Tag Archives: animal assisted therapy

Learning about the experiences of canine-assisted therapy handlers

By Kelly Carapezza August 17, 2021

Interacting with animals, especially dogs, regularly elicits an immediate rush of the warm fuzzies for me. I also witness this among fellow shoppers when I walk through the pet store with my long-haired German shepherd. “Oh, how beautiful!” they will exclaim as they give themselves permission to pet my dog rather than greeting me.

It makes me chuckle at how quickly some people will jump at the opportunity to engage with animals, and then humans become an afterthought. If I don’t have my buddy with me, my visit to the pet store is much different — less greeting and more shopping.

Throughout history, animals have provided loyalty and companionship to humans. Sigmund Freud noticed that using his dog in counseling sessions helped clients feel more comfortable expressing emotions and sharing personal information about themselves. Several decades later, psychologist Boris Levinson momentarily left a child who was mentally ill with his dog. Upon returning, Levinson found the child interacting with the canine. This incident sparked further research into the use of animal-assisted therapy (AAT) with children.

During the 1980s, the Delta Society started defining formal and informal definitions and interventions incorporating animals into human treatment. Today, AAT is implemented among military veterans diagnosed with posttraumatic stress disorder. AAT has also been used as an adjunct therapy among families referred by child protective services and has facilitated growth in family functioning. Nonprofit organizations have registered various animals to provide mental and emotional support to humans. Approved animals include horses, canines, cats, llamas, alpacas, rats, rabbits and birds.

Dogs and CAT

As a dog lover and dog owner, I am drawn to the use of therapy dogs in various settings. Specifically, canine-assisted therapy (CAT) is a burgeoning treatment modality underneath the umbrella of AAT with a particular focus on canines. Over the past decade, dogs have been used in various settings, including nursing homes, schools, hospitals, libraries and more. Most of the research literature focuses on the impact these animals have on different populations. However, research is lacking on how canine handlers themselves are affected as treatment vessels.

Canine handlers come from a variety of backgrounds ranging from volunteers to trained clinicians. With proper certification, canines can facilitate a variety of therapeutic encounters. However, handlers who are certified or licensed professional counselors may offer even more empathic interactions than do volunteers from career backgrounds outside of counseling.

In the context of a therapy animal team, handlers maintain various characteristics to be successful. AAT is not practiced by everyone, so handlers need to consider personal motives. One characteristic that Michael Firman and colleagues found indicated in a 2016 study was intrinsic motivation. This includes AAT handlers who practice not for monetary benefit but because they are passionate about AAT.

Pet Partners is one of several national nonprofit organizations that registers a variety of handlers and animal teams. Handlers must complete and pass the online or in-person handler course, pass the required in-person team evaluation, and submit required applications and a background check to officially register as a team.

Handler experiences needed

I often wonder what it’s like to provide CAT therapy to people. As a counselor, I’ve experienced rapport building with a variety of people, from young children to older adults. Through my observation of several colleagues, it seems that having a dog present with clients certainly influences human interactions.

According to a qualitative study published by Anna Swall and colleagues in 2016, more studies are needed to explore the experiences of canine handlers involved in providing CAT. Swall’s study further indicated that CAT handlers were able to use canines to build therapeutic rapport between the participant and the handler. Therapy animals are trained to demonstrate Rogerian concepts such as unconditional positive regard. For example, if a child in a reading program makes a mistake while reading aloud, the canine does not laugh at the child or make judgments. It is quite the opposite. Therapy canines are used to decrease discomfort in humans and provide a supportive and loving environment.

In a study conducted by Nancy Eisenberg in 2015, researchers found that an individual’s ability to cultivate an emotional relationship with animals is congruent with their emotional connections toward people. Therapy animals also can serve as mediators when clinicians are attempting to build rapport with particular clients. And with animals included in therapeutic interactions, counselors have an additional model of empathy-like responses to present to clients.

Research has shown that dogs can also display sensitivity to human emotional states, as evidenced by their responding to negative emotions such as crying. Specifically, canines have responded to distress in humans by producing expressions and postures such as a relaxed open mouth and facial mimicry. In AAT settings, animals can supplement traditional therapeutic interactions by demonstrating positive behaviors with humans who are experiencing negative emotions.

MicroOne/Shutterstock.com

My firstborn

I tend to treat my dog as if he is human. I talk to him regularly about what to put on the calendar and ask for his opinion about handling specific client scenarios at work. Sometimes the bonds we share with our pets may seem silly, especially to those who do not have pets, but there is no denying how special and important these bonds are to us.

Handlers also develop a unique bond with their animal. This bond influences the animal and its response to the environment. In a 2019 study, Stephanie Kuzara and researchers identified various handler interaction styles, including authoritative and permissive. For example, CAT handlers working with students displayed increasing warmth behaviors, known as permissive styles, toward their canines when students approached the therapy animal team. In contrast, handlers showed authoritative styles by increasing control over the canine alongside demonstrating warmth behaviors depending upon student personalities.

Such observations led to further questioning about how the handler-canine relationship influences therapeutic outcomes. Researchers recommend studying handler interaction styles and how they affect the therapy animal and therapeutic atmosphere. Few studies currently exist regarding handler-canine dynamics; these studies are needed to better understand handler and canine team suitability and standards.

Ethical considerations

Animal welfare is crucial to AAT interventions. Counselors are trained to manage compassion fatigue and burnout, and therapy animals also have limits. Handlers are trained to be aware of an animal’s stress triggers. For example, a therapy animal engaged in visiting hospitals may experience too much stimulation due to the bright lights, fast-paced environment and medical equipment. In such a case, the handler may instead provide AAT in nonmedical settings such as schools or outpatient settings. Knowing the animal’s window of tolerance will prevent the animal from harming others and allow it to continue performing at full physical and mental capacity.

