An Introduction to Equine Therapy

“There is something about the outside of a horse that is good for the inside of man.” —Winston Churchill

What is equine therapy?

Equine therapy is a tool or a treatment that uses the horse to help improve the mental, psychological, and/or the physical functioning of humans of any age. There are three major types of equine therapy: Hippotherapy, Therapeutic Riding, and Equine-Assisted Psychotherapy.

Hippotherapy

This is a therapeutic tool or adjunct employed by specially trained occupational therapists, physical therapists, or speech language pathology professionals using the “manipulation of equine movement to engage sensory, neuromotor, and cognitive systems to promote functional outcomes.” The horse’s three-dimensional swinging movements (up and down, forward and backward, and side to side) are used to stimulate areas of the body the rider is not able to: spasmodic muscle tone and the range of motion in all the joints, especially the pelvis, hips, and spine. This tool is used for a variety of human conditions such as cerebral palsy, multiple sclerosis, traumatic brain injury, and developmental disabilities. Hippotherapy originated in Germany and came to the U.S. in the 1970s. 

Is it a form of occupational therapy?

People of all ages, starting at two years, find equine therapy to be a welcome alternative to physical or occupational therapy office visits that use a therapeutic ball or machines. No rider skills are taught. It offers an opportunity for complex motor learning, engaging the sensory and cognitive systems for the promotion of functional outcomes. It exists within a medical model of treatment, in which specialized therapists apply equine movement as a treatment tool. Because it is a medical treatment, these specialized therapists are able to diagnose and bill insurance for their services. 

Who is involved? 

Hippotherapy involves the hippotherapy horse, the horse handler, the therapist, and often side walkers (someone who walks next to the rider for physical support). There can also be a person sitting behind the rider helping with balance. Facilities often have wheelchair ramps for mounting and dismounting. 

How is it done?

Work is done in an enclosed area such as an arena. Helmets may or not be required for the rider. A consent and liability form will be signed by the client, parent, or legal guardian. Like any activity with a horse, there are risks involved. With a quiet, well-tempered horse and skilled people working with the person at a walk gait, the risks are quite low. 

How many sessions are usually involved?

The number of sessions will vary, given the needs of the person. Sessions are usually an hour, but this will vary on the level of tolerance of the person. For example, a young child with severe CP—who is lying on the horse without a saddle in various positions that focus on joint movement—may participate for less than an hour. 

What are the benefits of hippotherapy?

Children and adults who experience great discomfort trying to do prescribed movements in the physical therapist’s office are often much calmer and happier on a horse. Elements such as being outdoors and being moved by the gentle rocking motion of the horse’s walk, as well as the sensory experiences of smelling the animal, hearing the rhythmic steps underneath them, and touching their coat, all seem to contribute to this feeling of relaxation. Another element that often is not acknowledged is the impact equine therapy can have on whole families. People with the kinds of disabilities for which hippotherapy can be so helpful are often much more limited in the range of other activities they can participate in; the fact that they can enjoy this activity is often a great relief and source of joy and pride to their families. Family members often act as side walkers and engage with the horse handler and therapist around client care. 

How do I find a hippotherapist?

The American Hippotherapy Association is the professional agency that trains and certifies professionals to be able to practice this therapeutic tool. Local trained therapists can be found on their website: americanhippotherapyassociation.org/. 

Therapeutic Riding

This second type of equine therapy is an adaptation of traditional horseback riding, where a specific plan focused on contributing positively to their cognitive, physical, emotional, and social well-being is created for an individual with special needs. Although riding skills are not emphasized, the fundamentals of a balanced seat are important. 

What are the benefits of therapeutic riding?

It can offer positive emotional and psychological benefits to the rider, such as increasing self-esteem, emotional regulation, empathy building, focus, communication skills, and body awareness. Physical skills can improve in areas of coordination, endurance, muscle tone, balance, speech, and posture. 

Therapeutic riding has been beneficial for autism, Down Syndrome, mental health disorders, developmental delays and disabilities, learning disabilities, the deaf, Alzheimer’s or dementia, attention challenges, war veterans, and high-risk individuals. 

The horse is a mirror giving instant feedback to its rider. For example, anger or tension in the rider will make for an angry, tense horse that shakes its head and tail, pulls on reins, etc. The rider cannot ignore the feedback mechanism because he/she is intimately connected by sitting on the horse’s back and must think about their own safety. 

Likewise, as a rider relaxes, his horse also relaxes. Thus it is an excellent tool to show people how they affect their world, rather than being victims of it. By noticing the horse, a rider can see himself. Communicating with a horse calls for firmness, but not abuse, giving directives, proper timing, listening and feeling for the horse’s response, intuition, experiment, and risk. One can find it easier to explore and develop a relationship with a horse than with other humans and then use what they learn to improve their human relationships as well.

How old do you have to be to do therapeutic riding?

Therapeutic riding is used with people 4 years old and up, depending upon the requirements of the facility.

Who runs the sessions?

Sessions involve a trained riding instructor, a suitable horse, an arena, and if needed, volunteers to act as side walkers. 

Can someone in a wheelchair participate?

Facilities will have a ramp for mounting the horse from a wheelchair. 

Is it risky? 

The rider or legal guardian will sign a consent and liability form and the rider will wear a helmet, often provided by the facility. Although horseback riding itself is considered a high-risk sport, under these conditions, with high attention by the instructor and a quiet well-mannered horse, risk remains low. Work is often done at a walk gait learning how to maneuver walking over poles or simple geometric shapes in the arena, such as a half or full circle. Riding equipment is often Western style, yet English tack can also be used. 

