The Horse Listeners

Before Devon Combs stepped into the arena at Mirasol Recovery Centers, she felt lost. At just 21 years old, she had already been faking happiness for years, but her battle with depression and bulimia had recently led her to drop out of school, contemplate suicide, and spend time in a Denver psychiatric ward. Then she met equine therapist Marla Kuhn and Jack the therapy horse.

Combs grew up with horses, but it wasn’t until adulthood that she fully embraced what they did for her, and what they can do for many of us. Humans have depended on horses for millennia. In the more than 50 centuries since being domesticated, they have been our partners in work, our comrades in war, and our teammates in sport.

Recently, wellness professionals have begun harnessing that bond for another purpose: helping us heal. A wide range of equine-assisted activities — incorporating riding, life coaching, and psychotherapy — are gaining recognition as effective tools for processing emotions, catalyzing change, and treating physical and mental health conditions.

When Combs and her fellow patients piled out of the van at the ranch where Mirasol held its equine therapy sessions, she looked forward to the familiarity of horse time and the opportunity to display her competence with the animals. But when she strutted into the arena, Jack turned abruptly and walked away, leaving her confused and embarrassed. Her therapist told her to stop and breathe and wait. It was in that unexpected moment of vulnerable stillness that things started to shift.

“My inner critic’s voice was nowhere to be heard and I was aware of a connection to my body, which felt foreign. For the first time in a long time, I wasn’t trying to make things happen, trying to change the way I felt, trying to change the way I looked, or trying to make everyone like me. I gave myself permission to just stand still and breathe. Simultaneously, Jack walked straight up to me from the far side of the arena,” Combs recalls.

Healing interactions with horses can come in a number of variations. Some approaches get patients and clients into the saddle. Hippotherapy, for example, takes advantage of the fact that the cadence of an equine’s walk mimics our own. The pelvic movements build muscle and develop balance. Therapeutic riding, on the other hand, teaches skills that help kids and adults with developmental disabilities learn body control and patience and have fun while they’re at it. Other programs keep people on the ground, where they tackle a variety of interactions depending on their particular needs. They might practice leading a horse from Point A to Point B, learn skills for basic care, or engage in talk therapy, relying on the horse’s presence for emotional support.

And across that diverse spectrum of equine-assisted activities, people are experiencing benefits. Riders with spinal cord injuries and cerebral palsy find their neurological and motor functioning get better. Individuals struggling with PTSD report lower stress and greater ability to manage emotions. Those on the autism spectrum develop social skills and empathy. And a growing body of research suggests that just spending time with horses calms our autonomic nervous system, improves self-esteem and self-efficacy, and helps youth learn impulse control, the value of commitment, and the payoffs of having responsibility. But why?

If a person is experiencing extreme grief, a therapy horse might lie down at their feet, groaning, even if they’ve convinced loved ones they’ve recovered.

According to certified horse handler Suzanne Opp, simply sitting atop a horse provides people with a different, more powerful perspective on the world, and riding the animals as they calmly walk around a pen can relax tension and improve mobility. While the precise mechanisms underpinning horses’ health-promoting effects on us aren’t fully understood, most experts credit two innate equine characteristics as the primary factors. First, horses are prey animals. As such, they evolved to be highly sensitive, hypervigilant, and always present in the moment. They are thus able to detect and interpret subtle cues and tiny changes in their surroundings. These traits are most explicitly highlighted when working with veterans with PTSD, who, according to Columbia University’s Man O’ War Project, may recognize and relate to the heightened fear response. Second, horses are social creatures. Whether wild or domestic, they prefer to live in herds and thus seek out relationships with other animals, including humans. A 2016 study published in Biology Letters demonstrated that horses are able to read and interpret people’s conscious and unconscious movements and facial expressions. And they want communication to be clear and congruous. In the therapy session described above, Devon Combs’s contradictory emotions — her attempts at appearing strong when inside she felt a mess — violated this principle and prompted the horse to keep his distance. It wasn’t until she accepted her own emotional state that he approached.

