“Therapy” is a protected term that relates to the “therapeutic medical treatment of impairment, injury, disease or disorder” (Merriam-Webster, 2020).
Equine-assisted therapy broadly refers to any type of therapy or treatment that includes equine interactions, activities, or treatment strategies, and the equine milieu. Services are regulated by healthcare laws and provided by appropriately educated, trained and credentialed (licensed or registered) healthcare professionals. These individuals act within their scope of practice, and focus on addressing the patient’s clinical treatment goals. Patients (or their parents or legal guardians in specific cases) seek therapy as a treatment for physical or psychological illness or disability, and agree to the treatment by signing an informed consent and actively engaging in the treatment planning process.
Specific to equine-assisted therapy, typically physical therapists, occupational therapists, speech therapists, mental health professionals, nurses, and on some occasions, medical doctors, are the licensed healthcare professionals who most commonly provide some form of equine-assisted therapy. Most professionals who offer equine-assisted therapy are required to obtain additional training, education, supervision and certification (when available) prior to adding a new technique or area of practice specialization (Cook, 2011; ACA, 2016; APA, 2016; NASW, 2016; AOTA, 2016; APTA, 2016).
Just like any form of conventional healthcare, when licensed healthcare professionals choose to include equines and the farm milieu, they do so within the limits of their scope of practice, treating only patients whose conditions would typically be treated by their distinct healthcare practice. Adding a horse to therapy does not change a professional’s scope of practice, or enable them to treat populations or conditions they wouldn’t otherwise treat (ACA, 2016; AOTA, 2016; APA, 2016; APTA, 2016; ASHA, 2016; NASW, 2016).
Licensed healthcare professionals do not conceptualize equine-assisted therapy as a distinct or separate service or profession (Ekholm Fry, 2013; Pham & Bitonte, 2016, AHA, Inc. 2017). Rather, professionals continue to practice whatever form of conventional healthcare they are licensed to provide such as physical, occupational, and speech therapy, or psychology, counseling, social work, or marriage and family therapy, while incorporating horses and the farm milieu into the patient’s treatment plan. Regardless of where the service is conducted and whether or not a horse is present, these professionals remain bound by the same laws and ethics associated with the profession in which they are licensed.
Equine-Assisted Mental Health
Equine-assisted mental health is a specialty area of practice in which licensed mental health professionals (psychologists, counselors, psychotherapists, and social workers or other healthcare professional whose scope of practice includes mental health) provide regulated mental health services in a farm environment working with horses.
It is important to note that professionals may choose to incorporate equines in the patient’s treatment plan, but their primary responsibility is to use clinical reasoning and their extensive training, education, and experience to treat the presenting condition is using whatever treatment method is deemed most effective.
Equine-assisted mental health is used to address all manner of mental/behavioral health issues like PTSD, anxiety, depression, addictions, other serious mental illnesses, as well as relationship challenges, phase-of-life issues, parenting, communication, and everyday life concerns.
To provide any speciality area of practice, professionals are required to receive additional training, education, and supervision prior to offering services. In the United States, professionals can obtain this training, education, and supervision from any individual or training organization they like, as there are no specific requirements put in place by state licensing boards at this point in time.
The only caveat is that if the professional providing equine-assisted mental health is a member of the American Counseling Association (ACA), or resides in a state that has adopted the the ACA’s Code of Ethics, then the counselor should be aware of the ACA Animal Assisted Therapy in Counseling Competencies.
Equine-Assisted Physical, Occupational, or Speech Therapy
When including horses in human healthcare, physical, occupational, and speech therapists use activities conducted in the farm milieu or while mounted on a horse (usually called ‘hippotherapy’) to improve functional outcomes. According to the American Hippotherapy Association (AHA), “Best practice dictates that occupational therapy, physical therapy and speech-language pathology professionals integrate hippotherapy into the patient’s plan of care, along with other therapy tools and/or strategies”. They go on to further clarify the use of the term “hippotherapy”:
The term hippotherapy refers to how occupational therapy, physical therapy and speech-language pathology professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine movement as a therapy tool to engage sensory, neuromotor and cognitive systems to promote functional outcomes (AHA, 2018).
The AHA advises healthcare professionals to specify their distinct areas of licensure to ensure it is clear what regulated healthcare service the professional provides when including horses (AHA, 2016). As such, the AHA recommends the use of the terms “equine-assisted physical therapy”, “equine-assisted occupational therapy”, or “equine-assisted speech therapy” rather than broadly using the term “hippotherapy” as a way of including all different provider types under one umbrella.