Furthermore, if the animal is sick or injured, it will not be used in therapy until receiving veterinary approval to resume AAT. Animals that become fatigued, irritable, stressed or frightened are removed from sessions by handlers so that they can rest and take breaks. AAT clinicians also provide antibacterial wipes and soap to use before and after AAT interactions. Providing clients with this information can help establish expectations for AAT and acknowledgment of both animal and human welfare.

The American Counseling Association’s ethics code indicates that counselors are to do no harm. AAT therapists must take the added dynamic of a therapy animal into account so that the animal does not damage the therapeutic relationship. Specifically, AAT clinicians must be sensitive toward individuals who do not like dogs or who have pet allergies. In these cases, most AAT clinicians will leave the therapy animal at home or in another room to avoid causing the client added stress in sessions.

AAT clinicians are also required to include AAT specialization and risk management information when clients complete their informed consent. This information serves as a waiver of safety, meaning that clients agree to the risks outlined in the consent form. Furthermore, animals used in therapy must undergo extensive training to ensure others’ safety and decrease the risk of physical harm from jumping, scratching or biting. AAT training and evaluations are meant to reduce client safety risks and ensure that proper precautions have been taken.

In 2016, ACA released the Animal-Assisted Therapy in Counseling Competencies, which indicate the practice of basic counseling skills in addition to using an animal to enhance therapy. These competencies are the latest breakthrough to provide clinicians with a direction to practice AAT in counseling, but more research studies are needed for practice standardization.

Counselor education and supervision

I am a counselor educator-in-training, and I think it would be exciting to incorporate AAT into accredited course curriculums. For example, counselor education and supervision programs could offer an elective course for students who are interested in this type of adjunct therapy. Furthermore, students who become certified in AAT can conduct research and focus on advancing the knowledge of CAT within the counseling field, just as many other professions have included AAT in their research.

In addition, studies focused on AAT handlers could inform other AAT practices, including CAT. Analyzing handler empathy could also provide new information regarding empathizing with challenging populations. In 2019, Lyndsey Uglow conducted a study to explore the effectiveness of AAT in a hospital setting and concluded that uniformity and treatment standardization were needed to ensure reliability and consistency when practicing AAT among various populations. Therefore, collecting qualitative research data may supplement AAT handler protocols on a broader scale.

Developing settings

Exam time was always exciting for me as a college student because of the therapy dogs that would visit the library at the end of the semester. It was a great way to take a break from the stress and strain of studying, and it also boosted my mood.

Therapy animals have become increasingly popular in other settings, including the workplace. It is not uncommon to hear about designated pet-friendly areas that allow well-behaved animals to interact with employees. Furthermore, Pet Partners has provided therapy animal teams for workplace well-being visits. Animal-assisted workplace well-being (AAWW) is implemented to increase employee satisfaction and productivity. AAWW has proved to decrease stress levels and often leads to effective collaboration between employees.

Therapy animals have also been used recently for animal-assisted crisis response (AACR) to assist in the aftermath of mass shootings, natural disasters and other community crises. AACR is not a mental health intervention per se, but handlers are trained to provide psychological first aid concepts to facilitate recipient stabilization.

Finally, AAT has been offered to patients in minimally conscious states. In a 2019 study by Karin Hediger and colleagues, researchers found that AAT increased patient arousal, indicating possible increased levels of consciousness. Therefore, the AAT application could serve as a breakthrough in neurorehabilitation for patients with disorders of consciousness.

Further research

As a doctoral student, I am currently in the process of conducting a qualitative study that will analyze a variety of handler experiences, from school counselors to licensed professional counselors to marriage and family counselors. Overall, AAT continues to grow as researchers explore various aspects of this adjunct treatment. CAT requires further exploration in the context of a handler’s perspective working with their four-legged co-therapist to promote a positive environment across a wide array of populations and backgrounds. I look forward to contributing to the literature in this area post-dissertation.

 

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Kelly Carapezza is a licensed professional counselor who works in the private practice setting, specializing in trauma therapy and eye movement desensitization and reprocessing. She has experience training her German shepherd in basic obedience and therapy dog classes and anticipates obtaining AAT certification through Pet Partners. Contact her at kelly@hillcitycounseling.com or through LinkedIn.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Canine companions

By Laurie Meyers May 4, 2018

Having kids and young adults train rescue dogs isn’t technically animal assisted therapy, but for the kids—and dogs—involved in the Teacher’s Pet program, the result has definitely been therapeutic.

The youth —with the help of professional animal trainers— use positive reward-based training to increase local rescue dogs’ chances of being adopted. In return, working with the dogs helps the students develop patience, empathy, perseverance and hope, says Amy Johnson, the creator and executive director of Teacher’s Pet, a Detroit-area non-profit program.

The idea for the program was born when Johnson, a former public school teacher, was working as a dog training instructor at the Michigan Humane Society. Johnson, an American Counseling Association member, wasn’t sure what the training would look like at first — she simply knew

Images courtesy of Teacher’s Pet. Identifying features of (human) participants have been blurred for confidentiality.

she wanted an intervention that would help both kids and dogs. Johnson contacted every group she could find in the United States and Canada that worked with both youth and dogs to learn more about how their programs worked. Her intent was to work with kids who — like their canine counterparts — were behaviorally challenged and often unwanted. So, not only did Johnson contact school counselors and psychologists for their input, she decided to become a professional counselor herself.

The end result was a program that is 10 weeks long and meets twice a week for two hours. Teacher’s Pet currently works with teens from an alternative high school and three detention facilities and young adults, aged 18-24 at a homeless shelter, says Johnson, a licensed professional counselor. At each facility (except for the homeless shelter), the training takes place on site. Participants from the homeless shelter are brought to an animal shelter to complete the program.

The program’s group facilitators are all professional trainers and they choose only dogs with good temperaments to participate, says Johnson, who is also the special projects coordinator and director of the online animal assisted therapy certificate program at Oakland University in southeast Michigan. Before the participants begin working with the dogs, the facilitators give them some safety training.

“We spend the first day going over body language and stress signals,” Johnson says. “They meet the dogs on day two, after one more hour of dog body language education.”

