Tag Archives: animal assisted therapy

Confirming the benefits of emotional support animals

By Cynthia K. Chandler April 20, 2015

Have you received a telephone call of the following nature? “Can you certify my pet to be an emotional support animal?”

If you are a professional counselor, then the likelihood of you receiving such a request is on the rise. This is because word is spreading that the U.S. Department of Housing and Urban Development dog_1(HUD) recognizes the benefits of emotional support animals and provides regulations allowing them to live with an owner in designated nonpet housing (with a few exceptions) without requiring a pet deposit fee.

Exercising this right does not require that an animal be certified. What it does require is documentation that an individual has a legitimate need for an emotional support animal. The responsibility of providing this documentation lies with professional counselors and other mental health or health providers. In 2008, HUD stipulated that “persons who are seeking a reasonable accommodation for an emotional support animal may be required to provide documentation from a physician, psychiatrist, social worker or other mental health professional that the animal provides support that alleviates at least one of the identified symptoms or effects of the existing disability.”

 

Documentation and other considerations

A counselor who chooses to provide such documentation must do so in letter format on the counselor’s letterhead. The documentation should state that:

1) The named individual is under the counselor’s care

2) The individual has an emotional or psychiatric disability

3) The counselor recommends the individual have an emotional support animal to assist with the disability

The letter is provided directly to the individual who wants to have an emotional support animal live in the home. The individual can then choose with whom to share the letter.

In the documentation, the counselor does not label, define or describe the particular disability of the client. Rather, the counselor must state in general terms that the client has an emotional or psychiatric disability and that an emotional support animal can alleviate one or more of the symptoms or effects of the disability. Individuals need only provide proper documentation to a landlord to have a pet live with them as an emotional support animal in housing typically designated as excluding pets. The judicial system has interpreted this right to fair housing to additionally extend to individuals who wish to have emotional support animals live with them in college or university housing facilities, such as residence halls, dormitories or university-owned apartments.

The responsibility of providing documentation that would allow individuals to have an emotional support animal live with them should not be taken lightly. Based on the accompanying symptoms of a client’s emotional or psychiatric disability, a professional must determine whether living and engaging with an emotional support animal in the home might provide the client with some relief from the disability. To make this determination, it may be useful to have some understanding of how an animal may alleviate symptoms or effects of an emotional disability. Fortunately, there is research that provides guidance in this area.

In my 2012 book, Animal Assisted Therapy in Counseling, I reviewed several research studies on the psychophysiological and psychosocial benefits of positive social interaction with a pet, such as holding or stroking an animal. These benefits include calming and relaxing, lowering anxiety, alleviating loneliness, enhancing social engagement and interaction, normalizing heart rate and blood pressure, reducing pain, reducing stress, reducing depression and increasing pleasure. Based on the results of these studies, it is plausible that living with an emotional support animal may alleviate symptoms associated with a number of emotional and psychiatric disabilities. HUD states, “Emotional support animals by their very nature, and without training, may relieve depression and anxiety, and/or help reduce stress-induced pain in persons with certain medical conditions affected by stress.”

Another factor to consider in recommending that a client have an emotional support animal is whether the client has the ability and desire to properly care for an animal. Although human-animal interaction is known to assist people with developmental, emotional, social and behavioral disorders, it is important to assess whether any impairment is so severe that an animal would be neglected or harmed.

Dogs are the most common species to serve in the role of emotional support animals, but Section 504 of the Rehabilitation Act and HUD’s Fair Housing Act (FHAct) do not designate species restrictions for this role: “While dogs are the most common type of assistance animal, other animals can also be assistance animals.”

 

Emotional support animals vs. service animals

HUD legislation uses the broad term “assistance animals,” which is inclusive of both service animals and emotional support animals, when addressing the right to fair housing for individuals with these animals. In contrast, the fair housing rights and rights of access to other facilities included in the Americans with Disabilities Act addresses service animals only. To be clear, an emotional support animal is not the same as a service animal or a psychiatric service animal. Thus, emotional support animals do not have the same federal rights of access to facilities as do service animals. HUD provides the only current federal legislation that covers rights regarding emotional support animals, and this legislation is specific to allowing individuals to have animals live with them as emotional support in designated nonpet housing without financial penalty.

In 2013, HUD clarified that an emotional support animal is not merely a pet: “An assistance animal is not a pet. It is an animal that works, provides assistance or performs tasks for the benefit of a person with a disability, or provides emotional support that alleviates one or more identified symptoms or effects of a person’s disability.” However, HUD also stipulated that emotional support animals “do not need training to ameliorate the effects of a person’s mental and emotional disabilities.” Furthermore, “For purposes of reasonable accommodation requests, neither the FHAct nor Section 504 requires an assistance animal to be individually trained or certified.”

There are no qualification requirements for determining whether a specific pet is appropriate to serve as an emotional support animal. So, by default, an emotional support animal is basically a person’s pet that lives with that person and provides emotional support. HUD does stipulate that housing providers are not required to provide accommodations if an animal is destructive, poses a direct threat to the health and safety of others or interferes with the ability of a facility to perform its intended purpose. So, in practice, most people with proper documentation can have a pet live with them and serve in the role of emotional support animal as long as the animal is not destructive, disruptive or dangerous.

