15Taking Hold of the Reins: Responding to the Ethical Need for Professionalism in Equine-Facilitated Psychotherapies

Anne M. C. Barnfield, Shelley L. Goodwin, Jaqi Allan, Shannon D. Boyce

Pulling open the barn door we are greeted by the smell of fresh hay, a whinny, and big brown eyes looking at us expectantly; our hearts swell with joy and, without noticing, our shoulders drop as we release the tension that we have been holding. Comfort and a sense of contentment settle into our bodies. Welcome to the barn!

Each author of this chapter has opened that door numerous times in their lives, and it is that sense of welcome and comfort that has drawn us to work in the field of equine-facilitated psychotherapy. We share a deeply personal understanding that being around a horse can be psychologically beneficial. In the horse world there is a widely cited fun quote that reads, “My therapist told me I need a stable relationship in my life, so I bought a horse.” This saying expresses what horse people already strongly believe—horses are good for our well-being, nurture us, and are there for us; we benefit from having them in our lives. In recent years, this belief has moved out of the barn and into a growing field in psychology, in which horses are incorporated into therapeutic interventions. For almost a century, horses have been actively used to help those with disabilities experience achievement and empowerment; however, it is only in the past two decades, through equine-facilitated psychotherapy, that horses are being used to help people achieve improved mental wellness. The importance of ethically developing and implementing equine-facilitated psychotherapy will be explored in this chapter with respect to Principle IV (Responsibility to Society) of the Canadian Code of Ethics for Psychologists, (Canadian Psychological Association [CPA], 2017).

Since it does not rely on language as the mechanism for interaction and change, equine-facilitated psychotherapy, like other animal-assisted therapies, overcomes a perceived limitation of traditional psychotherapy, namely its reliance on verbal communication (Wilson et al., 2017). By working with a horse, equine-facilitated psychotherapy provides therapists with a way to engage with the client in a less direct manner, allowing the client to engage in the psychotherapy experience in a way that a traditional office setting would not allow. Horses have helped teens who have experienced abuse to develop self-confidence and those with attachment difficulties to understand relationship skills (Lentini & Knox, 2015). Horses also have helped youth with autism understand personal space and boundaries, bereaved adults work through grief, and police and military veterans who experience the symptoms of post-traumatic stress disorder (PTSD) to connect with family (Russell, 2013; Symington, 2012). As horse enthusiasts, we are aware of the psychological benefits that come from being around horses, and as clinicians we also believe that equine-facilitated psychotherapy can provide opportunities to help populations who may not be served easily with traditional forms of talk psychotherapy.

Equine-facilitated psychotherapy can range from individual to group sessions, with considerable structure and exercises, to no structure or prescribed interventions. Given this variability, it can be difficult to evaluate the efficacy of interventions or therapeutic approaches. However, promising recent systematic reviews are providing empirical support (Srinivasan et al., 2018; Trzmiel et al., 2018). Equine-facilitated psychotherapy, like other forms of animal-assisted intervention, is still lacking the large-scale randomized controlled studies that would facilitate a standardized approach. There is a need for rigorous, scientific evaluation that could provide the next level of empirical evidence needed. The lack of standardization (i.e., a consistent approach to how equine-facilitated therapy is conducted) places equine-facilitated psychotherapy outside the mainstream empirical literature and on the margin of traditional psychotherapy practice.

Because of this lack of standardization, clinicians encounter challenges if they are thinking of providing equine-facilitated psychotherapy. Such challenges include: (a) addressing whether clinicians should recommend this form of psychotherapy to their clients; (b) how to work with colleagues who may not have sufficient equine and/or psychotherapy training; (c) how to work cooperatively in a multidisciplinary setting; and (d) how to obtain appropriate training to competently provide this type of service. Needless to say, these issues can create ethical challenges for practitioners who wish to engage in this new and evolving area of clinical practice. It is from this context that we hope to engage the reader in considering the development and implementation of effective, ethical equine-facilitated psychotherapy for mental health issues.

In this chapter we will provide a collective examination of what ethical equine-facilitated practice can look like, focusing our attention on Principle IV (Responsibility to Society) of the Code (CPA, 2017). We begin by introducing ourselves and explaining why we are writing this chapter together. We will then: (a) briefly outline the history and describe several forms of equine therapy; (b) outline the major ethical challenges related to honouring Principle IV; (c) share some personal stories of facing these issues, and how we handled them; and (d) give our view on where we need to go from here. In doing this, we will look at how we have tried to build an ethical bridge between the two worlds (equine and psychology) that we know so well, so that we can support the ethical development and provision of equine-facilitated psychotherapy in an effective, principled, and purposeful manner.

