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A horse can benefit both the patient and the therapist
“All the therapists reported that their job was made easier because horses made it possible to express difficult emotions in a completely different way than in an office," says a researcher.
“Including a big, warm creature in the therapy space creates a completely different dynamic than what can be achieved in an office,” says Charlotte Fiskum. She is an associate professor of psychology at NTNU.
She led a study demonstrating that using horses in therapy, known as equine-assisted therapy, helps therapists and protects them from burnout.
“For many patients, a one-to-one conversation in an office can feel intimidating, and talking as a tool for change does not suit everyone," the researcher says.
The horse can make it easier to talk about difficult things
Horses help both the therapist and the patient by providing a physical starting point for building a good relationship and addressing difficult issues, she explains.
"Horses can help build a safe bridge between the therapist and the patient,” says Fiskum, speaking on behalf of the research group.
Many people struggle to trust others, yet they may dare to form a bond with a horse without risking criticism or rejection, the researcher adds.
Using horses to help regulate emotions
The study consisted of ten in-depth interviews with experienced psychiatrists and psychologists. In addition to extensive experience as psychotherapists, they had also worked with equine-assisted therapy for at least ten years.
The interviews were conducted by researcher and psychiatrist Norunn Kogstad.
“All the therapists reported that their job was made easier because horses made it possible to express difficult emotions in a completely different way than in an office. The therapists could also use the horses to regain composure and get support managing emotions and thoughts – both their own and their patients’ – during therapy sessions,” says Fiskum.
Psychologists too often work alone
She believes that psychologists should work more in teams, but that financial constraints often mean they have to work alone.
“Burnout is a major challenge. The vast majority of therapists describe their workdays as both mentally taxing and hectic," says Fiskum.
She explains that there is much they may not be able to provide within the current framework of mental healthcare.
Fiskum emphasises that every case is different.
Animals as facilitators in therapy
“Therapists also need to make sure they focus on their own well-being. The most important thing is managers with system-level responsibility who facilitate reflection and peer support, as well as good working conditions. In addition, having a horse as a colleague can be a great help,” says Fiskum.
Numerous studies show that simply spending time with animals such as horses and dogs can be beneficial for people’s mental health.
Using horses as a therapeutic tool has shown positive results for patients struggling with confidence, relationships, self-regulation, and substance abuse.
Horses have strong social awareness and sensitivity
“A horse can provide the patient with both comfort and physical contact, and the therapist can use these situations to help the patient cope with issues such as loss and grief,” says Fiskum.
She highlights that many animals can serve as facilitators in a therapeutic setting.
Horses are better suited than dogs because they are both prey animals and herd animals, giving them a high degree of social awareness and sensitivity.
“Horses are very sensitive to their surroundings and body language. A horse often picks up on a person’s inner emotions. Unlike dogs, horses are less concerned with pleasing people," the researcher says.
She explains that when a horse reacts to an emotion, it does not hesitate to show it. It may back away, neigh, or clearly indicate that it does not want contact.
“A horse doesn't care about your appearance"
A horse that is relaxed and trusts the people present may try to rest its head on a person’s shoulder.
Or it may seek attention by rubbing its muzzle against the person. Horses that like each other sometimes breathe into each other’s faces.
“The therapist can use the patient’s reactions to the horse’s behaviour in order to understand how they interact with other people, providing useful insight,” says Fiskum.
For example, a therapist who uses cognitive therapy can use the patient’s interpretation of the horse’s behaviour and reactions to identify and change their negative thought patterns.
“A horse doesn't care about your appearance, what education you have or don’t have, and it doesn't judge you for something you've done. There are many people who struggle to trust others, but who might dare to form a bond with a horse, because there is no risk of being criticised or rejected. Working with horses is a bit like a miniature laboratory for bonding and social interaction,” says Fiskum.
Less office, more nature
Equine-assisted therapy may simply involve spending time together in the stable.
Sometimes, it is also possible for patients to sit on a horse led by the therapist, or even to go for a ride. But most of the work with horses takes place on the ground.
In another study, Fiskum has researched the use of horses in substance abuse treatment. She interviewed an adult patient.
“He had been bottling up his feelings for years, but when he saw the horse, he simply walked into the stall, sat down next to it, and started to cry. The patient finally found a space that felt safe enough to let out his difficult emotions. Situations like that are not so easy to create in an office,” she says.
Greater diversity in therapy is needed
Fiskum also believes that there should be greater flexibility in how therapy is conducted.
Tailoring treatment to each patient’s needs and wishes is part of effective, knowledge-based care.
“Equine-assisted therapy is resource-intensive, and it isn’t available everywhere. Dogs can be wonderful therapy animals for patients who are anxious. In some cases, patients also bring their own dog along as a source of comfort during their session with the therapist. It's important that the therapy is associated with something that the patient experiences as safe,” she says.
In Norway, equine-assisted therapy is offered at Oslo University Hospital and there are also a number of private providers.
Reference:
Kogstad et al. Therapists’ reasons for including horses into psychotherapy, a qualitative study, BMC Complementary Medicine and Therapies, 2026. DOI: 10.1186/s12906-025-05185-2
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Read the Norwegian version of this article on forskning.no
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