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Is there an epidemic of emotional support animals?

By Cynthia K. Chandler February 6, 2019

On June 6, 2017, ABC News reported that a man had been severely injured on a Delta Air Lines flight after being attacked by another passenger’s emotional support dog. The dog had been sitting in its owner’s lap in a center seat. The dog reportedly growled before the attack, prompting the man to ask the owner if the dog was going to bite him. The victim received multiple bites to the face, became covered in blood, and was removed from the plane and transported to the hospital. The dog’s owner was in the military and said he had been issued the dog for emotional support.

On Oct. 29, 2017, USA Today described an incident in which a service dog, a yellow Labrador retriever, was sitting calmly in an elevator next to its owner, who was in a wheelchair. Then another woman entered the elevator carrying a toy poodle in her purse. Just as the elevator door closed, the poodle jumped out of the woman’s purse and bit the service dog on the snout, causing blood to drip on the elevator floor. After this occurred, the woman first declared that her poodle was a service dog. She then changed her story and said the poodle was an emotional support dog. Finally, she admitted the poodle was a pet that she had just wanted to bring into the building with her.

On Feb. 22, 2018, The Washington Post reported that an emotional support dog on a Southwest Airlines flight bit a 6-year old girl in the face during boarding. The flight was delayed for takeoff while paramedics examined the child and declared her healthy enough to continue with the flight. The dog and its owner were left behind.

There are important lessons we should take away from these reports, the first being that dogs bite. Or, to be more accurate, dogs without the proper temperament and training to be out in public may bite. Second, people often are not objective about their pets’ behavior and, because of this, may put other people and other dogs at risk for injury. And third, some people, such as the woman with the toy poodle on the elevator, may not be honest about their need for an emotional support animal.

Confusion around emotional support animals

The Fair Housing Act that established the right for an emotional support animal to live with its owner in pet-restricted housing does not provide any right for the pet to accompany the person anywhere else. The Air Carrier Access Act established the right for an emotional support animal to accompany its owner during air travel. As a public safety issue, it is extremely important to understand these two pieces of legislation and what an emotional support animal is exactly.

First of all, an emotional support animal is not a service animal. Therefore, rights related to emotional support animals are not covered by the Americans with Disabilities Act. Currently, there is no official oversight regarding the qualifications of a pet to be an emotional support animal. There is currently no requirement for a pet to be evaluated by a qualified animal evaluator to be called an emotional support animal. The pet’s owner is the one who decides that the pet is an emotional support animal. The Fair Housing Act regulation about emotional support animals stipulates that these animals do not have to be trained, certified or registered. It is my opinion that the absence of a requirement for proper training and evaluation of pets to be emotional support animals is a real public safety concern.

Opportunism and irresponsibility have gravitated to the realm of emotional support animals. Many services now exist, mostly in the form of websites, that charge a fee to pet owners to register their pets as emotional support animals. In reality, this type of registration means nothing because it does not signify that a particular pet possesses a temperament that makes it safe to be around, either in public or on a plane. Nor does this registration mean that the pet has any special aptitude or skill to serve in the role of an emotional support animal.

In my opinion, current commercial services that register pets as emotional support animals are mostly a scam. These services take people’s money for no legitimate purpose and mislead the public by implying that people and other animals are free from danger when around pets that are registered as emotional support animals. Presenting a pet as a registered emotional support animal is equivalent to promoting the falsehood that the pet possesses some special qualification.

Most of these website services will also sell a vest or some other type of uniform for a pet to wear in public that indicates the pet is registered as an emotional support animal. This can insinuate that the pet must be allowed in places other than the owner’s home or on an airplane (the only two places legislation actually designates that emotional support animals must be allowed). In essence, registration of a pet as an emotional support animal is worthless to everyone except the commercial enterprises that take money from the pet’s owners.

A significant lack of understanding also exists concerning the documentation required to establish a person’s need for an emotional support animal. Recently, a counselor forwarded me the official policy of a college in Florida that requires pets to be registered as emotional support animals before they can live with their owners in college housing. That policy is out of compliance with the Fair Housing Act, which does not require pets serving as emotional support animals to be registered as such. And, as a matter of course, the college’s policy is forcing people to participate in — that is, pay money for — a worthless scam known as emotional support animal registration (although the college is likely unaware of this fact). The college’s policy is further out of compliance with the Fair Housing Act because it requires health care and mental health care providers to name and describe a client’s diagnosis or disability when providing emotional support animal documentation. Naming or describing a person’s diagnosis or disability is not required by the Fair Housing Act.

The Fair Housing Act does require emotional support animal documentation to be provided by a licensed health care or mental health care provider, as well as for the recipient of the documentation to be under the care of the provider. The required documentation involves a few statements by a health care or mental health care provider, on an official prescription pad or letterhead, declaring that:

1) The person is under the provider’s care.

2) The person has a diagnosed disorder or disability. (Remember, there is no requirement to name or describe the diagnosis or disability.)

