Background

Equine-facilitated psychotherapy (EFP) is a form of animal-assisted therapy used to treat human psychological problems that employs horses in and around the natural surroundings of the stables. It is an interactive process in which a mental health professional, licensed to provide psychotherapy, working with an equine professional, partners with suitable equine(s) to address psychotherapy goals set forth by the mental health professional and the client (PATH Intl. 2013). Founded in the 1990s as an independent branch of equine-assisted activities and therapies, EFP aims to help people challenged by emotional, social and mental health conditions. It promotes personal explorations of feelings and behaviors and allows for their clinical interpretation. This intervention requires an ongoing therapeutic relationship with clearly established treatment goals and objectives that the therapist and client develop. An example of an EFP approach is for a client to observe and talk about the behavioral dynamics in a horse herd. For instance, viewing one horse running after another horse in the paddock may elicit various interpretations by clients (“What are the horses doing now?” One client may view this dynamic as “the older horse is chasing the younger horse out of the herd…the younger horse is anxious and frightened”. Another can view the same dynamic as “they are playing with one another and enjoy being together, they don’t want to feel that they are left alone”). Viewed as projection, this offers a window into the client’s internal world. Together, the client and therapist explore these projections (Bachi et al. 2012).

Several studies have evaluated the mental, emotional, and social factors that equine-facilitated activities and therapies address, and some suggest that various populations benefit from interventions with horses. These interventions apparently serve diverse populations in terms of symptomatology, such as adult female survivors of abuse (Meinersmann et al. 2008), cancer survivors (Cantril and Haylock 2007), and people who are recovering from trauma (Yorke et al. 2008). Notably, however, it is not appropriate for all people because of safety issues associated with horses and the open environment in which this therapy takes place (PATH Intl. 2013). For example, a psychotic state is considered as contraindication for EFP because of danger it may pose, given the client’s unexpected behavior and the horse’s possible reaction to it.

Possible outcomes of equine-facilitated interventions with populations that could benefit also from an attachment-based psychotherapy are illustrated in empirical studies. For example, one study found following EFP a trend for positive change (non significant) in self-image, self-control, trust, and general life satisfaction of at-risk adolescents in a residential treatment home (Bachi et al. 2012). Another study revealed that EFP improved global functioning for children who had experienced intra-family violence (Schultz et al. 2007). Furthermore, children who had a history of physical abuse and neglect had a statistically significant greater percentage improvement in scores after treatment than those who did not have such history. In addition, another study revealed that following equine-assisted counseling children identified as being at high risk for academic and/or social failure improved on scores of behavior and psychosocial assessment (Trotter et al. 2008).

Only a few studies propose a theoretical basis for equine-facilitated interventions or explore the unique features that underlie them. Studies that look into the practices of professionals who conduct EFP analyze conceptual and theoretical frameworks that guide practitioners in this field (Bachi 2012). One such study explored the practices of therapists using this intervention to treat adolescent depression (Frame 2006). Respondents perceived that interactions and exercises with the horses provided feedback mechanisms, in addition to object representations of past and current relationships through which therapeutic change could take place. Cognitive behavioral therapy, experiential therapy, Gestalt therapy, and object relations theory were all cited as theoretical or clinical approaches in EFP. Another qualitative study sought to determine the theory that underlies the practice of professionals who perform EFP with various populations (Esbjorn 2006). Through a combination of heuristic and grounded theory methods, the researcher found that psychotherapists implement this therapy using a variety of models. Yet, there was substantial agreement regarding what the equine brings to the therapeutic encounter: unique equine attributes, opportunities for metaphor, and relational aspects. The participants agreed that this approach might be beneficial to a large spectrum of populations. Many clinicians alluded to transpersonal benefits including somatic aspects, a calming effect, and equines increasing clients’ attentiveness and their being present in the moment (Esbjorn 2006). These studies suggest that the human-horse interaction has a fundamental role in EFP because of certain features like relational aspects, metaphor, and feedback. Nevertheless, a conclusive theory to guide EFP is yet absent (Bachi 2012).

