Hoofprints - Stanford Medicine and Horsemanship

ADDY

An entry on how I chose that horse, or how we chose each other.

This was the second class of the day. There were 3 horses. And we were each asked to say hi to each horse and choose one that you wanted to work with.

There was this broad male horse that was young, active, dominant, healthy and energetic.
There was this other horse, a submissive tender female horse that seemed really nice and gentle.

Then there was this smaller horse, off by itself, really restless, seemingly bored and anxious at the same time, hooving at the gate as if waiting to get out of the ring.
He immediately reminded me of myself. I too was hyperactive, comfortable to be doing my own thing away from the pack, and at times anxious about the situations. I nicknamed him ADDY, because he seemed quite ADD (attention-deficit disorder), and I chose to work with him.

In retrospect, I think what drew me to him was the fact that he seemed complex. I wanted to figure him out, help him out by easing his anxieties. Perhaps its no surprise that the other two medical students also chose him.

Turns out he was an older Ararbian horse, a breed of horse that gets bored easily, is very intelligent, and he was also past his prime so he didn't care much about trying to mate with the female horse who was in heat. Can't say the same about the broad young male horse.

We are drawn to other people who are similar to us. We also tend to see qualities in other people in terms of ourselves- how are they similar and how are they different? As a budding psychiatrist, I think its important to keep these in minds. The one person we know best is ourselves, and understanding ourselves, our personality and traits can help us understand the human mind and how other people are. But at the same time, this can blind us as we think from a subjective perspective, an egocentric one perhaps, that is framed by who we are and who we are not. Something to keep in mind.

How playing with horses for 2 months left a strong impression on me

I would like to echo the special thank you to all the course facilitators.

I joined the course as a way to get off campus and have a relaxing Wednesday afternoon off from medical school, but the course has been much more than that. It has opened my eyes to the possibilities of different treatment modalities, especially in relation to mental health. Equine-assisted therapy is truly a fascinating subject I hope to learn more about and engage in later in my career as a child/adolescent psychiatrist.

Horses have also taught me a lot of social dynamics, the importance of strong leadership, nonverbal communication such as body language, intention and emotional tone of our words. Experts have often said communication is 90% non-verbal, and I believe it. I think the class has made me a much more aware and effective communicator, and even a more strong leader.

Thank you!

Response - Is love enough??

In this subject I tend to be idealistic so I had to give this some thought. I certainly think it is the foundation of most of what is good in this world. In working with the horses is it enough to get them to do something they are uncomfortable with? Very much like humans this will in part depend on whether trust accompanies that love. The horses must at this point in the course sense we mean them no harm but is this the same as having nothing but good intentions? Afterall, they rely heavily on instinct. Being domesticated doesn’t squash this survival mechanism. If both trust and love are there is THIS enough? I trust and love my husband but he could not talk me into skydiving! Equally important we must consider what are that particular horses’ life experiences, temperament, external influence in that moment and perception of the task.

As with our human patients we must always weigh the benefit of persuasion with the ultimate outcome keeping in mind our methods will need constant adjustment depending on the goal and patient.

In gratitude

I would like to take a moment to extend my deep and heartfelt gratitude to Dr. Kane, the teaching assistants, and my fellow classmates for the wonderful and transformational experiences I have gained while in the Medicine and Horsemanship course. When I entered the course, I was already in a place of transition regarding my academic career and the direction my dissertation and eventual career as a psychotherapist was taking. However, I never expected that as the course continued those transformations would continue to evolve in ways I would have never dreamed of. Now as the course is coming to a close I am amazed at what doors have appeared before me. I am now re-considering doing my dissertation on equine-assisted therapy or somewhere in that direction, I still have some time to decide and there are so many interesting options to consider. :) I am also very excited to attend, hopefully with Dr. Kane, a weekend course regarding equine-assisted psychotherapy in April. I feel very grateful to have bonded with a handsome horse by the alias of “Orion,” and to top if off I was lucky enough to have all of you there to experience this with me. Thank you all for sharing this course experience with me; it has been an exciting ride. Thank you to the teaching assistants for bringing your knowledge, skills, and compassion to the course. A special thank you to Dr. Kane for offering this amazing course and for caring enough about this topic to step forward as a medical professional and teacher to pass down your wisdom to us with passion, presence, and peace.

NCEFT

I must admit that I was more than a little bit skeptical of the benefits of equine assisted rehabilitation prior to visiting NCEFT. I couldn't imagine how the movement of a horse could be a better course of therapy than work with a licensed physical therapist. Even after watching the DVDs provided by the facility, I still was unconvinced.

It was the moment that I saw one of the children atop the horse, overcome with enthusiasm and working hard to ride by herself that my opinion changed. The horses awakened in her an unrestrained excitement, which led to strong motivation to perform the activities requested by the physical therapist. I feel that this motivation is especially important for children, who may not understand why they need to undergo grueling physical therapy that none of their friends have to undertake. I agree with Tamara that it was magical seeing the children interact with the horses.