Now a certified practitioner in the Equine Gestalt Coaching Method, Combs works one on one with clients in the Denver area and leads retreats throughout the U.S. She still marvels at horses’ ability to sense things we don’t. “Horses are intuitive, and they’re masters at reading human body language. They naturally pick up on a person’s emotional state and energy. When a 1,200-pound animal reacts based on what they’re reading from us, it can’t be denied,” she says.

This sensitivity is arguably what allows horses to shine light on our inner worlds, particularly if there are gaps between a true state of being and a false façade. If a person is experiencing extreme grief, even if they’ve convinced loved ones they’re now doing fine, the horse might lie down at their feet, groaning. Patients who make a habit of faking fearlessness when frightened will find that their equine partners sense their anxiety and grow anxious, too.

Before she pursued her own career in equine-assisted therapy, Suzanne Opp was one of Combs’s clients. The equines, she explains, serve as a mirror. “Horses help people get in touch with feelings that they may not be able to through talk therapy methods or talking with a human,” she says. “They’re so reflective, the horses bring out things in us that we may not realize are there.”

The therapists, coaches, and handlers who partner with equines in these activities focus on how the animals respond to patients and clients during sessions. Combs refers to herself as a facilitator, stringing pieces of information together. “I’m a horse listener,” she says. “I’m listening and watching, and when needed, asking the client coaching questions that will further help them uncover their truth with the help of the horse. The horse is giving the big feedback.”

Similarly, Opp says that much of the therapeutic interaction hinges on her observations of the horse’s behavior. If the horse lies down and rolls onto its side or back, or licks and chews (a sign of thoughtful processing and relaxation), she points it out to the therapist who then asks the patient to offer an interpretation. Often, the horse’s actions represent something that feels familiar, but that we might not have been able to see or articulate previously: For example, a woman who feels ignored by her husband at home might recognize and articulate that experience only when her equine partner turns away in the round pen.

Part of why these opportunities for reflection work so well, experts believe, is that they are framed through the judgment-free lens of the horse’s behavior. It opens up a route for self-analysis that’s separate from expectation or fear of failure. And it’s typically where surprises are unveiled.

It has now been a decade since Combs became an Equine Gestalt Coach, and the healing power of horses continues to gain acceptance. For many like Combs and Opp, the experience is so transformative it inspires them to become a practitioner themselves. There are now hundreds of certified instructors, horse handlers, and coaches throughout the United States and beyond; and Columbia University Irving Medical Center’s Man O’ War Project is developing research-based guidelines for using horses in the treatment of PTSD. Furthermore, the link between horses and well-being, once a fringe idea, is becoming more mainstream. In addition to therapy and coaching retreats like the ones Combs leads, ranches all over the world are offering programs that integrate horse time with yoga and meditation.

“It was in the arena I discovered that it was okay, in fact healthy, to be myself,” Combs says. “Which is what horses had brought me all along, without judgment or asking anything in return, except for me to be in my heart. Horses came into my life at an early age to be my companions on my journey. They stuck by me through hell and I always drew strength from their wisdom, spirit, and power.”

This article is featured in the May/June 2020 issue of The Saturday Evening Post. Subscribe to the magazine for more art, inspiring stories, fiction, humor, and features from our archives.

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My First Patient

In my final year of graduate school, I was required to do a clinical traineeship.

The traineeship is like a baby version of the 3,000-hour internship that comes later and is required for licensure. By this point, I’d taken the necessary coursework, participated in classroom role-play simulations, and watched countless hours of videotape of renowned therapists conducting sessions. I’d also sat behind a one-way mirror and observed our most skilled professors in real-time therapy sessions.

Now it was time to get in a room with my own patients. Like most trainees in the field, I’d be doing this under supervision at a community clinic, much the way medical interns get their training in teaching hospitals.