 

Recommendations

Because federal law does not require emotional support animals to be trained or certified, the potential exists for some of these animals to be unpredictable and cause harm. Until there is greater oversight regarding emotional support animals, I recommend that counselors avoid a chain of liability and not name a specific pet to serve as an emotional support animal. When providing documentation, refer only to the benefit of the individual having an emotional support animal, but do not name a specific animal. The decision concerning the specific pet to be designated as an emotional support animal should be made by the individual owner of the pet. It is not the responsibility of the counselor or other mental health provider to sanction the appropriateness of a particular pet to serve as an emotional support animal. That is not to say that counselors should avoid assisting individuals in the decision-making process regarding emotional support animals.

For instance, counselors can recommend that clients have their pets evaluated by a qualified evaluator before designating the pets to serve as emotional support animals. A standardized evaluation can often determine if an animal possesses the appropriate stamina and temperament to serve in this role.

Evaluation is important for health and safety reasons. Some animals may find the role of emotional support animal to be too stressful, and the emotional and physical health of the pet will be damaged. We must not overlook the welfare of the animals when considering whether they might provide emotional support for individuals with emotional and psychiatric disabilities. In addition, some pets can respond to stress with overprotective tendencies and aggression, putting members of the public at risk.

Many individuals desire to have their emotional support animals accompany them to pet-restricted facilities outside the home. Many businesses and institutions today are wrestling with how to make this happen while still maintaining the safety of those who may come in contact with these animals. It is my opinion, as a very experienced handler and animal team evaluator, that if individuals were to have their pets’ temperament evaluated by a qualified evaluator, both initially and periodically (say every two years), and provide current documentation that the animal had passed a standardized temperament evaluation, then they might be granted permission by a business or institution on a case-by-case basis to have their emotional support animal accompany them to places where pets are typically not allowed.

 

Animal temperament evaluations

Animal temperament evaluations assess the animal’s social attitude and behavior toward both people and a neutral test dog. In addition, the evaluation assesses the animal’s ability to walk politely on a leash, interact with a small crowd of people and respond to a variety of basic obedience commands by its handler. Failing a temperament evaluation would not interfere with the right of an individual to have the pet live in the home in the role of emotional support animal. Federal law protects this right. Qualified animal temperament evaluators can be found through national organizations such as the American Kennel Club (AKC) Canine Good Citizen (CGC) program and the national Pet Partners program.

The AKC website (akc.org/dog-owners/training/canine-good-citizen/) provides information about the CGC evaluation, which is best suited for the simple purpose of determining if a pet is well-behaved enough to be around the general public. However, it is designed solely to evaluate the temperament of dogs, not other species. The CGC evaluation is relatively inexpensive, takes about 30 minutes to complete and requires the handler to take the dog through a series of basic obedience commands. Local CGC evaluators can be found at many large pet stores that offer dog training for handlers or at community obedience training clubs. The Pet Partners organization offers evaluations for a number of different domestic animal species, but the investment in cost and effort is higher. This is because the intended purpose is to register Pet Partners teams that can provide services to the public as handler and therapy animal (note that a therapy animal is not the same as an emotional support animal). The Pet Partners registration requires a rigorous handler-team evaluation — for temperament, skills and aptitude — and requires the handler to complete a training that is available online or through an eight-hour, in-person workshop. The training includes learning about risk management and infection control procedures that are valuable to follow when a pet is engaging with the public. The Pet Partners website (petpartners.org) provides information on training and finding a local evaluator.

The animal temperament evaluation procedure may resolve a prominent ethical dilemma. If an emotional support animal can alleviate or assist with a person’s emotional or psychiatric disability at home, why shouldn’t the animal be allowed to serve this purpose outside of the home as well, such as in the classroom or a work environment? At the same time, because no oversight exists regarding behavioral requirements for emotional support animals, how do businesses and institutions protect the public from danger posed by a potentially unruly animal? Because there is no federal regulation that requires facilities other than housing to allow the presence of emotional support animals, then businesses and institutions can establish their own policies around this issue.

Requiring a standardized animal temperament evaluation may be a reasonable solution to thisDog_2 ethical quandary. The business or institution could provide a letter of access, for a designated period of time, to an individual accompanied by an emotional support animal if that person provides the institution with:

1) Official documentation from a professional counselor, or other mental health or health provider, designating the need for an emotional support animal (this could be the same documentation used for federal housing rights)

2) Proof that the animal passed a recently administered standardized temperament evaluation from a reputable source such as AKC or Pet Partners (the evaluation should have been completed within the past two years because appropriate animal temperament can deteriorate over time)

 

Advocacy

Perhaps the greatest source of confusion today is around the concept of emotional support animals. The general public may not be aware that emotional support animals are not the same as psychiatric service animals and therefore do not have all of the same federal rights to access facilities. Many people are unaware that current federal law does not require emotional support animals to be trained or evaluated. Thus, some emotional support animals with inappropriate temperament may pose a risk to the general public. Generally, the public does not realize that most emotional support animals are essentially a person’s pet serving in the role of emotional support.

