Running head: EQUINE ASSISTED GROUP

Equine Assisted Group Psychotherapy for Sexually Abused Children Kari Whatley

Running head: EQUINE ASSISTED GROUP Equine Assisted Group Psychotherapy for Sexually Abused Children Rationale The proposed group is an equine assisted psychotherapy group which seeks to assist

children who have experienced sexual abuse by providing a safe environment in which they may identify with others who have experienced abuse and begin moving toward healing. Childhood sexual abuse is an all too common experience with one in four girls and one in six boys experiencing sexual abuse before the age of eighteen (Pereda, N., Guilera, G., Forns, M., & Gmez-Benito, J., 2009). This particular group is designed for female victims of sexual abuse between the ages of 9 and 12. The experience of abuse may lead to depression, low self-esteem, anger, shame, selfhatred, and a significant lack of trust in authority figures (Pfeifer, 2010). One of the primary detrimental aspects of sexual abuse is the secrecy and fear associated with abuse (Buckland, R. & Murphy, J. 2001). Hence, group therapy is one of the most effective modalities for sexually abused children as it defeats the sense of isolation and allows abused individuals to interact with other victims who they perceive as normal (Lev-Wiesel, 2008). Group therapy in itself has been shown to decrease feelings of isolation and increase self-esteem (Tourigny, Hbert, Daigneault, and Simoneau, 2005). However, unintentional resistance is high in children of abuse due to their inherent lack of trust in authority figures as well as an age-related ability to express significant emotions with words (Buckland & Murphy, 2001). Utilizing horses as part of therapy has the potential to reduce resistance associated with traditional group as children are not primarily focused on an authority figure. Additionally, children are able to express their emotions experientially rather than in direct response to therapeutic questions. The greatest contribution of the horse to therapy is its ability to provide

Running head: EQUINE ASSISTED GROUP accurate and direct feedback to both the client and the therapists (Schultz, P., Remick-Barlow, G., & Robbins, L., 2007). The proposed group would be facilitated by both a therapist and co-therapist, one of whom must be an equine specialist to enable dual observation of both the group and horse. The children selected for group are referred by a local child advocacy center. Staff facilitating the group will consist of a licensed LPC and co-therapist who will function as an equine specialist.

Equine assisted group psychotherapy provides a venue for the group process to take place in an exclusively experiential and disarming setting. Equine assisted psychotherapy has been shown to increase self-awareness, reduce feelings of guilt, increase self-esteem, and aid in the creation of healthy boundaries (Klontz,T., Bivens,A., Lienart,D. & Klontz,B., 2006). Session Outlines Each session is designed to be experiential, encourage group interaction, and create opportunities for meaningful therapeutic observation. The group is asked to engage in various activities with the horse that may reveal multiple healthy and unhealthy beliefs and responses from which the child usually operates. For example, the group may be instructed to keep a horse within a box or boundary. In attempting to keep the horse within the boundary, one child may become aggressive while another may withdraw. Statements such as if I make the horse listen, he wont like me provide relevant feedback for therapists. Through observing interactions, unconscious behavioral patterns, body language, and group interaction, the therapist is provided feedback from which to ask prompting questions that may lead to meaningful realizations. Hence, the counselor responds to the client as the client is triggered by the horse, activity, and fellow group members. All sessions engage in some activity with the horse while group closings will take place in a gazebo with chairs placed in a circle for optimum interaction.

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Session # 1______________________________________________________
Needed Materials 6 brushes, 3 horses, cones, and a cross rail Goal # 1 To begin establishing a sense of emotional safety, positive interaction, and identification with fellow group members. Welcome/ Icebreaker The girls will be welcomed to the farm and explained that they will be helping care for several horses by brushing them. The girls will be introduced to the horses and asked to choose a horse to brush. Instructions: Each individual usually finds themselves drawn to a particular horse over another. There should be two girls for every horse. Each individual will be given a different kind of brush. After an initial time of being with the horses, the girls will be asked to play talking brush as adapted from the effective treatment activity talking ball (Lowenstien, L., 2008, p. 2). Every two minutes the girls will be asked to trade brushes with someone who has a brush different than the kind they currently have. At that time the group will be posed with questions such as whats your favorite color or do you play any sports? The girls will give an answer only to the person they are swapping brushes with at the time. Goal # 2: Initiate teamwork and increase group interaction and participation. Instructions: The girls will be directed to the arena where cones will make a path to a small cross rail serving as an obstacle. The girls will be instructed to work together get the horse to go over the obstacle. All group members will need to participate in order to accomplish the goal. The only rule is that the girls cannot touch the horse in order to get it to go over the obstacle. Encourage the girls to work together and be creative. There is no wrong way to get the horse over the obstacle. * Conclusion questions will be based on feedback from the over the hurdle activity. For example, is there anyone in particular you feel helped you get the horse over the obstacle? How did you feel when the horse did not listen? When you feel unheard how do you respond?

