What is Equine-Assisted Therapy?

Equine Assisted Therapy is a therapy program that involves and partners with horses. There are two main types of equine-assisted therapy: Equine Assisted Psychotherapy and Therapeutic Riding.

Therapeutic Riding is generally focused on working with children and adults with disabilities. While it may be beneficial for mental health, it’s often used more for physical therapy type activities. I volunteered with a therapeutic riding program in my undergrad program, and we helped kids mount the horses from a large mounting block, and then they would walk the horse around with an attendant holding the horse on a lead line. Additional helpers, such as myself, would encourage the kids to reach down for a stuffed animal to exercise their arms and stretch. This was a much more pleasant version of physical therapy for the recipients than a traditional office session, and the kids looked forward to coming.

Horses for these therapeutic riding programs need to be 100% unflappable. They needed to stay perfectly still while riders may take several helpers and 5-10 minutes to get mounted. They couldn’t spook and have a kid with no lower body strength fall to the ground. They can’t have strong opinions or personalities. In some ways, they’re more of a tool for therapy- not an active participant. This is similar to a guide dog’s role.

The relationship can still be there, but it’s a different type of relationship than one formed on mutual acceptance of who you each are.

Equine Assisted Psychotherapy (EAP) refers to the incorporation of horses in mental health treatment. There are equine assisted therapy programs in some residential facilities and occasionally in prison settings, but most EAP work is done at a farm. Horses do best in their home environment, rather than trekked to different locations. In Equine Assisted Therapy, the horse is present and is an important part of the process, but the THERAPEUTIC INTERVENTION comes from the licensed therapist. It’s important to understand that horses are not trained or licensed professionals. We need to understand that animals are not clinicians, even if being around animals is therapeutic for us in some way.

There are a number of different treatment models that use horses in therapy- including EAGALA (Equine Growth and Learning Association), what I originally trained in, and AAPT (Animal Assisted Play Therapy), which is what certification I’m working towards.

The models are largely similar, but there are a few practical differences.

Professionals Involved1 Licensed Clinical Therapist for individual sessions. 1-2 for group or family sessions.1 Licensed Clinical Therapist and 1 Equine Specialist for each therapy session. Equine specialists may work solo for life coaching type sessions or EAL (equine assisted learning) activities.
Is Riding Involved?Rarely.Rarely.
How is the Horse Involved?The horses are seen as a partner in therapy. They’re allowed to opt out of participating in therapy.Horses are seen as a tool in therapy and they aren’t given the option to not participate.
Animals InvolvedAny animal that is a good fit for working with clients can be involved.EAGALA only certifies professionals to work with horses in therapy.
Table: Differences between AAPT and EAGALA

I’m going to speak more to equine assisted psychotherapy because that is what my practice offers. I also am pretty focused on working within the AAPT model, although my base is in EAGALA work so I have a bit of a blend.

I choose to move to AAPT vs. EAGALA because I like how ethically-based the practice is, how much they use animal training and behavior as an important part of the practice, and I love how animal and client consent to work together is a huge part of the work. I also wanted to work with more than just horses and I didn’t want to be bound to finding a co-therapist all of the time. And I enjoy working with clients individually; I am not sure how I feel about having two therapists for one client or how these teams work with that setup. It seems like it would be a bit overwhelming for clients.

I am also uncomfortable working with an unlicensed professional because they wouldn’t have a background in ethics, implicit bias training, or a good understanding of HIPAA compliance and confidentiality. They also likely wouldn’t qualify for any type of liability insurance, beyond the type of insurance we need to carry for our farm. I was concerned that any potential issues would fall back on me as the licensed therapist who carries professional liability insurance. If I work with another professional, I want a partner- not a supervisee.

In terms of the equines involved in EAP work, they are not expected to be perfect. We like our animals to be kind, but we encourage them to have their own personality and desires. The interaction with an animal who has a mind of its own is what makes equine assisted therapy helpful. If the horse lays down and rolls when the client walks towards it, how does the client interpret that? If the client tries to hit the horse, the horse isn’t required to sit there; he can walk away. And then we can process with clients how their behavior may impact the horse (or vice versa in some cases).

