Equaine assisted object-relations psychotherapy for adolescents with a diagnosis of conduct disorder : an exploratory study

Abstract

Conduct disorder (CD) is the most common diagnosis amongst adolescents that present with behavioural difficulties. These behavioural difficulties may include; defiance, hostility, no respect for authority figures, stealing, lying, manipulation and harming others as well as setting fires, damaging property, and truancy. As the literature reveals there are various comorbid diagnoses that may also be present with these behavioural difficulties, such as attention deficit hyperactivity disorder (ADHD) as well as depression. Adolescents diagnosed with conduct disorder can be a challenging population to work with and treat and they may invoke negative countertransference in the healthcare professionals that treat them. Various conventional methods such as behavioural management, anger management, parenting programmes, family therapy, hospitalization and pharmacology has shown some useful results when working with this population, but they are not optimal. Statistics obtained mostly from the United States and Europe indicate that behavioural difficulties and especially violence is on the increase with often disastrous consequences for the family and community surrounding these adolescents as well as huge financial implications. Melanie Klein, a psychoanalyst and the mother of psychodynamic object relations, postulates that these behavioural difficulties are because of a possible hostile and rejecting relationship with the primary object and form the basis for the adolescent’s object-relations, resulting in behavioural difficulties. An alternative method of treatment, equine assisted psychotherapy (EAP), the use of horses in the psychotherapeutic process has been proposed and this research explores the outcomes of using this type of therapy with adolescents diagnosed with conduct disorder from a psychodynamic object relations perspective. This research sourced 15 adolescents between the ages of 13 years and 17 years 11 months, from the local child welfare for the experimental group, and 15 adolescents within the same age range from the same local child welfare for the control group. The experimental group underwent six, 30 – 40 minute sessions of EAP each at a stable yard situated in the south of Gauteng. A mixed methods approach (both qualitative and quantitative methodology) was used in this research in order to fully and effectively research this phenomenon and the outcomes thereof. Child and adolescent interviews, background histories, transcripts of the EAP sessions as well as clinical observations were used for the qualitative data and administered to the participants in the experiential group. The quantitative data consisted of scientific assessment procedures, namely the 6-18 Child Behaviour Checklist (CBCL) Youth Checklist, as well as the Minnesota Multiphasic Personality Inventory – Adolescent (MMPI-A). These assessments were administered prior to the start of the EAP sessions to both the experimental and control groups as well as approximately six months afterwards, once again to both groups. The EAP sessions were transcribed verbatim from the tape recordings and this formed part of the raw data. These transcripts were then analysed using thematic analysis and common themes were reported on as well as integrated with the relevant literature and psychodynamic object relations theory. The quantitative data was obtained through the use of the 6-18 CBCL Youth Checklist and MMPI-A and was analysed using the Wilcoxon Signed Rank Test. The results of this research propose to add value through adding to the limited amount of data pertaining to the use of EAP on adolescents diagnosed with conduct disorder from a psychodynamic object-relations perspective as well as exploring the possibility that EAP may be a useful and alternative method in treating these adolescents.