Other safety measures include limiting the number of dogs — five or six per class of 10 students — and keeping the dogs on long tethers placed 10 feet apart so that they can’t interact with each other, she says. There are also always at least four trainers in the room and the dogs are closely monitored. If a dog gets overexcited, is struggling to get off the tether or barking at another dog, a trainer will remove it from the room, Johnson says.

At the beginning of each session, the lead facilitator goes over the goals for the session, such as teaching the commands “sit,” “stay” or “down,” learning to walk on a leash or not jump for the food bowl. The individual trainers explain how to teach the commands and let the teens or young adults do the actual training as they supervise. The dogs are never forced to participate—if an individual dog is nervous or reluctant, the goal for the day is to establish trust and confidence, she says.

Johnson says that sometimes dogs that come off the streets have specific problems like trembling when people walk by. In that case, the students will sit with the dog until it becomes more comfortable and then start with small steps like going for a brief walk outside.

As participants are teaching the dogs new behavior, often their own behavior changes, she says.

In particular, a lot of the teens and young adults who participate have poor communication skills, Johnson says. For instance, some are so shy that they don’t project their voices and the dogs don’t respond to their commands. The participants have to learn to speak firmly and assertively, and to demonstrate a sense of command by standing up straight. One boy told Johnson that he decided to test the tone of voice and body language he used with the dogs on his peers to see what would happen. Imitating the behavior he used with the dogs gave the boy more confidence and he found it easier to interact with his peers, she says.

Johnson describes another boy who was very angry, had little patience and low impulse control. He had a soft heart and would choose dogs that were struggling, which told Johnson that he was projecting his anger.

“Inside he was like the dogs [scared],” she says. So the trainers paired the boy with a dog that was afraid of men. His job was to make the dog like him, Johnson explains. The boy had to be patient and sit with the dog. As the dog got calmer and more confident, the boy would gently encourage it to move closer and closer. By the end of the program, the dog was joyfully playing with boy.

Johnson says that the program facilitators coordinate with the participants’ counselors when possible, so that if they are struggling with particular problems — such as patience or impulse control — training sessions can include activities that help address those difficulties.

The teens and young adults also learn from each other. The first hour of each session is devoted to training and the second to journaling and “debriefing” — talking as a group about what worked and what didn’t.

Johnson believes that even just the oxytocin release that comes from spending time with the dogs is highly beneficial. The program participants are often deprived of loving human touch and the dogs will lick and hug and make them laugh — reducing their anger and anxiety.

As the program draws to end, saying goodbye isn’t easy, but that in itself can be a lesson learned, Johnson says. The students start to detach from the dogs a little bit, and they’ll talk about how that is a normal part of processing grief and loss, she says. The kids also write letters to potential adopters  touting the dogs’ accomplishments.

When the program is over, the teens and young adults say goodbye to the dogs and learn that they can say goodbye and not have it be the end of the world, says Johnson. The participants also get lots of pictures of themselves with the dogs and a certificate for the wall. Many former students have told Johnson that they keep a picture of themselves and the dog they trained on their dressers.

“I had a youth email me seven years later and ask me for another copy of his certificate because his was in a storage unit that was auctioned off,” she says.

Many graduates want to volunteer with Teacher’s Pet for adoption and other events, Johnson says. The organization also remains a resource for the students — they can get letters of recommendation or basic things like clothes for school or school supplies if needed.

Johnson says that Teacher’s Pet is also currently working with the American Society for the Prevention of Cruelty to Animals (ASPCA) on a longitudinal study to determine if the program produces behavioral changes in the kids, and if so, for how long.

 

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For more information about Teacher’s Pet, visit the website at teacherspetmi.org or email Amy Johnson at amy.johnson@teacherspetmi.org.

Related reading, on therapeutic power of the human-animal bond, from the Counseling Today archives: “The people whisperers

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor:ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

The people whisperers

By Laurie Meyers December 26, 2017

Licensed professional counselor (LPC) Hallie Sheade can’t remember a time when she didn’t love horses. She has been told that her equine passion started when she was 2 and begged to be allowed to ride a carnival pony without her mother holding her hand. Sheade, an American Counseling Association member, has taken riding lessons since she was 5, but it was at age 9 that she first encountered the path that would eventually lead her to specialize in animal-assisted therapy.

One day, a horse named Cowman who had been labeled difficult and stubborn showed up at the barn where Sheade took lessons. True to his reputation, Cowman didn’t get along with the other horses — or with people. But Sheade believed that Cowman was just misunderstood. She could relate. After all, she was feeling misunderstood by her own parents. Sheade began spending hours with Cowman, often grooming the horse as she poured out her troubles to him. A bond formed between them, and Sheade became the only person with whom Cowman would cooperate.

Then something interesting occurred. After months of spending time with Sheade, Cowman started to get along with other horses and to take direction from other people. And Sheade? Her relationship with her parents began to improve. “I felt calmer and more at peace after spending time with Cowman,” Sheade says. “I think it goes back to the fact that horses naturally embody [Carl] Rogers’ core conditions — empathic, nonjudgmental and able to offer unconditional positive regard. Therefore, just being with them can help us to feel more connected and understood, making it easier to tolerate life’s stresses.” She recalls that being the person Cowman chose to respond to also made her feel confident, capable and special.

Sheade’s memory of what she and Cowman shared would grow into a fascination for the human-animal bond and a desire to use that connection to help others who are hurting. Although her story illustrates the potential power of that bond, it does not stand as an example of actual animal-assisted therapy (AAT). Simply bringing your dog to work so that clients can pet it is not the equivalent of AAT, say the specialists interviewed for this article. Counselors — and the animals with which they work — need the proper training for true therapeutic benefits to be realized.

Instinctive helpers

Therapy animals need the right temperament and training to work with people who are experiencing stress and distress, says Cynthia Chandler, director of the Consortium for Animal Assisted Therapy at the University of North Texas. In other words, a skittish and difficult-to-control pet dog is not a therapy animal, no matter how beloved it may be.

