Equine Assisted Psychotherapy Group Proposal

The following is a proposal for an Equine Assisted Psychotherapy (EAP) group using a combination of the Equine Assisted Growth and Learning Association’s (EAGALA) therapy model and incorporating a variety of cognitive therapies such as mindfulness, acceptance commitment, and motivational interviewing. Within the equine therapy model will be the use of horses as partners using non-mounted horsemanship and skills exercises. Non mounted work with a horse can provide opportunities for a client to develop nonverbal communication skills, enhance self-awareness, and adjust patterns of attitudes, behaviors, and feelings through clearly defined treatment goals established by the client and therapist (EFMHA/PATH 2009).

The population of the group will be comprised of adult women over the age of 18 who are suffering from the symptoms of clinically diagnosed posttraumatic stress disorder. The group population may include but is not limited to female veterans, survivors of domestic, emotional, and physical abuse, neglect, bullying, terrorism, community or school violence, and sexual assault.

Literature Review

In collecting and reviewing the current journal articles for EAP there was an immediate confusion over the names of interventions using horses in a therapeutic setting being led by a mental health professional. A variety of names were used ranging from Equine Facilitated Therapy, Equine Assisted Therapy, Equine Facilitated Mental Health, Equine Facilitated Group Work, Equine Assisted Experiential Therapy to name a few. For the purposes of clarity and simplicity, this review will use the acronym EAP for all equine therapy interventions. Finding articles for the specific target population of adult trauma survivors in a group format was limited, with a majority articles focusing on children, veterans, or individual therapy.

The focus of this review is to make a connection between various equine therapies that are psychotherapeutic in nature, based in group work, and primarily focused on non-mounted horsemanship activities. Common themes from the articles are efficacy of treatment intervention, relief of symptomology, impact of partnering with equines, and skills development through group work.

Interventions

Equine assisted psychotherapy is a form of experiential therapy that has been used with psychiatric clients through the use of controlled interactions with horses by using metaphors to gain an understanding of the issues clients may have (Klontz et al., 2007). Through the use of activities with horses EAP allows clients to process unfinished business, adjust negative and unproductive behaviors, alleviate psychological distress, and be fully present in the moment (Klontz et al., 2007). EAP is not used as a stand alone intervention and the change process in EAP is developed through the application and combination of evidence based methodologies such as cognitive behavioral, person centered, gestalt, mindfulness, and motivational interviewing, along with horsemanship skills and exercises of herd observation, equine behavior, grooming, and handling (Schroeder & Stroud, 2015; Ferruolo, 2015). EAP, like traditional interventions, has clearly and mutually defined treatment goals and uses the ongoing relationship between the client and therapist (Mueller & McCullough, 2017). The treatment setting of being in a barn aids clients in feeling less like patients, increasing their motivation to risk failure in a judgment free atmosphere while obtaining a sense of confidence and mastery in leading their equine partners (Mueller & McCullough, 2017).

Horse Partnering

Working closely with horses provides an opportunity for clients to safely express leadership responsibilities, which can be empowering due to the large size and strength of horses paired with the horses’ sensitivity to their environment. This sensitivity of horses as prey animals affords them to be keenly aware of emotional and physical changes as well as verbal and nonverbal communication of clients (Earls et al., 2015).Through mirroring emotional and physical states horses can provide immediate feedback to clients about the affect of their non-verbal behavior on others, aiding clients in increased cognizance of their emotions and behaviors (Klontz et al., 2007; Schroeder & Stroud, 2015).In EAP clients become aware of the affect of their emotional arousal levels and how to be present, communicate clearly and effectively, and experiment with behavior changes (Schroeder & Stroud, 2015).EAP is effective due to the horses’ ability to detect subtle changes in the mood and behaviors of people because they are animals of prey inclined toward hypervigilance of potential dangers and changes in their environment to which survivors of abuse can relate (Meinersmann et al., 2008).  EAP and the unique characteristics of horses promote wellbeing for clients suffering from trauma through interactive and sensory experiences, mindfulness, body awareness, grounding exercises

for management of stress and anxiety, and provide group members present focused relational experiences with each other and the horses (Schroeder & Stroud, 2015).