The practice of EFP is growing rapidly in the United States and Europe. Educational institutions and insurance companies are increasingly recognizing this form of therapy (Hallberg 2008). Despite the increasing number of professionals and organizations that offer this innovative therapy, EFP lacks a firm and published theoretical and research base (Hallberg 2008). If interventions are being legitimized and widely implemented before best practices have been established it poses emotional, physical and financial risks for clients. These interventions should be further explored and theoretical foundation should be developed as to promise that clients’ treatment are effective and grounded in solid knowledge to guide them.

Problem Formulation

The Need for Theories to Guide Equine-Facilitated Psychotherapy

Because EFP programs are expanding, researchers interested in utilizing horses for therapeutic purposes should evaluate EFP’s efficacy, determine which populations and diagnoses it is appropriate for, and develop published theoretical knowledge to guide intervention (Bachi 2012). Therefore, this paper aims to explore whether or not the application of attachment theory to EFP is both relevant and also how it could inform better practice.

Studies have shown that relationships with companion animals can physically and psychologically benefit their owners (Crawford et al. 2006), and many people relate to their pets as close family members (Phillips Cohen 2002). This ability of humans to bond so closely with animals is a foundation of animal-assisted activities and therapies. Attachment theory may offer insights into the formation of strong relationships that can also be applied to the human-animal bond (Phillips Cohen 2007). Only a handful of studies regarding attachment to animals exist within settings of animal-assisted therapies (e.g. Banks et al. 2008).

Studies of the application of attachment theory to the human-animal context suggest contradictory findings. In one study that considered attachment theory, the researcher suggested that people may have different internal working models for their attachment with people and their attachment with animals (Endenburg 1995). Conversely, another study found a close correspondence between people’s attachment orientations in human-pet relationships and their attachment orientations in human–human relationships. However, the researchers concluded that pet attachment orientations are not merely extensions of general patterns of interpersonal attachment and need to be understood with reference to unique qualities of the human-pet bond (Zilcha-Mano et al. 2011a, b). These findings suggest a need to further explore this topic. Based on theory and clinical observations, the author believes there are many parallels between attachment to humans and attachment to animals. Thus, the relevance of attachment theory to EFP also requires further investigation.

Part of the gap between practice and knowledge of EFP might be understood within the framework of attachment theory by examining questions such as: To what extent do therapy horses serve as attachment figures? To what extent do horses exhibit features of an attachment figure? What situations enable attachment bonds between humans and horses to develop? Exploration of the human-horse relations and the attachment to horses through such questions may offer insight about the underlying processes for change (Bachi 2012).

Consequently, this paper aims to examine the theoretical fit between primary concept of attachment theory and central features of EFP, what may be possible contributions as well as limitations of this theory as a framework for this intervention.

Attachment Theory-Based Psychotherapy

Human lives, according to Bowlby, revolve around intimate attachments, which are mainly shaped by first relationships with parents or caregivers. Though, in instances of deficiencies in those involvements, later relationships can offer opportunities for restoring emotional capabilities and healing (Wallin 2007a). In attachment-based psychotherapy, the therapist’s task is to provide a secure base from which the individual can explore the world, as comparable to the mother’s role (Bowlby 1988). The therapist’s aim is to enable the client to reappraise and re-construct his working models of himself and his attachment figure(s), in light of the new understanding he develops and the experiences he has in the therapeutic relationship. This process can help reduce the influence of past relational deficiencies and enable clients to better recognize present relationships for what they are. Furthermore, attention should be paid to the ways a client’s earlier experiences affect the transference relationship (Bowlby 1988).