3) The person can benefit from having an emotional support animal to reduce or alleviate symptoms associated with the diagnosis or disability. (These symptoms do not need to be named or described; however, for readers’ information, common symptoms that the presence of an emotional support animal might reduce or alleviate include anxiety, depression, loneliness, and emotional or physical pain.)

Health care and mental health care providers should never specify a particular pet as an emotional support animal in supplied documentation. Why is that? One, health care and mental health care providers are unlikely to be qualified to evaluate animal behavior. And two, they would basically be endorsing that particular pet as an emotional support animal, thereby placing themselves at jeopardy for a lawsuit should the pet injure someone. By the way, the flawed college policy I mentioned earlier also erroneously required health care and mental health care providers to describe in their documentation the specific emotional support animal and its abilities. Once again, this is not in compliance with the Fair Housing Act.

Documenting need

Another major public safety issue is the documentation that health care and mental health care providers are now supplying to support the seemingly epidemic need for emotional support animals. Over the past few years, I have found that a large number of mental health care providers, including many licensed counselors, are playing loose with the ethics of the duty of care in the way they are providing this documentation.

Allow me to outline three questionable activities I have observed or learned about that give me cause for concern.

  • Some mental health care providers supply documentation of a person’s need for an emotional support animal after only a single visit and then exercise little or no follow-up. Thus, the client’s need is not thoroughly assessed or properly monitored.

Technically, a person may be considered to be “under the care” of a mental health care provider after only one visit, but in my opinion, a single visit for the sole purpose of providing emotional support animal documentation is a gross misrepresentation of the duty of care. Also, I recommend that mental health care providers place a termination date of six months on the supplied documentation because a person’s condition can change and, thus, so can the need for an emotional support animal.

  • When supplying documentation, some mental health care providers do not assess or consider the client’s ability to determine whether a pet (emotional support animal) might be a disturbance, a danger or destructive.

Providers of emotional support animal documentation need to consider their obligation to public safety — that is, their role in helping to protect those with whom a client with an emotional support animal may come into contact. Remember, an emotional support animal is any pet that an owner wants to declare as such. It is unlikely that the designated emotional support animal will have training or have been evaluated for proper temperament.

  • Some mental health care providers supply documentation endorsing the need for an emotional support animal to people with whom they have had little to no direct contact.

Consider this scenario: A new for-profit enterprise is growing by leaps and bounds. This enterprise involves website services that document individuals’ needs for emotional support animals. These internet services are recruiting large numbers of mental health care providers, especially licensed counselors, to join a network to review questionnaires completed by applicants requesting documentation of their need for an emotional support animal. On the basis of the questionnaire, and sometimes a brief communication with the applicant via telephone, email or webcam, the mental health care provider assesses the applicant, provides a diagnosis and determines that the applicant could benefit from having an emotional support animal. On the basis of the mental health care provider’s brief assessment and applied diagnosis, the website service then provides a form letter to the applicant after taking a fee.

Several counselors have contacted me asking whether they should accept the invitation they received to become a provider for this type of web-based service that supplies emotional support animal documentation. I always recommend that they decline such offers. I do not consider these types of services ethical or responsible. Furthermore, I believe any mental health care provider who works for this type of service to provide emotional support animal documentation in this accelerated and impersonal manner is:

1) Performing at a highly questionable level of ethical functioning regarding duty of care

2) Contributing to the potential endangerment of those who may come into contact with emotional support animals that do not have the proper temperament and training to be out in public

3) Contributing to an epidemic of emotional support animals

An escalating problem

The large and growing number of emotional support animals is highly problematic. The public often confuses emotional support animals with working service animals. Unfortunately, because of this, people have learned that they can get away with taking their emotional support animals just about anywhere, even though they have no legal right to do so.

This confusion often occurs because:

  • Federal law does not require that a service animal wear a uniform or have documentation.
  • People often do not want to offend a person who may be accompanied by a service animal, so they do not inquire if the animal is truly a service animal.
  • The law places a limit on what a person accompanied by a service animal can be asked. Only two questions regarding a service animal are allowed: Is the animal required because of a disability? What work or task has the animal been trained to perform? Specific questions about the person’s disability are not allowed.

Because of the general public’s confusion concerning service animals versus emotional support animals, people with emotional support animals can easily misrepresent themselves as being accompanied by a service animal and go places where they are not allowed. Falsely claiming that a pet, including an emotional support animal, is a service dog is illegal in some states. According to a 2018 article in Texas Monthly, such a false claim made in Texas is classified as a misdemeanor and is subject to a fine of up to $300 and community service at a place that serves people with disabilities.

There is no way to determine how many emotional support animals there are, but it is clear they are rapidly growing in number. A 2014 article in The New Yorker detailed one commercial website that registers pets as emotional support animals. It reported 2,400 such registrations in 2011; the number at just that one site grew to 11,000 in 2013. So, yes, we have a growing epidemic of emotional support animals.