In EAP clients note the horses’ non-judgmental attitudes that allow clients to participate in self-reflection and may contribute to clients’ increased likelihood to take risks (Meinersmann et al., 2008). A client may interpret a horse’s reactions and behaviors into a metaphor, which is related to the client’s unexpressed feelings, allowing a transference of the issues into the present moment of the therapy session(Klontz et al., 2007). In certain equine activities like mutual choosing where the client first approaches, touches, and attempts to halter a horse, desire and inquisitiveness outweigh any fear and the effects of trauma can begin to fade (Mueller & McCullough, 2017). Because horses work in the moment and do not react to a person’s shortcomings or inappropriate actions, typical issues of transference between group members and the therapist do not happen in EAP and can potentially lower behaviors of self-protection and client resistance (Klontz et al., 2007).

Symptom Relief

Data supports that EAP is an effective treatment for lowering anxiety and depression symptoms and increasing overall psychological well being, including trust and self-esteem (Ferruolo 2015). Because contact with horses may increase mindfulness through the horses’ acceptance, non-judgment, and present focus, EAP may be effective in treating people with anxiety (Earls et al., 2015). This interaction between clients and horses has been associated with self-actualization and psychological well being increases as well as a decrease in clients’ psychological distress and global severity of symptoms sustained over a 6-month period (Klontz et al., 2007).

Women who survive abuse and develop PTSD are at risk for developing depression, anxiety, and substance use disorders along with feelings of shame, guilt, negative thoughts of themselves and others, increased social withdrawal, and difficulties with trust and intimacy in relationships (Schroeder & Stroud, 2015). The results of using EAP as a therapeutic intervention with women who have survived abuse and have diminished mental health includes increases in the areas of self-efficacy, awareness, and empowerment, paired with lower levels of depression and anxiety symptoms (Meinersmann et al., 2008). Although some studies lacked a comparative control group, the EAP group had lowered generalized anxiety, depression, and posttraumatic stress symptoms, decreased severity of emotional distress responses and alcohol use, and increased use of mindfulness (Earls et al., 2015).Children and adolescents who have been sexually abused showed positive results in reducing symptoms of anxiety, depression and negative behaviors after taking part in an EAP program with no differences in efficacy for age or gender (Kemp et al., 2013).

Skills Development and Group Process

EAP was found to be more effective than conventional interventions by enhancing trust, contentment, self-efficacy, and relatedness (Mueller & McCullough, 2017). The experiences of a group of women survivors of abuse in an EAP program indicated common patterns and themes of control and power, setting boundaries, communicating clearly, breathing, staying in their bodies, with the horses being seen as co-therapists through mirroring, providing safety, unconditional love, acceptance, non-judgment, sensitivity, and responsiveness to clients during sessions (Meinersmann et al., 2008). Group interventions have been proven as effective in recognizing and altering negative or distorted thoughts, feelings, and behaviors of post trauma survivors who learn to make interpersonal connections, change restrictive self-perceptions, and gain interpersonal and coping skills needed to manage the lasting effects of trauma and build healthy relationships (Schroeder & Stroud, 2015).

Partnering with horses in EAP seems to promote a special emotional connection that enriched the group process (Schroeder & Stroud, 2015). Reflection and introspection from the group process led to increased self-awareness and understanding of self as well as elevating social skills (Ferruolo 2015). Group formats have been successful in identifying and altering group members’ distortions of thoughts, feelings, and behaviors resulting from trauma (Schroeder & Stroud, 2015).A benefit of groups is enabling support between members, which is frequently comparable to the members’ relationships and goal experiences outside of the group (Schroeder & Stroud, 2015). EAP facilitates a variety of group interactions including ability to express disagreements, support, confrontation, and encouragement, with members feeling support and acceptance from each other, the facilitators, and the horses (Schroeder & Stroud, 2015).

