It’s Saturday night in downtown Long Beach, California, and laughter can be heard from the streets below. Sarah Smith is sprawled on her bed, diligently peeling through sociology notes, preparing for her impending exams. An acoustic guitar rests against her bed, and a colorful gay-pride flag is pinned next to her bookshelf.

At first glance, Sarah comes across as a typical college student – but her serious blue eyes sometimes betray a history of violence, abandonment and emotional trauma.

Sarah was born into adoption at a private hospital in Orange County and was molested by her pre-school teacher at the age of three. Eighteen years of psychological and sexual abuse followed Sarah into adulthood, where the lingering devastation of her childhood spiralled into uncontrollable drug addiction and mental illness.

Sarah eventually surrendered to the streets, becoming homeless aged 19. She was living out of friends’ cars and public bathrooms until Pathways to Independence found her and gave her food, healthcare, education and a place to live. She is now five years sober, and is close to graduating from her sociology program at Cal-State Long Beach with a 4.0. Two years ago she was diagnosed with throat cancer, and after a determined battle against the disease, she is now in full remission.

To work through ongoing problems attached to her self-esteem, confidence and trust in other people, Sarah enrolled in an equine-assisted therapy program.

Horses make great companions for psychotherapy because they can mirror and respond to human behavior. Being herding animals, they rely on an acute stream of sensory data to sense safety or danger; they can also hear the human heartbeat within four feet, and research on heart-rate variability indicates that horses have a profound ability to synchronize their own heartbeat with that of human beings. When people are introduced to the herd environment for therapy, horses respond within the same spectrum of physical and emotional responses that govern their own behavior, allowing therapists an insight into the inner psychology of the client.

Clouds hung dramatically low above the stables of Ortega Equestrian Centre in San Juan Capistrano and in the main arena, a herd of three mares donated by the nonprofit Otra Mas were awaiting Sarah’s arrival.

The program director, Carol Caddes, is a horse lover and licensed marriage and family therapist with over 20 years of experience. Sarah, for her part, had very little experience with horses and had never undergone any form of emotional treatment outside of medication and traditional office-based talk-therapy.

Sarah’s gaze searched the eyes of each horse. She established an immediate connection with Madonna, a 20-year-old mare trained by champion cowgirl Carol Rose in Texas. Caddes guided Sarah into a sensory exercise that stretched her comfort zone by feeling her way around Madonna’s body with her eyes closed.

It is common for people to feel intimidated by the sheer size and power of horses –weighing up to 2,000lb, horses can become metaphors for dealing with intimidating life circumstances. As Sarah developed more confidence, she assumed more control within the herd by leading Madonna from behind without the use of ropes or a whip – an instinctual method used by horses to push and lead each other.

“I was a little skeptical at first and I found the horses to be very intimidating. I didn’t know what was going to happen. I had no expectations … I made eye contact with Madonna and I felt immediately connected to her. The sensory exercise was really cool, it was scary, but it bridged the gap between me and the horse,” Sarah explained.

Therapy is administered out of the saddle, and the horses are at liberty to respond as they wish. Caddes believes that “you get more of an authentic response by giving the horse more freedom. It’s magnificent to be on the back of a horse, but it’s also magnificent to companion-walk with them when they choose to be with you.”

Caddes works within a physiological therapy model, always watching eye dilation, heart rate, body language and gestures. Her role was to safely guide Sarah through a series of ground-based activities that kept both her and the horse within a therapeutic window of arousal – “If they get too high the client will dissociate and the horse will panic, if they get too low there can be a feeling of depression or disengagement,” she explained.

At the beginning of the second therapy session, Sarah found the horses far less intimidating. Caddes directed Sarah to select a prop and make it symbolic of an aspect of her life. Sarah unravelled a small colorful parachute that signified her confidence in school. Sarah then cast the parachute to the wind and laid it down in the middle of the arena, but Madonna wouldn’t budge. Instead, a nine-year-old pinto mix named Chips wandered over and began investigating the parachute. With a flick of the head and a stomp of her hoof, the wild pony unexpectedly bolted to the other end of the arena in a nostril-flared panic, leaving Sarah marooned on her fabric island in the middle of the wide arena.

“Chips got scared, I don’t know what happened, but it reminded me of being a child. I went over to comfort her and said I will never hurt you.”

Sarah mustered the courage to reapproach Chips, and softly stroked the pony’s mane. She was struck by an intense surge of emotion, and tears began to stream down the side of her face. Chips gently nuzzled into her, allowing Sarah to be fully present with the horse and revisit her trauma without been enveloped by its vortex.

“I saw Chips like me as a child, I was crying hysterically, a real deep cry, I felt a sense of protection and sadness. The horse allowed me to feel those feelings, the horse comforted me when I was emotionally vulnerable.”

On her third and last session, Sarah led Chips and Madonna out of the stables and into the arena, where she divided the therapeutic space into three sections that represented her past, present and future. The moment was peaceful, and Sarah drew in a deep breath, relaxed her shoulders, and took a confident stride forward, compelling Madonna into a companion walk, side by side, shoulder to shoulder.

“I was in disbelief – I didn’t think I could have an emotional connection with a horse. I felt like I made a friend, there was a bond. It allowed for me to really get in touch with how I feel. If you’ve been hurt, sometimes it’s harder to be around other human beings – but there’s no judgment with a horse.”

She explained that “walking through her childhood” with the horses forced her to put her pain in the past, and helped her identify the person she hopes to become. Sarah also noted a considerable improvement in her communication skills and confidence as a direct result of this program.

Reflecting on the experience, Sarah is in awe of the horses, unable to articulate how healing the program was. “Words are so limiting sometimes,” she said with a smile.