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Veterans’ experiences of natural horsemanship : a phenomenological investigation Grimes, Katie Nicola 2018

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 VETERANS’ EXPERIENCES OF NATURAL HORSEMANSHIP: A PHENOMENOLOGICAL INVESTIGATION by Katie Nicola Grimes BSc (Hons)., Kingston University London, 2004  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  MASTER OF ARTS in The Faculty of Graduate and Postdoctoral Studies (Counselling Psychology)  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver)   July 2018     © Katie Nicola Grimes, 2018 		 ii	 The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, a thesis/dissertation entitled:  VETERANS EXPERIENCES OF PARTICIPATING IN NATURAL HORSEMANSHIP: A PHENOMENOLOGICAL INVESTIGATION   submitted by KATIE GRIMES in partial fulfillment of the requirements for the degree of MASTER OF ARTS in COUNSELLING PSYCHOLOGY  Examining Committee: DR. MARLA BUCHANAN Supervisor  DR. COLLEEN HANEY Supervisory Committee Member  DR. MARVIN WESTWOOD Supervisory Committee Member  Additional Examiner   Additional Supervisory Committee Members:  Supervisory Committee Member  Supervisory Committee Member     		 iii	Abstract Equine-based interventions aimed specifically at assisting veteran populations are growing in popularity. While the research into the efficacy of equine therapy is limited, the emerging evidence indicates a trend in the direction of beneficial outcomes (Hoagwood, Acri, Morrissey, & Peth-Pierce, 2017; Kendall et al., 2015; Staudt & Cherry, 2017). By investigating the human-horse connection from the lived experiences of those involved, can lead to a better understanding of how the human-horse connection may translate into therapeutic gains. The purpose of this interpretative phenomenological study was to explore the experiences and meaning-making of veterans engaging with horses in the context of natural horsemanship (NH). By utilizing NH that focuses on horses’ natural behaviour and herd instincts, the aim is to improve understanding of how learning to communicate with horses in its most natural form can enhance understanding of the potential healing arising from the human-equine connection, and how this may be of therapeutic benefit to veterans. Five veteran participants interested in working with horses to assist with operational stress injuries took part in the study. This study employed a focus discussion group, a personal account, and a semi-structured in-depth individual interview. Five major themes emerged from the data analysis including: the authentic relationship, active awareness, the role of the trainers, horse appeal, and away from the yard. This study contributes to the development and delivery of equine interventions, rooted in the fundamentals of the human-equine bond, potentially offering an alternative or adjunct path to healing.      		 iv	Lay Summary Equine-based programs in the field of mental health are a relatively new area.  There is limited understanding of the unique value horses may offer to human healing. The aim was to further understanding of the processes of engaging with horses in its most natural form, by means of a natural horsemanship approach without additional therapist factors or expected outcomes. Therefore, the present study explored the experiences of five veterans who engaged with horses in the context of natural horsemanship. The findings to emerge from this study revealed themes based around the authentic human-horse relationship, which fostered feelings of empowerment and opportunities to emotionally connect, increased awareness, the importance of the horse trainers, the horse as a motivator to engage, and transferable skills. This study offers insights into the unique horse qualities and processes of the human-equine partnership to help improve the development and delivery of future equine-based programs.            		 v	Preface This thesis is an original and unpublished work by the author, Katie Grimes. All work including recruitment, collection of data, analysis, and writing, has been completed by the author. Ethical approval was obtained by the University of British Columbia Behavioural Research Ethics Board (BREB), certificate number H16-01395.                   		 vi	Table of Contents Abstract ........................................................................................................................................ iii Lay Summary ................................................................................................................................ iv Preface ............................................................................................................................................ v Table of Contents .......................................................................................................................... vi Definition of Terms ....................................................................................................................... ix Acknowledgments ......................................................................................................................... xi Dedication ..................................................................................................................................... xii Chapter 1: Introduction ................................................................................................................ 1 Overview of the Research Topic ............................................................................................... 1 Animal-assisted therapy .......................................................................................................... 2 Equine therapy ......................................................................................................................... 3 Limitations within the Literature ............................................................................................ 6 Gap in the Literature ................................................................................................................ 7 Purpose of the Study and Statement of the Research Question ............................................ 8 Significance of the Study ........................................................................................................... 8 Chapter 2: Literature Review .................................................................................................... 10 Human-Animal Bond .............................................................................................................. 10 Animal-assisted therapy ........................................................................................................ 11 Physiological ......................................................................................................................... 11 Psychological ......................................................................................................................... 12 Canine-assistance therapy and veterans ................................................................................ 13 Underlying mechanisms of the effects of AAT ..................................................................... 13 Unique Equine Qualities ......................................................................................................... 15 Natural horsemanship ............................................................................................................ 15 Equine Therapy Approaches .................................................................................................. 15 Established Equine Therapy Programs ................................................................................. 16 PATH Intl. ............................................................................................................................. 17 EAGALA ............................................................................................................................... 17 Can Praxis .............................................................................................................................. 18 Equine Therapy Research ....................................................................................................... 18 Autism spectrum disorders (ASD) ........................................................................................ 18 Attention deficit hyperactivity disorder (ADHD) and behavioural issues ............................ 19 At-risk youth .......................................................................................................................... 20 Trauma ................................................................................................................................... 21 Adults and Mental Health Concerns ..................................................................................... 22 Eating disorders ..................................................................................................................... 22 Substance abuse ..................................................................................................................... 23 Trauma ................................................................................................................................... 23 Horse owner equine relationships .......................................................................................... 24 Equine therapy and veterans .................................................................................................. 24 		 vii	Veterans and Posttraumatic Stress Disorder ........................................................................ 25 Limitations within the Literature .......................................................................................... 27 Summary .................................................................................................................................. 29 Chapter 3: Methodology ............................................................................................................. 31 Research Design ....................................................................................................................... 31 Methodological approach: Interpretative phenomenological analysis (IPA) ........................ 32 Participants .............................................................................................................................. 32 Participant demographics  ..................................................................................................... 33 Participant recruitment .......................................................................................................... 33 Natural Horsemanship Trainers ............................................................................................ 34 Overview of horse activities .................................................................................................. 34 Data Collection ......................................................................................................................... 35 Facilitated focus discussion group questions ............................................................................ 36 Data management .................................................................................................................. 37 Data Analysis ............................................................................................................................ 37 IPA and focus group data ........................................................................................................ 37 IPA approach ......................................................................................................................... 38 Role of the Researcher ............................................................................................................ 40 Situating the researcher ......................................................................................................... 41 Trustworthiness of the Study Findings .................................................................................. 41 Ethical Considerations ............................................................................................................ 43 Chapter 4: Results ....................................................................................................................... 44 Theme 1: The Authentic Human-Horse Relationship .......................................................... 44 Learning to speak horse: Empowerment ............................................................................... 45 Meeting the herd: The emotional connection ........................................................................ 47 Natural horsemanship: From the wild to the round pen ........................................................ 50 Theme 2: Active Awareness .................................................................................................... 51 Theme 3: The Role of the Trainers—Establishing Safety ................................................... 55 Theme 4: Horse Appeal—Motivation to Participate ............................................................ 57 Theme 5: Away from the Yard—The Potential Value ......................................................... 59 Quality of life improvements ................................................................................................. 59 Transferable skills: Communication, awareness and regulation ........................................... 59 Equine experiences: Applicability to trauma-related healing ................................................ 61 Conclusion ................................................................................................................................ 63 Chapter 5: Discussion .................................................................................................................. 64 Summary of Results ................................................................................................................. 64 Trustworthiness of the Study Findings .................................................................................. 66 Relevance of Findings to Previous Research ......................................................................... 67 The relationship ..................................................................................................................... 67 The relationship as empowerment and emotional connection ............................................... 69 The importance of natural horsemanship .............................................................................. 70 Awareness .............................................................................................................................. 71 The trainers ............................................................................................................................ 72 The horse as motivation to engage ........................................................................................ 72 Away from the yard: The potential value .............................................................................. 73 		 viii	Implications for Counselling Practice .................................................................................... 74 Future Research ....................................................................................................................... 77 Limitations ............................................................................................................................... 78 Conclusion .................................................................................................................................... 78 References ..................................................................................................................................... 80 Appendices ................................................................................................................................. 101 Appendix A: Recruitment Poster ......................................................................................... 101 Appendix B: Consent Form .................................................................................................. 102 Appendix C: Demographic Questionnaire .......................................................................... 106 Appendix D: Focus Discussion Group and Interview Guide ............................................. 107   							             		 ix	 Definition of Terms Animal-assisted therapy (AAT): Utilizes the human-animal bond as a fundamental factor of the treatment process as part of goal-directed interventions (Chandler, 2012).  Equine-assisted activities (EAA): Involves a range of activities where clients, instructors, participants and equines are involved. Activities include therapeutic riding, mounted or grounded activities, grooming and stable management (Professional Association of Therapeutic Horsemanship International [PATH Intl.], 2018a). Equine-assisted/facilitated counselling (EAC/EFC): Inclusion of equines into the counselling process to facilitate therapeutic outcomes. Partnership between the client, a mental health professional and an equine professional experienced in EAC, combined with traditional counselling techniques (Trotter, Chandler, Goodwin-bond, & Casey, 2008). Equine-assisted learning (EAL): Incorporates equine assisted activities as part of an experiential learning approach that encourages the development of skills for educational, professional or personal goals (PATH Intl., 2018a). Equine-assisted psychotherapy (EAP): Utilizes equines alongside a licensed mental health professional and an experienced horse professional as part of the treatment process (similar to that of EAC/EFC) (Schultz, Remick-Barlow, & Bobbins, 2007).  Equine-assisted therapy (EAT): Incorporates equine activities to meet the needs of the clients’ goals (PATH Intl., 2018a). Equine-facilitated psychotherapy (EFP): Interactive process involving a licenced mental health professional, equine professional and client to address the needs of the client’s psychotherapy goals (similar to that of EAC and EAP) (PATH Intl., 2018a). 		 x	Hippotherapy: Refers to the use of the equine movement as a physical therapy treatment for physical and functional limitation and sensory dysfunction (American Hippotherapy Association [AHA], 2016). Natural horsemanship (NH): Refers to a philosophy of how to work with horses through non-verbal communication, based on a thorough understanding and simulation of the natural and adaptive behaviours found in horse herds (Goodwin, McGreevy, Waran, & McLean, 2009).  Operational stress injury (OSI): Defined as any persistent psychological difficulty (including anxiety disorders, depression, and posttraumatic stress disorder (s) as well as other conditions that may interfere with daily functioning) as a result of duties performed while serving in the Canadian Armed Forces or as a member of the Royal Canadian Mounted Police (Veterans Affairs Canada [VAC], 2016).  Posttraumatic stress disorder (PTSD): Resulting from exposure(s) to one or more traumatic events that involve actual or threatened death, serious injury, or sexual violence. Including the presence of four groups of symptom clusters related to intrusion, avoidance, negative alterations in cognitions and mood, and hyperarousal. Symptoms are present for at least one month following the traumatic event, with significant distress or impairment in social and/or occupational functioning (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]; American Psychiatric Association [APA], 2013). Therapeutic Riding (TR): Aims to positively contribute to the physical, cognitive, emotional and social well-being of individuals with special needs (PATH Intl., 2018a). Veteran: “VAC considers any former member of the Canadian Armed Forces who releases with an honourable discharge and who successfully underwent basic training to be a veteran”(VAC, 2015, para.3). 		 xi	Acknowledgments  I wish to offer my sincere appreciation to my supervisor Dr. Colleen Haney for her unwavering support and encouragement, and for continuing to inspire my work in this field. I also thank my thesis committee members, Dr. Marla Buchanan and Dr. Marvin Westwood for their guidance and sharing their knowledge and expertise to my research. I also extend my gratitude to Dr. Richard Young for helping me think more critically when I was in the very early stages of forming my research question.  I would also like to extend my gratitude and thanks to all the horses, participants’ and trainers, in particular, Jay, for their willingness to bring this research to life.  To my partner, thank you…always.            		 xii	Dedication To Penny, my kindred spirit. To Bob, aka Vesuvius, our gentle giant, you will forever be in our hearts. Thank you both for gifting me with me your beauty, power, grace, and spirit that envelops and enlivens my soul.		 	 1	Chapter 1: Introduction  The relationship between humans and horses has a long history extending back to ancient Greek times, where it is reported the ancient Greeks offered horseback rides to lift the spirits of the incurably ill (Lessick, Shinaver, Kimberly, Rivera, & Lemon, 2004). Equine-based interventions are growing in popularity and increasing worldwide, with programs expanding across Canada, to assist individuals with a range of issues including depression, addictions and eating disorders (Russell, 2013). Programs aimed specifically for veteran populations are also gaining in number. While the academic literature into the effectiveness of equine-based programs and veterans is limited, anecdotal accounts and reports from media resources attests to the benefits of equine-based interventions (Lanning & Krenek, 2013). Exploring this unique relationship from the experience of the participants themselves will provide a greater understanding of the potential therapeutic benefits arising from the human-equine connection and will, therefore, contribute to the academic knowledge base, with the aim of supporting the development of effective therapeutic equine programs for veterans. Overview of the Research Topic Equine therapy (ET) is an umbrella term to describe the use of horses in a therapeutic context.  