Written by: Nicole Kitchener

Can equine-assisted therapy help heal invisible wounds?

Thumbnail for Treating Veterans with Equine-Assisted Therapy

Equine-assisted therapy (EAT) has hit the Canadian mainstream in a big way over the past five years. EAT is delivered through several different methods, targeting various clientele, but, at its crux, horses are used in mounted or unmounted exercises outside of a clinical setting to guide clients through a psychological journey of healing and self-understanding.

Canadian Armed Forces veterans, in particular, have said they find comfort, community and recovery through horses. Many veterans not only profoundly relate to the hierarchal nature of the horse’s social structure, which is analogous to that of the military’s chain of command, they are also often able to overcome fear and develop confidence working with horses. The horse’s movements and behaviours serve as metaphors to help the veterans change patterns of thinking related to deep-seated “invisible wounds” of war that can manifest through mental health conditions like post-traumatic stress disorder (PTSD), depression, anxiety, substance abuse and suicide.

With no official national certification regulations or standards of practice, individuals can deliver EAT with a range of education and skill levels. Some offer full-fledged programming with licensed psychotherapists and teams of professionals, others set up shop after a weekend course or two in equine-assisted learning, equine-assisted facilitation, equine leadership or similar type sessions developed for group and individual growth using horses as “teachers.”

Anyone who accepts military veterans into a program surely does so with the best of intentions. But could unqualified or underqualified practitioners create more problems for the particularly vulnerable veteran community than they are solving? Many industry experts believe so.

Caroline LeBlanc owns Serene View Ranch in Alexandra, Prince Edward Island. With nearly 27 years as a registered psychologist, she combined her professional background in trauma and PTSD with a lifelong horse passion, and opened the facility four years ago. In the two and a half years since she started a three-phase equine mindfulness therapy program, she has been flooded with interest from island veterans. LeBlanc explained her groundwork and riding program is based on evidence-based trauma psychotherapy and is delivered by a team of psychologists, a certified mindfulness specialist, highly trained equine therapists and many more experts in their fields.

“What’s going on in Canada and the rest of the world is a difficulty with standardization. I have met way too many people doing equine-assisted therapy – or they say they’re doing equine-assisted therapy – and they don’t have a model, they don’t have a mental health professional on board, and they’re doing more harm than good. That scares me,” she said. “You need a mental health professional and you need equine therapists that have extensive experience with horses.”

As with any form of mental health therapy, EAT programs should operate under standards of practice and ethical guidelines, she said. Without such parameters, veterans may be pushed too quickly, exacerbating anxiety, fear or other symptoms.

“You’re dealing with very vulnerable people and you add the horse on top of that and they become 10 times more vulnerable,” added LeBlanc. “It’s like any other form of therapy. You may touch on areas that are difficult for the client. People may not be ready. We’ve had some clients who want to do equine therapy, they do one session and it’s too powerful for them.”

LeBlanc is also concerned about horses being used that “aren’t suitable for human contact.” An example she gives is an Ontario centre that uses Friesian stallions for therapy. The sister of one of Serene View’s equine specialists attended a session at the facility, but was nearly trampled by the high-spirited animals. “She couldn’t concentrate on her therapy because she was so afraid of the horses.”

LeBlanc said the woman was also working alone, whereas a team approach allows for constant back and forth on the veteran’s progress and helps mitigate issues that might arise.

On the opposite side of the country, Terry and Paul Nichols operate 10-day residential therapy programs for veterans and first responders at their Quesnel, B.C., Pen-Y-Bryn Farm. Their program, called The Forge, is a full-immersion multidisciplinary clinic, with horses at its core, explained Terry Nichols. Clients participate in equine-assisted mindfulness sessions, group and individual therapy with a registered psychologist, trauma-centered yoga and registered massage therapy. They also get down and dirty with day-to-day farm work.

Paul Nichols, a veteran himself who faced serious struggles with PTSD, found healing in part by spending hours aboard his Canadian Sport Horse mare Zoe. It was with Zoe that Paul rode across Canada for six months in 2015 to raise awareness about veterans’ issues. Terry, a therapeutic riding instructor, provided equine-assisted mindfulness sessions for the many veterans who joined Paul in stints on the ride. Terry said she became “super protective” of how therapy is delivered to veterans during these sessions at various facilities along the national journey.

“We met hundreds – not even exaggerating – who said they want to help veterans with horses,” she said. “You can’t transfer working with kids with disabilities, for example, to working with veterans with post-traumatic stress disorder. You can’t just go from one to the other. It needs to be an experience surrounding the clientele you’re supporting. Some of the programs bring awareness with the horses, but don’t have the capacity to offer a certified mental health professional to help with what comes up, and I think that’s what’s really important.”

Terry Nichols uses her own qualifications as an example. “I have my equine-assisted learning certification. I did it in five days and paid $5,000. And that entitles me to be an ‘expert’ and to open a business? Really, it gives me so little because I’m not a psychologist, I’m an equine-assisted mindfulness instructor. I can bring awareness and maybe bring some understanding of body language, but I’m not qualified to do what a mental health professional does. I think it takes a team to serve our veterans to a certain standard they deserve, so they are supported with what comes up in the horse therapy work. There has to be more there for them.”

Can Praxis is an Alberta-based equine therapy program for veterans and first responders and their spouses (or other loved one). Launched in February 2013, the intensive program runs in three, three-day phases. The first involves theory on conflict resolution and unmounted equine-assisted learning for both “the injured” and their spouse. For phase two, pairs attend separately. They learn to care for and ride horses and debrief with facilitators in the evening by a campfire. The couples come together again for the final three-night pack ride through the Alberta foothills, again with evening debriefings.

