Experiences of an Equine Facilitated Psychotherapeutic Intervention: an IPA Study
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Doctorate in Professional Educational, Child and Adolescent Psychology Experiences of an Equine Facilitated Psychotherapeutic Intervention: An IPA Study Catherine Stracey UCL Institute of Education A thesis submitted for the degree of D. Ed. Psy I, Catherine Stracey, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Signed: Word count: (exclusive of appendices and list of reference) 34,373 words 1 Abstract The Department of Health, (DoH, 2018) Long Term Plan called for a wider range of evidence based programmes designed to protect and promote children and young people’s (CYP) emotional well-being and mental health. Research exploring Animal Facilitated Learning and Therapeutic interventions reported improvements in the emotional wellbeing of CYP. This study explored the experiences of two young people (YP) attending an Equine Facilitated Psychotherapeutic (EFP) intervention, the professionals who facilitated it, school staff where the YP were students and the YP’s parents. Research questions considered how the participants experienced and made sense of the EFP intervention. The ‘voice’ of the YP was privileged and an in-depth exploration of their experiences is presented. Two YP (aged 14-15) attending a Pupil Referral Unit (PRU), two Equine Assisted Growth and Learning Association (EAGALA) trained professionals, a member of the PRU staff and two parents participated. Qualitative methodology was employed with a ‘Mosaic’ approach to gather data from the two YP. Semi-structured interviews were conducted for the adult participants. Attachment and affect regulation theories were considered as a psychological framework to underpin and situate the findings. Interpretative Phenomenological Analysis (IPA) was employed, constructing idiographic accounts, as well as tri-angulating data both within and across groups providing a multi-perspectival account. Three super-ordinate themes were identified across the groups: developing relationships, self-efficacy and environment. The findings suggested that attachment and affect regulation 2 theoretical perspectives are an appropriate framework to guide and inform EFP practice. The findings reported that two YP with complex social, emotional and mental health (SEMH) needs, who did not respond to traditional counselling or mentoring approaches, engaged with the intervention, and demonstrated improved social communication and interaction skills. The parents and school staff member reported improvements in their own emotional wellbeing. Implications for EPs include the exploration of EFP interventions to support CYP with SEMH needs. 3 Impact Statement The NHS Long Term Plan (Department of Health, (DoH), 2018) suggested a strategy to build a wider range of evidence based responses designed to protect and promote CYP’s mental health and emotional well-being. Adolescents are often uncomfortable engaging with a highly clinical service (DoH, 2015) and therefore less traditional forms of intervention may be more successful. Increasingly, AAIs are being offered as an alternative intervention to CYP who may be experiencing difficulties with their social and emotional well-being (Breitenbach et al., 2009). Equine-Facilitated Psychotherapy (EFP) is an emerging specialism offered by a small but growing number of practitioners. This current study extends the existing research base in the following areas: • The primary concepts of attachment and affect regulation theories have been suggested to have relevance to some of the central aspects of EFP and could be used as a guiding framework from which to asses EFP practice and development. The current study examined the application of these perspectives to an EFP intervention and concluded that they provide a useful psychological framework to guide and inform practice • Existing research into equine facilitated interventions (EFI) primarily adopted a quantitative design, with a variety of assessment tools measuring different aspects of SEMH needs. A unique contribution of this study was to employ a qualitative design that privileged the ‘voice’ of the young people (YP) who participated, with the inclusion of additional adult perspectives to enable tri-angulation of the data. A 4 variety of research tools were utilised to ensure the YP lived experiences were authentically captured. The multi-perspectival approach augmented the data from the YP and afforded the researcher the ability to identify areas of convergence and divergence. The research makes a novel contribution to the existing academic literature and our understanding of how an EFP intervention is experienced. There are several professional implications arising from this study: • The current Local Authority referral process operates without coherent guidelines. It is important for the Local Authority, supported by Educational Psychologists (EPs), to establish a clear referral pathway and ensure all relevant teams within the vulnerable learners, children and families divisions have access to relevant information and guidelines • To foster a multi-agency approach, in line with SEND Code of Practice (Department for Education, DfE, 2015), it is necessary to establish a process whereby relevant teams are notified of a referral and subsequent attendance • It is necessary for the outcomes of the CYP attending an EFI to be disseminated amongst other professionals in order to provide optimum support and efficacy. EPs are ideally placed to bridge the gap to provide the necessary support for CYP to strengthen and reinforce their developing skills to ensure continued positive outcomes. The findings to be disseminated to EPs to increase professional knowledge. To disseminate the research to a wider audience the findings will be forwarded to a peer reviewed publication. 5 Table of Contents Abstract .......................................................................................................... 2 Impact statement ........................................................................................... 4 1. Chapter 1: Introduction ......................................................................... 10 1.1 Overview ............................................................................................. 10 1.2 Conceptualisation of Mental Health .................................................... 10 1.3 National Context ................................................................................. 12 1.4 Animal Assisted Interventions ............................................................. 16 1.5 Benefits of Animal Assisted Interventions ........................................... 18 1.6 Equine Facilitated Interventions .......................................................... 20 1.7 The Local Context ............................................................................... 22 1.8 Researcher’s position………………………………………………………23 1.9 Research aims………………………………………………………………24 2. Chapter 2: Literature Review ................................................................ 25 2.1 Overview ............................................................................................. 25 2.2 Attachment Theory: A Framework for Equine Interventions ................ 25 2.2.1 Overview of Attachment Theory ....................................................... 28 2.2.2 Development of Attachment Theory ................................................. 32 2.2.3 Implication for future research .......................................................... 39 2.3 Research and Equine Interventions .................................................... 39 2.3.1 Critical evaluation of the existing research – Aims of the research .. 43 2.3.2 Participants, sampling and intervention............................................ 45 2.3.3 Design, data collection and data analysis ........................................ 47 2.4 Rationale and Aims of the present stud………………………………….48 2.5 Research Questions……………………………………………………….50 3. Chapter 3: Research Methodology and Design ................................... 51 3.1 Overview ............................................................................................. 51 3.2 Research Design ................................................................................ 51 3.2.1 Choosing a qualitative analysis ........................................................ 52 3.3 Epistemological position and theoretical foundations .......................... 53 3.3.1 Definition of phenomenology ............................................................ 53 3.3.2 Idiography ........................................................................................ 55 3.3.3. Hermeneutics .................................................................................. 56 3.3.3.1 Hermeneutic circle ....................................................................... 56 3.3.3.2 Double hermeneutic ...................................................................... 58 3.4 Reflexivity ............................................................................................ 59 3.5 Multi-perspectival accounts in IPA ...................................................... 61 3.5.1 Summary of the position of the current research regarding a phenomenological approach ............................................................ 63 3.6 The Context of the Research .............................................................. 64 3.7 The Equine Facilitated Intervention ....................................................