Rational for Group

The goal of this EAP group is to promote a therapeutic change through the use of activities with equines among adult female group members who have been exposed to interpersonal trauma. Through establishment of a safe environment and the use of metaphors with horses, members will become empowered and develop skills and ability to successfully cope with difficult and confusing feelings, share common experiences and feelings, make appropriate decisions, manage intrusive thoughts, begin the process of working through their unresolved feelings of mistrust, fear, and difficulty in interpersonal relationships associated with their traumatic experiences. The use of horses through EAP to facilitate therapeutic change is an effective alternative to traditional therapies for clients experiencing PTSD and impaired functioning. The format of group therapy has been established as an effective intervention for treating those with trauma. This EAP group using evidence-based methodologies in treating trauma survivors has the desirable features of a short-term adjunct treatment that is time limited and cost effective while decreasing PTSD symptoms and increasing positive interpersonal connections, emotional regulation, and self-efficacy.

Group Organization

Group Composition

The composition of the proposed EAP group will be a homogeneous group of voluntary, outpatient, adult women suffering from trauma-related disorders resulting from interpersonal trauma exposure such as rape/sexual assault, sexual abuse, neglect, physical abuse, emotional abuse, and intimate partner/domestic violence. While homogeneous group composition can aid in greater cohesion amongst members and encourage exploration and sharing of their common experiences thereby allowing bonding between members, diversity can also aid in learning opportunities and create additional bonds of those shared experiences (Corey, Corey, & Corey, 2014). The EAP group will be a homogeneous group limited to women dealing with the common shared experiences of interpersonal trauma, but in all other respects diversity of the group membership would be desirable.

Recruiting, Screening, and Orienting Members

Recruiting methods to locate potential members who might benefit from the group will include publicizing the group through announcements, emails, and networking to obtain referrals from mental heath professionals and through professional counseling organizations, outpatient treatment programs, human service groups, community agencies serving clients dealing with interpersonal trauma such as rape crisis centers, battered women’s shelters, and hospitals (Trotter, 2012). Potential group members will currently be participating in or have completed individual counseling and the EAP group will be considered an adjunct treatment. Referral by the potential member’s individual session therapist will help in determining when the group is beneficial to a prospective client. A release form from their individual therapist will be required to facilitate to consultation, management, and coordination of treatment planning and individual goals for each group member (Corey et al. 2014).

The facilitators of the group will conduct screening of prospective members to determine appropriateness of the group and ensure that the needs and goals of each member is well-matched and compatible with those of the group. The facilitators will briefly meet in person with each potential member to determine if the client can understand the group process and if there are any contraindications to having the client participate in the group (Corey et al, 2014; Yalom & Leszcz, 2005). Facilitators will determine if the client is able to benefit from the group and if each member is developmentally and emotionally ready, motivated, and capable of participating in the group processes and interacting with others and with horses (Corey et al, 2014; Yalom & Leszcz, 2005). Facilitators will determine what benefit the group will provide to the client that individual therapy cannot provide. Facilitators will also want ensure that there is no negative impact on a member by joining the group and to prevent possible harm that could be done to the member, the group, or the equines. (EAGALA, 2015; Yalom & Leszcz, 2005) Facilitators will need to know of any physical, emotional, or developmental differences of potential group members in advance to determine suitability and specific client needs that may not be feasible for this specific group. While inclusion of any client who may benefit from the group is the desired outcome, not all differences can be accommodated in every group.  In the initial interview the potential members can ask questions of the facilitators about the group and process to make an informed decision and determine if they believe they are a good fit for the group (Corey et al., 2014). This meeting will also serve the purpose of a brief orientation of the group process for those individuals who are selected to join the group.