Maybe you have a horse in the herd who isn’t really into people- but a client works really hard to befriend it. That gives us a lot of therapeutic material to work with and the client can (hopefully) see their hard work pay off.

In other situations, I have had clients who don’t have a lot of body awareness about their safety around the horses; this is something that we can discuss and think about in other aspects of their life.

The dynamic between two imperfect beings is what is valuable in animal assisted therapy. The horse accepts us for who we are when we come in (within reason), and we accept the horse.

In therapeutic riding (or with a guide dog), you need the animal to be perfect because someone’s physical safety relies on it.

In EAP work, the therapist helps the client work on looking out for their own safety, and the therapist also keeps an eye out for the client’s well being. But there are some safety considerations which I’ll cover later.

What does an equine therapy session look like?

Equine Assisted Therapy sessions can take a few different approaches. Sometimes, people will do a traditional talk therapy session while brushing a horse or walking it on a lead while chatting with the therapist. The presence of the horse, or the action of brushing it, can be soothing and help relieve anxiety.

In other sessions, the client may focus on observing the horse and/or herd. Clients may talk about what makes them like a particular horse or how a horse reminds them of someone they have a difficult relationship with.

Many times, the therapist will provide an activity for the client to complete with the horse. For example, they may be tasked with developing an obstacle course, then trying to get a horse through the course without touching the horse. This fosters conversations about how difficult (or not) that they made the course, what it was like to try to communicate with the horse without touching it, and how they dealt with frustration when the horse was ALMOST through the course then walked the opposite direction.

Some therapists even offer equine-assisted EMDR, a specific modality for coping with trauma. This is not something that I offer personally, but may pursue in the future.

Other times, we work on clicker training the horse which is great practice for patience, positive reinforcement, and relationship. There’s a lot of satisfaction to seeing the horse do a trick that you trained.

And then, sometimes the session derails and you pivot accordingly. The horse decides to lay down with the client instead of doing the activity, and the person just feels so accepted in that moment that they break down.

Or the horses decide they want to play around and then the client and therapist step back for observation.

Or the client decides it’s too hard and gives up.

These are all really really valuable things for a therapist to see and process with a client. They are things that we OFTEN miss during traditional talk therapy because we can’t see how that client interacts with others in their life.

What are the problems with equine-assisted therapy?

Physical Safety

There can be a number of problems with equine-assisted therapy. First of all, you’re working with LARGE ANIMALS. There is considerable risk involved, particularly where these animals have a mind of their own. You’re often working with multiple horses at once and herd dynamics can be tricky. One horse may get jealous of the attention that another is getting and nip at it. Maybe a horse gets bitten by a horse fly and takes off bucking because OW that hurt!

Horses are constantly swatting flies, stomping their feet, pawing the ground, and managing the ‘who’s the boss’ game by displays of dominance like nipping or kicking each other. I got started with horses when I was 6 years old and over the years I’ve had MANY injuries. I’ve been kicked, bitten, squished, fallen off, been thrown, and been stepped on. My least favorite injury was getting a tail to the eyeball (inevitable, I’ve had this happen twice) and scratching my cornea. My worst injury was a fall that involved a trip in the ambulance and a lecture from the paramedics about standing up after the fall. I still have aches and pains from that one. Corneas heal well (and fast), but I’m fussy about my eyes so that one still makes me shudder the most.

The risks are, however, much higher ON horseback. While riding at a walk is minimally risky, once you get into jumping and riding green (new to riding) horses, you definitely run more risks. My husband keeps saying “I feel like I haven’t had a fall yet and I need to get that over with” but he also rides predominantly at a walk and once a month at most. My kids, on the other hand, have each had a small fall as they ride weekly at a walk, trot, and canter. I’ve been riding so long that NOT having a host of injuries would be weird.