The therapist’s role involves five main tasks (Bowlby 1988). The first task is to provide the client with a secure base from which he can explore painful relational experiences in his past or present life. In this role the therapist must be a trusted companion who provides support, encouragement, sympathy, and guidance when needed. The second task is to assist the client in his exploration by encouraging him to reconsider expectations, feelings, behaviors and unconscious biases concerning significant figures in his current life. The third task is to help the client examine the relationship between client and therapist. The client imports into this relationship his perceptions, constructions, and expectations of how an attachment figure is likely to feel and behave towards him. These are dictated by the client’s self and his working models of parents. The fourth task is to encourage the client to consider how current perceptions, expectations, feelings and actions may be occurring as a result of past experiences, especially direct experiences with parents or memories of what parents repeatedly told by them. The fifth task is to enable the client to recognize that his images (models) of himself and of others are derived either from past painful experiences or from misleading messages from a parent, and may or may not be appropriate to his present and future (Bowlby 1988).

In attachment-based psychotherapy, some of the essential processes that transform a therapist from being a helpful professional to being an attachment figure are ongoing intimate proximity and availability, along with the “knowing”—the holding in mind through absence and interruption, similarly to healthy parental love (Holmes 2009). Notably, however, the therapist’s role is transformative but temporary.

Ongoing research of attachment theory provides grounds for the development of the self in a specifically relational context (Wallin 2007a). Some of the findings that have profound implications for psychotherapy are first that co-created relationships of attachment are the key context for development (Bowlby 1982). Second, that preverbal experience makes up the core of the developing self (Ainsworth et al. 1978; Main et al. 1985). Third, that the stance of the self toward experience predicts attachment security better than facts of personal history themselves (Fonagy et al. 1991; Main 1991). Thus, attachment theory highlights intimate bonds, the non-verbal realm, and the relation of the self to experience (Wallin 2007a).

Application of Attachment Theory-Based Psychotherapy to Equine-Facilitated Psychotherapy

As with traditional therapy, also EFP begins with an assessment phase which provides grounds for setting goals for the therapeutic relationship. Initial sessions of EFP can enrich the assessment phase of treatment by information obtained from observation of how a client relates to the horse, the natural surroundings and the therapist. The experiential process which includes the physical and behavioral dimension, the “real time” reaction and interaction, especially with first exposure to horses, is unique to this form of therapy. It can help the therapist to identify a client’s working models and additional diagnostic information such as, defensive tendencies, or client’s interpretation of situation. In addition, when applying attachment theory to EFP it could be helpful to use an established measure for assessing attachment patterns, such as the Adult Attachment Interview, which actually assesses the respondent’s current overarching “state of mind with respect to attachment” (Main et al. 1985, p. 437, as cited in Wallin 2007a). The Adult Attachment Interview can help establish the therapeutic alliance, facilitate shared goals for therapeutic work, and serve as a source for understanding and motivation that facilitate the therapeutic process (Steele and Steele 2008b). An individual’s working model of attachment could be revealed in characteristic patterns of narrative, discourse, and imagination, as well as behavior (Wallin 2007a). For example, security of attachment in adulthood should be reflected in a coherent integration of preconscious and conscious layers of mind (Steele and Steele 2008b). Furthermore, this interview can assist in identifying who has, and who lacks resilience in the face of adverse childhood experiences, including loss or trauma (Steele et al. 2009). The Adult Attachment Interview could provide an understanding of the developmental roots of adult reliance on idealization or other defensive strategies and the sources of ongoing anxiety, fear, and confusion in their lives (Steele et al. 2009). Once the treatment process is established, repeated administration of this tool at timely intervals appraises the extent to which an individual moves toward integration, thus measuring progress and outcome (Steele and Steele 2008b). Equine-facilitated psychotherapy is performed with various lengths of interventions (long-term or concentrated/targeted), because it is used to treat a wide range of populations. Thus, the timely intervals that suit reassessment during this therapy is subjective to the therapist’s assessment in relation to the specific client’s development and needs.

In addition, when applying to EFP, the treatment’s aim and the therapist’s role are similar to the “traditional” attachment theory-based psychotherapy process, including the five tasks of the therapists (Bowlby 1988), as aforementioned. Yet, the therapeutic process is enriched by the presence of the horse, which as an additional living being in the relational context, evokes feelings, thoughts, and behaviors in the client (e.g. clients might differ in their attachment to different horses). These can be harnessed to advance the therapeutic process as it relates to attachment theory. The following describes how several of the primary concepts of attachment theory correspond to some of the central features of EFP, such as: secure base and haven of safety through the provision of a holding environment, affect mirroring, mentalizing and reflective functioning, and non-verbal communication and body experience. This section is composed of definitions and descriptions of these concepts, their application to human-horse context and EFP, and interpretation in light of potential therapeutic (transformative) processes.

