A relationship developed with a horse can offer challenges to help overcome fears, build up trust, respect, compassion, develop communication skills, problem solving and coping techniques as well as self confidence and self esteem. These skills are transferable to many other areas of ordinary day to day life.

People learn about themselves and others by participating in activities with the horses. Horses are very intelligent animals and they are deeply perceptive to human behaviour which makes them a great companion in therapy. They are extremely open to building trustful relationships if the trust is mutual. They can sense any kind of stress that we may be experiencing and react according to the signals they receive from us. What’s most fascinating about them is that they can neither lie nor judge but they can surely help us discover new things about ourselves and open doors to a new found confidence, joy of life, understanding, free us from our resentments and provide us with a wider perspectives of ourselves.

Once you get to form a bond with your horse, you will realise how the subtle changes in the way you feel further impact your relationship with your horse and consequently with your  family members and your social circle. Moreover, they can also assist you in building natural leadership skills or they can help you tone down those compulsive behaviours that end up restricting your life.

Recent applications of EAP transcend beyond the treatment of addiction and mood disorders as it is now widely recognised to be a very powerful tool in treating trauma and other mental illnesses. In fact, so powerful that we have seen the EAP turn many skeptics into firm believers just after a couple of sessions!

SMART Recovery was created by professor Joe Gerstein as an alternative to AA and taking it’s principles from Albert Ellis’s Rational Emotive Behaviour Therapy programme which itself was a founding cornerstone of Cognitive Behavioural Therapy, much loved by the Department of Health. The programme is thought of as an alternative to AA which considers Alcoholism, an illness, has a spiritual dimension and considers lifelong abstinance essential. SMART Recovery are clear in offering their meetings can also be used as an adjunct to 12 Step ones. In contrast to AA, SMART Recovery has no spiritual dimension, considers it possible to recovery entirely from problems with alcohol and uses only scientifically tested therapy tools which can evolve as new findings are made.

SMART Recovery has a 4 point programme:

1. Enhancing and Maintaining Motivation
2. Coping with Urges
3. Problem Solving
4. Lifestyle Balance

All very useful tools for alcoholics.

It’s fantastic that there is an alternative for those who find the religious foundations of 12 Step groups difficult and I really hope this group finds a strong hold in the UK.

In AA there is a saying that all you need to set up a new meeting is a coffee pot and a resentment against another meeting! I can see how this can also apply to entire fellowship approaches so I hope SMART evolves on it’s own merits and doesn’t get drawn into too many comparisons against AA. It should instead evolves as another much needed support tool for alcoholics.

Robin Lefever

FDAP Update

I received a call last week from the new CEO of the FDAP, Carole Sharma,regarding my statement about Therapists receiving cash kick backs from clinics for referrals. Carole previously had a role at the National Treatment Agency and seems to have had a good reputation there for getting things done. Given that she has only just taken on this new role at the FDAP it is impressive to see that she has hit the ground running and the FDAP may now take on a new invigorated role in our industry under her stewardship.

http://www.fdap.org.uk/

I have been campaigning for a year now about the practice of “independent agents” telling clients they are recommending the best clinics for them while in fact they only refer to a handful of clinics who pay them cash kick backs. Unfortunately this practice spread to the extent that lots of the Central London therapists will not make a referral to a clinic unless there is a the promise of readies in a brown paper bag under the table. It is also sad but true that this practice is actively promoted by some of the largest and best known private hospital groups in the country. I have long complained that this practice is highly unethical and will sooner or later, bring our profession into disrepute.

I had hoped that our regulatory bodies, EATA for the clinics and the FDAP as regulators of the therapists, would have taken some more decisive action in the past but it seems might be ready to look at this again.

I see no problem with therapists charging for helping clients pick the best clinic for their needs and neither do I see any problem with therapists charging clients to assist the families. The problems come when the therapists and agents are taking a kick back from the clinics. This inevitably results in the decisions being based on who gives the kick back rather than which is the most appropriate clinic. Commission agents have tried to give themselves the facade of decency by creating a few self appointed membership organisations but these are merely a fig leaf. They state that the agents have to  declare that they are receiving a commission from clinics but they still don’t point out that they will only refer to the clinics who pay them kick backs.

Recently the FDAP has ruled that the commission agents and therapists should declare their commission interests to their clients but this clearly doesn’t go far enough. I look forward to discussing this issue with Carole when she has time to discuss it.

The FDAP have asked me to name any therapists who I am aware may be breaching their codes but I have declined to do so yet. I would far rather a profession such as ours, which considers itself to be a highly ethical, would be able to regulate this ourselves. However, at some point we will all need to take stronger action.

Robin Lefever

I attended a refresher course on Equine Assisted Psychotherapy last weekend.

I first heard about EAP about 10 or 12 years ago, when I met a lady in the USA called Sandra Hodgeson. She had been using horses in rehab clinics in the USA and I was very impressed with what I saw. It was just a few years later that EAP training first came the UK and I signed up to train right away. In the many years since then the training for EAP has evolved and there is now an organisation for accrediting practitioners called EAGALA. I decided it would be an idea to refresh my training and get the new certificates from EAGALA  so I have just done that.

