Atlas›Domain XV · Nature, philosophy, social & rites of passage›Guide 032
Guide XV-032

Equine-assisted psychotherapy and learning

A 26 · L 50 · M 2422 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Eagala Model (ground-based, two-person team of licensed mental health professional and equine specialist) as Eagala publishes it, with the PATH Intl. Equine Specialist in Mental Health and Learning (ESMHL) role (2026 candidate handbook), US consensus terminology for equine-assisted services (PATH Intl. optimal-terminology page), and the IAHAIO White Paper (2018 update) for definitions and animal welfare. Natural Lifemanship (Trauma-Focused Equine Assisted Psychotherapy) is noted as a distinct relational model where it differs.

Equine-assisted psychotherapy (EAP) is not a separate psychotherapy with its own theory of change. It is a setting and a set of practices in which a licensed mental health professional, working within their own scope of practice, incorporates horses into psychotherapy or counselling. US consensus terminology treats psychotherapy and counselling that incorporate horses as therapies delivered by licensed professionals, and treats equine-assisted learning (in education, organisations or personal development) as a separate, non-therapy service offered by specially trained or certified professionals [source: PATH Intl., Optimal Terminology; consensus document in The Journal of Alternative and Complementary Medicine, DOI 10.1089/acm.2020.0415]. The umbrella term recommended is "equine-assisted services"; the American Hippotherapy Association calls "equine therapy" and "horse therapy" incorrect terms [source: PATH Intl. Optimal Terminology; AHA, What is Hippotherapy]. Hippotherapy is a different thing: a treatment tool using equine movement, delivered only by licensed or credentialed physical therapists, occupational therapists and speech-language pathologists within their own services, not by psychotherapists [source: AHA].

Core idea of change, as the model holders state it. Eagala describes horses as active, responsive partners rather than tools; because sessions are unmounted and the horses are free to move, their responses (approaching, avoiding, setting boundaries) become material the client works with. Facilitators avoid directing clients or interpreting their experience, so clients make their own meaning, and clients' life stories are said to unfold metaphorically in the arena [source: Eagala, What is the Eagala model?; Eagala, Model page]. Eagala describes the approach as solution-oriented, holding that clients have the insight to find their own solutions [source: Eagala blog, Eagala or PATH]. Natural Lifemanship, by contrast, frames change as building a connected, attuned relationship with the horse through principles of choice, attachment and detachment, and pressure and release, grounded in a bottom-up, regulation-first reading of trauma neurobiology (drawing on Perry and on polyvagal-informed state cues) [source: Natural Lifemanship conference presentation, UWSP 2020, citing Jobe, Shultz-Jobe and McFarland 2016]. These change mechanisms are the models' own accounts; they are attributed, not established [synthesis].

2. Framework

EAP is a model and a set of standards rather than a manualised protocol; the published sources give no fixed phase sequence, session count or session length [uncertain: not verified]. Eagala calls its model "both a set of standards and a facilitation style" [source: Eagala, Model page]. The structure below is the working sequence a psychotherapist follows; elements not in sources are marked.

Roles and format (sourced).

  • Team: a licensed mental health professional (MH) responsible for the client's emotional process and psychological safety, and an equine specialist (ES) responsible for observing horse behaviour and managing physical safety; each keeps their own professional boundaries [source: Eagala, What is the Eagala model?].
  • Setting: arena or pasture; exclusively ground-based, no riding, no lead ropes in the Eagala Model; horses free to move [source: Eagala].
  • PATH Intl.'s ESMHL is the equine expert "before, during and after" equine/human interactions in unmounted mental-health and learning sessions; selects and assesses horses, watches their responses, helps tailor sessions safely, advocates for the horse and stops any activity that compromises its wellbeing. The ESMHL does not provide therapy, teach riding or facilitate life-skills learning [source: PATH Intl. ESMHL Candidate Handbook 2026].
  • Formats: individual, family and group sessions are all described in practice; a 2025 multi-site observational evaluation of the Eagala Model with veterans (107 participants, 12 sites) is the main recent programme evaluation [source: centreforevidence.org summary of Marchand et al. 2025, IJERPH, DOI 10.3390/ijerph22101557]. Session counts and durations used there [uncertain: not verified].