On my first day, immediately after the orientation, my supervisor hands me a stack of charts and explains that the one on top will be my first case. The chart contains only basic information — name, birth date, address, phone number. The patient, Michelle, who is 30 and has listed her boyfriend as her emergency contact, will be arriving in an hour.

If it seems strange that this clinic is letting me, a person who has performed exactly zero hours of therapy, take on somebody’s treatment, it’s simply the way therapists are trained — by doing. Medical school was also a trial by fire; in medicine, students learned procedures by the “see one, do one, teach one” method. In other words, you watched a physician, say, palpate an abdomen, you palpated the next abdomen yourself, and then you taught another student how to palpate an abdomen. Presto! You’re deemed competent to palpate ­abdomens.

Therapy, though, felt different to me. I found performing a concrete task with specific steps, like palpating an abdomen or starting an IV, less nerve-racking than figuring out how to apply the numerous abstract psychological theories I’d studied over the past several years to the hundreds of possible scenarios that any one therapy patient might ­present.

As if on cue, she starts crying. And by crying, I mean howling in the way one might if just informed that the person she loves in the world has just died.

Still, as I make my way to the waiting room to meet Michelle, I’m not terribly worried. This initial 50-minute session is an intake, which means I’ll gather a history and establish some rapport with her. All I have to do is collect information using a specific set of questions as my guide; then I’ll bring those results to my supervisor so that we can formulate a treatment plan. I spent years as a journalist asking probing questions and establishing a comfort level with people I didn’t know. How hard, I think, can this be?

Michelle is tall and too thin. Her clothes are rumpled, her hair unkempt, her skin pasty. Once we’re seated, I open by asking what brings her here, and she tells me that recently she has had trouble doing anything but cry.

Then, as if on cue, she starts crying. And by crying, I mean howling in the way one might if just informed that the person she loves most in the world has just died. There’s no warm-up, no wetness in her eyes that leads to a light drizzle and gradually a downpour. This is a level-four tsunami. Her entire body shakes, mucus drips from her nose, wheezy noises emanate from her throat, and, frankly, I’m not sure how she can breathe.

We’re 30 seconds in. This isn’t how the simulated intakes went at school.

Unless you’ve sat alone in a quiet room with a sobbing stranger, you don’t really know how simultaneously awkward and intimate it feels. To make matters weirder, I have no context for this outburst, because I haven’t gotten to the history part yet. I know nothing about this very distressed person sitting five feet away from me.

I’m not sure what to do or even where to look. If I look right at her, will she feel self-conscious? If I look away, will she feel ignored? Should I say something to engage with her or wait for her to finish crying? I’m so uncomfortable that I worry a nervous giggle might erupt. I try to stay focused, thinking about my list of questions, and I know I should be asking how long she’s felt this way (“history of present condition”), how severe it’s been, whether something happened that brought this on (a “precipitating event”).

But I do nothing. I wish that my supervisor were in the room with me right now. I feel totally useless.

The tsunami continues with no sign of letting up. I consider waiting it out, figuring she’ll run out of steam soon and then be ready to talk, the way my son would as a toddler after throwing a tantrum. But it just keeps going. And going. Finally I decide to say something, but as the words leave my lips, I’m convinced I’ve just uttered the dumbest thing that any therapist has ever said in the history of the field.

I say, “Yeah, you seem depressed, all right.”

I feel bad for this woman the instant I say it, like I should punctuate it with a big duh. This poor, depressed 30-year-old is in tremendous pain, and she isn’t coming here so that a trainee on her first day can state the blatantly obvious. As I try to think how to correct my error, I wonder if she’ll request a different therapist. I’m sure she isn’t going to want somebody like me in charge of her care.

But instead, Michelle stops crying. As quickly as she started, she wipes the tears away with a tissue and takes a long, deep breath. And then she half smiles. “Yeah,” she says. “I am so f-ing depressed.” She seems almost giddy to be saying this aloud. It’s the first time, she tells me, that somebody has said the word depressed about her ­condition.

