1. Is an inclusion of a natural setting, horses and dogs, beneficial for a client in psychodynamic psychotherapy? Géza Kovács Heerlen, 6th december 2013

2. versus What is it about?

3. 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 psychodynamic Psychotherapy 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?

4. 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?

5. 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

6. Preliminary results Client Change Interview (N=15) Cause of changeExperienceChangeNumber Setting/environmentRest/calmnessInner peace6 HorsesMirroring/warmth/challen ge/setting boundaries Selfimage/ insight/ selfconfidence 11 DogsConsolation/support/ humor Feelings of acceptance joy 11 Other animalsnurturanceInner peace3 Specific excercisesProcess issues/insightSelfimage/understand- ing/ acceptance 7 Contact with handler/ equine therapist Process issues/insightSelfimage/understan- ding/ acceptance 10

7. Main questionsSubquestions 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

8. 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 Interview o Semi-structured questions Treatment report o Videoregistration of human-animal interaction in EFPP

9. Thank you for your attention!