Exclusion of members to the group will prohibit those with tendency toward violence or animal abuse, those with allergies to animals or the environment of stables or farms, those with specific animal phobias, those with diminished mental capacity or inability to understand consequences of actions, those with serious mental disorders or symptoms such schizophrenia, psychosis, delusions, or hallucinations, those who engage in suicidal behavior, or if the exposure to the event is still highly traumatizing or happened very recently (Corey et al, 2014; Mandrell 2014; Yalom & Leszcz, 2005). Thoughtful consideration will be given by the facilitators to inform those potential group members who are not appropriate for the particular group make up. If the group is not likely to be appropriate for the client facilitators will offer support and referrals to other types of services that are more appropriate for the client or determine if the client may be a candidate in the future after additional individual counseling (Corey et al., 2014).

Inclusion criteria for members to the group will allow those clients currently attending individual counseling, referred by their individual therapist noting substantial personal need, those possessing motivation and desiring personal change, living a practical distance from the meeting site, possessing the ability to commit to attendance and participation in the group processes and activities, possessing the ability to derive satisfaction from relationships with other members, and possessing the ability to examine themselves and their relationships with others (Corey et al., 2014; Yalom & Leszcz, 2005).

Group Format, Duration, and Setting

The size of an EAP group would take into consideration the desired group experience and the experience level of the facilitators. The number of horses used as partners must also be considered and determined for each type of exercise and client type. According to Mandrell (2014), an ongoing EAP adult group size of eight to ten client members with one mental health professional and one horse professional is optimal. The treatment team to client to equine ratio is dependent on the level of expertise of the facilitators (Mandrell, 2014). With this number of participants the group is small enough to allow each member to participate regularly and still retain a sense of the group and allows for sufficient interaction between members, facilitators, and equines. The number of horses participating in the group must also be considered and observed as a part of the group (EAGALA, 2015).

In this type of an EAP group a closed format is preferable as introduction of new members to the facility, education and instruction of working with equines, and rules of the group and facility would be time prohibitive if new members were added each week. A closed group offers stability and weekly new members might disrupt the cohesion of the group and have difficulty becoming part of the established group (Mandrell, 2014).

The EAP group meeting would meet weekly with a session length of 3 hours. The group will be ongoing in six-week segments to allow for cohesion and productive work among the group members, facilitators, and equines. At the end of the six-week period the members may elect to enroll in a new group. The new group will be formed, building on the experiences of any returning members and refreshing with a mix of new group members.

The appropriate setting for an EAP group is at an established professional equine facility, ideally in a covered arena or optional open pasture during good weather. The setting for the activities with horses must be large enough for the horses to run and move freely with each other but not so large that group members cannot interact with horses and become part of the herd. A covered or enclosed arena allows for sessions to be held in a variety of weather conditions. An additional area that allows for some privacy is optimal for the discussion portion of session and allowing face-to-face interaction of group members and facilitators (Trotter, 2012).

Group Leaders Role and Function

The co-facilitating team consists of a licensed mental health professional (MH) and a horse professional called an Equine Specialist (ES). Both facilitators must be trained and certified in the EGALA model. It is essential that the MH have experience in traditional counseling techniques to foster an effective therapy group, but they must also allow the group members to struggle and work through their individual challenges at their own speed and not intervene or rescue members. By allowing clients to struggle they can then generalize the experience and allow the clients find their own answers (Mandrell, 2014). The MH is responsible for treatment planning, assessments, intake information, documentation of informed consent and releases, session notes, understanding the ethical practice standards, ensuring the rights of clients are being respected, and verifying any state equine laws (EAGALA, 2015). The MH must share pertinent information with the ES about the session such as session goals but does not need to disclose details of the clients’ treatment plans or cases (Mandrell, 2014). The MH is responsible for the therapy part of the session, ensuring the interventions match the treatment plan, monitoring progress, and creating an emotionally safe and positive environment (EAGALA, 2015).