It is important to understand that EAP has no requirement for and has nothing to do with horsemanship. This is a “good thing” as I only just about learned how to stay on a horse as a youngster but I’m not sure I would want to chance it again now. I have always been particularly fearful of the back end of the horse in case it kicks, but I have learned from horsey types that it is really the front end of the horse that I should be more worried about. On that topic, safety is taken extremely seriously, from picking the right horses to work with, through to constant monitoring of the activity.

EAP is best understood as a team effort. There is a horse professional, a therapist, a horse and a client. All work together to gain understanding through experiences in the activities. Each of them plays an active role, the horse professional noting the behaviour of the horse, the horse having a wide variety of responses and the client doing as much as they feel comfortable. It’s probably the therapist who has the smallest role. So much is discovered by the patient themselves in the activity, that there is relatively little left for the therapist to do.

I always wondered if it would be possible to use other animals than horses but I think horses are particularly well suited to this sort of activity. It seems that as horses are herd animals,they are intrinsically social. On top of that they are also quite sensitive. All of these properties make them incredibly sensitive for therapy work.

There are many different therapeutic excercises we can do with the horses in EAP. All of this work takes place on the ground, no riding is necessary. A typical exercise might involve having the horse go around a course but without touching it at all. It sounds really hard and it can be.  Sometimes these tasks also involve restrictions like no talking or no touching the horse,and sometimes they don’t. Either way, I find it so easy to explore issues via the horses that I would find very difficult to acknowledge in a regular therapy situation.  I don’t know why it is so effective exactly but it just seems to make problems seem so clear and there is immediate feedback when I try and change. I think that really helps. I can see right away if another way of being is more helpful.

Anni Tidmarsh and Tracie from windsofchangescotland.co.uk were excellent trainers. They have a training school and a therapy place in Scotland and are well worth visiting if you have a chance.

There are so many different therapies out there and each of them will suit different people. EAP may well not be everyone’s cup of tea, but for those who are prepared to give it a go with an open mind, I bet they will be surprised how far and how fast they can work with is compared to other treatments.

Robin

I recently attended a workshop run by a fantastic man called Dr Rufus May. Rufus featured in the TV documentary called “The Doctor Who Hears Voices” in which his amazing work is explored.

Rufus suffered from hearing voices himself but didn’t find that taking medications was enough help and so started to explore other methods of treatment. Rufus came across the work of  Professor Marius Romme from Maastricht University in Holland and realised that there were other treatment methods he could use.

Rufus is now working as a clinical psychologist in the NHS and also runs training workshops for people who hear voices and interested professionals. The workshop I attended had Doctors Psychiatrists and Social Workers attending. It was interesting and nice that the professionals were outnumbered by sufferers as Rufus seems committed to people helping each other.

Rufus advocates the use of a self help group called the Hearing Voices Network, a self help group for voice hearers. He is not against medications, just as we are not, but like us, he is frustrated that often is it only medication that is on offer when there are so many other treatments out there.

The main thesis of his training seems to be that if people are hearing voices, they can learn to gain better control of them by engaging in a dialogue with them. Several members of the audience talked about either trying to ignore the voices, or medicate themselves so much that they couldn’t hear them. In fact, most found this just made things worse. One of the interesting exercises we did was to try and have a conversation with someone while a colleague would talk to us through a rolled up piece of paper straight into one of our ears. As you can imagine, it was so hard to remain focused, especially if the content of the other voice was related to the conversation we were trying to have. So many times I found myself stuttering or just stopping mid sentence, just as I have seen voice hearers do in the past. We did this to gain some insight into how distracting the voices can be and what it is like to have this problem.We also did exercises learning to role play with the voices. The voice hearer would go into the role of one of the voices and then as the facilitators we would try and engage them in a dialogue, asking what they wanted for the person and to explore when they came into the persons life and to try and find out what purpose they may be trying to serve. By giving the voices time to talk,  it seems that voice hearers can negotiate a lot more time for themselves to get on with every day life.

I love this approach because it totally bypasses the whole discussion about if the voices are real or imagined.It just doesn’t matter, all that matters is that the voice hearer comes to feel a lot more in control of their experience. I feel the same way about so many other areas of mental health. So much time is spent wondering exactly what the diagnosis is when really what matters is can the person get some relief from their problems.

This work reminded me a little of some training I did with Zerka Moreno in Psychodrama, where people act out their problems, externalising their internal psychology.

I can see a lot of value in Rufus’s work,  even for those of us not aware of hearing voices. Most of us have some form of internal dialogue and, when we are feeling low for example, this can become rather self deprecating. Externalising these voices and engaging them in a dialogue could be a very interesting way of managing them.

The course was held in Hebden Bridge, West Yorkshire and this was a truly beautiful venue and the area that Rufus lives and works in. I came away thoroughly inspired by Rufus and the other voice hearers on the course. I hope I have another opportunity for training with him.

Robin

High Ropes

We have just added a ropes course to our list of therapies.

There are two courses, one low, and the other, pictured here, high. A wide range of therapeutic issues can be explored on a group basis  or on an individual basis.

At PROMIS we love to use active therapies in addition to more regular therapies as a way to look for as many solutions as possible.

All of our therapeutic activities are optional and designed for each individual. This might not suit some but for others it can be very helpful.

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