Equine-Assisted Mental Health Ethical Issues
Animal-assisted therapy (AAT) is a growing field in the mental health profession. The therapy and research on equine-assisted therapy (EAT) remain in its early stages and few studies empirically support this modality. Notwithstanding, client’s treatment outcomes based on the approach remain promising. AAT is credited with providing physiological, physical, and psychological health benefits for both professionals and clients. EAT, a type of AAT, is increasingly gaining recognition globally as a useful treatment strategy for diverse client groups, especially adolescents. EAT is highly applicable to addressing diverse mental health and human development needs, such as behavioral issues, attention deficit disorder, depression, eating disorders, and substance abuse problems. It allows clients to learn more about themselves and others by engaging in activities with the horses, and subsequently processing their feelings, patterns, and behaviors. This paper provides a review of the literature on the emergent field of EAT and addresses the ethical issues revolving around it for professionals, animals, and clients. The paper concludes with calls for further efficacy research to ensure that EAT becomes a mainstream therapeutic modality and that the mental health profession’s ethical code of conduct incorporates guidelines for the protection of animal welfare and rights.
Keywords: animal-assisted therapy, equine-assisted therapy, experiential therapy, ethical issues
Equine-Assisted Mental Health Ethical Issues
For millennia, humans have utilized horses to meet their needs. In particular, people have forged a strong relationship with horses as a means of transportation, a beast of burden, or co-worker. Horses are viewed as symbolic icons, capable of bonding with people and influencing them through positive interactions. Both humans and horses can form a mutually rewarding dynamic relationship grounded in the psychological, emotional, and physical interactions. Horses possess a natural capability to mirror people’s behaviors. Furthermore, horses are not judgmental; therefore, they do not form expectations or prejudices against humans but react to the immediacy of the human intent and behavior. Moreover, horses can be incorporated for behavioral and mental treatment. Equine Assisted Therapy (EAT) can be employed to address a range of mental health and human development needs, including depression, anxiety, attention deficit disorder, behavioral issues, eating disorders, and substance abuse.
The practice of EAT is increasingly gaining traction across the world; however, the code of ethics and considerations governing the field appear to lag behind. The therapy involves the use of horses as co-workers. Thus, sound ethical standards are needed since the animals are reliant on humans for care and protection, and the potential for exploitation and abuse of the companion animals exists. This paper provides a review of the literature on the emergent field of EAT and addresses the ethical issues revolving around it for professionals, animals, and clients. Mental health professionals working with horses must observe and respect animal welfare and rights by ensuring that the horses are not treated in a demeaning, condescending, and disrespectful manner. In addition, clients must be made aware that EAT is essentially an experiential, complimentary therapy, which necessitates recognition of the dynamic interplay of all factors that contribute to or become risk factors for effective mental health interventions.
Animal-assisted therapy (AAT) has a rich and long history spanning thousands of years. Since ancient times, people have recognized the mental and physical healing benefits offered by animals. The first documented case on the use of AAT was in 1792 in England when farm animals were utilized as a component of the treatment process. In the course of the 19th century, companion animals became prevalent in European mental institutions. The use of animals in therapeutic settings became more pronounced in the mid-20th century, as the efficacy of the animal as a co-therapist became evident. The experiential movement of the 1970s gave fresh impetus to the adoption of EAT as a form of mental health therapy. EAT utilizes the horse as a catalyst for change, responds to diverse concerns, and employs various techniques and tools designed to deliver certain client goals.
AAT utilized in both individual and group counseling settings seeks to enhance the physical, emotional, mental, and social functioning of the client. Examples of AAT encompass canine-assisted therapy detailing the use of dogs, feline-assisted therapy involving the use of cats, and EAT detailing the use of horses and donkeys. AAT may be structured to respond to mental or physical health issues. Introducing animals as part of the treatment process helps to complement the therapeutic relationship between the client and the therapist.
Definition of Terms
AAT represents a goal-centered intervention where an animal that satisfies certain criteria forms an integral component of the treatment process. AAT involves purposely-trained professionals and animals working as co-therapists.
EAT incorporates the combined use of horses in which a licensed therapist and horse specialist work with clients to address diverse treatment goals. The behavior of the horse acts as a vehicle by which the therapist can teach the client coping skills. The model integrates with experiential therapies by valuing direct experience as the most crucial opportunity for change in the client.