The ES is responsible for the equines and the physical safety of all participants (Notgrass & Pettinelli, 2015). Through use of body language, posture, and movement, the ES must be a confident horse handler with the ability to communicate effectively and move the horses without touching them, become alpha of the herd managing their behavior with confidence and without confusion about who is in charge (Mandrell, 2014). The ES is responsible for understanding the current mood, limitations, and needs of the horses as well as insuring that the environment is safe for both horses and clients (Trotter, 2012). The ES is responsible for setting up and preparing the area with any needed props for the planned session and maintaining notes on the horses’ behavior during the session (EAGALA, 2015). The ES shares their knowledge of horses and herd dynamics with the MH, continually observes the behavior and responses of the horses throughout the session, appropriately matches horses with clients, and helps the clients to understand the behaviors and actions of the horses (Notgrass & Pettinelli, 2015; EAGALA, 2015).

As a co-facilitating team the ES and the MH together design the session activities based on the curriculum and the therapeutic needs of the clients (Notgrass & Pettinelli, 2015). According to EAGALA (2015), co-facilitators serve as relational models, provide feedback to each other, show group members the benefits of sharing strengths, insight, and perspectives of the other, and can complement, grow, and learn from each other.

Facilitating Stages of the Group

The Initialstage of the group would begin with introductions and orienting members with each other, the facilitators, the facility, the horses, and the group process including establishing ground rules, which are essential in establishing trust and rapport between members and the facilitators (Corey et al., 2014). As part of the ground rules for the group the facilitators will discuss attendance, confidentiality, homework, and bringing up unfinished business at the beginning of each session. In this phase the MH will lead discussions about group goals and each group member will discuss their individual goals with the group.

During this stage as members introduce themselves, the MH will lead discussions with guiding questions that help members to disclose information about the trauma they have experienced. The initial sessions are about assessment and determining what is happing in the moment for the clients and then seeing how the horses respond to the clients. By keeping directions to the clients about the exercises to a minimum, the facilitators can determine how each client typically reacts in every day life situations (EAGALA, 2015).

In the Transition stage the focus for the facilitators is to establish trust, create a safe environment, and outline boundaries by dealing appropriately with conflicts, negative reactions, modeling behavior, and keeping to the here and now (Corey et al., 2014). Through the sharing of experiences and understanding the goal of each member, the initial anxiety and feeling of being alone in their experience will develop into members having empathy for each other and understanding of their common experiences (Corey et al., 2014)

In the Working stage of the group the sessions are focused on the treatment goal and not necessarily on the solution, but rather on process and allowing the clients to make choices and problem solve through the experience of the activities with the horses. The facilitators will begin to observe shifts in behaviors, patterns that are repeated, unique moments, and discrepancies with both the clients and the horses and these observations are brought to the attention of the clients who will then reveal the meanings and how these relate to their lives and their treatment goals (EAGALA, 2015).

In the Final stage members will be gaining insight and demonstrating an understanding of how to apply the skills that have been learned to their lives and taking the metaphors of the interactions with the horses to reinforce the changes and insights that have been made in peak moments of depth and awareness.(Corey et al., 2014; EAGALA, 2015). Facilitators will help members process their feelings of the group termination.

Group Curriculum

While each week will have specific planned and structured activities (See Appendix C), these are used as guidelines as the sessions are experiential in nature and provide the opportunity for members to tell their stories and share their experiences rather than keeping to a strict curriculum. Clients are invited to create representations of challenges, moments in their lives, how things are now and how they want them to be (EAGALA, 2015).

Sessions Outline

Session 1

1. Objective or purpose of the session: Orientation and introductions- Discuss the purpose of the group, the ground rules, safety with equines, and confidentiality of the group. Discuss selection of group members who are dealing with a variety of traumas. Discuss the goals and objectives of the group including expression of feelings, empathy, building trust, and making appropriate choices. Discuss personal treatment goals.
2. Opening Activities: Self-introductions by each member and getting to know each other through ice breakers activities. Tour the facility and review “Barn Rules”.
3. Equine Activities (Working Phase): Herd Observation
4. Topic areas for discussion: Laying metaphorical foundations.
5. Closing Activities: Group members share reactions to the first session. Members discuss any experiences they have had during the session and how these experiences might apply or relate to their life and relationships outside of the group. Review journal writing assignment for the week.

