Insights into the processes underpinning Equine-based therapy: A qualitative study with Mental Health practitioners in South Africa

Insights into the processes underpinning Equine-based therapy: A qualitative study with Mental Health practitioners in South Africa

Lyrise Naidu & Raisuyah Bhagwan

Issue: Vol. 7 No.6 2026 Article 20 pp. 1703 – 1720
DOI: https://doi.org/10.38159/ehass.20267620 Published online 31st July 2026

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ABSTRACT

This study explored how equine-based therapy was implemented and facilitated within therapeutic contexts across South Africa. Drawing on qualitative data from fifteen mental health practitioners across South Africa, the study highlighted the collaborative roles of mental health professionals, equine specialists, and horses in facilitating healing amongst those presenting with mental health distress. Thematic analysis revealed five core themes: therapeutic process, setting, practitioner-client-horse engagement, pre-session check-ins, client orientation, and session facilitation. Practitioners emphasized the importance of using nature-based settings, experiential learning, and metaphorical reflection to foster emotional regulation, self-awareness, and relational insight for their clients. The study underscored the horse’s intuitive responsiveness to human emotion, offering clients immediate, embodied feedback that enhanced therapeutic outcomes. Despite the growing recognition of the efficacy of equine-based therapy in treating trauma and mental health distress, its integration has remained fragmented due to a lack of understanding of its processes and varying terminology and gaps in training. This study positions equine-based therapy as a complementary intervention that can support mental health and well-being. Grounded in collaborative, strengths-based, and client-centred approaches, equine-based therapy offers transformative potential for vulnerable populations and mental health practitioners alike.

Keywords: equine-based therapy, implementation, mental health, therapeutic process.

BIBLIOGRAPHY

Acri, Mary, Kimberly Hoagwood, Meghan Morrissey, and Shirley Zhang. “Equine-Assisted Activities and Therapies: Enhancing the Social Worker’s Armamentarium.” Social Work Education 35, no. 5 (July 3, 2016): 603–12. https://doi.org/10.1080/02615479.2016.1173669.

Almasloukh, Khalid Bandar. “Equine-Assisted Activities and Therapies: State-of-the-Art Review.” Nursing Science Quarterly 35, no. 1 (January 23, 2022): 92–100. https://doi.org/10.1177/08943184211051367.

Anastasya, Karina Shasri, Indra Gazali Syamsuddin, Meutia Atika Faradilla, Meutia Atika Zefanya, Andira Larasari, Daniella Satyasari, Daniella Yohana, et al. “Mechanisms and Benefits of Equine Therapy for Enhancing Mental Health.” Research & Development 5, no. 1 (March 7, 2024): 40–43. https://doi.org/10.11648/j.rd.20240501.16.

Ayala, María Dolores, Andrea Carrillo, Pilar Iniesta, and Pedro Ferrer. “Pilot Study of the Influence of Equine Assisted Therapy on Physiological and Behavioral Parameters Related to Welfare of Horses and Patients.” Animals 11, no. 12 (December 10, 2021): 3527. https://doi.org/10.3390/ani11123527.

Bachi, Keren, Joseph Terkel, and Meir Teichman. “Equine-Facilitated Psychotherapy for at-Risk Adolescents: The Influence on Self-Image, Self-Control and Trust.” Clinical Child Psychology and Psychiatry 17, no. 2 (April 14, 2012): 298–312. https://doi.org/10.1177/1359104511404177.

Badin, Léa, Émilie Alibran, Kristell Pothier, and Nathalie Bailly. “Effects of Equine-Assisted Interventions on Older Adults’ Health: A Systematic Review.” International Journal of Nursing Sciences 9, no. 4 (October 2022): 542–52. https://doi.org/10.1016/j.ijnss.2022.09.008.

Beauchen, Kate. “Equine Facilitated Psychotherapy in the Body Psychotherapy Session: Horse as Surrogate for Therapeutic Touch.” International Body Psychotherapy Journal 16 (2017).