I am an advocate for the idea of emotional support animals, but I firmly believe there should be greater oversight. This would include evaluation of the appropriateness of a pet to serve as an emotional support, taking into consideration both the prospective health and welfare of the animal and the health and welfare of the public, particularly if the animal is to accompany the individual to facilities outside the home. Current federal law clearly states that an emotional support animal does not have to be trained or certified to be allowed to live with a person, implying that the animal does not have to be evaluated either. But federal law does not make stipulations about access to facilities other than the home for emotional support animals. Thus, businesses and institutions are free to make policies that allow individuals to be accompanied by their emotional support animals, while also providing for the safety of the public.

Counselors can more effectively advocate for their clients if they understand federal regulations pertaining to emotional support animals. Additionally, this information is beneficial for protecting the general public from those who might misrepresent the role of their animal or the right for the animal to accompany them into pet-restricted areas. Unfortunately, profit opportunists exist who encourage such misrepresentation by selling (to anyone who is willing to pay) an official-looking — yet completely unofficial — vest for a pet to wear and a worthless “certification” document that may ultimately confuse the public about the legitimate role of the animal and the rights of the individual the animal is accompanying.

Federal advocacy for those with emotional or psychiatric disabilities, through recognition of the right to have an emotional support animal in the home, is a positive development in our society. Moreover, businesses and institutions that recognize the potential benefits of allowing an emotional support animal to accompany a person with a disability outside of the home reflects enhanced sensitivity to human welfare.

Animals are an excellent source of nurturance and companionship. Creating additional yet responsible opportunities for human-animal interaction enhances people’s lives. Movement toward greater integration of well-behaved animals into our daily lives at home, school and work is a reflection of enlightened social evolution.

 

 

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Cynthia Chandler is a professor of counseling and director of the Consortium for Animal Assisted Therapy at the University of North Texas. She is author of the book Animal Assisted Therapy in Counseling (2012). Contact her at cynthia.chandler@unt.edu.

The case for animal-protective counseling practice

By Peter Wollheim October 27, 2014

As counselors know, the ethical and legal requirement of the “duty to warn” has been adopted as a standard of care across many helping professions. It probably represents one of the most universal Photo of dog with personelements of counseling ethics regardless of cultural or national identity. Based on the Hippocratic notion of “first, do no harm” or avoidance of malfeasance, this duty is considered strong enough to override considerations of client confidentiality. In the 2014 ACA Code of Ethics, Standard B.2.a. notes that confidentiality is not guaranteed “when disclosure is required to protect clients or identified others from serious and foreseeable harm.”

Unfortunately, the ACA Code of Ethics does not define harm, which could conceivably encompass financial fraud, verbal abuse, sexual seduction or unjustified termination of employment. But even more noticeably absent is any explicit duty to warn or protect should a client self-disclose current or future intent to maliciously injure animals or elements of the natural environment. These are excluded from the category of “identified others.”

I would like to present the case that a species-centric definition of such “others” requires serious re-examination given a number of important developments:

  • Neurobiological research on animal consciousness and experiences of pain
  • The promotion of animal-assisted psychotherapy and counseling
  • The growth of the animal rights movement and increased attention to humane slaughtering practices
  • Greater awareness of the mental health benefits of animal companionship

In general, it appears contradictory, if not hypocritical, to employ animals as co-partners in counseling and therapy while not defending their welfare within the context of counselor-client relationships.

Extending our ethical considerations

Much of our profession’s ethics, such as the core value of autonomy, rests on the formal philosophy of Immanuel Kant. His theories taught that moral agents should be treated as ends in themselves rather than means to an end. Avoiding exploitative relationships, maintaining confidentiality, providing competent services, avoiding and correcting discriminatory practices, and respecting the rights of research participants all reflect the Kantian emphasis on the intrinsic value of the individual as an ultimately self-defining “who” rather than a “what.” Even the use of the term duty in ethical codes comes directly from Kant.

The injunction to recognize and respect the subjectivity of each client argues for the most basic ethical adage, “Do unto others as you would have them do unto you.” It also encourages those empathic insights and sense of “fellow-feeling” that are so crucial to the therapeutic alliance. You cannot act upon the Golden Rule without a basic recognition that others experience pain in ways similar to, if not identical to, you.

A similar idea underlies Martin Buber’s distinction between relationships based on the authentic “I-Thou” and the impersonality of “I-It.” That existential perspective has also shaped much of psychotherapy. In terms of psychopathology, the inability to experience interpersonal empathy often indicates narcissistic, sociopathic and antisocial personality disorders. Even Kant argued that cruelty to animals deadens feelings of compassion in people.