Secure base and haven of safety through the provision of a holding environment

As part of a theory of emotional nurture, the major tasks of the therapist are containment (Bion 1970) and holding (Winnicott 1971), which reflect the secure base that she/he must provide if exploration is to be possible (Bowlby 1988; Holmes 2009). Providing a secure base, the therapist strives to be reliable, attentive, and empathic (Bowlby 1988). For Winnicott, the therapeutic process is first and foremost the provision of a congenial milieu, a “holding environment” analogous to maternal care (Phillips 1988). This early maternal care refers to the infant’s first experiences as being held in arms and in mind which bring to his psychosomatic integration (Phillips 1988). In therapy, it entails the provision of a professional setting for trust where the client can later “reveal himself to himself” (Winnicott 1950–1955).

In EFP there are a range of opportunities for the provision of a secure base and a haven of safety through a holding environment. First, the horse’s back is viewed as a “therapeutic mobile setting” which holds the client physically and symbolically. Second, the unique natural setting in which this therapy occurs can promote elements of holding as they relate to rapport and trust. Third, the acceptance and non-judgment of the horse can contribute to the client’s sense of being held.

Mounting a horse astride or lying prone may be used during EFP to promote trust and rapport within the therapeutic alliance (as described below). The horse’s ability to hold the client physically can be facilitated as representational and symbolic mental holding of the client and thus used to restore experiences of failure in early life attachment. This feature is unique to this therapy and cannot be achieved during conventional forms of psychotherapy or animal assisted therapy (that is performed with smaller animals). The following example of an actual EFP procedure presents the subject of trust in the therapeutic process and beyond it, through use of the horse’s back as a “holding” environment: In the treatment of ‘A’ (13 years old), who had been raised in conditions of parental neglect. When asked about the care he experienced from his mother he frequently brought up memories of disappointment and unfulfilled needs. ‘A’ was requested to lie prone upon the horse’s back on a bare-back pad with a surcingle and was borne by the horse, in a slow and rhythmic walk, while ‘A’s head rested on the horse’s pelvis and his hands, body and legs were relaxed and exposed to the horse’s warmth and cradling-relaxing movement. This process promoted feelings of trust and confidence between ‘A’, the horse and the therapist. Following this experience, a dialogue was held about trust and acceptance of beneficial aspects of the “other” concerning past and present relationships (Bachi et al. 2012).

The former example could be viewed as a major trust exercise. Equine-facilitated psychotherapy can offer additional experiential methods to work with individuals who have severe difficulty with trust, or forming attachments to begin with. For example, learning to lead a horse with a rope when the client is standing aside him, could offer opportunities to exercise elements of leadership and self-confidence, but also trust. Standing besides the horse’s shoulder and neck, the client faces mutual issues of trust such as, whether the horse will trust him as a leader? Whether the client will trust that the horse will not hurt him? Whether the client can trust himself and his abilities to lead the horse (can the client “hold” the horse)? The therapist has a central role in facilitating such an exercise so that it will enable a positive experience for the client. Furthermore, the dynamic between client and horse may elicit issues of trust in the client’s past or present life experiences, which should be then processed with the therapist.

