attachment theory
equine-facilitated therapy
horse-human bond
 human-animal interaction
animal-assisted therapy


Over the past two decades there has been a growing body of evidence, clinical and anecdotal, that equine-facilitated therapy (EFT) is a powerful tool for social workers and mental health clinicians. Recent research studies have begun to identify, name, and explain the mechanisms of EFT as a treatment tool for individual clients. However, EFT lacks a unified theoretical foundation; many studies lack an explicit theory altogether. Strong empirical support begins with a strong theoretical foundation, the research field lacks a unified voice for the scientific value of EFT. Attachment theory can guide the understanding of how EFT operates and can support more rigorous inquiry to evaluate its effect in mental health treatment. This article reviews the human-horse relationship in the context of attachment theory and concludes with a recommendation for research to strengthen the empirical base of EFT in social work practice.


American Horse Council. 2005. National economic impact of the U.S. horse industry. Retrieved from

Amiot, C. E., & Bastian, B. 2015. Toward a psychology of human–animal relations. Psychological Bulletin 141(1): 6.

Anestis, M., Anestis, J., Zawilinski, L., Hopkins, T., & Lilienfield, S. 2014. Equine-related treatments for mental disorders lack empirical support: A systematic review of empirical investigations. Journal of Clinical Psychology 70(12): 1115–1132.

Bachi, K. 2012. Equine-facilitated psychotherapy: The gap between practice and knowledge. Society & Animals 20(4): 364–380.

Bachi, K. 2013. Application of attachment theory to equine assisted psychotherapy. Journal of Contemporary Psychotherapy 43(3): 187–196.

Bachi, K., Terkel, J., & Teichman, M. 2011. Equine facilitated psychotherapy for at-risk adolescents: The influence on self-image, self-control, and trust. Journal of Clinical Child Psychology and Psychiatry 35: 403–411.

Berget, B., & Ihlebæk, C. 2011. Animal-assisted interventions; effects on human mental health-A theoretical framework. In Uehara, T. (Ed.). Psychiatric Disorders-Worldwide Advances. Retrieved from

Bowlby, J. 1969. Attachment and loss. Volume 1: Attachment. New York, NY: Basic Books.

Bowlby, J. 1982. Attachment and loss, Second Edition. New York, NY: Basic Books.

Burgon, H. L. 2011. Queen of the world: Experience of ‘at-risk’ young people participating in equine-assisted learning therapy. Journal of Social Work Practice 25(2): 165–183.

Burgon, H. L. 2014. Equine assisted therapy and learning with at-risk young people. New York, NY: Palgrave Macmillan.

Button, S. S. 2010. The effects of therapeutic horseback riding on classroom attention of special education students. Northern Illinois University.

Carlsson, C. 2016. Equine-assisted Social Work or Therapy–Addressing Gaps and Contradictory Results. In Equine Cultures in Transition: Human-horse relationships in theory and practice: changing concepts of interaction and ethics 27-29 Oktober.

Dashper, K. 2015. Listening to horses: Developing attentive interspecies relationships through sport and leisure. Society and Animals.

Dunlop, K., & Tsantefski, M. 2017. A space of safety: Children's experience of equine‐assisted group therapy. Child & Family Social Work.

Equine Assisted Growth and Leadership Association (EAGLA). 2015. Why horses? Retrieved from

Esbjorn, R. J. 2006. When horses heal: A qualitative inquiry into equine facilitated psychotherapy. (Doctoral dissertation.) Institute of Transpersonal Psychology, Palo Alto, CA.

Ewing, C., MacDonald, P., Taylor, M., & Bowers, M. 2007. Equine-facilitated learning for youths with severe mental disorders: A quantitative and qualitative study. Child Youth Care 36: 59–72.

Fine, A.H. 2016. Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice (2nd Ed). New York: Academic Press.

Fook, J. 2014. The meaning of animals in women’s lives: The importance of the 'domestic' realm to social work. Animals in Social Work: Why and How They Matter, 18.

Fox, V.M., Lawlor, V.A., & Luttges, M.W. 1984. Pilot study of novel test instrumentation to evaluate therapeutic horseback riding. Adapted Physical Activity Quarterly 1 (1): 30-36.

Geist, T. 2011. Conceptual framework for animal assisted therapy. Journal of Child and Adolescent Social Work 28: 243–256.

Hallberg, L. 2008. Walking the way of the horse: Exploring the power of the horse-human relationship (p. 78). Bloomington, IN: iUniverse.

Harris, A., & Williams, J. M. 2017. The impact of a horse riding intervention on the social functioning of children with autism spectrum disorder.

International Journal of Environmental Research and Public Health 14(7): 776.

Hausberger, M., Roche, H., Henry, S., & Visser, E. K. 2008. A review of the human–horse relationship. Applied Animal Behaviour Science 109(1): 1–24.