AAT helps clients who may be reluctant to engage in conventional therapies or who manifest difficulties in trusting the therapist. EAT is an experiential intervention since it addresses both the developmental difficulties and the particular behaviors that interrupt clients’ lives. EAT details an interactive process where a licensed mental health professional working with equines and suitably credentialed trained professional pursue psychotherapy goals expressed by the clients and the therapist. Horses are highly sensitive to the client’ mood shifts. As such, they play the role of a biofeedback machine availing the client and the therapist with information.
The potent nature of the relationships between humans and animals has been documented broadly in the literature. On average, people with pets experience both physical and emotional benefits. According to Masini, spending time with pets tends to make individuals feel better, calmer, and happier. EAT helps therapists to decode clients’ reactions to horses’ behaviors. It also assists in illuminating clients’ thoughts and feelings even before the therapist and the client are aware of them. EAT facilitates the formation of a healthy relationship since the horses provide a wholesome, non-judgmental relationship. Furthermore, horses can reflect and respond to the body language, thoughts, and feelings of the client. Thus, the mental health professional can decode feelings and thoughts that the client has not been aware of or has been attempting to mask, including guilt, fear, anger, and feelings of inferiority.
EAT helps clients to derive a host of psychosocial benefits. For instance, it aids clients to cultivate healthy social skills through interactions with the horse. Moreover, EAT is held within a group setting, hence enabling clients to form positive social interactions, as well as empathy grounded in the connection built with the horse. EAT delivers positive influences on clients, including enhancement of self-esteem and self-efficacy, a decrease of depression, and enhancement of interpersonal communication.
AAT field has witnessed a phenomenal growth, judging by the number of professionals and organizations involved in the provision of the innovative therapy. However, the field still suffers from a lack of concrete theoretical and research base. Several theories can be applied to inform and enrich the theory and practice of AAT, including cognitive-behavioral therapy, behavioral therapy, Gestalt counseling, and person-centered counseling. EAT is an experiential approach because it employs direct experiences to foster change in the client.
The experiential perspectives heavily borrow from Gestalt theory where clients derive meaning from their individual interpretations of the immediate experience. Focus on the body language and interpretation strongly correlates with Gestalt techniques, which are essentially person-based and present-centered. Cognitive-behavioral therapy represents a therapeutic technique that concentrates on altering the client’s maladaptive or unhealthy beliefs, thoughts, and behaviors. Facing difficult emotions enables clients to self-monitor and comprehend why they react to certain emotions in a particular way. Person-centered approaches are integrated into EAT sessions owing to their focus on the healing properties inherent in supportive, safe, and non-judgmental relationships. Horse responses to non-verbal cues are immediate, concise, and consistent in nature, providing the mirror echoing the client behaviors.
Ethical Issues and Considerations for Professionals, Horses, and Clients
Ethical issues must be taken into account when working with therapy or companion animals. First, the therapists practicing EAT must follow the ethical codes and standards of practice required in their profession. However, it is essential to highlight that the ethical codes and standards presently do not directly address AAT. Some of the unacceptable professional conduct that therapists should avoid includes the breach of client confidentiality, any form of abuse or harassment of animals or clients, and the misrepresentation of practice credentials or qualifications.
Considerations about the Therapist: Training and Credentialing
Therapists working with horses must undertake adequate training and certification. The majority of the professionals practicing EAT can choose to be credentialed by one or more associations that give training and certification in this field. Some relevant associations for professionals working with horses include the Professional Association of Therapeutic Horsemanship International and the Equine Assisted Growth and Learning Association. Both organizations are globally renowned for the utilization of equines in therapy to support human development and mental health needs. Some fundamental moral principles that shape the foundation of ethical functioning by EAP professionals include beneficence, veracity, nonmaleficence, autonomy, and fidelity.
The Equine Assisted Growth and Learning Association certification model demands a co-facilitating team comprising an equine specialist and mental health professional. To foster change, communication between the client and the horse is crucial and must be interpreted by the therapist or the equine specialist. The therapist is expected to highlight crucial insights and inferences that enrich the therapeutic experience. The horses also bring their experiences and behaviors into the therapeutic setting; therefore, the therapist should possess a broad knowledge of the animal behaviors to decode them and give the client feedback.
Considerations about the Horse: Health and Welfare
The prevailing perspective of the use of animal-assisted interventions is largely human-centered detailing “what animals can offer to clients”. However, minimal attention is paid to what the interventions may be doing to the horses. As such, is essential to track closely the length and number of sessions to ensure that they are not stressful for the horses. Horses working as co-therapists may face possible exploitation or abuse. Although, a majority of the programs manifests a benign influence on the animals, sometimes, there are troubling examples where animals are subject to harm. Some animals suffer from excessive feeding accompanied by too little exercise, which leads to the premature death.
