collection

Number of Participants

This study included 10 adult participants who had received a

minimum of 6 hours of EFP. The total number of hours, sessions, or weeks

for most participants was unknown; however, one participant attended 8

weeks and another participant attended 12 weeks. EFP occurred in locations

including, but not limited to, inpatient programs, EFP facilities, EFP

programs for veterans, and an intensive retreat for female survivors of sexual

abuse.

Location, Frequency, and Duration of Data Collection

Nine interviews were conducted via phone, and one was conducted via

Skype. Interviews varied in duration between 17 and 57 minutes. Data were

collected over a 5month period. Research questions were consistent and

asked in the same order to each participant.

Data Recorded

The 10 interviews were audio-recorded. Systematic data collection

procedures were followed as outlined in Chapter 3. The interviews were

transcribed verbatim, read repeatedly while playing the audio-recordings,

saved in secure files, and emailed back to the participants for transcript

review.

Data Analysis

Process

Transcripts were verified, and corrections were made as appropriate

via member checking. Transcripts were printed, phenomenological

reduction was done to bracket information, and then the information was

organized by circling keywords to establish themes. The epoche process

was used to balance analysis and interpretation. Interpretation began after

the bracketing of information and narrowing of keywords to combine them

into meaningful themes. I hand coded the detailed descriptions using exact

words chosen by the participants and avoided overgeneralization. Data were

organized into meaningful clusters, and with repetitive or overlapping data, I

followed a delimitation process. Finally, integration/synthesis of textural

and structural descriptions was performed to capture the essences of

participants’ experiences.

Codes and Categories

As part of data analysis, significant sentences were coded and

categorized and placed in the following table. The interview excerpts were

later converted into core themes.

Evidence of Trustworthiness

Credibility

I maintained a reflective writing strategy after interviews to identify

any biases or assumptions that might have occurred. The continuous

evaluation of self-disclosure through reflective writing assisted me in

acknowledging any potential influences on interpretation. I also utilized

member checking to verify the accuracy of data collection prior to analysis

and interpretation. Additionally, member checking enabled me to verify the

accuracy of viewpoints from participants.

Transferability

The results of this study are not intended for generalization; however,

possibly for the use of transferability. Rich, thick descriptions of

participants’ lived experiences are used to contribute to shared experiences,

so the reader may decide to transfer the findings to other settings.

Dependability

Rigorous procedures and strategies were followed, including data

collection procedures, the epoche process, phenomenological reduction,

member checking, and an audit trail. The audit trail included information on

the audio recordings, files of the transcripts, collection strategies, and how

the study was conducted. During data analysis and interpretation, the

interview protocol (Appendix B) was followed, meticulous accurately

interview transcriptions were completed by listening to audio interview

recordings several times to ensure accuracy of data. I also consulted with

dissertation committee members to ensure trustworthiness of the interview

protocol (Appendix B) and that the process was aligned with

phenomenological research. I had two external individuals, both certified in

equine therapy and one also a licensed therapist, who are experts in EFP to

look over the interview questions for appropriateness. As mentioned

previously, these individuals served as an expert panel to verify research

questions. Application of this methodology would produce repeatable

results and allow others to replicate this study and findings.

Confirmability

To maintain objectivity, I remained cognizant of the purpose of this

study and the nature of the audience, as well as my prior experiences with

equine facilitated psychotherapy. The rigorous procedures I followed, along

with the audit trail and internal consistencies are part of the process of

confirmability.

Results

This phenomenological study resulted in collected data from 10 adult

participants who experienced equine facilitated psychotherapy (EFP). Six

main themes emerged from the Skype interview and phone interviews,

including: (a) personal enrichment, (b) phenomenon, (c) introspection, (d)

professional enrichment, (e) relationships, and (f) experience with horses.

Participants associated feelings of happiness, positivity, and

profoundness with experiencing EFP. Self-confidence and empowerment

were also associated with enrichment along with increased self-worth, and

lessened depressive and anxiety symptoms. Additionally, rediscovery of self

and a sense of accomplishment and achievement were also identified.

Theme 1: Personal Enrichment

Participants identified with positive transformation as the result of

EFP through change in demeanor, skills of self-regulation, and ceased

suicidal ideations. Family relationships became stronger and healthier. All

participants identified experiencing personal enrichment during and after

EFP. Other recurring identifiers among all participants in this study

included words such as “valuable, self-assessment, reflective, incredible

experience, helped me heal, extremely happy, understanding relationships,

understanding self, empowered, positive self-worth, optimistic, sense of

achievement, inner strength and confidence.” Subthemes, “joy, confidence;

empowerment; self-worth; and accomplishment/achievement,” emerged as

common and consistent identifiers from data collected during interviews

with participants. About seven of the participants articulated experiences of

joy during and/or after EFP with words such as “happy, incredible

experience, positive feeling, nice feeling, feeling positive energy, great

experience, uplifting, and inspired happiness.”

Subtheme: Joy. At least seven participants identified with this

subtheme with words of “joy, happy, happiness, positive feeling, great

experience, satisfaction” as it related to their experiences of EFP and intense

emotions that described feelings with pleasure and satisfaction of a desired

outcome.

P4: It puts me in a place that is extremely happy, I don’t know how

to really describe it, but I am just incredibly euphoric and happy

as long as I am touching them and burrowing my face. For one,

it gets me outdoors which

I don’t do very often and it’s definitely very emotionally

fulfilling.

Honestly, the contact I’ve had with animals is more emotionally

secure than the contact I have with any humans; even family

(female).

P6: It was a really positive feeling and experience knowing that

things don’t always have to be the way they were, used to be in

a negative context. You can actually do something, accomplish

it, and feel good about yourself (female).

P3: I was able to work through a lot of trauma and I believe and

still believe that it was working through the horses, the

experiential learning that really helped me heal. It was a really

profound experience. It was a great thing for me. I have been

probably the most mentally healthy I’ve ever been my whole

life (female).