The higher risk on horseback is why many EAP practices don’t offer riding as part of the session- not only is the risk higher, but our insurance expenses rise substantially if we put people ON the horses. As we haven’t seen any evidence that ridden work is MORE beneficial than groundwork, it hasn’t been something most EAP programs use much.

Overall, I believe equine assisted therapy is safe, but there are risks involved. That’s why equine assisted therapists need to share their focus between the client and the horses, making sure to pay attention to their body language in anticipation of that fly bite reaction or that nip to their herd mate. It’s part of our job. And we are human so that is why we have liability forms.

Horses have Opinions

Horses have opinions, and in some models of therapy, we allow them to opt out of participation. This can be discouraging or frustrating to clients. Sometimes the horse isn’t feeling the activity or doesn’t feel like listening. In my opinion, these are the best sessions. They give us a lot of feedback about how the client handles frustration, how they choose to deal with roadblocks, and how they respond when a relationship is a bit rocky. A client being able to work through those hard things with an equine partner makes the work INVALUABLE. This is work that is REALLY hard to do and practice with other humans.

Horses (and other animals) are the perfect practice relationships because they are fairly non judgmental (they may have opinions about perfumes, people who itch them in a good/bad spot, etc) and they’re FUN. They’re soft and it’s rewarding to figure out how to befriend them. And there’s less social pressure. The horse isn’t going to talk about you behind your back or end up making a TikTok about how they think you smell like rotten carrots.

But there is always something interesting happening in animal assisted therapy sessions. In one session, I had Solace and Piper in the arena. My client decided to work with Piper and as I’m watching them work, Solace pops over for a pat and *CRUNCH* takes a bite out of my plastic clipboard. He drops the chunk of plastic in my hand with what I can only imagine is a horse smirk. PAY ATTENTION TO ME.


Allergies- there is dust, hay, and lots of outdoor ick so if you’re allergic, this might be an issue. There are also bees so if you’re anaphylactic to stings or any other outdoors thing, you should really have a doctor’s note and an Epi-pen on hand. I think other types of animal-assisted therapy, or other types of experiential therapy, may be better for those who are anaphylactic to the outdoors.


There are bugs. This really throws a lot of people off. There are flies, mosquitos, stink bugs, lady bugs, spiders, wasps, bees, etc. etc. etc. Horses need to be outdoors. And there are bugs outside. That’s their home and you’re visiting it.

Again- if you’re anaphylactic to bee stings, this isn’t the ideal place.

Dirt and Poop

If you’re fussy about getting dirty, this is going to be ROUGH. There’s no leaving the horse barn without a bit of poo, dirt, drool, or horse snot on you. They WILL sneeze on you. Horses love a good itch on the withers, but you’ll quickly find that dirt has gotten stuck under your fingernails. It’s part of the deal.

I find it helpful for people who have some OCD issues with cleanliness. Horses give us just enough motivation to tolerate getting dirty so I think it’s a nice way to do some exposure therapy.

In terms of poop, this is a common ice breaker. An animal will fart, poop, or pee in session. You can have a hard topic, a horse farts, and suddenly everyone is laughing. As you might guess, kids are a HUGE fan of these ‘ice breakers.’


While confidentiality is an important part of therapy, confidentiality when working outdoors is tricky. Many equine assisted therapy practices are at riding stables where boarders and riders may overhear portions of the session- or simply stop by to watch.

My practice is at my private farm which is convenient for confidentiality, but I still have my family coming and going from the house, delivery drivers, and occasionally a vet/farrier shows up at the end of a session, early for an appointment. Occasionally neighbors wave as driving by or the neighborhood kid stops by to say hi to my kids. I try to control for these factors, but there is a limit to how much I can do.

The outdoors, however, is a pretty decent place for confidentiality and you generally can see how far away other people are- it’s not like there’s someone hiding and listening nearby. Also, equine-assisted therapy doesn’t rely on a lot of discussion about your current issues, early trauma, etc.

