Veterans, horses and the rediscovery of ‘with’

Several years ago, with MSc students Georgina Hodgman and Emma Pollard, I was facilitating a focus group with some long-term prisoners. The prisoners were all former members of the armed forces. There was real poignancy in hearing from people who had once served their country but were now serving sentences. During a break, one of them showed me a rather creased photograph of himself in happier times, wearing his scarlet tunic and bearskin whilst on duty outside a royal residence in London; his active service over a decade and a half had extended to numerous conflicts around the globe.

They were a diverse group in many respects. Yet all agreed emphatically, with more than a hint of nostalgia, when one said that, in the services, 'sometimes saying nothing means something, and saying something means something else'. Later I found a quote from a veteran of the Falklands War that seemed to be getting at something similar: 'It doesn't need to be said… you can hint towards it… they'll nod… and you'll know that they know' (Burnell et al., 2006, p.285).

That caught my eye, and related issues came into sharper focus when I became involved in evaluating an equine-assisted learning programme at Tower House Horses, Micheldever in Hampshire…

You can't fool a horse…

My first visit to Tower House was encouraging, yet I knew I needed to approach the evaluation with care. Research into equine interventions has been characterised by methodological shortcomings and sometimes extravagant claims (Anestis et al., 2014). Yet there is also substantial variation in forms and targets of intervention (Lee et al., 2016) and some 'confounds' such as novelty are hard to avoid (Barnfield, 2015). Even in more mainstream areas, much evaluative work fails to specify parameters of settings, and relies too much on group averages.

With such considerations in mind I conducted a small number of interviews along Realistic Evaluation ('context-mechanism-outcome': Pawson & Tilley, 1997) lines. These were aimed in part at developing materials for a larger-scale study, and included participants comparing photographs from their personal portfolios of the course.

Contextual aspects highlighted in the interviews included the peacefulness of the natural setting, time out from problems and an interpersonal environment that resembled a 'secure base' in the attachment theory sense. Against this background, in the words of one client, horses 'notice everything that's going on'; in those of another, 'you can't fool a horse'.

In terms of mechanisms or processes, this responsiveness to nonverbal cues (and the need to gain their trust in order to work collaboratively) makes horses and ponies a powerful source of feedback. One client described 'falling out' with a horse. In psychotherapeutic practice this might be termed 'relational rupture', and repair provided clients with vivid insights into their personal patterns and the possibility of alternative approaches which lead to different outcomes. Such feedback is immediate, direct and self-evidently authentic. Meanwhile, horses remain open to cooperating with fresh approaches in a way that is commendably non- judgemental.

Several photographs show synchrony between the gait and posture of client and horse, once trust and cooperation had been achieved. This nonverbal mirroring has also been observed in successful psychotherapy and other positive dyadic interactions. People described a sense of peace and immediacy, permeated with a sense of trust – one client described a 'turning point'. Although 'being in the moment' is an aspect of mindfulness that has been highlighted in interventions using horses, the photographs and interviews both suggested an importance of not just being in the moment, but being in the moment with another living being. One client spoke of the importance of achieving 'mental contact' with the horses and ponies. Another likened the experience to 'talking without speaking' and a third reported: 'I've lost a lot of knowing how to connect, but now it's like I've never lost it.'

This seemed a central and much-needed outcome. It resonated with those quotes from the start of this article. I couldn't shake off the thought that at times a conventional focus on what is 'within' a person (or animal) may result in the possibilities of 'with' being overlooked. As De Jaegher and colleagues (2010) pointed out, psychology has a long history of studying how we make sense 'of' people, but how we make sense 'with' them can be at least as significant.

Such concerns have parallels with developments relating to complexity and dynamic systems in other sciences. Interactions, and processes of change or transition, loom large in such thinking. And transition is an area of particular concern to the armed forces; sharing common processes with personal development (and its pitfalls) more generally.

Could such parallels help us to more fully understand the relevance and potential of equine-assisted learning?

Find where you belong

In Blake Ashforth's 2001 book on role transitions in organisational life, belonging is identified as one of four major interdependent areas – along with identity, meaning and control – needing realignment when individuals' organisational roles and circumstances are altered. It's regarded by many as a fundamental human motive. The military establishment demands an exceptional degree of social integration (Hatch et al., 2013), and indeed the British Army's current recruitment campaign invites potential recruits to 'Find where you belong'.

Analysing the transition into military life in these terms helps illuminate long-standing military practices. These include initial separation from civilian routines whilst building up an identity that is functional in the new setting; orientation to military values through structure, traditions and ceremonies; whilst increasing confidence and new ways of engaging tasks through discipline, training and teamwork. Driving all this is a sense of belonging, integration within a larger whole, including loyalty, comradeship, mutuality and coordinated activity at an interpersonal level. These patterns are crucial to resilience as well as performance (Jones et al., 2012).