Well-trained therapy animals can help counselors establish therapeutic bonds with their clients more quickly and can also alert counselors to emotions that clients may not have expressed yet verbally. However, counselors must be properly trained to read these signals and work effectively with therapy animals, says Chandler, a member of ACA.

“Using AAT requires understanding how animals interact as social beings and what that interaction can contribute to the psychodynamics of a counseling session,” says Chandler, whose book Animal-Assisted Therapy in Counseling is in its third edition. Counselors using AAT must have an understanding of species-specific behaviors — for example, how particular types of animals signal distress or give support — and an in-depth awareness of their own animals’ personalities.

Possible therapy animals include pocket pets (such as hamsters), rabbits, reptiles, llamas, dolphins and cats, but the most common are dogs and horses. Chandler, co-leader of ACA’s Animal-Assisted Therapy in Mental Health Interest Network, believes that dogs and horses make the best therapy animals because they come from family systems and have lived with humans for such a long time. Their natural instinct is to include the counselor and client in their herd or pack, she explains.

Like humans, dogs and horses also seek positive nurturing interactions. “[The desire for nurture] has a physiological basis,” Chandler says. “When we’re engaging in a nurturing touch, it releases oxytocin and endorphins.” When clients reach out to touch a therapy animal, they feel more socially connected, and their stress hormones go down, she explains. “[This] allows clients to feel safer to engage and discuss difficult issues,” says Chandler, who has another book, Animal-Assisted Interventions for Emotional and Mental Health: Conversations With Pioneers of the Field, currently in press.

Horses and dogs are also excellent distress detectors, Chandler says. Both species are extremely good at sensing stress, through smell and body language, and then reflecting that stress is present in an environment, she explains. They communicate this through their body language, such as moving toward an anxious client to soothe the person or moving away when the situation feels overwhelming to them. They also give off other signals to alert counselors to important information, she says. For instance, a horse might prick up its ears or a dog might bark or repeatedly look back and forth between the client and counselor.

Chandler jokes that horses and dogs are existentialists. They don’t like angst, uncertainty or resistance, and their natural inclination is to resolve issues, she explains. Chandler’s former therapy dog, Rusty, a red and white cocker spaniel, was known to walk over to clients who were resistant, put his head on their knees and just stare at them. Typically, Chandler says, tears would start forming in these clients’ eyes within about 30 seconds, and they would then begin to open up. Rusty would indicate his approval — and support — by jumping up into their laps.

Through her personal practice, research and interviewing other animal therapy experts, Chandler has studied the human-animal bond and how it works in therapeutic settings. In the process, she has developed what she calls human-animal relational theory. When humans and social animals come together within the therapeutic setting, she says, a whole series of relational happenings occur, even if a dog is across the room or a horse is across a pasture. “How an animal engages or doesn’t engage will bring out something big in the client,” Chandler says.

Being able to recognize the significance of the therapy animal’s behavior is the job of the counselor, Chandler says. “Hey, Jesse [Chandler’s current therapy dog, also a cocker spaniel] just woke up and jumped up in your lap. Why do you think she did that?” Chandler might ask a client. For Chandler, Jesse’s reaction might hint at resistance on the part of the client. Jesse, like Rusty, doesn’t like it when she senses that clients are holding back and will often jump into their laps and nuzzle them until they talk about what is bothering them. However, the client might assign a different meaning to Jesse’s action. Either way, Chandler marks the moment, and then she and the client process it together.

Risk reduction

Leslie Stewart, whose research focuses on AAT, emphasizes that it is important for counselors to recognize that AAT is a specialized form of counseling — just like play therapy or art therapy — that requires specific knowledge. Because animal behavior is never 100 percent predictable, AAT also carries an increased risk of harm, she acknowledges. But Stewart, who helped write the Animal-Assisted Therapy in Counseling Competencies endorsed by the ACA Governing Council in 2016, believes that in the hands of competent providers, the potential benefits of AAT far outweigh the risks.

Risk reduction begins with informed consent. Counselors should always talk to clients about what they can expect if they decide to use animals in their counseling sessions and caution them about any potential risks, Stewart says. For instance, clients with previously unknown allergies could be at risk of anaphylaxis. Many animals shed, so clients should be prepared to find fur and hair on their clothing. Something as simple as a game of catch could cause accidental injury if a client takes a wrong step and pulls a muscle or breaks a bone.

Then there are the larger risks. “Horses are big and move quickly. When they are scared, they react quickly, and we can’t always stop them,” Stewart cautions. “They also can’t see their feet, so they can’t see our feet.”

And even trained therapy dogs will bite under certain circumstances, Stewart notes. “In cases when animals’ needs aren’t perceived and met, they feel they need to react in ways humans see as aggressive,” she says. Becoming competent in AAT requires counselors to learn to recognize the early signs that an animal needs some space or has had enough and needs to take a break.

Client assessment is also crucial, she says. Stewart, who has counseled survivors of sexual assault and juvenile offenders, doesn’t bring any of her therapy animals with her when assessing clients. Some clients are afraid of or simply don’t want to work with animals, she explains, whereas certain clients — such as those with a history of violent, impulsive behavior — perhaps shouldn’t engage in AAT.

Stewart teaches AAT at Idaho State University, where she is an assistant professor of counseling. She works with three therapy animals: Killer the rabbit, a border collie named Star Sapphire and a German shepherd named Sophie. She emphasizes that knowing an individual animal’s personality is just as important as knowing species behavior.

“Sophie is a big gentle dog, typical of her breed, sort of no-nonsense, friendly and enjoys getting human attention,” Stewart says. “She’s not a lap dog and is not going to be all over you, whereas Star Sapphire is going to be all over you.” The dogs show affection differently, and Stewart highlights the contrast to help students recognize that clients also express needs differently.

