Triads in Equine-Assisted Social Work Enhance Therapeutic Relationships with Self-Harming Adolescents
Clin Soc Work J
DOI 10.1007/s10615-016-0613-2
ORIGINAL PAPER
Triads in Equine-Assisted Social Work Enhance Therapeutic
Relationships with Self-Harming Adolescents
Catharina Carlsson1
© The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract Despite an increasing number of studies, there
is still a lack of knowledge about the unique features
that underlie the process in equine assisted social work
(EASW). This study aimed to reveal, through qualitative
methods, the dyads within the triad that become stronger
during the process of EASW, as well as the efect of the
participation of the horse on the relationship between
the counselor and client. Data were collected through indepth interviews with nine female self-harming clients
aged 15–21 years and eight staf members. The interviews,
together with video-recorded human–horse interactions
with three staf members and four clients were analyzed,
resulting in additional issues answered by these three staf
members and four clients in a second interview. Critical
dialogues between patterns and fragmentations in the narratives and video-recordings, as well as a dialogue with the
participants while they were viewing videos of their own
EASW sessions, led to the conclusion that adding a horse
qualitatively changes therapeutic relationships in EASW.
The diferent triads consist of diferent liaisons between
actors in the triad, giving rise to unique combinations. The
quality of the relationships depends on both the staf and
the clients’ attachment orientations. Further research is
needed to investigate how the degree of emotional connection to the horse afects the impact that horses have on triads in EASW.
* Catharina Carlsson
1
Department of Social Work, Linnaeus University,
391 82 Kalmar, Sweden
Keywords Adolescents · Attachment orientations ·
Equine-assisted social work · Self-injury · Therapeutic
relationship · Triads
Introduction
Social work practices promote social change and development by building therapeutic relations and identifying
needs, goals, and resources that unfold over time, representing unique combinations for every client (Adams
et al. 2009). These relationships are often modeled as
dyads (between two parties) and described as including
trust, empathy, honesty, respect, sensitivity, responsibility, patience, active listening, the ability to negotiate,
and responsiveness (Hasenfeld 2010). In equine-assisted
social work (EASW), however, the therapeutic relationships are conducted with a horse, resulting in a triad. Previous studies have focused primarily on the eicacy of
EASW as a method (Anestis et al. 2014) and not on the
process involving the role of the third party in the therapy. Given that results in the eicacy studies have shown
a discrepancy in results for the clients, interest in the process has been developed (Carlsson 2016), particularly
regarding the therapeutic relationship between client and
staf, which is of greatest importance in therapy or social
work (Bickman et al. 2004; Duncan et al. 2003; Lundberg et al. 2015; Kim et al. 2007). Relationships with
professionals are professional as well as interpersonal
(Lundberg et al. 2015). Therefore, it seems important to
recognize and acknowledge both the functional roles of
the clients and staf that may go beyond the purview of
the traditional professionalism, as well as the role of the
horse. Furthermore, helpful components of this relationship are determined by individual preferences, needs and
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Clin Soc Work J
wishes. Clients and staf may perceive the horse, intervention, and triad diferently (Vidrine et al. 2002). In
addition, if the activity could be equally efective without the horse or if the staf interacted more with the
horse than with the clients, then the therapy could not be
regarded as EASW (Notgrass and Pettinelli 2014). Further, the goal in EASW is to engage in and observe the
process between the client and the horse, which justiies
studying the process between the client and the horse in
the triad as well.
The dyadic model is limited by its disregard for the
inluence of one or several actors (Simmel 1971). Adding
a third party not only increases the number of participants,
but also qualitatively changes the relationship (Simmel
1971). A triad could consist of a liaison between two parts,
but cannot be explained without considering the role of the
third part. Likewise, a triad may be perceived as less threatening and engaging than a dyad, as the stigma associated
with treatment clinics is removed (Brandt 2013; Richmond
and Padgett 2002). However, the stable may be perceived as
an intimate, protective setting for one client but as threatening or stressful for another (Bachi et al. 2012; Yorke et al.
2008).
The present study is theoretically grounded in the work
of George Simmel, the forerunner of microsociology. However, the creative method (Alvesson and Kärreman 2007)
selected for this study calls for a more eclectic use of theories; in this case, system theory, social psychology, and
individual psychology, in the form of attachment theory.
EASW relies on the therapeutic relationship in the dyad
between staf and client, but could also be fueled by the client’s attachment to the therapeutic horse (Karol 2007). As
highlighted by Bower and MacDonald (2001), many programs that include animals have been developed with the
hope of creating an opportunity to form an attachment base
with another living being. However, there is debate regarding whether EASW relates more to attachment or caregiving (Kurdek 2009). Nevertheless, Bachi (2013) argues that
part of the gap between the practice and knowledge might
be understood within the framework of attachment theory,
the theoretical framework considered in this study.
There are indications that EASW can contribute positively to the treatment of emerging adults with psychiatric
disorders. It has been demonstrated that EASW may help
develop social skills and a feeling of mastery, improve
meta-cognition and relectivity, and increase self-conidence and self-esteem (Burgon 2012; Klontz et al. 2007).
EASW can also contribute to the development of communication skills, enable emotional awareness and regulation, reduce anxiety, and provide the opportunity to
experience authentic relationships (Bizub et al. 2003;
Carlsson et al. 2014). Even though not all studies (Ewing
et al. 2007; Greenwald 2001) found positive efects of
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EASW, it would still be useful to explore how EASW
may be used in the treatment of speciic client groups,
such as young persons with self-injury problems.
The clients included in the present study were in residential treatment for self-injury behavior at the time of
the study. Self-injury is a condition that often develops
during adolescence. Known causes include a combination
of an individual’s perfectionism, high standards, and low
self-esteem (Holmqvist et al. 2007; Jablonska et al. 2009;
Lundh and Bjärhed 2008). Emotional regulation may
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