Unfortunately for animals, Kant did not extend his ethical considerations to non-human beings. Like most Enlightenment thinkers, he believed that only humans demonstrate the logical capacity and free will to act as moral agents. This line of thought was preceded by rationalist philosophers from Aristotle to Descartes, and metaphysicians from Plato to Judeo-Christian theologians who denied that animals possess consciousness or a soul.

But surely we as counselors should refute this perspective. For starters, the standard of full rationality and free will doesn’t entirely fit clients who are dealing with thought disorders, depression, developmental disabilities, schizophrenia and schizoaffective disorder, autism spectrum disorders, Alzheimer’s, states of intoxication or, for that matter, childhood and adolescence. Yet those whom philosophers ill-advisedly called “marginal human beings” enjoy full respect and protection under the ACA Code of Ethics.

Furthermore, current research in ethology, primatology, comparative neurology and consciousness studies increasingly demonstrates that moral consciousness is a difference of degree rather than kind. An increasing number of studies provide evidence for various dimensions of mental complexity across several species, including schema construction, tool making and use, abstract reasoning, self-consciousness and mathematical abilities. Highly social and mutually cooperative animals such as those that congregate in extended families, herds or troops demonstrate empathy, altruism, forgiveness, levels of ethical decision-making and perhaps that most social and moral emotion of all — shame. Examples include rodents, canines, elephants, chimpanzees, orangutans and baboons.

The evidence that animals experience pain is growing rapidly as well, even as it still generates considerable debate. Whatever one’s personal stance on this issue, modern animal-handling techniques recognize the importance of considering such questions in actual practice. The increased use of humane slaughter and hunting techniques, championed by Temple Grandin and others, is based on measurable indicators of suffering such as neurochemical stress reactions and learned avoidance of pain. The American College of Veterinary Anesthesiologists has also considered this matter deeply and issued a list of behavioral and physiological indicators of animal distress.

Protecting our counseling colleagues

Even more directly, the use of non-human beings as adjuncts or co-therapists is acknowledged under labels such as “animal-assisted activities” (AAA) and “animal-assisted therapy” (AAT). It has Young child receives animal-assisted therapy from counselor and doglong been noted that the simple companionship of domesticated animals helps reduce human stress levels, lowers blood pressure and elevates morale and feelings of well-being. Animal-based counseling practices take these benefits to higher levels. AAA and AAT currently employ a long list of species, including dogs, horses, rabbits, birds, reptiles and fish.

Section D of the ACA Code of Ethics (“Relationships With Other Professionals”) lays out specific obligations counselors have to their professional colleagues. The introduction to this section states in part, “Counselors develop positive working relationships … with colleagues to enhance services to clients.” Standards D.1.b. (“Forming Relationships”), D.1.d. (“Establishing Professional and Ethical Obligations”) and D.1.h. (“Negative Conditions”) carry these implications forward as well.

To pose the question directly, how have animals not served as colleagues to the counseling profession? From the development of behaviorist theories to clinical trials of psychotropic medications, from Harry Harlow’s experiments on social isolation with rhesus monkeys to neurosurgery studies on brain function, animals have been recruited to provide important insights into learning, sociability, substance and process addiction, and the proper use of psychopharmaceuticals.

In practice it seems difficult to defend any human counselor who employs non-human adjuncts yet fails to act on behalf of their welfare. The continuity and emotional bonding of the client-assistive animal relationship obviously depends on the health and longevity of the animal in question. In these sorts of relationships, animals are not interchangeable. Clients would surely suffer from grief reactions due to the sickness, injury or death of individual non-human companions or co-therapists.

Moral considerations aside, it’s self-defeating to ignore the documented and even predictive associations between animal torture and serious psychopathology. There are high levels of uncertainty in forecasting client violence, but a growing body of evidence links animal cruelty to antisocial personality disorder, antisocial personality traits, polysubstance abuse and potential for serial homicide. Malicious harm to animals also appears indicative of early childhood trauma, current domestic violence and developmental disabilities. Animal hoarding often symptomizes obsessive-compulsive or borderline personality disorders. The extent of these associations is so high that many states mandate psychiatric assessment for all individuals charged with violating animal cruelty laws.

Other considerations

Critics may object that an animal-protective policy fails to respect cultural sensitivities. So-called blood sports have enjoyed popularity around the globe. The animals involved in staged gladiatorial contests range from bulls and cocks to dogs, rats, fish and even insects. The most hotly debated example remains the corridas, or bullfights, that some have branded as sadistic but that proponents defend as central to Spanish and Mexican national identity. Fox hunting has raised parallel concerns in the United Kingdom. Animal racing and rodeos are subject to similar controversies.

Yet amateur and professional associations of hunters, anglers, circus owners, race course owners, rodeo and bull fight organizers and even pest exterminators have published ethical guidelines meant to minimize pain to creatures that are either used for sport or subject to systematic killing. Fans of corridas, for example, prize the “clean kill,” just as ethical hunters advocate the doctrine of “fair chase.” Fly fishers argue for “catch and release,” while the United Kingdom’s Masters of Foxhounds Association insists that quarry be “quickly and humanely dispatched.” If such organizations provide ethical protection for animals, why should the American Counseling Association lag behind?