The second element concerning the provision of a holding environment relates to the physical setting. In EFP, the setting in which the therapy takes place is an integral part of the process. This intervention is practiced in a unique therapeutic setting that includes the stable and its surroundings, as well as the natural environment. This setting offers opportunities for the provision of a holding environment since it may be experienced by clients as a relaxing and non-threatening setting. This setting can promote openness and rapport between client and therapist. Time off from the stresses of daily life in such an environment may encourage the client to listen and connect to his/her physical and mental “self”. Nonetheless, since EFP is provided in nature, it can also pose difficulties with regards to creating intimacy and protection in an open setting that does not have physical boundaries. Especially when considering the provision of a holding environment, it is necessary for the therapist to initiate the establishment of virtual boundaries in order to create a solid sense of security (Bachi et al. 2012). This may be achieved by several ways, such as, the therapist is responsible to reduce possible intrusions to the therapy session by scheduling sessions in times that do not conflict with other activities that take place in the stable. Furthermore, she/he needs to create clear guidelines for conduct that protects the client’s privacy with barn workers who might possibly be in proximity to the therapy session. In addition, the therapist needs to discuss with the client the issue of privacy in such an open environment and the challenges that it may pose (“What does the client need in order to feel protected?”). Finally, especially in stables that are used also for activities other than therapy (e.g. leisure riding, horse training) because the physical setting of this intervention cannot be controlled by the therapist and there could be unexpected interruptions the therapist should make all efforts to convey a clear message to the surrounding that assures the client’s privacy and confidentiality.

The third element of a provision of a holding environment in EFP refers to the horses’ acceptance and non-judgment. Animals, including horses, are excellent co-therapists since they refrain from making judgments especially ones based on personal opinions or standards (in contrast, a therapist’s reactions to a client’s qualities could be therapeutically useful or harmful). They do not care about an individual’s physical appearance, or past mistakes. Though, they do react to emotions and behaviors, as aforementioned. Horses will react to love and kind care, or alternatively to aggression, anxiety, or maltreatment. Therefore, their presence in a therapeutic process can promote trust and feelings of acceptance to whoever treats them in a positive manner. This characteristic of horses may be harnessed during therapy since the provision of a holding environment may connote the acceptance, warmth and love of parental figures, which can “react negatively but still love”. The horse’s role can be viewed more like a therapist that provides ongoing positive regard. Such a process may enable the client to develop a sense of security within and outside of one’s self.

For Winnicott, the provision of a holding environment enables the “natural” growth processes to reassert themselves (Phillips 1988). In addition, a holding environment which is ego-supportive can be approached as part of the internalization of the therapist, where it is a form of introjection (Eagle and Wolitsky 2009). In EFP, the holding environment is potentially expanded. In addition to the therapist, it is composed also of the emotional and physical gain from the horse and the presence in a natural setting. This expanded holding of the client can be regarded as providing him with a secure base from which he can explore and a haven of safety in which he can trust, and return for comfort and reassurance (Marvin et al. 2002).

Affect mirroring

“The mother’s face is the mirror in which the child first begins to find himself” (Winnicott 1971). When the infant looks at the mother’s face he can see himself, how he feels, reflected back in her expression (Phillips 1988). Emotionally attuned caregivers convey their empathy and capacity to cope through affect mirroring that is both “contingent” and “marked” (Fonagy et al. 2002). The caregiver is “contingent” upon the infant to initiate affective expression. The caregiver’s response is then “marked” by an exaggerated simulacrum of the infant’s facial and verbal affective expression. Thus, the caregiver offers the infant a visual/auditory representation of his own internal affective state. This provides the infant with the capacity to “see” and “own” his feelings (Holmes 2009). The infant can only discover what he feels by seeing it reflected back. If the infant is seen in a confirming way that makes him feel he exists, he is free to go on looking and exploring (Phillips 1988).