Can Praxis is a collaboration between Steve Critchley, a 28-year veteran with a military and career background in conflict resolution and mediation, and Jim Marland, a registered psychologist with extensive experience in prisons, who is also an equine-assisted learning facilitator.

Critchley shares the same concerns as Nichols and LeBlanc. “Our biggest fear is the programs that are focused on the ‘feel-good’ and not managed correctly by registered psychologists,” he said. “Unless you’re trained as a registered psychologist and understand the forensic psychology of dealing with psychiatric patients then you’re not qualified to conduct therapy. Period.”

That’s not to dump on equine-assisted learning and similar courses completely. In fact, said Critchley, Can Praxis’ psychologists are required to undergo this type of training to understand the equine aspects of what the organization does. “EAL is like advanced first aid training. It doesn’t qualify you for open heart surgery,” he said. “It’s good for some team building, it’s good for some temporary feel-good stuff. It certainly does not qualify you to be involved in equine therapy.”

Surprisingly, given it’s rapid growth, there is scant specific empirical scientific evidence EAT works for veterans with mental health conditions. Having been approached by veterans themselves and equine organizations requesting funding for EAT programming and/or research, Veterans Affairs Canada (VAC) has made some strides in recent years to assess its safety and efficacy beyond anecdotal accounts.

In July 2015, then federal Minister of Veterans Affairs Erin O’Toole granted $250,000 to the Canadian Institute for Military and Veteran Health Research (CIMVHR) to orchestrate a national pilot study on EAT. CIMVHR subsequently sub-contracted an independent research team at Université du Québec en Outaouais to carry out the analysis, which was launched in March 2018 and is still currently underway.

Dr. Dave Blackburn, the principal investigator, is a former CAF officer, who now specializes in mental health research as it pertains to current Canadian military personnel and veterans. He also conducted a French-language study on the evolution of an EAT program in Quebec for veterans with PTSD.

In a nutshell, he said, VAC “wants to know if equine-assisted therapy is effective for veterans and what the impacts are on family members.”

Through late spring and early summer, the team’s equine specialist Émilie Lecompte-Chatel travelled across the country to visit five leading Canadian EAT centres chosen for study participation. The facilities include Paul and Terry Nichols’ farm in B.C., Can Praxis, Serene View Ranch and two other locations; Tranquil Acres Therapeutic Equestrian Centre in Ottawa, Ontario, and Équi-Sens Centre Équestre Therapéutique in Terrebonne, Quebec. She interviewed veterans who take part in the respective programs and ascertained what and how each EAT model works, said Dr. Blackburn.

“The facilities, the staff they have, the care for the horse, the other type of stuff that is very important for that type of program,” he said, adding, “We are not doing a comparative study of each centre. We are doing five little studies for the full project. That is the goal of the study – to have a large overview of different types of programs. What we want to try to see at the end is: is there any impact on veterans with mental issues and what are those impacts?”

An important aspect of the study is to determine the effects on the family and whether the veteran is using lessons learned at EAT sessions at home and in the community, Dr. Blackburn said. “Does the family see a difference from before and after the therapy with the veteran at home?”

He expects a draft report will be finished by the new year with the final study released next spring.

This isn’t the first shot of funding VAC has put toward establishing an evidence base on EAT’s effectiveness. Can Praxis was also given $25,000 in 2013 and 2016 to provide pilot studies first for the program’s phase 1 and then phase 2 and 3 together. The results were published in the Canadian Military Journal in spring 2014 and spring 2017, respectively, and can be found online.

Dr. Randy Duncan, an educational psychologist affiliated with the University of Saskatchewan, has voluntarily measured and evaluated Can Praxis’ program from its inception. Critchley said outcomes based on Dr. Duncan’s research indicate that anywhere from three to 40 months after taking part in phase one, about 93 per cent of veterans and their loved ones are using what they’ve learned either all of the time or some of the time. The length of study, plus the large number of participants, standing at around 560, means Dr. Duncan is close to submitting the data for peer review, said Critchley.

Ideally, said Terry Nichols, Dr. Blackburn’s investigation and other Canadian research, will not only help VAC ultimately establish EAT standards of practice, but will also pave the way for financial support, as it doesn’t cover the cost of such programs as it does with psychotherapy and other interventions. (Although, in the last federal budget, the government added “psychiatric service dogs” to the list of medical items veterans can claim as a tax credit.)

“The equine therapy portion of our program, we donate,” said Nichols. “We aren’t funded for that piece. But we believe it’s important to have it as the cornerstone of our program.”

Can Praxis operates as a non-profit, and is able to offer its programs free to participants thanks to generous funding from Wounded Warriors Canada. By the end of the next fiscal year, this privately funded organization will have supported Can Praxis to the tune of just over $1 million since 2013.

Canada’s 15,000 veterans eligible to receive mental health support might not be the only beneficiaries if VAC gives EAT the thumbs up. Current Canadian Armed Forces members, numbering 68,000 in the regular service and 27,000 reserves, not to mention active and retired first responders, may also find this avenue of treatment opening up to them. Ensuring the legitimacy, safety and efficacy of EAT and the individuals who offer such programming is crucial.

As Critchley said, “This isn’t a game we’re playing. This is people’s lives and we have to be extremely cautious of that.”