Wednesday, December 2, 2015
Social Workers Gallop Off in All Directions
I recently came across a document that stated that the National Association of Social Workers has endorsed “equine-assisted therapy” (EAT) for mental health problems. “Wha-a--?”, I said, and began to look up whether there had been such an endorsement. Now, this can be hard to do; I know NASW sometimes passes resolutions at their annual conference, and these can be hard to locate later for those of us who are out of the social work loop (e.g., the resolution against Holding Therapy some years ago). I didn’t find a resolution about EAT, but I did find that NASW had given continuing education credits for a class on this topic (naswct.org/wp-content/uploads/2015/04/NASW-Conference-2015-Brochure.pdf).
Horseback riding has been used therapeutically for many years for children with cerebral palsy and other neurological disorders that contract muscles and distort the structure and function of the limbs. Riding provides a warm and gentle stretch for leg muscles and is so enjoyable that children are distracted from any discomfort. But, of course, this does not mean that people with other kinds of disabilities-- people who don’t need their muscles stretched—will also benefit from horseback riding. (Similarly, prescription eyeglasses that correct visual disabilities don’t help hearing impairments.)
For some time now, there has been a strong tendency to equate mental illnesses with “brain disorders”. Certainly it’s true that at some level every mental illness has a foundation in brain function and even structure, but this does not mean that it makes sense to force all mental illnesses and all results of brain injury or atypical development unto the same category. I understand the motivation to do this forced combination—everyone knows the results of an injury are not the victim’s fault, and some people still think that the mentally ill could stop being sick if they really tried, so presenting mental illness as equivalent to brain damage supports the important argument that the mentally ill should not be stigmatized.
The two things are not really exactly the same, though, and their treatments cannot be identical. Brain disorders like CP can have powerful effects on the body and affect children’s behavior and development by damaging physical growth and abilities. Horseback riding helps corrects muscle and bone development and use; it does not cure the brain damage that caused the problems of physical development. It won’t cure any posited brain disorders that may lie behind mental illness, either.
Horseback riding, and learning to handle and care for horses, can be great fun for kids, and shared enjoyable activities are an important key to social skills, sharing, taking turns, and understanding other people. Sharing such activities with a social worker or other helping person can improve interactions and help establish a strong relationship.
But these points are a far cry from evidence that EAT in itself is an effective treatment for autism, ADHD, or other disturbances of children’s mental life. There is very little evidence to that effect. In a recent review, Kendall et al (2014; Explore, 10(2), 81-87) described EAT as under-researched and largely anecdotal in its support. Even though there are randomized designs used in some studies of EAT, they generally fall down by having a treatment group who have elaborate social, interactive, and riding experiences, but are compared with another group who are given no new experiences at all. This failure to isolate the horseback-riding variable means that no one can know whether apparent benefits came from increased social experience, from interactions with social workers or other helpers, or from riding itself.
In addition to the lack of empirical evidence supporting EAT as a therapy for children with developmental delays or other mental problems, there has been a strong tendency for advocates of EAT to make exaggerated, even ludicrous, arguments for the treatment. I discussed some of these several years ago at http://childmyths.blogspot.com/2011/02/clever-hans-rides-again-equestrian.html. I was responding to claims that horses know when a child is lying (they don’t care for this, it seems), and that a horse’s gait is “downloaded” into a child’s brain, thus apparently doing an end run around all the problems that have been blamed (wrongly) on a lack of crawling experience. These both summon entertaining images-- a deeply disapproving horse shaking its head at a fibbing child (but why lie to a horse?), and the probable human gait that would be based on a “downloaded” horse pattern. (This last makes me think of playing horses as a little girl and being both horse and rider simultaneously.)
Perhaps NASW feels that interest in EAT by social workers can lead to some serious research about the treatment’s effectiveness, and that is possible, even though much about the treatment is implausible. Nevertheless, it would be wise to limit shows of approval like continuing education credits until better evidence is presented. It would also be a good idea to draw the line clearly between the “downloading” faction and the work of those who are interested in the actual possibilities of this proposed treatment modality.