Equine 'colleagues' can help protect therapists from burnout

by Norwegian University of Science and Technology

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"Including a big, warm creature in the therapy space creates a completely different dynamic than what can be achieved in an office," said Charlotte Fiskum, associate professor of psychology at the Norwegian University of Science and Technology (NTNU). She has led a study at NTNU demonstrating that equine-assisted therapy helps therapists and protects them from burnout.

The work is published in the journal BMC Complementary Medicine and Therapies.

"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. Horses help both the therapist and the patient by providing a physical starting point for building a good relationship and addressing difficult issues. Horses can help build a safe bridge between the therapist and the patient," Fiskum said, speaking on behalf of the research group.

Using horses to help regulate emotions

The study was based on 10 in-depth interviews with experienced psychiatrists and psychologists who, in addition to extensive experience as psychotherapists, had also worked for at least 10 years with equine-assisted therapy. The interviews were conducted by lead author Norunn Kogstad, a Ph.D. research fellow and psychiatrist.

"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," Fiskum said.

She believes that psychologists should work more in teams, but 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. There is a lot that we may not be able to provide enough of within the current framework of mental health care," Fiskum added, emphasizing that every case is different.

Animals as therapy facilitators

"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," Fiskum said.

Numerous studies show that simply spending time with animals such as horses and dogs can benefit 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.

"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," Fiskum said.

She said many animals can serve as facilitators in a therapeutic setting, but argued that horses are better suited than dogs because horses are both prey and herd animals, meaning they have 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. When a horse reacts to an emotion, it does not hesitate in expressing it. It may back away, neigh or clearly signal that it does not want contact," Fiskum said.

A miniature laboratory for bonding

A horse that is relaxed and trusts the people present may try to rest its head on a person's shoulder. It might also try to get attention by rubbing its muzzle against a 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 behavior to understand how they interact with other people, providing useful insight," Fiskum said.

For example, a therapist who uses cognitive therapy can use the patient's interpretation of the horse's behavior and reactions to identify and change negative thought patterns.

"A horse does not care about your appearance, what education you have (or don't have), and it does not judge you for something you have 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 criticized or rejected. Working with horses is a bit like a miniature laboratory for bonding and social interaction," Fiskum added.

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 researched the use of horses in substance abuse treatment and 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," Fiskum said.

She also believes there should be greater flexibility in how therapy is conducted because 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 is important that the therapy is associated with something that the patient experiences as safe," Fiskum said.

Equine-assisted therapy is offered at Oslo University Hospital, among other places, and there are also a number of private providers. This study was conducted in collaboration with the Lundehagen Center for Psychotherapy and Research, which is led by psychiatrist and Ph.D. research fellow Norunn Kogstad.

More information

Norunn Kogstad et al, Therapists' reasons for including horses into psychotherapy, a qualitative study, BMC Complementary Medicine and Therapies (2025). DOI: 10.1186/s12906-025-05185-2

Key medical concepts

burnoutCognitive Behavioral Therapy

Clinical categories

PsychiatryPsychology & Mental health Provided by Norwegian University of Science and Technology Who's behind this story?

Sadie Harley

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