P10: It was very uplifting. It was a very powerful experience for me

(female).

Subtheme: Confidence. At least six participants identified the

effectiveness of EFP as increasing their own awareness about their own

abilities through trust. Feelings of trust and the relationship with horses as

identified by participants allowed them to trust the process of working with

their therapists. Participants experienced confidence as well as the sense that

they were becoming better people. They identified with this subtheme with

words such as, “beneficial without fear, setting worries aside, changed one’s

demeanor, helped me understand self, and freeing.”

P7: It definitely increased my self-confidence, helped me work on

some relationship issues, and noticing some patterns of things

that probably weren’t the best or healthiest. Such as not setting

great boundaries and things like that. Like I said, I think my

confidence is a lot higher (female).

Subtheme: Empower. At least nine out of ten participants identified

overcoming a sense of powerlessness in their lives both within themselves

and in their relationships. Participants shared how they recognized their own

abilities during and after EFP and regaining control of their lives and

recognizing the power to change. Half of the participants used the word

“empower” while others identified learning how to control themselves and

things, learning to keep going through therapy and change, learning to deal

with family, and recognizing inner strength.

P1: I think after completing a few programs, EAGALA and PATH

program with the riding, one of the things that helped me that

was very empowering because as I worked through things with

the horses; at first I was extremely fearful of horses and just

being able to work through that fear and work through you

know the anxieties I had being around horses really encouraged

me to conquer other fears I had in other areas of my life

(female).

P6: To be able to get them to do things was kind of empowering for

a lack of a better word (female).

P9: I got through that initial hurdle of being a little nervous, the first

time I did it, to me, it was very empowering after I got the hang

of it and to be able to turn to the side to get the horse to stop

and that’s the only signal you gave (female).

P10: I’ve had experiences with horses before, but using it in a

therapeutic sense like I did then, it provided a sense of maturity

and a little bit of empowerment. It was a very powerful

experience for me (female).

Subtheme: Self-worth/Self-esteem. About half of the participants

reported an increased sense of self, their own abilities, and emotional

evaluation to respect themselves and being worthy of respect from others.

Additionally, they perceived that validation from themselves was more

valuable than relying on others for their sense of self-worth/self-esteem.

More than half of the participants used the terms “self-worth” and “self-

esteem” while others identified with self-care and positive self-image. P1:

Being able to be around them for me is very therapeutic. In fact, I have

actually not been working with my therapist as much as I was before. I am

also off all medications I took for PTSD; since I’ve been working with the

horses I have less anxiety and lucky to not go on a lot of medications, so it’s

been very beneficial for me (female).

P6: I know I’ve used them to increase my value of myself, or my

self-worth is the right way to say it. Probably in far more ways

than I’ve actually mentioned. Like I said, from increasing self-

worth, the power of selfachievement; believing that you can do

things were the biggest things I think I took away from it

(female).

P7: I feel, I think it helped my sense of self-esteem being able to

control a large animal and I think it’s helped my relationships

too (female).

Subtheme: Empathy. Empathy for one participant was pivotal in her

therapeutic process as she reported the difficulty of letting her emotional

guard down, connecting with the horse, and allowing herself to be in touch

with her emotions through the process of having empathy; both giving and

receiving.

P10: It taught me a lot of empathy; not just giving, but receiving

empathy which that was difficult for me, but when a horse hugs

you, you learn (female).

Subtheme: Accomplishment/Achievement. More than half the

participants reported a sense of achievement and accomplishment after

participating in EFP. Some identified facing their own fears, both emotional

and fear of horses. Social interaction with others resulted in feelings of

accomplishment and achievement. Other participants also reported feeling

encouraged and more confident in themselves after EFP because they didn’t

give up, they followed through even with the discomfort, and they also felt

less alone as they recognized others participating in EFP struggling with

similar issues.

P2: A lot of it was rediscovering myself; trying to figure out where

my place was in the world again and finding out bits and pieces

about myself during one specific exercise, I realized that once I

have accomplished something; it doesn’t matter whether if it’s

been accomplished to the standard or not – I keep pushing

myself to perfection (male).

P6: The most beneficial I think would be the sense of

accomplishment and achievement of being able to follow

through with something that was

scary in the beginning, but then you kind of work through it and

you are successful at it.

You can actually do something, accomplish it, and feel good

about yourself.

When I have struggles, or start to get depressed, or feel low

again, I definitely think back to about how big of an

accomplishment it was for me to get in a ring with a horse after,

because when I was little, I was bitten and I was afraid of

horses (female).

Theme 2: Phenomenon

This study examined adult participants’ experiences of EFP; therefore,

all the participants had input about the occurrence of this therapy; their

observations, their impression, and circumstances. Two subthemes were

identified; amazing and benefits. Participants also reported a change in

psychological effects such as “thinking process, behavior, mood, perception

of world, and old habits.” Experience was described as powerful, positive,

and great along with rewarding, profound, and rewarding.

Subtheme: Amazing. Participants often identified an increase in self-

awareness and self-acceptance while experiencing EFP, finding strength

from within to persevere. Fears were conquered for participants as they

moved through equine activities and paralleled present experiences during

EFP with fears they held onto in life. Three interview excerpts are included

to support amazing. Seven (?) participants described EFP with words such

as, “amazing, incredible, emotionally fulfilling, successful, positive feeling,

hopeful, optimistic, and powerful.”

P1: And for myself personally, I just feel like I’ve gotten such an

amazing results from what I’ve done versus conventional

therapy, psychotherapy so

I think it’s great (female).

P2: It is amazing to see the transformation (male).

P5: I guess you could say I’ve taken it to a career choice, but even

if I hadn’t I still think I’d be telling people “Oh you have to go,

it’s amazing—sit with the horses, there’s something calming

about them, sitting in the environment.” We’ve just become so

disconnected so that is an issue that we will get connected or

feel like we’re connected again; we wouldn’t have half of the

issues (female).