Students learn what it means to be affectionate with Sophie. When she curls up four feet away, she’s showing affection. Stewart also asks them to figure out how to communicate affection to Star, even when they might prefer that Star not be all over them. Stewart also has the students use positive reinforcment-based obedience techniques to teach Star something new, such as sitting in a chair in class. By teaching Star, students are learning how to better communicate and deal with frustration when working with clients, she says.

Stewart also provides education about how certain species view the world and what does and does not make a particular type of animal comfortable. “For example, a lot of humans want to hug dogs, but most dogs don’t like being hugged. It stresses them out,” she says. Students are tasked with redirecting a client’s need to show affection into an action that will not cause the therapy animal stress. For instance, Sophie likes to put her head on someone’s knee and get her ears scratched.

Stewart also brings Killer to class. Rabbits’ actions are more subtle and require close attention — which also happens to be a necessary skill for counselors when working with human clients.

Talking horses

As part of her path to specializing in AAT, Sheade studied with Chandler while getting her doctorate at the University of North Texas. She developed two models of equine-assisted therapy: equine-assisted play therapy and equine relational therapy. She now runs Equine Connection Counseling, a private practice that specializes in equine therapy.

Sheade uses equine therapy with both children and adults. Equine Connection Counseling’s partner, Wings of Hope Equitherapy — an accredited therapeutic horseback riding facility — provides the space and horses. The therapy takes place primarily on the ground through interaction with the horses rather than on horseback.

With children ages 3 to 9, Sheade uses equine-assisted play therapy, which incorporates horses into child-centered play therapy. Sessions are one-on-one in a play area that contains various toys and multiple miniature horses, which are slightly bigger than a very large dog. Sheade lets the child choose how (or whether) to interact with the horses. Many children want to immediately engage with the horses, while other children prefer to start with toy horses, she says. The children are allowed to groom the horses with brushes that Sheade provides or they can integrate the horses into play using various toys. For example, children might use the medical kit to give the horses a “checkup” or dress the horses up by putting a lei or boa around their necks or balancing a hat on their heads.

Some children don’t interact with the miniature horses at all, choosing merely to play with the toys on their own. However, Sheade says the parents of those children often report that the horses are all their children talk about afterward.

The horses serve as potent change agents, Sheade says. “They [clients] want the horse to want to be around them,” she says. Horses do not like chaos, however. It isn’t uncommon for children to run up and greet the horses, but if a child is emotionally dysregulated — for example, displaying behaviors such as defiance and opposition, uncontrolled energy or excitement — the horses will react in ways that do not communicate to the child “let’s play,” Sheade says. One horse might run off to the other side of the arena, whereas others might stand in place but show no interest in interacting, she explains. This is the horses’ way of giving feedback, but it is less threatening to a child coming from an animal than it is coming from a grown person, Sheade says.

For example, one of Sheade’s clients was a young girl who was oppositional and defiant. She would approach the horses and get very frustrated when she couldn’t get them to do what she wanted them to do. Sheade helped her become aware that her actions, such as rushing up to the horses in a demanding and impatient manner, were actually driving the horses away.

Children with social difficulties sometimes find that the horses don’t want to interact with them. When this happens, Sheade has them examine how they approached the horses. Was it in a physically threatening way? Did they speak in an angry tone of voice? As the children learn how to interact with the horses, they can take what they are learning and apply it to other relationships in their lives, Sheade says.

The horses also offer emotional support. For instance, if a child is playing alone in the sandbox because he or she is sad or upset, one or more of the horses tends to gravitate toward the child to give comfort through their presence, Sheade says.

Sheade also works with adults, particularly military veterans and others with posttraumatic stress disorder or other trauma. These sessions, using the equine relational therapy model, are also one-on-one and take place mainly on the ground with a herd of horses. Clients choose which horse they want to work with and usually stay with that horse throughout the therapeutic relationship. By inviting clients to pick a horse and have it be “theirs,” Sheade says she is encouraging a bond based on the therapeutic relationship.

Although the primary bond is between the client and the chosen horse, the herd still participates, Sheade says. When clients are distressed, it isn’t only “their” horse that typically reacts. Often, the whole herd will gather.

The sessions are usually a mix of activities and talking, Sheade explains. As clients speak, Sheade is watching the horses’ reactions. This can tell her more about how clients are feeling and often gives her an avenue to broach uncomfortable topics. For example, sometimes when veterans are talking about trauma, their horse might signal the herd to leave. Sheade then asks clients what they think prompted the retreat. Usually, the answer is that the clients’ anxiety was building because they were struggling with a topic they didn’t want to talk about but knew they needed to address.

With equine-assisted counseling, clients don’t necessarily have to talk specifically about what is troubling them, because interpersonal challenges are revealed in the way the horse and client interact, Sheade says. For instance, someone who is a survivor of sexual violence might not know how to assert themselves and say “no” to a horse. Or new clients might think that when the horses walk away from them, it is automatically an indication that they dislike the person.

“What we’re targeting … is [the clients’] thoughts and feelings in the moment — what they believe about themselves or the horses,” Sheade says.

Working with trauma

LPC Shawna Corley’s therapy dog, Rylie, a Great Pyrenees-golden retriever mix, plays a vital role in establishing a sense of safety and trust with Corley’s clients, most of whom are trauma survivors. Children, in particular, find it easier to “talk” to Rylie, Corley says.

One client, a 7-year-old girl who had been sexually assaulted by a relative, kept insisting that she was fine, even though she had been experiencing flashbacks. Corley, who doesn’t include Rylie in her intakes, gradually began bringing her into sessions with the girl. Once the client established a bond with Rylie, the girl could tell her anything she wanted, just like she was talking to a friend. Corley, who presented a session on incorporating therapy animals into counseling at the 2016 ACA Conference & Expo in Montréal, would sit apart from the client and Rylie, but close enough to hear.

The child would audibly whisper into Rylie’s ear that she felt bad or sad. Corley, a private practitioner in San Antonio, would then ask the girl for permission to speak to Rylie. After “listening” to Rylie, Corley would say something like, “Rylie tells me that you have been feeling sad. Can you tell me about that?” Relaying the conversation through Rylie helped the girl begin to talk to Corley about her trauma.