Working phases [synthesis, built on the sourced roles above].

  1. Referral and suitability: is EAP indicated for this client, and is it within your licence, training and insurance? Goals: decide fit; screen medical, allergy, phobia, trauma-with-animals and immune-status risks (IAHAIO asks professionals to screen for allergies and risk factors and apply exclusion criteria, e.g. for immunosuppressed people) [source: IAHAIO 2018]. Move on when the client consents to the specific setting and risks and the team has agreed roles.
  2. Preparation and contracting: informed consent covering horses, outdoors, confidentiality in a shared setting, touch, the right to stop, weather plans and photography; treatment goals written in the usual clinical way. Move on when consent is documented and the client knows what will and will not happen.
  3. Orientation sessions: safety briefing by the ES, first observation of the herd, low-demand contact. Move on when the client can stay regulated enough near horses to engage with a task.
  4. Working sessions: activity or open time in the arena, observation by both facilitators, processing in the arena and after. Move on (or change the plan) based on progress toward the clinical goals, not horse "performance".
  5. Integration and ending: transferring what happened in the arena to the client's life; planned goodbye to the horses; aftercare and referral back to office-based therapy or other services as needed.

Criteria for moving between phases are clinical judgement, documented progress (IAHAIO's definition of animal-assisted therapy requires documented progress) and the ES's view of horse readiness [source: IAHAIO 2018; synthesis].

3. Guiding principles

  • Therapy stays within your scope. IAHAIO requires animal-assisted therapy to be delivered or directed by a formally trained professional with active licensure, working within the scope of their practice [source: IAHAIO 2018]. Practical meaning: the horse does not make an unlicensed person a therapist, and an EAP certificate does not extend your licence.
  • Two professionals, two jobs. MH holds emotional and psychological safety; ES holds horse behaviour and physical safety [source: Eagala]. Practical meaning: agree before each session who calls a stop for which reason, and never let the MH also act as horse handler unless separately qualified [synthesis].
  • Ground-based and free-moving. No riding; horses free to move and respond [source: Eagala]. Practical meaning: design activities that leave the horse a choice, and treat a horse walking away as information, not failure.
  • Horses are partners, not tools or props. [source: Eagala; IAHAIO: animals are living beings, not tools]. Practical meaning: no activity whose purpose is to make the horse do something it is resisting.
  • Client makes the meaning. Facilitators avoid directing and avoid unnecessary interpretation and judgement [source: Eagala]. Practical meaning: describe what you saw, ask what it means to the client; do not tell them what the horse "was saying".
  • Solution-oriented. Clients are held to have the insight to find their own solutions [source: Eagala blog]. Practical meaning: let the client design and revise their approach to a task before offering suggestions.
  • Metaphor is the client's. Eagala describes clients' stories unfolding metaphorically with horses [source: Eagala Model page]. Practical meaning: use the client's names and labels for horses and objects; do not import your own symbolism.
  • Animal welfare is non-negotiable. Only animals in good physical and emotional health that enjoy the work should take part; handlers must know each animal, recognise discomfort and stress, give rest, water and safe surfaces, keep sessions time-limited and prohibit straining activities [source: IAHAIO 2018]. Practical meaning: the ES's "stop" for the horse ends the activity, no discussion in the moment.
  • Watch the horse for consent and stress. Stress signs include ears pinned or stiffly back, tension around the eye, strained mouth and nostrils, high or swishing tail, head toss, pawing, bite or kick threats; a quiet, tolerant horse may still be stressed [source: Matlock, Equine Stress Behaviour slides, AHA]. Practical meaning: "compliant" is not "consenting".
  • One Health and One Welfare. Human, animal and environmental health are linked [source: IAHAIO 2018]. Practical meaning: plan for the horse's and the client's wellbeing together, from programme design onward.
  • Infection control is part of the clinical plan. Screen for allergies, immune compromise and other risk factors; prevent zoonoses [source: IAHAIO 2018; Dalton et al. 2020]. Practical meaning: hand-washing facilities and an exclusion conversation are set up before the first session.
  • Regulation before insight (Natural Lifemanship version). Change is sought bottom-up through regulation and connection; safety, choice, connection and regulation are named as the components of healthy relationships [source: NL presentation]. Practical meaning: if the client is dysregulated, pause the task and work on regulation first.
  • Confidentiality is harder outdoors. Eagala facilitators "embrace confidentiality" [source: Eagala Model page]. Practical meaning: farms have staff, volunteers, neighbours and other clients; contract for being seen, and agree who else is present [synthesis].
  • Touch with consent. Touch (of horse or, rarely, of client for safety) needs consent before and during, a right to stop, and is never sexual [synthesis]. Practical meaning: tell the client in advance when the ES might need to physically guide them away from a horse for safety.
  • Dual roles are managed, not ignored. Where one clinician is both MH and ES, or also owns the horses and the farm, the APA Ethics Code Standard 3.05 on multiple relationships applies (APA Ethics Code); other ethics points here are [synthesis]. Practical meaning: write down which role you are in, and keep the separate ES model unless you have a documented reason not to.