Subtheme: Benefits. Ten participants reported benefits on a personal

level and five on a professional level. Participants identified with the

subtheme benefits through making an association on levels as an individual,

through their personal and professional relationships, as well as with society

as a whole.

P1: Being around the horses, noticing how they react when I start to

get anxiety they were influenced so it really helped me to self-

regulate so that was one of the things I noticed immediately

while working with the horses.

Well, I am actually taking some coursework in equine therapy

myself and I think having gone through it and getting some of

the benefits and rewards from that really helps me to continue

to want to work with the horses (female).

P2: Well, my experiences after were a huge change in my demeanor

in how I perceived the world afterwards; my mood improved

immensely, my relationship with my family became stronger

and I was less agitated afterwards. I had had a lot of issues

beforehand with outbursts of anger, but after this program I’ve

learned how to control things and learn to not necessarily jump

head first into everything, but to take a step back and reevaluate

the situation before making a decision on how to proceed. I was

having extreme suicidal thoughts and things like that so this

program certainly helped me understand what was going on in

my own life and the horses being the way they are, helped to

draw so much out of me during that 8-week period that I had

gone through the program myself. I keep in touch with the

organization that I went through and mentor in their program

with veterans that are coming through and I try to do as much

as I can in the community to raise awareness of the benefits of

the program that we offer there (male).

P3: I participated in a 5-day intensive retreat using equines as part

of therapy and it was the most incredible experience of my life.

So, I guess I’m giving back now because I experienced the

benefits of equine therapy to such a deep degree that I want to

offer that to other people (female).

P5: For me, I think it’s helped me shift some things that I wanted to

work with and didn’t know how (female).

P8: Before, I was, I guess the problem I really had was I didn’t

really know what was going on, the first day that I got to equine

assisted therapy, I like quickly and consciously became aware

of some like deep hidden guilt, like shame, and thinking

processes that weren’t serving me anymore.

After equine therapy, it had helped me out a lot (female).

P9: I needed to really work on making my mental health and my

physical health stronger. So, that helped me with that (female).

P10: I just can’t even begin to define the benefits of equine therapy, I

think it’s amazing and I think it’s terrifying, but there’s just

something special about the way people can interact with an

animal as opposed to the way you can interact with a person

(female).

Theme 3: Introspection

Ten participants reported examining their own thoughts and feelings

during EFP as well as how their behavior affects themselves and others

through equine activities.

Four subthemes emerged: self-awareness, self-acceptance, reflective, and

encouragement.

Subtheme: Self-awareness. Half the participants reported self-

awareness and self-acceptance as an improved outcome as well as learning

self-observation.

P1: It opened up a lot of self-awareness for me and helped me push

through a lot of anxiety and things I was working through in my

personal life

(female).

P6: I think that the biggest impact it had on me was, it increased the

degree of self-awareness that you can do things when you put

your mind to it and also that things don’t always have to remain

the same, they can change (female).

P8: I think by the third time, they had me on the horse, yeah just

learning the horse’s language was really interesting it brought a

lot of things to my awareness that I wasn’t aware of (female).

Subtheme: Self-acceptance. Seven (?) participants identified with

this subtheme with the awareness of their own strengths, capabilities, and

satisfaction with themselves. Identifiers that were shared include,

“awareness of self, self-regulating, I’m valuable, helped me understand my

life, helped me accept my fear and my emotions, selfawareness, accept

myself, find my inner strength, self-assurance, and finding myself.”

P5: The horse really reduces what you don’t know because, they’re

like Hello, were you aware that you have this, here it is! I think

it would benefit any counseling training to have it in there

(female).

P9: I guess another way that I’ve been affected is watching the

other women in the group and how they each reacted and dealt

with the situation maybe differently than me or with each other

and realizing that we are all on different levels in our lives

while we were in that therapy setting makes it helpful to know

that everybody is on different levels in their life outside of

therapy (female).

The part of the experience that became beneficial for me was

finding strength from within me, to be able to even make

myself stronger. I think that was important. I needed to really

work on making my mental health and my physical health

stronger. So, that helped me with that (female).

P10: … it made me feel like I was finding myself without other

people telling me who I was and that really carried on. I guess

going through the therapy with horses, I learned you could treat

people like that as well; don’t judge them and not let them

judge me and that really was through the horses (female).

Subtheme: Reflective. About one-third of participants reported

reflecting back on EFP and the parallels with how they handle issues day-to-

day.

P1: I think one of the things that got to me the most was one

exercise that we did with the horses where we were having to

set-up obstacles that were just like going through our daily lives

and it’s already challenging enough to go through these

obstacles, but then to bring a horse in and trying to going

through those obstacles with the horse is kind of making it like

this if your life, or this is your kid. Having to go through all of

these obstacles that are very challenging and then having to

deal with someone you’re leading in your daily life, like your

child or husband, is very challenging. It was very reflective. It

was very positive in the sense that it really gave us a lot of

positive feedback in that exercise (female).

Subtheme: Encouragement. Along with a sense of accomplishment,

awareness, and acceptance, participants reported encouragement during EFP

as well as feeling encouraged through reflection.

P6: When I have struggles, or start to get depressed, or feel low

again, I definitely think back to about how big of an

accomplishment it was for me to get in a ring with a horse after,

because when I was little, I was bitten and I was afraid of

horses. To be encouraged around people who I felt comfortable

with to actually even try something with a horse, thankfully it

was very nice.

It was, I guess it taught me that I can be in control of things that

go on in my life even though past history that I had been

through where I was more of a victim, that you didn’t always

have to play that role, be in that role

(female).

Theme 4: Professional Enrichment

Half of the participants became certified in fields of equine therapy

and another was set to collaborate with other professionals in providing

equine therapy to adolescents at risk as well as organize an intensive retreat

for survivors of sexual abuse. Participants who are veterans also became

mentors to help other veterans access EFP and raise awareness. Other

participants who became certified in equine therapy wanted to share this

experience with others, make a difference to others, and increase the

opportunity of EFP with others.