There are several different types identified in the literature, including but not limited to, equine-assisted therapy (EAT), equine-assisted psychotherapy (EAP), equine-assisted learning (EAL), equine-facilitated psychotherapy (EFP), equine-assisted counselling (EAC), and equine-assisted activities (EAA). When horses are integral to the therapeutic process, which involves working alongside a therapist, it tends to be referred to as EAC, EAP and EFP (Masini, 2010). Those who are working within those approaches often apply traditional client-based interventions or theories whilst utilizing horses (for example, Gestalt, cognitive-behavioural 		 	 2	therapy [CBT], dialectical behavioural therapy [DBT], solution-orientated therapy, relational and psychodynamic theories (Bachi, Terkel, & Teichman, 2011; Ferruolo, 2016; Masini, 2010; Siporiin, 2012). These interventions offer an alternative to traditional talking therapies that take place within the context of the ‘counselling room’.  Equine interventions are essentially experiential in nature, where communication and connection between client and horse occurs.   Animal-assisted therapy. Some of the earliest research into the therapeutic benefits involving animals in the therapy context came from Levinson (1962), who discovered he made significant progress with children in therapy when his dog, Jingles also attended sessions, describing the dog as a “co-therapist”.  Since that time, animal-assisted therapy (AAT) has received increasing attention in the literature regarding both the physiological and psychological benefits. Physiological effects have included reduced heart rate, blood pressure and cortisol levels (Barker, Knisely, McCain, Schubert, & Pandurangi, 2010; Beetz et al., 2011; Tsai, Friedmann, & Thomas, 2010; Vagnoli et al., 2015), with consistent evidence suggesting pet ownership offers a protective buffer from cardiovascular risk (Giaquinto & Valentini, 2009). Psychological therapeutic benefits include a reduction in anxiety (Grajfoner, Harte, Potter, & McGuigan, 2017; Hoffmann et al., 2009), depression (Souter & Miller, 2007; see also Olsen, 2016), loneliness in older adults in residential care (Banks, Willoughby, & Banks, 2008; Vrbanac et al., 2013), improved emotional regulation, recognition and emotional control in adolescents (Burger et al., 2009; Hanselman, 2001), reduction in distress and behavioural symptoms in children and adolescents, with improvements in social, emotional, cognitive and psychological functioning (Stefanini, Martino, Bacci, & Tani, 2016), improved perceptions of pain management (Marcus et al., 2013; Sobo, Eng, & Kassity-Krich, 2006), and compared to non-pet owners, pet owners generally fared better across a range of wellbeing measures (McConnell, 		 	 3	Brown, Shoda, Stayton, & Martin, 2011). The use of animal assistance programs for veterans with posttraumatic stress disorder (PTSD), particularly canine assistance and therapy dogs, has increased in recent years (Owen, Finton, Gibbons, & DeLeon, 2016). The literature suggests a positive link between canine assistance and a reduction in symptoms associated with PTSD in veterans (Krause-Parello, Sarni, & Padden, 2016) including, increased social interactions and networks (Taylor, Edwards, & Pooley, 2013), improved feelings of calmness with reductions in loneliness, depression and isolation, and concerns regarding their own safety and their families (Stern et al., 2013).  Equine therapy. Although ET is viewed as an arm of AAT, there are important fundamental differences to note. AAT largely focus on domesticated animals such as cats and dogs that have evolved from predators. Horses are prey animals whose first response is to flee from the presence of a threat (Evans, 2010). Horses have the ability to observe, evaluate and respond to social behaviours, essential for survival, not only in the herd but also from predators (Trotter, 2012). As they have a heightened sensitivity to human emotions (K. Brandt, 2006), a horse, for example, will move away from a person if they sense fear or anger and will follow a person they trust. The horse, therefore, has the unique capability to intuitively respond to human behaviours, providing immediate, unbiased feedback to the human about their communication (Maros, Gácsi, & Miklósi, 2008).  A. V. Smith, Proops, Grounds, Wathan, and McComb (2016) demonstrated that horses were able to spontaneously discriminate between, and respond, both behaviourally and physiologically to positive (happy) and negative (angry) human facial expressions.  Additional qualities to that of AAT, is the size and presence of a horse (Karol, 2007), physical touch and body-to-body contact (K. Brandt, 2006), with the added uniqueness that 		 	 4	individuals need to go to the horses’ environment in order to interact (Ewing, MacDonald, Taylor, & Bowers, 2007). Importantly, it is not possible to be inauthentic with a horse. When an individual is incongruent between their internal and external states, the horse will provide immediate non-verbal feedback when the communication is mixed or unclear (C. Brandt, 2013; Lentini & Knox, 2009). For example, fleeing when it senses fear, or becoming agitated, even though the external state of an individual is trying to present in a calm manner. It is suggested that ET is likely to be an effective approach for diverse clients due to its highly experiential nature (Dell et al., 2011; Trotter et al., 2008).  There is a skill to communicating with horses, which can be traced back to the early writings of Xenophon 2,300 years ago, “Art of Horsemanship”. In his teachings, Xenophon (1893) states “the one great precept and practice in using a horse is this - never deal with him when you are in a fit of passion. A fit of passion is a thing that has no foresight in it” (p. 37). Signifying that true horsemanship relies on developing a partnership by calm and gentle means, and not through coercive measures. “Compulsion and blows inspire only more fear” (Xenophon, 1893, p. 37). Thus, through gentleness, the horse will want to do as you desire. Natural horsemanship therefore, is a way of working with horses with a particular emphasis on understanding the horse's natural behaviour, tuning in to the language of the horse, to see the world through their eyes and to respond accordingly in an authentic, sensitive and gentle manner (Birke, 2007).  As communicating with horses rests on authentic non-verbal communication, to learn how to effectively communicate with horses, individuals need to be aware of their affective states and regulate their emotional responses in their communication with horses (e.g. if you want the horse to change their behaviour, you must first change your own). 		 	 5	Emotion regulation has been conceptualized as the process of how individuals change their emotional responses to appropriately respond to environmental demands (Aldao, 2013). When regulating emotions, individuals may try to redirect the flow of their emotions, thus changing emotional responding (Gross, 2015; Koole, 2009; van der Kolk, 2014). Developing emotion regulation generally involves increasing awareness of emotions and how they are registered in the body and learning how to stay in tune with others. Learning how to breathe calmly, for example, can help decrease arousal (van der Kolk, 2014). Thus, interacting with horses, by its very nature, hones the individual into a focused awareness, a sensitivity to the situation which draws the individual’s attention away from a predominately cognitive state, to a more intuitive, felt sense of experiencing. The horse reflects back to the individual what they are communicating, providing the individual with immediate feedback about his/her own communication and affective states. Equine interactions may help individuals who are dysregulated in their emotions. For example, people who have experienced traumatic events and are experiencing symptoms of hyperarousal such as feeling tense, being easily startled, increased stress, or feeling disassociated (van der Kolk, 2014). Interacting and learning how to communicate with equines brings the individual into the ‘here and now' and it, therefore, may help individuals become more aware of their emotions and how to regulate them in the present moment. Correspondingly, ET may be beneficial for people suffering with anxiety as interaction with horses may increase a sense of mindfulness (Earles, Vernon, & Yetz, 2015).   While research into the efficacy of ET is growing, much of the equine literature focuses on children with physical disabilities (Park, Rha, Shin, Kim, & Jung, 2014), autism spectrum disorders (ASD) (Gabriels et al., 2015; Hoagwood et al., 2017; Kern et al., 2011; Mapes & Rosén, 2016), and at-risk youth (Bachi et al., 2011; Burgon, 2014; Kendall et al., 2015; Trotter et 		 	 6	al., 2008). Though there is growing interest in equine programs to help veterans with PTSD, limited research exists with adults and mental health concerns in general, and specifically with veteran populations.  One example of a program in Canada for veterans diagnosed with PTSD and operational stress injuries (OSI) and their family members is Can Praxis. The program utilizes a meaning-centred counselling approach supported by a registered psychologist where couples learn to resolve conflict and crisis (Wounded Warriors Canada, 2017). The emerging evidence has suggested positive results on improved personal relationships (Duncan, Critchley, & Marland, 2017). Although the research is sparse into ET interventions and veterans, positive outcomes are indicated (Duncan et al., 2017; Ferruolo, 2016; Lanning & Krenek, 2013; MacLean, 2011; Masini, 2010).  Limitations within the Literature As ET is an emerging field, there is no consensus or standardized practice embedded within these interventions. Each of these approaches, under the umbrella of ET, is guided by a different approach, methodology and expected outcomes.  Furthermore, there is also great variation within these branches in terms of the method, population, number of sessions, activities, and delivery (e.g., individual or group format).  Several authors have reviewed the literature and concluded that the evidence into the effectiveness of ET on psychological outcomes is insufficient, as the evidence was mixed and often perceived difficult to interpret (Kendall et al., 2015; Lentini & Knox, 2009, 2015; Ratliff & Sanekane, 2009; Smith-Osborne & Selby, 2010; Staudt & Cherry, 2017). Limitations from the quantitative studies included: a) a few involved a control group, b) small sample sizes, and c) varying descriptions or vague descriptions of the actual interventions.  Some of the ET approaches were paired with a second therapeutic technique including theories of projection, 		 	 7	transference and utilizing the horse as a metaphor (Klontz, Bivens, Leinart, & Klontz, 2007). The positive outcomes could, therefore, be accounted for by the use of the additional therapeutic approach or modality, or perhaps due to the therapeutic relationship with the therapist (C. Brandt, 2013), and thus, blurring the lines between what is it about the intervention that results in therapeutic benefits. There was agreement however across the reviews, that the anecdotal and subjective data indicated there were positive psychological benefits in engaging with equine programs, with the strongest evidence coming from studies involving children and adolescents (Kendall et al., 2015; Lentini & Knox, 2009, 2015; Ratliffe & Sanekane, 2009; Smith-Osborne & Selby, 2010).  Gap in the Literature  Though the literature is still in its infancy, much of the research focuses on outcomes of equine interventions, thus quantifying the effects of human-horse relations. While the data indicates a trend in the direction of positive outcomes, the empirical evidence provides only weak support for the efficacy of ET, with much of the equine literature focusing on children and adolescent populations (Kendall et al., 2015; Ratliffe & Sanekane, 2009). Limited research exists with adult populations.  The literature into equine-based programs and veterans is similarly scarce. Furthermore, few studies have explored the experiences of the human-horse connection, missing the how of what happens (Burgon, 2014). Of those studies that have, the focus was mainly on horse owner’s relationships with their equines.  For example, Keaveney (2008) identified themes of emotional support, love, caring and friendship. Yorke, Adams, and Coady (2008) found the bond horse owners had with their horse was therapeutic during recovery from trauma. Few studies have explored human-horse experiences with no pre-existing relationship.  		 	 8	As programs are expanding that utilize horses for therapeutic purposes (Eagala, 2016; PATH intl, 2018b), more research is needed as there is little consensus about how equine interventions should be conducted or how effective different therapy programs are for the treatment of different psychological symptoms (Earles et al., 2015; Lee, Dakin, & Mclure, 2016). Purpose of the Study and Statement of the Research Question The broad purpose of this phenomenological study is to understand the experiences of the human-equine partnership. This study focuses on veterans and equines within the context of natural horsemanship (NH). By utilizing NH as a method of engaging with horses that focuses on the horses natural behaviour and herd instincts (MacLean, 2011), the aim is to improve understanding of how learning to communicate with horses in its most natural form can improve understanding of the potential healing arising from the human-equine partnership, and how this may be of benefit to veterans.  The primary research question is: What are veterans initial experiences of participating in natural horsemanship.  In exploring this question with participants, the researcher will include a discussion of the thoughts, feelings, context, relationship and the parts of the experience that were most important for them while engaging with horses.    Significance of the Study The aim of the study is to reveal the meaning of participant’s experience of engaging with horses, without additional factors of the therapist, theoretical orientation, specific objectives or expected outcomes.  Understanding the meaning of the human-equine experience through in-depth exploration from the perspective of those involved, may further understanding of the unique therapeutic processes that horses can offer. This study will therefore contribute to the sparse literature of ET in general, by better understanding how utilizing horses relates to the 		 	 9	positive outcomes indicated in the literature and therefore can contribute to the development and delivery of equine interventions in a therapeutic context for veterans, potentially offering an alternative or adjunct path to healing for those who do not respond or do not wish to engage in traditional therapies.                     		 	 10	Chapter 2: Literature Review To investigate the human-horse connection and its therapeutic potential with veteran populations, the following literature review provides a discussion of the existing literature relevant to this study, including: a discussion of the human-animal bond, an overview of AAT including the hypothesized mechanisms of change, the unique qualities of the horse, the philosophy of natural horsemanship, equine therapy (ET) approaches, including established programs aimed at veterans with posttraumatic stress disorder (PTSD), a discussion of the current ET literature and its evidence base, and a presentation of veterans and PTSD.  Human-Animal Bond Animals have a long history of positively influencing human well-being (C. Brandt, 2013). It is believed from the historical evidence that the social symbiotic relationship between humans and companion animals was a natural process, without coercion from humans, suggesting that this interaction developed as a beneficial and meaningful connection that has extended for at least 10,000 years (Odendaal, 2000). Archaeological discoveries in the late 1970s in northern Israel suggest an even longer history. Where the remains of a person buried with their arm around a wolf or dog puppy was found 12,000 years ago, indicating the existence of a close, affectionate relationship between human and canine (Davis & Valla, 1978). Further evidence from dog fossils discovered in Switzerland suggests the domestication of dogs extends back to almost 15, 000 years (Napierala & Uepmann, 2012), with evidence from Siberia extending to 33,000 years ago (Ovodov et al., 2011).   Horses have signified a transformational shift in human history. It is believed horses were domesticated around 6,000 years ago where archaeological evidence of horseback riding was found in today’s modern Kazakhstan (Outram et al., 2009). Horses provided transportation 		 	 11	and thus communication, trade and commerce to communities, resulting in shaping civilizations. Not only were they instrumental in warfare but also they became a part of everyday life as a work aid and later a leisure pursuit (Bendrey, 2012; Levine, 2005). The relationship between humans and animals remains strong today with over 57% of Canadian households owning a pet (Consumer Corner, Canadian Pet Market Outlook, 2014), with approximately 41% of Canadian households having at least one dog (Canadian Animal Health Institute, 2017). Animal-assisted therapy. The literature indicates that the relationship between humans and their pets represents a unique bond that is different from that of interpersonal relationships (Cavanaugh, Leonard, & Scammon, 2008), and this relationship has been recognised for its therapeutic benefits.  Animal-assisted therapy (AAT) is the inclusion of pets as integral to the therapeutic counselling process (Chandler, 2012). Levinson (1962), a child psychotherapist, first brought the attention of AAT to the field of psychotherapy from his observations of the therapeutic effect of pets when included as part of therapy sessions. Since that time AAT has received considerable attention in the literature regarding the positive effects on both physical and psychological well-being.  Physiological. Physiological benefits include changes in hormone responses, heart rate and blood pressure. Barker et al. (2010) investigated stress buffering response patterns in 10 participants who interacted with therapy dogs (either their own or an unfamiliar therapy dog) and found in both groups physiological benefits including decreases in cortisol, blood pressure, heart rate and self-reported anxiety following interacting with a therapy dog. Beetz et al. (2011) found in a sample of 31 boys with insecure /disorganized attachment, significantly lower levels of cortisol when in the presence of a dog, compared to group of children with toy dogs, and a friendly adult group.  Furthermore, they also found that the more the children petted the dog, the 		 	 12	lower their stress reaction. Vagnoli et al. (2015) found children undergoing venipuncture in the presence of a dog (N=25) were less distressed, with lower cortisol levels, compared to when no dog was present. Tsai et al. (2010) found AAT decreased physiological arousal in hospitalised children by measuring blood pressure at three-time points during AAT sessions compared to non-AAT sessions. In a review of the literature from 1960 to June 2007, the evidence was consistent that pet ownership (in particular dogs) offers a protective buffer from cardiovascular risk (Giaquinto & Valentini, 2009). AAT has also shown to have a positive impact on pain management with patients self-reporting clinically meaningful pain relief in the presence of a therapy dog compared to those without (Marcus et al., 2013). Psychological. In a review of the evidence from randomized controlled trials (RCTs) from 1990 to October 2012 (57 RCTs identified, 11 met the inclusion criteria), Kamioka et al. (2014) concluded that the evidence indicates AAT may be an effective treatment modality for mental and behavioural disorders including depression, addictions and schizophrenia. However, they highlighted the RCTs were of relatively low quality, but the evidence within the studies indicated positive outcomes. Souter and Miller (2007) carried out a meta-analysis into the effectiveness of AAT and depression (165 articles identified, 5 met the inclusion criteria) and found AAT to be associated with fewer depressive symptoms. Olsen et al. (2016) found a reduction in depressive symptoms in men and women with severe dementia (65 years or older, N=28) who engaged with a dog twice weekly for 12 weeks compared to a control group.  Grajfoner et al. (2017) found significant improvements in mood and well-being and reduced anxiety when students (N=86, mean age 21; 57 female, 29 male) had the opportunity to engage with a dog in a brief one-off 20-minute dog-assisted activity. In an online sample of 217 people (171 Female, 46 Male; mean age 31 years), 167 reported to owning their own pet. Pet owners 		 	 13	performed better on a range of well-being measures including; loneliness, self-esteem, subjective happiness, exercise and fitness, and physical illnesses and symptoms, than non-pet owners across all wellbeing measures (McConnell et al., 2011). Significant improvements in adolescents (N=27) on emotional competencies (including emotion regulation and recognition), self-esteem and well-being were found compared to a control group, following an AAT training program that took place on a weekly basis within a school (Burger et al., 2009). In an RCT, 20 children and adolescents (9 male, 11 female) with severe psychiatric diagnoses were assigned to AAT consisting of 45 minute weekly sessions over a 3 month period, which resulted in significant improvements in emotional and behavioural symptoms (Stefanini et al., 2016). Canine-assistance therapy and veterans. Owen et al. (2016) found supporting evidence within the literature of canine-assisted therapy (CAT) and improved psychological outcomes of military service members with trauma-related stress. They further suggest CAT may be of benefit to veterans that are less likely to connect with mental health services through fear of stigma. Human-canine interactions are more likely to increase both passive and active social interactions.  