4. Intervention inventory

The published model holders describe standards, roles and a facilitation stance more than a catalogue of named exercises; Eagala's fuller exercise and observation material is taught in its in-person Fundamentals Training and is not published openly [uncertain: not verified]. The inventory below therefore combines the sourced practices with therapist-side procedures (screening, preparation, debriefing, collaboration), marked [synthesis] where no published source gives the steps.

4.1 Suitability and risk screening

  • Purpose: decide whether EAP is indicated and safe for this client before any farm visit.
  • Steps: (1) Clinical indication: what goal would horses serve that office-based therapy does not (e.g. low engagement with talk therapy, which Eagala names as a reason clients choose it) [source: Eagala]. (2) Medical and infection screen: allergies (horse dander, hay, pollen), asthma, immune compromise, pregnancy, mobility and balance, open wounds; IAHAIO asks for allergy and risk-factor screening and exclusion criteria such as immunosuppression [source: IAHAIO 2018]. (3) Animal history: fear or phobia of horses or large animals, prior bites, kicks or falls, animal cruelty perpetrated or witnessed, abuse that involved animals or farms. (4) Behavioural risk: impulsivity, aggression, self-harm risk outdoors, substance use on the day. (5) Practical: travel, cost, accessibility of the site (ground surfaces, toilets, shade) [synthesis for 3 to 5]. (6) Decide: proceed, proceed with adaptations (e.g. observation from outside the fence first), or decline and refer.
  • Example language (illustrative): "Before we think about working with horses, I need to ask about your health, any allergies, and any experiences you've had with animals, good or bad."
  • Watch for: a client who wants EAP mainly to avoid talking; undisclosed fear masked as enthusiasm; caregivers pushing a young person into it. Working when the client can name a goal and the risks have answers.

4.2 Informed consent and contracting for the outdoor setting

  • Purpose: make consent specific to horses, outdoors and a shared site.
  • Steps: (1) Explain the team (MH and ES), what each does, and that the ES can stop an activity for safety or horse welfare [source: Eagala; PATH ESMHL]. (2) Explain unmounted work, no riding (Eagala) [source: Eagala]. (3) Risks named qualitatively: being stepped on, knocked, kicked or bitten, falls on uneven ground, weather, ticks and insects, allergy, zoonoses [synthesis; zoonoses: Dalton et al. 2020]. (4) Confidentiality limits: other people on site, being seen arriving, photography and social media (no photos without separate written consent). (5) Touch: consent to touching horses is the client's choice; tell them the ES may physically guide them for safety and ask now whether that is acceptable. (6) Weather and cancellation plan; indoor fallback. (7) Right to stop at any time without penalty. (8) For minors: guardian consent plus the young person's own assent, revisited each session [synthesis for 3 to 8]. (9) Confirm the programme's insurance and liability waiver in its own words; your own professional liability cover for this setting is your responsibility to check with your insurer [synthesis].
  • Example language (illustrative): "You can say stop at any point, and so can the equine specialist, if she sees something that isn't safe for you or for the horse."
  • Watch for: consent signed without questions; a young person who says yes only in front of a parent. Working when the client can repeat back the key safety points and the stop rule.

