Equine-assisted therapy

Equine assisted psychotherapy, equine assisted therapy

Equine-assisted psychotherapy involves the use of horses in the therapy process. In some centers, it is a team process with the patient working with the horses, a therapist, and an equine specialist.


Humans have been connected with animals since before recorded history, as is evidenced by cave paintings from around the world. The ancient Greeks were the first to notice that horses helped seriously ill individuals as far back as 460 B.C. The first documented use of animals therapeutically was in ninth-century Belgium, when people with disabilities were asked to care for farm animals. Animals were used in the 1700s at the York Retreat, a progressive “lunatic asylum” for its times.

Dr. Boris Levinson is credited with starting the modern Animal Assisted Therapy movement. This approach advocated using pets to provide a safe environment for patients of all ages.

In 1969, the North American Riding for the Handicapped Association began and this has gradually developed into the Professional Association of Therapeutic Horsemanship (PATH), which is the leading organization for therapists involved with equine therapy. There are PATH centers around the globe providing services and training for clients and therapists alike.

Another association, the Equine Assisted Growth and Learning Association (Eagala), was founded in 1999. It was one of the first organizations to develop professional standards for incorporating horses into mental health treatment. It continues to try to increase awareness and set standards of practice for the field.

Who can benefit from equine-assisted therapy?

Equine-assisted therapy has been found to benefit individuals with a variety of struggles in a myriad of ways. Horses are not just used as an adjunct to psychotherapy. Speech therapists, occupational therapists, and physical therapists promote this method.

As such, there have been reports of benefits for individuals with:
  • Cerebral palsy
  • Eating disorders
  • Depression
  • Anxiety and trauma-related disorders
  • Attention disorders
  • Autism spectrum disorders
  • Stroke and other significant physical injuries

Equine-assisted psychotherapy techniques

Equine-assisted therapy, much like other animal-assisted therapy, isn't a technique that generally stands alone. Most of the time, EAT is used in conjunction with other modalities like psychodynamic therapy or cognitive therapy. The specific methods utilized will depend on the needs and goals of each client.

All forms of therapy emphasize the importance of active and reflective listening, collaboration with the horse as an active member of the team, and the belief that every individual can solve their problems with guidance in a way that creates a lasting effect.


While studies based on equine-assisted therapy alone are limited, studies have been done into the effectiveness of EAT with various disorders. They have found that individuals show better balance and trust, improved self-esteem and self-efficacy, as well as an overall improvement in general well-being and quality of life.

Individuals who have participated in equine-assisted psychotherapy have reported significant improvement in confidence and social skills. Clients are working with the animals but also working side by side with a therapist guiding the path. This allows the client to work on skills in a way that is less threatening than sitting in a therapy room.

Working with animals in psychotherapy allows for the improvement of nurturing and empathy as well. As individuals work with animals, they can learn to be more aware of emotions and the stress response that all people and animals feel in a safe, nonjudgmental environment. This can help as they generalize this skill to interacting with other people in their lives.

Additionally, horses are highly sensitive to the emotions of others around them and allow individuals to work through problems without worrying about judgment.

Despite the lack of equine-specific studies, some demonstrate the positive effects of human-animal interactions that apply to equine therapy. One study from 2018 shows that seeing and touching animals can trigger positive physiological changes, including higher levels of serotonin, endorphins, and oxytocin. Additionally, lower baseline levels of the stress hormone cortisol was observed. Further research from 2016 has also linked animal-assisted therapy to improved blood flow in people experiencing heart failure. It may even reduce blood pressure for some people.


As mentioned before, one of the downsides of this therapy is the lack of theoretically based clinical studies. While it has been recognized as beneficial anecdotally for many years, all animal-assisted therapies have only been widely clinically recognized as beneficial in the last 25-30 years, making it a relatively new clinical treatment. Due to the lack of research, it may not be allowed by some insurance companies for billing purposes and, as such, still has a cost-limiting factor on availability.

Another downside of equine-assisted therapy is the space required to hold therapy. While traditional therapy requires a small office, animal-assisted therapy requires a large enough space for humans and animals to be comfortable regularly. With horses, this means a much larger area is required, limiting the accessibility of this type of therapy and significantly increasing the cost both to the therapist or organization providing services and to the client receiving services.

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Additionally, in equine therapy, both the animals and the people must be chosen with care. Animals should be in good physical and mental health themselves. The horse's temperament must be patient and calm, otherwise, it could increase the anxiety or trauma of the patient. No specific type of horse is required. The equine specialist looks for certain qualities in the horses they choose. While many individuals can benefit from equine therapy, those who have an allergy or an overwhelming fear of horses may find the negatives outweigh the benefits.

Therapy timeline and stages

Equine-assisted psychotherapy consists of connecting and interacting with horses through a variety of activities.

These may include: 
  • Grooming and petting the horse
  • Bathing the horse
  • Leading the horse to designated areas
  • Feeding the horse
  • Recreational and goal-oriented activities, either individually or in a group

Some therapies will involve actual riding, while others do not. The speed at which these activities are completed largely depends on the individual doing the work.

Similar to talk therapy without animal involvement, the therapist will engage in active and reflective listening and will ask the client questions or make observations. As comfort levels increase, the client may be asked to tell their story in this low-stress environment.

Insurance coding for equine-assisted psychotherapy

Equine-assisted therapy doesn’t have a CPT code specific for use. However, because animals could be considered similar to other ‘tools’ that therapists use, like games, some therapists bill under regular coding 90837/34/32 while others use code 90899: Other Psychiatric Services or Procedures to report psychiatric services or procedures that do not have a specific code. In the notes, therapists should indicate information referring to the use of the horse and the client's response to the treatment.

Many insurance companies have their own specific billing codes to designate equine therapy. Always consult information received upon credentialing with specific insurance boards for best billing practices. Be certain to read descriptions, as many insurance companies only cover equine therapy as an occupational or physical therapy service, not psychotherapy. Always ensure you are billing for services only in your scope of practice.

Special training for the therapist

There are two schools of thought when it comes to equine-assisted psychotherapy. On one side, there are those who emphasize working on the horse, with the therapist as an expert in therapy and horsemanship. This requires significant training in both working with horses and mental health practitioner work. 

PATH offers a variety of options for specialization ranging from a Certified Therapeutic Riding Instructor for individuals training as an entry-level person in the field. This person can provide riding instruction and support to individuals with disabilities. Their Master Riding Instructor certification is earned by individuals who have a strong background in horsemanship as well as a firm grasp on many physical, developmental, or emotional disabilities that may benefit from equine-assisted therapy.

The other school of thought separates the horsemanship from the mental health aspect and requires more of a team approach. One individual is the equine expert and trains thoroughly in teaching, while the other is the licensed mental health professional. They work together to provide treatment.

Some universities offer coursework in equine-assisted therapy, and a few even offer bachelor’s degrees with an emphasis on equine or animal therapy. If you wish to seek licensure, you would then need to pursue a Master’s degree or Ph.D. with a program eligible for licensure in your state.

  • If you are looking for an equine therapist in the United States, be sure to check out the directory at Equine Therapy Network.

  • The PATH website has excellent information and training resources.

  • Another source of information and training mentioned is Eagala. They provide a specific equine therapy model and set standards for their credentialed providers.

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