In EFP, in addition to the therapist’s mirroring, the horse has an innate tendency to mirror affect, which can be facilitated into the therapy process accompanied by the processing of it verbally by the therapist. As described often in literature about horses and EFP (e.g. Hallberg 2008), a horse’s ability to mirror emotions, behaviors and physical elements of a person is one of the central features that provides a basis for the human-horse bond (McCormick and McCormick 1997). The horse is highly sensitive to “others” in his surroundings due to his instinctual nature as a herd animal and his biological defense strategy as a prey animal. The horse has the innate tendency to constantly sense, react, and respond to emotional expressions of animals or humans in his proximity, which may be framed as affect mirroring. For example, when an anxious person approaches a horse, the horse can sense it through the person’s body language, muscle tone, intonation and so forth. In such instances the horse will usually exhibit muscle tension and a heightened level of alertness (which also relates to his “flight” system). Horses are so aptly suited to provide emotional feedback in ways that a therapist perhaps is not, which explains the benefit of horses in the therapy context. These characteristics can be analogous to affect mirroring and can be facilitated in therapy to a restorative experience of mirroring. This enables the client to “feel felt” (Siegel 1999). Furthermore, since the horse’s emotional attunement and his ability to provide feedback are instinctual and part of his survival mechanism, his responsiveness to the client are usually earlier and more constant than that of a human’s abilities. Therapists can use these characteristics (acknowledged, translated verbally and processed) to restore or provide an experience of emotional, behavioral and physical attunement and feedback. Thus, the horse may serve as a big mirror that reflects the human presence astride and beside him. Still, the intervention of the therapist is crucial in facilitating this reflection in a nurturing direction that will foster growth. As part of mirroring, further steps are needed in order to promote exploration and companionable interaction (Holmes 2009; McCluskey 2005). These include affect regulation by the therapist, in which mirroring becomes dialogic (Holmes 2009).The importance of such a dialogic process is highlighted when the horse’s behaviors or emotions are misinterpreted by the client, who is not a horse expert. Nevertheless, the information may be useful therapeutic material (e.g. projection), but this could also potentially negatively impact the establishment of a secure base. For example, someone who thinks the horse does not like them because he walks away. Therefore, the therapist’s mediation and verbal process is crucial to facilitate such situations towards a sense of security. Consequently, the therapist’s knowledge and experience with horses is fundamental for the interpretation of the horse’s feedback and the processing of it. This process entails a constant non-verbal dialogue and emotional awareness within the therapeutic triangle of client-horse-therapist.

When affect mirroring takes place in EFP the horse as well as the therapist give the client back what the client brings (Phillips 1988; Winnicott 1967). This reliable and accurate reflection provides the client with a sense of existence, which can enable him to see himself and explore the world (Phillips 1988; Winnicott 1967). This responsiveness is part of what makes a potential “secure base” secure (Holmes 2009). Furthermore, affect regulation and mirroring is the pathway to self-understanding (Holmes 2009).

Mentalizing and Reflective functioning

Mentalization refers to an adult’s attention to mental states, including the mental states of others particularly in explanations of behavior (Bateman and Fonagy 2006; Fonagy et al. 1991). It is mostly a preconscious, imaginative mental capacity and it requires a representational system for mental states (Bateman and Fonagy 2006). In addition, various findings link security of attachment and mentalization (Bateman and Fonagy 2006). Given the generality of the definition of mentalization, most mental disorders will inevitably involve some difficulties with mentalization (Bateman and Fonagy 2006).

Reflective functioning refers to awareness of the nature of mental states in the self and others, the mutual influences at work between mental states and behaviors, the necessity of a developmental perspective, and the need to be sensitive to current conversational context (Fonagy et al. 1998; Steele and Steele 2008a, b). It enables one to respond to his/her experiences on the basis not only of observed behavior, but also of the underlying mental states, including desires, feelings and beliefs, that make behavior understandable and give it meaning. Furthermore, reflective functioning is intimately related to the capacities for insight and empathy (Wallin 2007a).

The use of mentalizing and reflective functioning through a therapeutic intervention can include increasing the client’s sensitivity and appropriate responsiveness to the “other’s” signals and emotional needs. This could improve the client’s own ability to reflect on the “other’s” behavior, thoughts and feelings regarding their interactions, and to reflect on experiences in his/her own histories that affect his/her current attachment patterns (Marvin et al. 2002).