Who Are We, and Why Do We Embrace Equine-facilitated Psychotherapy?

Anne: I am a faculty member in psychology at Brescia University College at the University of Western Ontario. From a start in biopsychology and experimental psychology, I gradually moved into human behavioural research and then eventually to investigating the effects of activities and therapies involving equines. The move into the equine world in some ways was inevitable, given my personal interests; in other ways, it was accidental. The serendipitous moment came ten years ago when a student wanting to engage in research in an independent study course asked me to supervise her. Both of us were horse riders and interested in the benefits of physical activity for mental health. Out of our discussions as to what to study for the research project, we decided to investigate the effectiveness of therapeutic riding (defined more fully later in this chapter) for children at a summer camp. From the implementation of that first student study, I became a researcher into the effects of therapeutic riding and equine-facilitated psychotherapy (e.g., Barnfield & Mitchell, 2018; Carey et al., 2013), and a therapeutic riding volunteer (leading and side-walking). At the same time, my interest in riding increased from simple once-a-week lessons, to leasing a horse, to eventually having one of my very own. My equine partner¹, Lilliput, is a Canadian Warmblood sport horse. We practice and compete at the local level in hunter-jumper and dressage riding. I also have been involved with several national and international organizations that promote equine-facilitated psychotherapy, including the Canadian Therapeutic Riding Association (CanTRA), the Certification Board for Equine Interaction Professionals, and Horses in Education and Therapy International (HETI).

Shelley: “Horses are not my whole life, but they make my life whole.” I don’t know who originally said this, but I have understood its sentiment for many years. In my younger years, when I was with my pony, I felt complete, as though the final piece of the puzzle was snugly put into place. I have been riding since I was seven and have a scar on my chin to prove it! A tumble off my pony, Kandy Kid, didn’t stop me then and other falls since have never deterred me from seeking the freedom I feel on the back of a horse, or the connection I sense when nuzzled into their necks during “barn time.” In my first career, I rode throughout North America as part of the Royal Canadian Mounted Police Musical Ride. Riding those famed black horses was a dream come true for me, but it also allowed me to meet my current riding partner, Nell, who is a Canadian horse, which is Canada’s national horse breed. Now, as a doctoral-level psychologist, I have obtained training in equine-facilitated psychotherapy and conducted research in equine therapy. I have a busy small independent rural practice and act as a peer reviewer for journals that sometimes publish articles related to animal-human interaction research. I also publish freelance articles about equine-facilitated psychotherapy in mainstream publications in an effort to provide psychological knowledge translation to the general public (Goodwin, 2009) as well as to mental health providers (Goodwin, 2011; Goodwin et al., 2017).

Jaqi: As a masters-level clinical social worker I have focused my career on mental health, in both hospital and community settings, with particular attention to issues of relevance to the LGBTQ community and to children with disabilities. As a member of an interprofessional team, I have conducted research on equine-facilitated psychotherapy and enjoy being around collaborating equine partners, whom I find to be such graceful beings. I also enjoy four-legged companions that are smaller in size (cats and dogs) and have been their live-in companion and adopter—and, I would say, they have been mine in return.

Shannon: As a doctor of veterinary medicine, I own a mixed-animal veterinary practice in rural Nova Scotia. Ever since I could speak, I have been thoroughly obsessed with horses, and I strongly believe that when they are “in your blood” you just can’t help it. I have three equine partners in my life—a senior Paint horse named Tom, who is a wonderful pasture pet, and two American Quarter Horses named Luke and Abby. Luke and I train and compete together in a variety of events including western pleasure, trail, and horsemanship riding at American Quarter Horse breed shows in the Maritimes. Abby is my new up-and-coming show prospect. Being a veterinarian is a taxing and stressful job at times; however, when I am with my equine partners, whether training, competing, or simply grooming and cleaning stalls, I experience first-hand the benefits to my personal mental health. Recently, I started volunteering with a local therapeutic riding program and have helped during their horse shows, where all athletes are equal while beside or astride a horse.

All four of us share a committed enthusiasm for engaging in collaborative authorship, ethical practice, equestrian life, and for seeing equine-facilitated psychotherapy develop, and have chosen to write this chapter together. It is important to us that we help students and professionals new to the field have access to scholarship that addresses the ethical issues of therapy provision in this new and evolving area of clinical practice.

What is Equine-Facilitated Therapy (EFT)?