4.3 Team pre-session planning (MH and ES)

  • Purpose: align clinical goals, horse selection and safety roles before the client arrives.
  • Steps: (1) MH shares only what the ES needs to know (goal, safety-relevant history) with the client's consent [synthesis]. (2) ES selects horses for physical and mental/emotional suitability and reports their current state [source: PATH ESMHL]. (3) Agree the activity or open format, the arena set-up, the stop signal and who says it, and where each facilitator will stand. (4) Agree how to handle a horse stress signal mid-session (ES calls it; MH holds the client) [synthesis].
  • Example language (illustrative, MH to ES): "Her goal is noticing when she overrides her own discomfort. If a horse shows stress, call it plainly and I'll help her with what comes up."
  • Watch for: the ES being drawn into interpreting the client's psychology; the MH making horse-handling calls. Working when each person can state their role in one sentence.

4.4 Safety orientation and first meeting with the herd

  • Purpose: give the client the physical-safety frame and a low-demand first contact.
  • Steps: (1) ES gives the site safety briefing (where to stand, gates, footwear, not walking directly behind a horse, what to do if a horse moves suddenly) per the programme's own rules [synthesis; follow the facility's published procedures]. (2) Client observes the herd from outside the fence or at the arena edge. (3) Invite the client to notice and describe what the horses are doing, without needing to approach. (4) Approach only if and when the client chooses.
  • Example language (illustrative): "For now there's nothing to do except watch. What do you notice about them? What do you notice in yourself as you watch?"
  • Watch for: freeze or hyperarousal near large animals; a client rushing in to prove they are not afraid. Working when the client can stay present and describe both horse and self.

4.5 Open (unstructured) time with the horses

  • Purpose: let the client engage however they choose, so their own patterns of approach, avoidance and relating appear. Eagala describes clients entering the arena either with a task or simply engaging with the horses however they choose [source: Eagala].
  • Steps: (1) Brief instruction only: the client may spend the time with the horses in any way that is safe. (2) Both facilitators step back and observe: MH tracks the client's process, ES tracks horses and safety [source: Eagala roles]. (3) No coaching or interpretation during the activity. (4) Close with processing (4.8).
  • Example language (illustrative): "Spend some time in the arena with the horses, however you'd like. We'll be here."
  • Watch for: the client looking to you for the 'right' answer (note it, return the choice to them); a horse repeatedly moving away (ES checks for stress before it is treated as relational material). Working when the client starts to act on their own choices and can talk about them.

4.6 Task-based activity

  • Purpose: give a goal (e.g. move a horse to a place, build something with arena objects and invite a horse into it) so that the client's ways of planning, persisting, asking for help and handling frustration become visible. Eagala names entering with a task or goal, and treats avoiding, approaching, struggling and succeeding as part of the process [source: Eagala].
  • Steps: (1) Agree the task with the ES (safe for these horses, no lead ropes in the Eagala Model) [source: Eagala]. (2) State the task briefly, with as few rules as safety allows, so the client must make decisions. (3) Observe without directing. (4) Pause if safety or welfare requires. (5) Process (4.8).
  • Example language (illustrative): "The task is to get one of the horses into the area you've marked out. You can't use ropes. Take as long as you need."
  • Watch for: the task turning into a contest with the horse; repeated force or pursuit (ES stops it per welfare rules) [source: IAHAIO; PATH ESMHL]. Working when the client notices and changes their own approach.

4.7 Dual observation of client and horse

  • Purpose: collect the session's raw material: what the client did, what the horses did, and what changed. Eagala's ES observes horse behaviour while the MH observes the client's emotional process [source: Eagala]. Eagala training teaches a structured observation method whose content is not published openly [uncertain: not verified].
  • Steps: (1) Each facilitator notes specific, observable events (who moved, when, what happened just before). (2) Note changes from the client's usual pattern and moments where the client's words and actions do not match [synthesis]. (3) ES separately notes horse stress or discomfort signs [source: Matlock, AHA]. (4) Share observations with the client as descriptions, not conclusions.
  • Example language (illustrative): "I noticed the grey horse walked off just after you went quiet. What was happening for you then?"
  • Watch for: observations that are really interpretations ('he didn't trust you'). Working when the client starts to bring their own observations.

