“I was asked to rehabilitate an abused horse, and he kind of healed me and I healed him.”
Kristen de Marco leads by making an impact on the people she serves and on the community at large. As the Executive Director of Gateway HorseWorks, a specialized psychotherapy program using horses to engage people in treatment, Kristen exemplifies leadership that makes a difference.
Gateway HorseWorks, founded by Kristen in 2015, is an innovative non-profit organization located in Malvern, Pa. They offer unique horse-based interventions for anxiety, depression, disordered eating, ADD/ADHD, addiction, PTSD, sexual trauma, military sexual trauma, and bereavement. Their model is driven by concern for those in the community who are suffering but who lack resources, and they aim to provide meaningful access to mental health care, wherever such access is lacking or difficult to obtain.
Kristen initially founded a for-profit company in 2011 to combine horse-based therapy with traditional mental health care. Desiring to lead the way in innovative horse-based treatment, she became certified as an Equine Specialist and offered psychotherapy services.
The people who needed her expertise most, however, could not afford access to it. In 2015, she received a call from a probation officer who helped incarcerated women adjust back to normal life. This officer thought a program like Kristen’s would support his clients’ mental health in a new way, but he told her that the county would never pay for it.
Unafraid of a challenge, Kristen took hold of the reins of the problem. “His call felt like my call to action,” she says.
She created Gateway HorseWorks as a non-profit organization with the mission to provide priority access for the most vulnerable in the community. The organization now has six horses and employs six staff members. Five board members offer direction, and over 100 volunteers help each year. In 2025, Gateway HorseWorks served over 400 unique clients in nearly 2,000 sessions.
Her organization influences mental health practice and provides leadership through its commitment to help those in need. A non-profit like Kristen’s impacts the entire community, she says. She serves her clients, of course, but also the community at large, which benefits when people at risk can return to productive lives.
As further proof of Kristen’s leadership, GSK gave Gateway HorseWorks their IMPACT award in 2024, recognizing the non-profit’s ability to “improve the health and wellbeing of individuals in their local communities.”
Why Horses?
Kristen grew up riding and training horses. When she was a child, her family moved frequently, and she found safety and consistency in horses — she loved being around them in the barn. After graduating from Villanova University, she went into the fashion industry, but her path shifted direction when she went through a divorce. She eventually returned to the refuge that horses had provided throughout her life.
“I found my way back to the barn,” she says. “I was asked to rehabilitate an abused horse, and he kind of healed me and I healed him.” She realized that others might be helped similarly.
Equine-based therapy is unique because it has real-time impact, she explains. Hands-on therapy that involves movement and interaction with an animal creates “an awareness achieved in working with horses that cannot be replicated in a traditional therapeutic setting,” according to the organization’s website.
“Horses offer honest, truthful and non-judgmental feedback in-the-moment, during which clients acquire mental and emotional awareness,” Kristen explains.
Equine therapy takes place on the ground, never through riding or horsemanship. Licensed mental health practitioners and equine specialists encourage clients to re-evaluate their thinking, their emotions, and their actions on the spot while working with the horses.
“Horses mirror human emotions, and participants begin to experience themselves differently,” Kristen says. She adds that participants engage with the horses as “metaphors” in their stories, and thereby experience their emotions more deeply.
Kristen emphasizes the importance of somatic experiences, which focus on the connection between mind and body, especially for people who have experienced trauma.
“Participants explore themes such as boundaries, trust, respect, and accountability,” Kristen says. “The treatment plan assists clients as they integrate these insights into their everyday lives, families and workplaces.”
Gateway HorseWorks also collaborates with inpatient programs, especially for people struggling with drug and alcohol abuse. In these programs, patrons who live in residential facilities attend therapy with horses once a week for six weeks. Clinicians at Gateway HorseWorks provide case notes back to the staff at the patients’ facilities.
The services offered by the company fall into three core areas. First, they offer mental health programs for target populations, such as veterans, human trafficking survivors, incarcerated people, people in recovery, youth on probation, and youth in residential treatment. Second, they present learning programs that help people maintain healthy relationships. Finally, they serve people in helping professions with wellness retreats that provide continuing education credits and assist professionals “as they reconnect with their purpose and avoid burnout,” Kristen says.
While a team of licensed mental health professionals and equine specialists provide guidance, “Clients also discover their own solutions through the healing power of horses,” Kristen adds.
Results
Kristen notes that people initially saw horse-based therapy as “pretty woo-woo.” To combat any doubts, the organization hired licensed and certified clinicians and specialists. She acknowledges that gaining credibility was “an uphill battle,” but thanks to evidence-based research, Gateway HorseWorks is proving its worth.
“Participants that attended our program in addition to their in-patient programming completed treatment at 68.5 percent,” DeMarco says. In comparison, “The general population who attended inpatient treatment but did not attend our program completed at 52.3 percent.” Intervention by Gateway HorseWorks positively influenced client engagement.
Kristen hopes that continued research will encourage more insurance companies to cover Equine Assisted Psychotherapy, the next step on Gateway HorseWorks’ journey to a leading role in the community.