Yount, Olmert, and Lee (2012) created a dog-training program for veterans with PTSD symptomatology and traumatic brain injury. From observations and participant self-reports, they found those that engaged in the canine program made improvements regarding impulse control, emotional regulation, ability to show affect, decrease in emotional numbing, and an improved sense of belonging and acceptance. Camp (2001) identified themes of increased social contact, community participation and more confidence in pursuing activities.  Underlying mechanisms of the effects of AAT. A number of theories are suggested, into the mechanisms of change as a result of the human-animal connection. The social support hypothesis suggests that animals provide a source of social support both direct and indirect (e.g., 		 	 14	as a result of the interaction between the human-animal, and as a catalyst to interact with others). Through the medium of social support this is translated into positive health effects (Brooks et al., 2013; McNicholas & Collis, 2006). The biophilia concept (Wilson, 1984) is often cited, where humans have an innate desire to connect with the natural world and all of its life forms including animals. It is assumed that neurobiological processes play a role in the human-animal connection via the activation of the oxytocin system. For example, positive social interactions with canines after only 15 minutes increase oxytocin levels in both dog and owner (Handlin et al., 2011; see also Odendaal & Meintjes, 2003). The release of oxytocin through the means of social support may alleviate symptoms associated with PTSD, including that of the human-animal connection (Olff, Langeland, & Witteveen, 2010). Oxytocin is also considered an important factor in attachment, promoting intimate bonding (Odendaal & Meintjes, 2003). Attachment theory is a further hypothesis to understand the underlying mechanism of the human-animal bond (Odendaal & Meintjes, 2003). It would seem these theories are linked. Humans have a desire to connect with others and the life-world. The human-animal connection facilitates social support and social interactions. The oxytocin system is activated when engaged in positive social interactions. Oxytocin is important in attachment bonds, including human-animal relationships, which as a consequence of the release of oxytocin and our connection to others including animals; this in turn improves psychological wellbeing. Beetz, Uvnäs-Moberg, Julius, & Kotrschal (2012) suggest the role of oxytocin in human-animal interactions not only offers an explanation but an integrative view. While a connection between human-animal interactions has shown to have therapeutic benefits, the use of horses specifically in therapy has not been well researched.  		 	 15	Unique Equine Qualities As prey animals, horses are highly attuned to their environment for the presence of a threat. As herd animals, they have strong social bonds and are each placed within a hierarchy of dominance, essential for the survival of the herd (Fine, 2015). As their survival relies on non-verbal communication, they have the unique ability to respond to human behaviours and emotions (K. Brandt, 2006; Burgon, 2014; Trotter, 2012). Due to their sheer size and presence, humans must learn non-verbal cues to effectively communicate with horses, if they are to develop a trusting relationship (Karol, 2007).  Natural horsemanship. Natural horsemanship (NH) has been referred to in the media as “horse whispering”. However, it is not elusive as the media portrayals. It is also not simply a training method, but a way of working with horses rooted in a philosophy of learning the language of the equine.  By understanding the horses natural instincts, herd behaviour and body language, human and horses are better able to communicate with each other through the use of non-verbal cues. The main principles of NH are based on mutual understanding, communication and gentle authority such as pressure and release techniques that mimic herd dynamics (Rolo, 2007). Learning to communicate with equines in a calm and non-reactive manner can encourage emotional awareness, regulation of emotions and self-control (Cumella, 2003). Connecting with the horse through NH principles leads to a connection based on trust and respect, opening up space for an emotional connection to occur (Kendall & Maujean, 2015). Equine Therapy Approaches The role of horses as a treatment approach has traditionally been limited to physical therapy treatment (referred as hippotherapy). The term hippotherapy originates from the Greek word hippos meaning horse, where the horses’ movements were considered by the Hippocrates 		 	 16	to be a natural ‘healing rhythm’ (Granados & Ferna, 2011). Hippotherapy tends to be carried out by an occupational, physical or speech therapist (AHA, 2016). Beneficial effects of utilizing equine movement for the treatment of individuals with functional limitations and sensory dysfunction have been highlighted.  For example, in a meta-analysis into the effects of hippotherapy on functional control in children with cerebral palsy, (77 studies identified, 10 met the inclusion criteria), 76 out of 84 children improved on postural control and balance (Zadnikar, & Kastrin, 2011).  Similarly, Park et al. (2014) found children who received 45 minutes of hippotherapy twice a week for 8 weeks (N=34) made significantly greater gains on gross motor functioning and in domains of self-care, mobility and social functioning compared to a control group. Newer approaches that incorporate horses into mental health treatment are referred to as equine therapies (ET) and are considered a branch of AAT.  ET is a board term to describe the multiple approaches that incorporate horses into the therapeutic process. When horses are utilized alongside a therapist, it tends to be referred to as equine-assisted psychotherapy (EAP), equine facilitated psychotherapy (EFP) or equine assisted-counselling (EAC) (Masini, 2010). The inclusion of horses into the mental health field is expanding and gaining increasing attention in recent years (Masini, 2010; Russell, 2013). Comparisons between the client-therapist and the human-equine have been proposed, regarding the bonds formed and their healing qualities (Karol, 2007; Yorke et al., 2008). Established Equine Therapy Programs There are two main organizations offering ET interventions/activities: The Professional Association of Therapeutic Horsemanship International (PATH Intl.) and The Equine-Assisted Growth and Learning Association (EAGALA).  		 	 17	PATH Intl. was established in 1969 (formally known as the North American Riding for the Handicapped Association, now based in Colorado, United States) to promote equine-assisted activities and therapies for individuals with special needs (PATH Intl., 2018b). PATH Intl. now has over 881 member centres and has expanded their programs over the years to include EFP for individuals with mental health needs, with 335 programs aimed at veterans (PATH Intl., 2016). Whilst there are a multitude of centres across the United States, none are currently offered in Canada (PATH Intl., 2018c). These programs may include a therapist (including a mental health practitioner, occupational therapist etc.) alongside an equine specialist. Activities involve both riding and groundwork. Groundwork activities incorporate feeding, grooming, tacking and leading the horse. Psychological treatment approaches of EFP are not defined. PATH Intl. certified therapists include varying theoretical orientations and approaches depending on their orientation (Mattson, 2015). Bachi (2013) noted that EFP approaches are likely to involve projection techniques, for example, watching herd dynamics, and together with the therapist, these projections will be explored. Masini (2010) highlighted therapists tend to apply traditional theories of psychotherapy as part of the equine therapy process. Klontz et al. (2007) commented that ETs offer a unique opportunity for the use of metaphors, projection and transference. EAGALA. Established in 1999 in the United States, EAGALA was founded in response to the growing interest in the inclusion of horses into the therapeutic process (EAGALA, 2010a). Like that of PATH intl., EAGALA incorporates a team approach, including a mental health professional alongside an equine specialist, the horse/s and the client. Unlike PATH Intl, activities are focused on groundwork (no riding). EAGALA’s EAP/ EFL model incorporates behavioural and cognitive theories and takes a brief solution orientated approach (EAGALA, 2010b). The equine assisted trauma therapy, as part of the EAGALA’s approach, aimed at 		 	 18	clinical trauma populations including military personnel, is based primarily on psychodynamic concepts (Parent, 2016).  Can Paxis. A more recent program effective since 2013, designed to improve and rebuild family relationships, is offered to veterans and active service members, members of the Canadian Armed Forces (CAF) and Royal Canadian Mounted Police (RCMP), diagnosed with PTSD and OSI (Duncan et al., 2017). They offer EAL as part of a meaning-centred counselling therapeutic approach. The program includes three phases, which takes place over 9 days that includes their family members. Activities include learning to care for horses and learning to ride (Wounded Warriors Canada, 2017).   There are many more programs offering therapeutic approaches of working with horses although they are generally not standardized. ETs can include a range of activities (mounted and un-mounted) that appear to have positive psychological benefits. When working alongside a therapist with additional therapeutic techniques or modalities, and expected outcomes of improvement to participant psychological wellbeing, it is difficult to assess how much of the therapeutic benefit stems from interacting with the horse itself.  Equine Therapy Research While the research into ET and its effects on positive psychological outcomes are growing, much of the research into ET comes from children and adolescents. Autism spectrum disorders (ASD). In a recent RCT into the effects of a 10 week therapeutic riding (TR) program involving 127 young people (aged 6-16 years) with ASD; Gabriels et al. (2015) found significant improvements from baseline to post-intervention on irritability, social communication, social cognition, and hyperactivity, compared to a barn activity.  Kern et al. (2011) explored the effects of a TR intervention with 24 children (aged 3-12 		 	 19	years). Participants rode once a week for 60 minutes. Parent and clinician measures were completed at four-time points over a 6 month period. A reduction in severity of ASD symptoms was found after 3 month and 6 month period intervals, assessment of parent-child interactions also significantly improved at both intervals. In a review of the literature, Mapes and Rosén (2016) identified 11 out of 12 studies that demonstrated the effectiveness of ET for children with ASD. Of which four included pre-posttest methodological designs (two of which are highlighted above). Limitations across all the studies included; only half incorporated a control group; only two studies clarified the type of ET intervention; duration of sessions varied between 10-70; and while the majority included standardized measures, several did not. The authors concluded that while the research highlights improvements in children with ASD, more understanding is required as to why ET works and what methods are most effective.  In a further recent review of the literature, Hoagwood et al. (2017) also agreed that the findings from ET for ASD were identified as the most promising. They stated that none of the studies identified the mechanisms of the therapeutic change process and suggested comparative studies to see if different animals have different therapeutic processes, or whether it is generally the human-animal interaction that functions as the primary mechanism of change. Attention deficit hyperactivity disorder (ADHD) and behavioural issues. Cuypers, De Ridder, and Strandheim (2011) investigated the effects of TH with five children with ADHD (aged 10-11 years). Participants received twice-weekly 1 hour sessions of TR for 8 weeks. Compared to baseline measures, positive effects were found post-intervention across domains of social role behaviour, quality of life and motor performance. Study limitations included small sample sizes and no control group. Holmes, Goodwin, Redhead and Goymour (2012) explored 		 	 20	the benefits of EAA on adolescents with emotional, behavioural and/or learning difficulties. Eleven students (aged 12-14 years) attended a racehorse rehabilitation centre for 3 hours across 4 days, where they were able to interact with horses. Measures of anxiety and self-esteem were collected at baseline and following each targeted interaction. Significant improvements were found in anxiety but no changes in self-esteem were reported. Limitations included small sample sizes and no control group. In an RCT, 53 children with emotional and behavioural issues were assigned to an EFL program, including both mounted and un-mounted activities (90 minute weekly sessions, across 11 weeks). The results indicated a positive effect on social competence (including personal responsibility, self-awareness and self-management) and behaviour (Pendry, Carr, Smith, & Roeter, 2014).  At-risk youth. Trotter et al. (2008) compared EAC to classroom-based counselling in at-risk students across two semesters (N=164).  Participants met in groups once a week for 12 weeks that included a masters level mental health counsellor and an equine professional. The intervention included traditional talk therapy and group processing. Of the 126 participants in the EAC treatment group, significant improvements were made compared to baseline across several behavioural domains from both self-reports and parent ratings including, conduct problems, aggression, feelings of inadequacy and social skills. Limitations included no random group assignment. Dell et al. (2011) explored whether an EAL program for First Nations and Inuit youth who abuse solvents (N=15) would be a valuable extension to their residential cultural treatment program. The intervention was offered once a week for 1 hour over a 12 week period. From the qualitative interviews with the participants, treatment program staff, and EAL facilitators, themes of spiritual exchange, complementary communication and authentic occurrence were found.  Bachi et al. (2011) investigated the effects of EFP for at-risk adolescents 		 	 21	(N=14; aged 14-18 years) in residential treatment compared to a matched control group (N=15). Participants received weekly individual sessions approximately over a seven-month time frame. Measures included; self-image, self-control, trust, and general life satisfaction. Whilst all measures failed to reach significance, the data indicated a positive trend towards changes. Burgon (2014) explored the experiences of seven at-risk adolescents who took part in a therapeutic horsemanship (TH) intervention over 7 months.  An EFP specialist certified as both a therapeutic riding instructor and social worker delivered the program. Themes relating to self-confidence, self-esteem, empathy, mastery, and self-efficacy were identified. Burgon (2014) suggests that ET interventions may be beneficial for at-risk youth without the inclusion of direct psychotherapy contact. Contrary to the majority of findings, Ewing and MacDonald (2007) found in their study of 26 youths with severe emotional disorders that took part in an EFP over 9 weeks, resulted in no changes in measures of self-esteem, empathy, locus of control, feelings of depression and loneliness. Qualitative data from observations and interviews with the therapeutic riding instructor, special education teacher and volunteers, indicated positive changes including, improved expression of emotion, social skills, confidence and trust.  Kendall and Maujean (2015) explored the effects of an equine program based on NH principles with 16 disengaged youths. Participants were matched with a horse and a mentor. A psychologist observed each youth for 15 minutes per week. Following 10 weekly sessions, of the 12 participants who completed the program, significant positive changes in measures of self-esteem and self-efficacy were found.  Trauma. Kemp, Signal, Botros, Taylor, and Prentice (2014) found improvements in symptoms of anxiety and depression and trauma in 15 children (referred for treatment for sexual abuse) aged 8-11 (9 girls, 6 boys) and 15 adolescent girls (aged 12-17) who took part in an EFT 		 	 22	program based on EAGALA principles (including activities designed to create metaphors). Similarly, Signal, Taylor, Botros, Prentice, and Lazarus (2013) also found a reduction in depression in children (N=15), adolescents (N=15) and adults (N=14) who attended an EFT program who were referred for treatment of sexual abuse. Interestingly, they highlighted that the treatment effect sizes were much greater compared to trauma-focused cognitive-behavioural therapy (TF-CBT). While the evidence for at-risk youth looks promising, not all studies have resulted in positive findings (see Bachi et al., 2011; Ewing & MacDonald, 2007). Adults and Mental Health Concerns  The literature into ET and adult populations with mental health issues is sparse. However, the evidence is encouraging. In an equine-assisted experiential therapy program, which involved groundwork activities combined with Gestalt and traditional techniques of role-playing, sculpting, role-reversal and mirroring, Klontz et al. (2007) found reductions in overall psychological distress and improved psychological well-being in adults as measured by the Brief Symptom Inventory (BSI) and the Personal Orientation Inventory (POI), which remained stable at 6 months. The intervention included 28 hours of treatment offered in a group format over an 8 month period. Thirty-one participants took part (22 women, 9 men) with a mean age of 27. All therapists held a Master’s level qualification. Limitations included no control group and reliance on self-report measures.  Eating disorders. Sharpe (2014) explored the experience of 14 females with eating disorders who took part in an EFC group intervention attending six, two and a half hour sessions. Each group included a registered counsellor and volunteers with a background in the helping 		 	 23	profession. Reported outcomes included a ‘reattunement’, a ‘quietening’ of eating-disordered thoughts and behaviours, noticing new sensations and a sense of time slowing or stopping.   Substance abuse. Kern-Godal, Brenna, Kogstad, Arnevik, and Ravndal (2016) investigated patients with substance use disorder (SUD) (N=16; aged 20-30) experiences of horse-assisted therapy (HAT). They found positive outcomes associated with attachment, reflective functioning and emotional regulation. They also note, there is a general lack of studies investigating the human-horse relationship from the perspective of the clients themselves. Trauma. Meinersmann, Bradberry and Roberts (2008) discovered in their interviews with females aged 27-49 (N=5) who have experienced abuse and had previously taken part in an EFP program as part of their healing process, improved feelings of control and regaining power, self-esteem and depression. The participants also reported that EFT was less time consuming and more effective than other kinds of therapy. Earles et al. (2015) investigated the efficacy of a specific ET intervention (Equine Partnering Naturally) for adults with anxiety and posttraumatic stress (PTSD) symptomatology. Sixteen participants (12 female, 4 male) aged 33-62 took part in a group-based format consisting of weekly sessions (2 hours) for 6 weeks. Sessions focused on groundwork activities and included a licensed mental health practitioner. Measures included the Patient Health Questionnaire for depression (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), Alcohol Use Disorders Identification Test, Somatic Symptom Severity Scale, and the Five Facet Mindfulness Questionnaire. Symptoms of anxiety, depression, alcohol use and emotional distress were significantly reduced, with an increase in mindfulness following the intervention. Limitations included no control group or follow up data. Finally, in an equine-facilitated group psychotherapy (EFGP) for women trauma survivors (with PTSD symptoms and a history of interpersonal violence), Schroeder and Stroud (2015) found the women (N=4; aged 		 	 24	mid-twenties-early sixties) reported being more mindful of themselves and others, and increased feelings of being more capable and competent.  Horse owner equine relationships. Through observations, in depth-interviews and open-ended qualitative questionnaires with 40 horse owners (aged 21-70 years), Keaveney (2008) identified themes of emotional support, love, caring and friendship. Trauma. Yorke et al. (2008) discovered adults (N=6; aged 18-51) who had experienced past trauma and the bond they had with their horse significantly contributed to their recovery from trauma. Themes of nurturing and intimacy were found, with touch and physical contact important factors to their healing process.  Equine therapy and veterans.  The research into equine-based programs with veteran populations is lacking but is encouraging. Lanning and Krenek (2013) examined the efficacy of the PATH International therapeutic riding (TR) program for veterans.  Thirteen veterans took part in weekly sessions lasting one-two hours. Data was collected over a 24-week period including a measure of depression (Beck Depression Inventory-II). Qualitative interviews were carried out to assess changes to veterans’ quality of life post-intervention. Positive changes in depression scores and quality of life domains were found. They noted it was unclear whether the TR intervention was a direct result of the positive changes due to a lack of control group. Self-report data were collected from a two day ET pilot program for eight male veterans with combat-related stress. The program incorporated CBT, motivational interviewing, and mindfulness frameworks that were facilitated by two social workers and a Master’s level counsellor. The data indicated positive outcomes on reducing anxiety and depression (Ferrulo, 2016).  Follow-up data from participants that completed Phase I of the Can Praxis program for veterans and their partners (N=88) found 67% reported their family relationships had improved 		 	 25	nearly 11 months following the program. A veteran and accredited mediation trainer, and an EAL trainer and psychologist facilitated the program (Duncan et al., 2017).  