4.8 Non-interpretive processing in the arena

  • Purpose: help the client make their own meaning of the activity. Eagala facilitators avoid directing clients or interpreting their experience, and avoid unnecessary interpretation and judgement [source: Eagala].
  • Steps: (1) Start with what happened, in the client's words. (2) Offer the team's observations neutrally (4.7). (3) Ask what it was like, what it reminds them of, what they would do differently. (4) Use the client's own words for horses and objects. (5) Do not explain the horse's 'message'.
  • Example language (illustrative): "What just happened out there? ... And what was that like for you?"
  • Watch for: the client seeking your verdict; you slipping into telling them what it meant. Working when the client links the arena event to their life unprompted.

4.9 Working with the client's metaphor

  • Purpose: let the arena become a picture of the client's life on the client's terms. Eagala describes clients' life stories unfolding metaphorically, with horses revealing relationship dynamics or symbolic aspects of life [source: Eagala Model page].
  • Steps: (1) Notice when the client names horses or objects after people or things in their life, or does so when invited (e.g. 'if these horses were people in your life...') [synthesis for the invitation]. (2) Use their names and labels thereafter. (3) Ask about the metaphor from inside it ('what does Worry need right now?'). (4) Only later, and only if the client wishes, bridge to the real-life referent.
  • Example language (illustrative): "You called that horse 'the boss'. What's it like being near the boss right now?"
  • Watch for: a metaphor that floods the client (e.g. a horse named for an abuser); slow down and use 4.11. Working when the client can step in and out of the metaphor and draw a real-life conclusion.

4.10 Welfare pause: when the horse says no

  • Purpose: protect the horse and use the interruption therapeutically. The ES must assess horse responses, advocate for the horse and stop activities that compromise its wellbeing [source: PATH ESMHL 2026]; IAHAIO requires recognition of stress and prohibits straining activities [source: IAHAIO 2018].
  • Steps: (1) ES names the stress signs plainly (e.g. ears pinned, tail swishing, pawing, bite or kick threat) [source: Matlock, AHA] and stops or modifies the activity. (2) MH helps the client with whatever this stirs (shame, anger, relief). (3) Once safe, invite curiosity: what did the client notice, and does it connect with how they handle others' 'no'? (4) Let the horse rest or swap horses as the ES decides.
  • Example language (illustrative): "She's telling us she's had enough for now, so we'll give her space. What's it like for you to hear that?"
  • Watch for: the client being blamed or blaming themselves for the horse's state; pressure from the client to continue. Working when respect for the horse's limit becomes a model the client can apply to their own boundaries.

4.11 Regulation activities (Natural Lifemanship version)

  • Purpose: bring a dysregulated client back into a workable state before or during horse contact. The Natural Lifemanship presentation lists regulation activities (mindfulness, emotions, movement, body sensations, drumming) and self-regulation strategies including slow or belly breathing, 'horse lips' (blowing out through relaxed lips), soft versus hard eyes (peripheral vision), rocking or swaying, muscle relaxation, and a container exercise; it reads state from eyes, body, face, voice and rhythm of movement [source: NL presentation, UWSP 2020].
  • Steps: (1) Notice cues of fight/flight or shutdown in the client (and, via the ES, in the horse). (2) Pause the task. (3) Offer one strategy at a time, e.g. a few slow out-breaths through loose lips, or softening the gaze to take in the whole arena. (4) Check the client's state, then resume or stay with regulation.
  • Example language (illustrative): "Let's pause. Try letting your eyes go soft, so you can see the whole arena without looking at anything in particular. What changes?"
  • Watch for: strategies used to suppress feeling rather than regulate; container exercises without later return to the material. Working when the client and horse both settle and the client can choose the next step. Full NL method requires NL training [source: NL presentation; training requirement synthesis].

4.12 Requests, pressure and release (Natural Lifemanship version)

  • Purpose: use the horse's response to a client's request as relational feedback. NL describes a horse responding to a request by ignoring, resisting or cooperating, and holds that pressure and release builds the relationship [source: NL presentation].
  • Steps: (1) With the ES managing safety, the client makes a clear, non-forceful request (e.g. to move or to come closer) [synthesis on example]. (2) Observe the response: ignore, resist or cooperate. (3) The client adjusts pressure, and releases it as soon as the horse responds. (4) Process how the client asks, escalates, gives up or releases in their human relationships.
  • Example language (illustrative): "He's ignoring that request. What could you try that's clearer, without being harsher?"
  • Watch for: escalating pressure that becomes coercion (ES stops it); a client who never asks at all. Working when the client finds a request that is both clear and respectful.