P1: Well, I am actually taking some coursework in equine therapy

myself and I think having gone through it and getting some of

the benefits and rewards from that really helps me to continue

to want to work with the horses.

I’ve definitely been a huge supporter of equine therapy;

especially within the veteran community. I actually started a

non-profit with women veterans and working with equine

therapy, art therapy, and music therapy as well. I really have

been trying to get the VA to understand how important it is to

provide these services in hopes that one day they will actually

be able to fund a lot of this so it’s not so hard for veterans to be

able to get access to these services. I’m definitely becoming a

huge advocate for equine therapy. And for myself personally, I

just feel like I’ve gotten such amazing results from what I’ve

done versus conventional therapy, psychotherapy so I think it’s

great (female).

P2: I’ve gone back and mentor now; helping other veterans and

people in this program. It is amazing to see the transformation.

I’ve come back and am now helping others that are in my

situation and I’ve actually gone and become a certified

facilitator for equine assisted psychotherapy program. I keep in

touch with the organization that I went through and mentor in

their program with veterans that are coming through and I try to

do as much as I can in the community to raise awareness of the

benefits of the program that we offer there.

Yeah, I’ve spoken mostly about the veteran program that I work

with, but the organization I work with, they have so many

different clientele that we work with. We work with women

recovering from substance abuse, we work with people that are

in abusive relationships, and we work with people that are

struggling with drug addictions. We have children that come in

having different issues, we work with children and adults on the

Autism spectrum; we have so many different groups that we

work with and across the board we have noticed an immense

change to every person that has come through (male).

P3: Two directions, one I would like to extend this offer, this type

of treatment to school-aged kids as part of a way to – a problem

we have in our school —we’re an alternative school and the

kids have different kinds of mental health stuff going on are

often times suspended from school. These kids have not been

successful in public school systems so they are sent to us. They

come to our schools because they’re really challenging children

and suspending them doesn’t seem to be beneficial at all and so

what my hope is that we can offer this as an alternative type of

intervention to kids instead of suspension, for kids to

experience experiential based therapy. I have developed a nice

three-way session with a local company that does ropes courses

and has a small barn. I am looking to collaborate with other

professionals to see what we might be able to offer. I want to

do that and I want to organize some kind of intensive retreat

like the one I went to because it was crazy that I had to fly

(across country) for this. There was nothing available on the

East Coast for survivors of sexual abuse. I was astounded when

I was looking for help for myself and that I couldn’t find

anything. I honestly don’t think a psychiatric hospital would

have taken

me in. I wouldn’t have qualified because I wasn’t suicidal; I

hadn’t reached that level of despair so checking myself into a

hospital didn’t look like a viable option. The treatments

available that were private were all extremely expensive and

way out of my price range, so I had to fly (across country) for

something that was affordable and professional. What I was

looking for, I think we need more of that on the East Coast

(female).

P5: I guess you could say I’ve taken it to a career choice, but even

if I hadn’t I still think I’d be telling people “Oh you have to go,

it’s amazing – sit with the horses, there’s something calming

about them, sitting in the environment.” We’ve just become so

disconnected so that is an issue that we will get connected or

feel like we’re connected again; we wouldn’t have half of the

issues. Yeah, that’s what I’ve been doing with it (female).

P7: I have actually gone on to get certified in equine assisted

psychotherapy because I found it to be really helpful for me and

wanted to be able to share that with other people (female).

Theme 5: Relationships

Eight of ten participants identified strengthened relationships as well

as learning tools to appropriately deal with triggers that surface with family

members as a benefit of EFP. Participants reported being a better father,

mother, husband, wife, partner, and daughter. There were also reports from

participants of facing their social anxiety during equine group activities in

which friendships were formed. Two participants rarely left their homes

prior to EFP due to fear and anxiety.

P1: It definitely helped in teamwork and teambuilding; the

EAGALA program helped me work through my relationships

that I deal with; reconnecting and socializing and things like

that again (female).

P2: ... my relationship with my family became stronger and I was

less agitated afterwards (male).

P3: Another way it has benefited is my family. My husband was

never around large animals, he only had a cat as a kid. He has

become very attached to our horses and caring for them

together has strengthened our relationship (female).

P4: Relationship with son better. It’s working because we had

some really tough times and now he’ll even cook a dinner and

sit down and eat with me when before he was in his room all

the time. I never saw him, except when we were going to

school (female).

P5: Helped me understand my relationships (female).

P7: … helped me work on some relationship issues, and noticing

some patterns of things that probably weren’t the best or

healthiest. Such as not setting great boundaries and things like

that.

… I think it’s helped my relationships too. It helped me be

more assertive and set better boundaries (female).

P8: really helped me deal with my family (female).

P10: … it changed the way I look at every relationship whether it’s

human to human, human to animals. Everything. It taught me

a lot of empathy; not

just giving, but receiving empathy which that was difficult for

me, but when a horse hugs you, you learn (female).

Theme 6: Experience With Horses

Experiencing the relationship with horses was explained in various

ways along with the profound healing effects of interacting with horses.

Participants identified with the horse’s natural ability to “mirror” their

moods and behaviors; bringing about psychological awareness.

Additionally, several participants who experienced social anxiety were able

to overcome the hesitation of leaving the house, being around a group of

people, and forming friendships. All of the participants shared about their

experiences with the horses.

Subtheme: Nonthreatening/nonjudgmental/connection. Half (?) of

the participants referred to the experiential learning, some to the size of the

horse, some about feeling non-judged, and others stating trust and

connection with horses.

Participants often referred to the horse as being nonjudgmental, which gave

them comfort and ease. They also stated that the environment of EFP felt

nonthreatening.