She goes on to explain that she’s an architect who’s had some success, having been part of a team that designed a few high-profile buildings. She’s always been melancholy, she says, but nobody really knows the extent of it because she’s generally social and busy. About a year ago, though, she noticed a change. Her energy level decreased, as did her appetite. Just getting out of bed each morning felt like a huge effort. She wasn’t sleeping well. She fell out of love with her live-in boyfriend but wasn’t sure if it was because she was so down or because he wasn’t the right person for her. In the past few months, she’s been secretly crying every night in the bathroom while her boyfriend sleeps, making sure not to wake him. She’s never cried in front of anybody the way she has just cried in front of me.

She cries some more, and through her tears, she says, “This is like … emotional yoga.” What has brought her here now, she confides, is that her work has started getting sloppy and her boss noticed. She can’t concentrate because trying not to cry is taking all of her focus. She looked up the symptoms of depression and ticked off all the boxes. She’s never been in therapy before but knows she needs help. Nobody, she says, looking me in the eye — not her friends, not her boyfriend, not her family — knows how depressed she is. Nobody but me. Me. The trainee who has never done therapy before.

(If you ever want proof that what people present online is a prettier version of their lives, become a therapist and google your patients. Later, when I googled Michelle out of concern, I learned quickly never to do this again, to always let patients be the sole narrators of their stories — pages of hits popped up. I saw images of her receiving a prestigious award, smiling at an event standing next to a handsome guy, looking cool and confident and at peace with the world in a magazine photo spread. Online, she bore no resemblance to the person who sat across from me in that room.)

I can’t completely block out my thoughts: Do the other trainees know how to do this the first time out?

Now I talk to Michelle about her depression, find out if she’s contemplating suicide, get a sense of how functional she is, what her support system is like, what she does to cope. I’m mindful of the fact that I’ve got to bring a history to my supervisor — the clinic needs it for its records — but every time I ask a question, Michelle segues into something that leads us in a completely different direction. I subtly redirect, but that inevitably takes us someplace else, and I’m very aware that I’m getting nowhere with the history.

I decide to just listen for a while, but I can’t completely block out my thoughts: Do the other trainees know how to do this the first time out? Can you get fired from this gig on your first day? And, when Michelle starts crying again, Is there anything I can do or say that will help her even the slightest bit before she leaves in … wait, how many minutes are left?

I glance at the clock on the table next to the sofa. Ten minutes have passed.

No, I think. Surely we’ve been in here for more than 10 minutes! It seems more like 20 or 30 or … I have no idea. Has it been only 10? Now Michelle is going into great detail about all the ways she’s screwing up her life. I go back to listening, then glance at the clock again: it’s still 10 minutes past the hour.

That’s when I realize: The clock hands aren’t moving! The battery must have died. My cellphone is in another room, and while it’s likely that Michelle has one in her bag, I can’t exactly ask her what time it is in the middle of her story.

Great.

Now what? Should I arbitrarily say “Our time is up,” even though I have no sense of whether 20 or 40 or 60 minutes have passed? What if I cut it off way too early or too late? I’m supposed to see my second new patient after this. Is he sitting in the waiting room wondering if I’ve forgotten his appointment?

Panicking, I’m no longer paying close attention to what Michelle is saying. Then I hear this: “Is it over already? That went faster than I expected.”

“Hmm?” I say. Michelle points to somewhere behind my head and I turn around to look. There’s a clock on the wall right behind me so that patients can also see the time.

Oh. I had no idea, and I hope that she has no idea that I had no idea. All I know is that my heart is racing and that, though the session has gone quickly for Michelle, it felt like an eternity to me. It would take practice before I’d come to feel the rhythm of every session by instinct, to know that there was an arc to every hour, with the most intense parts in the middle third, and that you needed about 3 or 5 or 10 minutes to put the patient back together, depending on the person’s fragility, the subject matter, the context. It would take years to learn what should or shouldn’t be brought up when and how to work with the time available to get the most out of it.