Those four aspects I mentioned – identity, meaning, control and belonging – can be seen as necessary characteristics of a complex, embodied, self-organising, adaptive living system (Needs & Adair-Stantiall, 2018). To generate and maintain itself such a system requires a sense of unity and distinctness (identity); it derives from its environment information and patterns relevant to its purposes (meaning); to exercise choice it needs a sense of autonomy and self-efficacy (control); yet the whole system develops through learning, reciprocity and connectedness with similar systems (belonging). For inherently social beings the predominant other systems are, or originate from, other people.

The official medical history of the Second World War recognised this. A customary psychiatric demarcation involving an 'emphasis on the individual, almost as an isolated unit independent of group dynamics' came to be discarded as 'entirely artificial and meaningless' (Ahrenfeldt, 1968, p.177). Instead, the military establishment ensures social integration and operational effectiveness through both top-down constraints (such as regulations and traditions) and the bottom-up, 'emergent' outcomes of coordinated and shared activity within groups (Kozlowski, 2015). Just as the 'wetness' of water resides not in its constituent hydrogen or oxygen molecules, but arises from the interaction between them, so emergent features such as trust, collaborative problem-solving and humour stem from the interactions between individuals and are not reducible to them in isolation.

There remains an intrinsic tension and synergy between the need to balance and integrate participation, sharing and connectedness on one hand with distinctiveness, autonomy and 'emancipation' on the other (Kyselo, 2014). Interactions involving mutuality, shared attention and responsiveness bring together the outlooks of 'other' and 'self' in a relationship of 'intersubjectivity'. Coordinated activity in childhood sharpens awareness that others have perspectives, knowledge and intentions (including towards us) and that we can have them too. It is through mutually responsive interactions involving intersubjectivity that the capacity to navigate the social world emerges (Stevanovic & Blaski, 2018).

When belonging breaks down

Such considerations place the sense of 'with' between comrades or with horses in a broader perspective. However, as with many psychological processes, there is shadow behind the light. Stein and Tuval-Mashiach (2015) characterised some of the most pressing problems of troubled Israeli veterans as 'failed intersubjectivity'. So what happens when belonging is damaged or otherwise impaired?

Seen from a systemic viewpoint, a reduction in external interactions involving connectedness and coordination leads to a rigid coupling of internal processes (Laroche et al., 2014). A system that evolved to serve action in coordination with others can go into overdrive with self-focused concerns, often centred upon its own viability or preservation. With increasing dominance through repetition and failure to elaborate alternatives, these form 'attractor states' which allow little scope for flexible reorganisation (Hayes & Yasinski, 2015). Renewed development requires openness to other perspectives and the flexibility to engage and adapt. These are conspicuously absent across a range of forms of mental disorder (Kashdan & Rottenberg, 2010).

We must remember that many veterans do not suffer from mental health problems as a result of their time in service. Most come to make a successful transition from military to civilian life. Although media coverage might lead you to believe that post-traumatic stress disorder (PTSD) is an almost inevitable consequence of military service, research indicates that it affects a minority and that its prevalence is less than that of alcohol abuse, anxiety and depression.

Then again, current and former military personnel are a very heterogeneous population in terms of experiences before, during and after service. Whilst some service personnel experience substantial combat exposure and are at risk of 'sub-threshold' (which still cause significant distress and can fluctuate with circumstances) as well as diagnosable disorders, many are never deployed in front-line operations at all. For some, childhood adversity (including problematic attachment) confers vulnerability to later problems in adjustment, perhaps including those occasioned by leaving the military 'family' prematurely under less than ideal circumstances. It is known, for example, that there can be particular complications with 'early service leavers' of less than four years' service.

Exploding the moral bedrock

All that said, let's consider the specific example of PTSD. It's a concept that continues to be beset by controversy over criteria, processes and empirical support for central assumptions (Needs, 2018). Yet there have been important innovations, including growing recognition of the often-pivotal importance of the interpersonal dimension.

Precipitating events for PTSD tend to be most undermining when they arise from human intent (Charuvastra & Cloitre, 2008), deny personhood and explode the moral bedrock that enables a sense of common ground and safety. In military contexts, such events include atrocities but also situations permeated by moral ambiguity, betrayal, or failure to fulfil obligations. The term that has come to be used for this separable form of trauma is 'moral injury' (e.g. Currier et al., 2015). Emotional states of shame, anger, isolation or disillusionment are often prominent; distress may be maintained less by a sense of physical threat than by a profound, visceral disruption of social integration and shared sense-making. This may be exacerbated by a sense of difference in experiences and values to civilians more generally, although this and disruption in areas such as identity can cause problems in its own right (Mobbs & Bonanno, 2018).