It must be noted that attention to the welfare of animals does not guarantee empathy for fellow human beings. One of the strictest and most comprehensive pieces of governmental legislation in this area was the 1933 law on animal protection, enacted by the top leadership of Nazi Germany. Almost immediately after coming into power, the Third Reich banned vivisection and tail docking, animal trapping, the killing of wolves and inhumane slaughter practices. The Nazis also promoted public school education in support of these policies.

Thus, extending consideration to animals does not by itself ensure the ethical treatment of people. But with the ACA Code of Ethics so firm in its resolve to underscore the universality of human rights and welfare, this historical aberration need not determine the limits of moral discourse. To the contrary, it should encourage a greater respect for the variety and multitude of creatures that experience a demonstrable inwardness and subjectivity.

Considering animal welfare encourages more deliberate and contextual thinking about how counseling clients function within their own web of significant relationships that includes family, occupation, political structures, mental health care delivery systems and the natural environment. But the counseling profession, like so many others, generally operates in an urbanized society characterized by an increasing separation of people from nature. Consider that even in the “Dimensions of Personal Identity” document that used to be offered on the ACA website, relationships with biota were never specified. And the place of animals in people’s lives was barely touched upon in the CACREP-accredited program from which I graduated. Yet, ironically, ecotourism opportunities and appeals to travel to unspoiled wilderness areas are sometimes touted in advertisements for ACA annual conference sites.

What all of this argues for is incorporation of animal-related considerations into any future drafts of the ACA Code of Ethics. At the very least, it urges all counselors and counseling agencies to adopt specific policies within their practices. For example, under my personal “statement of clients’ rights” Dog being pettedthat each client signs after review, we list the standard reasons for violating confidentiality. But we also add the following: “Please note that if clients reveal current or intended malicious harm to animals such as torture or neglect, we will need to consider reporting such activity to law enforcement or animal protection agencies.”

To date, I have never had to violate confidentiality on the basis of any client self-disclosing deliberate and malicious harm to animals. But at the very least, the policy does serve as a reminder of the essential “creatureliness” that clients and clinicians share as we engage in treatment together. It also reminds us that the genuine love that clients and animals often share for each other offers a model for experiencing trust, deep connection, unconditional love, pleasure, play and perhaps even joy. Such a wellspring of healing deserves the protection of ethical principles and professional practices.

Perhaps ACA will eventually recognize this in formal policy terms, having missed the opportunity in the 2014 revision of its ethics code. Until that day, those of us in private and agency practice can move ahead on our own.

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Peter Wollheim is a licensed professional counselor in Idaho and the founder of Mental Health Boise. Contact him at peter@mhboise.com.

Letters to the editor: ct@counseling.org

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Working with man’s best friend: Q+A on Animal Assisted Therapy

Compiled by Bethany Bray February 10, 2014

petTherapy

Image via Wikimedia Commons

Animal-assisted therapy (AAT) taps into the “instinctive bond” humans have with other living things, says Michigan counselor Amy Johnson.

The practice can also build trust and strengthen the therapeutic relationship between a counselor and a client, she says.

However, simply having a dog in the room during a counseling session is not considered AAT, says Johnson, who co-facilitates the American Counseling Association’s AAT in Mental Health Interest Network with Cynthia Chandler, a counselor educator in Texas.

“AAT in its purest form is a goal-directed, documented activity used to facilitate the therapeutic process,” says Johnson. “There is an expression within the AAT world that says, ‘All dogs have read Carl Rogers.’ This pretty much sums it up. A dog is honest, genuine and nonjudgmental.”

The AAT interest network serves as sounding board for its 242 members to share ideas and stay up-to-date on issues related to this special area of practice.

Johnson teaches at Oakland University in Rochester, Michigan and directs the schools Animal Assisted Therapy certificate program. Chandler is a professor of counseling at the University of North Texas and director of the schools consortium for Animal Assisted Therapy.

 

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Q+A: Animal Assisted Therapy

Responses from Amy Johnson and Cynthia Chandler, co-facilitators of the American Counseling Association’s Animal Assisted Therapy in Mental Health Interest Network

 

Why should counselors be aware of or interested in AAT?

AAT is an increasingly popular intervention that makes a great adjunct to traditional talk therapies. It harnesses the power of the human-animal bond to benefit the client and assist in counselor-client rapport building.

… Human beings have an instinctive bond with other living systems. Sigmund Freud often incorporated his Chow Chow, Jo-fi, into his practice because she would help provide Freud a good assessment of the mental state of his patients and she had a calming influence on his patients, especially children. In the 1960s, Dr. Boris Levinson, a pioneer in AAT, began documenting his experiences with his “co-therapist,” Jingles. He noted that even youth who were seriously withdrawn made significant progress with the help of Jingles.

When working with children and adolescents, seeing a therapist with a dog or animal often helps them determine how they feel about the therapist. For example, they might think, “If the counselor is that nice to her dog, maybe she will be that nice to me,” or “If the dog thinks she’s a good person, maybe she is.” This helps with building the therapeutic relationship, which as we know is the essential component in therapy.