Benda, W, and R. Lightmark. “People Whisperers: Integral Health and Healing.” Shift: At the Frontiers of Consciousness,” 2004, 30–33.

Bennett, Bindi, and Elise Woodman. “The Potential of Equine-Assisted Psychotherapy for Treating Trauma in Australian Aboriginal Peoples.” The British Journal of Social Work 49, no. 4 (June 1, 2019): 1041–58. https://doi.org/10.1093/bjsw/bcz053.

Braun, V., and V. Clarke. Thematic Analysis: A Practical Guide. SAGE Publications, 2021.

Buck, Page Walker, Nadine Bean, and Kristen De Marco. “Equine-Assisted Psychotherapy: An Emerging Trauma-Informed Intervention.” Advances in Social Work 18, no. 1 (September 24, 2017): 387–402. https://doi.org/10.18060/21310.

Burgon, Hannah, Di Gammage, and Jenny Hebden. “Hoofbeats and Heartbeats: Equine-Assisted Therapy and Learning with Young People with Psychosocial Issues – Theory and Practice.” Journal of Social Work Practice 32, no. 1 (January 2, 2018): 3–16. https://doi.org/10.1080/02650533.2017.1300878.

Burgon, Hannah Louise. Equine-Assisted Therapy and Learning with at-Risk Young People. Springer, 2014.

Bustad, Leo K. “Reflections on the Human-Animal Bond.” Journal of the American Veterinary Medical Association 208, no. 2 (1996): 203–5.

Chardonnens, Evelyne. “The Use of Animals as Co-Therapists on a Farm: The Child Horse Bond in Person-Centered Equine-Assisted Psychotherapy.” Person-Centered & Experiential Psychotherapies 8, no. 4 (December 2009): 319–32. https://doi.org/10.1080/14779757.2009.9688496.

Compitus, Katherine. “Animal-Assisted Therapy,” 27–43, 2021. https://doi.org/10.1007/978-3-030-87783-5_4.

Diaz-Bonilla, Carolina, Carlos Sabatino, Haoyu Wu, and Minh Cong Nguyen. “Global Poverty Monitoring Technical Note – October 2022 Update to the Multidimensional Poverty Measure.” Washington, DC, 2022.

Eagala. “Equine Assisted Growth and Learning Academy (EAGALA),” 2018.

Friedmann, Erika, Elizabeth Galik, Sue A. Thomas, P. Sue Hall, Seon Yoon Chung, and Sandra McCune. “Evaluation of a Pet-Assisted Living Intervention for Improving Functional Status in Assisted Living Residents With Mild to Moderate Cognitive Impairment.” American Journal of Alzheimer’s Disease & Other Dementias® 30, no. 3 (May 11, 2015): 276–89. https://doi.org/10.1177/1533317514545477.

Fry, Nina Ekholm. “Conceptualization of Psychotherapy Incorporating Equine Interactions in the United States.” Human-Animal Interaction Bulletin, December 1, 2021. https://doi.org/10.1079/hai.2021.0036.

Gomez, India B. Evaluating a Program of Equine Therapy for Veterans with PTSD Symptoms. Alliant International University, 2016.

Grimm, Erin J. Non-Traditional Therapeutic Interventions for at-Risk Youth & Students with Complex Support Needs: Equine Therapy. Duquesne University, 2015.

Haig, Laurie, and Kelly Skinner. “Use of Equine-Assisted Services to Improve Outcomes Among At-Risk and Indigenous Youth: A Scoping Review.” Frontiers in Public Health 10 (March 28, 2022). https://doi.org/10.3389/fpubh.2022.730644.

Hammarberg, K., M. Kirkman, and S. de Lacey. “Qualitative Research Methods: When to Use Them and How to Judge Them.” Human Reproduction 31, no. 3 (March 2016): 498–501. https://doi.org/10.1093/humrep/dev334.

Harbeson, Laura, and Raeunn Marie. “Psychotherapists’ Perceptions and Use of Projection in Equine-Assisted Interventions: A Phenomenological Study.” Northcentral University, 2019.