Lack of official oversight regarding the behavior of emotional support animals, along with the poor judgment of some owners, is resulting in public nuisances and endangering public safety. It has been demonstrated that people want to take their pets places that pets should not go. Furthermore, the public’s confusion about rights of access for service animals versus emotional support animals is adding to the problem. In addition, many health care and mental health care providers are contributing to the epidemic numbers of emotional support animals by their irresponsible, and perhaps unethical, approach to providing documentation.

Significant efforts need to be made to address the problems caused by the epidemic numbers of emotional support animals. USA Today reported that several states are cracking down on individuals who falsely claim to have service dogs just so they can take their pets or emotional support animals anywhere they please. Mental health care providers can certainly assist by being more responsible in their provision of documentation for emotional support animals. This can be accomplished by:

1) Providing proper and thorough assessment of a client’s need for an emotional support animal

2) Placing a time limit on the validity of the documentation they supply

3) Requiring follow-up visits from clients to renew documentation for emotional support animals

Mental health care providers can also decline to associate themselves with commercial web services that provide emotional support animal registries and documentation, because these services are designed to attract as many customers as they can, as fast as they can, for as much profit as they can.

In concluding this article, I want to clarify that I am very much in favor of emotional support animals living with their owners in housing. However, until federal or state governments pass legislation requiring greater oversight for emotional support animals, especially related to animal behavior requirements, and until many suppliers of emotional support animal documentation act more responsibly, we are all going to be at risk for being bitten, especially on an airplane. For now, our welfare is in the hands of the owners of emotional support animals.

 

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For more information, refer to the following resources:

 

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Cynthia K. Chandler is a licensed professional counselor and a licensed marriage and family therapist in Texas. She is a professor in the Department of Counseling and Higher Education at the University of North Texas and director of the university’s Consortium for Animal Assisted Therapy. Contact her at cynthia.chandler@unt.edu.

 

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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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.

Understanding and working with service dog handlers

By K. Lynn Pierce October 8, 2018

It happens almost as soon as Emily steps through the door of the grocery store. “What do you think you’re doing in here with that?” an employee demands loudly while moving to block her path. He’s pointing in anger at the black Labrador retriever beside her. As Emily comes to a halt, her service dog, Todd, automatically sits. He’s braced slightly against her leg to help her balance.

“We don’t allow dogs,” the employee states emphatically. “It’s a health code violation.”

“This is a service animal. He provides medical alert to assist me with my disability and is permitted to accompany me by the Americans with Disabilities Act [ADA].” The well-rehearsed line flows from Emily’s mouth even as she feels herself flushing, aware that people are staring as they pass. She wants desperately to move farther into the store, out of the way.

“Well, what about your papers or ID? I need to see some proof,” the employee insists, crossing his arms and looking at Emily in clear disbelief.

Emily replies, trying to stay calm. “The ADA doesn’t permit businesses to ask for proof of disability, and there are no registries or certifications for service animals.”

As the employee blusters and scoffs, Emily signals to Todd, who stands and walks with her around the employee. Thankfully, he does not follow them, but Emily still pushes down a wave of panic that he might call the police or that someone else might try to make her leave the store before she can get what she needs.

It’s the end of a long day, but partway to the checkout counter, Emily realizes that she forgot to grab bread to go with tonight’s dinner, so she and Todd head down the front aisle to the bakery. Along the way, Emily does her best to block out the delighted cries, sounds of surprise and conversations that break out as she and Todd pass. Emily hears one couple wondering whether she is a dog trainer because she doesn’t look like she’s blind. What could be wrong with her?

While looking at the choices of dinner rolls on display, Emily is startled by a shrill voice behind her. “Oh, what an adorable puppy! Can I pet him?”

Emily turns to see a woman already reaching toward Todd, who, on cue, backs partially behind Emily as she steps forward in front of him. “No, ma’am, please don’t distract him. He’s working.”

“Oh, it’s all right. I love dogs,” says the woman, now trying to reach around Emily’s leg to get to Todd.

“He is working,” says Emily firmly. “Please leave us alone.”

“Well, there’s no need to be so rude about it. Why would you bring a dog if you didn’t want people to pay attention to it?” exclaims the woman, glaring at Emily as she walks off in a huff.

Emily goes directly to a self-checkout to avoid more interactions with employees. By the time she reaches the car, Todd is alerting her that her heart rate is elevated. Emily sits in the car for a few minutes, shaking and breathing heavily before she feels safe to head home.

This is a common experience for people with disabilities who require service animals. For these individuals, their service animals are their lifeline, but all too often, they experience disproportionate discrimination, invasive questioning and other unwanted attention. Service dogs are becoming more common, particularly for people who have invisible disabilities. Consequently, it is more important than ever that counselors become comfortable working with service dog teams and know how to respond when clients ask whether a service dog would be helpful for them.

Defining a service animal

It is helpful to first understand what a service animal is not. Service animals are frequently confused with emotional support animals and with therapy animals.