Theories of impaired or incomplete 'processing' in PTSD and associated therapies are rooted in the tradition of making sense 'of'. If we accept the importance of making sense 'with', the hypothesis arises that experiences defy reconciliation when they seem to rip out even the possibility of intersubjectivity and connectedness. Trauma is more about shattering of a person's fundamental 'stance' towards a world and future of other people than loss of specific beliefs (Ratcliffe et al., 2014).

Overcoming trauma then turns upon overcoming a profound sense of isolation and displacement. Acknowledgement, trust and a degree of shared, responsive understanding can enable the finding of what Stolorow (2007) termed a 'relational home' for experiences that set a person apart from others (for an application to military personnel, see Carr, 2011). In practice, this may be a generic benefit of many interventions (Wampold, 2019) that are delivered with skill and sensitivity, but for some clients such issues may need to be at the forefront.

In addition, a major problem is that some of those most in need of experiencing connectedness and intersubjectivity are least likely to engage with help, professional or otherwise. A sense of difference, distrust and alienation can extend to potential sources of care even over practical matters such as housing and benefits. This is a good argument for making available sources of support such as peer mentoring, or for the involvement of charities run by former service personnel. For some veterans, however, problems may be complex and deep. Some may have tried conventional interventions but derived little benefit. This was the case with the majority of clients interviewed at Tower House.

The Tower House programme, then – out of doors, highly experiential, embodied, largely nonverbal methods, in situations that several clients emphasised were 'real' – may be especially appropriate for some veterans. Even non-veterans in the small sample contrasted these aspects with talking about memories or hypothetical instances in less immersive settings.

A note on anthropomorphism

Some readers may disregard any suggestion that mutual responsiveness and coordinated action with an animal might constitute an intersubjective process. Nonetheless, intersubjectivity is precisely how an equine intervention was characterised by Sharpe and Strong (2015), and Merritt (2015) described something similar in reciprocal exchanges with dogs. There was some suggestion that a tendency to anthropomorphic thinking in clients may enhance engagement – troubled clients can feel an affinity towards animals from a rescue background, or see something of their own tendencies, such as stubbornness, in an equine partner. But what is central here is the development of coordinated interaction between living beings and the emergence of experiences, actions and possibilities that would not have occurred otherwise. Along the way, many clients seem to rediscover that something akin to connectedness, or 'with', can be part of their lives once more.

There are other, complementary processes. It has been widely argued that interventions involving horses work at the level of metaphor, helping clients formulate new narratives as challenging tasks are accomplished and new patterns are brought forth. In the Tower House course, a task towards the end involves clients assembling a kind of obstacle course which represents their journey through life. Coaxing and leading a horse through what has been constructed tended to be experienced as elevating a sense of being no longer alone, an integration of emancipation (distinctiveness) and participation (connectedness) in Kyselo's terms; it may also foster a more open stance towards reconciliation with the specific issues depicted, including ones pertinent to Ashforth's framework. Parallels might be drawn with the symbolic enactments and liminal (transitional) states of rituals which help dislodge from rigid patterns and orient to new directions (Hinton & Kirmayer, 2017).

All clients described increases as the course progressed in capacities for self-reflection and self-awareness, particularly in seeing the link between their own and a fellow interactant's behaviour (whatever the species!). They frequently reported having learnt, through direct experience, to maintain calmness, set aside assumptions, appreciate other perspectives, consider options and not give up.

The trail ahead

Clearly, future research will need to address the durability, transferability and tangible benefits of immediate outcomes. We need bigger samples, and attention to issues familiar to other approaches (such as non-attendance and non-completion). Such research should not lose sight of the need for further delving into context and process, or of emerging analytical techniques from psychotherapy research based on interactional dynamics and patterns over time.

It is also important to be clear about intended targets. Benefits may be multi-faceted, but the strongest case may be made for equine-assisted learning as a means of enabling renewed openness and development through self-awareness and a deep experience of connectedness. In 'treatment-resistant' cases this may set the scene for engagement with more conventional forms of support or intervention.

Engagement with horses and ponies is not the only way of creating the conditions for collaborative participation with other living beings. I and others have previously touched upon other possibilities in relation to clients in criminal justice settings for whom a lack of connectedness to others is often a major problem (Akerman et al., 2018). To me, equine-assisted learning presents a distillation of processes which are at the core of effective psychological therapy and are intrinsic to social and personal development. For former members of the armed forces, these processes may also evoke something of what sustained them or was damaged in or following military service. Yet (crucial in working with veterans) this should not just be backward-looking. Several clients addressed this explicitly, one stating his realisation that 'We live a lot in the past, don't we?' Another expressed a rekindled sense of awe and connection as he stared at one of his photographs: 'To have something to trust me, to come to me…'. The experience of 'with' may enable a new beginning.

- Dr Adrian Needs  is Principal Lecturer in Forensic Psychology at the University of Portsmouth.

[email protected]

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