Therapeutic riding has existed in various forms for centuries—Hippocrates (whose name means “Horse Power”) wrote about the benefits of using horse-riding for rehabilitation in the 5th Century BC (Riede, 1987). However, a major modern turning point was in 1952, when Danish Olympian Dame Lis Hartel, who was paralyzed as a result of polio, brought the therapeutic effects of riding to the general public’s attention when she won a silver medal in Grand Prix dressage. This demonstration of the beneficial effects of riding created both interest and demand. When not on a horse, Dame Hartel required a wheelchair to be mobile; her performance and success in riding showed how horses can help people with physical disabilities increase strength, endurance, and flexibility. The connection between Dame Hartel and her beloved equine partner, Jubilee, was evident, with Jubilee altering her response to riding aids (use of leg pressure, rein contact, etc.) depending on whether Dame Hartel or someone else was riding her. After retirement from international competition, Dame Hartel, with the benefit of her personal experience of not only the physical, but also the social, emotional, and psychological benefits of riding, went on to assist in the development of therapeutic riding.

There are three types of therapy involving equines: therapeutic riding, hippotherapy, and equine-facilitated psychotherapy (see Goodwin et al., 2017). Although this chapter is focused primarily on equine-facilitated psychotherapy for mental health issues, it is important to have a basic understanding of the other two types for comparison. The most common is therapeutic riding which uses trained volunteers and certified therapeutic riding instructors to deliver horse-riding experiences. The focus of therapeutic riding is on teaching riding and horsemanship skills to develop confidence and self-esteem (CanTRA, 2018). Although there may be some personal well-being benefits obtained, therapeutic riding is not primarily focused on treatment of mental health issues.

Hippotherapy is a word that is derived from the Greek language and means treatment with the help of a horse. It is the second-most common form of equine-facilitated therapy. In this approach the horse is not used for development of riding skills, but more as a therapeutic “tool.” The goals of hippotherapy may include improvement of a client’s gross or fine motor or self-help skills, or improvement in such abilities as communication. While therapeutic riding uses trained volunteers and certified therapeutic riding instructors, hippotherapy therapists have training, and must be credentialed, in a particular profession such as physical or occupational therapy, or speech-language pathology. Treatment plans are developed, and interventions are established, based on specific therapeutic goals. As hippotherapy has been practised for considerable time, an established and expansive research base is available to support it (Bass et al., 2009; Carey et al., 2013; Gabriels et al., 2011).

The third, and most recently developed, type of therapy is equine-facilitated psychotherapy, which is the focus of this chapter. It is an experiential form of psychotherapy that includes horses and sometimes can be called different names, including equine-facilitated wellness, equine-facilitated counselling, equine-assisted psychotherapy, and equine-assisted/facilitated psychotherapy (see Hallberg, 2008). This form of psychotherapy can include a number of activities with horses (e.g., grooming or driving), as well as riding. In equine-facilitated psychotherapy, therapeutic treatment goals may include enhancing self-esteem and dealing with self-help issues, addressing boundary awareness, and other personal growth and development concerns. More recently, some clinicians are branching into treating clinical diagnoses such as anxiety, depression, and PTSD, and research is being conducted to validate this clinical work (Lentini & Knox, 2009; MacLean, 2011; Wilson et al., 2017). Anne was involved recently in a study on the effectiveness of equine-facilitated psychotherapy for military veterans with PTSD, the preliminary results of which show beneficial effects of this therapy for such personnel. Similarly, the Department of Veterans Affairs has collaborated with Can Praxis (an Alberta-based organization focused on treating veterans and active military members utilizing equines in psychotherapy) and the Canadian Institute of Military and Veteran Health Research to complete efficacy trials of equine-facilitated psychotherapy with veterans having a diagnosis of PTSD (Loney, 2015). Results are not yet available but are eagerly awaited. Equine-facilitated psychotherapy views the horse as a sentient partner that deserves respect in the process (Hallberg, 2008). Although horses do not have the same level of reasoning as a human being, the horse is treated with respect, and every effort is made to provide them with work that they enjoy. In using this approach, horses are not seen as tools that we use but as sentient beings that are perceptive to human emotion and very capable of feeling (Nakamura et al., 2018; Scopa et al., 2019; Smith et al., 2016). As noted earlier (in note 1), while some may see horses as tools in the therapeutic setting, we see horses as partners, working with us willingly to aid others.

Practicing Equine-facilitated Psychotherapy Today

Due to the growing popularity of equine-facilitated psychotherapy and early results suggesting its benefits (e.g., Barnfield & Mitchell, 2018; Carey et al., 2013), several third-party benefit providers now fund this modality (e.g., Albany NY Veterans Affairs; Heroes Equine Learning Program—charity [H.E.L.P.]; Veterans Affairs Canada). With the opportunity to add this type of therapy to a private practice, many clinicians are taking it on with vigour.

