Equine Therapy and Its Positive Impact

What is Equine Therapy?

Equine therapy is a holistic and complementary form of animal-assisted therapy that uses horses as a bridge between therapist and client. At the heart of this approach is the interaction with the horse—calm, mindful, and largely nonverbal. Acting as a co-therapist, the horse's neutral presence, intuitive communication style, and nonjudgmental nature make it ideal for supporting people with a wide range of needs.

This form of therapy is suitable for both children and adults with physical or intellectual disabilities, psychosomatic conditions, or emotional trauma. The goal is not to teach riding skills, but rather to promote mental, emotional, and physical well-being through the horse-human connection.

While commonly referred to as horse therapy or therapeutic riding, equine therapy is technically one of four distinct branches grouped under the umbrella of equine-assisted activities and therapies:

These categories often overlap in practice, which is why equine-assisted therapy is frequently used as a general term. However, each specialization requires its own qualifications and training. The following sections will delve deeper into the specific methods and goals of equine therapy.

Equine assisted therapy - why use horses in therapy?

Horses offer something truly unique in a therapeutic setting: they are emotionally neutral, highly sensitive, and nonverbal communicators. In equine-assisted therapy, the horse serves as a mirror—reflecting the client's posture, tension, and emotional state without filters or judgment. If a person is anxious or agitated, the horse will respond immediately. In order to build trust and elicit specific responses from the horse, the individual must become aware of their own behavior and emotional state—making horses exceptional partners in developing emotional regulation.

Equine-assisted psychotherapy, in particular, benefits from this dynamic. Clients learn to manage their emotions, build trust, and experience healthy, nonverbal interaction. This is especially valuable for individuals with autism spectrum disorder, selective mutism, or trauma-related conditions. Horses don’t impose conversation—they wait. It’s the person who initiates contact, often finding their voice or a new sense of agency in the process.

For individuals with PTSD, anxiety, or attachment disorders, this calm and receptive presence can be deeply healing. The horse provides a “safe space” where trust is rebuilt, not through words, but through presence and connection. Many clients describe this as the first relationship where they didn’t feel judged, pressured, or misunderstood.

Beyond the emotional level, horseback riding for therapy has strong physical benefits. The gentle, rhythmic motion of the horse mimics the human gait, promoting relaxation and improving neuromuscular coordination. This is particularly helpful for individuals with spasticity, muscle tone disorders, or those recovering from physical injury. Even passive riding stimulates core muscles, enhances balance, and supports sensorimotor integration.

Whether on the ground or in the saddle, horses invite mindfulness, movement, and authentic interaction—making them powerful partners in equine-assisted activities and therapies.

Benefits of equine therapy

Few therapeutic methods engage the body, mind, and emotions as comprehensively as equine-assisted therapy. The combination of movement, presence, and relational interaction activates multiple sensory channels at once, creating a uniquely immersive therapeutic experience.

Physical Benefits of Equine Therapy

The act of riding a horse gently stimulates core muscles, enhances balance, and fosters body awareness—all without the need for verbal instruction or conscious control. These physical benefits make hippotherapy, a clinical branch of equine therapy led by physiotherapists, especially effective for patients with neurological or muscular conditions.

Key physical outcomes include:

• Improved balance and posture
• Enhanced coordination and body control
• Development of both fine and gross motor skills
• Strengthening of postural muscles
• Passive muscle relaxation and reduction of spasticity

Mental and Emotional Impact

The therapeutic bond with the horse is equally powerful on a psychological level. Through meaningful, nonverbal interaction, clients often experience a sense of calm, trust, and achievement that can be hard to find in traditional settings. Equine-assisted therapy for veterans, for instance, is widely used to reduce symptoms of PTSD and promote emotional healing.

Key psychological effects include:

• Heightened self-awareness
• Increased self-esteem through small successes
• Boost in self-confidence when overcoming fear or new challenges
• Reduction in anxiety, aggression, and behavioral issues
• Development of social skills, empathy, and emotional resilience
• Improved focus, attention span, and mental endurance

These benefits make equine therapy a valuable tool for a wide range of individuals—children with autism, teens with ADHD, adults recovering from trauma, and more.

Who Can Benefit from Equine-Assisted Therapy?

Equine-assisted therapy is designed to meet a wide range of physical, emotional, and cognitive needs. Whether used in individual or group sessions, this approach supports people of all ages who face challenges in development, communication, mobility, or emotional regulation.

Equine-Assisted Therapy for Autism

Therapeutic riding autism programs are among the most well-established and researched applications of equine therapy. Because no two people on the autism spectrum are alike, traditional therapy can struggle to create space for individual expression. Horses, by contrast, offer a calm, nonverbal presence that invites interaction without pressure or expectation.

