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Equine-assisted psychotherapy for survivors of childhood sexual abuse and related insecure attachment issues
Childhood sexual abuse (CSA) is recognized risk factor for a multitude of negative consequences. These outcomes include abnormal sexual development and functioning (Jackson, Calhoun, Amick, Maddever, & Habif, 1990), sexual aversion, avoidance, and/or ambivalence (Noll, Trickett, & Putnam, 2003), post-traumatic stress disorder (McLeer, Deblinger, Atkins, Foa, & Ralphe, 1988), psychopathology (Cutajar, Mullen, Ogloff, Thomas, Well, & Spataro, 2010), and increased risk of self-harm (Romans, Anderson, & Herbison, 1995) among other social, cognitive, and behavioural outcomes. In addition, CSA research indicates children who have experienced inappropriate, unwanted, or disturbing sexual trauma are more likely to undergo childhood development plagued with issues related to attachment (Ensink, Borelli, Normandin, Target, & Fonagy, 2019).
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Attachment organization plays a critical role in predicting victims’ adaptation to CSA (Ensink et al., 2019). Attachment theory holds that children develop internal working models (IWMs) of attachment based on patterns of parental sensitivity and responsiveness (Bowlby, 1969). Children develop secure IWMs when caregivers respond consistently and sensitively to their distress, and consequently, children may develop insecure IWMs when caregivers do not respond consistently and sensitively to distress (Bowlby, 1969). Children who have experienced CSA are more likely to develop insecure attachment patterns than children without CSA (Ensink et al., 2019; Kwako, Noll, Putnam, & Trickett, 2011). Furthermore, research indicates development of insecure attachment in children with CSA persist throughout early adulthood and adulthood relationships, signifying the importance for early therapeutic interventions (Labadie, Godbout, Vaillancourt-Morel, & Sabourin, 2018).
Insecure attachment patterns have been targeted by therapeutic interventions for children, such as creative art and/or play therapy (Malchiodi, 2014; Mousavi & Safarzadeh, 2016). However, there are numerous therapy options available for children with CSA including trauma-focused cognitive behavioural therapy (Holtzhausen, Ross, & Perry, 2015), game-based cognitive-behavioural therapy (Misurell & Springer, 2011), eye movement desensitization and reprocessing (Posmontier, Dovydaitis, & Lipman, 2010), play therapy (Rocha & do Prado, 2006), and variations of animal-assisted therapies, including equine-assisted psychotherapy (Dietz, Davis, & Pennings, 2012).
Equine-assisted psychotherapy (EAP) has gained more attention in research over the last couple years in examining treatment of various psychological disorders and behaviours. Recent research indicates EAP can reduce trauma symptoms in children with CSA, whilst also demonstrating effectiveness in reorganizing insecure attachment that children may have developed from CSA (Dietz, Davis, & Pennings, 2012; Bachi, 2013). While EAP research has examined the treatment of survivors of sexual abuse, the primary focus of this body of research has focused on female adult survivors’ experiences; very few researchers have studied the impacts of EAP on the attachment patterns of child survivors of CSA. This article will explore how EAP functions to support and alleviate symptoms of CSA in children within the framework of attachment theory. I will discuss how EAP may foster secure attachment in children with CSA through primary concepts of attachment theory that correspond with features of EAP, namely secure base, affect mirroring, and non-verbal communication/body experience.
EAP and attachment-based theory
EAP is a psychological intervention that uses the distinct qualities of a horse, in addition to a licensed therapist, to assist in the treatment of a patient (Wilson, Buultjens, Monfries, Karimi, 2015). Thus, the main difference of EAP from other forms of psychotherapy is the involvement of the horse as a co-therapist. For children with insecure attachment and CSA, the role of the horse as a co-therapist allows EAP to offer a unique treatment in alleviating traumatic CSA-related symptoms whilst fostering secure attachment patterns through the child’s attachment to and interactions with the horse.
EAP, Secure Base and Affect Mirroring: Attachment to Horse
In attachment-based psychotherapy, it is the therapist’s goal to provide a secure base for the client, similar to a mother’s role for a child (Bowlby, 1988). In this context, a secure base involves the therapist as a trusted companion who provides support, encouragement, sympathy, and guidance to the client (Bachi, 2013). This promotes the client’s ability to explore painful relational experiences in their past or present life, such as CSA. In EAP, the client fosters a secure base with the horse; with the horse fulfilling the child’s needs, this relationship can aid in fostering secure attachment in children with CSA as it is a powerful mechanism to break the psychological barriers of mistrust (Bachi, 2013). This is significant as Bowlby (1969) described insecure attachment as children who do not trust their caregivers to fulfill their needs.
