Part 1: Pressure vs Pain

Pressure versus pain can be somewhat difficult to intuit. Think about any time you hit your funny bone, or bump your knee on your desk. What do you do? As humans, and as predators, we generally grab the part or our body that got hurt. "Ow! I could have done without that!"

And we press on or hold the part that got hurt. This is actually a good thing at times, since if you have a cut you should apply pressure... but I digress. The point is, we move into pain. We quickly close in on pain. On the other hand, if someone is aiming at you with a water balloon, you tend to move away. We move away from pressure. 

An example of pressure and pain could be a hard rubber ball at the end of a string, and your best friend, who is a bit of a trixter, swinging it. At first, you would move away from pressure, since you know your friend will probably bonk you on the head. However, when that friend finally nails you with the ball on your head, you will grab your head with your hand. You will move into the pain. Of course, if you are quicker, you will probably grab the ball... but that ruins my example.

The first thing you can look at when someone reacts to you, is whether or not YOUR behavior was interpreted as pressure or pain. In the picture below, my horse is not moving away, but is allowing me to pet him. This seems like a neutral position. 

Neutral - touching without pressure nor pain

If I pinch my horse, what will he do? Well, I'd prefer not to experiment, but ultimately, it depends on how he interprets the feeling. When a horse feels the pinch of a girth being tightened, sometimes he turn to bite. This sounds like moving into pain. Other times, a horse may start to move away from a saddle when someone approaches. This sounds like moving away from pressure. This doesn't mean that when your horse calmly walks over to you he views you as pain!

An example of horses in a more natural environment would be when a horse pokes at his belly when he starts to colic. Moving into pain. When a horse walks away from another horse that has her ears pinned, that is moving away from pressure. In fact, that would be an example of emotional pressure, since there is no physical touch.

So, from this we learn that clients who move toward their treatment goals are moving because they or their therapist is providing them with pressure. When they leave or give up, they may have been pushed to the point of feeling pain, or too much pain.

When dealing with others, think about whether what you are doing elicits pain or pressure, and modify what you are doing to attain a more desirable result.

Feeling stuck? An introduction to getting un-stuck.

There are times in therapy when clients get stuck. As a client, this can be very frustrating, and can even lead some to seek out a new therapist, or a new type of treatment. Worse, some clients may give up on the process of healing all together, because they start to believe that there is no hope. Clearly, being stuck is something to avoid. 

It seems that it should be easy to keep people interested in treatment when they get to interact with horses, but getting stuck still happens. As a therapist, one may decide it is the clients falt. For example, the client must be doing something wrong such as not sharing, being defensive, or using defense mechanisms, or is just not invested in treatment. This may be true, but may also be an excuse so the therapist does not feel like a failure! If you are a treatment professional, ask yourself if there is something more going on. Remember, "it's never about what it's about", meaning, it is often not what is being talked about, rather, it is something deeper. If you are the person who is stuck, ask the same question! There are three areas that can be reviewed to determine how to get things moving again, and this article will, therefore, be divided into three parts:

1. Pain vs Pressure
2.  Ball vs Chair
3. Approach vs Retreat

The first, Pain versus Pressure, is something I learned about through EAGALA, and the last two, are Parelli Natural Horsemanship concepts that I have found very helpful with myself and my clients.

Prey Animals Frustrate Predators

I've been working on my Parelli Level 2, which is the natural horsemanship I'm learning with their home-based curriculum. You can check out their curriculum at: http://www.parellinaturalhorsetraining.com/ Right now they have a sale....

Anyway, Linda Parelli said something I thought was quite brilliant: horses and other prey animals frustrate predators to stay alive. If the predator gets frustrated enough, they will give up, and that horse gets to go on living another day. 