 

What are some tips or insights you’d give regarding AAT that could be useful to all counselor practitioners?

AAT can be used in a variety of settings — inpatient, outpatient, community, school, abuse/neglect, foster care, substance abuse, geriatrics, nursing homes, etc. If the therapist is trying to bring AAT into her facility or agency or take it to another agency, getting the support of the person in charge makes a huge difference.

 

What are some current issues or hot topics your interest network has been discussing?

The biggest would have to be the need for competencies and standards within the scope of practice. There are many individuals and professionals who think just bringing a dog into the room is AAT, but that could not be further from the truth.

Dogs, or other animals, need to be intentionally integrated into treatment. Why is the dog there? When does the practitioner step in, and when does she let the client and dog interact? How does the practitioner use the dog’s story with the client? How does the clinician handle projection from the client onto the dog? How does the clinician determine if the goals are being met because of the interactions with the dog? Intentionality is key.

 

What challenges do counselors face in this area?

There is definitely the need for more research — more quantitative research. Anyone who practices AAT can relay anecdotal stories all day long about how using AAT has impacted their clients, but for mainstream acceptance, insurance coverage, facilities to accommodate, etc., there needs to be more empirical data.

 

What’s going on in this area? Any new therapies, legislation, etc.?

There are more and more programs emerging that are certifying practitioners in AAT. Educating facilitators will definitely help promote positive and safe practices.

Liability insurance is often tricky, though there are more and more companies offering additional insurance for the dog or animal (dogs are easier).

It is critical though, as a therapist’s coverage will probably not include things like dog bites.

 

What would a new counselor need to know about this topic?

The types of animals being used vary as well. People use dogs, cats, pocket pets (hamsters, etc.), rabbits, llamas, reptiles, etc. Practitioners should have a working knowledge of animal behavior in order to keep the animals safe.

The animals have to be the No. 1 priority of the practitioner. If the animal is stressed, tired, overstimulated or not feeling well, there will need to be a place for him to go. If he’s hungry or needs to relieve himself, that should be done promptly. The practitioner is the advocate for the animal.

It’s also important to note that AAT is not for everyone. If a counselor has a dog in his office, he will need to make any new clients aware that he does have a dog and probably post a sign in the office. There are things like allergies, cultural beliefs and fears to consider.

 

What would a more experienced counselor need to know?

Really, the above: There has to be intentionality to the practice, the need for additional insurance coverage, the dog has to be the No. 1 priority, making clients aware, etc.

 

What makes you, personally, interested in this area?

I (Amy Johnson) have a nonprofit called Teacher’s Pet: Dogs and Kids Learning Together that pairs court-adjudicated youth with hard-to-adopt rescue dogs. Over the last nine years, I have seen the changes in youth, dogs and staff firsthand. It is beautiful to witness and never gets old.

One goal we have for our kids is fostering empathy. Dogs provide a safe venue in which to practice pro-social skills that are often minimal or very limited in troubled youth.

Larry Brendtro wrote that “being treated as a person of value and being able to show concern for others gives life purpose and meaning.” As human beings, we all need to have purpose and meaning. Without the opportunity to give and receive kindness, Brendtro adds, “young people remain self-centered and fail to develop empathy.”

Empathy cannot be taught, only experienced. So asking the youth in the program to “save” or improve the lives of “their” shelter dogs provides opportunities to practice empathy as well as a sense of responsibility, accountability and accomplishment, not to mention practicing patience and impulse control.

 

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The Animal Assisted Therapy in Mental Health Interest Network is one of 17 interest networks open to ACA members. In the coming months, CT Online plans to highlight each network – from sports counseling to traumatology – with an online Q+A article.

For more information on ACA’s interest networks or to get involved, see counseling.org/aca-community/aca-groups/interest-networks.

 

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

Follow Counseling Today on twitter @ACA_CTonline

Creature comforts

By Leslie A. Stewart, Catherine Y. Chang and Amy Jaynes May 1, 2013

Dog_LandingAnimal-assisted therapy (AAT) in counseling continues to be a topic of much confusion and curiosity among professional counselors, clinical supervisors and counselor educators, mainly because the concept of animal-assisted mental health is only marginally understood. For many who have experienced the power of the human–animal connection, the rationale behind incorporating a therapy animal into counseling needs little explanation. However, this is a biased perspective that is heavily influenced by personal experiences and values.

To provide an intentional and efficacious intervention to clients, professional counselors must understand the human–animal connection from a more professionalized perspective. This article will illuminate a more purposeful and empirically based approach to AAT in counseling that is grounded in literature and tempered by the clinical experiences of experts. This brief article only scratches the surface of the topic, however, so we encourage interested readers to seek additional information from the resources provided on page 56.