Assessment of mentalization and use of specific techniques such as interpretive mentalizing and mentalizing the transference (Bateman and Fonagy 2006), can be used in EFP to enhance mentalizing function. The innovation that this therapy brings is the opportunity to practice and enhance mentalizing and reflective functioning through an exchange with the horse. For example, a major component of a client’s bond with a horse is established through caregiving (e.g. grooming), which in EFP can be facilitated as a platform to explore how the “other” (the horse) feels, develop awareness to his mental state, and explanation of his behavior. Caring for a horse may offer an opportunity for clients to experience a process that relates therapeutically to parental care, and promotes mentalization and reflective functioning. This process focuses on the current state of mind of the client and giving him more explicit support through the exploration of his exchange with the horse. Such a process may be less threatening and more accessible for clients who suffer from failures of mentalizing and reflective functioning, because of the non-judgmental characteristic of the horse. Another method to enhance mentalization and reflective functioning could be achieved while riding. For example, achieving cooperation from a horse to ride at different paces requires the client’s attunement to the horse’s state of mind and will. It requires the client-rider to engage in non-verbal communication while mounted in order to be able to sense when the horse is happy and willingly cooperating with him, and when the horse is uncomfortable or rejecting the client’s requests. Notably, the subjectivity in each horse’s reaction could be further harnessed to achieve a specific therapeutic goal. These could be initial procedures that would then enable the client to progress onto the exploration of the exchange with the therapist and other human figures.

Non-verbal communication and body experience

Focusing on the body within an attachment-oriented framework is fundamental since emotions are an experience of the body (Wallin 2007c). Translating the language of the body into the language of feelings helps foster the interactive regulation of emotion that enables the client to experience the therapist as a new attachment figure and a secure base. Reciprocally, the client’s confidence in the therapist as a secure base can facilitate a deepening exploration of bodily experience and a growing sense that feeling can be tolerated (Wallin 2007c). Furthermore, focusing on the non-verbal domain can allow the therapist to connect with the facets of the client’s self that have never been integrated and cannot be articulated (Wallin 2007b).

One of the foundations of EFP concern non-verbal communication and body experience which are viewed by a systemic and holistic framework. The non-verbal communication and body experience are practiced either when the client is mounted on the horse’s back or unmounted while caring for the horse or observing herd interactions. The horse’s back is approached as a “therapeutic mobile setting” in which being mounted on a horse offers an opportunity to expand and deepen the experience of the therapeutic process. Touch and movement and their emotional translation are dominant aspects of this experience. Schulz (1999) describes the association between the horse’s movement (rhythm) and riding and the human primary developmental process of physical and mental aspects. Moreover, the three-dimensional movement of the horse is similar to that of a human while walking. A well-trained and symmetric horse transfers to the rider movements that develop both physical and emotional aspects of that person (Kuprian 1989; Rosenzweig 1992). In addition, the exposure to touch through the connection with the horse and the physicality of riding during this therapy can help establish a healthy physical self-image and also heal damaged emotional and sensory motor elements (Bachi et al. 2012).

The following example demonstrates how non-verbal communication and body-mind connection through an unmounted experience contribute to the improvement of the client’s physical, emotional and behavioral state. ‘L’ (14 years old) had been raised in a family with a violent father. In the early stages of the treatment ‘L’ could not bear any physical touch from an “other”, even a tap on her shoulder. As a result of her attraction and motivation to groom horses she gradually accepted touch, first from the horses and later after the building of trust, a significant change was seen in her acceptance of human touch. Grooming requires one to exhibit extensive and various types of touch onto a horse’s body. This exposure to the non-verbal domain via the physicality of the interaction with the horse enabled L’ to experience her physical self and the tactile exchange with an “other” in a new positive and nurturing way. Through this physical experience L’ was able tolerate touch and feel unthreatened by it. Gradually, she began to enjoy this new dimension of herself as well as the “other” (Bachi et al. 2012). Driven from attachment theory, this allowed the therapist to connect with the facets of L’s self that have never been integrated and were not articulated. Following this, L’s female self-image developed and changed from neglecting her appearance and covering her face with a wide-brimmed hat to being well groomed and exposing her face to the world. The therapeutic process included processing the complex relationship with her parents and the traumas that she had experienced. Complementary to this, therapeutic work was geared towards integration of those physical aspects that brought about increased emotional equilibrium and better social adaptation, alongside a more positive self-image and a sense of self-control in her life (Bachi et al. 2012).