Wow

That really changes how I understand a lot of interactions. I mean, if a horse is often losing confidence and exhibiting behaviors as a result of fear, then I'm bound to get frustrated. That is the whole point of their behavior. So what should I do? Well, I would take note of the behavior and my reaction to it, and if I feel frustrated, stressed or otherwise irritated, I can remember the purpose of this feeling from the point of a prey animal, relax, and retreat. That's the hard part - noticing the feeling withing yourself.

Next, I can take time to think about what I did, or what was in the environment, or frankly, what part of the horse's individuality, elicited the behavior. This is the fun/creative part. There are innumerable possibilities, so sort them out in a hierarchy, and pick one to try. Then try it! Remember to go through this process again until communication improves.

I bring all of this up because it seems very relevant for individuals and families as we deal with one another. So as not to offend, let's take children for example. They can be very frustrating at times. They won't eat, they hate bedtime, won't take a nap, won't pick up their things, they cry, get tired, and are downright frustrating at times. But we love them so. We have a choice here, and important one at that: we can become frustrated and ESCALATE or TAKE NOTE of how we feel. Say to yourself, "Hm, interesting. I feel frustrated."

If you are able to notice where in your body you feel frustration, that can be helpful, too. Next, remain calm. You need your frontal lobes right now, and they start to turn off the more adrenaline you make (horses are the same way). I should note, that it is usually MUCH easier to think about these things when it is NOT happening. You should plan for uncomfortable or not-pleasurable things that happen before they happen, so you can elicit a change in the moment.

Here is a helpful process from High-Fidelity Wraparound, and it is called a Functional Assessment:

1. Clearly describe the potential crisis behavior, fequency, duration and intensity:
2. What happens before the behavior occurs (triggers)? are there times/situations where the behavior does not occur? Why?
3. What happens during the behavior? Does something make it worse?
4. What happens after the behavior occurs? Is there a time when the behavior doesn't occur:
5. Best guess about whey the behavior occurs? (what's the function of the behavior). What has been successfully tried in teh past?
6. Select a positive replacement behavior.

 This is very formal, but as you practice it, it becomes second nature, and you are able to do it on the fly. Next time, I will go through the process with an example to show you how it works. If you wish, please submit a question.

Turning our heads at violence and abuse

It probably happens a lot of places, but it definitely is happening here in Helena, Montana. Residents enjoy little crime, and the ability to do things like leave cars and homes unlocked. We have a low population, and enjoy the right to bear arms. Past that, folks don't seem to want to talk about the existence of violent crime and abuses of all kinds, including domestic violence, physical and emotional abuse, and especially sexual abuse. This needs to change.

The people that are involved in anti-stigma campaigning (mental health) are already on board. This is similar to our volunteer pool. We have a great group of people who really care about others and want to help others, and recognize the need for mental health services. How do we get new people that don't think about mental health as being a part of the overall good of the community?

Perhaps we start with discussing what is important about it. What's in it for me?

Let's talk about your pocketbook. Does it bother you that people steal from you? How about when they steal from local stores, and prices are higher to adjust for the theft. Do you enjoy paying for brick and mortar to house more criminals every year? They get food, clothing, and shelter at your expense. Had you thought about it? Is it worth it just to get these people off the streets, or would it be better for them to be PRODUCTIVE members of society, caring for themselves and their family members. Their work could potentially contribute to the local economy in a powerful way.

According to Dr. Grohol of PsychCentral.com*, over half (55%) of males in state prison have mental health issues. For women, it is even higher, 73%! There is generally very little treatment available. In Minnesota, things got better with a mental health court in place, as evidenced by a 20-25% improvement in offender outcomes.

I'm not suggesting that criminals not serve time for their crimes. I'm just saying that if people are LOOKING for problems within their coworkers and friends, and being open about talking about mental health issues, then folks would be more likely to seek out treatment before they get involved in illegal activities that violate your rights and mine. Sweeping it all under the rug just makes it worse and more costly in the long run.

