This morning my inbox was filled with concerned emails from people who watched last night’s John Oliver show. I don’t watch television and thus have no personal connection to this show. However, I believe John Oliver, in all his crass humor, pointed out a very uncomfortable truth.
The general pubic, and even some providers offering interactions with horses, don’t understand the critical distinction between “petting a horse” and the clinical practice of equine-assisted therapy. Until the vital differences between therapy and non-therapy services are clearly articulated, understood, respected, and adhered to BY THE PROVIDERS THEMSELVES, we cannot possibly expect the public to take this intervention seriously.
Clinical intentionality and the professional competencies required to design safe, ethical, and effective equine-assisted interactions to meet varying treatment goals for different populations are essential components to differentiating between “just petting a horse” and a carefully thought out and well executed treatment intervention (see the ACA’s Animal-Assisted Therapy in Counseling Competencies). Simply exposing patients to horses without these components in place is not sufficient to warrant the use of the term “therapy”.
“Therapy” is a protected term used to describe the treatment of physical or mental illnesses, disorders, or diseases that are regulated or sanctioned by healthcare laws and provided only by credentialed (licensed or registered) healthcare professionals. The licensed professionals who provide therapy go through many years of specialized education and supervised clinical experience and must pass board exams before they are allowed to practice independently. They must also receive additional training and supervision prior to including any new speciality area of practice or novel treatment approach (like equine-assisted therapy). This course of rigorous study, supervision, and regulation helps guarantee a certain level of competence that is intended to keep patients safe.
Unfortunately in the equine-assisted therapy industry (especially when talking about equine-assisted mental health), many licensed healthcare providers offer services that include horses without an adequate depth and breadth of education and training. There are no regulations related to what type, or how much, specialty training and education someone needs to have before providing equine-assisted therapy. Therefore, people who offer these services may have vastly differing levels of knowledge and experience. In some cases, the services may look a lot like “just petting a horse”, because in truth, that’s about all the provider knows how to offer.
In other cases, non-licensed individuals offer services that are not therapy, but are considered (and called) “therapeutic” and look pretty much identical to therapy services from a layperson’s vantage point. Some programs even suggest that non-therapy equine-assisted activities can be used as “treatment” for complex medical or mental health conditions or diagnoses, and list all the psychological and physiological benefits that may be gained from engaging with horses. The problems with this are many and multi-faceted, below are only a few of the possible examples.
- Based upon the results of research, when equine interactions are provided by licensed healthcare professionals and adhere to the practice requirements of these various professions, they are MORE EFFECTIVE in the treatment of most medical or mental health conditions than a non-therapy service provided by a non-licensed individual. Although this might seem like common sense, for some reason in this industry therapy and non-therapy services are commonly used interchangeably and many people believe that the benefits should be (or are) the same.
- Patients seeking medical or mental health treatment may receive unsafe or ineffective alternatives to therapy rather than being directed to the correct service.
- Using therapeutic techniques that resemble those used in therapy without an informed consent and an agreement to “treatment” is unsafe and unethical. Clients seeking life or professional development coaching or participating in educational services may be pushed into areas they are not prepared for or interested in delving into. This is unfair to the clients, and devalues the important and VERY DIFFERENT services a life/professional development coach or educator has to offer.
- Both therapy and non-therapy services offer valuable and VERY DIFFERENT (can I just say that again?) benefits, but because they are not clearly separated, in many cases providers compete for the same clients (or patients), resources, and funding rather than clearly articulating the important differences and using a referral system to make sure the client (or patient) receives the right services at the correct phase of his/her healing journey.
- Research results are seriously compromised because many researchers study a non-therapy equine-assisted activity as a form of treatment. This, coupled with other methodological issues, impacts the results and the overall validity of the research.
As John Oliver points out, there is little empirical evidence that actually shows working with horses is an effective treatment tool for many of the populations currently served by the various forms of equine-assisted therapy. Although there has been a wealth of research conducted, after reading over 350 peer-review published research articles, I can comfortably say that methodological issues severely limit our ability to understand what is REALLY happening when horses and humans connect, or to state with any level of certainty what is or isn’t effective.
To this end, we as an industry need to come together to get clear on some important points including the value of separating therapy from non-therapy services, using correct terminology, and increasing our expectations regarding provider competencies. I believe these three initiatives will greatly improve the industry and maybe even help people like John Oliver understand the importance and value of the horse-human relationship.
Oh, and finally, just so we can all be on the same page about the extent the existing research related to addictions and equine-assisted interactions, here is a list of peer-reviewed papers from 1985-2016. I haven’t updated the list to include the new papers out in 2017 and 2018 – more to come on that front later.
Adams, C., Arratoon, C., Boucher, J., Cartier, G., Chalmers, D., Dell, C.A., et. al., (2015). The helping horse: How equine assisted learning contributes to the wellbeing of First Nations youth in treatment for volatile substance misuse. Human-Animal Interaction Bulletin, 1(1), 52–75.
Cody, P., Steiker, L. H., & Szymandera, M. L. (2011). Equine therapy: Substance abusers’ “healing through horses”. Journal of Social Work Practice in the Addictions.
Dell, C. A., Chalmers, D., Dell, D., Sauve, E., & MacKinnon, T. (2008). Horse as healer: An examination of equine assisted learning in the healing of First Nations youth from solvent abuse. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 81–106.
Dell, C. A., Chalmers, D., Bresette, N., Swain, S., Rankin, D., & Hopkins, C. (2011). A healing space: The experiences of First Nations and Inuit youth with equine-assisted learning (EAL).Child and Youth Care Forum, 40(4), 319–336.
*Kern-Godal, A., Arnevik, E.A., Walderhaug, E., & Ravndal, E. (2015). Substance use disorder treatment retention and completion: a prospective study of EAT for young adults. Addiction Science and Clinical Practice, 10(21), 3–12.
*Kern-Godal, A., Brenna, I.H., Kogstad, N., Arnevik, E.A., & Ravndal, E. (2016). Contribution of the patient horse relationship to substance use disorder treatment: Patients’ experiences. International Journal of Qualitative Studies on Health and Well-Being, 11, 1–12.
*Kern-Godal, A., Brenna, I.H., Arnevik, E.A., & Ravndal, E. (2016). More than just a break from treatment: How substance use disorder patients experience the stable environment in horse-assisted therapy. Substance Abuse: Research and Treatment, 10, 99–108.