Emotional support animals are pets that are permitted to live with or travel with someone who has a disability. They are not required to be trained in any specific way, and animals other than dogs can be designated as emotional support animals.

Many counselors are already familiar with therapy animals because they are often used in animal-assisted therapy. Therapy animals are simply animals that are used by their handlers to assist others, frequently in mental health or medical settings, but also in courtrooms and during crisis or disaster response scenarios. Often, the facility in which the handler works will impose general training or temperament requirements for therapy animals, but these animals are not expected to do specific tasks.

When it comes to service animals, there are a number of misconceptions. One of the most common myths is that service animals require a special certification or license or official documentation. In reality, there is no registry or certification for service animals that has any legal meaning. Another myth is that service dogs must be a certain breed or size, but there are actually no restrictions. In fact, many small breeds make excellent medical alert dogs and don’t require the space considerations that larger breeds do.

So, what is the definition of a service animal? According to the ADA, a service animal is a dog that has been individually trained to work or perform tasks for a person with a disability. A disability as defined by the ADA is a legal term, not a medical one. Under the ADA, a person with a disability is someone who has a physical or mental impairment that substantially limits one or more major life activities.

Service animals are not pets; under the law, they are considered to be necessary medical equipment. They can be in public with their handler because their handler has a right to equal public access under the law, and the service animal performs tasks required by the handler to achieve that access. This means that outside of a few specific limitations, service animals are allowed to go anywhere that a wheelchair, walker or other assistive device can go. Just as wheelchairs are custom fit for their users, service animals are specifically trained for an individual’s needs through a set of trained tasks.

Trained tasks are not actually defined by the ADA. The only thing the ADA clearly states is that comfort is not a task. This is very important, so let me elaborate. Counselors may have cause to think about and discuss with a client whether a service dog would be helpful for that client. However, if after researching categories of tasks, the answer to the question of “What would a service dog do for my client?” is anything like, “It would make them feel better when they experience anxiety,” then the client cannot utilize a service animal.

Because the ADA defines only what a trained task is not, organizations such as the International Association of Assistance Dog Partners provide lists of common tasks. Generally, these tasks are broken down into categories on the basis of what the tasks accomplish (hearing, mobility, guide, medical alert, psychiatric assistance, etc.) or what “kind” of service animal might perform them. Because counselors are not typically experienced in training dogs, it is easier to start with determining broad categories of tasks that counselors believe might be helpful for their client. It is best to focus on tasks that would help the client in public because the point of public access with a service dog is that the dog is actively mitigating the client’s disability and is therefore required. Counselors are likely to find several “bonus” tasks that would provide great additional benefit, but these are best added once it is clear that a service dog is necessary for the client to successfully function independently in public places.

Working with prospective handlers

In assessing whether a service animal is a good fit for a client, a simple first test is to ask:

1) Is my client disabled under the definition set forth by the ADA?

2) Is my client a suitable candidate for a service animal?

3) Are there trained tasks a service dog could perform that would help mitigate my client’s disability?

Often, the first question will provide counselors with the overall answer. If the client isn’t disabled, then that person won’t be able to use a service animal. If the client is disabled, then the focus moves to the question of whether the client is a suitable candidate for using a service animal.

Some basic considerations for arriving at an answer to the second question include whether the client is physically and financially able to care for a dog, whether the client can handle major life changes at this point and the client’s overall degree of resiliency. Service dog programs agree that potential contraindications include suicide attempts by the client in the past year, severe paranoia or psychosis and any other situation that might put the dog’s safety at risk. A good candidate might have a history of bonding strongly with canines. It is also important to determine whether the client is in a stable enough position to be able to effectively use a service animal.

Then we arrive at the question of trained tasks, which is essentially, can the client be helped by a service dog? In assessing a client, a counselor might ask what the client’s disability is preventing the person from doing. A possible answer would be that the client has posttraumatic stress disorder and is hypervigilant. The client experiences flashbacks and becomes stuck in place. Sometimes the client becomes disoriented and cannot remember where he parked. Additionally, at home the client disassociates without warning and cannot get to his medication. He also has nightmares and disrupted sleep.

For this client, possible trained tasks to be used in public might include a “watch my back” command, in which the service dog would alert the handler to people approaching from behind, and a “search” command, in which the dog could search an enclosed area such as an office for other people. The dog would also be trained to respond to and eventually alert the handler to flashbacks by sensing shifts in breathing and body language or other cues specific to the client. For example, the dog could be trained to lick the handler’s face if it does not receive a response from the handler. It could also alert other known people, such as the client’s spouse or co-workers, that the client needs assistance. In responding to a flashback or other episode, the dog could be trained to lead the handler to the exit of the building, either automatically or upon receiving a “find the way out” command. In instances in which the handler can’t locate his car, the dog could be trained to “find the car” and lead the handler there.