Defining AAT in counseling

Many readers of this magazine may have been exposed to various forms of AAT as well as animal-assisted activities. Although it may seem a trivial matter of semantics, there is a considerable difference between these two terms. Animal-assisted activities involve qualified volunteer animal-handler teams providing a service that is intended to raise morale and improve quality of life through “meet and greet” interactions. Examples of this include reading assistance dog programs and therapy animal visits to hospitals or nursing home facilities.

AAT shares some of the benefits of animal-assisted activities, but according to the therapy animal registration organization Pet Partners, it differs in that AAT is a “goal-directed intervention which is administered by a health/human service provider with appropriate training and expertise and within the scope of practice of the provider’s profession.” AAT in counseling can be conceptualized as a specialized area of AAT. Expert Cynthia Chandler defines AAT in counseling as the incorporation of pets as therapeutic agents into the counseling process, thus utilizing the human–animal bond in goal-directed interventions as part of the treatment process. When delivered or directed by a professional counselor with appropriate skills and expertise regarding the clinical applications of human–animal interactions, AAT in counseling may be incorporated into sessions in a variety of ways and across a wide range of treatment settings.

AAT in counseling requires a specialized set of skills and competencies that allows professional counselors to incorporate specially trained animals into the counseling process. Together, the professional counselor and the therapy animal can affect the therapeutic process in ways that move beyond the scope of traditional counselor–client helping relationships. For more details regarding the training and skills necessary for AAT in counseling, see the second edition (2012) of Chandler’s book Animal Assisted Therapy in Counseling or the Pet Partners website at petpartners.org.

Counselors not only employ AAT approaches across a rich diversity of practice settings and techniques, but they also choose a variety of therapy animal partners. Pet Partners recognizes the following domestic animals as eligible for therapy animal evaluation: dogs, cats, guinea pigs, rabbits, domesticated rats, horses, donkeys, llamas, cockatoos and African grey parrots. Pet Partners does not endorse any specific breeds. Therefore, all breeds of dogs (or other animals) may be eligible for evaluation. However, the organization currently excludes wolf hybrids and exotic animals such as ferrets and reptiles from eligibility.

Practitioners of AAT in counseling can be found in a wide variety of settings, including traditional office spaces, farms and stables, correctional facilities and older adult care facilities. Although counselors wishing to use an AAT approach enjoy such a wide variety of options, it should be noted that all therapy animals, regardless of species or breed, must be specially trained and appropriately suited for therapeutic work. It is important that therapy animals be desensitized to touch, accepting of unfamiliar people and tolerant of unfamiliar environments and situations. Obtaining registration through a recognized therapy animal organization helps to ensure that the potential therapy animal’s training and temperament meet minimum standards in these areas. It is further recommended that the therapy animal also be the counselor’s personal pet because this familiarity and bond allow the counselor to predict the therapy animal’s behavior and responses across a wide variety of situations.

Empirically supported benefits 

Although the empirical benefits associated with AAT in counseling are only beginning to be explored and understood, several researchers and practitioners have found that including a therapy animal in the counseling process has a unique, positive impact on the therapeutic alliance. Experts Cynthia Chandler and Aubrey Fine assert that the relationship between the therapy animal and the client facilitates rapport between the client and the human counselor, which may help the professional counselor build positive therapeutic alliances more quickly. Others, such as Martin Wesley, Neresa Minatrea and Joshua Watson, have found that incorporating AAT into counseling sessions improved the client’s perception of the quality of the therapeutic alliance. Considering that the quality of the therapeutic alliance is an essential predictor of positive outcomes in therapy, AAT may offer professional counselors a valuable treatment option.

In addition to facilitating the alliance between professional counselors and clients, many practitioners have observed the need for language decrease in the presence of the therapy animal. In fact, the client may alternatively choose to express himself or herself through physical interactions with the animal. This option for physical interaction has been noted as another unique benefit associated with AAT in counseling, with the therapy animal offering opportunities for clients to experience safe and therapeutic touch as part of the counseling process. In this way, a therapy animal may offer opportunities that are beyond the scope of human counselors.

Model of practice 

Although AAT in counseling is surging in clinical practice popularity and existent research has affirmed the therapeutic benefits of AAT when practiced by an appropriately trained counselor, little research has been done to investigate and understand the theoretical underpinnings of this unique approach. To address this gap, two of the authors of this article, Leslie Stewart and Catherine Chang, along with Robert Rice, conducted a grounded theory study in 2012 to uncover an emergent theory of AAT in counseling. On the basis of this study, we found that counseling professionals who expertly utilize AAT in counseling develop a specific set of skills and competencies and utilize a highly developed working relationship with a therapy animal to purposefully affect the therapeutic process, while enhancing the scope of traditional counselor–client relationships.

According to this emergent theory, the specialized skill set and competencies developed by professional counselors employing AAT in counseling serve as a critical foundation for the relationship with the therapy animal. The highly developed working relationship, informed by the counselor’s skill and competency, helps the counselor to address the critical element of animal advocacy more effectively, while also allowing the counselor to interpret the animal’s responses and patterns of interaction with clients in a therapeutically meaningful way. This therapeutically meaningful interpretation of the animal’s responses allows the counselor–animal team to affect the process of therapy in ways that would not be possible without the therapy animal’s presence.