The Emergence of Credentialing Bodies

The field has progressed to the point that we now have two recognized organizations advocating for specific training requirements for those working with horses in psychotherapy. It has only been since 2017 that CanTRA published their accreditation standards for their Equine-Facilitated Wellness certification (CanTRA, n.d.). These standards detail the different levels of training available for the regulated mental health professional as well as the equine expert. The standards provide guidance and guidelines to ensure safety that until now has been missing. For example, they clarify that “in no circumstance does CanTRA condone a situation where more than one unrestrained horse and/or more than one client are in an arena together at one time” (CanTRA, 2018). As each of us has seen, some practitioners have had several clients in the arena with one or two horses. In balancing our clients’ safety and that of our equine partners, it is important to not overwhelm either the clients or the horses, as this can place both at physical and psychological risk. CanTRA has partnered with the credentialing body, the Certification Board for Equine Interaction Professionals, to further promote the appropriate certification of persons working in both education and therapy settings.

Equine-Facilitated Wellness Canada (EFW-CAN) is another Canadian organization that provides credentialing for Canadian mental health practitioners who wish to provide equine-facilitated psychotherapy. Developed at about the same time as CanTRA’s guidelines, the EFW-CAN credentialing requirements are slightly different and require mental health practitioners to be “members of a professional association” (Equine Facilitated Wellness Canada, n.d.) but not necessarily of a regulated profession, and to have training in the area of equine-facilitated wellness. There also are different classifications for practitioners who identify as “learning professionals,” such as those in education, nursing, life coaching, and literacy training.

There is no doubt that a lack of adequate training and regulation of practice can place the public at risk. Credentialing of practitioners is one way to reduce the risk to the public by ensuring qualified mental health practitioners are providing services. Yet we also need to consider the importance of having equine partners who are chosen for this demanding job based on their suitability. Horses are large fight-or-flight animals that, if not well trained and handled, can cause significant injury to clients very quickly. Quite simply, some horses have the aptitude, physical strength, and personality for this type of work, and others do not. It’s important that the right animal is selected for the job (Kitchener, 2018). Secondly, if the therapist is not properly trained, the client may receive inadequate and/or inappropriate treatment for their mental health issue, putting the client at risk of harm. In addition, if the therapist does not have adequate training in equine behaviour and management, there are risks of harm to the equine partners from unsafe interactions and heightened stress reactions (Horses and Humans Research Foundation, 2019). It is important also for the therapist or assisting equine expert having a strong emotional relationship with their equine partner—being able to “read” the horse’s emotional state, to understand their responses, and to know when situations are stressful to the animal.

Ethical Interprofessional Collaborative Practice (IPC)

Interprofessional collaborative practice (IPC) is an approach that promotes engaging community members and breaking down silos between professions (Canadian Collaborative Mental Health Initiative, 2006; Goodwin et al., 2016). As we have learned, a number of organizations recommend that equine-facilitated psychotherapy be conducted in a team fashion, with a horse expert, a mental health practitioner and an equine partner working together (CanTRA, n.d.; Equine Assisted Growth and Learning Association [EAGALA], 2018). Thus, IPC between disciplines involved in equine-facilitated psychotherapy is seen as optimum (Timmons & Fine, 2015). In an equine-facilitated psychotherapy environment, membership on ICP teams may go beyond members of traditional mental health disciplines (e.g., speech-language pathologists, occupational therapists, recreation therapists) and include not only the mental and physical health providers and horse experts, but also stable managers, veterinarians, farriers, equine massage therapists, and equine chiropractors.

Mental health professionals, as well as other collaborating partners in equine-facilitated psychotherapy, are to be guided by their own profession’s code of ethics. In addition, all partners should be aware of each other’s codes and endeavour to practice to the highest standard across those codes (Bourque & Horney, 2016; Canadian Association of Social Workers [CASW], 2005; CPA, 2017). Most codes, if not all, have an expectation that professionals will promote the development of knowledge and promote innovation within their field in ways that benefit the welfare of all human beings and of society as a whole (Bourque & Horney, 2016; CASW; CPA). Principles of Veterinary Medical Ethics of the CVMA contains a similar principle for veterinarians as well as promoting the welfare of animals (Bourque & Horney, 2016). Thus, as we promote and practice equine-facilitated psychotherapy with an IPC approach, it is important to have a firm understanding not only of our profession’s code of ethics but of all collaborating partners’ code of ethics.