I walk Michelle out, ashamed about getting flustered and distracted, of not gathering the history and having to report to my supervisor empty-handed. All through graduate school, we students had been awaiting the Big Day when we would lose our therapeutic virginity, and now, I think, mine turned out to be more disgrace than thrill.

Then, relief: Discussing the session that afternoon with my supervisor, she says that, despite my clumsiness, I did just fine. I’d sat with Michelle in her suffering, which for many people can be an unusual and powerful experience. Next time I won’t worry so much that I have to do something to stop it. I’d been there to listen when she needed to unload the burdensome secret of her depression. In the parlance of therapeutic theory, I’d “met the patient where she was” — history-taking be damned.

Years later, when I’ve done thousands of first sessions, and information-gathering has become second nature, I’ll use a different barometer to judge how it went: Did the patient feel understood? It always amazes me that someone can walk into a room as a stranger and then, after 50 minutes, leave feeling understood, but it happens nearly every time. When it doesn’t, the patient doesn’t return. And because Michelle did, something had gone right.

As for the clock snafu, though, my supervisor doesn’t mince words: “Don’t BS your patients.”

She lets that sink in, then goes on to explain that if I don’t know something, I should simply say, “I don’t know.” If I’m confused about the time, I should tell Michelle that I need to step out of the room for a second to bring in a working clock so that I’m not distracted. If I’m to learn anything in this traineeship, my supervisor emphasizes, it’s that I can’t help anybody unless I’m authentic in that room. I had cared about Michelle’s well-being, I’d wanted to help, I’d done my best to listen — all key ingredients for starting the relationship.

I thank her and start toward the door.

“But,” my supervisor adds, “be sure to get that history in the next couple of weeks.”

Over the next few sessions, I get what I need for the clinic’s intake form, but it’s clear to me that’s all it is — a form. It takes a while to hear a person’s story and for that person to tell it, and like most stories — including mine — it bounces all over the place before you know what the plot really is.

Tech Disconnect

When social media keeps us apart

We’re all getting more connected, but not in the way we would if we spoke to each other face to face, says psychotherapist Lori Gottlieb, who describes her training in her book Maybe You Should Talk to Someone. She says the minute a therapy session ends, or even at a break in the conversation, “The first thing they do is look at their phones.”

Device compulsion can be observed everywhere, she says. Groups of people are ostensibly spending time together but are actually alone in their devices. Gottlieb worries we may “lose our ability to be with others. We are very lonely. Community has changed drastically.”

Not that she’s immune: “I didn’t grow up with devices,” she says, “but I’m as dependent as the next person.”

It’s not just about mobile phones. Gottlieb feels our dependence underlines a larger cultural issue of instant gratification. We now live in a constantly plugged-in era, with entertainment, commerce, and community a tap away; in that way, Gottlieb likens the internet to a “no prescription pain-killer.”

But what about using Facebook, Instagram, and Twitter to stay in touch with friends and relatives? Not the same as a phone call. Social media, Gottlieb argues, is really a “false sense of connection.” Sharing with others using technology is “reporting on your experience.” By contrast, when you sit down with someone and talk, “you’re having an actual shared experience.”

If you truly are feeling lonely, maybe, as her book title suggests, you should talk to someone. “No, not everyone needs therapy,” she says, “but it’s often very helpful for most people.” Gottlieb likens therapy to holding up a mirror to let you see your own situation. “That doesn’t mean you become a Pollyanna,” but that you can begin to “find joy or contentment or peace” by acknowledging the good things that you have.

—Troy Brownfield is a staff writer at the Post.

This article is featured in the May/June 2019 issue of The Saturday Evening Post. Subscribe to the magazine for more art, inspiring stories, fiction, humor, and features from our archives.

Featured image: Shutterstock