4.13 Attachment and detachment with connection (Natural Lifemanship version)

  • Purpose: practise moving toward and away from another being while keeping connection. NL names movement between attachment and detachment with connection maintained as a principle of relationship [source: NL presentation].
  • Steps: (1) Notice when client and horse come together and when they separate. (2) Help the client attend to whether connection holds when they or the horse move away. (3) Link to the client's patterns of clinging, avoiding or cutting off [synthesis].
  • Example language (illustrative): "When she walked away just then, what happened to the connection between you?"
  • Watch for: abandonment or rejection material arising strongly when the horse leaves; slow down. Working when the client can tolerate distance without collapse or pursuit.

4.14 Rhythmic riding (Natural Lifemanship; mounted, specialist only)

  • Purpose: NL describes rhythmic riding as providing bilateral movement and activating vestibular, proprioceptive and limbic systems [source: NL presentation; these mechanism claims are the model's own, evidence status uncertain].
  • Steps: Do not deliver unless trained in NL rhythmic riding and working with a programme whose mounted-work safety, horse and instructor standards are in place; the Eagala Model excludes riding [source: Eagala]. For the therapist outside that training: refer, and prepare and debrief the client as in 4.18.
  • Example language (illustrative): "The riding part needs a specialist team; I can help you think about whether that's right for you."
  • Watch for: fall risk; mounting without the client's clear choice. Working only as judged by the trained team.

4.15 Infection control and hygiene routine

  • Purpose: reduce zoonotic and allergy risk. Dalton et al. (2020) found asymptomatic carriage of MRSA, C. difficile and Salmonella in therapy dogs and called the evidence base thin; no study demonstrated actual transmission; they recommend standardised infection-control policies, expert consultation and better communication between infection-control staff and handlers, citing SHEA guidance as a starting point [source: Dalton et al. 2020, medRxiv preprint; CDC Stacks]. The review did not address horses specifically [source: same].
  • Steps: (1) Apply the IAHAIO exclusions agreed at screening (e.g. immunosuppression) [source: IAHAIO]. (2) Confirm the facility's veterinary care, vaccination and parasite control [source: IAHAIO]. (3) Hand-washing before and after contact; cover wounds; closed footwear; no eating in the barn [synthesis]. (4) Tick check advice after pasture work [synthesis]. (5) Ask the client to report illness or rashes after sessions [synthesis].
  • Example language (illustrative): "We wash hands before and after every session, and I'll ask you to tell me if you notice any rash or illness afterwards."
  • Watch for: immunocompromised clients not disclosed; allergy symptoms. Working when the routine runs without reminders.

4.16 Working with fear of horses or trauma involving animals

  • Purpose: decide whether and how a fearful client can benefit, without forcing exposure [synthesis].
  • Steps: (1) Assess the fear: phobia, a specific bad experience, or trauma in which animals or farms were involved. (2) If the fear itself is the clinical target, treat it within an exposure framework you are trained in, with consent and the client controlling pace, contraindications reviewed, and the horse's welfare protected. (3) Otherwise start with observation from behind the fence (4.4) and let the client set distance. (4) If animals were used to harm or threaten the client, consider whether EAP is the right setting at all.
  • Example language (illustrative): "You decide how close we get. Staying on this side of the fence today is completely fine."
  • Watch for: dissociation, panic, or compliance to please the team. Working when the client chooses each step and stays within a tolerable range.

4.17 Integration in office sessions (bridging)

  • Purpose: carry arena learning into the client's life and the wider treatment plan [synthesis].
  • Steps: (1) Brief written or verbal recap of each arena session's key moments in the client's words. (2) Link to treatment goals. (3) Plan one real-life experiment drawn from the session. (4) Review it next time.
  • Example language (illustrative): "Last week you said you stopped chasing the horse and she came to you. Where else in your life might stopping the chase matter?"
  • Watch for: arena moments that stay as 'nice experiences' with no transfer. Working when the client reports using it outside.