Some bonus tasks performed at home by the service dog might include waking the handler from nightmares and retrieving medication from a known location. The dog could also use the known “search” command upon returning home if the handler was concerned that an intruder might be present. Perhaps the handler also has a secondary concern of mobility issues from knee and back problems. In that case, more mobility tasks such as balance feedback and bracing to help the handler get out of chairs could be added to the service dog’s responsibilities, along with some named items for retrieval such as “phone,” “remote” and “keys.”

This service animal would clearly be a huge comfort to the client, but we can recognize that it would be performing many tangible trained tasks beyond comfort, thus setting it apart from a regular pet or an emotional support animal. This is what justifies the animal working with its handler in public as medical equipment under the law.

Getting a dog

What steps should be taken after determining that a client would be helped by a service animal? Most handlers are best served getting their first dog from a program rather than attempting to train the dog themselves, unless they possess extensive training experience or have connections to the right people to provide the training. The organization providing the service animal will likely want documentation and a release of information from the counselor if the client’s disability is related to a mental health-based diagnosis rather than a concern that is primarily medical. Be aware that scam programs do exist. It is important to look for red flags, such as programs that want a large sum of money upfront or that won’t allow prospective clients to visit a training or to be connected with current clients.

Accreditation bodies such as Assistance Dogs International can help limit the risk in choosing an organization. These accreditation bodies assist training programs by setting standards for the required level of obedience training, thus helping to ensure that the animal will be safe to work in public. They also have agreements concerning their obligations to clients should needs change or challenges arise.

When choosing a service animal organization, clients should read and understand the contract as well as the policies and practices of the program thoroughly before committing because there may be fundraising requirements or extensive policies regarding gear, care, travel and so on. Generally, clients will have custody through an organization that maintains ownership of the dog. Therefore, it is important to ask for information concerning who makes the call on when a dog retires, whether animals retire into handler care and what the process is for getting a successor dog, in addition to all of the requirements for being a handler through the organization.

The experiences of handlers

Very little research is available on the experiences of service dog handlers. There is prevalent stigma against service animals, however. In her 2017 study of just under 500 handlers, sociologist Meghan Mills found that the majority of participants (68 percent) reported discrimination during daily tasks. Mills also reported that 77 percent of respondents indicated the legitimacy of their service dog had been questioned, and nearly half said they had not used their service dog in public “sometimes” because of unwanted attention.

The experiences of handlers appear to be affected by factors such as gender, race, age and geographic location. It is common for handlers to experience negative reactions from their friends, family members and communities. This can be especially true for those with invisible disabilities who may already have the legitimacy of their illness questioned regularly. Service dogs are not as common as other assistive devices, and this can draw additional attention. The social norm in the United States of pet dogs being prohibited in most public spaces compounds this experience. Even when handlers start with strong support networks, the constant discrimination they face over time can lead either to their exclusion by others or to self-imposed isolation to avoid these experiences.

Because people tend not to understand public access laws or how to interact appropriately with service dog teams, handlers are often characterized as demanding or rude for protecting their legal rights or safety. In online service dog forums, handlers regularly ask how to be strategic about telling strangers not to distract a dog who needs to be watching for medical alert (for example, a dog trained to give early warning for a seizure). These handlers do not want to endanger themselves, but they have been told that they are being unreasonable to expect strangers not to talk to, bark at or call their dog.

New handlers in programs or on their own will practice being assertive and calm, repeating the law and educating in the face of people yelling and threatening to call the police. As a result, handlers can put unreasonable expectations on themselves and their dogs to be flawless. Handlers may be concerned that an off day or a small mistake could make their access and the access of other teams more difficult.

Working with teams

Counselors who understand the role of service dogs have a unique opportunity to model positive social interactions for handlers. Showing respect through appropriate etiquette to service dog teams is a simple step that will communicate understanding and put service dog handlers at ease.

The core of service dog etiquette is not interfering with the animal’s focus by talking to, petting or otherwise engaging the dog. In the same way one would not comment on a person’s wheelchair or cane, it is rude to focus too much on a service dog or to ask too many questions. The presence of a service dog, as necessary medical equipment, is not an invitation for conversation about the client’s disability or about service dogs (either in general or about the handler’s in particular). Handlers may be sensitive to these questions because they commonly are asked by others in inappropriate settings. As with any other client, it is best to build rapport first, then ask more probing questions once a relationship is established. In support of building a therapeutic relationship, I’d recommend that counselors say something along the following lines: “I’m not going to ask you things I don’t need to know about your service animal, but is there anything you would like to tell me about how you want me to interact with you as a team while we’re working together?” This would be a polite way for counselors to align themselves with these clients while also signaling understanding of and respect for their boundaries.

If counselors are aware that a client is a service dog handler, it is important to think in advance about the potential barriers the team may face in a counseling setting. For example, if the waiting room becomes uncomfortable because another client is being too curious or is distracting the service dog, consider whether there is another location where the client could go to wait for the session. Educating other counselors and staff in the practice on basic etiquette is also important because it removes the responsibility from the client. If a client who is a handler is going to participate in a group, spend time beforehand discussing how the client would like to be supported in setting boundaries with the other group members. This step could improve the outcome.

