RICHMOND, Mass. — It’s so cold that pigeons have sought refuge in the barn; they flutter and coo in the rafters. Chunks of ice lie by a water trough with no hope of thawing. And in the center of the arena, six teens wearing thick winter coats jam gloved hands into jean pockets, trying to stay warm, but failing.
Nonetheless, the therapist is in and ready to work.
He approaches one of the boys, looks at him intently, and with no thought of propriety, licks him on the cheek. "Ah, thank you," the teenager says, and turns to his companions with a grin. “I got horse snot all over me,” he says.
Welcome to equine-assisted psychotherapy at Berkshire HorseWorks, where people tackle their mental-health issues by getting up close and personal with thousand-pound hairy beasts with whiskers.
It’s an unusual way of dealing with depression, anxiety or post-traumatic stress disorder, so unusual that some insurance companies balk at paying for it, and some critics charge that there's scant evidence that it works. But the therapy is so popular that more than 700 programs worldwide have specialists certified through the Equine Assisted Growth and Learning Association, started by a Utah mom nearly 18 years ago.
As prey animals, horses are keenly attentive to non-verbal behavior and emotional states; this sensitivity helps keep them alive in the wild and allows them to act as mirrors to people in therapy. Horses also provide novelty that can attract people who need mental-health treatment but resist getting counseling in an office, proponents say.
“Horses have extra benefit because they’re large. They can’t be pushed around or bullied or told what to do. You have to work with them; you have to figure out a way to develop a relationship with them. And so much of our life issues are about relationships, whether with others or with ourselves," said Lynn Thomas, the Utah mother who co-founded EAGALA in 1999 and serves as the nonprofit's chief executive officer.
Clients include the special-needs students who recently gathered at Berkshire HorseWorks, a few miles from the Massachusetts-New York border, and residents at Copper Hills Youth Center in West Jordan, Utah, who have been getting psychiatric help from horses in South Jordan for five years.
In Massachusetts, horses helped people traumatized by the Boston Marathon bombing; in Connecticut, they have nuzzled children recovering from the Sandy Hook school massacre. At hundreds of other programs in the U.S., they help individuals and families deal with a wide range of mental-health issues, including ADHD and eating disorders. They even assist with couples therapy.
But although trained counselors and equine specialists are there to guide the session, the real work is done by the clients, who learn about themselves by interacting with the horse, Thomas said.
“We’re not there to be the experts; we believe our clients have the best solutions for themselves when given the opportunity to discover them. We provide the space where they find what they need to do, the changes they can make,” she said.
Boots on the ground
According to government statistics, about one in five Americans suffer from some form of mental illness, yet only 40 percent of them receive treatment. Equine-assisted therapy can get some people into treatment who wouldn’t otherwise agree to sit around talking about their feelings in an office, Thomas said.
Unlike therapeutic riding, also known as hippotherapy, equine-assisted psychotherapy is done on the ground. Participants build a relationship with one or more horses in an enclosed space, at first just getting comfortable standing near them, then progressing to touching the horse, walking with it, putting a halter on, brushing the horse, and doing other activities with it. During the interaction, the person in therapy is making observations about the horse’s behavior, or their own, and how it relates to their problems.
They are typically accompanied by two other people: a mental-health professional and an equine specialist, both of whom have to be certified through EAGALA to be part of that program.
One key part of EAGALA training is that participants don’t learn the horses’ names. Instead, they are encouraged to "name" their horse to enhance their personal connection.
This is why, at Berkshire HorseWorks, the group of special-needs students recently named their therapy horses Tiny, Moonlight and Snowball. (Their real names are 007, Zephyr and Pumpkin.) The group, which included a girl who has made several suicide attempts and a transgender boy who has trouble communicating, approached the horses awkwardly at first, but warmed up within a few minutes, not only to the horses, but to each other.
The leader, Hayley Sumner, is a former public-relations strategist who left marketing to get a master's degree in social work and become certified in equine therapy. At this session on St. Patrick's Day, she invited the students to identify observations about their horse (for example, one had a white stripe on his face) and to contrast them with their perceptions (a horse is standing to the side; he could be annoyed, or just sleepy). Watch out for perceptions, Sumner told the students, for they can be faulty.
Watching their students walk around the arena, sometimes using a tennis ball or hula hoop to interact with the horses, the teachers whispered to each other incredulously.
"This is a whole different side of Christopher," one teacher said. "I can't believe how he's come out of his shell," another agreed.
The students, who will return for five more sessions funded in part by a grant from a community foundation, were surprisingly confident around the horses, Sumner said, more so than the inmates serving time for assault and battery who had come the previous day.
Prisoners, she said, are often scared of the horses. "We had one man who was serving time for assault and battery, and he was 6 foot 5 and terrified," she said.
The animals' size is, in part, what makes them so effective in ways that other therapy animals, such as dogs, can't match. Meeting 1,500 pounds of fear in the eye, and overcoming it, helps many people with insecurity and fear and leads to other breakthroughs in mental health, said Jolene Green, a licensed clinical social worker and EAGALA-certified therapist in South Jordan, Utah.
A client's fear, however, is not always baseless.
While EAGALA therapists and equine specialists choose horses without serious behavioral issues, any horse can spook over something as simple as a plastic bag rustling nearby, and horses can react unpredictably to the temperament and behavior of the people around them.
“It’s fascinating when I get a dangerous person in the arena. My alpha (dominant horse), he’s got a protective heart, and if a sociopath walks in the room, I can’t guarantee their safety,” Green said.
