Equine-assisted social work in a residential treatment context: Authenticity, compassion, and mentalization in work with self-harming adolescents

Abstract

Abstract Introduction: Adolescents placed in residential care due to chronic non-suicidal self-injury often present with complex trauma histories, emotional dysregulation, and profound relational instability. These experiences contribute to self-stigmatization and a “relational paradox”: a simultaneous longing for, and fear of, authentic relationships. Equine-assisted social work (EASW) has been proposed as a validating, non-hierarchical intervention that may restore trust, authenticity, empathy, and compassion; however, the relational mechanisms underlying such interventions remain insufficiently understood. Methods: This qualitative study examines how authenticity, mentalization, and compassion are enacted within EASW in a Swedish residential social work setting. Nine adolescents (15–21 years) with persistent self-injurious behavior and four residential staff members trained in dialectical behavior therapy and equine-assisted interventions participated. Weekly individual sessions with horses were video-recorded and followed by video-elicited interviews. An autoethnographic, emotionally reflexive, and relational approach was adopted, drawing on attachment theory, emotional labor, dramaturgy, feeling rules, mentalization theory, and social-relational perspectives. Thematic analysis was conducted across clients, staff, and researcher-generated data. Results: The findings indicate that the horse functioned as an emotion-sensitive relational “third,” exposing incongruence between expressed and embodied effect and thereby disrupting established feeling rules and professional hierarchies. Within the stable context, participants demonstrated capacities for emotional awareness, compassion, empathy, and mentalization that are often presumed to be compromised in highly dysregulated residential populations. Authenticity emerged not as a trait but as a situational, relational achievement facilitated by embodied co-regulation. The horse’s perceived vulnerability, non-verbal presence, and lack of evaluative stance helped participants reorient from diagnosis and performance toward shared responsibility, care, and playfulness. Conclusion: This study contributes to social work knowledge in residential youth care by demonstrating how embodied, interspecies relational practice may provide temporary regulatory scaffolding that supports authenticity, reflective functioning, and compassion among adolescents with complex self-injurious behavior. The findings highlight the importance of non-hierarchical, validating, and emotionally reflexive practice and underscore the need to recognize the horse as a sentient partner in social work interventions.