Running head: EQUINE ASSISTED GROUP Questions for Talking brush activity: 1. What is your favorite color? 2. What is your favorite food? 3. What do you like to do for fun? 4. What is one thing you are afraid of? 5. Have you ever been around a horse before? Timeline: 10 minutes to choose, meet, and engage with horse 20 minutes of Talking brush 40 minutes of over the hurdle 20 minutes of reflection and conclusion of first group session.

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Session # 2_________________________________________________________
Needed Materials Halter, horse, markers, cones, tape, and horse house Goal # 1 Encourage group interaction, increase confidence, and reveal patterns of relating. Instructions Give the group a halter and lead rope and instruct them to choose a horse from the pasture and work together to put the halter on. Goal # 2 To gain a sense of what the child needs to feel safe, identify fears, and allow other group members to better recognize and express their own needs through connecting with others. Instructions: The group will be asked to bring their haltered horse into a ring divided by poles and containing cones, pens, and markers. The group will be told that counselors have pre-labeled cones with everything a horse needs to feel safe and content (hay, shelter, other horses, etc.) and with things that make a horse feel unsafe (snakes, small spaces, loud noises, angry people, etc.). Next, the group will be asked to use the divided arena to create a safe and unsafe home for their horse. Place all the safe cones on one side of the ring and all the unsafe cones on the other. How do you think the horse feels when he is surrounded by safe things or scarey things? What do you do when you dont feel safe? The group will then be asked to take tape and label their own cones with three things that make them feel safe and three things that make them feel unsafe or fearful. The group is then to place its cones in the safe or unsafe home. For example, a child may choose to put a parent, sibling, or pet into the safe home and anxiety provokers like the dark, an offender, or bad feelings into the unsafe house. Timeline: 30 minutes for goal 1 activity 45 minutes goal 2 activity 20 minutes for closing (Group will be reminded that there are two more group sessions before the closing of group)

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Session # 3: The Buddy System________________________________________

Needed Materials 2 horses, treats, ball, and blanket Goal # 1 Encourage group members to reach out when they need help and to use all the recourses available to them. Instructions The group will be introduced to best equine friends Milah & Sassy. Tell Milahs story: Before Milah came to live with us, the adults that were supposed to take care of her were mean to her and did not give her enough to eat. Milah is scared of a lot of things, even though other horses are not, because she was treated so badly. Milah can be very shy and takes more time than other hoses to trust people. We were all very worried about how Milah would feel in her new environment until Milah met Sassy. Sassy is 30 years old (which is old for a horse) and knows what to do in situations where Milah is confused or scared. Whenever Milah is nervous or does not know what to do she runs to Sassy. Activity The group will be put in charge of helping Milah overcome her fear of new things by guiding Milah to touch several scary objects (a large ball and a blanket). If the group senses that Milah is becoming very frightened they are to use their additional resources to get Milah to touch the object. Recourses being a treat or Sassy the horse. Questions for Activity 1. How can you tell that Milah and Sassy are best friends? 2. How did you decide when it was time to go get Sassy? 3. When is a time you have gone to someone for help? 4. Why did you choose that person? 5. How do you know if someone is your friend? 6. How does it make you feel to ask for help? Timeline 10 minutes for Milahs story 50 minutes on buddy system activity 30 minutes for discussion and conclusion (Group will be reminded that next week is the last group session)

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Session # 4: Obstacles and Boundaries__________________________________

Needed Materials 1 horse, cross rail, and cones Goal # 1 To have the group gain confidence and awareness of how powerfully they can affect their surroundings. Instructions: The group will combine the skills they have acquired over the past weeks as they are confronted with the toughest challenge. The group is instructed to maneuver a horse over an obstacle while keeping the horse within a set boundary. To accomplish this task, the group will have to work together, speak up, communicate with each other, and be assertive. Activity Questions: 1. How did you set boundaries with the horse? 2. What feels hard about setting boundaries? 3. When is a time you have spoken up for yourself ? 4. Was it easier or harder to get the horse over the obstacle when it respected your boundaries? 5. Can you think of an obstacle in your life that would be easier to overcome if you set boundaries or spoke up for yourself? Goal # 2 Provide the group with a sense of closure with each other and the horses. Ensure that each group member has a chance to express what they have learned and how they feel about fellow group members. Discussion questions: 1. What is one thing you have learned in group? 2. Is there a particular group member you feel especially close with? 3. What is something you would like to practice or remember from group? Timeline: 45 minutes on boundaries 20 minutes for discussion activity 30 minutes for brushing horses, unfinished business, and say goodbye