P1: I felt like it was a nonthreatening environment, I’ve always had

issues dealing with one-on-one therapy, feeling like I was being

judged so this took away those feelings of insecurities for me

working with the horses and being in that moment where I’m

able to connect and work through one a lot my things; working

with the horses and feel that sense of not feeling like I was

being looked at under a microscope was really helpful (female).

P3: Certainly, having the physical body of the animal, I think was

huge for me being able to connect with another living creature

that wasn’t judging me, just allowing me to cry and share my

story. I think there was a lot of release internally of sadness,

trauma and anger that had come out and when we groomed the

horse. I was also able to ride the horse bareback around in a

round pen; I hadn’t sat on a horse yet even though I had

adopted 2 big geldings, I hadn’t ridden them yet. The physical

contact, the emotional contact with the horse. All the memories

I had been suppressing were able to come out (female).

P4: Honestly, the contact I’ve had with animals is more emotionally

secure than the contact I have with any humans; even family.

Because they’re not judgmental and they realize the touch is

enjoyable, but it’s not erotic which I don’t know how to

describe that which is very important for me because I have

PTSD (female).

P5: The exercises with a personal counselor I need to, whenever I’m

feeling it, I need to put movement into the body and have to

have a good relationship with the counselor to do stuff like that,

but it’s just different with a horse because you just can because

there’s no judgment or at least you don’t feel like there is

(female).

P6: My experience with equine therapy, before I went to any of

them, any of the sessions, I wasn’t really fond of horses or

equine therapy. I had a bad experience when I was little, so I

avoided horses. However, when I went to

equine therapy and was taught how “freeing” because I can’t

think of another word, it is to actually be able to work with an

animal that is much larger and larger than you and being able to

communicate with what’s going on (female).

P10: I’ll say it again, the way that you can kind of let your guard

down, your emotional guard, the horse can understand you,

they feel you. You feel like you’re not being judged for a little

while, you’re not being looked at differently, it made me feel

like I was finding myself without other people telling me who I

was and that really carried on. I guess going through the

therapy with the horses, I learned you could treat people like

that as well; don’t judge them and not let them judge me and

that really was through the horses.

I can’t imagine anything better. They’re such large animals and

it feels like they should dominate, but they don’t and when you

can connect with them, it’s just really, wow, I don’t know how

to put it into words, I need to regroup a little bit, can you say

the question again so that I can get back on track? I went a

little emotional. Well, actually that might be a perfect example.

It’s allowed me to get a little in touch emotionally and learn

how to care for and be cared for at the same time. It’s such a

profound connection that it really, it changes, for me, it changed

the way I look at every relationship whether it’s human to

human, human to animals.

Everything. It taught me a lot of empathy; not just giving, but

receiving

empathy which that was difficult for me, but when a horse hugs

you, you learn.

I think it’s amazing and I think it’s terrifying, but there’s just

something special about the way people can interact with an

animal as opposed to the way you can interact with a person.

It’s a lot easier to trust the animal. Horses just, I don’t know,

they seem to understand and feel their person rather than most

animals do (female).

Subtheme: “Mirroring”/feedback. About half of the participants

also referred to the “mirroring” effect that horses had of their own emotions

and behaviors that led them to self-discovery. Often in EFP research as well

as this study, clients and participants report that the horse “mirrors” their

moods and behaviors, thus providing a gateway to recognize one’s own

behaviors. This is often referred to as the horse “mirroring” participants’

thoughts and particularly their behaviors before, during, and after EFP. It

helped participants identify and change unwanted patterns. Horses are

known to mirror what they experience, thereby giving feedback on human

body language and other physical and emotional signals (Rothe et al., 2005).

P1: I thought it very valuable, especially for self-regulating with the

horses because I felt like they were really mirroring my PTSD

and some anxiety. Being around the horses, noticing how they

react when I start to get anxiety they were influenced so it

really helped me to self-regulate so that was one of the things I

noticed immediately while working with the horses

(female).

P2: I was having extreme suicidal thoughts and things like that, so

this program certainly helped me understand what was going on

in my own life and the horses being the way they are, helped to

draw so much out of me during that 8-week period that I had

gone through the program myself. Honestly, I think the most

beneficial part of it is working with the horse because you have

to build a certain relationship with the horse to understand

anything that is trying to be taught. In a sense the horse is

acting naturally as a mirror as to what’s going on in our own

selves. It helps to bring to light that this is what I’m doing to

people outside in my life, to myself and it helped to have the

relationship with the horse during the period of time and

working with them is immense.

You have to give me a minute here to pull myself together

because any time I talk about what it’s done for me, I get

choked up. It saved my life honestly and like I said I was

extremely suicidal. I thought almost every day about it and one

horse I worked with had literally saved my life

(male).

P3: I was able to work through a lot of trauma and I believe and

still believe that it was working through the horses, the

experiential learning that really helped me heal.

I think there was a lot of release internally of sadness, trauma

and anger that had come out and when we groomed the horse

(female).

P4: It’s not that I am getting stressed out by a sense of touch, but I

can be. The horses, oh my gosh, all I can do while I’m there is

rub my hands all over them. We’re supposed to be brushing

them, I do brush them for a little while, but at some point, I

want to put that brush down so I can actually feel their hair. It

puts me in a place that is extremely happy, I don’t know how to

really describe it, but I am just incredibly euphoric and happy

as long as I am touching them and burrowing my face.

With the horses, I am getting all the physical contact that is

extremely beneficial without the fear and that’s the only time

that happens. I hug a horse, they’re taller than I am, but it’s in

the same range hugging another person without the fear.

I found that about the same time I had more stress too is

because my son came to live with me and suddenly to only

leaving the house to get toilet paper and groceries every couple

of days or so, I am leaving the house three or four times a day

because he needed me to. I don’t think that transition would

have been possible if I hadn’t been given the horse therapy

when all that started (female).