As previously noted, many service dog teams experience frequent discrimination. Over time, some handlers become fearful of entering new environments because of the potential of access concerns or other negative interactions. Some handlers have been threatened or experienced violence simply for having a service animal. Conflict may also result from the handler not allowing people to pet or interact with the service animal or from refusing to be illegally removed from a building. Many teams have been attacked by pet dogs or by dogs that are claimed to be service animals. It is worth counselors evaluating for trauma responses within this demographic because, over time, the constant alienation can build up, even without the experience of acute incidents.

Handlers may also have lost the support of family or friends or access to some of their spaces because of this treatment decision. Loss of access can be due to lack of ADA coverage (as is the case in religious spaces) or due to elements of specific environments in which the social cost of advocacy may outweigh the gain of access. It is important that counselors not place the burden of education exclusively on handlers and understand that in some situations, there is no clear path forward to gain access once it has been denied. This means that counseling with handlers may involve elements of grief counseling.

There are interventions used in training programs that can deepen the bond in a team and help handlers be more effective in using their service dogs. Some of these interventions target specific symptoms, whereas others address interpersonal and environmental processing through the team bond. Counselors working with long-term clients who are handlers may be served by seeking consultation and supervision in this area.

 

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K. Lynn Pierce recently started her counselor education and supervision doctoral program at Pennsylvania State University. She is a service animal handler of four years and provides consultation and workshops for mental health and related professions around service dog inclusion and integration. Contact her through her website at klynnpierce.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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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 case for including animals in counselors’ duty to report

By Troy Gregorino April 12, 2017

This past year, the American Counseling Association Governing Council endorsed formal competencies for the practice of animal-assisted therapy in counseling. The authors of the standards, and the coordinators of ACA’s Animal-Assisted Therapy in Mental Health Interest Network, contend that the competencies (available at counseling.org/knowledge-center/competencies) represent a key step forward in both the protection of clients and the promotion of therapy animals’ well-being. My own contention is that the adoption of these competencies additionally points to a need for ACA to endorse a “duty to protect” that applies to animals.

As a doctoral student in counselor education and supervision at University of the Cumberlands in Williamsburg, Kentucky, one of my areas of interest is animal-related counseling issues. I have become increasingly convinced that the human-animal bond is for many people an integral aspect of wellness, recovery, purpose and hope. Furthermore, I contend that it is misguided for the counseling profession to advocate for the protection of animals that we happen to use in our interventions but to take no stance in the protection of other animals whose lives are intertwined with the people we serve. Anecdotally, I have encountered significant support for this sentiment, both within and outside of the counseling profession. I offer a rationale for it here, not merely as a philosophical concept to be considered hypothetically, but as an invitation and a call to action for ACA decision-makers.

Tracing back to the Hippocratic oath, doctors and mental health counselors are required to maintain the confidentiality of information disclosed to them in the context of the therapeutic relationship. An exception for counselors is their “duty to protect” potential victims from the anticipated violent behavior of a client. I’d like to make the case that a client’s anticipated violence toward animals ought to be included on the counseling profession’s list of actions that require mandatory reporting.

Applying counseling’s code of ethics to animals

Animals are already protected by existing state, national and international laws, and I think that adapting the ACA Code of Ethics to reflect adherence to those laws is both a logical extension of our ethical framework and in keeping with the spirit of our duty to report.

The intention of mandated reporting, dating back to the California Supreme Court’s landmark 1974 Tarasoff ruling (amended in 1976 to replace “duty to warn” with “duty to protect”), was to impose a legal obligation on psychotherapists to notify individuals who might potentially become victims of violence perpetrated by a counselor’s client.

The ACA Code of Ethics names “serious and foreseeable harm” (Standard B.2.a.) as an exception to maintaining confidentiality. In full, the standard reads: “The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues.”

To elevate that standard to afford protection to nonhuman victims, it could be amended to read, “… clients or identified others, including animals protected from cruelty by applicable state laws …” Imagine the profound impact our profession could have on alleviating undue suffering with the addition of those nine words. Our responsibilities as counselors would remain essentially just as they are, but without a pass for ignoring instances of “serious and foreseeable harm” to animals protected by law. The ACA Governing Council’s endorsement of competencies that, in part, safeguard the comfort and well-being of animals used in therapeutic interventions is laudable; extending those concerns to protect the most defenseless victims from the most egregious acts of cruelty seems to me to be a reasonable and much-needed next step.

It is worth noting that animal protection laws vary considerably from state to state. For instance, according to the Animal Legal Defense Fund, all but two U.S. states impose felony-level penalties for severe forms of animal abuse, and some states allow for the inclusion of animals in domestic violence protection orders. Additionally, some states require mental health evaluations or counseling for animal-abuse offenders. My proposed amendment to our ethics code is intended to be both comprehensive and flexible enough to accommodate the multitude of variations in state laws.