Through our experience, we have come to know that good equine-facilitated psychotherapy includes a strong support circle surrounding the therapeutic team (psychotherapist, equine expert, and equine partner), ensuring that all are well cared for. Just as we humans need self-care such as our medical doctor, massage therapist, and chiropractor, our equine partners have their own self-care team, which can include veterinarians, equine massage therapists, farriers, and equine chiropractors. When ridden by novice riders, horses may experience back issues and muscle strain as the novice rider begins to adjust to the movement of the horse. Just as humans go to professionals to seek pain relief for their muscle strains, having a veterinarian, massage therapist, or chiropractor available to the horse can be of great benefit. Although these professionals may not be involved in the therapy session per se, you will see how they can play significant roles in assisting the provision of equine-facilitated psychotherapy, maintaining our equine partners’ health, conducting research, and being part of the process of ensuring confidentiality. The interprofessional aspect of equine-facilitated psychotherapy is an underexplored area that is ripe for future research.

Unlike traditional therapy, equine-facilitated psychotherapy may be conducted in a large barn, arena, or both, with a horse expert or other horse handlers in attendance. In this situation, those involved in the provision of therapy must consider the welfare and well-being of both the client and the horse, but also be aware of the presence in the stable environment of barn staff, other horse owners, members of the public, and other professionals (e.g., veterinarian, farrier, equine chiropractor), who may be coming and going. This environment means the therapist is not able to provide the level of privacy and confidentiality of a traditional therapy office. As such, the situation presents a multitude of ethical challenges which we try to capture below.

Our broad interdisciplinary approach is woven into the examples chosen from our lives. We explore the challenges of implementing equine-facilitated psychotherapy, including sometimes choosing not to implement this intervention, into our professional practice. Where needed, we have modified and disguised the details to protect and maintain the privacy and confidentiality of those involved.

Ethical Challenges Related to Competence—Shelley’s Story

As an early-career psychologist, I won a free trip anywhere in North America that Air Canada flies. As I picked up my prize, I knew that this was my chance to attend an equine psychotherapy training opportunity that had been on my bucket list for several years. At the five-day training course there were 10 participants with varying educational and clinical backgrounds, and equine experience ranging from considerable to next to nothing. As the training unfolded, I heard participants with no horse experience and/or who were not regulated as health care providers say that they were planning on adding equine-facilitated psychotherapy to their practice. As the week progressed, I began to question how to ethically introduce this therapeutic model into my own rural-based practice and maintain confidentiality in the process. I also openly questioned the lack of scientific rigour in the psychotherapy approach we were learning. I walked away with more questions than answers. I also walked away worried that some of the participants, despite the trainer’s clarity in laying out the requirement to have additional training before being certified to provide equine-facilitated psychotherapy, were planning to offer this therapy immediately after this short course.

As this was a new field of practice, there were no standardized protocols available and, once home, I was left with a feeling of it all being “airy-fairy.” Although I had practiced as a clinical psychologist for eight years at that point, there was no clinical therapist in my area with experience in equine-facilitated psychotherapy. This meant I had no one to consult with locally. In my barn, located in my backyard, I had the ideal therapeutic horse, a Canadian mare named Venus. She was 23 years old and “unflappable.” She would fit the bill perfectly, but it would mean having clients in my barn, which was only 20 feet from my house. I became concerned that this situation would result in losing my personal life-space to my work. Furthermore, promising confidentiality on my property, with family members frequently stopping by, neighbours in close proximity, and everyone knowing what type of work I do, would be next to impossible. I began to doubt its transferability from my personal experiences of wellness to the general public. I questioned how my regulatory body would view this new type of therapy. I worried my colleagues would think I was not being professional enough. I worried that if I did this, I would be associated with people providing this intervention who were not being ethical, and I didn’t want to be tarred with the same brush. I was confused and conflicted about my next step.

All this uncertainty was too much for me at that point. The lack of clarity was something I was not comfortable with. Although I believed that being around horses is good for people, and I liked the quote often attributed to Winston Churchill, that “there is nothing so good for the inside of a man as the outside of a horse,” I also believed then, as I do now, that it is important that when we provide the public with a service we need to be providing a competent service. I knew I needed to be comfortable and confident in order to provide this service, and I just wasn’t. Defining what competent service looked like was difficult at that time because of the early stages of the development of this intervention, but I did have my Code to help guide me with this decision. I decided to work in the field by conducting research-related activities and scholarly writing, as well as freelance writing, in an effort to engage in knowledge mobilization—taking the current research and putting it into the public’s hands. This also gave me time to figure out how to provide a confidential service and not lose the personal refuge of my barn to my professional life.