P5: It’s not the first time I had come across this, sometimes it’s not

their stuff, they mirror what’s going on with us, they can make

themselves ill trying to pass us a message (female).

P8: Grounding yourself and finding space to kind of; like when

your mind’s moving really fast and when you’re getting

triggered and you’re beginning

to spin off, using the tools that you can to help calm you down

to music or through an animal that can mirror back to you an

honest reflection and the people.

I guess recognizing, recognizing having like the horse to

engage my mood and knowing that it’s that subtle of an energy

(female).

P9: I think what the equine therapy did more than anything was

kind of make me more appreciative of how animals can react to

people, how sensitive they are or how they can feel what you’re

feeling. I think that had a huge impact on me (female).

Subtheme: Socialize. At least three participants identified fear and

anxiety as affecting their socialization. Prior to EFP, two participants didn’t

leave their home often, but were gradually able to do so more and more after

experiencing EFP.

P1: It definitely helped in teamwork and teambuilding; the

EAGALA program helped me work through my relationships

that I deal with; reconnecting and socializing and things like

that again.

Really, I just love being around them; it’s been good for me,

encouraging me to get out and volunteer (female).

P3: It has broadened my social circle, I’ve met a lot of people

through horse care.

Watching the emotional work with the other ladies and what

they were going through was also soothing for me because I felt

less alone and hearing the experience of other people who were

also went through hard times in their life (female).

P4: For one, it gets me outdoors which I don’t do very often and it’s

definitely very emotionally fulfilling (female).

P9: I guess another way that I’ve been affected is watching the

other women in the group and how they each reacted and dealt

with the situation maybe differently than me or with each other

and realizing that we are all on different levels in our lives

while we were in that therapy setting makes it helpful to know

that everybody is on different levels in their life outside of

therapy (female).

Summary

This chapter included demographics, detailed data collection, data

analysis in response to research questions, and evidence of trustworthiness.

Through collecting the data on experiences of participants, personal

enrichment emerged as an influential theme including participants

identifying with feeling or being valuable; self-regulating; empowered;

worked through anxiety, depression, PTSD, and suicidal ideation;

rediscovering self; enhanced relationships; healing; successful, increased

self-confidence and self-worth; and learned to set healthy boundaries.

Aspects of experiences included common emerging identifiers of EFP as

providing positive feedback, reflective, tools to apply to daily lives,

therapeutic, relationship with the horse, the horse “mirrors” your

behaviors/emotions, nonjudgmental, connection with the horse,

accomplished, changed behavior patterns, grounding, mindfulness, positive

feelings, positive experience, and introspection. Participants’ responses

often overlapped on how they had been affected by the experiences of EFP;

however, common identifiers include enhanced relationships, helped with

transition in life, overall helpful, increased self-awareness, positive

selfimage, increased self-confidence, provided useful tools, helped me deal

with triggers, helped me get rid of guilt and shame, the horse literally saved

my life, and became certified in equine therapy. The research question of

what participants did with their experiences after EFP are that half became

certified in equine therapy; one founded a non-profit with female veterans,

another participant mentors in a program with veterans as well as for women

recovering from substance abuse and abusive relationships, and children and

adults on the Autism spectrum, became a facilitator; and one that will

organize an intensive retreat for women survivors of sexual abuse.

Participants also added that they would like to continue EFP.

Chapter 5 includes an interpretation of the findings, limitations of the

study, recommendations, implications for social change, and conclusion.

Chapter 5: Discussion, Conclusions, and Recommendations

Introduction

The study captured the essence of experiences of adults who have

participated in EFP. The primary purpose of this study was to gain an

understanding of participants’ experiences during and after EFP by capturing

textural and structural descriptions. Results of this study detailed the lived

experiences of nine adults who were dealing with one or more of the

following: PTSD, anxiety, social issues, suicidal ideation, relationship

issues, intimacy issues, sexual abuse, and dissociative symptoms. Through

inquiry, I gathered descriptions of “what” and “how” in relation to their

experience of EFP. In the current study, nine women and one man

discussed how their lives changed after participating in EFP. Through

qualitative inquiry and the phenomenological approach with four research

questions, data were collected via structured in-depth phenomenological

interviews, which were audio-taped through phone and/or Skype. I

transcribed each interview verbatim using member checking for accuracy, a

data analysis spiral as part of the qualitative strategy, and hand coding for

procedure. Few studies in literature have focused on the experiences of

individuals during and after EFP. Specific themes emerged from data

analysis and were narrowed down to the following: (a) personal enrichment,

(b) phenomenon, (c) introspection, (d) relationships, (e) professional

enrichment, and (f) experience with horses.

Interpretation of the Findings

The purpose of this study was to explore participants’ experiences of

equine activities during EFP, including what they did with them in their

personal and professional lives. Additionally, this study extended

knowledge by bridging a gap between limited knowledge of EFP and

common themes of lived experiences of individuals during and after equine

therapy. The results of this study indicated that EFP can have a significant

impact on participants’ personal and professional lives.

The theoretical framework of EFP orientation derives techniques from

various modalities such as brief therapy and solution-focused therapy

(Schulz, 2005). Some participants did identify when their therapist would

observe their interaction with the horse and draw parallels to problems in

other areas of their lives, which is a component of this framework that is

consistent with existing research (Russell-Martin, 2006; Shultz, 2005). For

instance, P6 stated, “I think having that positive experience, especially with

the instructors or the therapists that were there, in encouraging other people

along to be able to do this.” P2 stated, It helps to bring to light that this is

what I’m doing to people outside in my life, to myself and it helped to have

the relationship with the horse during the period of time and working with

them is immense.