The human use of the horses in the therapy sessions should not in any way inflict fear, pain, or harm to the horse or in some way prevent the horse from meeting its needs and goals. Therapists and equine specialist carry the responsibility to ensure that all elements of the animal’s well-being, such as disease prevention and treatment, housing, handling, and humane euthanasia, are provided where necessary. Animal inoculations and parasite control are necessary to ensure that the companion animal remains healthy. Finally, zoonotic infections should be taken into consideration to guarantee that neither the client nor the animal sustains harm.
It is pertinent to take into account the suitability of the animal to ensure that the client is comfortable with the animal since the lack of interest in the animal may detract the client from the experience, which in turn undermines the success of the intervention. The equine must be intentionally involved to guarantee that the participation meaningfully contributes to client’s treatment goals. As such, it is essential to ensure that the horses are adequately trained in the capacity they are expected to function to make sure that they feel confident and safe. In the same way that therapists are susceptible to burnout, horses equally experience burnout or fatigue, which necessitates that those working with therapy horses guard against fatigue.
Considerations about Therapy Space
Environmental distractions coupled with the predictability of the client’s behavior can present problems to the therapist, especially in an outdoor setting. The therapist should take into account the client’s capacity to tolerate distraction and should consider alternative approaches to aid the client. The manner in which the animal interacts with the client within a certain environment mirrors the animal’s comfort level, which necessitates that the therapist should be equipped with skills to recognize the nuanced behavior. People who have a history of animal phobia or allergies to animals may be unsuitable for EAT. Similarly, clients who have a history of animal abuse may be unsuitable for EAT, which calls for screening prior to the utilization of AAT.
Considerations about Diversity
The clients’ worldview mirrors and influences their interaction with and understanding of animals, as well as how the client regards the animal as the co-therapist. In most cases, the client’s physical and emotional response to a certain species of animals hinges on the previous direct and indirect experiences with the species coupled with client’s desires, beliefs, and fears. Sometimes, the client’s worldview may impede rather than foster rapport building and may compromise the safety or mental well-being of the animal. It is essential to take into account the worldview of the client since it may build or fracture the therapeutic relationship between the animal and the client.
It is crucial to appreciate that animals have needs also. Thus, professionals working with animals must guard against conflict of interests, which manifests when the human use inflicts fear, pain, or harm or otherwise undercuts the capacity of the animal to satisfy its needs. The challenge of working with horses lies in balancing the needs of clients and animals. The professionals working with animals ought to plan to satisfy the individual animal’s needs, including exercise, diet, relaxation, and stimulation. In addition, therapists should be wary not to humanize animals because such an action robs the animals the very essence of what makes them therapeutic co-workers. Considering the differences in individual and cultural attitudes towards animals, mental health professionals working with them should utilize EAT in a manner that is culturally sensitive by taking into account the racial, ethnic, cultural, and other individual differences.
Conclusion and Recommendations
EAT represents a therapeutic model in which horses form an integral component of the therapeutic process. The success of EAT demands that the therapist should not consider animals as “tools” but rather as valuable partners in the mutually respectful, professional relationship. As such, the needs of the animal should always be considered, embraced, and balanced with those of the clients. It is also pertinent to take into account the welfare and safety of the animal, especially the experience that the horse will have in its capacity as a therapy animal. Both the client and the equine should be meticulously evaluated before involvement in EAT sessions since clients who possess a history of animal abuse may be unsuitable candidates for the intervention. Similarly, if the horse is unsafe, the therapy session may be ineffective and may invite setbacks in treatment. Finally, the therapist should be aware of the possible medical conditions that may present a safety hazard to both the client and the horse.
In the future, efficacy research in the field will be necessary to the establishment of EAT as a legitimate therapeutic modality. The growing significance of EAT as a complementary intervention requires that therapists continue to examine the usefulness of EAT and highlight the underpinning constructs that contribute to its efficacy. Stakeholders in the profession should pursue change at the societal, institutional, group, and individual levels to enhance the welfare and quality of life of the therapy animals. Professionals in this field should know when to practice EAT given that some clients are unsuitable candidates for this form of intervention and some animals are equally unsuitable to work as therapy animals.