Many children and adults with autism experience:

• A stronger sense of trust and self-expression
• A calming effect through the horse’s rhythm and energy
• Increased motivation to communicate and connect
• Fewer meltdowns or behavioral outbursts
• Greater emotional regulation and confidence

Horses create a safe, non-judgmental environment—often helping clients break through social withdrawal or re-engage with the world in new ways.

Equine-Assisted Therapy for Down Syndrome

People with Down syndrome often experience delayed motor development and low muscle tone, alongside challenges in social interaction. Equine-assisted therapy benefits this group by encouraging:

• Improved motor coordination and core stability
• Better body awareness
• Gentle stimulation of sensory perception
• Easier social bonding through shared activities with the horse
• Increased confidence and social engagement in group settings

Especially in paired or small-group sessions, horses can act as social bridges—helping participants initiate interaction and develop trust in others.

Equine Therapy for ADHD

Children and adults with ADHD or ADD often struggle with focus, impulse control, and overstimulation. Traditional settings may not offer the type of physical and mental balance they need.

In horseback riding for therapy, movement is not just allowed—it’s essential. Riding focuses the body, calms the mind, and creates space for structured attention.

Benefits include:

• Improved concentration and task focus
• A physical outlet for restlessness
• Development of patience and self-control
• Engagement of both cognitive and motor systems simultaneously

Because horses respond best to calm, focused energy, they naturally teach clients to regulate their emotions and actions. This makes equine-assisted therapy for ADHD a powerful, whole-body intervention.

Equine-Assisted Therapy for PTSD and Veterans

Among the most profound applications of equine assisted therapy is its role in supporting military veterans with PTSD (post-traumatic stress disorder). Traditional talk therapy can be challenging for those who have experienced trauma, especially when verbal expression or emotional vulnerability feels overwhelming or unsafe.

Equine-assisted therapy for veterans offers an alternative path to healing—one rooted in presence, trust, and nonverbal connection. Horses are highly attuned to emotional states and respond calmly but immediately to shifts in energy, helping clients become more aware of their own internal landscape.

Veterans with PTSD often report:

• A sense of emotional safety when interacting with horses
• Reduction in hypervigilance, anxiety, and dissociation
• Increased trust-building capacity
• Improved emotional regulation and grounding
• Greater connection to the present moment

In many cases, horses help veterans reconnect not only with themselves but also with others—restoring confidence, empathy, and the ability to form healthy relationships again. Because of these benefits, equine-assisted psychotherapy is increasingly recognized as a trauma-informed modality in the treatment of PTSD.

Who Can Offer Equine Therapy?

The terms equine therapy and equine therapist are not legally protected in many countries, including Germany, which means technically anyone could call themselves an equine therapist. As a result, it’s essential to carefully evaluate a provider’s qualifications, therapeutic setting, and approach.

In Germany, the only legally required certification for offering equine-assisted sessions is the official competency certificate in horse care and handling, issued and checked by local veterinary authorities. However, this alone is not sufficient to ensure professional therapeutic standards.

Qualified practitioners in equine-assisted activities and therapies typically have a background in fields such as:

• Psychology
• Education or special education
• Occupational therapy
• Social work
• Physiotherapy (especially for hippotherapy)

They also complete a specialized training or equine assisted therapy certification program, often through accredited institutions or national associations. The horses themselves should be trained therapy horses, selected and prepared specifically for work with clients who may use wheelchairs, walkers, or have unpredictable movements—factors that can otherwise trigger fear responses in untrained horses.

Equine therapy sessions may take place at riding stables, clinics, rehabilitation centers, or therapy-focused equestrian facilities. Some occupational therapy or pedagogical centers collaborate closely with certified riding instructors or equine professionals to offer safe and effective programs.

If you're looking for a provider, ask about:

• The therapist’s educational background and certifications
• The training and temperament of the therapy horses
• Safety protocols and accessibility of the facility
• The structure and goals of the sessions

Many centers offer introductory conversations or trial sessions to assess compatibility—an important step in finding the right match for the client’s needs.

How to Become an Equine Therapist

If you're wondering how to become an equine therapist, it's important to understand that the title is not legally protected in many countries and is not officially recognized as a standalone medical or therapeutic profession. Instead, it is considered an advanced specialization that builds upon an existing qualification in a related field.

