Patients with substance-use problems describe value of horse therapy

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Patients with substance-use problems have provided Scandinavian researchers with intimate insights of the value of horse-assisted therapy to their treatment.

Detailed interviews with eight patients being treated for substance use disorder indicated that the horse therapy they undertook helped build a positive self-image and provided important emotional support during treatment.

The study team says there is a continuous struggle to find treatment methods that motivate substance use disorder patients to remain in treatment long enough to bring about beneficial change.

The patients – four men and four women, all aged between 20 and 30 – were interviewed as part of an ongoing wider investigation of the impact of horse-assisted therapy for substance use disorder patients at an addiction treatment facility in Norway.

Five of the patients had no previous experience with horses.

A 2012 study found that horse therapy participants remained in treatment longer and were significantly more likely to complete treatment than those not participating.

These findings, together with an unreported pilot study, prompted further investigation into patients’ perspectives of horse-assisted therapy as part of their treatment.

The addiction facility where the study took place offered different levels of treatment and assessment to young adults aged 16 to 26 with problems related to substance use.

The researchers set out to learn more about the eight patients’ relationships with the horses and their perceptions of the consequences of that relationship.

“Participants’ own descriptions suggest that the horses were facilitators of a positive self-construct and provided important emotional support during treatment,” Ann Kern-Godal and her colleagues reported in the International Journal of Qualitative Studies on Health and Well-being.

Horse-assisted therapy can be defined as psychotherapy that in some way or another includes horses. Benefits are believed to be a result of the inherent characteristics of the horse, such as learning from its herd-based, cooperative behaviour to experience new forms of behaviour and feelings.

The horse is also claimed to be useful as a metaphor – non-judgmental and motivational; useful for building self-esteem, confidence, and mastery; and effective for building trust and attachment with both the horse and the therapist.

It has also been suggested that social interaction with the horse can shed light on human interactions and their meaning, as well as on possibilities for behaviour change.

The study team noted that recent reviews of literature on horse-assisted therapy, while cautiously optimistic, all drew attention to shortcomings, including the mixed diagnoses of client groups, and the need for improved methodology and theoretical analysis

The horse therapy used in the center’s program is a carefully planned part of patients’ overall treatment plan. It is provided as therapy and, while it might prove to be enjoyable, it is neither recreational riding nor instructional.

It is provided by experienced psychotherapists who are also qualified riding instructors and skilled horse handlers.

The activities were developed over some years. Participants work directly with the horses in grooming, feeding, riding, driving; and might undertake other stable activities, such as mucking out, moving hay or tack cleaning in cooperation with stable staff.

Three main themes emerged from the data collected in the interviews – the relationship with the horse, emotional effect, and mastery.

Words such as “‘happy”, “calm”,’ and “safe”’ were used frequently in descriptions of different perceptions of the relationship with the horse and/or its role in the therapy process.

All except one of the participants, who had participated in only one horse session, emphasized that their relationship with one or more of the horses was one of the most important characteristics of horse-assisted therapy, characterized as being “special and mutual”, “communicative”, and “like a friendship”.

Most participants said that they had a favourite horse, or that one horse meant more to them than the others. Several participants described their first meeting with their favourite horse as “choosing one another”.

Some talked of perceiving a special sense of togetherness or mutuality.

“I felt that he recognized me, and that we are good together, and we trust each other, both of us,” said one patient.

All but one participant described their interactions with the horses as involving a mutual, emotional relationship that was important to them and to their therapeutic process. Emphasis was placed on the horse appearing to understand and accept them without judgment.

“You don’t need to be popular to make the horse like you,” said one patient. “The horse accepts you, like, for who you are.”

A sense of special communication was common throughout patients’ descriptions of their relationship with the horse. Several mentioned that they talked to the horse and felt that the horse understood them.

The researchers noted: “This understanding was not necessarily expressed by the participants as the horse’s semantic understanding of what they said but as a possible understanding of their emotional state, and sometimes in contrast to human understanding.”

Most patients described the horse as being like a friend but mentioned that relating to the horses was different from relating to humans. This was described as part of the horses’ appeal.

