Mia is a 10-year-old African American female living with a family member in an urban area. Mia is diagnosed with PTSD due to abuse and neglect experienced while living with a foster family. Mia was born addicted to substances and consequently taken into custody by the Department of Children and Families (DCF) and placed with a foster family who fled to another state. During this period, Mia was subject to extensive abuse and neglect by her foster parents, including severe sexual abuse. Mia was subsequently brought back to the area in which she was born, and placed with a family member with whom she currently lives. Mia presents with sexualized behaviors which she has acted out towards family members and the family dog. She also has a history of isolated incidents during which she plays with her feces.
Mia is an intelligent and bubbly girl that can present with a high rate of distractibility and impulsivity. Mia demonstrates oppositional behaviors when teachers or providers attempt to redirect her, but she is often able to reflect on/has insight around her actions. Mia has been receptive to trauma-informed interventions, which is why she was initially referred for equine therapy. Mia is motivated by working with animals and gravitates towards "hands on" activities.
Before the start of EFT-CT, Mia was highly symptomatic across a range of clinical domains. On the CBCL, her primary caregiver indicated that Mia exhibited a number of behavior problems on the (CBCL Total Problems T-score = 68, clinical range) both internalizing and externalizing in nature, including clinically significant social problems (T = 72), thought problems (T = 74), and attention problems (T = 77). Her caregiver also reported broadly impaired executive functioning on the BRIEF-P, indicated by a Global Executive Composite score in the clinically significant range (T = 71, 98th percentile), and with the most significant problems in the domain of metacognition (T = 75, 98th percentile, clinically significant range). In addition to significant difficulty with getting started on tasks, organizing her thinking, or strategizing, self-monitoring and working memory, Mia exhibited significant difficulties with behavioral inhibition (T = 78, 98th percentile). Regarding trauma-specific symptomatology, Mia endorsed clinically significant problems in two of the three symptom DSM-IV-TR symptoms clusters on the PTSD-RI (avoidance, T = 80; arousal, T = 92), as well as subclinical problems with trauma-related intrusions (T = 63), and a posttraumatic stress total score also in the clinically significant range (T = 86). She also endorsed clinically significant problems with dissociation (T = 75), and sexual concerns (T = 99), related to Mia's trauma exposure. Mia herself did not endorse any significant symptoms on a self-report of depression (CDI-2 total problems T-score = 54; 66th percentile).
Mia was able to form a strong and positive attachment with the therapy pony during EFT-CT sessions. Because of her motivation to work closely with the pony, she successfully followed instruction and safety protocols. Much of the work with Mia at Bear Spot Farm focused on riding and helping her gain an understanding and awareness of her body. For instance, her clinician carried out rhythm and balance-based exercises with Mia while she rode, to help her gain an effective riding position, and thus communicate with therapy pony better. These exercises set the stage for Mia to be in her optimal window of arousal, evidenced by her decreased impulsivity and heightened sense of control over her body. Mia demonstrated improved functioning and was able to express feeling "free" and "calm" while she rode.
Due to difficulties with transportation and scheduling, Mia was unable to continue her participation in the pilot program. While she continued to receive other services, Mia demonstrated setbacks after exiting the pilot program. Increased impulsivity and oppositional and unsafe behaviors have created challenges for Mia and her family across multiple domains. After treatment, Mia also played with and hid her feces on a few occasions. Mia did not complete enough treatment to reach a second clinical assessment period, thus, no data on her clinical functioning post-treatment is available.