equine psychotherapy pamela schultz, ph.d., rn associate dean & director of nursing new mexico...

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EQUINE PSYCHOTHERAPY EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Associate Dean & Director of Nursing Nursing New Mexico State University New Mexico State University

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Page 1: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

EQUINE PSYCHOTHERAPYEQUINE PSYCHOTHERAPY

PAMELA SCHULTZ, Ph.D., RNPAMELA SCHULTZ, Ph.D., RNAssociate Dean & Director of Associate Dean & Director of

NursingNursing

New Mexico State UniversityNew Mexico State University

Page 2: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

The ProblemThe Problem

Substantial numbers of children witness Substantial numbers of children witness family violence. family violence.

The prevalence is actually unknown but The prevalence is actually unknown but studies have suggested that 11%-20% of studies have suggested that 11%-20% of children have a childhood incidence of children have a childhood incidence of witnessing family violence.witnessing family violence.

There is evidence that family violence There is evidence that family violence between parents has adverse effects on between parents has adverse effects on the children in the family the children in the family

Page 3: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Problem (cont’d)Problem (cont’d)

These children are at greater risks for These children are at greater risks for behavioral problems, including aggression, behavioral problems, including aggression, cruelty to animals, truancy delinquency, mental cruelty to animals, truancy delinquency, mental health disorders, including anxiety, anger, health disorders, including anxiety, anger, depression and suicidal ideations, withdrawal, depression and suicidal ideations, withdrawal, low self-esteem, attention-deficit disorder.low self-esteem, attention-deficit disorder.

Family violence witnessed by children affects Family violence witnessed by children affects the developmental representations of the developmental representations of relationships. Consequently, these relationships. Consequently, these representations may shape children’s representations may shape children’s perceptions and behavior in later life. perceptions and behavior in later life.

Page 4: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Problem (cont’d)Problem (cont’d)

A therapy based in relationship-A therapy based in relationship-building may provide children with building may provide children with experiences that enhance trust, experiences that enhance trust, communication, and guidance to communication, and guidance to healthier relationships.healthier relationships.

Page 5: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Equine PsychotherapyEquine Psychotherapy

EAP is a specialized form EAP is a specialized form of psychotherapy using of psychotherapy using the horse as a therapeutic the horse as a therapeutic tool.tool.

Horses have several Horses have several characteristics that are characteristics that are similar to humans in their similar to humans in their behavioral responses and behavioral responses and social structures, thus social structures, thus providing a mirror for the providing a mirror for the client to gain insight in a client to gain insight in a unique and non-unique and non-threatening environment. threatening environment.

Page 6: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Equine Psychotherapy Equine Psychotherapy (cont’d)(cont’d)

The horse is a large, The horse is a large, powerful animal that powerful animal that commands respect commands respect and elicits fear. and elicits fear. Overcoming these Overcoming these obstacles and obstacles and building a relationship building a relationship promotes confidence, promotes confidence, relationship skills and relationship skills and problem solving skills.problem solving skills.

Page 7: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Equine Psychotherapy Equine Psychotherapy (cont’d)(cont’d)

EAP is designed to EAP is designed to address self-esteem address self-esteem and personal and personal confidence, confidence, communication and communication and interpersonal interpersonal effectiveness, trust, effectiveness, trust, boundaries and limit boundaries and limit setting, and group setting, and group cohesion . cohesion .

Page 8: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

RationaleRationale

This type of therapy This type of therapy provides opportunities provides opportunities for the child to identify for the child to identify and understand and understand personal emotions, personal emotions, develop empathy, develop empathy, develop a sense of develop a sense of responsibility, learn to responsibility, learn to problem-solve and to problem-solve and to succeed in new succeed in new undertakings.undertakings.

Page 9: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Purpose of StudyPurpose of Study

Test the efficacy of EAP in a cross-Test the efficacy of EAP in a cross-sectional group of children referred sectional group of children referred to a psychotherapist for various to a psychotherapist for various childhood behavioral and mental childhood behavioral and mental health issues.health issues.

Page 10: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

MethodologyMethodology

Over an 18-month period children were Over an 18-month period children were referred to a psychotherapist for treatment of referred to a psychotherapist for treatment of various conditions. various conditions.

Each child and parent was interviewed by the Each child and parent was interviewed by the therapist to determine the suitability for EAP. therapist to determine the suitability for EAP.

The sample size was one of convenience in The sample size was one of convenience in that it included all children referred to the that it included all children referred to the therapist during that 18 month period therapist during that 18 month period (unselected consecutive sampling). (unselected consecutive sampling).

Page 11: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

The InterventionThe Intervention

An equine specialist and a therapist work An equine specialist and a therapist work together to plan safe treatment sessions. together to plan safe treatment sessions.

Interventions or activities are planned Interventions or activities are planned around the concept of the horse’s around the concept of the horse’s reflective behavior. reflective behavior.

Interventions are tailored to each Interventions are tailored to each individual and their needs as assessed by individual and their needs as assessed by the psychotherapist and the child and/or the psychotherapist and the child and/or parent. parent.