For example, I recently sat in on a hearing for youth offenders. First on the docket was a youth who has been sexually molesting girls 10 years younger than he. The judge altered the order of the cases so that no one would have to hear the molestation case. Why not? Who was there that would be so offended? Also, did you know that sex offender (SO) treatment is ONLY available at youth prison such as Pine Hills? I believe it is the same for adults. These people are not going to be locked up and have their keys lost. They get released, and no treatment is available, without private pay (they have to pay for it outright). 

Montana Sexual Offender Treatment Association

Fresh Steps EAP is actively participating in High-Fidelity Wraparound through Montana's PRTF Waiver. This program looks at children between the ages of 6 and 18 for risk of being placed in residential treatment. If they are at risk, they enter the program and receive High-Fidelity Wraparound services that have been shown to reduce negative behaviors to include crime. The reason it works is because professional and non-professional team members alike, both collaborate and integrate their services. Agencies standing alone cannot create the powerful outcomes simply because they are not connected to the community. Why? This is where we live, and everyone needs to be 'plugged in' to the community for needed resources. This means that eventually families will learn to be independent and no need professional services. 

If it costs $100K per year to treat a youth in a residential treatment facility, then it may cost over $1M to treat this child over the course of over 10 years. Why not spend the money up front, and get the family and youth back in the community? Much cheaper. Much better for everyone. 

For more information about High-Fidelity Wraparound, please visit:

Vroon VanDenBerg


National Wraparound Initiative

and for more about 

Montana's PRTF Waiver


 

*http://psychcentral.com/blog/archives/2009/07/18/imprisoning-people-with-mental-illness/

What's an Equine Specialist, and what do they do?

Equine Specialists (ES) or Equine Professionals (EP) are the specialist on the EAP team that knows the most about the horses. I have seen folks use both terms, but I will use the term ES in my blog. ES's know a lot about horses. They should not only have not only worked in the equine industry for many years, have had horses themselves, and have participated in formal equine training, but also have studied equine behavior so they can be sure to include the horses in the EAP sessions. They should also become certified though EAGALA, as this process helps the ES become sensitive to mental and behavioral health issues. It is great if a therapist and ES team can go to the training together, so they are continually working on their team-building, and developing their own unique approach to the treatment.

ES's may develop unique activities for clients in EAP sessions, and overall, keep the horse a part of the session, and maintain physical safety of everyone involved. This means that the ES is keeping an eye on the horses, and if something seems to be escalating or getting problematic, they will know what to do to de-escalate the situation or keep the horses and humans separated until it is safe to resume. This does not mean that the horses are running wild and people are screaming, rather, things more subtle, like the horse has its ears pinned, and clients are circled up to talk about how the horse was feeling before it becomes a situation.

You really can't do without a good ES. A good ES is someone who can follow the therapist's train of thought (in terms of treatment and guiding clients through the session), and is comfortable with feelings. Inexperienced ES's can de-rail a session quickly if they become uncomfortable with what is being shared in the session. They can do things like cheer someone up when they are starting to have real feelings about something deeply hurtful, for example, or focus on a small cut on the horse's leg, or manure in the arena, instead of letting the clients have their experience, and forgetting about the little things that can wait.

EAGALA has as a part of its training, something called apostrophe S's, or 'S. This is about the things that bother you that interfere with your ability to create a safe, productive space for clients. If you find yourself thinking, "Geez, that sounds a lot like my life" and you begin to drift off into your own world - STOP! These are your 'S's, and they can be very harmful to your clients. A good ES knows how to check this 'stuff' at the barn door!

Finally, it is really important to have an ES that can help with activity development that is RELEVANT to the client's needs. What may not be helpful is someone who just 'goes through the book' and has clients experience all of the activities in the certification manual until they have exhausted the possibilities. Therefore, creativity is key!

Fresh Steps EAP is very fortunate to have Micah Lange as our ES. She is certified in EAGALA, and has a great deal of horse experience. She is also continuing her learning by studying the Parelli model of Natural Horsemanship. Thank you Micah!

Why have a Therapist?