The development of life skills among participants is consistent with existing

research (Levinson, 1997; Rothe et al., 2005), and a favorable opportunity

for doing something is available for individuals to change undesirable

behavior (Shultz, 2005). Participants also described times when the horse

would “mirror” or provide feedback to them, which brought about

psychological awareness. This ideology and collaboration between humans

and horses along with problem solving was also discussed about participants

learning through interaction with the horse and the use of metaphors, a brief

technique. The use of EFT activities allows for brief therapy and solution-

focused therapy techniques to be applied. Additionally, this modality

intertwines with the conceptual framework through the use of equine

activities by identifying appropriate use of metaphors, transference, the

horse’s ability to give unbiased and accurate feedback, the horse’s ability to

“mirror,” and the variety of emotions and behaviors that arise, allowing the

therapist to promote awareness and growth. For instance, P1 stated, “I

thought it very valuable, especially for self-regulating with the horses

because I felt like they were really mirroring my PTSD and some anxiety.”

P2 stated, “In a sense the horse is acting naturally as a mirror as to what’s

going on in our own selves.” P8 described Grounding yourself and finding

space to kind of; like when your mind’s moving really fast and when you’re

getting triggered and you’re beginning to spin off, using the tools that you

can to help calm you down to music or through an animal that can mirror

back to you an honest reflection and the people.

The continuance of problem-solving and coping skills during EFP is

consistent with the literature (Levinson, 1997; Rothe et al., 2005); moreover,

the horse’s ability to give unbiased and accurate feedback allows therapists a

portal to address reactions of participants immediately (Klontz et al., 2007;

Lentini & Knox, 2009).

The theme of personal enrichment was significant as participants

noted changes in their beliefs about their own value. Many expressed

changes in mood, emotions, confidence, and self-worth. For instance, P2

stated, “Well, my experiences after were a huge change in my demeanor in

how I perceived the world afterwards; my mood improved immensely, my

relationship with my family became stronger and I was less agitated

afterwards.” P1 stated, “I am also off all medications I took for PTSD; since

I’ve been working with the horses I have less anxiety and lucky to not have

to be on a lot of medications.” Findings in the literature indicating that

participants report an increase in confidence and self-worth during or after

EFP are consistent with the findings of this study (Bray, 2002; Iannuzzi &

Rowan, 1991; Rothe et al., 2005; Tramutt, 2003). The theme of introspection

was common among participants as they identified with their own thoughts

and feelings how introspection became a positive tool in their daily lives.

Participants recognized behavioral patterns and the impact that these patterns

had on them as well as others, and they ultimately made improvements by

confronting their fears and anxiety. For instance, P6 stated, The most

beneficial I think would be the sense of accomplishment and achievement of

being able to follow through with something that was scary in the beginning,

but then you kind of work through it and you are successful at it.

P8 stated, In the moment, I was very aware that I needed to make new

habits, that was kind of like the whole process I’m going through and

realizing that I can build new habits in the moment and I don’t have to go

back to whatever synapse is in my head that I’ve learned.

P7 stated, “it’s helped my relationships too,” explaining, “I think mainly that

I find it to be a really, really beneficial therapy and I saw it work for myself

as well as seen it work for other people; it made a really big difference.” P8

described “moving from triggers and not processing it and applying the

knowledge that they gave to me for the real world when I’m out in it.” P8

recalled, A month later, I was able to use what tools they gave me to take on

some strong influences in my life that I was going through. I can get a little

more specific with that with the certain tools that they gave and things that I

did. Behavior modification after receiving EFP has been documented in

literature (Lentini & Knox, 2009), which is consistent with findings of this

study of participants’ behavior modifications and improvement in anxiety.

Mental health issues and psychosocial issues that influence communication,

cognition, behavior, social skills, and anxiety, as well as mood disorders are

addressed and documented throughout the research (Rothe et al., 2005).

Equine activities elicit feelings of trust, safety, and respect that inspire

feelings of personal success (Rothe et al., 2005).

The theme of changes in relationships was very significant for the

participants in this research study. The participants asserted that familial

relationships had improved and that EFP had significantly improved their

relationships by helping them identify how their own behaviors contribute to

interpersonal effectiveness, as well as how tools developed through equine

activities were applicable to daily life. For instance, P1 stated, It opened up

a lot of self-awareness for me and helped me push through a lot of anxiety

and things I was working through in my personal life. It definitely helped in

teamwork and teambuilding; the EAGALA program helped me work

through my relationships that I deal with; reconnecting and socializing and

things like that again.

Specific relationship enhancements were not noted in existing research

findings; however, existing research had shown that equine-assisted family

therapy (EAFT) was an effective intervention for the reduction of emotional

and behavioral disorders in high-risk youths (Mann & Williams, 2002).

The theme of professional enrichment influenced half of the

participants in this research study. Forty percent of participants in this study

were veterans who were struggling with anger, PTSD, and reintegration into

the family system and society. The trauma of war, sadness, anger, and

sexual abuse were among the issues shared by participants that were dealt

with through equine treatment. This study adds to past research

demonstrating that horses mirror moods, prompting individuals to self-assess

their own moods and habitual behaviors so that they are aware of the

messages these send to other people. Participants’ awareness of how their

behaviors affected others, as reported in this study, stemmed from immediate

responses to horses, echoing reports of many other participants in equine

therapy studies. Therefore, this mirroring from horses and self-assessment

from participants provides content and a gateway for the therapeutic process

between participants and licensed therapists or mental health professionals.

Engagement with horses among participants fosters engagement between

participants and professionals to process emotions, behaviors, and patterns.

Although quantitative research exists that examines participant-reported

reductions in psychological distress or enhanced psychological well-being as

a result of EFP, there is limited or essentially nonexistent qualitative

research examining and evoking the lived experiences of individuals who

have participated in EFP (Cumella et al., 2013; Kemp et al., 2014;

Klontz et al., 2007; Schultz et al., 2007; Shultz, 2005). Bachi (2012)

identified the need to study the relationship and bond that develop between

client and horse. Participants in this study often described experiences they

had with horses during EFP as treasured.