Running head: EQUINE ASSISTED GROUP Marketing and Screening Potential members are female children between the ages of 9 and 12 who have experienced sexual abuse. Potential members must be living with a non-offending guardian or non-offending family members and be able to attend four group sessions. Potential members may express a mildly fearful, neutral, or positive response to the idea of working with horses. Children that express extreme fear would be a hindrance to group work and are more suited for traditional groups or one-on-one equine assisted therapy. Children will be referred for group by child advocacy center therapists and local counseling agencies. All marketing will be directed at therapists who may refer children they

believe would benefit from group therapy. Non-offending parents or guardians will be informed of the referral and asked to sign a consent form for screening and attend a short meeting in which the screening process and group information may be conveyed. Upon being suggested for group, children will be screened for maturity, ability to socialize, and a willingness to listen to the stories of others. Children who have been more recently victimized may be experiencing too much trauma to benefit from group therapy or to be able to handle the stories of others without acting out (Lev-Wiesel, R., 2008). Screening questions will be geared toward the appropriateness of the specific child for group and assessed through conversation and a short intake form. More specific questions related to assessment such as the age in which abuse occurred and specific symptomology will be directed to non-offending parents or guardians. If the child is screened and identified as a positive match for group, their non-offending guardians or parents will be explained the benefits and liabilities associated with therapy as well as group requirements. Additionally, limits of confidentiality and the inherent risks associated

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with horses should be identified. At this point group consent forms will be signed in addition to the consent forms required for screening. It is extremely important that guardians are aware of all screening, counseling sessions, and group therapy and that written consent is given prior to any interventions.

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Running head: EQUINE ASSISTED GROUP Theory Gestalt therapys basic philosophy is that humans are growth oriented and that the observable experiences of the client are more relevant than what may or may not be said (Murdock, 2009). Gestalt therapists recognize that unhealthy dysfunctional patterns are the result of necessary coping strategies created during the experience of painful or difficult

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situations (usually during childhood) (Murdock, 2009). This theory may be especially effective when considering survivors of sexual abuse who have put up walls of self-protection and secrecy that no longer serve them well. Gestalt therapists emphasize that dysfunctional self-protection prevents the individual from experiencing and growing in the present. Yontef (2005) identifies that the key question related to Gestalt therapy is What do you experience right now? (p. 272). Though it may be proposed in various styles and formats, group work seeks to answer the same question. How a child is experiencing the group, the horses, and the activities in the present is what provides the opening for self-awareness, healing, and discovery. The concepts of organismic selfregulation as well as an awareness of unfinished business contribute highly to the structure of group (Murdock, 2009). The holistic approach associated with Gestalt therapy also influences therapeutic patterns and awareness of the group process. This theory, along with the ABC model of REBT, influence the way in which group will be conducted (Murdock, 2009). The ideals of both Gestalt therapy and the cognitive approaches of REBT support the goal of encouraging children to recognize and advocate for their own needs.

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13 Child Advocacy Center 1800 El Nina Dr. Mobile, AL Phone: (555)555-1500 Fax:(555) 555-1520

Informed Consent
Kari Whatley, LPC - Intern

Overview Welcome to Counseling Services at the Child Advocacy Center. This document contains important information about our services, confidentiality, and client guidelines. Please read carefully and know that your therapist would be happy to answer any additional questions you have regarding services for yourself or your child. This release offers information on therapeutic expectations, benefits, and liabilities. By signing this release you are showing a willingness to enter into therapy and an awareness of potential risks as communicated in this document. Qualifications In the future I will have earned a Masters of Arts in Professional Counseling from Liberty University in Lynchburg, VA. I am licensed with the State of Alabama as a Professional Counselor Intern (# 18668). As an intern I am under the supervision of Licensed LPC John Doe (# 14665). The board office may be contacted at 555-555-555. Nature of Counseling Services Psychotherapy has both benefits and liabilities. Possible liabilities include the experience of uncomfortable emotions or the vivid remembrance of painful past events. Benefits may include greater self-awareness, healthier coping skills, better relationships, and improvement in regards to specific life issues. As a therapist I cannot guarantee the outcome of therapy but only to work in the best interest of the client as outlined by counseling ethics. Procedures Counseling typically begins with an assessment or screening of the potential client be they child or adult. In this way, the client and therapist can better understand the problem at hand and work toward specific client goals. If you or your child is engaging in group therapy, an intake form for both you and the child will be utilized as part of the screening process. Screening is important to determine that our services are a healthy fit for you and/or your child. The screening and intake can take up to one session and are instrumental in determining therapeutic appropriateness and goals. Fees It is important to recognize that treatment is a real commitment of both time and finances. It is necessary to consider what resources are available to you ahead of time. If you have health insurance some counseling may be covered for your sessions with a licensed therapist. The child advocacy center will work with you to ensure that you receive the benefits you are offered.