Hartwig, Elizabeth Kjellstrand, and Quinn Koelfgen Smelser. “Practitioner Perspectives on Animal-Assisted Counseling.” Journal of Mental Health Counseling 40, no. 1 (January 1, 2018): 43–57. https://doi.org/10.17744/mehc.40.1.04.

Hebesberger, Denise V., Andrea Beetz, and Kurt Kotrschal. “Behavioral and Physiological Effects of Equine-Assisted Early Intervention for Mother- Child Dyads with Insecure Attachment.” Human-Animal Interaction Bulletin, December 1, 2019. https://doi.org/10.1079/hai.2019.0003.

Howe, David, Ravi Kohli, Martin Smith, Clare Parkinson, Linnet McMahon, Robin Solomon, and John Simmonds. Relationship-Based Social Work: Getting to the Heart of Practice. Jessica Kingsley Publishers, 2018.

Jolly, Jennifer. “A Qualitative Study on Equine-Assisted Psychotherapy and Its Impact on Cognitive, Behavioral, Social, and Emotional Growth Through Interpersonal Bonding.” Drake University, 2022.

Kirby, Meg. An Introduction to Equine Assisted Psychotherapy: Principles, Theory, and Practice of the Equine Psychotherapy Institute Model. Balboa Press, 2016.

Lewis, Shereva. “Counselors Who Use Horses as Co-Facilitators in Treating Individuals with Anxiety Disorders.” University of Holy Cross, 2025.

Lowry, Caitlin S. Straight from the Horse’s Mouth: A Thematic Analysis Exploring Client and Practitioner Perceptions of an Equine-Assisted Family Therapy Session. Nova Southeastern University, 2023.

McCullough, Leslie. “Integrating Body-Mind-Attachment Practices into Equine-Facilitated Psychotherapy: A Case Example of Oppositional Defiant Disorder.” In Equine-Assisted Mental Health Interventions, 133–46. Routledge, 2018.

Mojdara, Patricia M. “A Quantitative Examination of Two Equine Therapy Models on Veterans With Mental Health Needs.” Fielding Graduate University, 2025.

Moser, Albine, and Irene Korstjens. “Series: Practical Guidance to Qualitative Research. Part 3: Sampling, Data Collection and Analysis.” European Journal of General Practice 24, no. 1 (January 1, 2018): 9–18. https://doi.org/10.1080/13814788.2017.1375091.

Mota-Rojas, Daniel, Eleonora Nannoni, Ana C. Strappini, Ismael Hernández-Avalos, Julio Martínez-Burnes, Adriana Domínguez-Oliva, and Patricia Mora-Medina. “An Overview of the Benefits of Animal-Assisted Interventions in Medical and Therapeutic Contexts for Human Health: Cognitive Mechanisms, Sensory Percetion and Welfare Considerations.” Frontiers in Veterinary Science 13 (2026).

Motta, Robert W. “The Impact of Animals on Secondary Trauma.” In Secondary Trauma, 123–34. Cham: Springer Nature Switzerland, 2023. https://doi.org/10.1007/978-3-031-44308-4_12.

Murphy, Lynne, Jacqueline Wilson, and Stacey Greenberg. “Equine-Assisted Experiential Learning in Occupational Therapy Education.” Journal of Experiential Education 40, no. 4 (2017): 366–76.

Naste, Tiffany M., Maggi Price, Jane Karol, Lia Martin, Kathryn Murphy, Jennifer Miguel, and Joseph Spinazzola. “Equine Facilitated Therapy for Complex Trauma (EFT-CT).” Journal of Child & Adolescent Trauma 11, no. 3 (September 17, 2018): 289–303. https://doi.org/10.1007/s40653-017-0187-3.

Nurenberg, Jeffry R., Steven J. Schleifer, Thomas M. Shaffer, Mary Yellin, Prital J. Desai, Ruchi Amin, Axel Bouchard, and Cristina Montalvo. “Animal-Assisted Therapy With Chronic Psychiatric Inpatients: Equine-Assisted Psychotherapy and Aggressive Behavior.” Psychiatric Services 66, no. 1 (January 1, 2015): 80–86. https://doi.org/10.1176/appi.ps.201300524.