I was also struck by the total cost of running such a facility (they estimated $2,000 for a half hour session), and I was amazed that such a facility could exist, despite its astronomical cost. I think it really exemplifies the things that are possible when you get together a group of horse-lovers with a passion for helping others.

-Shawn

Field trip to NCEFT

Yesterday, our class took a field trip to the National Center for Equine Facilitated Therapy (NCEFT). Located in rustic Woodside, Calif., the center has provided equine assisted therapy and activities to individuals with special needs for over 37 years. Today, they treat approximately 100 patients with a variety of health conditions.

What an eye-opening experience for me in many ways, and I had two big revelations.

First, I had never connected the movement of the horses with the movement of humans. Riding a horse creates similar walking patterns in pelvis rotation and twist. Seeing this movement in action helped me understand how powerful equine therapy could be in assisting people develop those same muscles, particularly if they cannot fully walk themselves.

Second, I saw two children, both around ages 6-8, with cerebral palsy undergo personal physical therapy sessions with a horse. While both children required assistance to walk and move, they were simply giddy to see and interact with the large gentle animals. Responding to animals opens up another (nonvocal?) dimension, and watching the kids helped me understand the healing magic that pets might provide. Somehow these two children managed they sit up and play catch on the horses, helping to strengthen their core muscles and improve hand-eye coordination. It was an incredible transformation.

Advise (, Pet,) and (No) Consent

Love makes the world go around but will it help a horse do a very scary thing?

Varied Responses

Many lessons learned this past week during the “informed consent” portion of our internship with the horses. It is interesting to see emerging both student and horse personalities.

The task at hand was to lead the horse over a shiny, crinkly mylar space blanket. Add to this mild yet stormy weather and a good size human audience and you’ve got some varied responses from our horse “patients”. It was interesting to watch the different approaches. So many lessons were learned in this small space of time! When I attempt to relate this to patient care I am reminded there are many facets to these relationships. What is the clinician’s end goal? What is the patient’s perception of how necessary a test or procedure is? Is the trust established to date enough of a motivator to convince a patient to move forward? Is that trust built on reputation, intimidation or mutual respect? Finally, if a patient declines care, how much of that responsibility should the clinician absorb?

Of the three horses, one examined the blanket by pawing and studying it first before going over. This was impressive! He wanted to figure it out himself. The next horse was fine walking on it but not if we walked on it first and reminded her of the noise it made. The last horse despite much effort just wasn’t having it. These scenarios were such a great representation of how different patients might react to the same situation. You have your investigative patient, your committed but don't remind me what it is going to be like patient and finally your non-compliant (at least for now) one. What a great learning experience!

Informed Consent

Consent to walk over a Mylar blanket? No problem, at least not for me and surely, I thought, not for our teams dream horse the sweet, calm, cooperative, Beau/Orion/ Remy. In my mind it was just a harmless sparkly, blanket. Boy was I wrong!

We began our walk as usual with Beau calm, gentle, and willing, until we got within a few feet of the blanket. The entire expression and motion of this Paint horse changed. He signaled loud and clear how very frightened he was. His eyes widened, ears pointed forward, his nostrils flared, and his feet and body refused to move forward toward the blanket. I thought if I showed him I was calm and walked him forward he would follow. He did not. I tried to be playful and encouraging, he was still terrified by an object I saw as harmless. Nothing I did seemed to help this sweet horse relax or feel any safer. On reflection of our interactions, I believe, I should have gone even slower, no rush in trying to convince Beau to go over the dreaded blanket, to sign his informed consent, so to speak, today. I think for Beau going slower is perhaps the best and fastest way for him to learn and to accomplish this goal.

I know in my work as a healthcare provider, I often ask children or their parents to accept a procedure, a medication, or sign a consent, right now. My interactions with
Beau have allowed me to better understand that something I perceive to be harmless, routine, or needed might, in fact, be incredibly stressful or frightening; even though I do not perceive it as such. I will be more mindful of this as I work with children and their families.

Choose or be Chosen

Choose or be chosen?

Wednesday our second day of class at Webb Ranch was so interesting, insightful, and so much fun. Even though I have been around horses for the past few years I have little understanding of their body language or meaning.

I feel so honored to be a part of this class. What I have learned so far has allowed me see the horses actions and interactions much more clearly. I actually think I understood much of what they were saying with their body movements and facial expressions. I am so excited by the fact that I can learn to have interspecies communication!

I chose the horse whose name we did not know; he was the beautiful white and chestnut Paint Quarterhorse. I believe now from just reading the Blog that is his name is Dream. How very strange I am now thinking, as I remember the first day of class I wore a tee shirt with large print that read "Dream". Is this destiny, a case of synchronicity, or just a strange coincidence? Who knows and I am not sure that "Dream"
is really his name. I will ask next class. Even if it is not it certianly seems most fitting for him. He was truely a Dream (patient) during his physical exam and during the entire class as he stood and walked with us in the corral.

I look forward to our journey with each other and with the horses. Eileen