Rylie has other ways of telling Corley about what a client is feeling. If Rylie perceives a lot of sadness and stress, she will lie on Corley’s feet. To communicate the presence of anger or frustration, she sits on Corley’s feet. Rylie’s physical signals — natural behaviors that Corley reinforced through training — can be especially helpful for adult trauma survivors who have difficulty recognizing and labeling their own emotions. When clients are talking about their trauma, Rylie can let Corley know that clients are becoming upset before their distress triggers a traumatic reaction.

Rylie also sometimes gently urges clients to talk. If clients sit in session for an extended period of time without talking, Rylie often will go over and push their knees with her paw. She will keep doing this until they say something, Corley says.

Because Corley sees clients who are experiencing physical abuse or engaging in self-harm, Rylie is trained to spot injuries such as superficial cuts and bruises underneath clothing. Rylie will then alert Corley, using her nose to pinpoint an area with injuries. Rylie will keep coming back to the area until Corley acknowledges the signal. Rylie’s information provides Corley an opportunity — either immediately or in the future — to initiate a conversation about the injuries.

Rylie also strives to provide a sense of safety, according to Corley. If clients are feeling vulnerable, Rylie will move toward them to physically surround them in a protective manner. She will also protect them by accompanying them to the door when it is time to go.

Safety and training

It is crucial for counselors who are interested in AAT to understand how proper training protects both their clients and the therapy animals themselves, Chandler says. She and Stewart emphasize the importance of recognizing signs of stress in a therapy animal and realizing when an animal doesn’t want or isn’t able to work.

“An animal with the right temperament and attitude can handle counseling quite well,” Chandler says. However, absorbing all the stress and pain that is part of the therapeutic process wears them out, she says. “Jesse only sees a few clients a day [and] not every day,” she says. “Sometimes therapists have more than one dog or horse so they can rotate.”

Although programs that grant certificates for AAT — such as the one at Idaho State — are becoming more common, it can still be difficult to find training, Stewart acknowledges. Courses are available online, but she says that those alone are not sufficient; counselors must do formal coursework. She recommends that counselors who are having trouble finding appropriate coursework contact ACA’s Animal-Assisted Therapy in Mental Health Interest Network (see “Additional resources” sidebar, below).

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Competencies (counseling.org/knowledge-center/competencies)

  • Animal-Assisted Therapy in Counseling Competencies

ACA Interest Networks (counseling.org/aca-community/aca-groups/interest-networks)

  • ACA Animal-Assisted Therapy in Mental Health Interest Network

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  •  “Animal Assisted Therapy in Counseling” by Leslie Stewart & Catherine Y. Chang

Counseling Today (ct.counseling.org)

Journal articles (counseling.org/publications/counseling-journals)

  • “Therapy Dogs on Campus: A Counseling Outreach Activity for College Students Preparing for Final Exams” by Sandra B. Barker, Randolph T. Barker & Christine M. Schubert, Journal of College Counseling, October 2017

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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The Counseling Connoisseur: Nature-informed counseling for children

By Cheryl Fisher October 13, 2016

“Once there was a tree … and she loved a little boy” — from The Giving Tree by Shel Silverstein

 

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I recently returned from a wonderful week in Nova Scotia featuring painted clapboard cottages against blue skies and a seascape of majestic hills and swirling tides. With a history rich in forts, fur trades and complex propriety, Nova Scotia also affords miles of pristine trails for the avid (and not so avid) hiker.

On one such hike, I ventured up Cape Split, which offered a spectacular view of the Bay of Fundy following a two-hour uphill jaunt. The inland path was lush with evergreen and paved in centuries-old rocks. Snarled roots from ancient maples protruded from the narrow trail, and patches of mud provided slippery terrain. At times the trail seemed endless and unforgiving. However, just at that moment when body and morale were failing, the forest opened to a grassy knoll that blanketed the age-old rock formation overlooking the (now) returning six-foot tides of the Bay of Fundy.

Damp with perspiration from navigating the trail, we sat down and unloaded our backpacks, laying out a feast before us of lobster rolls and blueberry lemonade. The cool breeze from the bay mingled with the warmth from the sun. In that moment, I was sure there was nothing sweeter than communion with nature and the physical and emotional exertion and spiritual nourishment it afforded.

 

Camps and communion

For many children (and their excited parents), the end of summer signifies a return to school, studies and schedules. It is a time when we bid farewell to the lackadaisical whimsy of carefree days. Summer memories of camps, cookouts and canoes fade, making way for the cooler activities of autumn. However, for many children, summer camp did not include nature hikes, bonfires or kayaking; it involved indoor activities centered around a theme such as weight management, music acquisition or computer skills.

photo-1447875372440-4037e6fae95dResearch suggests that connecting to nature can result in reduced stress, increased energy, improved sleep, reduction of chronic pain, and accelerated healing from injuries and surgery. In particular, Peter Kahn and Stephen Kellert have argued that “a child’s experience of nature exerts a crucial and irreplaceable effect on physical, cognitive and emotional development.”

Yet modern living has insulated us from the positive ionic exchange between grass, trees, river and sky, resulting in a physical, psychological and often spiritual connection from the Earth and her creatures. According to researcher and therapist Martin Jordan in his book Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces, this detachment is associated with a variety of dis-ease, including epidemic rates of obesity and depression.

Richard Louv, author and founder of the Children & Nature Network, coined the term “nature deficit disorder” in his book Last Child in the Woods to refer to a generation of children who no longer spend time outdoors hiking, camping and otherwise interacting with the natural world. Direct contact with nature appears to benefit children physically, emotionally and spiritually.

 

Physical

Interacting with natural elements provides a varied and complex terrain and physical stimulation for children. Negotiating inclining hills or slippery declines, catching and releasing tadpoles or crickets, and chasing butterflies, for example, create opportunities for skill-building in a variety of areas, including large and fine motor skills, balance and hand-eye coordination. Most people can remember the challenge of a new skill … and the thrill of successful mastery.