Pálsdóttir, Anna María, Marie Gudmundsson, and Patrik Grahn. “Equine-Assisted Intervention to Improve Perceived Value of Everyday Occupations and Quality of Life in People with Lifelong Neurological Disorders: A Prospective Controlled Study.” International Journal of Environmental Research and Public Health 17, no. 7 (April 3, 2020): 2431. https://doi.org/10.3390/ijerph17072431.

Pendry, Patricia, Annelise N. Smith, and Stephanie M. Roeter. “Randomized Trial Examines Effects of Equine Facilitated Learning on Adolescents’ Basal Cortisol Levels.” Human-Animal Interaction Bulletin, December 1, 2014. https://doi.org/10.1079/hai.2014.0003.

Priest, Simon. “Clearing up the Confusion over Outdoor Therapies: How They Fit with, Overlap, or Relate to One Another.” Journal of Outdoor Recreation, Education, and Leadership 14, no. 3 (August 9, 2022): 114–21. https://doi.org/10.18666/JOREL-2022-11552.

Salah, F A. “Understanding of Therapists’ Experiences and Perceptions of Equine Facilitated Psychotherapy, an Interpretative Phenomenological Study,” 2024.

Schmidt, Julia, Andrea Wartenberg-Demand, and Simon Forstmeier. “Equine-Assisted Biographical Work (EABW) with Individuals in the Second Half of Life: Study Protocol of a Multicentre Randomised Controlled Trial.” Trials 21, no. 1 (December 15, 2020): 857. https://doi.org/10.1186/s13063-020-04784-3.

Schroeder, Katy, Daniel Stroud, Dawn M. Sherwood, and Monique A. R. Udell. “Therapeutic Factors in Equine-Facilitated Group Psychotherapy for Women Survivors of Interpersonal Violence.” The Journal for Specialists in Group Work 43, no. 4 (October 2, 2018): 326–48. https://doi.org/10.1080/01933922.2018.1516707.

Schultz, Pamela N., G. Ann Remick-Barlow, and Leslie Robbins. “Equine-Assisted Psychotherapy: A Mental Health Promotion/Intervention Modality for Children Who Have Experienced Intra-Family Violence.” Health & Social Care in the Community 15, no. 3 (December 6, 2006): 265–71. https://doi.org/10.1111/j.1365-2524.2006.00684.x.

Scopa, Chiara, Laura Contalbrigo, Alberto Greco, Antonio Lanatà, Enzo Pasquale Scilingo, and Paolo Baragli. “Emotional Transfer in Human–Horse Interaction: New Perspectives on Equine Assisted Interventions.” Animals 9, no. 12 (November 26, 2019): 1030. https://doi.org/10.3390/ani9121030.

Suarez, Elisabeth. “The Effects of Equine-Assisted Psychotherapy on the Psychosocial Functioning of At-Risk Adolescents Ages 12-18 Copyright© by Bettina N. Shultz Bound Copy at Denver Seminary All Rights Reserved.,” 2005.

Takacs, Jillian Claire. “ It’s Not Just About Petting Horses”: Understanding Equine-Assisted Psychotherapy and Horse-Human Healing Relationships. Queen’s University (Canada), 2022.

Tedeschi, Philip, Jennifer Fitchett, and Christian E. Molidor. “The Incorporation of Animal-Assisted Interventions in Social Work Education.” Journal of Family Social Work 9, no. 4 (August 14, 2005): 59–77. https://doi.org/10.1300/J039v09n04_05.

Tobin, Kelly Marie. “The Relationship between Equine-Assisted Psychotherapy and Client-Therapist Attachment on Symptom Reduction.” Walden University, 2020.

Townsend, Rob, and Michelle Hood. “Horse Talk: Equine Based Learning Programs and Their Engagement with Individuals.” Australian Journal of Adult Learning 59, no. 2 (2019): 254–68.