"We do not act rightly because we have virtue or excellence, 

but we rather have those because we have acted rightly."

Aristotle 384 B.C.-322 B.C., Greek philosopher and scientist, 

student of Plato and teacher of Alexander the Great

I have often heard people mumble about how a therapist isn't really needed, and in fact, have heard some people say that therapists actually get in the way of people in counseling. They have some horses, and have helped people in their lives, perhaps a relative or friend, and found that just BEING around the horses helped with mental health issues, and wonder why anyone needs to pay a therapist to do what the horses already do so well. After all, people admit that they felt better after coming home from Iraq and spent a lot of time with their horse. People see children blossom when they spend time with a horse. This is certainly true, and is one of the major reasons we use horses in therapy. Not everyone has access to a horse, and not all of these results are lasting or permanent. However, we would like this to be so.

 

There is a reason people go to a therapist's office and talk for 50 minutes. It is because they feel better when they do this (though not everyone responds to talk therapy). Now, just imagine putting the skills of the therapist with the skills of the horse... you get equine therapy. Now, we also need an Equine Professional or Equine Specialist (whichever you prefer) in the session as well, but I'll get into that next time. For now, let's think about how the therapist is helpful in Equine Assisted Psychotherapy.

Now, I could get all particular about it and point out that it is called Psychotherapy, and in order to actually DO that job, you probably should be a psychotherapist. But, we shall delve a little deeper...

You can probably do some plumbing, but you may not be a plumber. You might be able to install a light switch, but you don't call yourself an electrician. You might train your own horses, but you don't tell people you are a professional horse trainer. You can help children with their homework, or teach them about something you know, but you may not be a teacher. 

I have cut my husband's hair, but I'm not a barber. It came out OK, and it saved $12, so we were happy. When we have to pay that $12, however, we definitely expect that the barber is licensed, and that things are kept clean and sanitary. If we get a bad haircut, we probably won't refer our friends there, but what about if we get an infection? A license doesn't assure us that we will get a good haircut, but it does assure us that this barber is under the pervue of a licensure board. This means that if something bad happens, a customer can file a grievance with the board, and be sure that this sort of thing does not happen again. It doesn't mean that I want to go to the trouble of complaining - I don't. Application for the license both explains and maintains standards. It is just that any given barber is less likely to break a law because of the availability of this process. It keeps them honest.

The same is true for other professions, including therapists. In Montana, there is one board shared by Licensed Addiction Counselors (LAC's), Licensed Clinical Professional Counselors (LCPC's), and Licensed Clinical Social Workers (LCSW'S). I am an LCSW. This means that I have not only completed my Master's degree in Social Work, but also that I have completed 2000 hours of supervised practice, and followed that up with a standardized examination through the ASWB (Association of Social Work Boards) that demonstrated my ability to do the work. It was no simple feat. 

All these hoops are present to assure that if someone is going to get paid to help you mend your emotional well-being, then they better well know what they are doing. Just like with the barber, there is a license board with a grievance procedure to keep everyone honest. A therapist should be aware of ethical guidelines and agree to follow one or more Code of Ethics - not only because there are negative consequences, but also because it is the right thing to do. A Code of Ethics is basically rules to live by for professionals. They have to do other things too, like maintain continuing education, and practice within their scope. Scope is just a fancy way of saying 'your particular area of expertise'.

So, if you are engaged in ethical practice, then you should be practicing withing your scope. If you aren't a therapist, and you are practicing therapy (no matter what you call yourself), then you are at great risk of causing harm. You could safely say, then, that licensure is about protection of the public.

Special training is needed for any additional services you provide, such as dance therapy, art therapy, play therapy, and equine therapy. There are centers around the country and around the world that specialize in training existing therapists to perform these value-added forms of treatment. EAGALA trains, certifies, provides continuing education and support for its members. EAGALA is the Equine Assisted Growth and Learning Association. Their website can be found here:

http://www.eagala.org

My agency, Fresh Steps EAP, follows the ethical guidelines set forth by NASW (National Association of Social Workers) as well as the code from EAGALA. In fact, we are one of the few agencies in the world to hold the designation "EAGALA Distinguished Program Member". 