Session 2

1. Objective or purpose of the session: Trust
2. Opening Activities: Check in. Review feedback from previous session. Share journal entries, struggles, and successes. Review Equine safe practices.
3. Equine Activities (Working Phase): Grooming Horses, Rapport Building, Pay It Out
4. Topic areas for discussion: Shared Experiences and Mutual Support
5. Closing Activities: Group members share reactions of the session. Members discuss any experiences they have had during the session and how these experiences might apply or relate to their life and relationships outside of the group. Review journal writing assignment for the week.

Session 3

1. Objective or purpose of the session: Communication
2. Opening Activities: Check in. Review feedback from previous session. Share journal entries, struggles, and successes. Review personal goal progress.
3. Equine Activities (Working Phase): Trail of Support, Charades
4. Topic areas for discussion: Passive, Assertive and Aggressive Communication
5. Closing Activities: Group members share reactions of the session. Members discuss any experiences they have had during the session and how these experiences might apply or relate to their life and relationships outside of the group. Review journal writing assignment for the week.

Session 4

1. Objective or purpose of the session: Exploring Feelings
2. Opening Activities: Check in. Review feedback from previous session. Share journal entries, struggles, and successes.
3. Equine Activities (Working Phase): Flag Race, Feelings Horses, Pony Express
4. Topic areas for discussion: Avoidance, Numbness, Guilt, and Shame
5. Closing Activities: Group members share reactions of the session. Members discuss any experiences they have had during the session and how these experiences might apply or relate to their life and relationships outside of the group. Review journal writing assignment for the week.

Session 5

1.   Objective or purpose of the session: Relationships
2. Opening Activities: Check in. Review feedback from previous session. Share journal entries, struggles, and successes.
3. Equine Activities (Working Phase): Moving with Pressure, Red Light Green Light
4. Topic areas for discussion: Respect, Boundaries, and Limitations
5. Closing Activities: Group members share reactions of the session. Members discuss any experiences they have had during the session and how these experiences might apply or relate to their life and relationships outside of the group. Review journal writing assignment for the week. Discuss upcoming termination.

Session 6

1. Objective or purpose of the session: Resilience and Acceptance ; Termination
2. Opening Activities: Check in. Review feedback from previous session. Share journal entries, struggles, and successes.
3. Equine Activities (Working Phase): Acceptance Alley
4. Topic areas for discussion: Strengths and Abilities
5. Closing Activities: Group members share reactions of group experience. Members summarize the experiences they have had during the group and how these experiences might apply or relate to their life and relationships outside of the group in the future. Termination reflections and activity. Spend alone time with horse to say goodbye.

Ethical Considerations

Ethical and legal considerations for working with groups and equines can differ from traditional therapy situations. The MH professional will honor all ethical codes and standards of mental health organizations per the ACA Code of Ethics. The MH is legally and ethically required to honor all personal identity and health information privacy laws such as the Heath Assurance Portability Act (HIPPA) for the state in which they practice. Although not legally governed as a mental health professional, the ES is required to adhere to the same ethical considerations as MH professionals by the EAGALA code of ethics (EAGALA, 2015).

In the EAP group format there will be a discussion regarding confidentiality and each group member will be asked to sign a confidentiality agreement as part of the client informed consent document but this is not legally or ethically binding as it is for the co-facilitating professionals (See Appendix A). As with any group there is the possibility that what is discussed or observed in the group will not be kept confidential by members. There is also a possibility that confidentiality may not be kept due to the open-air setting of the group meeting place being held in a barn, stable, pasture, or arena where sessions can be observed and where other people on facility business may hear discussions from the session. Participants in the EAP group would be advised that while every precaution would be taken to protect and guard the confidentiality of the group members, this might not always be possible.