Trösch, Miléna, Florent Cuzol, Céline Parias, Ludovic Calandreau, Raymond Nowak, and Léa Lansade. “Horses Categorize Human Emotions Cross-Modally Based on Facial Expression and Non-Verbal Vocalizations.” Animals 9, no. 11 (October 24, 2019): 862. https://doi.org/10.3390/ani9110862.

Trotter, Kay Sudekum, and Jennifer N Baggerly. Equine-Assisted Mental Health for Healing Trauma. Routledge New York, NY, USA:, 2018.

Trotter, Kay Sudekum, Cynthia K. Chandler, Deborah Goodwin-Bond, and Janie Casey. “A Comparative Study of the Efficacy of Group Equine Assisted Counseling With At-Risk Children and Adolescents.” Journal of Creativity in Mental Health 3, no. 3 (October 10, 2008): 254–84. https://doi.org/10.1080/15401380802356880.

Turner, Mandi J. “Horses in Therapy: The Practice of Equine Facilitated Psychotherapy,” 2018.

Vasconcelos, André, Jomar Monsores, Tania Almeida, Laura Quadros, Eduardo Ogasawara, and João Quadros. “Applying Gestalt Approach as a Method for Teaching Computer Science Practice in the Classroom: A Case Study in Primary Schools in Brazil.” Education and Information Technologies 28, no. 2 (February 2023):2383–2403. https://doi.org/10.1007/s10639-022-11278-z.

Vincent, Aviva, and Kathleen J Farkas. “Application of Attachment Theory to Equine-Facilitated Therapy.” Society Register 1, no. 1 (2017): 7–22.

Vincent, Aviva, Meghan Morrissey, Mary Acri, Fei Guo, and Kimberly Hoagwood. “Volunteer Engagement within Equine Assisted Services.” Animals 14, no. 2 (January 12, 2024): 249. https://doi.org/10.3390/ani14020249.

White-Lewis, Sharon, Rebecca Johnson, Sangbeak Ye, and Cynthia Russell. “An Equine-Assisted Therapy Intervention to Improve Pain, Range of Motion, and Quality of Life in Adults and Older Adults with Arthritis: A Randomized Controlled Trial.” Applied Nursing Research 49 (October 2019): 5–12. https://doi.org/10.1016/j.apnr.2019.07.002.

Wilson, Kaitlyn, Melissa Buultjens, Melissa Monfries, and Leila Karimi. “Equine-Assisted Psychotherapy for Adolescents Experiencing Depression and/or Anxiety: A Therapist’s Perspective.” Clinical Child Psychology and Psychiatry 22, no. 1 (January 27, 2017): 16–33. https://doi.org/10.1177/1359104515572379.

ABOUT AUTHOR(S)

Dr. Lyrise Naidu holds a PhD in Health Sciences from the Durban University of Technology, where her doctoral research explored equine-based therapy as a therapeutic modality in social work practice. She completed her Master’s degree with a focus on community engagement at a university located in India. Currently, she is a Postdoctoral Fellow at the Durban University of Technology. Her research interests include community engagement, social work education and child and youth well-being.

Professor Raisuyah Bhagwan is a Full Professor in the Department of Community Health Studies at the Durban University of Technology and a National Research Foundation (NRF) C2-rated researcher. She completed her PhD in Community and Development Disciplines at the University of KwaZulu-Natal in 2002. Her research focuses on community engagement, social justice, spirituality, indigenous knowledge systems, community development, and social work education. Professor Bhagwan has published extensively in these fields, supervises postgraduate research, and has established several international research collaborations. She is the recipient of the CHE–HELTASA National Excellence in Teaching Award and is widely recognised for her contributions to community-engaged scholarship and transformative teaching and learning.

TO CITE ARTICLE

Naidu, Lyrise and Raisuya Bhagwan. “Insights into the processes underpinning Equine-based therapy: A qualitative study with Mental Health practitioners in South Africa.” E-Journal of Humanities, Arts and Social Sciences 7, no.6 (2026): 1703 -1720. https://doi.org/10.38159/ehass.20267620