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However, you are ultimately responsible for all counseling related fees. Counseling fees range from $60-$90 per hour. Group therapy sessions are billed at $30 an hour. Contact Hours Office hours are Monday through Friday, 8:00 am to 5:00 PM. Calls made after hours will not be returned until the next day. If there is an emergency please call 911. The child advocacy center offers no emergency services. Record-Keeping Procedures State requirements mandate the maintenance of treatment records. These records are available to you. If you wish to see the content it is best to be done in a session during which content may be adequately explained within the proper context. Records are kept for several years. Confidentiality Confidentiality of clients is protected by law. This law covers all forms of communication. Information may only be released to others with your written consent. Exceptions to confidentiality include: Threat of harm to self or others Disclosure of abuse or neglect of children or the elderly Court mandate for the release of information, Counselor is currently being supervised1 Clerical assistants who process client information and papers, The request of insurance companies for relevant information
1) I am a counseling intern with all of my counseling being supervised. Your case will be discussed with my supervising counselor. However, all confidentiality laws apply to my supervising counselor as well as myself.

Signatures Verifying Consent Your signature indicates that you have read and understood all information in this document and that you agree its terms. ________________________________ ________________________________
Print Full Name Print Full Name

_____________________ ___/___/___
Client or Guardian Signature Date

_____________________ ___/___/___
Witness Signature Date

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Equine Group Psychotherapy Release

I hereby give permission for my child to participate in the Equine Psychotherapy Group for Sexually Abused Children. I recognize that there are inherent risks in working with horses and I release all parties including therapists, farm owners, and staff from any and all liabilities in the event of a potential injury or death. I understand that horses are dangerous and I understand the benefits and liabilities of engaging in equine assisted psychotherapy. _____________________ ___/___/___ Guardian Signature Date _____________________ ___/___/___ Witness Signature Date

Running head: EQUINE ASSISTED GROUP Outcomes Group therapists realize that sexual abuse effects individuals developmentally and on multiple levels. Group therapy is expected to initiate only degrees of difference in change not

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total transformation. Questions pertaining to outcome are geared toward measuring the clients ability to advocate for ones own needs.

Group Therapy Outcome Survey______________________________________

The Group Therapy Outcome Survey is identical to the intake evaluation presented to both parent and child. There are two surveys for both parent and child in order to present a more adequate picture of possible degrees of change in the childs psychological well-being. 1. Do you feel good about your ability to make new friends? Always | Sometimes | Rarely | Never 2. Do you like meeting new people? Always | Sometimes | Rarely | Never 3. Do you feel different from other children? Always | Sometimes | Rarely | Never 4. Do you have trouble sleeping? Always | Sometimes | Rarely | Never 5. Do you ask adults for help when you feel overwhelmed? Always | Sometimes | Rarely | Never 6. How often do you feel deeply sad? Always | Sometimes | Rarely | Never 7. Do you have trouble getting along with other people? Always | Sometimes | Rarely | Never 8. Do you speak up if something is bothering you? Always | Sometimes | Rarely | Never

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Group Therapy Intake / Outcome Form for Parent or Guardian____________

1. Does your child speak up when she needs something? Always | Sometimes | Rarely | Never 2. If your child acts out, what does she do and how often? Always | Sometimes | Rarely | Never 3. Has your childs school performance recently increased or decreased ? Always | Sometimes | Rarely | Never 4. Does your child play any team sports or have they begun a team sport in the past four weeks? Always | Sometimes | Rarely | Never 5. How often does your child express sadness or fear? Always | Sometimes | Rarely | Never 6. How often does your child express happiness? Always | Sometimes | Rarely | Never

Running head: EQUINE ASSISTED GROUP Problem Solving Undoubtedly each group will begin to create unhealthy forms of interaction or have individuals who aim to control the group as a form of resistance. These patterns are no less complex with children and must be addressed in an age appropriate yet direct way. Problems such as a child who chronically talks may be related to a maturity issue, control issue, or as a poorly expressed need for attention.