 

Emotional and cognitive

According to Kahn and Kellert, a child’s experience of nature “encompasses a wide variety of emotions” and an “unfailing source of stimulation.” I remember the awe and wonder I experienced when my childhood naturalist neighbors taught me how to look for the tiny green caterpillars grazing on the cabbage leaves in the garden; then observing their transformation as they ate their way to chrysalises; and the unbearable waiting and waiting until these dormant creatures emerged into beautiful white butterflies.

More recently, I ventured into raising the threatened monarch butterfly. Still with the curiosity of a child, I planted my milkweed, purchased my microscopic caterpillars and watched in amazement as larvae transformed into J’s hanging from the top of my butterfly shelter. Sadly, a virus attacked my precious guests and killed each before they could take their first flight. I experienced genuine grief over this loss.

 

Moral

Nature provides endless teaching opportunities around issues of moral conscience. Kellert identified nine values of the natural world:

  • Aesthetic: Physically appealing
  • Dominionistic: Mastery or control over nature
  • Humanistic: Emotional bonding with nature
  • Moralistic: Ethical or spiritual connection to nature
  • Naturalistic: Exploration of nature
  • Negativistic: Fear and aversion of nature
  • Scientific: Knowledge and understanding of nature
  • Symbolic: Nature as a source of language and imagination
  • Utilitarian: Nature as a source of material and physical reward These values tend to emerge in a developmental manner, generally shifting from more self-centered, egotistical values to more social and other-centered values.

 

Nature-informed counseling

Nature-informed counseling refers to a vast array of scientifically based psychological therapies that use nature in clinical practice. Among the foundational assumptions of nature-informed counseling are that we are not machines; we are human beings who are sensual, curious and creative. We are interdependent with the full ecosystem in which we reside.

Furthermore, ecotherapy is an organic model of care that tends to the whole relationship between humans and the other-than-human. Here are several ways to incorporate nature-informed methods into your counseling practice:

1) Animal-assisted therapy: I am fortunate to be able to bring my goldendoodles to my office to be co-therapists. However, in addition to dogs, there are other smaller pets that may work more easily in your practice. For example, I had a betta fish (who was named Olive by a client) that I used with clients. Or place a bird feeder outside your window (if you are fortunate enough to have a window).

2) Horticulture therapy: There are numerous ways to integrate plants in a therapeutic manner. Have clients plant seeds and tend to their care. Or keep small pots of herbs in your office, providing an opportunity to explore aromatherapy. It is a wonderful release to pinch off a bit of rosemary, mint or thyme and inhale the calming, soothing or energizing fragrance.

3) Wilderness therapy: I have used “kayak therapy” with trauma survivors with great success. However, you may not work in a community with easy water access or even know how to kayak. Therefore, your wilderness approach might be more in line with taking clients on a walk on a trail or observing wildlife with them in a nearby lake or pond.

You can also co-create homework around nature walks. For example, I was working with a couple who seemed stuck, so I asked them to go for a walk together (without talking) and collect items along the way that reminded them of their marriage. When they returned to my office, they emptied their treasures, which included a rock (“that used to be how I saw our marriage”), a feather (“we are drifting away”) and a few twigs (“we have roots still”). After a discussion centered around the items gathered, I had the couple finish the session by using the items to create a sculpture that reflected the relationship they wanted to craft.

4) Other ideas:

  • Assess your clients’ relationship with nature. Where is their “happy place”? How often does they get to visit it? Where are their favorite memories housed?
  • Invite a family with which you are working to spend the night in a tent in the backyard and reflect on this experience in session.
  • Teach cloud spotting. Teaching clients mindfulness takes on a fun twist as you lie on your back and gaze at the ever-changing cloud formations.
  • Use transitional objects. I keep a box in my office filled with seashells, sea glass and rocks lovingly collected by my own mother when she walks the beach. I use these as transitional objects when clients might benefit from imprinting an image or experience to an object that they can carry in their pockets or purses throughout the day.

 

Ethical consideration

As with all forms of practice, ethical standards must be followed to avoid harm and litigation. So what are the ethical considerations when utilizing the wisdom of nature in psychotherapy? This depends on the extent and type of nature-informed therapy you are using. For example, the ethical guidelines for hiking a trail with a client may look a bit different than the guidelines forphoto-1469440317162-d9798b137445 planting a sunflower seed and tending to it as metaphor for self-care and growth. However, in general the following issues must be addressed.

1) Do all parties feel physically and emotionally safe? Although you may thrive sitting in a field of poppies, your client may possess strong allergies to flower pollen that render therapy outdoors a physically uncomfortable experience. In addition to allergies, the client may exhibit phobias around the outdoors that need to be understood and appeased. Temperature and air quality may also be variables to consider.

2) Framing the relationship. For some therapists and clients, an office space with a designated chair arrangement signifies a professional relationship and the tasks that will ensue. A client may feel uncomfortable with the more lax and familiar atmosphere of sitting cross-legged on a hollow log while disclosing current therapeutic issues. Trading leather chair for log stump may alter the relationship in ways that prove unsettling for either the client or the therapist.

3) Is it confidentiality compliant? I have clients who love taking a walk during therapy. Some lament that it is the only time they have for physical activity. However, if we are walking in a heavily populated area, their confidentiality may be at risk. At the same time, an area that is too isolated may not be prudent should an emergency situation arise.

4) Get appropriate training. If you do not know how to kayak, taking clients on a wilderness kayak expedition probably isn’t wise. Always get training before using any modality in therapy.

5) Informed consent. It is always prudent to have clients sign an informed consent form that stipulates the possible risks and benefits of any therapy used in session. Therefore, a specific consent form that addresses the specific type of nature-informed therapy — including possible benefits and risks — needs to be explained and signed prior to taking that walk in the woods or a stroll in the garden during session.