EAGALA Distinguished Program Members around the world 

Through EAGALA, I and my staff have received special training to use horses in therapy. As for me, my job is to make sure that clients are kept emotionally safe during these very powerful sessions. I also develop and implement treatment plans with the individual's or family's goals. I am there to provide an opportunity to process, learn, and grow, in a safe space. If I fail to do this, I am at risk of not only hurting someone, but also of losing everything for which I have worked: my career. When I proudly hang up my license as well as my special certifications, I am letting everyone know that ethics and providing the best service is not only important to me, but also that I am staking my reputation on it.

The usual answer is, it is essential to have a therapist present in any EAP or EAL (Equine Assisted Learning) session because of the powerful nature of the sessions. Emotional issues come out even when you do your best to avoid them. When strong feelings emerge, you need a therapist to handle things in a safe and respectful manner. Another point is that if you indeed are avoiding feelings, you are causing harm to the person by letting them believe that their feelings are not acceptable. They may tend to 'stuff' their feelings because it has been made clear that they should not be shared. This can be particularly harmful to children.

If you are still with me, than kudos to you! This is a very controversial subject because many horse folks are really motivated to get started doing this work, but may not have found a therapist to work with. If this is you, contact me right away! Join EAGALA, join our networking group, start meeting people in your area that are interested in sharing your passion for this work, and attend trainings and the annual conference. There is support for you, and our hope is that you start a program in your area that is fun, profitable, and successful! Trust the process!

EAP, an Overview

You may ask, what exactly IS Equine Assisted Psychotherapy?

The simple answer is that it is a mental health therapy session that incorporates horses into the session. There is less talk and more hands-on activities. Folks learn more about their approach to different situations, and are allowed to explore new ways to do things, so they can transfer that knowledge and experience into their lives outside the arena. You could think of it as using the metaphors created in the play and activities with the horses that are meaningful. 

We often tell new clients that they will not be told 'what to do'. Within the first or second session, however, we find people asking what to do. We encourage them to explore new ways of problem solving and new ways to communicate since horses don't speak English. Horses rely on reading body language and other messages from non-equids in order to survive. Our horses respond to hearing a squirrel chirp. As far as I know, they don't speak squirrel, they just have an instinct that something is wrong, and need to keep an eye out when they hear this sound.

In any given activity, there might be one or more of the following 'rules': 

1. No halters or lead ropes
2. No touching the horse
3. No bribing the horse or pretending to have food
4. No talking
5. (and most importantly) Anything else you CAN do.

For some reason, the 5th rule is the hardest for everyone to remember, until they have participated in a few sessions. 

All activities are done on the ground, so there is no riding, or horse experience needed. Every session has two humans facilitating. These are the licensed (or license eligible) therapist, and the equine professional. The therapist is primarily there to be sure that treatment goals are being met, and that emotional safety is present. The equine professional or equine specialist (either name is good) is there to develop relevant activities to help the participant attain their treatment goals, to incorporate the horse into the session, and maintain physical safety for everyone.

Activities can vary from an observation activity to grooming, or getting the horse to move or stand still. Activities can be held in an arena, round pen, paddock, pasture, or really any area that meets the client's needs. 

The thing to know is that EAP is very difficult to understand until you have actually seen or experienced it. At this point, you probably get the basic gist of the work, but knowing horses and the amazing power they have to heal is something you have to see in person to really appreciate. 

One of our volunteers, Gay, with a mare, Destiny

Demonstrations are a great place to see this work. Fresh Steps EAP offers demonstrations throughout the year, and hopes to have demonstrations in other areas of Montana. Send an email if you would like to be added to our mailing list. Get involved! We have a strong volunteer program, and encourage you to help out, and get some fun time with the horses.