Page 12: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Examples of the Examples of the InterventionIntervention

Grooming the horse is learned and practiced. The Grooming the horse is learned and practiced. The child becomes acutely aware that the horse will only child becomes acutely aware that the horse will only lift their hoof for inspection if the horse chooses to. lift their hoof for inspection if the horse chooses to. The child is unable to force the horse to do this. The child is unable to force the horse to do this. Children sometimes perceive resistance or an Children sometimes perceive resistance or an unwillingness from the horse to lift their hoof which unwillingness from the horse to lift their hoof which may lead the child to have feelings of fear, may lead the child to have feelings of fear, inadequacy, and/or anger and frustration. At this inadequacy, and/or anger and frustration. At this time the opportunity for the therapist to help the time the opportunity for the therapist to help the child process these feelings is immediate and child process these feelings is immediate and powerful. This is done by calling attention to the powerful. This is done by calling attention to the child’s feelings and encouraging them to talk about child’s feelings and encouraging them to talk about their feelings. The child soon learns that the horse their feelings. The child soon learns that the horse is more likely to respond when the child is less is more likely to respond when the child is less fearful and/or angry.fearful and/or angry.

Page 13: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Examples (cont’d)Examples (cont’d)

Special attention to consciousness of one’s body is Special attention to consciousness of one’s body is essential for safety, which is used as a essential for safety, which is used as a demonstration of how it is in the rest of the world. demonstration of how it is in the rest of the world. Many times children are unable to understand their Many times children are unable to understand their place in the world, they may feel themselves to be place in the world, they may feel themselves to be insignificant or invisible. By instructing them about insignificant or invisible. By instructing them about how to approach the horse, for instance, remain in how to approach the horse, for instance, remain in their line of vision, do not come upon the horse their line of vision, do not come upon the horse until the horse can see who is approaching, the until the horse can see who is approaching, the child experiences their place in relation to others child experiences their place in relation to others within their environment. While providing for the within their environment. While providing for the child’s safety the therapist helps the child to see child’s safety the therapist helps the child to see how they fit into the world. how they fit into the world.

Page 14: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Examples (cont’d)Examples (cont’d)

Children are able to make connections Children are able to make connections with the horse which facilitates with the horse which facilitates vulnerability. They may be in a large vulnerability. They may be in a large enclosure with the horse and instructed enclosure with the horse and instructed to have the horse move using voice to have the horse move using voice tone and body language. This allows tone and body language. This allows the child to move from powerlessness the child to move from powerlessness to seeking support to feelings of to seeking support to feelings of success.success.

Page 15: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Evaluating the InterventionEvaluating the Intervention

The Children’s Global Assessment of The Children’s Global Assessment of Functioning (GAF) Score is determined by Functioning (GAF) Score is determined by the treatment team before treatment starts the treatment team before treatment starts and at 3 month intervals until treatment is and at 3 month intervals until treatment is concluded.concluded.

This is a 100-point rating scale measuring This is a 100-point rating scale measuring psychological, social and school functioning psychological, social and school functioning for children aged 6-17. It was adapted from for children aged 6-17. It was adapted from the Adult Global Assessment Scale and is the Adult Global Assessment Scale and is considered a valid and reliable instrument considered a valid and reliable instrument for rating a child’s general level of for rating a child’s general level of functioning in a health-illness continuum. functioning in a health-illness continuum.

Page 16: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Description of the SampleDescription of the Sample

63 children ages 4-16 years63 children ages 4-16 years59% males59% males41% females41% females

Males significantly older than the femalesMales significantly older than the femalesmales = males = 11.5 11.5 ++ 2.6 2.6females=females= 10.110.1 + 3.3 p = 0.05

EthnicityAnglo = 51%Hispanic = 46%Black = 3%

Page 17: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Psychiatric Diagnosis Psychiatric Diagnosis CategoryCategory

Mood disturbancesMood disturbances 57%57% ADHDADHD 16%16% PTSDPTSD 8%8% Adjustment disordersAdjustment disorders 5%5% Disruptive disordersDisruptive disorders 5%5% OtherOther 5%5%

Page 18: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Diagnosis, Gender, EthnicityDiagnosis, Gender, Ethnicity

Females tended to be diagnosed with Females tended to be diagnosed with mood disorders more often than mood disorders more often than malesmales

No ethnic differences in diagnosisNo ethnic differences in diagnosis

Page 19: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

Violence in the HomeViolence in the Home

Interparental violenceInterparental violence 40%40% Child abuse and/or neglectChild abuse and/or neglect 27%27% Sexual abuseSexual abuse 20%20%

children with a history of sexual abuse were children with a history of sexual abuse were significantly more likely to have had a parent with significantly more likely to have had a parent with a substance abuse problem (75% vs. 22% , a substance abuse problem (75% vs. 22% , p < p < 0.0010.001). ).

children who were identified as having a history of children who were identified as having a history of abuse were significantly more likely to have abuse were significantly more likely to have witnessed interparental violence in the home (65% witnessed interparental violence in the home (65% vs. 25%, vs. 25%, p = 0.002p = 0.002).).

Page 20: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

GAF ScoresGAF Scores

Pre treatment 54 Pre treatment 54 ++ 3.2 3.2 Post treatment 61.7 Post treatment 61.7 + 5.0 p = 0.001

All children showed improvement in GAF scores Females showed significantly greater

improvement in GAF scores p = 0.02 Younger children showed significantly greater Younger children showed significantly greater

improvement in GAF scores improvement in GAF scores p = 0.01p = 0.01 Children with a history of intrafamily violence Children with a history of intrafamily violence

tended to show greater improvement than those tended to show greater improvement than those who did not who did not

p = 0.01p = 0.01

Page 21: EQUINE PSYCHOTHERAPY PAMELA SCHULTZ, Ph.D., RN Associate Dean & Director of Nursing New Mexico State University

ConclusionsConclusions

EAP is an effective intervention for EAP is an effective intervention for children with a history of mental children with a history of mental disturbance and a history of disturbance and a history of intrafamily violence.intrafamily violence.