“You can’t guarantee it; they’re horses.”
As such, not everyone is a candidate for equine therapy; counselors make that decision on a case-by-case basis. And insurance companies vary in whether they will cover the treatment. While Green said most of her clients' sessions have been reimbursed in full, some insurers consider it experimental treatment and won't pay. Others pay the cost of an office visit, and clients cover the difference.
The outside of a horse
Former President Ronald Reagan wasn’t the first to say it, but he popularized a memorable phrase about how horses help improve mental health: “There’s nothing so good for the inside of a man as the outside of a horse,” he said.
Autumn, who did not want to give her last name because of the personal nature of her therapy, is a 33-year-old client of Green's who is working on feelings of low self-esteem and fearfulness caused by a difficult childhood. Although she has ridden horses before, she said that communicating with horses at eye level on the ground is an entirely different experience, one that has helped her enormously.
“I have a hard time opening up and getting close to people. But there’s something incredible about the connection I have with the horse, which makes no judgments,” she said. “I’ve never connected with a horse the way I do now.”
Autumn named “her” horse “Brave” to help remember what she wants to be. “He reminds me a little bit of myself, cautious but curious,” she said.
In equine-assisted therapy, horses unwittingly sometimes participate in role-playing. Autumn said in one of her earliest sessions, she named two horses for people who had treated her badly in the past. "I sat on a pallet with my back to them and just cried," she said.
That's a typical part of the EAGALA experience, seeing not only themselves, but other people in the horses, said Thomas, the nonprofit's co-founder. "Horses can become symbolic characters in a client's life story."
Thomas, who lives in Santaquin, Utah, was the director of a residential treatment program in southern Utah before she had twins in 1997 and then another baby 18 months later. She stopped working for a while to be a full-time mother, but then, intrigued by the early successes of horses used in therapy, thought she'd work from home to start a certification program. Within a year, it had become a full-time job.
“To have it go global like it did has been an amazing journey. And it’s been an amazing opportunity to provide another niche for horses, especially horses that aren’t competitive or aren’t good for riding.
“I still would not call myself an equine specialist, but I have a deep respect for them, and I’m in awe of how they can change people’s lives," she said.
EAGALA, which has more than 4,500 members in 50 countries, held its annual conference in Denver March 21-24, with renowned animal-rights proponent Temple Grandin as the keynote speaker. Grandin, who overcame severe autism to become a leading designer of livestock facilities and an international spokeswoman for autistic people, teaches at Colorado State University, where an equine-therapy research and education center is named for her.
Although much of her work has been on behalf of cattle, Grandin said, "horses were basically my salvation."
Body and mind
EAGALA is not the only group that certifies practitioners of equine-assisted psychotherapy. Others include PATH International (Professional Association of Therapeutic Horsemanship International); CBEIP (Certification Board for Equine Interaction Professionals); and the O.K. Corrall Series in Reno, Nevada, run by Greg Kersten, a co-founder of EAGALA.
The groups benefit from anecdotal success stories, but so far do not have a large and affirmative body of research behind their work that might win over skeptics like Michael Anestis, a psychology professor and chairman of clinical admissions at the University of Southern Mississippi.
Anestis is the lead author of a study published in the Journal of Clinical Psychology in 2014 that challenged the conclusions of research done on the therapy and said there is no compelling evidence that equine-assisted therapy is more beneficial than the passage of time.
"Equine proponents make a lot of strong claims, but lives are at stake here and the data simply do not support their contentions," Anestis said in an email.
"Maybe studies will support that at some point — I'm skeptical on this point — but until then it is not ethical to promote this treatment as it currently is in so many places. We would never stand for this behavior in the treatment of cancer, and mental illness is no less important," he said.
A representative of the American Psychological Association said that group had no comment on the practice.
Most published studies involve a small number of participants, a factor that some researchers believe discredits them. At least 11 studies have shown improvement in social functioning and motor function among children with varying degrees of autism, however. There have also been a handful of studies specifically on the EAGALA method that show improvement in patients who have demonstrated violent behavior or who have been sexually abused.
Allysa Beers, a recreation therapist at Copper Hills Youth Center, says she has observed the program’s successes with teenagers who are struggling with various kinds of mental illness. The center has sent residents to Green’s farm for therapy for nearly five years.
Beers recalls that one girl, who was noncommunicative, began a two-week session by breaking down in tears when she was asked to put a halter on the horse because she didn't know how to do it and couldn’t bring herself to ask for help.
“By the last session, when she was asked to create an obstacle course for her horse to go through, she started talking it out with her horse. Jolene and I were watching her with amazement; it was the opposite of what we had seen two weeks before,” Beers said.
Green said one of her most memorable clients was a man who did 10 therapy sessions without speaking. Afterwards, he called and asked if he could return with his wife, and when the couple came, the wife said her husband was a veteran with PTSD who had returned from service abusive and angry. After the therapy, she said, "He said, 'I had forgotten what it was to be human; the horses reminded me.'"
Then there’s a story recounted in a book about EAGALA therapy, about the corporate group that came in for team building and weren’t progressing until the horse put its mouth on the supervisor’s head and pulled off her hair.
It was a wig, and it turned out that the supervisor had not told her team she was in treatment for cancer. With the revelation, the team was able to grow closer.
In that case, and others, the physicality of a therapy session with horses can result in outcomes not possible by sitting in an office talking, Green said.
“We are learning that trauma is held in both the body and the brain, and just talking is not always an effective approach. It’s got to involve something using both our body and our mind: physical, mental, emotional, spiritual,” she said.