4.18 Preparing and debriefing a client attending an external programme

  • Purpose: support a client attending EAP, equine-assisted learning, therapeutic riding or hippotherapy run by others [synthesis].
  • Steps: (1) Check which service it is, using the consensus terms: therapy by licensed professionals versus learning or horsemanship services, which are not therapy [source: PATH Optimal Terminology]. (2) Check credentials (e.g. Eagala-certified MH and ES pair; PATH ESMHL) and that a licensed clinician leads any psychotherapy [source: Eagala; PATH]. (3) With consent, agree information sharing with the programme. (4) Before: hopes, fears, safety, consent. (5) After: what happened, what it meant, any distress, any injuries.
  • Example language (illustrative): "What did you notice about yourself out there that you want to bring in here?"
  • Watch for: a 'learning' or coaching programme presenting itself as therapy; a client in crisis being sent without clinical support. Working when the two settings reinforce each other.

4.19 Evaluating a programme before referral or partnership

  • Purpose: make sure the setting is safe for client and horse [synthesis, using sourced criteria].
  • Steps: Ask: (1) Who leads mental health work and what is their licence? [source: IAHAIO; PATH]. (2) Is there an ES or equivalent with horse-welfare authority to stop activities? [source: PATH ESMHL]. (3) How are horses selected, rested, watered, vetted and vaccinated, and how are stress signs monitored? [source: IAHAIO; Matlock]. (4) Written safety, emergency, weather and infection-control procedures? (5) Insurance and waivers? (6) Accessibility, toilets, shade, surfaces? (7) Confidentiality on site and photo policy? (8) An ethics committee or code (Eagala has a code of ethics and ethics committee; the Eagala blog states PATH has no formal code of ethics) [source: Eagala blog].
  • Example language (illustrative, to a programme): "How does your equine specialist decide a horse needs a break, and what happens then?"
  • Watch for: vague answers on welfare or licensure. Working when you can answer all eight points in writing.

4.20 Referral for hippotherapy or therapeutic riding

  • Purpose: route physical, sensory, motor or speech goals to the right professional.
  • Steps: (1) Recognise that hippotherapy is not a separate service but a tool used inside physical therapy, occupational therapy or speech-language services, by licensed or credentialed PT, OT or SLP [source: AHA]. (2) Refer to the client's physician or to such a therapist; do not deliver it. (3) Therapeutic or adaptive riding is a horsemanship service, not therapy [source: PATH Optimal Terminology]. (4) Coordinate on any emotional goals with consent [synthesis].
  • Example language (illustrative): "The movement-based work you're asking about is done by physical or occupational therapists. I can help you find one."
  • Watch for: programmes offering 'hippotherapy' without PT, OT or SLP. Working when roles are clear to the family.

4.21 Ending and goodbye to the horses

  • Purpose: plan the ending so loss of the horses does not repeat earlier abandonments [synthesis].
  • Steps: (1) Name the ending several sessions ahead. (2) Invite the client to plan their goodbye (a last visit, a photo only with consent and programme permission). (3) Review gains in the client's words. (4) Arrange aftercare and continuing therapy or referral. (5) If a horse retires, falls ill or dies during treatment, tell the client honestly and treat it as a real loss.
  • Example language (illustrative): "We have three sessions left with the horses. How would you like to say goodbye?"
  • Watch for: missed final sessions; grief about the horse. Working when the client leaves with a clear picture of what they take with them.

4.22 Documentation and outcome monitoring

  • Purpose: keep this a therapy with documented progress, as IAHAIO's definition of AAT requires [source: IAHAIO 2018].
  • Steps: (1) Record goals, activity, observations of client and horse, processing, risk events and injuries. (2) Use the standard outcome measures you already use for this presentation [synthesis]. (3) Record consent changes and ES welfare stops.
  • Example language (illustrative): "Let's look at how your scores have moved since we started at the farm."
  • Watch for: notes that describe horses but not clinical change. Working when progress is visible against goals.

5. Handling problems

The model holders' published guidance addresses horse welfare stops, roles and infection control; most of the guidance below on client difficulties is [synthesis] unless tagged.