In the EAP group, the co-facilitators will adhere to the Ethical Codes and Standards established by EAGALA and the practice of EAP is to be safe and humane to both humans and animals (EAGALA, 2015). For the EAP group to adhere to the ethical treatment and use of equines, facilitators must acknowledge fatigue, stress, distress, discomfort, or lack of a desire of an equine. If an equine is displaying signs of distress facilitators must take action and attempt to reduce stress for the animal and the facilitators must possess the knowledge and ability to interpret therapy animal vocal and non-vocal communications (Chandler, 2016). According to Prezosi (1997), an equine facilitator must have the therapy horse’s welfare as a priority and must never force it to perform an action that it does not agree to execute willingly. The facilitators must ensure the environment is safe for the horse and should know each horse well enough to distinguish when it is and is not comfortable and should not knowingly place the horse in a circumstance where it is not comfortable (Prezosi, 1997). As use of any animal in a therapeutic setting can be dangerous, clients will be asked to sign a Voluntary Waiver and Release Form (See Appendix B).

Evaluation

To measure the effectiveness of the EAP group, standardized assessments will be administered to the group members prior to the start of the group and a follow up assessment will be given after the last session. These assessments will be used to measure symptom severity specifically related to trauma. The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) is short assessment of eight items measuring the basic symptoms of PTSD including (numbing, intrusion, avoidance, arousal), stress susceptibility, somatic malaise, stress vulnerability, and functional impairment of roles and social interaction, with a five point scale to rate symptoms (Connor & Davidson, 2001). The Davidson Trauma Scale (DTS) is a 17-item scale measuring each symptom on 5-point frequency and severity scale (Davidson et al., 1997). The choice to use these assessments is based on reliability and validity, measure of symptom severity and overall improvement, ease of use for clients to self-report, and brief length.

Clients would also be required to keep a weekly personal journal about their experiences in the group and these journals would be referenced in the group discussions at the beginning of each session as clients self report their progress throughout the group duration. To allow for the possibility that members may have different or changing perceptions about the outcome of their group experience, four weeks after the last session a brief online questionnaire will be sent to each member allowing them a chance to evaluate the effectiveness of the group and the facilitators and establish what aspects of the group were most valuable or least effective for them (Corey et al., 2014).

Appendix A

EAP Group Informed Consent

Welcome to the Equine Assisted Psychotherapy Group. Equine Assisted Psychotherapy is a team approach to counseling with a therapist, a horse professional, and a horse. We seek to integrate the emotional, spiritual, physical, relational, and mental elements in the process. A variety of techniques and approaches are used.

It is important to be clear about the nature of group work and the therapeutic relationship. Read them carefully and bring up any questions that you may have so that we can discuss them. Then please sign below so I will have in my records that you have received, read and clarified with me the information received.

About the Relationship with the Therapist

The therapeutic relationship has to be different from most relationships. As facilitators of the group process our relationship with the group members is limited. Therapy professions have provisions against such relationships to protect us both:

• I cannot have any other kind of business relationship with you besides the therapy itself.
• I cannot give legal, medical, financial, or any other type of professional advice.
• I cannot have any kind of romantic or sexual relationship with a former or current client, or with people close to the client.
• I must keep the identity of clients confidential, therefore I may not acknowledge you when we meet in a public place and I must decline to attend your personal events or gatherings if you invite me.
• Lastly, when the group work ends I will not be able to befriend you like your other friends and cannot give or receive gifts from clients except tokens with personal meaning to the group process.

Consent for Group Process Work

This group will meet on Thursday afternoons from 3:00pm-6:00pm. The fee is $50 per group session. I agree to pay this fee even for group sessions I do not attend. There are six group sessions to begin on March 1st and end on April 5th. The total of $300 includes the pre-group session and the cost of any material used within the group.

I agree to work in this group. This means openly expressing my thoughts and feelings, and exchange helpful feedback with other members of the group.

I will do my best to promptly attend all session of this group even if I do not always feel like it. If I cannot attend for some reason, I will tell the group if possible a week in advance. If it is an emergency, I will call the therapist as soon as I know I cannot attend.