Limitations of Applying Attachment Theory to Equine-Facilitated Psychotherapy

Applying attachment theory to EFP entails some limitations. Theory and research show that attachment theory is beneficial for the development of the self in a specifically relational context (Wallin 2007a). Consequently, application of this theory to EFP is relevant for populations of children and adults that could benefit from therapy that aims to address past or present relational issues. It is designed to bring about change in attachment-related mechanisms such as working models or reflective functioning. In some cases of clients whom have severe issues of trusting another human being or have undergone traumatic experiences early in life, therapy facilitated with animals may be a powerful way to break the ‘‘vicious circle’’ and the psychological barriers toward the formation of a secure attachment. In addition, the animal may enable nonverbal interactions, which are often much more natural for clients who have problems in verbalizing their feelings and thoughts, such as small children and people with organic, developmental, or severe emotional problems (Zilcha-Mano et al. 2011b).

Nevertheless, other theories were applied successfully to equine-facilitated interventions with various populations (see Esbjorn 2006; Frame 2006). For example, equine-assisted counseling has been used successfully to treat trauma and abuse clients, by using various theories other than attachment as the method of therapy.

In addition, ethical considerations must be followed to assure the welfare of both equines and clients. The horses must be protected from any physical or emotional distress that may be caused by clients. These restrictions are important not only for ensuring the client’s and horse’s welfare, but also for contributing to the therapist’s image as a caring, responsive, and protective attachment figure (Zilcha-Mano et al. 2011b).

Finally, therapy with horses could be the preferred choice of therapy for some but not for others, based on personal preference related to attraction or reservation, allergies or former experiences with horses. These should be screened throughout the intake process and taken into consideration in decision about one’s treatment trajectory.

Conclusion

Attachment as a Guiding Theory for Equine-Facilitated Psychotherapy

Based on literature and clinical observations, the author proposed that attachment theory can be applied to EFP to enhance its theoretical basis and address some of the gap between practice and knowledge. The application of attachment theory-based psychotherapy to EFP illustrates that there is a good fit between primary concepts of attachment theory and some of the central features of EFP. This application is both relevant and also would inform better practice of EFP. A number of areas of attachment theory such as safe haven, affect mirroring, reflective functioning and non-verbal communication were applied to EFP via theoretical underpinnings and clinical anecdotes. For example, one of the most unique aspects of utilizing horses in psychotherapy is their ability to provide instantaneous feedback, as described concerning affect mirroring, mentalizing and reflective functioning sections. This is one of the central characteristics that explain the contribution of horses to the therapy context.

Other clinical anecdotes illustrate how the inclusion of equines in therapy offers benefits above and beyond traditional attachment-based psychotherapy, via their unique presence and the experiential and physical domains. During EFP, multiple opportunities for experiencing intimate relationships with the therapist as well as with the horse are provided through an experiential process. Furthermore, EFP involves relational dynamics that may correspond to preverbal experiences. Thus, EFP entails the co-creation of relationships that may foster attachment feelings and behaviors. Such a process can help shift the client’s experience towards a more coherent and secure sense of self.

Yet, these and other concepts should be further explored. For example, the therapeutic alliance of client-horse-therapist and relational opportunities that it may offer could be further examined in light of attachment theory. Furthermore, this paper explored the application of attachment theory to EFP from the clients’ perspectives. Notably, the inclusion of animals in therapy can also provide a safe haven and a secure base for the therapist. Their presence may offer a source of comfort for the therapist, when engaged in challenging and complex processes with clients (Zilcha-Mano et al. 2011b). In addition, such a theoretical exploration should be followed by empirical studies that will provide the grounds for these theoretical claims and will situate them in the lived experience within the therapeutic process. Inquiries may be conducted by a research design that is composed of established measures such as the Adult Attachment Interview, with additional questions at the end concerning the experience participants have with horses. Consequently, this paper can serve as a reference to further theorize and explore the link between attachment theory and EFP.