The Department of Veterans Affairs (VA) in New York has offered EAT programs for veterans with PTSD since 2008. MacLean (2011) discovered from the comments of six veterans who took part in one of the EAT programs offered that adopts a NH approach that the veterans had learned new ways of communicating, patience and trust.  Veterans and Posttraumatic Stress Disorder Posttraumatic stress disorder (PTSD) is conceptualized by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013) as resulting from the presence of a stressor (exposure/s) to one or more traumatic events that involve actual or threatened death, serious injury, or sexual violence and the presence of four groups of symptom clusters related to intrusion, avoidance, negative alterations in cognitions and mood, and hyperarousal. Exposure to the traumatic event may occur by directly experiencing or through learning the traumatic events/s have occurred to a close family member or friend, or repeated or extreme exposure to aversive details of the traumatic event/s. Symptoms are present for at least one month following the traumatic event, with significant distress or impairment in social and/or occupational functioning. Two specific components are noted including dissociative symptoms (depersonalization and derealization), which are new to the DSM-5, and delayed expression. PTSD is a common consequence for active military service members and combat veterans (Xue et al., 2015). Estimated lifetime prevalence rates of PTSD in the United States are 8.7%, with higher estimated rates for active military personnel and veterans (APA, 2013). The 2013 Canadian Forces Mental Health Survey (CFMHS) reports 12 month prevalence rates of 		 	 26	PTSD of 5.3% among regular force members, with lifetime prevalence rates of 11.1%. Depression rates were reported more commonly than PTSD (8% and 15.7% for 12 month and lifetime prevalence, respectively) (Statistics Canada, 2013). According to the data from Veteran Affairs Canada (VAC) from 2012-2017, 20% of all veterans in receipt of disability benefits, receive benefits for service related psychiatric diagnoses, and 73% of those veterans have a PTSD diagnosis (VAC, 2018). PTSD is a complex problem in military members and veterans, with many suffering debilitating and significant psychological distress. Traumatic stress impacts the psychobiological systems including, hyperarousal and vigilance, hypoarousal and dissociation, failure to regulate physiological reactivity, and disruption of affect regulation (van de Kolk, 2014). PTSD can also interfere and result in significant distress on an individual’s personal and social life (Xue et al., 2015).  The deployment cycle of military life can be a challenging transition. Assisting military service members with the transition of reintegrating back into their families and communities is critical, particularly as the transition may be impacted by additional factors of trauma-related symptoms and disability (Milliken, Auchterlonie, & Hoge, 2007). As veterans with PTSD have reported significant interpersonal difficulties (Koenen, Stellman, Sommer, & Stellman, 2008), approaches that address issues of emotion regulation and interpersonal skills are likely to be beneficial (Ray & Vanstone, 2009). While there are several effective approaches to help veterans with PTSD (see Schnyder & Cloitre, 2015; Foa, Keane, Friedman, & Cohen, 2009), newer and alternative approaches are growing. ET is one such approach that is increasing in popularity. It is suggested that approaches that incorporate animals as an alternative or adjunct to therapy may be beneficial for veterans 		 	 27	that may not otherwise seek help due to the stigma attached in receiving mental health services (Owen et al., 2016; Staudt & Cherry, 2017). Individuals with PTSD are more likely to be socially isolated or have difficulty connecting with others as a result of their symptoms. By interacting with animals it may help to bridge this gap (MacLean, 2011). Lanius (2017) highlights how animals can play a key role in healing from trauma, particularly when they may never have had a safe attachment figure. Ashton (2011) suggests ET for military personnel may be more effective than standard approaches as it is less intimidating than working with a therapist. As horses are nonjudgmental, veterans may also feel more motivated or inclined to engage in ET and as it is largely non-verbal and highly experiential. Furthermore, as the horse is a prey animal, vigilant to the presence of a threat in their environment, individuals who have trauma-related symptoms may relate to equines (Klontz et al., 2007), more so that that of domesticated dogs. As Earles et al. (2015) noted, engaging with equines naturally encourages a ‘here and now’ presence (try not paying attention to a 1000lb horse standing in front of you!). This may help redirect attention from a largely cognitive state to a more present embodied focus, encouraging greater emotional awareness and regulation of emotions. MacLean (2011) suggested that veterans were able to accomplish more from therapeutic horse related activities than in a talk therapy session. She further notes how NH is a natural fit with PTSD as it is based on developing a trusting partnership. Limitations within the Literature Several authors have reviewed the literature into the effectiveness of ET interventions on psychological outcomes in recent years. Ratliff and Sanekane (2009) concluded that since there are multiple types of ET interventions used with differing populations and for different purposes, including the multiple variables within each of the interventions, it is difficult to interpret the 		 	 28	efficacy of ET interventions. Furthermore, as there are multiple approaches of ET, it is critical we understand what works and why and for whom, and particularly for the interventions to be cost-effective. However, they did acknowledge that the subjective data indicates positive effects of psychological distress.   In another comprehensive review of the literature of EFP with children and adolescents, Lentini and Knox (2009, 2015) highlighted the multiple activities incorporated within the interventions and the various psychotherapeutic frameworks, including, psychodynamic, cognitive, behavioural, Jungian and Freudian perspectives. They recognized the complexity for therapists in choosing an approach due to the vast variations of its application. Due to wide-ranging methods, terminology, and theories, the field would benefit from a standardization of the language. Smith-Osborne and Selby (2010) in their review of the literature noted that much of the attention of the effectiveness of ET interventions focuses on children and adolescents.  Similarly they highlighted as a result of the various approaches, the evidence into the effectiveness of ET was mixed due to the lack of rigorous research designs, making it difficult to interpret.  As C. Brandt (2013) highlighted, research into ET studies primarily stemmed from equine communities rather than academic and mental health communities, resulting in a lack of rigorous research designs. In a recent systematic review, Kendall et al. (2015) reviewed the literature on ET interventions from 2008-2012 (188 articles were initially identified, any unrelated studies to the therapeutic use of horses were removed, resulting in 15 remaining articles). They similarly pointed out the extensive variation of the various ET approaches and its effectiveness on positive outcomes. Sample sizes ranged from 1-164, few incorporated a control group, with a general lack of random assignments, and many involved small sample sizes.  The assessment measures 		 	 29	also greatly varied in terms of psychometric assessment and qualitative methods. As previously mentioned, the differing programs are guided by a different approach, methodology and expected outcomes. Therapists also varied including, social workers, play therapist, mental health workers, counsellors and therapeutic riding instructors. As C. Brandt (2013) highlights, the positive outcomes could be accounted for by the use of the additional therapeutic modality or intervention or due to the therapeutic relationship with the therapist. Thus, obscuring what aspects of the intervention leads to therapeutic benefits. There were also substantial variations in terms of its format and delivery (length of intervention, session duration, group/ individual).  Kendall, Maujean, Pepping and Wright (2014) note that to understand the therapeutic value of the horse, the specific mechanisms of change need to be identified. Furthermore, few studies have explored the experiences of the human-horse connection from the participants’ own perspective (Kern-Godal et al., 2016), missing the how of what happens (Burgon, 2011).  In a recent review of the literature, Staudt and Cherry (2017) examined ET for people with trauma/PTSD. From the nine studies they identified (including youth and adults) despite the limitations they discovered with each study, consistent with previous findings, they suggest ET maybe useful for both youth and adults with trauma-related symptoms. They further note that the perspectives of clients and providers are needed. Summary The rise in popularity of equine-based programs to help individuals dealing with mental health concerns lacks an evidence base into its efficacy. As there are various equine interventions under the umbrella of ET, it is difficult to ascertain to what extent the positive benefits result from the interaction with the equine. The research of ET interventions with adult populations is further limited, including veteran populations. More research is therefore needed to understand 		 	 30	how utilizing horses may lead to human healing. Although the research into the human-equine bond is limited the findings are positive, including trauma (Earles et al., 2015; Kemp et al., 2014; Meinersmann et al., 2008; Signal et al., 2013; Schroeder & Stroud, 2015; Yorke et al., 2008) and specifically combat trauma (Duncan et al., 2017; Ferrulo, 2016; Lanning & Krenek, 2013; MacLean, 2011). The field lacks general understanding about the fundamentals of the human-horse connection and human healing. Studies that focus on NT could improve understanding of how utilizing equines lends itself as a therapeutic medium, particularly as the literature into NH is scare. As Klontz (2007) notes, equine interventions would benefit from a dismantling study to investigate the degree to which the inclusion of horses affects treatment and in what areas. Kendall and Maujean (2015) suggest an exploration of programs that build on the psychology of the horse (NH) and how these principles can be translated to therapeutic outcomes. Similarly, Lanning and Krenek (2013) suggest more understanding of the effect of the human-horse interaction is needed. Several authors highlight more understanding is required into the mechanisms of therapeutic change (Hoagwood et al., 2017; Kendall et al., 2014; Staudt & Cherry, 2017). Staudt and Cherry (2017) also highlight that ET offers a promising approach for trauma and PTSD and note that the field of ET is ‘ripe’ for future research for veterans, and may also increase access to services for military members. This study explored the human-horse connection and how horses may bring about healing for humans. This study focused on the experiences of veterans engaging in NH. By investigating the human-horse connection in its most natural form, without additional factors of the therapist, theoretical orientation, specific objectives or expected outcomes, from the experiences of those involved, can lead to a better understanding of how the human-horse partnership may translate into therapeutic gains. 		 	 31	Chapter 3: Methodology  This study follows an interpretive phenomenological approach. The focus of phenomenology is to reveal the rich descriptions of experiences of a phenomenon, in this study, veterans engaging with horses through natural horsemanship (NH).  The approach enables participants to express their experiences in their own words, revealing new and subtle understandings of the phenomenon and then utilizing this knowledge “to make a difference to the lived world of ourselves and others” (Langdridge, 2007, p.9). As illustrated by Creswell (2013), phenomenology is best suited where it is important to understand common experiences in order to develop practices and policies or to develop a deeper understanding (p. 204). In describing and uncovering the meaning veterans attach to their experiences of engaging in NH, this research offers a deeper understanding of human-horse experiences, contributing to the literature in this growing area of interest, and in a broader sense, informing practices of therapeutic equine programs for veterans. Research Design Heidegger’s phenomenological position, rooted in existential philosophy (Langdridge, 2007), is often referred to as interpretive phenomenology or hermeneutic phenomenology, as it built on the hermeneutic tradition (interpretation of experience), placing interpretation of the lived experience at its heart (van Manen, 1990). Interpretive phenomenology asserts that researchers utilize their prior knowledge to help guide the researcher and the study to reveal the meanings of the individual’s lived experiences.  The meaning of the experience may be hidden; therefore interpreting participants’ descriptions can help reveal the meaning of their lived experience (van Manen, 2009). The researcher does not ‘bracket’ their preconceived ideas and knowledge, for Heidegger or interpretative phenomenology, it would be impossible to attempt to 		 	 32	do so (Landridge, 2007). A researcher from an interpretive phenomenological framework is active within the research, by actively creating interpretations of the phenomenon under study (Koch, 1995). The interpretive view denotes that we as human beings are constantly interpreting our position and making meaning through our interaction with the world. The interpretive process in interpretive phenomenology, shifts between the whole and its parts (Wojnar & Swanson, 2007), described as the hermeneutic circle, a merging of meanings is its aim.  As the researcher has experience of the phenomenon being studied (the human-horse relationship), the researcher’s understanding of the phenomenon allows access to it, but remains open to new meanings and understandings (Leonard, 1989). It is imperative that the researcher in interpretive phenomenology be reflexive of researcher subjectivity and positionality. Methodological approach: Interpretive phenomenological analysis (IPA).  Interpretive phenomenology analysis (IPA) was employed to analysis the research data (J. A. Smith & Osborn, 2008) in this study to describe and explore the meanings veterans attached to their experience of participating in natural horsemanship (NH). IPA is an appropriate approach as its theoretical foundations draws on Heidegger’s interpretive/hermeneutic phenomenology and idiography (Eatough & Smith, 2008), where the aim is to focus on the individual’s lived experiences of particular experiential phenomena by understanding how the phenomenon (process, event etc.) is understood for the individual and the personal meaning they attach to that experience (J. A. Smith, Flowers & Larkin, 2009) (See Data Analysis for further information). Participants Participants were veterans interested in working with horses, to assist with operational stress injuries. Langdridge (2007) suggest five-six participants are sufficient for an interpretive phenomenological approach. J. A. Smith et al. (2009) note that IPA studies tend to involve small 		 	 33	sample sizes due to the in-depth exploration of personal accounts.  They suggest three-six participants as being reasonable to obtain meaningful understandings of both the similarities and differences between participants.   Inclusion criteria for this study were: a) self-identified veterans with an OSI, b) 19 years of age or older, c) an interest in learning how to work with horses through NH, d) commitment to four one hour sessions with an experienced horse trainer/s, d) willingness to talk about their experiences after completion of the sessions. Six participants were recruited on a first come-first served basis that met the inclusion criteria. One participant was unable to attend at the last minute, and therefore the study was comprised of five participants in total. Participant demographics. Of the five participants, four identified as male and one identified as female; two participants identified as Caucasian, two identified as European, and one as Canadian.  Ages ranged between 29-65 (mean age = 49). Of the five participants, two participants were currently employed. All participants resided in Canada, BC at the time of the study. Participant recruitment.  A purposeful criterion sampling strategy was employed as this study was interested in veterans who have experienced the phenomenon of interest, participating in NH (Creswell, 2013). Recruitment posters with information about the pilot study were posted via the Veterans Transition Network (VTN), and the British Columbia Operational Stress Injury Clinic (BCOSI) (See Appendix A). Interested participants contacted the lead investigators of the study; those that met the inclusion criteria were provided with further information about the study and a copy of the consent form. At the introduction session, the researcher met with each participant to complete the research consent form and to check that the participant understood the research process and to answer any questions or concerns (see Appendix B). The sample was 		 	 34	fairly homogenous which is typical of an IPA approach (J. A. Smith & Osborn, 2015), where the research question is meaningful to the participants (J. A. Smith et al., 2009).   Natural Horsemanship Trainers  As part of learning how to work with horses through natural horsemanship (NH), participants interacted with the trainers, as part of the learning process.  The focus of the interactions was based on learning and understanding horse behaviour and instincts and herd dynamics. The head trainer was selected by the research team as he is highly skilled and knowledgeable in natural horsemanship and has a good reputation with over 30 years of horsemanship experience. The participants interacted with the head trainer as part of the ‘round-pen’ experience, where the focus was on providing experiential learning of natural horsemanship. The co-trainer provided basic educational learning experiences including grooming, basic horse care, learning about herd behaviour, and herd dynamics and provided participants opportunities to ‘meet and greet’ with the herd while they were in the field and one-on-one grooming opportunities.   Overview of horse activities. On the first day, participants were introduced to the horse trainers. The head trainer provided basic safety of how to engage with horses and an overview of how to work with horses based on natural horsemanship principles. This involved learning about herd dynamics and understanding what it means to be a prey animal. The head trainer provided a demonstration in the round pen where the participants could observe the learning objectives. As part of the demonstration, participants observed how to cause movement through indirect pressure, learned about non-verbal communication, and were informed about the importance of groundwork to establish boundaries with the horse.  The head trainer demonstrated and communicated to the participants how to put a halter on a horse, how to move a horse, to lead a 		 	 35	horse, to walk in a circle, to drive a horse forward, to direct movement, and how to observe and interpret the horses body language, based on how horses react to each other in their natural environment.  The participants learned the importance of being gentle, consistent, and timely with their body language and to observe and understand the horse’s body language. In doing so, trust is established.   During the following sessions, participants had the opportunity to work in the round pen with the horses with the head trainer and to meet and greet the herd in the field with the co-trainer, and opportunities for one-to-one grooming. Activities in the round pen included: circling, leading, backing up the horse, and join-up (where the horse will follow a person around the round pen with no lead rope).  All participants participated in a minimum of 4 hours in total of natural horsemanship experiences (maximum = 6.5 hours in total; mean = 4.9 hours). Data Collection   Informed consents of all participants and a brief demographics questionnaire were obtained (see Appendix C). Researcher observations were taken, including recordings of events, behaviours and interactions.  The observations contained both descriptions (e.g., activity, time, space, actions) and the researcher’s reflections (ideas, impression, questions that arose from the observations), to assist with the researcher’s engagement with the data as part of researcher reflexivity. A focus discussion group was used as veterans’ experienced the same phenomenon (engaging with horses through NH) in the same time and space. A focus discussion group was a useful method as it is socially oriented, and thus veterans had the opportunity to share their experiences together as they experienced them together.  Selecting a group of fairly homogenous participants is often used for focus groups to facilitate group interviewing (Palinkas et al., 2015).  Palmer, Larkin, de Visser, and Fadden (2010) note that homogeneity, as part of the focus group 		 	 36	formation is likely to be important as it can allow access from an experiential perspective. Three participants attended the focus discussion group. One participant was unable to attend, and therefore a semi-structured, in-depth interview was scheduled. The interview questions followed the same format as the focus discussion group questions, where the focus was on the participant’s descriptions and meaning of engaging in NH. The other participant requested to provide a personal narrative account, reflecting the focus discussion group questions. All sources of data were used and analysed as part of the data analysis. The discussion group and individual in-depth interview were audio recorded and transcribed verbatim using repeated listening of the recordings.  