Trickett, Noll, and Putnam (2011) found that subsequent to CSA, children’s attachment systems are activated, as the child’s need for comfort and security are heightened, especially if the perpetrator was a family member or parent (Kwako et al., 2011). In addition, there is an increased risk in developing insecure attachment with their caregivers, often due to the caregiver’s reaction when the child discloses the abuse. For example, parents may react to the disclosure with dismissal or minimization of the event, or become overwhelmed and frightened (Ensink et al., 2019). These reactions neglect the child’s needs and promote insecurity for the child, fueled by mistrust. EAP can foster secure attachment by encouraging trust between the child and the horse through physical and emotional safety (Bachi, 2013). Physical safety can be demonstrated by the horse’s gentleness and ability to hold the client on its back, whereas emotional safety may be experienced through the impact of affect mirroring.
Attachment theory outlines affect mirroring as an emotionally attuned caregiver’s ability to offer a visual and/or auditory representation of the child’s own state, which allows the child to “see” or “own” their feelings (Holmes, 2009). In EAP, the horse’s innate tendency to mirror affect provides the client with the opportunity to emotionally connect with the horse (Siegel, 1999). This response from the horse acts as a secure base for the child and allows for a safe setting for children to work through traumatic issues and practice secure attachment that may be conveyed to human relationships (Parish-Plass, 2008).
EAP and Non-verbal Communication/Body Experience: Powerlessness
A major theme among survivors of CSA is the feeling of powerlessness (Meinersmann, Bradberry, & Roberts, 2008; Rossiter & Matthews, 2011). In their research on themes of power in survivors with CSA, Liem, O’Toole, and James (1996) found that CSA victims closely associated views of themselves as powerless. This feeling of powerlessness affects a child’s belief in their ability to produce change in themselves or to exert control over their actions, thoughts, emotions, and goals (Liem, O’Toole, & James, 1996). This can lead to the development of insecure attachment if the child’s attempts to end the abuse (i.e., through disclosure) are dismissed or minimized by the caregiver. Through EAP, survivors of CSA may exert a degree of power in sessions by overcoming their fear or timidity of the horse through non-verbal communication or body experience (Rossiter & Matthews, 2011). The feeling of “controlling” a big, imposing horse provides clients with confidence to control similar emotions related to their traumatic experiences (Rossiter & Matthews, 2011; Meinersmann et al., 2008).
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Another facet of powerlessness for children with CSA may be their fear of power. Winter and Stewart (1978) describe this aversion to power to derive from the early experience of another person’s exertion of power over one’s self and the little freedom to maneuver around that power. Therefore, the child experiences power as uncontrollable and inescapable (Winter and Stewart, 1978). This further connects to the attachment-based theoretical concept of non-verbal communication and body experience, as the child’s ability to control and maneuver the horse, often through non-verbal communicative techniques and physical touch, gives children positive experiences of power which can translate into human relationships and aid in reorganizing insecure attachment patterns related to mistrust of power (Rossiter & Matthews, 2011).
EAP and Non-verbal Communication/Body Experience: Communication
As discussed, the feelings of power achieved in EAP can be understood through the concept of non-verbal communication and body experience within an attachment-oriented framework (Bachi, 2013). This notion can also be applied to how interaction with the horses in EAP can improve communication of children with CSA. Bachi (2013) outlines the experience of a fourteen-year-old girl who experienced abuse at her father’s hand. The girl could not bear physical touch, but after extensive grooming of horses during her EAP sessions, the girl was able to tolerate touch and feel unthreatened by it. This non-verbal communication and body experience between the child and the horse allowed for the healing of the girl’s trauma related to touch and helped work towards a greater sense of self-control and open communication in her relationships (Bachi, 2013).
The non-verbal communication aspect of EAP enables the child to foster attachment with the horse as a secure base and can aid in the therapist’s ability to understand aspects of the child’s self that have not been articulated (i.e. aversion to touch) (Bachi, 2013). Furthermore, the perceptive nature of horses encourages clients to be more aware of their non-verbal communication, such as body language (Rossiter & Matthews, 2011). This heightened awareness of communication strategies gives children the opportunity to work through their communicative patterns, expand their capacity for trust, and develop skills for healthy communication in relationships (Rossiter & Matthew, 2011). In turn, improving communication in relationships can aid in resolving insecure attachments amongst children with CSA, as it may work to repair learned patterns of poor communication that previously encouraged insecure attachment patterns.
While children may seek therapy for different outcomes related to CSA experiences, equine-assisted psychotherapy based within an attachment-theory framework can support and alleviate symptoms of CSA whilst working towards secure attachments in the child’s relationships. Three aspects of attachment-based theory (secure base, affect mirroring, and non-verbal communication/body experience) integrated with the practice of EAP can provide an effective treatment for children with CSA and insecure attachment issues related to trust, powerlessness, and communication. For these outcomes, EAP remains unparalleled in current psychotherapeutic applications due to the unique characteristics and experiences of working with horses as co-therapists.
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