Recommended Professional Backgrounds:

To pursue a career in equine-assisted therapy, candidates typically start with a foundational degree or certification in areas such as:

• Psychology or psychotherapy
• Education or early childhood development
• Social work
• Occupational therapy
• Physiotherapy
• Speech and language therapy

The equine component is then added through an intensive, hands-on training program that covers both theory and practice in areas like:

• Equine behavior and handling
• Therapeutic principles and client interaction
• Session design and safety protocols
• Trauma-informed practices
• Ethics and legal considerations

In addition, substantial horse experience is essential. This includes:

• Solid riding skills and stable management knowledge
• Familiarity with horse care and communication
• Official certifications such as a basic riding certificate or national horsemanship badge (where applicable)

Each training provider defines its own prerequisites, but most require a combination of therapeutic qualifications and practical horse experience.

Legal and Practical Requirements

In Germany, for example, the only mandatory requirement to conduct equine-assisted therapy is the competency certificate in horse handling and welfare. However, this is a minimum standard and not a proof of therapeutic competence. Serious providers typically follow the guidelines set by national associations such as the DKThR (German Board for Therapeutic Riding) or the Federal Association for Therapeutic Riding and Animal-Assisted Therapy.

If you're aiming for a professional and ethically grounded practice, completing a recognized equine assisted therapy certification from an accredited institution is strongly recommended.

What Happens During an Equine Therapy Session?

There is no one-size-fits-all format in equine-assisted therapy—each session is tailored to the client's specific goals, needs, and abilities. Depending on the provider and the client’s condition, a session typically lasts between 30 to 60 minutes and may follow this general structure:

1. Initial Conversation and Goal Setting

Before approaching the horse, the therapist and client discuss the client’s current emotional or physical state. Together, they define short-term therapeutic goals for the session—whether it’s building confidence, practicing motor skills, or processing emotions.

2. Preparing the Co-Therapist (the Horse)

Depending on the client’s physical and cognitive capabilities, the horse is groomed and tacked up either with or without the client’s help. This shared preparation phase fosters:

• Physical engagement and fine motor practice
• Emotional bonding and trust-building
• A calm and focused mental state

3. Therapeutic Interaction

This is the core of the session and can involve:

• Guided riding (with the therapist or an assistant leading the horse)
• Bodywork exercises performed on horseback to stimulate balance and posture
• Groundwork activities like leading, observing, or grooming
• Interactive tasks, such as obstacle courses or creative games
• Sensory work, like mindful touch and stroking the horse
• Nonverbal communication training
• Group sessions, in which participants collaborate and reflect through shared experiences with the horse

Each exercise is adapted to match the client’s physical abilities and psychological needs. The movement of the horse is used purposefully to stimulate specific physiological or emotional responses.

4. Reflection and Closure

After dismounting, the client helps care for the horse—removing the tack, grooming again, and leading it back to the stable. The session concludes with a short reflection: What was experienced? What changed? What stood out?

This moment of verbal or nonverbal integration helps solidify the progress made during the session and can inform the next steps in therapy.

Equine-assisted activities and therapies thrive on flexibility, sensitivity, and presence. The horse isn’t just a tool—it’s an intuitive partner that helps reveal, reflect, and support healing in ways traditional methods often can’t.

Costs of Equine Therapy

A key consideration for anyone exploring equine-assisted therapy—whether for themselves or a loved one—is the cost. Since equine therapy is not typically recognized as a reimbursable medical treatment by public health systems in most countries, sessions are usually paid out-of-pocket.

What Do You Pay For?

The cost of a session reflects more than just the therapist’s time. It includes:

• The care and maintenance of the therapy horse(s)
• Use of the riding facility and equipment
• Preparation and follow-up time (documentation, goal-setting)
• Possible assistance by a second person during the session (if needed for safety or support)

Average Costs

Depending on the provider, location, and length of the session, rates usually range from €40 to €90 per session. Some providers may charge additional fees for intake interviews or detailed therapy planning. A standard session lasts 30 to 60 minutes; group sessions may extend up to 90 minutes and are sometimes less expensive per participant.

Insurance Coverage – What’s Possible?

In Germany, equine therapy is not classified as a prescribable medical treatment (Heilmittel) and is therefore not typically covered by statutory health insurance. Some private insurance providers may cover part of the cost as a complementary or preventive service, especially when it supports a specific diagnosis such as trauma, PTSD, or developmental delay.

It's worth contacting your insurer to ask:

• Whether any part of the therapy qualifies as a reimbursable health benefit
• If hippotherapy, as a medical-physiotherapeutic service, could be included
• If sessions may count toward preventive or alternative care categories

In contrast, some countries like Switzerland may cover certain aspects of therapeutic riding as part of recognized rehabilitation programs.