In several of our offices (Anne, Shelly, Shannon), we have pictures of our horses. From these pictures, it would not be hard to conclude that we have knowledge of horses. As a result, we often are asked questions about the efficacy of this emerging form of therapy; therefore, it was not surprising when, several years ago, one of my clients approached me with the idea of receiving equine-facilitated psychotherapy. They knew that I had horses and thought that I could provide equine-facilitated psychotherapy to them instead of the traditional in-office therapy they were currently receiving. At that point I was not doing equine-facilitated psychotherapy and declined. However, I recognized that I had a responsibility to my client to explore options in the local community and beyond. I decided to contact my provincial psychology association, which maintained a private practice referral registry, to see if there was anyone in the area or province that provided this service and who was credentialed.

From my experience with horses, I realized that I would feel more comfortable providing a referral to a practitioner providing equine-facilitated psychotherapy where both a therapist and a horse expert are in the session. After careful consideration of all aspects, I searched for a therapist who was regulated by a governing body and had psychotherapy in their scope of professional practice. The closest I found was three hours away. I spoke with my client about this and they decided that it was too far to travel. However, they identified other issues they had that could benefit from equine therapy, specifically occupational therapy-related problems. There was a credentialed and certified equine therapy provider locally who could meet these needs. This opportunity allowed the therapy sessions to be claimed through my client’s allied health benefits—an issue for those who have to rely on health benefits to pay for therapies.

Ethical Challenges Related to Research—Anne’s Story

As a scientifically trained person, I strongly believe in the importance of continuing to conduct research to further evaluate the efficacy of equine-facilitated psychotherapy. I am saddened, however, by the constant difficulties in pursuing such research and the negative attitudes often encountered from those with the power to permit or deny such research. Research by experimental psychologists like me helps to establish practices that are evidence-based (a cornerstone of professional practice for clinicians) and supports the capacity of other professionals and non-regulated health care providers to strive for the highest ethical standards of practice possible within the development of new theoretical approaches, which is inherent in Principle IV. Despite these difficulties, we all—Anne, Jaqi, Shelley, Shannon—have participated in research related to horses and some of us have conducted our own research related to equine-facilitated psychotherapy.

Conducting any type of research is frequently challenged by the need for funding, and difficulty in finding both participants and the time to conduct the research. Those involved in equine-facilitated psychotherapy research often experience difficulties in getting to do such research because of lack of understanding of what this type of therapy actually is and how it is applied. Unlike other areas in psychology, EFP research comes with even further difficulties, including lack of knowledge about this emerging field by funding agencies, academic institutions, and research ethics boards (REBs). I have run into difficulties in being able to evaluate the effects and effectiveness of equine-facilitated psychotherapy because of this issue. Any research related to, or run from, a government-funded institution (such as a university), or using government research funding, must abide by the Tri-council Policy Statement on Ethical Conduct for Research Involving Humans (Canadian Institutes of Health Research et al., 2018). As part of this policy, all institutions must have an REB, which oversees research to ensure that it adheres to the policy guidelines. It is only after REB approval that research can proceed. The problem with the emerging field of equine-facilitated psychotherapy is that members of a REB often do not have any experience with, or knowledge of, this form of therapy. My research on equine-facilitated psychotherapy for military veterans and first responders (emergency services personnel) suffering from PTSD had to go through such REB scrutiny. As my work involved therapy, it went to a “full board” Health Sciences REB (HSREB). The interdisciplinarity of equine-facilitated psychotherapy, which occurs with our interprofessional collaborative practices (ICP, as mentioned earlier), means that several different sets of ethics standards may apply. In this case, both “practice” and “research” issues for such work need to be considered. With the HSREB, it seemed that a lack of comprehension regarding the equine-facilitated psychotherapy setting led to misunderstandings and delays. It is, of course, necessary to protect research participants from harm, but research in this field is also necessary for proper evaluation and to understand how the therapy best works. From personal experience, I can say that achieving REB approval in this field can take a lot of time and effort!

A specific example of an REB-related issue which I encountered was what I thought was over-protectiveness of participants. Potential participants in equine-facilitated psychotherapy research often are very keen to take part—they see equine-facilitated psychotherapy as an interesting and potentially helpful intervention and often are excited at the prospect of being involved. Responsibility to Society involves co-operating with societal structures designed to protect members of society; however, we also have a responsibility to engage in research to evaluate potential benefits to society. The REB seemed quite apprehensive, however, and required what I considered to be extreme measures regarding enrolment and voluntary participation. Interestingly, one of the study participants interviewed as part of the military veterans with PTSD and equine-facilitated psychotherapy research wanted to take part in equine-facilitated psychotherapy because of early experiences with horses and his love of these animals, while another had no horse experience at all but was intrigued by this aspect of the therapy. Both participants told me that they found the whole experience interesting, pleasant, and beneficial. Not one participant in any study has ever voiced a negative opinion about participating in equine-facilitated psychotherapy; the only regrets expressed have been that the experience did not go on for a longer time. The outcomes of some of this work on equine-facilitated psychotherapy were presented at the HETI 16th International congress in 2018 (Barnfield & Mitchell, 2018).