How long does each session last?

Sessions are usually an hour in length and are done weekly or biweekly, depending upon the facility’s availability and the client’s finances.

How do I find a therapeutic riding instructor?

The Professional Association of Therapeutic Horsemanship International (PATH Intl.), pathintl.org/, certifies instructors and is a resource for finding a program in your area. PATH has developed a multitude of equine-related activities for therapeutic purposes, such as therapeutic carriage driving and interactive vaulting (gymnastics on horseback). 

The original organization was founded in 1969 as NARHA (North American Riding for the Handicapped Association). This type of equine therapy does not include a licensed mental health professional and therefore is generally not billable for insurance.

Equine-Assisted Psychotherapy 

This third type of equine therapy is a specialized form of psychotherapy that involves the clients and horse(s) interacting outdoors—sometimes they are accompanied by a trained psychotherapist, sometimes by a horse specialist, and sometimes by both a trained psychotherapist and a horse specialist. It is a non-riding experience that gives the clients moment-to-moment feedback about their own thoughts and moods, as well as how they are perceived by others. The clients are not talking about their experience; they are in the moment having the experience with the horse. This is what it makes it unique from more traditional forms of psychotherapy. 

It has been found that some people feel more comfortable opening up and engaging with a horse and receiving feedback from the horse, and that personal growth is achieved in a more effortless and often fun manner than would be possible otherwise. 

Who is this type good for?

This type of therapy is beneficial for individuals, couples, families, groups and businesses, agencies, and corporations. It is an excellent alternative to “talk therapy.” A wide variety of diagnoses and problems—such as addictions, PTSD, depression, anxiety, grief and loss, ADHD, social phobia, and relationship/communication challenges and problems—can benefit from this work. Pretty much any problem one would seek therapy for will benefit from this type of therapy.

What’s involved?

The professional will require consent and liability forms that include following safety directives around horses. Since it is a non-riding experience, helmets are not required. Sessions can run from 1 to 2 hours, depending upon the clinician, and often are held weekly or biweekly.

Will insurance reimburse the expense?

A licensed mental health therapist involved in the therapy can diagnose and bill insurance for this type of treatment. A horse specialist cannot bill insurance. When looking into this type of treatment, consumers should seek clarification as to the professionals involved and the insurance coverage. 

The Eagala Method

The Eagala (Equine Assisted Growth and Learning Association) organization, (https://www.eagala.org/index), is a worldwide network that trains and offers certification and is a clearinghouse for the horse professional and the mental health professional. Its roots began in ranch residential treatment for teens in the 1990s. Eagala is a subset of EAP/EAL (Equine Assisted Psychotherapy/Equine Assisted Learning) and consists of two trained people (a horse specialist and a mental health clinician) working as a team with the horse and client in an enclosed area.

Clients can range from 6 or 7 years old and up, with physical ability and overall health taken into consideration. Court-mandated clients often respond well to this form of treatment. No previous horse experience is needed or necessary. Variations of this work have evolved into Equine-Assisted Learning (EAL), Equine-Facilitated Learning (EFL), and Equine-Assisted Therapy (EAT). All involve one trained clinician, the horse, and the client, rather than two trained people, but may include two trained professionals. These variations are experiential and promote the development of life skills, leadership development, team building, personal growth and exploration, and executive coaching. 

The Process

The client meets outdoors with a horse or horses and one or two trained professionals (depending upon their training and the model used). The horses are loose in an enclosed area and are just being their natural selves without expectations. The client’s interaction with them and the skill of the professionals and their observations of the process is the backbone of the therapy. An example of an activity with a group or family might be for them to choose one horse to work with and then have them get the loose horse over a short jump without talking or touching the horse. The group will come up with a consequence if the rules are broken and everyone will do the consequence. The process they go through in the decision making and execution of the activity will mirror how they approach life and interact with each other in other settings. Plus, the experience of how the horse responds to the group gives them feedback on how they are perceived by others. 

Benefits of Equine Therapy

• Helps to build confidence, self-esteem, and bravery 

• Teaches and builds trust (in self and others) and empathy 

• Supports one’s ability to solve one’s own problems

• Increases thoughtfulness and reduces impulsivity

• Builds emotional awareness of self and others

• Builds assertiveness (as opposed to passivity or aggression)

Working with horses in this way is very effective and beneficial. Horses are prey animals, always on the lookout for their safety and well-being. Although we humans are predators, we experience ourselves as prey with each other. Because of this, horses reflect or give us a chance to see ourselves (behaviors and emotions) in a non-judgmental and unbiased relationship.

Because this is an in-the-moment experience, the client will not only remember the details of the activity and impact on self, but often find it very transformative. This therapy bypasses the intellectual process, the part of us that wants to understand, and gives us a meaningful experience that integrates flawlessly.

About the Author

Over the past 50 years, Esther Siegel has been a volunteer and practitioner of various equine therapies including hippotherapy, therapeutic vaulting, therapeutic riding, and equine-assisted psychotherapy. She has certification by EAGALA, volunteered as a Special Olympics coach for equestrians and for United Cerebral Palsy, and is a Board member for Patient Ponies for Special People. She has a minor in Equestrian Science from William Woods College and practices psychotherapy as a Marriage and Family therapist out of her home. She has a long history of teaching horseback riding to many hundreds of kids and doing summer horse camps. She has practiced equine assisted psychotherapy with groups, agencies, families, individuals, and couples at her home in northern California since 2002.