Following analysis, the thematic findings were forwarded to the participants for their feedback. Carrying out member checks ensures participants lived experiences were represented as closely as possible. Those participants who wanted to provide feedback to the researcher stated that the results were an accurate reflection of their experience (see section below “Trustworthiness of the Study Findings” for further information).  Facilitated focus discussion group questions. Prior to the focus discussion group, questions were circulated to all participants (see Appendix D). The interview schedule was used flexibly and modified in light of participants’ responses allowing the researcher to probe in detail in light of areas of interest that arose (J. A. Smith & Osborn, 2008).  The researcher was interested in gathering information about the participants’ thoughts, feelings, relationships and context with regard to their experiences with the NH process. Prompts, probes and clarifying questions were used to help get a deeper, more meaningful understanding of the participants’ experiences if it was not covered in their descriptions. (For example, Can you tell me about that? What did you notice when…? How did you feel when…?). 		 	 37	It was important to use open-ended questions to encourage participants to share their experience as part of the focus discussion group and the in-depth interview.   Data management. All informed consent forms and confidential information were held in a locked and secure location. At the time of the informed consent interview, participants chose their own pseudonyms to safeguard their identity and were kept confidential and kept separately from the informed consent forms. Participants are identified only by their chosen pseudonyms throughout this document. Any details or information that could potentially identify any individual have been removed, changed or avoided. All digital data, including audio-recordings of the focus discussion group and in-depth semi-structured telephone interview, were kept in a password-encrypted file on the researcher’s password protected computer. All confidential information will be destroyed after five years. Data Analysis  An interpretive phenomenological analysis (IPA) (J. A. Smith & Osborn, 2008) was followed as part of the thematic analysis, to describe and explore the meanings veterans attached to their experience of natural horsemanship.  IPA and focus group data. While semi-structured interviews are a popular method when conducting IPA, it doesn’t necessarily need to be in this form. Both personal accounts (J.A. Smith & Osborn, 2008; for examples see Boserman, 2009; J. A. Smith, 1999) and focus group data have been employed as part of IPA studies (J. A. Smith et al., 2009).  For example, de Visser and Smith (2007) combined individual interviews with group discussions to explore both the shared and differing understandings of the phenomenon of interest. Flowers, Knussen and Duncan (2001) note that the focus groups enhanced rather than diminished the analysis. 		 	 38	Randazzo, Farmer and Lamb (2015) further highlighted how it is possible with focus groups to obtain rich personal accounts. One obvious advantage of focus groups is enabling multiple voices to be heard at one point in time (J. A. Smith et al., 2009).  Other reasons to use focus groups is to gain access to a naturally occurring group that have an interest in the topic of study (Dunne & Quayle, 2001), thus enabling greater access from an experiential perspective (Palmer et al., 2010). Bradbury-Jones, Sambrook and Irvine (2009) argue that focus groups in phenomenological research can be beneficial in providing a greater understanding of the issue under study. Phillips, Montague, and Archer (2016) contend, “the quality of IPA should be judged on the analysis itself and not on the data generation method” (p. 290). When combing IPA with focus group generated data, attending to the interplay between group sense-making and personal accounts is important (Phillips et al., 2016; Tomkins & Eatough, 2010).  J. A. Smith (2004) suggests IPA is appropriate with focus group data if participants are able to describe personal accounts whilst in the presence of a group. Palmer et al. (2010) suggest approaches to analysing data by taking into account personal experiences, shared understandings and contextual features. Phillips et al. (2016) also suggest stages to follow when analysing group-generated data, by attending to the group interaction, setting and context. Palmer et al. (2010), Phillips et al. (2016) and J. A. Smith and Osborn (2008), note that the stages proposed are not prescriptive but are offered more as guidelines. IPA approach. IPA is be considered to be similar to thematic analysis (Langdridge, 2007), although it is closely related to free textual analysis in that there are no rules about what to comment upon in the transcript and no meaning units need to be assigned (J. A. Smith & 		 	 39	Osborn, 2015).  IPA is therefore not a prescriptive methodology, but an approach that can be flexibly utilized in light of the researcher’s aims and analytical tasks (Eatough & Smith, 2008).  IPA is characterized by a set of common processes involving “moving from the particular to the shared. . . the descriptive to the interpretive” (J. A. Smith et al., 2009, p.79), which involves the researcher “engaging in an interpretive relationship with the transcript” (J. A. Smith & Osborn, 2008, p.66).  J. A. Smith and Osborn (2008) describes this as a two-stage process of interpretation whereby the researcher is engaged in a double hermeneutic where the researcher is trying to make sense of the participant making sense of their experience. Guided by J. A. Smith et al. (2009), the transcripts were read several times, enabling the researcher to immerse herself in the data. Next, any interesting or significant comments were noted in a margin next to the transcript. Then, returning to the start of the transcript notes were transformed into emerging subthemes in the other margin. These themes characterize one expression of the hermeneutic circle where the part is related to the whole. In this stage, as the researcher makes sense of the participants lived experience, the subthemes therefore, reflect both the participant’s original words and the interpretation of those words by the researcher. The following stage involved looking for connections and relationships between the themes. As clustering of subthemes emerged, the researcher returns to the transcript; the actual words of the participants, to make sure the connections of themes make sense with the original source material (Langdridge, 2007; J. A. Smith & Osborn, 2008). From this, a list of major themes was produced. The process was then repeated for the other data sources. Lastly, identifying patterns across all cases was sought, and a master table of themes was produced.    		 	 40	Role of the Researcher  Guided by an interpretive phenomenological framework, I took an active role in the study. It is important as the researcher, to state my experience of the phenomenon (human-horse experience) and how I came to discover the importance of the research question (see situating the researcher).  Although interpretive phenomenology does not require the researcher to bracket their pre-existing beliefs they have about the phenomena, for Heidegger (1962), it is impossible to bracket off ones being in the world; “every seeking [of inquiry] gets guided beforehand by what is sought” (p.24). However, that is not to say that researchers do not attend to their preconceptions, experiences and assumptions, but rather, by making those known. This can further be described as a two-way process, whereby on one side the researcher brings their preconceptions to the encounter of the things themselves, but also how the things themselves may illuminate our preconceptions. Reinterpreting bracketing with reflexive practices highlights how the researcher actively and cyclical engages in reflexive practice by attending to and working out their preconceptions in terms of the things themselves throughout the process (J. A. Smith et al., 2009).  Throughout the research process, I kept a reflexive journal recording preconceptions, thoughts and feelings prior to the commencement of the study, before understanding others experiences of the phenomenon, and throughout the data collection stage to minimize bias, contributing to the transparency and credibility of the study. I continued to engage in reflexive practice throughout the data analysis and write-up stage.  As the researcher, I also took the necessary time to engage with the natural horsemanship trainer/s and veterans to explain the purpose of the study and answer any questions they had.  		 	 41	Situating the researcher. I have a long relationship with horses, where I was first introduced to horses at the age of three. Engaging with horses is therefore an area of interest to me. Being with my own horse is my ‘therapy’. I have developed a profoundly trusting reciprocal relationship with my horse. The connection I have with my horse is incomparable to any other relationship I have and is also different to that of my dogs.  Being with horses is an embodied experience.  When I am with my horse, I forget the troubles of the day; I not only feel at ease, I feel nurtured. I therefore strongly believe in the healing power of horses. Although this experience may not be true for others, from my observations in my personal life, people who have limited or no experience of horses are at a minimum intrigued by horses, where many experience a desire to connect, to interact with horses.  As a result of my experiences, I have insight into the human-horse relationship, enabling a co-construction of meaning between the researcher and the participants. Remaining self-reflexive throughout the process to my own preconceptions is therefore essential in remaining open to new meanings and understandings (Leonard, 1989).  Trustworthiness of the Study Findings  Three main criteria were used to ascertain the trustworthiness of the study findings: representativeness, pragmatic value and comprehensiveness. As part of member checks, the results were shared with the participants for their feedback. Participants were asked if the findings were representative of their experience; if the findings have pragmatic value, for example, are they useful to future equine interventions for veterans, and if the findings were comprehensive, for example, if anything was missing or anything they would like to add.  Of the participants that provided feedback (N=3), they unanimously agreed that the findings were 		 	 42	representative of their experience and made no changes to their accounts. All believed that the findings are useful for future equine interventions for veterans. One participant expressed,   I am of the opinion that an equine intervention could be most beneficial to a veteran  who was really struggling with life and PTSD. Experiencing the non-verbal bond with  a horse in "Meeting the Herd" and having an "Authentic human-horse relationship”  could really raise the prospect of an increase in "future optimism" for the veteran who  had very little. [Nova142] Others suggested they thought it would be helpful to “relate things learned in the ring and herd to functioning every day” [Grace]. Grace also suggested for future equine interventions that it would be helpful to “have a therapist in the ring or right after in order to capture the feelings of the moment and work through them and find healthy ways of coping.”  Member checks added credibility to the findings that emerged from this study.  Additional trustworthiness procedures as outlined by Creswell and Miller (2000) included: • Researcher reflexivity: describing my beliefs and biases and assumptions early in the research process (included in the role of the researcher); • Audit trail: documenting a research log of all activities and illustrating data analysis procedures (as outlined in this section); • Triangulation: by employing different methods of data collection (focus discussion group, individual interview and a personal account) resulted in multiple layers of shared understanding, contributing to the trustworthiness of the findings.    		 	 43	Ethical Considerations  Research ethics approval was received from the relevant institutional bodies. All appropriate informed consents were obtained from all participants.  To ensure confidentiality participants chose pseudonyms at the informed consent stage.  The focus discussion group and semi-structured in-depth interview were carried out in a quiet and private location to ensure participant confidentiality. Any obvious identifying markers were also altered (Havercamp, 2005).                  		 	 44	Chapter 4: Results “I will carry this profound statement with me as I continue my journey into the future. That I can control how I feel even though my mind is telling me I cannot”[Dirk].  The findings from the analysed data, that combines a focus discussion group, a personal account and an individual interview, are presented in this chapter. Five discreet but interrelated themes emerged from the study. The major themes were: a) the authentic relationship, b) active awareness, c) the role of the trainers, d) horse appeal, and e) away from the yard. The first theme includes three corresponding sub-themes: learning to speak horse (empowerment), meeting the herd (emotional connection), and natural horsemanship (from the wild to the round pen). The final theme, away from the yard, also has two subthemes: quality of life improvements and transferable skills. Each theme represents participants’ shared lived experiences and meaning-making of engaging with horses within a natural horsemanship context.  Theme 1: The Authentic Horse-Human Relationship Working with horses is highly experiential and embedded in a relational experience. Horse experiences are authentic, responding in an authentic non-judgemental way to their environment, reacting to humans based on the non-verbal communication the horse receives. For example, Nova142 expressed, “to know that just the way I moved my body, the horse interprets it the right way . . . there is no ambiguity.” Grace noted, “The horse has absolutely no baggage to misinterpret . . . no second guessing like you would with people.” Nova142 agreed, “They [horses] don’t lie.” Nova142 explained, “you don’t take on any drama with [the horse], you don’t feel bad afterwards.” All participants in the focus discussion group agreed with Nova142 “the horse doesn’t judge.” 		 	 45	The human-horse relationship is at the heart of participants’ experiences both in the ‘round pen’, a training area where humans ‘learn to speak horse’, based on natural horsemanship principles and engaging with horses in their environment, ‘meeting the herd’. Therefore, the following subthemes are rooted within the authentic human-horse relationship, which yielded distinct participant experiences.  Learning to speak horse: Empowerment.  All participants expressed how ‘learning to speak horse’, gave rise to feeling empowered. Participants learned herd games of ‘who moves who’ and ‘join-up’. These techniques are based on natural horsemanship principles, reflecting herd dynamics, where the dominant horse within a herd ‘moves’ the other horses, through consistent nonverbal communication and gentle pressure and release techniques. When the horse starts to feel calm and safe and trusts and respects you as the ‘leader’, they will follow you at their will, with no lead rope.  Bill describes how he appreciated the experiential nature of communicating with horses and the sense of achievement and excitement in becoming the horse’s leader. “I enjoyed working with the horses in the round pen; it was a little more hands-on.” He went on to explain, “it feels like you’ve accomplished [something] that you managed to do it [communicate with horses] just right.” Bill expressed, “It was exciting; I’ve never really worked with horses on the ground.” In establishing the partnership, Nova142 similarly expressed excitement and delight in learning to speak horse, “I want you to go that way, and I’m telling, showing you the signs I want you to go that way, and oh look you’ve received the information, and now you’re going that way, it was very exhilarating.” He continued by expressing his understanding of the human-horse communication: “I was able to transmit to the horse, without touching the horse, using the communication of that pressure on, pressure off. I was just delighted! It just felt empowering.” 		 	 46	Nova142 emphasised, “You don’t need force [although] it’s important to be clear.” Bill shared a similar account of his understanding of the communication when asking the horse to change direction: “The horse had pretty much gotten comfortable with me to the point where I guess trusted me enough to go [in] the opposite direction.” Grace related to this by sharing her experience of the horse following her lead: “We had to move the hindquarters and engage them, and then have Cody follow us around, I found that empowering because he wanted to . . . from the moment he considered me as his leader.”  Most of the participants described a sense of power and control when working in the round pen. Grace expressed: “The sense of control of, and with the horse, was empowering, and it wasn’t false.” Nova142 related to this by stating: “There’s even a heady sense of power almost, not in a bad way but in this, I’ve asked this horse, and oh! Look at that!  The horse is doing it!” Nova142 described one particular incident that appeared to be particularly meaningful,  So I started walking around and the horse just stuck to me, and I was like how, how is this horse bonded to me? There’s no rope, I don’t have the whip, there’s nothing, this horse has chosen to follow me around this ring. I felt man this is, this is pretty cool, this is the thing that can bite and stomp you to death, and now it wants to be with me. Dirk described a similar poignant experience “I felt a sense of control over this beautiful creature that could destroy me.” Bill articulated the sense of potential risk in working with horses “being in the round pen . . . there’s nothing else for you to concentrate on because what you’re doing is kind of important to your safety.” Bill related working in the round pen to other sports and activities that require a particular level of concentration such as scuba diving and skydiving. He reflected that these experiences “make me feel alive to be honest, having the potential for a little bit of danger [for] something to go wrong but [is] still somewhat within your control.” He further 		 	 47	connected this to military activities:  “Its kind of like doing military stuff, where you’re doing some potentially dangerous stuff but there [are] safety things in place.” Bill reflected that these experiences help him to feel “more connected.” Wolfpack recognised how the relationship between human-equine and human-canine is different: “You have to learn to talk horse, and that was a big [deal]; my dog I can call him but the horse, you can’t call a horse.”  Learning how to communicate from a natural horsemanship approach stems from an equine perspective rather than a human perspective. Participants found the experiential process to be challenging, exciting and exhilarating. Participants experienced a sense of achievement, accomplishment, pride, and having a sense of power and control in forming a trusting partnership with the horse. This encouraged feelings of self-worth and self-esteem.  Nova142 effectively articulated this: “In the round ring there was a sense of pride, a sense of self-worth, wow! This is, you know, self-esteem, all that kind of stuff. Oh! I can, I can do that!” The horses’ sheer size and presence also appeared to be a contributing factor to their experience, as they were viewed as big and powerful, with a perceived element of risk as horses can move quickly and react instinctually, yet coupled with the awareness they were in a safe environment. The embodied meaning of the experience in learning to “speak horse” was therefore ultimately empowering. Meeting the herd: The emotional connection.  