With full understanding of the need for confidentiality (that is privacy) for all group members, I accept these rules:

We will use first names. Other information (such as phone numbers) can only be exchanged on a person-to-person basis. Do not give personal information about others out to anyone.

We will not allow children, spouses or other visitors in our sessions.

We will not permit any kind of recordings of our sessions, even by our members or facilitators.

I will adhere to privacy/confidentiality provision by not disclosing any of the issues presented by any group member, as it may be identifiable.

I understand that the facilitator(s) will keep a clinical record on each individual group member and that this record will only contain first names of other group members.

I understand that the other group members are not therapists and are not obligated to maintain the same ethics and legal provisions that the therapist must adhere. There are specific exceptions to confidentiality in any therapeutic modality. Mental health professionals have a legal and ethical responsibility to report information to the appropriate persons with or without your consent in the following instances: if you are a danger to yourself or others; if there is a suspicion of child or elder abuse; or subpoenaed by a court to release medical records. If in the professional judgment of the facilitator(s) any of these exceptions apply, a reasonable effort will be made to discuss them prior to the release of information. I understand that I cannot be absolutely certain that they will always keep what I say in the group confidential even though every group member has agreed to maintain confidentiality. In addition, since the EAP group is on a working farm, it is possible that someone might stop by during my session. I understand that the facilitators will attend to this as quickly and with as little interruption as possible, should it happen during my session time.

I understand that the therapist cannot guarantee confidentiality from other therapists regarding information shared in individual sessions. Rather, the therapist guarantees discretion. The purpose of these two provisions is to maintain a robust therapeutic process for everyone. Once secrets begin to develop, the full impact of emotional sharing required to facilitate everyone’s therapeutic process diminishes.

I have read the attached informational materials describing the possibilities of group therapy and how I can best use it as a resource for my growth and development. I agree to abide by these rules and provisions above and to discuss any questions and concerns I may have at present or in the future with the therapist(s). My signature below indicates that I give informed consent to receive group services as described above:

____________________________________________________________________________

Participant  (Print Name)    Signature     Date

___________________________________________________________________________

Therapist (Print Name)    Signature      Date

Appendix B

EAP Group Voluntary Waiver and Release Form

Safety is our number one priority in the facilitation and management of all levels of the Equine Assisted Psychotherapy Group (EAP Group). However, even with the adherence to recognized risk management practices in horse-related activities, accidents do occur. Participation in the EAP Group is entirely voluntary.

I acknowledge that there are numerous hazards and potential risks of injury or death, which can occur from caring for horses, being in the physical proximity of horses, or being involved in therapeutic, learning, and counseling activities that include horses. I also acknowledge that The “Personal Disclosure Statement” provided to me also describes risks in participating in EAP Group.

WARNING

UNDER TEXAS LAW (CHAPTER 87 CIVIL PRACTICE AND REMEDIES CODE), A FARM ANIMAL PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF APARTICIPANT IN FARM ANIMAL ACTIVITIES RESULTING FROM THE INHERENT RISKS OF FARM ANIMAL ACTIVITIES

VOLUNTARY RELEASE OF LIABILITY – I am over 18 years of age. Because of the potential benefits of the EAP Group and in consideration of being accepted for participation the group, I assume full responsibility for myself for all risks inherent and otherwise, related to attendance and participation. I assume full responsibility for myself for bodily injury, death, loss of personal property, and expenses thereof, as a result of my negligence, or other risks, including but not limited to those related to participation in any aspect of EAP Group for the full duration of my participation in this program.

I acknowledge that I have been given the opportunity to ask questions regarding any aspect of this voluntary waiver and release form and by signing in the space provided do acknowledge that I have read completely and fully understand all aspects of this release form and agree to its terms in their entirety. I have been informed of the full nature of the EAP Group and its inherent risk and fully understand the nature of the program.

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Participant  (Print Name)    Signature     Date

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Therapist (Print Name)    Signature      Date