A likely objection to this suggested modification to our code of ethics might involve concerns about damaging client-counselor rapport. However, the same philosophical justification that applies to our current “duty to protect” mandate applies here too. The amended code would simply reflect the standard established by existing law by identifying and protecting those against whom acts of violence constitute legal violations. As it stands now, the ACA Code of Ethics does just that by protecting humans from illegal acts of violence, but it in effect flouts the law when it comes to protecting animals.

In addition to reconciling this disparity in our duty to report, this amendment would be congruent with our duty to take seriously behaviors that are likely to place both the client and the victim in harm’s way. After all, as counselors, we would be hard-pressed to conceive of the therapeutic value of not intervening in the commission of a violent crime. In the case of child abuse, for instance, it would neither contribute to the protection of the victim nor to the progress of the perpetrator to not treat the crime as being of paramount and urgent importance. The same can be said for the significance and immediacy of animal cruelty.

Extending our duty to report to include acts of animal cruelty is a logical and consistent next step because, unlike with other criminal acts (knowledge of which does not warrant breaching confidentiality), animal cruelty is a crime that involves intentional bodily harm. From that perspective, our failure to include it in our duty to report would seem an ethically arbitrary exclusion.

Clinical implications of animal cruelty

Entities such as the U.S. Department of Education, the National Crime Prevention Council and the American Psychological Association agree that cruelty against animals is a warning sign for at-risk youth. Since 1987, the American Psychiatric Association has included animal cruelty as a symptom of childhood conduct disorder in its Diagnostic and Statistical Manual of Mental Disorders. It defines the disorder as a “repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.” According to the American Psychiatric Association, additional implications of such tendencies include an increased likelihood for exhibiting similar symptoms in adulthood, sometimes resulting in meeting the criteria for antisocial personality disorder.

Dating back to the early 1960s, researchers have strived to clarify the role that childhood animal cruelty might play as a predictor of subsequent violence against humans. John Macdonald sampled 48 patients with psychotic symptoms, and 52 without. He determined that three primary characteristics — fire setting, enuresis and childhood cruelty toward animals — were consistently discovered among the individuals considered to be the most sadistic. Although he concluded that this combination of traits could serve as a strong predictor of homicidal behavior, he noted that the presence of this triad alone was of minimal value in foretelling such acts.

More recent scholarly literature has increasingly suggested evidence for a connection between animal abuse and either co-occurring or subsequent forms of interpersonal violence. Researchers are divided over the legitimacy of this supposed link. In 2001, Frank Ascione published a thorough overview of psychological, psychiatric and criminological research linking animal abuse to acts of violence against humans. He asserted that animal abuse is an often overlooked warning sign that, in addition to helping to identify youth who are themselves victims, “could help identify youth at risk for perpetrating interpersonal violence.” In 1997, Ascione and colleagues also examined the prevalence with which victims of domestic violence report various forms of cruelty perpetuated by their abusers toward their pets. In 2008, Christopher Hensley and Suzanne Tallichet emphasized an exploration of the motivations behind animal cruelty by interviewing inmates about their childhood animal cruelty crimes.

These and myriad other studies have been met with a range of criticisms, from failing to establish a verifiable link between human and animal violence to applying flawed methodologies. Regardless of what one may think of the reliability or validity of the research to date, a wholesale dismissal of the apparent relationship between animal cruelty and violence against humans seems unwise. More important, however, is that the strength of this proposal does not rest on the legitimacy of such data. Reliance on the supposed link unnecessarily detracts from the central argument that a wanton act of cruelty against a defenseless other is, on its face, egregious enough in my opinion to trump a counselor’s duty to protect a client’s confidentiality.

Why amend our duty to report?

The most obvious beneficiaries of this change in the short term would, of course, be those animals who stand to be spared from enduring abusive acts. But is it not also in the long-term interest of the perpetrator, at least potentially, to have the opportunity for reform sooner rather than later? Cultural anthropologist Margaret Mead famously commented in 1964 that cruelty toward animals “could prove a diagnostic sign, and that such children, diagnosed early, could be helped instead of being allowed to embark on a long career of episodic violence and murder.”

Furthermore, is it not ultimately in the interest of the counseling profession as a whole to err on the side of empathy for the most vulnerable and to draw an ethical distinction between the importance of confidentiality and the urgency of violent crime? Are we not all made better by extending and explicitly endorsing the reach of our ethical consideration to protect even (and, indeed, especially) those with no voice in the matter? Although none of us is currently prohibited from reporting acts of animal cruelty, I have no doubt that adding the amendment proposed here to the ACA Code of Ethics would over time contribute to the prevention of incalculable instances of undue harm.

As counselors, we are called to reflect on the broader implications of our work and on how the changes we help to facilitate contribute to a healthier quality of life. That means considering broadly the wellness of people and, from my viewpoint, the animals with whom people’s lives are so frequently intertwined. ACA’s historic endorsement of competencies for animal-assisted therapy is a heartening step forward as we adjust continually to the social, cultural and philosophical shifts of our times. I hope we will seize on the momentum of this achievement by embracing an amendment to our ethics code that is consistent with our recent progress.