Participants had the opportunity to meet, and ‘be-with’ the horses in their own environment, where they were able to have physical contact and closeness through grooming, stroking, touching and scratching the horses. All participants valued this encounter, with the majority describing being-with the herd as an emotional experience, where they were able to express and receive affection. Wolfpack expressed: “Grooming that one little horse, that was phenomenal, I enjoyed that.” He explained, “I found 		 	 48	what I call her ‘sucky spots’ and [she] was like butter in my hands!” In observing the horses groom each other, Nova142 described the experience as “heart-warming. . . . I didn’t know that horses groom each other. . . . they reciprocate.” When Nova142 experienced the reciprocal grooming himself, he described a kind of relational attunement, a shared empathy, In the herd and the grooming, that connection [the] horse is telling you, I’m willing to groom you back, that was pretty special. Yeah, there was an emotional connection when that horse told me I am willing to groom you back. Nova142 further reflected, “There’s a real emotional warmness.” He communicated that this was “a pretty profound moment.” Nova142 reflected on his experience as “soothing, caring, relaxing, nurturing.” He emphasised the meaning-making he experienced in meeting the herd: “You’re getting the emotional warmth and the vulnerability.” All members in the focus discussion group echoed this experience. Wolfpack reflected how he experienced a different connection in being-with the horses compared to that of his dog. Signifying how the horse itself has unique qualities in forming a particular relational connection with humans. “I can’t connect with my dog like I could with the horse, and I don’t know, that horse, right from day one I connected with her.” Bill shared how he considered grooming the horse as an opportunity to give something back to the horses in appreciation for the work they did in the round pen: “You got to do a little bit of work for them too!” Grace similarly appreciated being-with the horses: “I love being out in the field and just seeing that I could hit the horse’s sweet spot and make it feel good.” Grooming and being-with the horses were equally valued by Dirk, Amazingly, I noticed that her eyes relaxed while she sniffed my hand . . . the horse was indicating to me that she was willing to communicate with me and allowing me to touch 		 	 49	her. . . . At some point during the curry[ing] procedure, I noticed the horse’s lips moving and her head would come around toward me. [Horse trainer] explained that I must have found a ticklish or comfort spot. I continued to curry in the same place, and sure enough, her lip moved, her tongue rolled sideways in her mouth, and her eyes softened noticeably. I had found her Nirvana. Dirk further expressed, “I came to the realization through [the horse trainers] words that horses were as emotional as humans and expressed these emotions in much the same way.” He explained, “Horses decide whether or not you will be friends or acquaintances.” Dirk reflected how the relational connection was based on trust: “If I were trusted, it was usually met with short periods of hesitation and withdrawal. When trust was at last established, the eyes . . . softened and [the horse] enjoyed the scrubs and positioning of my hands.” Being able to physically touch and connect with horses was very much welcomed by Dirk, “Molly and I shared the occasional hug when we could.” Dirk describes an emotional attachment, a reciprocal emotional connection in being-with the horses, “at the end of the day two horses, one the alpha and the other the submissive, each took a shoulder and gave me a farewell hug.” Reflecting on his experience, Dirk expressed how the “human-horse relationship was an accepted part of my time.” He described how there were horses to be “curried and fed . . . attended and loved, when they decided.” And how in the field, “there were five unlikely friends, galloping or clustered, just begging us to come see them.” Meeting the herd provided a highly sensory, relational and emotional experience as part of the authentic human-horse relationship. Through the close physical contact and touch, participants experienced a shared emotional expression in being soothed, calmed, and nurtured. In being-with the horses, trust between horse and human was explored and developed. The 		 	 50	meaning associated with the reciprocal physical contact in the relationship appeared to be a genuine felt sense of caring and being cared for. The experience inspired emotional and relational safety, a shared empathy and co-regulation. The horse-human relational experience of emotional connection encourages resourcing, regulation and attachment opportunities. Natural horsemanship: From the wild to the round pen. All participants noted how it was valuable observing the horses in the field where they had the freedom to behave in an environment akin to that of being in the wild. Bill articulated, “It was cool seeing how they interacted as a herd . . . seeing the different hierarchies that they themselves have and how they interact with one another.” Wolfpack described a similar experience “visiting the horses in the paddock . . . I’ve never seen how horses react . . . out in the paddock we saw how they reacted without any training taking place.” Nova142 enjoyed how “interaction with one horse would transmit information to the other horse.” He further reflected on how his own presence would impact on the herd dynamics: “You know, how what you did would ripple all the way through the whole herd . . . how my participation in that would change the dynamic of what was going on.” For Nova142, observing the herd, changed his perception of horses “[it was] interesting . . . when you knew what to look for, the horses were paying attention to you, they weren’t just standing at the fence . . . the whole communication thing was very interesting.” The experience of observing herd dynamics aided the participants understanding of how the horses’ herd behaviour translates into how we can ‘learn to speak horse’ in the round pen. “The round ring was more communication, using their programed behaviours for sure” [Nova142].  Grace reflected,  		 	 51	Dogs are trained to do what we want them to, so they’ll easily do something whereas horses are not quite, they do it because they want to, and to have a horse do what you want because they want to, is kind of cool. Observing horse-to-horse behaviour in the field and how this translates to human-horse communication in the round pen was similarly interpreted by Bill, “It definitely kind of shows you, if that’s how they do it in the wild with each other, it makes sense that they would hold that same kind of mentality when working with humans.” Nova142 similarly reflected “[the horse] is doing what it wants to do [in the round pen] because its nature, so the horse didn’t mind, so I felt this gratitude to the horse.” He explained, “you don’t tell a horse, you ask a horse.” Natural horsemanship as an ethos to working with horses was embedded within the subthemes of ‘learning to speak horse’ and ‘meeting the herd’. Observing horses natural behaviour and translating this to communicating with horses in the round pen, made sense to participants’ experience.  Moreover, it offered participants an appreciation in endeavouring to understand and communicate to them from their world, and in their language, and when this was received, there was a feeling of gratitude. This encouraged mutual respect in developing an authentic human-horse relationship. Theme 2: Active Awareness The second major theme to emerge from the data was awareness. Awareness in the ‘here and now’ was experienced related to the self, other and togetherness. This theme is related to the authentic relationship but is distinct as awareness in the here and now of your own non-verbal communication, and the horses’ non-verbal communication, is necessary to develop an authentic relationship with horses. As horses are prey animals, they live in the here and now, ever aware of the present moment, as their survival relies on it. To connect with a horse, one needs awareness 		 	 52	of their internal world, how they are feeling, and what their body is doing, awareness of sensations, and how this information is communicated to the horse. If the horse is uncertain of the messages being conveyed, they will feel unsafe, as you as their leader are not providing direction as head of the herd.  Most participants commented on awareness of self and other and the impact this had on the human-horse partnership. Nova142 articulated how it was challenging paying attention to multiple dimensions of awareness, The first [day] I went into the round pen, I was just like; wow there’s this meat wall four feet from me! And . . . you’re trying to use your binocular vision [and] take everything in, and his feet going in the right area, his eyes looking at you and so I really felt inept in what I was doing.  He further explained,  There was a challenge for me to take in what the horse was doing and what I was doing in regards to my body language to the horse, trying to keep track of both of those at the same time, initially was quite difficult . . . if you’re paying attention to the horse, then you’re not paying attention to what your body is doing, so you’ve lost the horse. Bill shared a similar experience, The timing and your body position and [the] non-verbal communication, your body language with the horse; you know at the start, you kind of feel, like am I doing it right? Am I doing it right? You know, you don’t really have any clue until you’ve done it a few times and then eventually, it kind of clicks a little bit and it feels a little more natural . . . . I wanted it to do this, and I wanted it to do that, and it like actually works. 		 	 53	Grace noted how the communication would be received differently depending on body movement and positioning when driving the horse forward, “learning that if you got the [training aid] towards the shoulder instead of the hindquarters, you’re just telling the horse something completely different although you’ve only moved two inches.” Grace went on to describe how she found it difficult working with one horse, Cody and I are going to have a bit of a discussion! Because he was so sweet with everyone else [in the round pen] and he gave me attitude! Normally, I get scared when a horse bucks . . . but for some reason, although I kind of felt shaky . . . we worked it out in the end. Grace describes the awareness of her own experience and that of Cody’s, and while she expressed feeling ‘shaky’, Grace was able to regulate her internal experience and direct her focus of attention on the partnership, by trying to communicate more clearly so that they could continue their work together.  Dirk’s experience in initially meeting the herd links with Grace’s experience of awareness of affect and self-regulation. Furthermore, Dirk articulates the will to engage with horses, The inner sanctum of my lower body did not feel in control at all. However, with persistence, I moved forward and soon realized that this was going to be a wonderful experience. Before long, I was currying and talking to the horse, ever mindful of her eyes. Dirk also reflected how his emotional experience appeared to be reflected back at him by one particular horse, 		 	 54	This magnificent animal must have sensed that I was less than comfortable in close proximity because her eyes were large enough to expose the whites. I wondered how I appeared to her? Did she sense my anxiety, perhaps fear, and uncertainty? I think yes.  Dirk went on to describe the reflection of movement between horses and humans “I reached to the horse's jaw and touched her. She moved suddenly, and so did I.” Dirk highlights how we can learn more about ourselves through the immediate non-verbal feedback the horse offers. Bill described how a heightened self-awareness and concentration in the here and now had a positive impact,  It really kind of took you away from whatever had been going on that day or that week or whatever you could just kind of concentrate and be in the moment of what you are doing, and you know, it just kind of pushed everything else out of that pen.  Bill communicated how the experience was “relaxing, it just took some stress off, a bit off the edge of the day.” Grace similarly communicated that being-with the horses was “a calming presence, and you’re feeling present and calm and grounded.” The meaning derived from the participants’ experiences encompassed an understanding that awareness of self, awareness of the horse, and being present in the here and now, alongside a will to engage with the horses, were the terms for being able to form an attuned partnership.  Several participants reflected how they enjoyed the experience of communicating through non-verbal means, as it appeared to be more ‘clear’, or genuine. “There is no way to mis-communicate, you're not using words, so your intent to the horse gets it 100% or doesn’t get it at all, there is no ambiguity in the round ring” [Nova142].  “Being heard and having your intent actually understood and not misinterpreted” [Grace]. “It was nice, just having to concentrate on your body and theirs and you're not thinking about verbalizing or anything like that; it’s a good 		 	 55	way to communicate” [Bill].  He further reflected, “body language is a big portion of communication, but it gets kind of lost these days.”  Working with horses requires active awareness in the present moment by actively attending to bodily awareness of the self and other (the horse). ‘Togetherness’ occurs when human and horse create an attuned awareness, a shared understanding of receiving and perceiving information by means of body awareness. By holding a sense of self and other, participants had the opportunity to visually observe the process of connecting, whether this was helping or hindering the formation of their ‘togetherness’. Awareness of affect and self-regulation was equally required in meeting the herd and in the round pen. Unlike mindfulness practice in the counselling room that for some may require a particular concentrated effort, the participants described a more intuitive awareness, akin to a visceral experience, where you cannot not concentrate.  Awareness through the human-horse partnership encourages a real or authentic view of others and ourselves. Theme 3: The Role of the Trainers—Establishing Safety  All participants communicated they perceived the horse trainers as knowledgeable and experienced which enabled them to feel comfortable and safe when engaging with the horses.  I really enjoyed working with Jay, you could tell he knew completely what he was talking about and you know, he was very in-tune with the horses and he had a lot of really good insight and he’s really good at teaching and showing why things worked and did not . . . it was really good. [Bill] Wolfpack explained that observing the head trainer Jay was valuable: “When I saw the horse working with Jay and I realized his temperament that helped a lot too.” Grace described Jay as having a “quiet, calm presence.” She reflected, “He treats you exactly the same way he treats the 		 	 56	horses [a] quiet strength.” Wolfpack articulated that Jay’s manner helped him feel safe in the round pen, “The first [day] I was real nervous. The way Jay does things, when you finally get in there [the round pen], there’s no nervousness. The way Jay did things, excellent, because I felt relaxed going into that ring.” Bill commented on the importance of the horse trainers “You put your trust into the fact that the person showing you really knows what they are doing because it’s a big animal right.”  All participants described the sense of safety when working in the round pen with the presence of the head trainer. “Especially with Jay being in the ring with me that if something was to go wrong that he would be right there, he’d have my back” [Wolfpack]. Bill reflected a similar sentiment “Jay put me at ease and you know, I trusted he knew what he was doing and if I was in the wrong spot he’d tell me.” Grace expressed, “having Jay there and correct right away, it helps you learn faster and you get a quicker sense of accomplishment.” The feedback participants received in the round pen was an important component in supporting and encouraging them throughout the process “You could see him [Jay] get excited, it was like, you know, your doing it! Oh god, you’re doing it! Which was pretty cool that he was actually getting excited” [Bill].  All participants appeared to be comfortable in the presence of the trainers, a vital component of their experience. Nova142 reflected “ they both care . . . I didn’t feel judged by them at all.” Dirk commented “[they were] very comfortable and professional people.” Dirk commented he enjoyed the trainer/s knowledge and explaining to him horse behaviour when meeting the herd, which helped him to interact and engage with the horses in the field. On meeting Jay, the head trainer, Dirk expressed his initial impression, I was then introduced to Jay, a rugged looking, bulky man. Dressed in denim jeans and jacket, wearing a Stetson, Jay was the quintessential picture of a cowboy. His thick hands 		 	 57	and gentle demeanour emanated experience and control. I was immediately comfortable that Jay would take the lead - no pun intended - on the training and control of the horse.  The trainers offered support, encouragement and confidence in providing feedback to participants on their interactions with horses both in the round pen and in the field area. They offered skilled facilitation focusing specifically on natural horsemanship skills and understanding horse behaviour. The trainers were a central component to participants’ experience by providing safe opportunities to develop a partnership with horses.  Theme 4: Horse Appeal—Motivation to Participate All participants articulated a willingness to engage with horses. Bill described a positive experience of being with horses when he was younger and therefore engaging with horses was a motivating factor to participate,  I’ve always enjoyed working with horses as a kid. We did some horseback riding at some family vacations or at summer camp, and I always enjoyed being around the animals, so I thought one more opportunity to interact with them as I haven’t in a long time, sounded good to me. Grace equally reflected on how an opportunity to work with horses was appealing,  Oh my God! I [can] have something to do with horses! I know how good they are. I have my own [but] I don’t see her often enough. But I can go there and have the most miserable freaking morning ever and by the end of the [day] just playing with her . . . I can deal with the rest of the day. Several participants commented a fear of working with horses. Wolfpack expressed: “When I was 12, I fell off a horse and broke my wrist, I haven’t been around a horse since.” Dirk communicated a similar experience when he was 15 and had the chance to ride a horse,  		 	 58	The horse bolted from its position into a full gallop. . . . I do remember grabbing the saddle horn for dear life as the horse ran straight toward a fence.  Fast forward to the age of 65, I have had no further interactions with horses since that time.   Grace shared that while she has her own horse, she expressed “I’ve always been scared of horses, I [have been] kicked in my leg and all that stuff, been stepped on, you know.” Nova142 expressed his perception of horses “before going [in]to the program, you view horses as dangerous, they bite, they kick they can stomp you to death . . . ” While some participants described a fear of being around horses, in the same vein, they still appeared to offer motivation to initially participate in horsemanship sessions. They presented as having a sense of feeling the fear, but doing it anyway. Dirk expressed,  [On the way to the yard] I asked myself, are you sure you want to do this? My answer was that throughout life I had learned we need to go outside our comfort zone to experience some things. This was one such ‘thing’.  The motivation to continue to engage in the process was supported by the theme - the role of the trainers, as initially observing the trainers interact with the horses encouraged members they could do the same,  When [the trainer] took us out [to] the back paddock, I was like, I didn’t want to go near it! [when] I saw her walking around the horses, I [thought] I should be able to do this, she edged me out of my comfort zone. [Wolfpack] For Wolfpack, observing other group members engaging with horses, further encouraged his readiness to participate, The big thing that got me was the first day when Jay was explaining things, and I saw the horse following him around without a lead. I [thought], if I could do that, [that would] be 		 	 59	phenomenal. . . . and [Nova142] was the first one to go in after Jay and I saw him doing it and it made it that more believable, because you’d look at Jay and think is he the horse whisperer?! [Wolfpack]  The meaning derived from the participants’ lived experiences in their willingness to form a partnership with the horses, and even for some, in the face of their initial perceived fear, suggested the horse itself may offer unique motivating qualities. The highly experiential nature may also play a contributing motivating factor, coupled with the view of going outside of one’s comfort zone.  Theme 5: Away from the Yard—The Potential Value All Participants expressed intrinsic value through their opportunity to engage with horses that extended outside of the time at the yard including the following: Quality of life improvements.  One participant described how the experience of engaging in natural horsemanship sessions had a positive impact on his quality of life. Wolfpack expressed: “Being able to breathe and be myself, and at the end [of the day], every night I went home after the sessions, was the only time in about 10 years that I’ve had a good nights sleep.” Engaging with the horses appears to be a significant contributing factor in Wolfpack’s experience.  Being outside in the natural environment, participating in a highly experiential and sensory activity may also contribute to Wolfpack’s improved sleep and sense of being ‘himself’. Transferable skills: Communication, awareness and regulation.  Nova142 and Grace expressed how they discovered they were able to communicate differently through their experience of the horse-human connection: “It feels really good in the end. I was able to communicate without getting angry, or I was able to finally do it the right way and look it’s working!” [Grace].   		 	 60	You can’t yell, if you yell at the horse, it’s going to go very bad. So, you just have to maintain composure and reassert in a calm way . . . it’s easier to start yelling right, when you’re dealing with humans! With a horse, if you yell, you’re just going to freak the heck out of the horses.  You’re not going to get the outcomes anyways. [Nova142]  Both participants described how they learned alternative ways of communicating in the moment, in order for their intent to be received. Fostering a deeper sense of awareness with the ability to self-regulate opened up the possibility for these options.  For Grace, she also became aware of ones own ways of communicating, “I learned stuff about myself. Not just about the horse.” She expressed, “I’m a people pleaser.” Grace reflected,  Getting the take away of how I communicate with others, that I’ll back down very quickly, and its hard, you know, you were told, don’t let the horse win, keep going, but you know, [I thought] the horse doesn’t really feel like it, do I really have to do this?! And that’s kind of what I’m like in normal life. Learning to communicate with horses, through natural horsemanship offered participants the potential of transferring these skills to communicating with humans,  You can learn and take those things and use it with humans. Being told, well, the horse understands it this way if you do that, and if you try and do the same thing with humans, it could possibly work as well. [Grace] Grace expanded on this, “And learning how to be clear, and learning that you don’t have to be forceful, you can do it gently.” This also highlights an understanding of natural horsemanship, where you don’t use force or coerce a horse to do something, you ask a horse from the perspective of their world by understanding how they perceive information. Therefore you gain a sense of both your world and what you want to communicate, and the ‘others’ world, of how 		 	 61	your communication may be interpreted.  This connects with expanding awareness of ourselves and others, and supporting self-regulation. Grace translated her experience to communicating with her children, I interpret that with my kids, I don’t have to yell at them, here’s the opening, this is what I need you to do, and I don’t have to be forceful about it, I just have to be self-secure enough to stay calm, stay grounded.  