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Exploring Therapists' Conceptions of Equine Facilitated/Assisted Exploring Therapists’ Conceptions of Equine Facilitated/Assisted Psychotherapy for Combat Veterans Experiencing Posttraumatic Stress Disorder Dissertation Submitted to Northcentral University Graduate Faculty of the School of Psychology in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY by BARBARA NEWELL ABRAMS Prescott Valley, Arizona March 2013 UMI Number: 3569187 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. UMI 3569187 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Copyright 2013 Barbara Newell Abrams APPROVAL PAGE Exploring Therapists’ Conceptions of Equine Facilitated/Assisted Psychotherapy for Combat Veterans Experiencing Posttraumatic Stress Disorder by Barbara Newell Abrams Approved by: Chair: Kristopher Lichtanski, Ph.D. Date Member: Nicol Moreland, Ph.D. Date Certified by: School Dean: Robert E. Haussmann, Ph.D. Date Abstract Combat Veterans diagnosed with posttraumatic stress disorder (PTSD) represent a vulnerable population that requires effective psychotherapeutic interventions. However, not all established treatments are universally effective for the estimated 20% of Veterans diagnosed with PTSD. A need for innovative approaches to manage symptoms of combat-related PTSD has been suggested in order to support traditional psychotherapeutic methods. Consequently, therapists have embraced complementary and alternative interventions for Veterans that include equine facilitated/assisted psychotherapy (EFP/EAP). Therapists who include EFP/EAP have agreed that interacting with horses in a therapeutic environment can have a positive impact on the health and behavior of individuals experiencing symptoms of PTSD. This descriptive phenomenological study, pursued through a common factors lens, explored the lived experiences of five licensed/credentialed mental health professionals who included EFP/EAP with Veterans diagnosed with PTSD. Semi-structured face-to-face interviews were conducted with participants selected from the East and West Coasts of the United States. The research questions addressed why therapists chose to include the EFP/EAP intervention, how they conceived the EFP/EAP treatment as efficacious for Veterans, and how the common factors of the client, therapist, and collaborative relationship, in addition to specific factors, were reflected and involved in the EFP/EAP therapeutic process. Therapists’ descriptions revealed seven major themes: “The horse-human relationship,” “Building trust,” “It engages people both mentally and physically,” “From the beginning,” “Nonverbal communication,” “Emotional safety,” and “A faster vehicle.” Additionally, therapists’ descriptions supported the common factors paradigm in psychotherapy. Findings indicated that therapists in this study chose EFP/EAP as a treatment option for Veterans diagnosed with PTSD because qualities of the horse evoked positive past subjective experiences in the therapists, the EFP/EAP intervention supported their primary theoretical orientations as psychotherapists, and the horse and its environment can address treatment goals relevant to behavioral and psychosocial difficulties in Veterans’ lives. A recommendation for future research is for larger, international studies that explore the viewpoints of therapists who practice equine therapies in other countries in order to expand the knowledge base and address the competency and standards discussion in the EFP/EAP field. v Acknowledgements I offer sincere thanks to the mental health professionals who were flexible and generous with their time, thoughtful and thorough in descriptions of their personal experiences, and patient with the technicalities of the research process. Thanks and appreciation to High Hopes Therapeutic Riding. The staff, participants, volunteers, and horses were all instrumental in establishing a foundation for my understanding of the diverse therapeutic aspects of humans and horses. I offer sincere thanks and appreciation to my committee members - both past and present, for contributing valuable feedback and direction to this study. A special acknowledgement goes to Dr. Kristopher Lichtanski, my Chairman, whose expertise, guidance, and invaluable support gave me encouragement throughout this project. To my peer reviewer, Dr. Leslie McCullough, heartfelt thanks for advising, correcting, and challenging my conceptions. Mostly, many thanks and much love to my husband and to my mother for supporting, understanding, and tolerating this lengthy educational journey. Your personal sacrifices allowed me the space to reach this goal. Table of Contents List of Tables.........................................................................................................................viii Chapter 1: Introduction............................................................................................................. 1 Background........................................................................................................................ 3 Problem Statement.............................................................................................................7 Purpose...............................................................................................................................9 Theoretical Framework ......................................................................................................9 Research Questions.......................................................................................................... 17 Nature of the Study.......................................................................................................... 17 Significance of the Study.................................................................................................19 Definitions....................................................................................................................... 21 Summary.......................................................................................................................... 24 Chapter 2: Literature Review................................................................................................ 28 Factors in the Therapeutic Process of Psychotherapy.................................................. 30 Horses as Therapeutic Vehicle.......................................................................................54 Posttraumatic Stress Disorder in Combat Veterans...................................................... 69 Summary.......................................................................................................................... 86 Chapter 3: Research Method...................................................................................................92 Research Methods and Design........................................................................................94 Participants...................................................................................................................... 96 Materials/Instruments......................................................................................................98 Data Collection, Processing, and Analysis....................................................................99 Methodological Assumptions, Limitations, and Delimitations..................................108 Ethical Assurances.........................................................................................................111 Summary.........................................................................................................................112 Chapter 4: Findings............................................................................................................... 116 Results.............................................................................................................................117 Evaluation of Findings...................................................................................................163 Summary........................................................................................................................ 200 Chapter 5: Implications, Recommendations, and Conclusions........................................ 203 Implications...................................................................................................................208 Recommendations..........................................................................................................250 Conclusions....................................................................................................................255 References..............................................................................................................................265 Appendices.............................................................................................................................303 Appendix A: Interview Guide......................................................................................304 Appendix B: Informed Consent....................................................................................308
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