Hoy, J., & Wehman, S. 2017. The relevance of human-animal interaction for social work practice. Washington, DC: NASW Press.

International Association of Human-Animal Interaction Organizations. 2014. IAHAIO White Paper. In (EDs.) Fine, A. H. (2015). Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice. (pp. 415-418). NY: Academic Press.

Kaplan, S. 1995. The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology 15(3): 169-182.

Karol, J. 2007. Applying a traditional individual psychotherapy model to equine-facilitated psychotherapy (EFP): Theory and method. Clinical Child Psychology and Psychiatry 12(1): 77–90.

Kemp, K., Signal, T., Bortros, H., Taylor, N., & Prentics, K. 2014. Equine facilitated therapy with children and adolescents who have been sexually abused: A program evaluation study. Journal of Child Family Study 23: 558–566.

Kern-Godal, A., Brenna, I. H., Arnevik, E. A., & Ravndal, E. 2016. More than just a break from treatment: how substance use disorder patients experience the stable environment in horse-assisted therapy. Substance Abuse: Research and Treatment 10, 99.

Kidd, A. H., & Kidd, R. M. 1987. Seeking a theory of the human/companion animal bond. Anthrozoös 1(3): 140-145.

Krob, K. E. 2015. Heroes and horses: Veteran and equine experiences with equine facilitated learning and therapy. Dissertation: University of Northern Colorado Press.

Lentini, J. A., & Knox, M. 2009. A qualitative and quantitative review of equine facilitated psychotherapy with children and adolescents. The Open Complementary Medicine Journal, 1: 51–57.

Matuszek, S. 2010. Animal‐facilitated therapy in various patient populations: Systematic literature review. Holistic Nursing Practice 24(4): 187-203. doi:10.1097/HNP.0b013e3181e90197

McCullough, L., Risley-Curtiss, C., & Rorke, J. 2015. Equine facilitated psychotherapy: A pilot study of effect on posttraumatic stress symptoms in maltreated youth. Journal of Infant, Child, and Adolescent Psychotherapy 14(2): 158-173.

Messent, P. 1987. Problems with an encompassing theory. Anthrozoös, 1(3): 149-150.

Naste, T. M., Price, M., Karol, J., Martin, L., Murphy, K., Miguel, J., & Spinazzola, J. 2017. Equine Facilitated Therapy for Complex Trauma (EFT-CT). Journal of Child & Adolescent Trauma 1-15.

Nimer, J., & Lundahl, B. 2007. Animal-assisted therapy: A meta-analysis. Anthrozoös 20(3): 225-238. doi:10.2752/089279307X224773

Poresky, R. H. 1990. The young children's empathy measure: Reliability, validity and effects of companion animal bonding. Psychological Reports 66(3): 931–936.

Poresky, R. H., & Hendrix, C. 1990. Differential effects of pet presence and pet-bonding on young children. Psychological Reports 67(1): 51–54.

Professional Association of Therapeutic Horsemanship International (PATH International). 2015. About PATH Intl. Retrieved from

Roth, E. Q., Vega, B. J., Torres, R. M., Soler, S.M.C., & Pazos, R.M.M. 2005. From kids and horses: Equine facilitated psychotherapy for children. International Journal of Clinical and Health Psychology 5(2): 373–383.

Sable, P. 2013. The pet connection: An attachment perspective. Clinical Social Work Journal 41(1): 93-99.

Schultz, P. N., Remick‐Barlow, G., & Robbins, L. 2007. Equine‐assisted psychotherapy: A mental health promotion/intervention modality for children who have experienced intra‐family violence. Health & Social Care in the Community 15(3): 265-271.

Sempik, J., Aldridge, J., & Becker, S. 2005. Health, well-being, and social inclusion: Therapeutic horticulture in the UK. Bristol, UK: Policy Press.

Tedeschi, P., Fitchett, J., & Molidor, C. E. 2005. The incorporation of animal-assisted interventions in social work education. Journal of Family Social Work 9(4): 59–77.

Trotter, K. 2001. Harnessing the power of equine assisted counseling: Adding animal assisted therapy to your practice. New York, NY: Routledge.

Trotter, K., Chandleer, C., Goodwin-Bond, D., & Casey, J. 2008. A comparative study of the efficacy of group equine assisted counseling with at-risk children and adolescents. Journal of Creativity in Mental Health 3(3): 1–42.

U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. 2015. Child health USA 2014. Rockville, MD: Author. Retrieved from

Walsh, F. 2009. Human‐animal bonds I: The relational significance of companion animals. Family Process 48(4): 462–480.

Wilson, C. C. 1994. A conceptual framework for human-animal interaction research: The challenge revisited. Anthrozoös 7(1): 4-24.