Grace reflected on the meaning of her experience, “Communicating clearer, its possible, I can do this in normal life”. The other members of the focus discussion group agreed with Grace’s sentiments. “Yeah, not having to yell” [Nova142]. “And keeping your temper” [Wolfpack]. The meaning of the experience for Dirk provided a deep emotional impact, “I was truly amazed at the degree of emotional effect this project had on my affect.” Furthermore, it appeared to open up a sense of agency in developing affect regulation and emotional safety to one’s experience. In talking to a member of the team while at the yard about his experience in the round pen, where he described feeling a sense of control when working with the horse, Dirk became aware how this contrasts with his experience of living with PTSD.  He stated, “I will carry this profound statement with me as I continue my journey into the future. That I can control how I feel even though my mind is telling me I cannot.” Equine experiences: Applicability to trauma-related healing.  Linking from the previous theme, Bill communicated, upon reflection on his own human-equine experience, that this may be helpful for others who have trauma-related injuries: Well for guys that are potentially having anxiety issues you know PTSD it could potentially be something that would really kind of ground them in the moment . . . if they are having intrusive thoughts or whatever, [it could] kind of push them out of their brains 		 	 62	for at least a little while and also you know, if the anxiety of being around the horses, eventually when they get comfortable with them, they could overcome that anxiety, and then when they start interacting with the horse and it actually reacts to them and does what they want it to do, you know, that sense of accomplishment, would be really beneficial to a lot of guys out there. Bill highlights and describes the thread that links the themes. How working with horses may help people with PTSD focus their attention to the present moment, to encourage body-based awareness rather than ‘head-based’ awareness. He also describes how human-horse interactions may evoke emotional experiences, while at the same time, encouraging self-regulation through the experiential process of connecting with the horse. He further suggests that when awareness expands to the horse, to be able to communicate with horses, offers a sense of achievement.  Reflecting on his own experience, Nova142 implies how engaging with horses may be less intrusive for some people with PTSD, suggesting it may offer the potential for engagement: The effort expended you know [engaging in therapies], there’s limitations, psychological barriers for [people with] PTSD and there is some physical barriers for wounded guys, and so the effort expended for myself getting there [this project] and you know putting the right foot wrong, was low compared to the benefit, the outcome. There’s some areas where you, I don’t know, lots and lots of effort [in] and then it’s a small reward. So for me, I live relatively close, but you know, the personal, yeah [the] effort in was low, and [it was a] big, big, big payoff.  The horse-human connection aided improvements to quality of life, including improved sleep, transferable skills, encouraging awareness of experience and regulation, the potential 		 	 63	applicability of healing from trauma-related experiences, and the possibility of reducing barriers to engage in services. Conclusion The human-horse partnership is the central thread that runs throughout the themes. Developing an authentic relationship with horses both in the round pen, and meeting the herd, relies on awareness of self and other, presence and self-regulation. Participants felt empowered and experienced an emotional connection as part of the relationship. The trainers were also integral to the process to enable horse-human connection in a safe environment. The horse itself appeared to be a motivating factor in wanting to learn and engage, coupled with the highly experiential and sensory nature of working with horses. These experiences were based solely on learning natural horsemanship skills and horse behaviour and having opportunities to be-with horses. The meaning of participants’ experiences suggests the horse may offer unique qualities where healing opportunities can occur.            		 	 64	Chapter 5: Discussion The purpose of the study was to explore veterans’ experiences of natural horsemanship (NH) utilizing an interpretive phenomenological research method. The aim was to better understand how the human-horse relationship may lead to healing, specifically for veterans, to assist with operational stress injuries (OSIs). Equine therapy (ET) is an emerging field. The majority of studies involve children and adolescents (Lentini & Knox, 2015). There is a general lack of studies investigating ET with adults and specifically with veterans. In a recent review of the literature, Staudt and Cherry (2017) identified only five studies with adult samples with trauma/PTSD, of which only one of the five studies involved veterans. It is evident more academic research is called for as ET is increasingly on the rise. Unless we have a greater understanding how ET may lead to positive outcomes, specifically identifying the unique therapeutic process horses can offer, the applicability and efficacy of equine programs will be limited.  This study contributes to the gap in the literature by exploring the human-horse experience from the perspective of the participants themselves. This chapter will provide a summary of the results, address trustworthiness of the study, highlight the relevance of the findings to previous research, implications for counselling practice, limitations of the study and suggestions for future research. Summary of Results To increase understanding of the human-horse partnership, an interpretive phenomenological approach was appropriate to investigate participant’s understanding, meaning and sense-making of their shared experiences of engaging with horses in the context of natural horsemanship (NH). This study revealed five major themes relating to NH experiences. The first 		 	 65	theme ‘the authentic human-horse relationship’, which had three corresponding subthemes (learning to speak horse: empowerment; meeting the heard: the emotional connection; natural horsemanship: from the wild to the round pen) described how the relationship participants experienced with the horses was fundamental to their experience. Participants described a genuine, authentic and non-judgemental encounter. From these firm foundations, clients’ experienced increased self-esteem and empowerment when working in the round pen (where they learned to communicate with horses), and through grooming, stroking and touching the horses, participants experienced an emotional warmth and relational connection. Working with horses in this study was guided by NH principles, where we as humans need to enter into the horse’s world and perspective of how they communicate if we want to develop a trusting relationship. Thus, developing a shared understanding of relating is central to developing an authentic relationship.   The second theme ‘active awareness’ was aligned with the first theme as developing a relationship rests on being in the present moment, awareness of self and other (including affect, body awareness, sensations) and regulating experience in the moment to be able to connect and develop a successful horse-human partnership. The third theme, ‘the role of the trainer—establishing safety’, is important as the trainers created a safe environment and provided safe opportunities to interact with the horses. The fourth theme ‘horse appeal— motivation to participate’ identified the horse itself as a motivator to engage in the study, even though several participants commented they were fearful of horses. The fifth theme ‘away from the yard—the potential value’ had two corresponding subthemes (quality of life improvements and transferable skills) that highlighted the potential impact of engaging with horses. Participants described how 		 	 66	they slept better, learned new ways of communicating which was linked with increasing awareness of internal experience and self-regulation.  Trustworthiness of the Study Findings The data involved a combination of a facilitated focus discussion group, an individual interview and a personal account. Participants in the focus discussion group were able to describe personal accounts that reflected a shared meaning of human-horse experiences and also unique understandings of their experiences. Indicating that IPA in this context was appropriate with focus discussion group data as participants were able to describe their own experience while in the presence of a group, which is essential to IPA (Phillips et al., 2016; J. A. Smith, 2004; Tomkins & Eatough, 2010). Participants shared understandings, and meaning-making were reflected across all sets of data (focus discussion group, individual interview and personal account), contributing to the reliability of the study.  Furthermore, participants had the opportunity to be involved in member checks, contributing to the credibility and trustworthiness of the study. All participants that provided feedback unanimously agreed that the study findings, observations and conclusions are accurately representative of their experience, and all agreed that the findings have pragmatic value to future equine interventions. Finally, throughout the analysis of all the data, I kept a reflexive journal recording my thoughts, feelings and observations and interpretations of the material, adding to the credibility and trustworthiness of the findings. Personal reflexivity brings forward my preconceptions prior to engaging in the participant’s experiences to help shift from a position of my personal meanings, to focus on the participant’s experience. The reflexive process is active and cyclical throughout the analysis phase, where the researcher engages in the hermeneutic circle between the ‘whole’ (my ongoing 		 	 67	personal account) and the ‘part’ (the encounter with the participant's story) (J. A. Smith et al., 2009).  Relevance of Findings to Previous Research Existing research on experiences of equine therapy programs is limited (see Burgon, 2014; Kern-Godal et al., 2016; Meinersmann et al., 2008; Schroeder & Stroud, 2015; Sharpe, 2014). Of these studies, only Meinersmann et al. (2008) and Schroeder and Stroud (2015) investigated ET and trauma/PTSD. Both studies involved adult women. Of the literature reviewed, this study is unique as it explores men and women veterans’ experiences of engaging with equines by means of natural horsemanship (without any specific therapeutic modality, intervention/s or expected outcomes), to increase understanding of the human-horse relationship and the potential unique therapeutic processes and qualities of the horse in creating that relationship. The relationship. In accordance with previous literature of ET, a central theme of engaging with horses was the development of a relationship/partnership. The first theme in this study, ‘the authentic human-horse relationship’, provided a genuine relational experience. “The horse doesn’t judge” was a sentiment described by several participants. The non-judgemental experiencing of horses is reflected in the literature (Bachi, 2013; Burgon, 2014; Kern-Gold et al., 2016). This genuine, authentic and non-judgemental nature of horses is reflective of how counsellors strive to develop the client-counsellor therapeutic alliance (Karol, 2007; Yorke et al., 2008). The therapeutic relationship forms the foundation of any intervention and even before any ‘therapy’ can begin (Horvath, 2001). It appeared participants potentially were able to access this more readily with the horses; they described how there was “no ambiguity” and “no second 		 	 68	guessing like you would with people”. The human-horse partnership therefore at the very least, has intrinsic value for positive relating experiences. All participants expressed they experienced a different connection when working in the round pen compared to meeting and being-with the horses. The subthemes of learning to speak horse fostered feelings of empowerment. In developing the ability to communicate with horses through non-verbal means and without touch, participants described a sense of achievement, excitement, pride, power, control, and improved self-esteem, which reflects previous findings (Burgon, 2014; Kendall & Maujean, 2015; Meinersmann et al., 2008). This was particularly noted during one activity ‘join-up’ where the horse followed the participants around the ring with no lead rope. Being able to form a partnership with a big and powerful animal appeared to contribute the participant’s sense of achievement, where all participants described an element of risk when working with the horses, “I felt a sense of control over this beautiful creature that could destroy me” described one participant. This highlights how the horse has additional unique qualities compared to other animal-based interventions that utilize, for example, mainly dogs, reflecting previous findings (Ewing et al., 2007; Karol, 2007; Trotter et al., 2008). When the participants had the opportunity to meet with the horses, to touch, stroke and groom them, this evoked a more emotional response and connection. Through a close physical connection, participants described feeling calm, nurtured, warm, and vulnerable. This was a reciprocal experience, where they expressed care and felt cared for. Several participants described the reciprocal grooming as a particularly profound relating experience.  Yorke et al. (2008) identified how the bond between humans and their pre-existing relationship with horses were a significant contribution during their recovering from trauma. They further highlighted the importance of the healing quality of physical contact. Although Yorke et al. (2008) explored pre-		 	 69	existing relationships between horses and their owners, the majority of the participant’s experienced an emotional connection in a short period, with no pre-existing relationship, where they were able to access and express care and affection. This study like that of others (Burgon, 2014; Meinersmann et al., 2008; Yorke et al., 2008) indicate the relational experience of being-with horses and close physical contact had a profound emotional impact on the participants, that has the potential to contribute to healing from trauma-related experiences. Lanius (2017) described how animals could play a key role in healing from trauma by experiencing a safe attachment when they may not have previously felt safe with another person. The release of oxytocin as a result of positive equine interactions can provide safe attachment opportunities, accessing the social engagement system leading to improved psychological wellbeing (Beetz et al., 2012).  The relationship as empowerment and emotional connection. Through participant’s descriptions and meaning-making of their experiences of working with horses, they clearly articulated how different activities led to different experiences. This study offers a greater understanding of the specific therapeutic processes that came about through the horse-human relationship. As highlighted above, working in the round pen was associated with empowerment, control, self-esteem, accomplishment, and exhilaration. Through physical contact with the horse, during grooming etc., this opened up space for an emotional connection to occur, where they felt calm, relaxed and soothed; a shared empathy.  This study signifies how specific-horse activities fostered specific therapeutic processes potentially identifying the mechanisms of therapeutic change, contributing to the gap identified in the literature (Hoagwood et al., 2017; Kendall et al., 2014; Staudt & Cherry, 2017). Furthermore, several participants noted how the connection with the horses was different to that of companion dogs. One participant described how he connected 		 	 70	straight away with a particular horse on the first day, “I can’t connect with my dog like I could with the horse, and I don’t know, that horse, right from day one I connected with her.”  This suggests that horses themselves offer specific therapeutic processes, beyond their sheer size and presence, compared to other animals, specifically in this case, dogs. Several participants reflected that dogs want to do as you ask, whereas a horse, you need to learn ‘how’ to ask, “you can’t call a horse” reflected one participant.  The importance of natural horsemanship. As highlighted above, working with horses is different when working with dogs. In natural horsemanship (NH), humans need to enter into the world of the horse, to see it through their eyes. This in itself encourages mentalizing, “the ability to understand actions by both other and oneself” (Bateman & Fonagy, 2016, p.3). Mentalizing techniques are also often incorporated in the treatment of PTSD (Bateman & Fonagy, 2016), suggesting that NH may be a good fit when working with trauma. Only one study addressed the specific therapeutic value of mentalizing in the ET literature (see Kern-Godal et al., 2016). Natural horsemanship, therefore, appears to be well suited as a philosophy and a way of therapeutically working with horses. Of the literature reviewed only a few studies identified NH as an approach. Of those that did, (Burgon, 2014; Kendall & Maujean, 2015; MacLean, 2011) they specifically commented on the value of its philosophy and how it played an important role in the therapeutic program. For example, MacLean (2011) noted how NH aligns with PTSD as it is based on a trusting partnership. This study is rooted in the fundamentals of learning how to connect with horses in its most natural form, without using particular therapeutic models or approaches. Simply learning how to form a partnership in itself and in a short period of time (minimum of four hours) led to positive experiences. This is particularly exciting and valuable, suggesting the horse itself may be a primary mechanism of change. Burgon (2014), in her work 		 	 71	with at-risk youth over a seven month period, who also employed NH principles, suggests that ET interventions may be beneficial for at-risk youth without the inclusion of direct psychotherapy contact. This may also hold true for the findings that emerged from this study.   Awareness.  Increasing self-awareness is commonly cited when working with horses. This study, like that of others highlights how engaging with horses increases awareness of experience (Burgon, 2014; Cumella, 2003; Earles et al., 2015; Pendry et al., 2014). As previously discussed, the second theme to emerge in this study ‘active awareness’ is interrelated to the first theme ‘the authentic human-horse relationship’. As successfully developing a partnership rests on self-awareness and regulation. As horses are prey animals, they are constantly living in the here and now, with a heightened awareness of their environment for their safety and survival. The horse, therefore, provides feedback on how you (the human) are communicating. For example, if you are agitated, the horse will become agitated or may flee as a result. The horse, therefore, has the unique capability to intuitively respond to human behaviours, providing immediate, unbiased feedback, reflecting human emotions and behaviours (Maros et al., 2008; Meinersmann et al., 2008; A. V. Smith et al., 2016). All participants described an increase in awareness, which appeared to occur instinctively as the environment in which they were in demands it. Some authors liken awareness experienced as part of the horse-human connection with mindfulness practices (Burgon 2014; Earles et al., 2015). Increasing awareness also links with a trauma-informed approach where increasing awareness of emotions and how they are registered in the body and learning how to stay in tune with others is key (van der Kolk, 2014). Similar to the theme the authentic human-horse relationship, being aware was accessed more readily, arising from a felt-sense of experiencing rather than cognitively attempting to ‘tune-in’ with the body.  		 	 72	The trainers. The role of the trainers was a theme that emerged and was expressed by all participants on how they were key to their experience:  “You put your trust into the fact that the person showing you really knows what they are doing because it’s a big animal right.” Unlike previous research of the literature reviewed, the experiences of the trainers were not cited. Yet, a horse trainer/specialist or facilitator of some kind is necessary. The ET literature cited varying teams (including social workers, play therapists, mental health workers, counsellors, and therapeutic riding instructors). While it’s not possible to exclude the trainers from the participant’s experiences, the focus in this study was on learning horsemanship skills and horse behaviour. In any equine based program, feeling safe is key. The trainers provided the safety. Therefore, it is vital that whoever is involved in the program, particularly when working in the round pen, is a highly experienced and knowledgeable horsemanship person. All participants expressed how they immediately felt at ease when meeting the head trainer, Jay.  As it is not possible to engage with horses in an equine program without the presence of another person, it is important studies highlight who clients/participants will be interacting with and what their role is, otherwise it is difficult to determine what parts of the program are beneficial.  The horse as motivation to engage. Participants described how the horse itself appeared to offer a level of motivation to want to engage in the study. Some expressed how they had prior positive horse related experiences and therefore was interested in having further opportunities to work with horses, where others described the opposite and had negative experiences, such as falling off a horse, and since that time, had no further interactions with horses until their participation in this study. This was curious, as there was something about horses that, despite feeling fearful there was still a want to engage with horses. This appears to link with the subtheme, ‘learning to speak horse’ where a sense of achievement was experienced in 		 	 73	communicating with horses where there is a perceived element of risk. Horses as motivators to engage in therapy have been previously identified in the literature (Bachi, 2013; Burgon, 2014; Kern-Godal et al., 2016; Klontz et al., 2007). C. Brandt (2013) notes the positive feedback the clients receive from horses is a strong motivator for clients to not only engage in therapy but also continue in treatment. Owen et al. (2016) suggested AAT might be of benefits to veterans who are less likely to engage with mental health services.  