Equine-assisted psychotherapy (EAP) is a specialized form of psychotherapy using the horse as a therapeutic tool. This modality is designed to address self-esteem and personal confidence, communication and interpersonal effectiveness, trust, boundaries and limit-setting, and group cohesion. Substantial numbers of children witness family violence. There is evidence that violence between parents has adverse effects on the children in the family. These children are at greater risk of behavioural problems and mental health disorders, including anxiety, anger, depression and suicidal ideations, withdrawal, low self-esteem, and attention deficit hyperactivity disorder. The purpose of the present pilot study was to test the efficacy of EAP in a cross-sectional group of children referred to a psychotherapist for various childhood behavioural and mental health issues over an 18-month period (June 2003-January 2005). Sixty-three children received a mean number of 19 EAP sessions. Scores on the Children’s Global Assessment of Functioning (GAF) Scale were determined pre- and post-treatment. The mean (+/- standard deviation, SD) pretreatment score was 54.1 (SD 3.2) and post treatment mean score was 61.7 +/- 5.0 (t = 9.06, d.f. = 96, P < 0.001). All children showed improvement in GAF scores, and there was a statistically significant correlation between the percentage improvement in the GAF scores and the number of sessions given (r = 0.73, P = 0.001). Univariate analysis showed that the greatest improvement in the GAF scores occurred in the youngest of the subjects. Children in the group who had a history of physical abuse and neglect had a statistically significant greater percentage improvement in GAF scores after treatment than those who did not have a history of abuse and neglect. This study has demonstrated a quick response to EAP, especially in younger children, but it remains to be determined what kind of long-term effects this type of intervention may provide.