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For children and adults setting clear limits such as I want you to tell me in three words or you will have one minute to respond is very important (Gladding, 2008). Before correcting the chronic talker it is important that they are aware of appropriate boundaries. After clear boundaries have been set and the need to hear from all group members is established, the facilitator may aim to silence the chronic talker through body language or by openly cutting off the chronic talker and moving to the next person. Based on the perceived intent of the individual who is chronically talking the therapist may need to adopt an authoritative facilitation style (Gladding, 2008). The silent member may be silent for a variety of reasons. The first intervention for a quiet member is simply drawing attention to the members silence and inviting them to speak (Gladding, 2008). Other group members may express a need to hear from the silent member in order to be comfortable sharing. If the silent member is still resistant, it is important to acknowledge and work with their resistance (Gladding, 2008). When working with children it may be possible that a highly resistant child was inappropriately placed and not yet ready for group. Members who attack other group members must be quickly addressed as it is the facilitators job to protect other group members and maintain an emotionally safe atmosphere.

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Drawing attention to the attack and linking it back to the attacker and what they may be feeling is critical. It must be made clear that attacks on other members are not acceptable and an apology to the attacked member may be in order. Regardless, the facilitator must work to ensure that any attacks are promptly stopped (Gladding, 2008). When members choose to stop coming it may be that they were not yet emotionally ready for group. As the facilitator it is important to make contact with absent members, however it is not necessary to persuade them to come back. The purpose is to check-in with the absent group member. Current group members will know that the member has repeatedly been absent and it is not necessary to address this unless it is brought up directly. If concern is expressed, it may be beneficial to affirm that the absent group member is okay but would not be continuing with group. If a member of the group feels a loss or unfinished business with the absent group member the therapist may choose to direct the attention back to the fellow group members current feelings and experience. All groups are as dynamic and unique as their members and conflict will naturally arise. However, the group process is to be trusted on every level. Therapists may need to take on varying leadership roles such as democratic, authoritarian, and Laissez-faire, depending on the nature of the group. It is the therapists obligation to protect group members and maintain trust in the group process. Conclusion Group is an amazing tool for reducing feelings of isolation and increasing confidence in multiple areas. Group therapy offers an excellent modality for sexually abused children (Tourigny, M., Hbert, M., Daigneault, I., & Simoneau, A.C., 2005). When group therapy is

Running head: EQUINE ASSISTED GROUP coupled with the resistance breaking qualities of equine assisted therapy, group takes on an additional cogent form of positive change.

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Running head: EQUINE ASSISTED GROUP References

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Berliner, L., 8c Ernst, K. (1984). Group work with preadolescent sexual assault victims. In I.R. Stuart & |.G. Grcer (Kds.), Victims of sexual aggression: Treatment of children, women, and men (pp. 105-124). New York:Van Nostrand Keinhold. Buckland, R., & Murphy, J. (2001). Jumping over it: Group therapy with young girls. In J. Murphy (Ed.),Art therapy with young survivors of sexual abuse: Lost for words (143166). East Sussex:Brunner-Routledge. Finkelhor, D., & Berliner, L. (1995). Research on the treatment of sexually abused children: a review and South African Journal of Psychology, 40(1), pp. 63-73 Gladding,S. (2008) Groups: A Counseling Specialty. Columbus, Ohio. Pearson Publishers. Lev-Wiesel, R. (2008). Child sexual abuse: A critical review of intervention and treatment modalities.Children and Youth Services Review, 30, 665-673. Lowenstien,L. (2008) Assessment and Treatment Activities for Children,Adolescents, and Families: Practitioners share their most effective techniques. Ontario,Canada:Champion Press. Murdock,N. (2009). Theories of Counseling and Pychotherapy. A Case Approach. Columbus, Ohio. Pearson Publishing. Pereda, N., Guilera, G., Forns, M., & Gmez-Benito, J. (2009). The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clinical Psychology Review, 29, 328-228. Pfeifer, N. (2010) Group art therapy with sexually abused girls. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 1408-1423

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Schultz, P., Remick-Barlow, G., & Robbins, L. (2007). Equine-assisted psychotherapy: A mental health promotion/intervention modality for children who have experienced intra-family violence. Health & Social Care in the Community 15(3), 265-271. Tourigny, M., Hbert, M., Daigneault, I., & Simoneau, A.C. (2005). Efficacy of a group therapy for sexually abused adolescent girls. Journal of Child Sexual Abuse, 14, 71-93. Trotter, K., Chandler, C., Goodwin-Bond, D., & Casey, J. (2008). A comparative study of the efficacy of group equine assisted counseling with at-risk children and adolescents. Journal of Creativity in Mental Health, Vol. 3(3), 254-284. Yontef,G.M. (2005) Gestalt Therapy in In A.S. Gruman and S.B. Messer Essential Psychotherapies theory and practice. New York, Guilford Press.