Away from the yard: The potential value. Transferable skills of increased awareness of one’s own way of communicating, learning new ways of communicating, which is interconnected with increased self-regulation, has been noted in the literature (Burgon, 2014; Kern-Godal et al., 2016; MacLean, 2011). A quality of life improvement in this study was improved sleep as identified by one participant, an original finding to emerge in this study from the literature reviewed. One interesting discovery to emerge as identified by one participant, who described how the effort expanded in engaging with horses in this study was less compared to other therapies, but the outcome/reward obtained was big. This links with previous research that suggest that working with horses may be less time consuming and potentially more efficacious than other traditional therapies and therefore the cost of treatment is comparable to traditional therapies (Kemp et al., 2014; MacLean, 2011; Meinersmann et al., 2008). MacLean (2011) believes more is accomplished when working with horses than could ever be achieved in traditional talk therapy sessions. This is an area that would be highly valuable to explore in the future. At the very least, it highlights how working with horses may be useful for people who may not want to engage in traditional therapy for a variety of reasons, which links with the theme the horse as a motivator to engage.  		 	 74	Implications for Counselling Practice The findings from this study revealed that positive experiences were gained through the development of the horse-human relationship from a natural horsemanship approach without additional factors or a particular theoretical perspective or expected outcomes. The findings to emerge from this study support findings from other ET literature, contributing to the knowledge base that engaging with horses increases feelings of self-esteem and empowerment (Burgon, 2014; Kendall & Maujean, 2015; Meinersmann et al., 2008), provides an emotional connection (Burgon, 2014; Meinersmann et al., 2008; Yorke et al., 2008), increases awareness in the here and now and encourages self-regulation (Burgon, 2014; Cumella, 2003; Earles et al., 2015; Pendry et al., 2014), and the horse itself may increase access to mental health services for some (C. Brandt, 2013; Owens et al., 2016). The components of engaging with horses (learning to speak horse and meeting the herd) were considered both important and led to different experiences, one empowerment, and the other the opportunity to become emotionally connected. The insights from this study contribute to the gap in the literature by providing greater understanding to the specific therapeutic processes to arise from particular activities, potentially identifying possible mechanisms of change.  Through the highly experiential and sensory nature of engaging with horses, as part of the process, participants have the potential to open up to opportunities to experience their internal world and that of the other, and discovering how to connect through awareness and self-regulation. The findings from this study reveal that developing the human-horse relationship can help improve self-esteem, confidence, a sense of achievement, pride and empowerment, the opportunity for feeling felt, caring and emotional experiencing through the nature of close physical contact and touch. As part of the process, being authentic, increasing awareness of 		 	 75	internal experiences and that of the other, and regulating experience to be able to connect are all therapeutic processes to be gained in working with horses. Led by the language of the body rather than the language of words. The results of this study suggest that working with horses through natural horsemanship has the potential to be an effective intervention for veterans with OSIs. Furthermore, the therapeutic processes that can be achieved through working with horses could help with a range of issues and concerns including anxiety and interpersonal issues particularly when working from a natural horsemanship philosophy as it rests on understanding the ‘other’, potentially increasing mentalizing abilities. Furthermore, working with horses appears to fit within a trauma-informed approach to healing. Where in working with horses, participants experience an authentic and non-judgemental relationship that offers feelings of empowerment and emotional relating, increases awareness, resourcing and regulating experiences in a safe environment (the importance of the role of the horse trainer/s) all of which are aligned with trauma work (van Der Kolk, 2014). Also, the horses appear to provide motivation to engage, offering unique qualities that other interventions may not contain. In this study, some enjoyed working with horses and were keen to have further opportunities; for others there was a level of fear in engaging with horses but a sense of wanting to push ones own boundaries of comfort. Other unique qualities in working with horses were the perceived element of risk due to their size and presence and also as they move quickly and react instinctually as they are a prey species, which aligns with previous research (Klontz et al., 2007), and opportunities to physically connect with another being through touch are important characteristics of working with horses (Yorke et al., 2008).  Additionally, participants in this study commented how working with horses is different to working with dogs, and the emotional connection was also perceived distinctive compared to dogs. Suggesting that 		 	 76	horses have unique qualities and can provide therapeutic processes that can be obtained beyond canine AAT and outside of a traditional counselling setting. Due to the largely non-verbal ways of relating, this may encourage engagement in individuals who may be reluctant to participate in more talking based therapies as identified by other AAT research (Owen et al., 2016; Staudt & Cherry, 2017). A curious insight to emerge from this study is how participants described profound experiences of the horse-human relationship in a short period of time (minimum of 4-hour sessions), not guided by any theoretical orientation, approach, or expected outcomes. As working with horses is highly experiential and a multisensory modality it may, as C. Brandt (2013) describes, offer more therapeutic dimensions simultaneously than in traditional settings.  Working with horses would benefit a range of clients who for example, may prefer to work outside of a traditional counselling setting, where the emphasis is less on talk therapy and more experiential. It may be helpful as Lanius (2017) describes, where working with animals may be less intimating or intrusive, thus increasing access to services. Working with horses is a multisensory approach based largely on non-verbal means where increasing awareness of self and other, regulating and resourcing are achieved through this highly experiential way of working and relating. A felt-sense of experiencing, where therapeutic processes may be accessed more readily for some. It is built on trust, acceptance and mutual respect where the horse is non-judgemental, encourages pushing one's boundaries of comfort and also offers physical closeness affection and connection. Understanding the therapeutic processes that can be gained from working with horses can guide and shape therapeutic interventions. Future Research  The main contribution of this study to the ET literature is investigating how the participant’s made sense of their experiences of engaging with horses, a relatively unexplored 		 	 77	area of ET. This provides important foundations for understanding the role of the horse, the potential unique qualities and processes that horses can offer and thus, contributing to the knowledge base of the therapeutic implications and efficacy of ET. To improve the knowledge base, future research should focus on the critical area of understanding the mechanisms of change. This study identified how specific activities fostered different therapeutic processes. Exploring further how particular activities may lead to therapeutic processes, and the possible mechanisms of change will further the efficacy of ET programs. The human-horse relationship was central to participant’s experiences in this study, implying that working with horses is based on the foundations of a relational approach. Exploring the therapeutic relationship further may help increase understanding of theories that may fit best with equine interventions. For example, establishing safe relationships with horses may lead to greater attachment opportunities through close physical contact and attunement. Measurements of the therapeutic alliance and attachment may enlighten this area further.  Exploring other domains of working with horses and the potential impact would be helpful. For example, understanding more about how being in nature may contribute to the positive experiences identified and how working with other participants as part of a group may encourage positive outcomes, including the relationship developed with the trainer/s. While it would be challenging to separate these components, it could provide further understanding of horse specific domains. Exploring clients’ experiences of traditional therapy prior to engaging with horses may also further understanding of the unique horse components, processes and mechanisms. Linking with this is the area of the horse as a motivator to engage. Understanding further from the clients themselves, of what was appealing about working with horses compared to other therapies. This may help identify barriers and therefore improve access to mental health 		 	 78	services for veterans and what ET offers outside of traditional therapies. During this study, a couple of the participant's partners attended some of the sessions and commented in passing they have seen a change in their partners. Interviewing participant’s family members of their observations of any changes may offer additional insight into therapeutic benefits from the horse-human relationship. Limitations  As with any qualitative study that involves a small number of participants, exploring their experiences within a particular context cannot be transferred to other contexts. However, that is not the aim of IPA studies, which uses small numbers to gather rich data. A strength of this study is hearing the experiences of the participants themselves and their meaning-making of engaging with horses through natural horsemanship. Natural horsemanship as an approach for engaging with horses offers greater insights into the therapeutic processes and potential mechanisms of change. A more diverse sample of participants could offer a broader array of descriptions and meaning-making.  While this study indicates the unique qualities of the horse that may lead to therapeutic gains, learning more about the impact of being outside in nature, learning a new skill, being with other people, may also be contributing factors to participants overall positive experience. Conclusion There is a general lack of studies that explore participant’s experiences of engaging with equine programs. This is essential to further understanding of how the horse itself can lead to positive psychological benefits. This study specifically did not include a psychotherapy component. The aim was to further understanding of the processes of engaging with horses in its most natural form, by means of a natural horsemanship approach; without additional therapist 		 	 79	factors, specific orientation or expected outcomes. While this study reflects a number of previous findings, this study offers insights into the gap identified in the literature by furthering understanding of the unique horse qualities and processes and potential mechanisms of change. The horse-human connection, therefore, is highly experiential, sensory, emotional, and relational and naturally encourages a present moment attentional focus. The findings to emerge from this study, in line with previous research, highlights how the human-horse relationship resulted in positive experiences for veterans, implying the promising nature of equine therapy interventions based on the foundations of horses themselves, tuning-in to their natural behaviour and herd instincts. This study contributes to the ET literature and identifies implications for counselling practice and future research.        								 	 80	References  Aldao, A. (2013). The future of emotion regulation research: Capturing context. Perspectives on Psychological Science, 8(2), 155–172. https://doi.org/10.1177/1745691612459518 American Hippotherapy Association. (2016). What is hippotherapy. Retrieved from http://www.americanhippotherapyassociation.org American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.  Ashton, L. (2011). Intrigued about equine modalities. 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Therapeutic value of equine--Human bonding in recovery from trauma. Anthrozoos, 21(1), 17–30. https://doi.org/10.2752/089279308X274038 Yount, R., Olmert, M., & Lee, M. (2012). Service dog training program for treatment of posttraumatic stress in service members. U.S. Army Medical Department Journal, 63, 63–69. Zadnikar, M., & Kastrin, A. (2011). Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis. Developmental medicine & child neurology, 53(8), 684-691. 		 	 101	Appendix A: Recruitment Poster 	ARE	YOU	INTERESTED	IN	JOINING	A	STUDY	INVOLVING	VETERANS	AND	HORSES?		FREE	PARTICIPATION	IN	EQUINE	PROGRAM	TO	ASSIST	VETERANS	WITH	OPERATIONAL	STRESS	INJURIES			AN	OPPORTUNITY	TO	ENGAGE	SOCIALLY	WITH	A	SMALL	GROUP	OF	VETERANS		Why	Participate:		To	address	veteran’s	social	isolation	and	emotional	regulation	through	working	with	horses.		What’s	Involved:		Four	one	hour	sessions	with	experienced	horse	trainers	and	a	1	hour	confidential	group	based	interview	upon	completion	of	the	program	at	UBC.			Who	participates?		Veterans	who	• have	an	interest	in	learning	how	to	work	with	horses	• want	to	find	ways	to	be	involved	with	others	• want	to	address	their	affect	regulation	(anger,	anxiety,	depression,	social	isolation	as	examples)	• are	over	18	years	of	age		IF	YOU	ARE	INTERESTED,	PLEASE	PHONE	Dr.	Marla	Buchanan,	604-822-4625	or	email	marla.buchanan@ubc.ca		Dr.	Colleen	Haney,	604-822-4639	or	email	colleen.haney@ubc.ca	 Version 3.  July 19, 2016 		 	 102	Appendix B: Consent Form  a place of mind THE 	UNIVERS ITY 	OF 	BR IT ISH 	COLUMBIA 	        Title - Equine Experience to Understand Emotional Regulation and Social Engagement with Veterans: A Pilot Study  Principal Investigator: Dr. Marla Buchanan, UBC Department of Educational and Counselling Psychology and Special Education (ECPS).  Co-Investigator: Dr. Colleen Haney, UBC, ECPS; Katie Grimes, MA  Candidate, UBC, ECPS  The purpose of this research is to study human-horse communication specifically related to emotional regulation (how people control their emotions). The results of this study will be used to inform researchers and helping professionals on the experience of and value of using animals to reduce negative emotions.  We are asking you to participate in a small group discussion after you have completed 4 one-hour sessions of human-horse interaction. The 4 sessions-will be taught by 2 experienced horse Trainers and will focus on basic groundwork with the horse. Groundwork includes grooming the horse, putting a halter on the horse, and walking with the horse. There will be no riding. The first session will focus on safety, how horses communicate, and will include a demonstration by one of the Trainers interacting with a horse. In the rest of the sessions you will be interacting with a horse under the supervision of the Trainers. The co-investigator will observe all sessions and record the types of horse-human activities. We request your permission to videotape, however you can decline. You will still be able to participate in the study if you choose not to be videotaped.    Study Procedures: All participants will be asked to attend a small group discussion (called focus groups) at UBC after the 4 horse sessions to discuss your experience of your interaction with the horse program. Groups of 3 or 4 Veterans will participate in a focus group interview Version 3, June 28, 2017  		 	 103	that will last about 1hour and will be led by a graduate student from the Counselling Program (ECPS) at UBC. Participants will be asked to describe their experience  of the horse program and to reflect on their thoughts, feelings, views and opinions about the horse program experience. Some demographic information will be asked including your age, current employment and relationship status, race and ethnicity. The questions are intended as a guide and the interview will be audio taped and transcribed and given a code number to ensure your confidentiality. The  par t ic ipants  in  the  focus group w i l l  b e  a s k e d  t o  n o t  s h a r e  c o n f i d e n t i a l  i n f o r m a t i o n  outside of the group. You will not be identified by name in any publications and/or any written reports.  Potential Risks: All horse activities will be done with experienced horse trainers. In the focus group interview you will have the opportunity to discuss your experience of being with the horses and what you found helpful. If you find participation in any of these activities upsetting, you will be able to debrief your experience with the researcher/psychologist on site. Additionally, you may debrief your experience with the Principal Investigator or the co-investigator, whose contact information is provided at the end of this form. They are available and willing to discuss your experience if you have a negative experience from your involvement in this study.  Potential Benefits: By participating in this study you will have a good understanding of the horse-person relationship and be able to inform the researchers what was particularly useful and helpful with the activities you participated in. You will also help us understand your experience and lead the way for a much larger study. You will have an opportunity to request a copy of the study results when the first paper is prepared for a conference presentation.  Confidentiality: Your identity will be kept confidential and all data collected from you will be coded and kept in a locked file cabinet at the University of British Columbia in Dr. Buchanan's research laboratory and will be destroyed after 5 years upon completion of the study. Any and all information that is gathered during the research process will be kept strictly confidential. Participants will not be identified by the use of names or initials, only by a pseudonym chosen at the time of the informed consent interview. The final report will use pseudonyms and avoid any details or information that could potentially identify any individual. Compensation: There is no compensation for your participation in this project.  Contact for information about the study: If you have any questions or desire further information with respect to this study, you may contact Dr. Marla Buchanan at 604-822-4625 or Version 3, June 28, 2017  		 	 104	send an email to marla.buchanan@ubc.ca  You may also contact Dr. Colleen Haney at 604-822-4639 or email her at colleen.haney@ubc.ca.  Consent: Your consent is entirely voluntary and you may refuse to participate or withdraw from the study at any time without negative consequences.  Your signature indicates that you have received a copy of this consent form for your own records and that you have given your consent to participate in this study.\     This study is supported by the Legion BC/Yukon Foundation.  Participant   Signature __________________________________________   Please print your name:__ ___________   Date: _   I	give	my	permission	to	be	videotaped	during	this	study		Participant	Signature______________________________________________________	   Researcher’s Signature___________________________________________________   Researcher’s Printed name________________________________________________    Version 3, June 28, 2017  		 	 105	 CONTACT	INFORMATION:	 Principal Investigator: Dr. Marla Buchanan, Professor Department of Educational and Counselling Psychology and Special Education (ECPS) Faculty of Education  604-822-4625 marla.buchanan@ubc.ca  Co-investigator:														Dr.	Colleen	Haney	Department	of	Educational	and	Counselling	Psychology	and	Special	Education	(ECPS)	Faculty	of	Education	604-822-4639	colleen.haney@ubc.ca	               		 	 106	Appendix C: Brief Demographic Questionnaire  Pseudonym                               1. What is your age?                                                                                                2. What is your gender identity?                                                                        3. What is you ethnicity?                                                                                      4. What is your marital status?                                                                           5. Are you currently employed?  YES                NO                                		 	 107	Appendix D: Focus Discussion Group and Interview Guide FOCUS	DISCUSSION	GROUP	/SEMI-STRUCTURED	INTERVEIW	QUESTIONS			 1. How	did	you	find	out	about	the	study?	a. Why	did	you	decide	to	take	part?	2. Can	you	describe	your	experience	of	the	program?	a. What	was	your	experience	of	being	in	the	round	pen?	b. What	was	your	experience	of	visiting	the	other	horses	in	the	field?	3. Can	you	describe	a	specific	incident	that	allowed	you	to	connect	with	your	horse	in	a	positive	way?	4. Thinking	back	over	to	all	the	sessions	you	attended	–	what	stood	out	for	you	most?	a. What	parts	of	the	program	were	beneficial?		5. What	recommendations	do	you	have	that	may	improve	the	program?		6. Was	there	anything	else	you	would	like	to	add	that	you	think	is	important	for	us	to	know?		 

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