Equine-Assisted Therapy is an experiential therapy, meaning that activities allow clients to practice skills that are helpful for their life. Therapists may spend 10 minutes processing the activity at the end of session, but it isn’t quite the same as 45-60 minutes discussing early childhood trauma with an audience.

In other words- there’s not a lot to overhear. And generally, you’ll have auditory privacy- just not necessarily visual privacy.

Therapist Self Disclosure

Therapist self-disclosure is a pretty hot topic in the therapy world. Traditional therapy approaches want us to be a completely blank slate with very little or no self-disclosure. Others believe that healthy self-disclosure with appropriate boundaries can be therapeutic.

But that’s all verbal self-disclosure.

There is a certain amount of self-disclosure in how you decorate a therapy office, or from the photos you hang on the wall. A therapist can “self-disclose” their sexuality, religion, favorite hobbies, etc. simply by having a well decorated office.

With a farm, particularly on your personal property, there’s a certain amount of self-disclosure about WHO YOU ARE. It’s a lot more difficult to keep a farm looking clean and neat. When you’re having a rough week, things might be less orderly or straight up chaotic.

Horses Get Sick and Die

The worst part of equine assisted therapy is when a horse dies. Horses live about 30 years at most, and even young horses can get sick and die suddenly. If an animal partner dies, the therapist may need to take time off to process this loss for themselves before inviting clients back to do the same.

Therapists try to take care of themselves well so that they can help other people. We want to return to therapy AFTER we are done with the sobbing uncontrollably phase because the session needs to help the client process the loss. It’s not fair for the client to come in and feel unable to process the loss because the clinician cannot cope with any mention of the animal.

In my opinion, this is really challenging. Therapists who work with animals may need to speed up their grief process a bit which isn’t always easy.

If a therapist lost a fellow human, they could return to work and pull themselves through the day fairly soon. Work gives them something else to think about and focus on, assuming every coworker doesn’t ask about their great grandpa all day.

With horse loss, this is akin to having a client who also lost their great grandpa that week and wanted to talk about it while the therapist is still raw from their loss. It would be tricky. This is why therapists often have certain populations that they don’t work with- for example, a therapist who really has struggled with pregnancy loss personally may not want to provide therapy to other women with pregnancy loss. This is something each therapist evaluates for themselves and it’s part of healthy-therapying.

That said, loss can also be really healing and helpful when processed well. Therapists are generally well trained and competent about handling loss, and we can model healthy coping mechanisms.

I love equine-assisted work. Not only do I get to help people as a therapist, but I get to work outdoors with horses and other animals all day. We get to enjoy the sunshine and the wind and snow and the Fall colors. During the work, we move around and get “exercise” which we KNOW IS GOOD FOR US, but people don’t always have time for in their busy lives. Being able to do BOTH is physically and mentally healthy.

I REALLY enjoy and appreciate the individual personalities of my clients, and how they interact with the personalities of my animals. I love seeing someone’s face light up at seeing a particular animal, or when they feel successful about completing an activity.

Animals manage to take away some of the fear and anxiety over therapy, and research has shown that petting a dog lowers the stress hormone cortisol, and interacting with dogs increases levels of the feel-good hormone oxytocin (the bonding hormone).

While MANY researchers have focused on dogs, there has also been research about cats, horses, and other animals. For example, a 12-week program where children worked with horses discovered that kids who participated in equine activities had lower stress hormones that the children in the waitlisted group.

Working with horses is NEVER boring. It’s messy. We laugh a lot. Sometimes we are silly and play around. Even grownups can get joy from being silly and pretending to canter over a jump to show the horse how to do it.

And every now and then, things get serious and inevitably a horse will fart and lighten the mood.

Welcome to working with animals. There is nothing quite like it.

Bay mare (horse) who is standing near some hula hoops that are being used for an equine-assisted therapy activity.