More Ethical Challenges Related to Research—A Story from Jaqi and Shelley

Another example regarding ethical issues in research is from several years ago when, early in our experiences with equine-facilitated psychotherapy, we participated in a mixed-method research project as part of a multidisciplinary research team. Part of the work included educating fellow team members about the importance of using standardized intervention practices so that efficacy could be determined. We recommended pre- and post-intervention surveys and inventories, explaining why they were important. Although there was some initial resistance as this approach was new to many of the other multidisciplinary team members, the recommendation was accepted by the team. For members who went on to present the project’s findings at provincial and national conventions, the importance of this approach to data collection became obvious when their convention submissions were accepted at quality conferences. These same team members have gone on to do more great work, not only in research, but also clinically. Helping colleagues and community resources to be more informed and conscientious with data collection and reporting is part of the ethical values of the Code (CPA 2017) highlighted in Principle IV (Responsibility to Society), captured under Beneficial activities and Development of society (Ethical Standards IV.1; IV. 20). The research may be a big or small project but, regardless of the size of the project, we believe we are contributing to our profession and to new development in our field. It can be exciting for any professional to promote and grow their profession in this way, and that was true for us.

Ethical Challenges Related to Disseminating Knowledge—As Experienced by all Authors of this Chapter

Presenting and publishing research findings, especially in an emerging field, is an important task in developing evidence-based practices and informing others of developments in the field. All of us have participated in presenting or publishing our research, or both (e.g., Barnfield & Mitchell, 2018; Boyce & Goodwin, 2017; Goodwin et al., 2017, Goodwin et al., 2016). Although important and exciting, it can sometimes be challenging to find time for this additional work in our busy lives and, being honest, the money to do it. Anne is the only one of us who is in academia full time and who receives some time and financial remuneration for writing and presenting research. Even then, to get funding is difficult. Government funding bodies (at least in Canada) are reluctant to commit money to “unfounded” practices (funding for Anne’s equine-facilitated psychotherapy research work to date has come from a private foundation’s gift and from the college where she works). The rest of us are in clinical practices where, if we decide to attend a national or international conference, we do so at our own expense, both financially and time wise. If we are writing an article for publication, we do so at the expense of our personal time, away from our families, horses, and fun activities. If we are travelling to conferences, we do so at the expense of fun travel with our families. The time and financial costs are considerable, with the average publication taking 100 plus hours to write (not including research time), and the costs of attending most national conferences easily starting at $1,000 for hotels, travel, and registrations fees. International conferences can cost three times that amount. Needless to say, this is a considerable investment. The rewards are also considerable, however. This includes the personal satisfaction of knowing that we are contributing to the growth of our field, introducing our clients to another option in mental wellness intervention, collaborating with colleagues, developing meaningful relationships with other professionals, adding to our publication lists, and acknowledging our responsibility to society. Shelley discovered a less obvious benefit of knowledge dissemination recently when she attended the American Psychological Association annual convention and discovered a booth in the exhibitor’s hall that was promoting the ethical practice of equine-facilitated psychotherapy. They had several books and promotional materials available. Shelley was excited to see these practitioners and had a lively hour-long discussion with them. This is a great example of how knowledge dissemination can take equine-facilitated psychotherapy out of the margins or, you could say, out of the barn, bringing it into the professional realm and adding visibility and credibility to this emerging psychotherapy. It also facilitates practitioners dialoguing and potentially collaborating with like-minded colleagues.

More Ethical Challenges Related to Disseminating Knowledge, Confidentiality, and Interprofessional Collaborative Practice—Shannon and Shelley’s Story

