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Table 1 Theme and sub-themes: cross-case analysis

From: Therapeutic horseback riding for at-risk adolescents in residential care

1. Benefits of riding as a mechanism of change in THR

 1.1 Relaxing and functioning better

It makes me more energetic at school and it’s a place to come and let go. It’s not like you get up in the morning and go study. You get up, come to the farm, to a place that’s more comfortable, somehow easier for me…

 1.2 Balancing and coping better with frustration

I have a low frustration threshold, so I get upset quickly, and then I have to deal with it... Here I have to make an effort. Because I like it. Yes, I like it, even if there are frustrations..

 1.3 Persevering and acting consistently in other activities

After the farm, I have a math lesson and the day is much harder, but even though it ends in the evening, it’s an easier day for me. That’s what I feel. It’s good for me. It helps me let things out, you know, not sitting all day … I don’t know if I could do it

 1.4 Coping with failures and enjoying success

The road to success involves falling several times and either succeeding or falling. When you’re with horses you have thousands of failures every day and once in a while a small success. Most of the time, it’s failures and occasionally you have one of those small successes and it fills you with happiness

 1.5 Gaining a sense of competence by meeting riding challenges

When I ride the horse and it’s hard for me to do what I need to do, I struggle with myself and, in the end, I succeed and overcome the difficulty. …

 1.6 Gaining autonomy and free choice in riding

…let’s say I have a choice. If I don’t want to ride today, I won’t ride. There was a time when I didn’t want to ride, and then I saw how everyone was progressing, and I said well, I’ll try. Slowly, slowly you evolve and progress

2. Benefits of the relationship with the horse as a mechanism of change in THR

 2.1 Increased confidence thanks to controlling a powerful horse

…it increases your self-confidence and sense of self-worth... you see that you’re controlling such a powerful animal…

 2.2 The ability to face and overcome their fears

At the farm, I fell. A horse threw me… Then I was afraid to mount the horse… Until I got to my horse, Donatello. I reached out to him and trusted him. I don’t know why. I had a connection with this horse. In the end, he helped me... Today... I do everything alone. I don’t need anyone to be with me.

 2.3 Autonomy, mutual and internal locus of control within the horse–adolescent relationship

It’s... easiest to give up and say it doesn’t depend on me, it depends on the horse, the horse decides. And what it mainly taught me is that many things depend on me too. We work together...like the difference between pulling too hard or too weakly to get the [desired] action and doing it exactly right..

 2.4 The boundaries of autonomy within the horse–adolescent relationship

Because I was stressed... I completely ignored the horse and was only focused on myself and... I got to the obstacle and the horse didn’t jump and I was so frustrated and started cursing... I really started getting upset and then they told me to get off the horse

 2.5 Connecting with the horse, despite difficulties in connecting with people

It annoyed me that they took Shrek [my horse]... and didn’t tell me ahead of time… So, with the new horse, I was devoted, I gave him all my love, all my warmth. But today I know that even if I leave someone, even though I don’t know what will happen, I know that... I’ll soon take everything he says with a grain of salt. I'm very emotionally closed in that way. I also have a hard time with love

 2.6 Learning to trust the horse

… the jumps…it requires a lot of precision and... trust in the horse and suddenly you’re in situations... where you know that you’re not in control...and at the moment of the jump you let go of everything and let her do the work. I learned to trust

 2.7 Nonverbal communication with the horse, responsibility, and mutual understanding

she’s an animal... she can’t talk... I have to know when something hurts her, when she doesn’t want to do something, when she feels good, what she likes

 2.8 The horse as a symbolic projection of a human being

… like people, horses can get up on the wrong side... and then you go to the horse and immediately notice that he’s a little sad or nervous. And how to communicate with it and how to calm it down if necessary

 2.9 Increased sensitivity to others thanks to the relationship with the horse

You have to take care of the animal after you ride, wash it. It’s like a part of you... The work with the horse helps you show more emotions, notice things