Is an inclusion of a natural setting, horses and dogs, beneficial for a client in psychodynamic psychotherapy?

Géza KovácsHeerlen, 6th december 2013

versus

What is it about?

• Wilson’s biophilia hypothesis

• Brown’s dogs and horses as selfobjects

• Myers’s affect attunement between animal and child

• Panksepp’s neurological assessed affect

• Stern’s affect attunement

• Yalom’s existential approach

• McCullough’s psychodynamicPsychotherapy

• Fonagy’s mentalization

• Wallin’s combination of ment-alization and mindfulness (nonverbal-somatic attachment)

• 2nd order cybernetics

Equestrian Focal Psychodynamic Psychotherapy (EFPP)

What is it about?

The EFPP program:

• 7 day clinical treatment session (a ranch in Northern Spain)

• 4 ambulant sessions (in the Netherlands)

• diagnostic -, core conflict -, departing- phase and consolidating-phase.

• A team of psychotherapists and equine therapists offer situations/exercises involving animals, dogs and horses in particular.

The helping factor in psychotherapy:• creation of intersubjective

relationship. • therapist-client working alliance

We hypothesize that EFPP facilitates the forming of this intersubjective relationship easier and provides for a more optimal treatment.

Equestrian Focal Psychodynamic Psychotherapy (EFPP)

The goal: corrective emotional experiences by means of sensory experiences in a natural setting relatively far removed from the patient’s usual environment.

What is it about?

Study 1.:

• Comparison of clinical psychodynamic group therapy with and without EFPP module, pre-post design

• Cluster B, C, NOS personality disorders, N=51

• SCL90, BDI, PANAS

• Both groups showed significant improvement, no significant difference between the groups .

Study 2.:

• Pre-post design

• patients bipolair disorder, dropped out of psychiatric care, N=25

• SCL90, BDI, WHOQ

• Significant improvement in particular on the BDI (t=5.532,df=20, p<0.0005)

Study 3.:

• Pre-post mixed method design

• patients with variety of axis 1 and 2 disorders,N=94

• SCL90, BDI

• significant results SCL90, BDI: F(2,45)=29,210 p<.05, η2 =.565; SCL90: F(4,096)=18,000 p<.001, η2=.739 Strong corrective emotional experiences could be distinguished.

Study 4.:

• Pre-post design with waiting list as control

• patients with insecure attachment representation, N=24

• SCL90, BDI, HSL

• Significant improvement: (BSI) t (48) = -3.27, p <.05. and depression (BDI) t (48) = -2.91, p < .05 after EFPP

Results so far on EFPP

Preliminary results Client Change Interview (N=15)

Cause of change Experience Change Number

Setting/environment Rest/calmness Inner peace 6

Horses Mirroring/warmth/challenge/setting boundaries

Selfimage/insight/ selfconfidence

11

Dogs Consolation/support/ humor

Feelings of acceptancejoy

11

Other animals nurturance Inner peace 3

Specific excercises Process issues/insight Selfimage/understand-ing/acceptance

7

Contact with handler/equine therapist

Process issues/insight Selfimage/understan-ding/acceptance

10

Main questions Subquestions will refer to:

• The moderators of effect in EFPP• The intersubjective relationship between patient

and dogs, horses and equine therapist• The enhancement of mentalization and

mindfulness skills• The preverbal or non-verbal sensory aspects• The added value of the setting

To what extent could EFPP be a more optimal psychotherapy than the usual forms of psychotherapy for patients with mental health problems arising from inadequate attachment representation?

What are the effects on psychological functioning in patients with mental health problems arising from inadequate attachment representation after EFPP?

What are the discernible differences on psychological functioning in patients who have undergone EFPP compared to patients who underwent regular psychotherapy?

Research objective

methods Mixed method design:

Quantitative : pre-post non-randomised (quasi) experimental design with repeated measures, TAU as control.

Questionnaires on: o psychological dysfunction (BSI)o Depression (BDI)o Working alliance (WAV)o Hope and selfconfidance (RL)o Attachmentrepresentation (HSL) and Personality problems

(SIPP-SF) (assessmentquestionnaires)

Qualitative: o Client Change Interviewo Semi-structured questions Treatment reporto Videoregistration of human-animal interaction in EFPP

Thank you for your attention!