Information is also disseminated informally. A veterinarian, for example, can be compared to a person’s hair stylist. Just as people tell their hair stylist everything, horse people talk with their veterinarians—a lot! Veterinarians are in many horse barns and get to hear what is happening in each one. It is not unusual to spend hours with a veterinarian as they do annual shots, care for a sick or injured horse, or provide end-of-life care for a beloved equine partner. During these times in the barn, people talk and inevitably share what is going on in their lives. Stable hands talk, owners talk, grain delivery folks talk, research participants talk, and clients in equine-facilitated psychotherapy talk too. So, having people in the barn who know the importance of not carrying talk from barn to barn becomes ethically important to ensuring confidentiality of clients and research participants. Shelley grew up, and still lives, in a small rural community, and is intimately aware of the importance of maintaining appropriate ethical boundaries while also, hopefully, maintaining personal relationships (Schank et al., 2010; Schank & Skovholt, 1997; Schank & Skovholt, 2006; Truscott & Crook, 2013). Shannon, who practices with guidance from her own profession’s code of ethics, is aware of Standard III. C.1, which specifies that “veterinarians have a responsibility to maintain the integrity and dignity of the profession and be worthy of the trust and respect of colleagues, clients and other health care professionals and the general public” (Bourque & Horney, 2016, p. 6). She also is aware of Standard III. B. 8, which specifies that “veterinarians . . . should protect the personal privacy of patients and clients. Veterinarians should not reveal confidences unless required to by law or unless it becomes necessary to protect the health and welfare of individuals or animals” (Bourque & Horney, p. 6).

An example of interconnections within the horse community starts with Shannon, a veterinarian who works with Shelley’s farm. They sometimes play in trivia quiz match teams against each other (Shannon’s team usually wins). A colleague of Shannon is Shelley’s neighbour. When Shelley’s 32-year-old mare developed a rare mammary gland tumour and needed to be euthanized, they wrote an article together for The Canadian Veterinary Journal (Boyce & Goodwin, 2017). Through the years, they have shared several clients (the clients have told them so), yet they have never discussed this connection between themselves. Being aware of each other’s ethics code allows professionals to engage in interprofessional collaboration with comfort and with respect. The horse community is small and, as horse people, they are aware of small-community ways relevant to the equine community. As is common with many small communities, they are mindful of numerous intersecting relationships amongst the membership. They each have ridden with clients on rides, having shown up for the event not realizing the other would be there. One of them frequently rides with a physician referral source and several healthcare providers who are members of an animal assistance non-profit group to which they belong. These relationships are important social connections, but also provide important interprofessional connections and supports within the developing field of equine-facilitated psychotherapy. When future opportunities for IPC arise, they will continue to manage the ethical challenges related to this work and will strive to uphold the standards of our various ethical codes so as to benefit all members of society.

Future Directions

Interest in equine-facilitated psychotherapy is increasing amongst the general public and professionals. This leads to issues regarding regulation, client safety, and the ethical application of this new form of psychotherapy. Principle IV (Responsibility for Society) (CPA, 2017) is particularly relevant to the development of this new psychotherapy. All of us (Anne, Shelley, Jaqi, and Shannon) have encountered people who are providing what they advertise as equine-facilitated psychotherapy. Although these individuals may have horse experience and may be registered mental health care providers, they often lack specific equine psychotherapy certification or credentials. Unfortunately, most members of the general public do not know the difference between registered and unregistered professionals, making this a significant issue for public safety. Not only may members of the public not be receiving services from a trained mental health professional, but they also may not be receiving services in a physically safe environment with equines who have been chosen for their ability to do this very demanding type of work (Kitchener, 2018). Working with colleagues whom we trust in this ground-breaking work, while also reading literature, conducting research, and checking with colleagues throughout the world who are engaged in this field, are all part of ethical practice.

Just as all seasoned horse owners know that they will get bitten by a horse a few times, have their toes stepped on a few times, and experience an unceremonious dismount (fall) off their horse a few times, the dedicated equine-facilitated psychotherapy practitioner also must learn to navigate the inevitable ethical challenges of their practice. We have shared some of ours so that you may learn how we have navigated such ethical challenges. We have shared our enthusiasm for and commitment to equine-facilitated psychotherapy and hope that you will join us in our ongoing pursuit of developing this new and exciting form of psychotherapy so that future generations will benefit.

Questions for Reflection

1. Would you be comfortable recommending equine-facilitated psychotherapy to a client? If yes, why? If not, what would help you become more comfortable with recommending such therapy?
2. You are a psychotherapist with limited experience with horses but would like to provide equine-facilitated psychotherapy. How would you develop competence to provide such psychotherapy? What role would supervision play in your development, and what would you look for in a supervisor?
3. In developing any new psychotherapy, how do the ethical responsibilities of researchers and therapists overlap and/or interact?
4. You are asked by a friend who has a child diagnosed with autism spectrum disorder if you know a place that offers equine-facilitated psychotherapy. You can only think of one place, but they provide therapy to veterans with PTSD. Is this an appropriate referral for you to make? Why or why not?

note

1. 1 The term “partner” is used to acknowledge our relationships with these other beings. Within the therapeutic field, horses are sometimes viewed only as tools or instruments. We disagree with this approach as it diminishes the role of the horse and does not recognize the need for a team approach with a willing and engaged partner.

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