Effective AAT counseling professionals go beyond the facilitation of safe human–animal interactions. These skilled clinicians are able to purposefully facilitate and interpret client interactions with the animal in ways that enhance the therapeutic process, while simultaneously utilizing the animal’s inherently spontaneous and unpredictable behaviors to reframe situations or serve as teachable moments. It is important to note that AAT-specific skills and competency are acquired additively to general counseling competencies. Counselors must demonstrate efficacy and competency as counselors before including AAT in counseling as an intervention.

The data of this study confirmed that counselors often can use an AAT-in-counseling approach to positively affect the therapeutic relationship but also revealed that when practiced with an intentional and skilled approach, AAT allows counselors to expand and enhance their existing counseling skills in ways that would not be possible without an animal partner. In addition, this study showed that AAT in counseling approaches may directly benefit counselors by helping them recognize, prevent and address symptoms of burnout and vicarious trauma. It seems that the highly developed working relationship between counselor and therapy animal is often reciprocal and may allow the animal to recognize and respond to signs of stress in the counselor, just as the counselor responds to signs of stress in the animal. This study also suggested that the counselor’s responsibility to care for the animal during and between counseling sessions provides the counselor with a much-needed break and encourages counselor self-care.

Ethical and practical considerations

Although AAT in counseling offers a potentially flexible and efficacious treatment option, the approach requires potential practitioners to consider and address numerous practical considerations. As is the case with all specialty areas in counseling, potential practitioners need to seek and obtain appropriate training and supervised experience before including an AAT-in-counseling approach with clients. It is imperative that counselors develop and demonstrate appropriate “hard skills” (knowledge of animal physiology, training, behavior, obedience skills and so on), which are incorporated with appropriate “soft skills” (general counseling competency, efficacy facilitating human–animal interactions, ability to translate interactions in therapeutically meaningful ways and more). Additionally, potential AAT practitioners must recognize the implications of including a living creature, which has its own needs and rights, into counseling work. Practical aspects of including AAT in counseling work will vary depending on treatment setting, clinical population and individual therapy animal, but certain considerations related to counseling ethics are applicable to all counselors who include AAT in their clinical work.

One of the most important ethical considerations is the issue of competency, which serves as the essential foundation of effective AAT in counseling. To comply with a minimum standard of professionalization, counselors should seek formal evaluation and registration with a recognized therapy animal organization. Examples of these organizations include Pet Partners, Therapy Dogs Inc., Intermountain Therapy Animals and Equine Assisted Growth and Learning Association (EAGALA). Although no counseling-specific registration or certification process currently exists, registration with such organizations helps to confirm that a therapy animal and its handler meet certain minimum criteria for general skills, obedience training and temperament suitability. In addition to addressing competency considerations through formal registration, a potential practitioner of AAT in counseling must develop thorough competencies regarding positive animal training philosophies and techniques, the behavior and physiology of the species of therapy animal, and counseling-specific clinical applications of human–animal interactions.

Developing such competencies will allow a counselor to better address another important ethical aspect of AAT in counseling: increased risk of harm. Although the inclusion of a specially trained and well-groomed therapy animal and a competent counselor helps to minimize risks associated with human–animal interaction, it is important to understand that human–animal interactions carry certain unavoidable risks for the humans and animals involved. All animals, regardless of temperament or training, may behave unpredictably or even aggressively when fearful, threatened or ill. Further, risks of allergies, minor accidental scratches or bruises from playful interactions, or damage to clothing by shedding, salivation or animal nails may occur when interacting with animals. Counselors wishing to employ this approach must inform clients of any and all risks associated with including AAT in the counseling process. They must also develop an additional informed consent document that is specific to AAT in counseling and that outlines risks and benefits associated with the approach.

The informed consent documents should also serve as the first step toward another essential ethical aspect of AAT in counseling: animal advocacy. A professional counselor may begin the animal advocacy process by setting clear limits in this document about client behavior toward the animal. Further, professional counselors must recognize their increased responsibility to ensure the welfare of the therapy animal. Because therapy animals cannot verbally express their needs, it is the responsibility of the counselor to recognize, respond to and actively prevent animal stress, fatigue and accidental exploitation. Additionally, the needs of the animal should be incorporated into the daily treatment setting. For example, therapy animals should be provided with fresh water, bathroom breaks and access to a quiet retreat area.

The literature suggests that the therapy animal plays an active and critical role in the counseling process. This highlights an important gap for AAT counselors because there is no current standard in the ACA Code of Ethics related to the treatment of therapy animals. This means that the responsibility for competent animal advocacy rests squarely on the counselor’s shoulders. Another gap that counselors often find problematic is the lack of formal training and registration processes that are specific to AAT in counseling. When considered in conjunction with the importance of counselor competence and animal advocacy, these gaps highlight important areas for professional advocacy related to AAT in counseling.

 

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Professional counselors interested in learning more about animal-assisted therapy in counseling may find the following web-based resources helpful:

Additional AAT resources