  • Stuck client (does nothing, or the same thing every session). Describe the pattern neutrally (4.7), ask what doing nothing is like; offer a choice between open time and a task; change one variable (different horse chosen by the ES, different space) rather than adding instructions [synthesis]. Remember Eagala treats avoiding and struggling as part of the process [source: Eagala].
  • Resistance or 'this is pointless'. Return to the agreed goal; ask what would make the time useful; offer to move back to office-based sessions without penalty. EAP is one setting, not the treatment itself [synthesis].
  • Overwhelm or dysregulation near horses. Stop the task, increase distance (ES moves the horse or the client steps outside the fence), use one regulation strategy (4.11), do not process content until settled. If dissociation recurs, review suitability (4.1) [synthesis; regulation strategies: NL presentation].
  • Unsafe client behaviour (chasing, hitting, throwing, ignoring safety instructions). ES stops it immediately for horse and human safety [source: PATH ESMHL; IAHAIO]; MH addresses it as clinical material once safe; repeated behaviour ends arena work until a safety plan is agreed [synthesis].
  • Injury: kick, bite, being stepped on, a fall or crush against a fence. Follow the facility's first-aid and incident procedures (the ESMHL must hold CPR and first aid and knows equine first aid) [source: PATH ESMHL]; seek medical care as needed; document; debrief the client's fear and any shame; review the activity and horse selection with the ES. The infection-control review found injury risk mentioned but not measured in the literature [source: Dalton et al. 2020].
  • Horse shows stress or refuses repeatedly. Treat as a welfare matter first: rest or replace the horse, review workload and selection [source: IAHAIO; PATH ESMHL]. Do not turn a stressed horse into 'evidence' about the client. Remember a quiet, tolerant horse may still be stressed [source: Matlock, AHA].
  • Client projects intentions onto the horse ('he hates me'). Do not confirm or correct; ask what makes them think so and what they notice in themselves; let the ES give factual horse information only if it serves safety or the client asks [synthesis].
  • Non-adherence (missed farm sessions). Check practical barriers first: travel, cost, weather, physical access, childcare; check whether the setting itself is aversive; agree a weather and cancellation policy at contracting [synthesis].
  • Rupture with the MH or the ES. Name it, invite the client's view, own your part; if the rupture is with the ES, address it in the team and with the client together; where needed, return to office sessions to repair before resuming [synthesis].
  • Team conflict between MH and ES. Hold role boundaries (MH: emotional and psychological safety; ES: horse behaviour and physical safety) [source: Eagala]; debrief privately, never in front of the client; agree a pre-session rule on who decides what [synthesis].
  • Confidentiality breaches on site. Other clients, volunteers or neighbours see or recognise the client; photos taken. Have a site photo policy, schedule private times if possible, and plan with the client what they will say if recognised [synthesis].
  • Disclosure of abuse, including animal cruelty, during a session. Follow your usual safeguarding and mandatory reporting duties; for minors, safeguarding takes priority over the session plan [synthesis].
  • Allergic reaction or illness. Stop, move away from the trigger, follow first aid and the client's own medical plan; review screening and exclusion [source: IAHAIO; synthesis].
  • Weather, heat, cold, ticks, poor ground. Follow the facility's published safety guidance; move indoors or cancel; advise tick checks; never push through unsafe conditions to keep a session [synthesis].
  • Accessibility and disability. Ask about the site's surfaces, ramps, toilets and seating before referral; adapt activities so the client can choose distance and position; refer to hippotherapy or adaptive riding for physical goals (4.20) [source: AHA; PATH; synthesis].
  • Dual roles and competence. If you own the horses or the farm, or act as both MH and ES, document the reasons, consult, and keep the welfare stop with someone whose job is the horse; apply APA Ethics Code Standard 3.05 on multiple relationships [source: APA Ethics Code]. Do not offer EAP without the training the certifying body requires (e.g. Eagala Fundamentals Training and certification renewed every two years with continuing education; PATH ESMHL for equine specialists) [source: Eagala; PATH ESMHL].
  • Client wants to ride or the programme offers riding. In the Eagala Model there is no riding [source: Eagala]; riding moves into horsemanship services or NL rhythmic riding with different training, safety and insurance requirements [source: PATH Optimal Terminology; NL presentation]. Refer rather than improvise.
  • Grief when a horse dies, is sold or retires. Treat it as a real loss, tell the client honestly, offer a way to say goodbye, and watch for reactivation of earlier losses [synthesis].

Sources

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