The results of this study indicate that EFP had significant impacts on

participants. Participants in this study identified growth in the areas of

personal and professional enrichment, introspection, improvement in

relationships, the phenomenon of EFP, and experience with horses.

Limitations of the Study

The data collection process involved one-on-one phone and Skype

interviews with adults who participated in EFP. To establish

trustworthiness, I engaged in journaling, providing reflection and

interpreting my own experiences to remain conscious of my own biases,

thereby lessening threats to validity. Additionally, issues of trustworthiness

outlined in Chapter 3 were addressed through checks and balances in the

research; by identifying that not all data would fit into a theme; by clarifying

researcher bias; through member checking; and by providing rich, thick

descriptions. According to Creswell (2013), adhering to at least three

validation strategies in qualitative inquiry is suggested. However, there may

be limitations to the current study because I did not use strategies involving

nonverbal cues, which I would have been able to observe in face-toface

interviews. Phone interviews do not allow the researcher to observe

nonverbal cues from participants, which may be useful data.

The aim of this study was not to generalize findings from this sample

to other populations; rather, I sought to investigate, understand, and define

the experiences of participants. Overgeneralization was avoided, and

qualitative strategies were followed. There is, however, the potential for

transferability. An additional recommendation would be to obtain more data

from men.

Recommendations

Results of this study may be used for further research that provides

groundwork in capturing the essence of participants’ experiences of EFP and

further expanding upon participants’ reduction in behavioral and emotional

symptoms. Additionally, future studies could evaluate the long-term effects

of EFP on participants. Existing research and the findings in this study

indicating significant improvements in psychological functioning for EFP

participants warrant further research into EFP. Perhaps future research could

address which aspects of EFP correlate with therapeutic benefits, population

sample, and long-term effects. Additional phenomenological study could

identify and enhance understanding of the experience of participants and the

formation of cognitive maps, attributes and characteristics of a phenomenon,

through inquiry. This understanding could capture how participants organize

information through experiential therapy and how participants interpret

participation in EFP. Furthermore, exploring how participants form these

attributes from EFP and inferences drawn from them could provide

additional information for the clinician about maladaptive thought processes,

thus changing behavioral patterns through EFP. Consistent findings may

also contribute to efforts to synergize EFP modalities with other treatment

modalities. Finally, further research could incorporate larger sample sizes to

contribute to the findings of EFP studies. Such research might uncover

benefits reported by participants, thereby supporting coverage of this

treatment by insurance companies and helping EFP to become a mainstream

therapy that more individuals can choose.

Implications for Social Change

This study contributes to existing literature in gaining insight into (a)

the experiences of adults during and after receiving EFP, (b) the aspects of

EFP participants considered to be most beneficial to their well-being, (c)

how participants have been affected by EFP, and (d) what participants did

with their experiences after EFP. The results of the study not only describe

the impact of EFP on the participant as an individual, but also the impact of

EFP experiences on participants’ relationships. Intimate relationships

include those involving family, friends, and society. Professional

relationships were impacted as well, as one-half of the participants in this

study became certified in equine therapy so that they could serve others.

The overall significance of this study of the lived experiences of individuals

derives from its provision of a deeper level of understanding for providers of

what is meaningful to individuals during and after EFP. This includes the

process and perceptions of these individuals that lead to outcomes, along

with why and how their reality changed. Rich and meaningful data on the

perceptions and experiences of EFP participants contribute to a better

understanding of individuals and their experiences. This study contributes to

the literature on the lived experiences of adults during and after EFP, which

may enhance knowledge and practice in equine therapy. By exploring deep

meanings described by individuals as developing during and after EFP, this

anecdotal evidence adds to existing literature.

This study, in addressing a gap in the literature, may enhance

understanding of this innovative therapy as well as increase access of the

human experience; emotions, personality characteristics, behaviors, needs,

and desires. The benefits of animal-assisted therapy (AAT) to overall

mental health are many, and quantitative research on equine therapies has

indicated effects such as improving mood and anxiety disorders and has

supported its use for behavior modification. This study may assist in

increasing understanding of what part of their experiences are meaningful to

individuals. It has implications for positive social change that may result

from insight into individuals’ experiences of equine treatment, in that

clinicians may improve their understanding of maladaptive thought

processes. Individuals understanding their own belief systems, thus readily

changing unwanted behavior patterns, is an important implication of

effective

EFP as well.

Conclusion

EFP has been reported to have a significant impact on veterans with

PTSD, suicidal ideation, problems with reintegrating into the family system,

anger, and depression. Additionally, it can be helpful for women survivors of

sexual abuse experiencing depression, anxiety, dissociative symptoms, and

intimacy issues, as well as others suffering from low self-worth and other

family and relationship issues (Lentini & Knox, 2009; Levinson, 1997; Marx

& Cumella, 2003; Rothe et al., 2005; Tyler, 1994). Participants in this study

reported facing significant challenges that led to significant changes in

themselves, their family life, and their role in society. The trauma of war,

sadness, anger, and sexual abuse were some of the issues addressed by EFP.

Valuable insight gained from capturing the essences of participants’

experiences fills a gap in literature on how horses may be used as tools for

individuals to gain insight and emotional growth.

Participants in this study identified the importance of their experiences

with horses and reported experiences of personal enrichment that included

positivity, joy, enhanced self-worth, sense of achievement, and establishing

healthy boundaries.

Impressive accounts of better relationships were often reported by

participants. Participants described EFP as an amazing experience and

transformation that resulted in changed perceptions followed by

introspection. Participants reported benefits such as self-awareness and

empowerment, and they conveyed the value of a therapeutic setting where

anger and fear diminished in a nonthreatening, nonjudgmental environment.

Fifty percent of the participants reported continued involvement with equine

therapy serving veterans, women survivors of sexual abuse, children, and

other individuals. By capturing the experiences of EFP participants, this

study makes a valuable contribution to literature and supports effective

evidence-based practice (EBP) for clinicians and the populations they serve.

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