“Physical contact, communication, and appearing to be unconditionally accepted by the horse were mentioned as illustrations of the differences between their relationships with humans and with horses,” the authors noted.

“They described the horses as animals with personality, but not necessarily a human personality. However, they used terms and expressions about human relationships when they talked about the horses.”

One patient commented: “We are friends, really good friends. I don’t know if I can use those words, but I feel … attached to them … Maybe [like] my girlfriend. The closest comparison I can think of.”

The key emotional effects linked to the horses included “feeling good”, “feeling tranquil”, and “feeling self-aware”.

These were often described in relation to each other, with some participants emphasizing that they had to turn their focus away from themselves and on to the horse.

The effect, they said, was similar, but in a positive way, to the effect of drugs. It enabled them to focus on something other than their personal problems.

Many participants also described being calmer with the horses, having a sense of tranquillity and security.

One patient commented: “When I go out riding, no matter which horse I ride, then I have time to sort my thoughts, in a calm way that doesn’t stress me out.”

One participant described the calming effect of the horses as being similar to the effect of medication on anxiety and depression.

“It’s because of [horse’s name] that I get rid of my anxiety,” the patient said. “My anxiety and uneasiness and depression. That’s, that’s the worst thing in my life. I have been through pretty tough times because of it. So that kind of disappears and eases up a lot when I’m with [horse’s name] or [horse’s name]. The horses mean a lot to me, because, in a way, they are the reason that I don’t get anxious.”

Another participant described how he was able to meditate when riding and compared it to listening to music, which was something special to him.

Participants also described better awareness of their own emotions and better body control as a result of their interaction with the horses. They described how the horses appeared to respond to their behaviour in a way that made their own behaviour easier to understand and regulate.

They said that by learning about how their own behaviour appeared to affect the horse, they recognized that it was possible and even manageable to change their own behaviour.

Most participants at some point used the word “mastery” or a similar term to describe aspects of their work with the horses. It was the most frequently mentioned therapeutic value arising from the relationship with the horse. However, their meanings of the word varied.

Some described a rewarding experience of managing an animal of such size, synonymous with “control”. Others emphasized succeeding in tasks through perceived cooperation with the horses, thus indicating a meaning of “achievement”. They also described how the human-horse relationship helped them overcome fear.

“All three meanings capture a sense of self-efficacy, success, and empowerment with the horse, with a task, with self,” the study team wrote.

They concluded: “These substance use disorder patients described their relationship with the horses and its therapeutic role as a genuine and positive reality. They indicated that the horse is experienced as being possibly more understanding than humans.

“As such the horses enabled them to explore issues and to recognize behavioural challenges in a way they described as safe, insightful, and pleasurable.

“If the horse lends a measure of pleasure and contributes to endurance in working with difficult themes, thereby contributing to therapeutic alliance, behaviour change, and retention in treatment, its contribution to substance use disorder is not insignificant.

“Its potential for contributing to positive post-treatment, on-going recovery, and relapse prevention should be further explored.

“The patients’ rich descriptions indicated that their relationship with the horses and the therapeutic implications of that relationship were important factors in their treatment process.

“The horses appeared to be facilitators of a positive self-construct and were an important emotional support during treatment.”

They continued: “The application of horse-assisted therapy as an adjunct therapy for substance user disorder and other psychological illness, including its possible contribution to positive post-treatment, on-going recovery, and relapse prevention in community-based settings, warrants further study.”

Contribution of the patienthorse relationship to substance use disorder treatment: Patients’ experiencesAnn Kern-Godall, Ida H. Brenna, Norunn Kogstad, Espen A Arnevik, Edle Ravndal
Int J Qualitative Stud Health Well-being 2016, 11: 31636 – http://dx.doi.org/10.3402/qhw.v11.31636

The full study, published under a Creative Commons License, can be read here

Related study 

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One thought on “Patients with substance-use problems describe value of horse therapy

  • June 14, 2016 at 5:27 am
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    I would like more info on horse theraphy idees to do with preskool kids

    Reply

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