A Brief History of Equine Therapy

The healing power of horses is not a modern discovery—it has been recognized for centuries. As early as 470 BC, the Greek physician Hippocrates noted the therapeutic benefits of horseback riding for mental and physical well-being.

The idea resurfaced in medical literature in the 17th century. English physician Thomas Sydenham recommended riding as a remedy for tuberculosis, referring to it as the best form of physical therapy for “lung disease.” Similarly, Austrian doctor Leopold Fleckles supported horseback riding for patients with chronic respiratory conditions.

However, equine-assisted therapy as we know it today gained real momentum after World War II, when riding was introduced in rehabilitation programs to help soldiers recover from physical injuries—such as amputations—and emotional trauma.

In Germany, the movement became more structured with the founding of the German Board for Therapeutic Riding (Deutsches Kuratorium für Therapeutisches Reiten – DKThR) in 1970. This organization set out to standardize terminology and training and to promote quality guidelines for practitioners in the field.

Since then, equine-assisted methods have expanded across Europe, North America, and beyond—ranging from hippotherapy in clinical settings to equine-assisted psychotherapy and educational programs for emotional and behavioral support.

Though some national health authorities, like Germany’s Federal Ministry of Health (2006), still claim that evidence for therapeutic effectiveness remains inconclusive on a large scale, multiple studies and case reports show significant success in small-group and long-term interventions—especially in areas such as autism, trauma, and developmental therapy.

Today, equine therapy continues to grow as an interdisciplinary field that bridges psychology, education, and physical rehabilitation—with the horse as its constant, trusted partner.

Equine Therapy: FAQs

How much does a session of equine therapy cost?

A typical session costs between €40 and €90, depending on the therapist’s qualifications, the type of therapy, regional differences, and whether extra services such as consultation or documentation are included.

When is equine therapy helpful?

Equine-assisted therapy can be highly effective when physical, emotional, or social development goals are involved. This includes:

• Improving motor function
• Enhancing self-esteem and confidence
• Reducing stress and anxiety
• Regulating behavior
• Supporting trauma recovery

Are equine therapy and hippotherapy the same?

No. Hippotherapy is a medically defined form of physiotherapy conducted on horseback by licensed physiotherapists. Equine therapy (or equine-assisted therapy) is broader and integrates psychological, pedagogical, and emotional approaches beyond physical rehabilitation.

What is the right age to start equine therapy?

Most programs begin around ages 3 to 4, though readiness depends more on the child’s ability to follow instructions and participate safely than on age alone.

Do health insurance providers cover equine therapy?

Most public health insurers do not cover equine therapy because it’s not recognized as a standard treatment. Some private insurers, however, may reimburse part of the costs as a complementary health service. It’s best to ask your provider directly.

Under what conditions can equine therapy be reimbursed?

Reimbursement is rare and usually offered only on a case-by-case basis. Some insurance plans cover hippotherapy when prescribed by a medical specialist, such as a neurologist or orthopedist, for specific diagnoses.

Who benefits most from equine therapy?

Equine-assisted therapy is beneficial for children, adolescents, and adults with:

• Physical disabilities
• Emotional or social challenges
• Cognitive impairments
• Stress, anxiety, or trauma-related issues
• Developmental delays

What happens during a typical equine therapy session?

Sessions include an opening conversation, grooming and preparing the horse, therapeutic exercises (either mounted or on the ground), and a closing reflection. Activities vary depending on the client's goals and abilities.

Do I need a riding certificate to become an equine therapist?

A formal riding certificate is not mandatory but strongly recommended. More important is a combination of therapeutic qualifications and horse experience, plus an official competency certificate in horse handling (depending on the country).

Can a doctor prescribe equine therapy?

Since equine therapy is not a medically approved treatment, it is rarely prescribed. However, hippotherapy may be prescribed by neurologists, orthopedists, or general practitioners when there is a clinical indication.

What conditions does equine therapy help with?

It can support individuals dealing with:

• Motor impairments
• Anxiety or stress disorders
• Autism spectrum disorders
• ADHD
• Trauma and emotional regulation
• Social or behavioral challenges

What’s the difference between equine therapy and therapeutic riding?

Therapeutic riding (or equine-assisted activities) focuses more on learning and recreation, often in a group setting. Equine therapy is explicitly therapeutic and targets specific developmental or emotional goals.

Who is qualified to offer equine-assisted therapy?

Qualified providers often have a professional background in psychology, social work, education, or therapy, and have completed a recognized equine assisted therapy certification program. Experience with horses is essential.