 

Conclusion

Nature provides endless opportunities for metaphors, messages and meaning construction. Incorporating nature-informed approaches into our practices is not only creative but also clinically sound. It is as easy as taking the time to reflect on the sights, sounds, and smells just outside the door.

 

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For more information:

  • Ecotherapy: Healing With Nature in Mind by Linda Buzzell and Craig Chalquist (2009)
  • Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces by Martin Jordan (2014)
  • Children and Nature: Psychological, Sociocultural and Evolutionary Investigations by Peter H. Kahn and Stephen R. Kellert (2002)
  • Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder by Richard Louv (2008)

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Cheryl Fisher

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is currently working on a book titled Homegrown Psychotherapy: Scientifically-Based Organic Practices, of which this article is an excerpt. Contact her at cy.fisher@verizon.net.

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
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ACA endorses animal-assisted therapy competencies

By Bethany Bray August 15, 2016

Animal-assisted therapy involves much more than helping professionals bringing a pet to work with them or having an “office mascot,” says Amy Johnson, a contributor to the new Animal-Assisted Therapy in Counseling Competencies. The competencies were developed in collaboration with the American Counseling Association’s Animal-Assisted Therapy in Mental Health Interest Network.

“We’re seeing teachers and practitioners bringing animals into sessions and classrooms without training [in animal-assisted therapy],” says Johnson, a licensed professional counselor (LPC) who directs the animal-assisted therapy certificate program at Oakland University in Rochester, Michigan. “From a client’s, animal’s and practitioner’s standpoint, there’s a high risk of a negative experience. In order for it to work, there need to be a set of standards and competencies – tenets to follow.”

The new animal-assisted therapy (AAT) competencies, which were endorsed by ACA’s Governing Council and released this spring, were developed to establish best practices for counselors who use animals in therapy. The co-authors also hope that the document helps spread the message that AAT is an intentional technique that involves another being with needs and sensitivities, says Johnson.

“It seems like enthusiasm about the human-animal bond has been steadily growing, and that’s wonderful. But at the same time, there’s a lack of awareness that this is a specialty area within counseling that requires training and knowledge beyond [a counselor’s graduate course work],” says Leslie Stewart, an LPC and assistant professor of counseling at Idaho State University who photo-1455287278107-115faab3eafais a co-author of the AAT competencies. “There is an increased risk of harm for the client and the animal; there are specialized approaches that a handler needs to take with the animal interaction in the therapeutic interaction.”

Practitioners who teach AAT often use a triangle model to show the connection between a counselor, the client and the AAT animal, explains Johnson. Each side of the triangle is an equal length, which means it needs equal weight and consideration. Being mindful of all three components is critical, she says.

“These [AAT animals] are living, sentient beings, not just a tool. … Sure, your dog is great, but can it see eight clients per day?” says Johnson.

Stewart and Johnson agree that interest in AAT has been growing steadily in recent years, not only among counselors but among other helping professions such as social work. As therapy animals are used in disaster relief, on college campuses and in other settings, AAT is receiving more media attention. With interest growing, there has also been an increase in training programs and sessions on AAT at professional conferences, Stewart says.

When done intentionally and correctly, AAT can be a useful tool for all types of counselors across a spectrum of settings, from classrooms with young children to older adults or veterans recovering from trauma, Stewart says. AAT can involve a variety of animals, from dogs and cats to rabbits, guinea pigs and horses.

AAT can be combined with other forms of traditional therapy such as cognitive behavior therapy. The animal can help clients to feel more comfortable in session or serve as an outlet with which clients can practice social or communication skills.

Or the animal can be used to illustrate a concept or lesson. For example, a school counselor or practitioner who works with young children might use a hermit crab to focus on the concept of moving, Johnson explains. Talking about the crab’s move from one shell to another might encourage a young client to talk through his or her own moving experience.

“One of the strengths of the [AAT] intervention is that when it’s practiced by a competent provider, it’s extremely flexible in its application,” Stewart says. “It can be tailored and adapted to meet the needs of counselors and their populations.”

The new AAT competencies were born out of ACA’s Animal-Assisted Therapy in Mental Health Interest Network. The group, of which Johnson and Stewart are both members, had been talking about the need for a set of AAT competencies for several years, they say. The competencies ultimately came to fruition when Stewart took them on as part of her doctoral dissertation at Georgia State University.

After Stewart completed the competencies – and her dissertation – in 2014, the AAT interest network submitted the competencies to ACA. After a brief review and revision process, the association’s Governing Council gave its final approval of the document at ACA’s 2016 Conference & Expo in Montréal this past March.

The document became ACA’s eighth set of professional competencies that are posted online and available to the public.

Stewart and Johnson hope the competencies are used by practitioners and graduate students interested in learning more about AAT, and by counselor educators, who can distribute the competencies as a resource for students.

The competencies also lay a foundation for other professions to develop AAT competencies “so that everybody’s practicing with the same intentionality,” Johnson says.

“I’m so excited and honored that ACA is recognizing not only the efficacy [of AAT], but the specialization involved,” Stewart says. “I hope that counselors and educators who are interested in this will take the time to recognize that, yes, your enthusiasm is warranted, but [AAT] is a skill that involves knowledge [and] a living being. … Stop and think for a few minutes: Everything we do, every decision we make as counselors, whether we’re working with an animal or not, communicates something to a client. What do you want to communicate to your client? If you’re not attending to an [AAT] animal’s welfare, what is that communicating to your client?”

 

 

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The American Counseling Association’s Animal-Assisted Therapy in Counseling Competencies are available at counseling.org/knowledge-center/competencies

 

Counselors: Interested in joining ACA’s animal-assisted therapy interest network? The group of more than 300 practitioners exchanges ideas through a Facebook page and the ACA Connect listserv and has a get-together every year at ACA’s annual conference.

Find out more at counseling.org/aca-community/aca-groups/interest-networks

 

Interested in learning more about emotional support animals and how they differ from animal-assisted therapy? See Counseling Today’s article “Confirming the benefits of emotional support animals

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.