How and Why Are Horses Used in Therapy

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The therapeutic benefits of horses have long been recognized. Horses have been utilized in Hippotherapy for physical, occupational, and speech related treatment goals. Hippotherapy uses horses as a therapeutic agent for individuals with physical, motor, or sensory challenges. This form of treatment involves riding the horse for benefits related to the  movement of the horse. Riding helps to engage neurological, sensory, and motor systems (American Hippotherapy Association, 2014). Furthermore, the movement of the horse improve balance, gait, posture, and strength in children with various physical challenges (Garcia, 2010; Granados & Agis, 2011). With Hippotherapy, clients are referred as part of treatment, and the instructors are certified through the  Professional Association of Therapeutic Horsemanship International (PATH intl., 2021).

However, it wasn’t until more recently that horses began showing up in mental health treatment as well. Currently there are a variety of therapeutic modalities incorporating horses for mental health treatment, referred to as “Equine Assisted Learning” or “Equine Assisted Psychotherapy.” Unlike Hippotherapy, Equine Assisted Psychotherapy typically does not involve riding the horse. 

It works as an experiential therapy, bringing mindfulness and reflection to the session in a less direct and confrontational way. Clients work towards individualized and agreed upon goals with the use of horses. It can be incredibly beneficial as a supplement when traditional talk therapy falls short. Equine Assisted Psychotherapy has been beneficial addition to treatment for a variety population with mental health challenges including but not limited to; all ages with anxiety, depression, grief, trauma, PTSD, Autism, low self-esteem and bullying, substance use, eating disorders, at-risk youth, ADHD, challenging family dynamics, and communication.

The Equine Assisted Growth and Learning Association (EAGLA) and Natural Lifemanship are a few organizations with evidenced based models who utilize Equine Assisted Psychotherapy. They incorporate horses as both treatment team members and therapeutic tools, in a sense. These models work best when the horse is as natural (think no pulled mane, lots of pasture time etc.) as possible, as opposed to a “done up show horse.” This helps the horses stay as in tune to their natural instincts as possible. 

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Models of Equine Assisted Psychotherapy


EAGALA was the first organization to begin using a framework to incorporate horses into mental health treatment. EAGALA utilized working with horses on the ground without riding. The EAGALA model requires a team of three; a mental health therapist, an equine specialist, and the horse(s), to all work together in treatment with a client. Sessions are typically held either in a field, or a ring with one or multiple horses.

From EAGALA came O.K. CORRAL, which focuses on both Equine Assisted Psychotherapy, and Equine Assisted Learning. The idea for this model is that equine-assisted work honors the natural behavior of horses and herds (OK CORRAL, 2021). There is currently another spinoff from EAGALA being developed that is referred to as Arenas for Change or “ARCH”.

Natural Lifemanship

While Natural Lifemanship uses similar frameworks to EAGALA, Natural Lifemanship emphasizes the principles guiding the horse-human relationship over everything else (Natural Lifemanship, 2021). Natural Lifemanship is the premiere modality for Trauma Focused Equine Assisted Psychotherapy, as it believes that when healing from trauma, among other mental health challenges, an integrated and healthy relationship with self and others is the goal (Natural Lifemanship, 2021). Unlike EAGALA, Natural Lifemanship will occasionally have clients mounted on the horses during session depending on if appropriate related to treatment goals (i.e., think normalizing touch after sexual trauma). Sessions typically only use one horse at a time and are facilitated in a ring.

But what is it about horses that makes them so helpful for mental health treatment? Let’s talk about the why. 

Due to horse’s prey animal status, they are very in tune with their fight or flight response. Horses are reactive to the affect and energy of their environments (Wilson, Buultjens, Montfries, Karimi, 2015). Horses are significantly more sensitive to body language and unconscious emotions that a client may project. This allows them to pick up on more client feedback than a human counselor could on their own (Wilson, Buultjens, Montfries, Karimi, 2015). In working with such large, yet sensitive and reactive animals in therapy, clients can learn more about themselves through mirroring—which can promote emotional learning and growth.

Horses can teach us not only about our own energy and non-verbal communication, but they can promote a self-awareness that asks us to check in with ourselves. Animals like horses offer non-judgmental support during counseling sessions. This can provide clients or patients with a calming energy. It allows patients the freedom to express their identity, emotions, and thoughts in a safe space.

Think about the times you show up to spend time with your horse. Are they seemingly more empathetic when you are experiencing a low mood? What about when you are feeling stressed or anxious yourself? Have you ever noticed how your horse picks up on it and either responds in a supportive way, or reacts and makes things more challenging? Sometimes you might not even realize that you are in a “mood” until your horse helps you recognize it. These are all ways in which horses are in tune with their surroundings. Spending time and learning about horses can help us learn more about ourselves too. 

Want to learn more about ways in which horses are utilized in mental health treatment? Check out any of the references below. I also highly recommend checking out the book “Transforming Therapy through Horses: Case stories teaching the EAGALA model in action” by Lynn Thomas. It is an easy to read primer.


American Hippotherapy Association.(2020). Retrieved from 

Equine Assisted Growth and Learning Association (EAGALA). (2010). Retrieved from

Granados, A. C., & Agís, I. F. (2011). Why children with special needs feel better with hippotherapy sessions: a conceptual review. Journal of alternative and complementary medicine (New York, N.Y.)17(3), 191–197.

Natural Lifemanship. (2018). Retrieved from

Path International. (2021). Retrieved from

O.K. CORRAL. (2021). Retrieved from 

Wilson, K., Buultjens, M., Montfries, M.,  Karimi, L. (2015). Equine-assisted psychotherapy for adolescents experiencing depression and/or anxiety: A therapist’s perspective. Clinical Child Psychology and Psychiatry, 22(1), 16-33. doi:  10.1177/1359104515572379

Lindsey is a Licensed Clinical Mental Health Counselor Associate located in Charlotte, NC. She knows from personal experience how symbiotic the relationship between horses and mental health are. Lindsey had spent much of her life working with, caring for, and riding horses in central New Jersey, before moving south to ride for the IHSA team at High Point University, and eventually attending Wake Forest University for Graduate school. As a therapist, she specializes in working with adolescents, and young adult females, as they navigate through various challenges related to stress, anxiety, life transitions, depression, body image, self-esteem and self-worth challenges, relationships, and grief.  Follow her professional Instagram account @GageYourGrowth for more easily digestible mental health related content!