This proposed amendment is consistent with our profession’s historically responsive adjustments to the societal implications of our work and to our forward-thinking recognition of the impact it can have on the world around us. As with past adjustments made to our ethics code, it is incumbent on mental health professionals to remain at the forefront of measures aimed at cultivating justice and advocacy in our service to others. The amendment proposed here would be one more step in the spirit of that legacy.

 

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Troy Gregorino is a licensed professional counselor and certified wellness counselor.
He is a doctoral student in counselor education and supervision at University of the Cumberlands. Contact him at tgregorino@gmail.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback.

 

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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 Counseling Connoisseur: Pet loss: Lessons in grief

By Cheryl Fisher April 11, 2017

 

“Until one has loved an animal, a part of one’s soul remains unawakened.” — Anatole France

 

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On Jan. 22, following a three-week whirlwind diagnosis and decline, my husband and I said goodbye to our 6.5-year-old goldendoodle, Lily. Her disease had rendered this Frisbee-catching superstar unable to stand or walk. She needed to be carried outdoors to “get busy,” and she no longer had the stamina to stay awake for extended periods of time.

The author, Cheryl Fisher, with her dogs Max and Lily.

We spent the entire last weekend with Lily in the emergency room as she struggled against various gastrointestinal issues and, finally, internal bleeding. Her vet and neurologist felt that the disease had progressed and her prognosis was bleak. It was then that we made the most difficult decision we have ever made — to let her go. We took time lying with her, holding her, reminiscing … and stayed with her until her last heartbeat.

On the first day without our Lily, I kept tripping over my grief as I called out to see if she needed to go outside or wanted to lie by the window and watch “her birds.” Max, our 9-year-old goldendoodle, moped around the house, trying to sniff Lily out without success. He looked at me as if begging, “Bring her back, OK?” I canceled my clients for the day. I couldn’t imagine sitting with their pain as my pain continued streaming from my eyes.

I found myself returning to the little Catholic girl inside of me and lighting a candle next to a picture of our Lily that I had placed on the fireplace mantle. I wrote, announcing our loss to all 210 close friends on social media. I started a scrapbook and printed pictures long held captive in my iPhone. I cried continuously, as if the floodgates had been lifted and years and layers of grief came pouring out. All the losses in my life appeared to be resurrected with Lily’s death. My heart ached and my stomach hurt.

My attempts to prep for my classes that week proved futile. I just couldn’t concentrate. I kept reading the same sentence over and over again. Mostly I was just tired. Tired from three weeks of relentless caregiving, painstakingly attempting to keep the horrific disease at bay — the disease that stripped my beautiful bird-watching, tail-wagging, never-had-a-bad-day rescue pup of her mobility, energy and dignity. In the end those soulful eyes would beg me to end her suffering, and in keeping the promise I had made to her, I mercifully did, holding her till the end.

 

Tips for coping with the loss of a pet

Experiencing the death of a pet can be painful and devastating. Our pets are often our most vulnerable family members, relying on us completely for their care. This includes end-of-life care, which may involve making very difficult decisions about treatment and finally letting go. This adds complexity to grief because we may struggle with questions surrounding the decision to stop treatment and euthanize: Did I do enough? When is it time to let go?

1) Grief comes in waves. Initially the waves may be intense and relentless, pummeling us to the ground. We may feel that we will never breath (or stop crying) again. But with time and some work, the waves gradually recede, allowing us to stand and take tentative strides toward a “new normal.” Still, the waves will come and go, often crashing near a special day or at a moment when our dear fur-family member comes to mind.

2) Grief is brain work. Grief affects our neurology. It makes it difficult to concentrate. We forget things. We are easily irritated. We definitely are not on our A game. We may even feel like we are in a dream (or nightmare). Neurologically, we have taken a hit and require time to recover. Don’t worry. The grief fog will lift eventually. In the meantime, be gentle and kind with yourself.

3) Grief is an ever-changing chameleon. Elisabeth Kübler-Ross identified stages of grief related to dying that can also be applied to our experiences of grief and loss. These stages are no longer thought to happen in a linear manner. Rather, they are common experiences that can occur moment to moment as the result of grief.

Anger: Initially, I felt anger at the sudden deterioration of Lily. She had been running and playing catch just days before her back legs began to buckle under her body. Following an MRI and spinal taps, she was placed on a steroid treatment that quickly led to weight loss and gastric-intestinal discomfort. I was angry at the doctor. I was angry at the disease. I was angry at God.

Guilt: Although I knew I had responded quickly to Lily’s symptoms, I was plagued with self-doubt around the decision to use steroid treatment. Should we have gotten a second opinion? Should we have taken her to a holistic veterinarian? Ultimately, I ruminated over our decision to stop all care and put her to sleep. Was there more that we could have done? It was profoundly clear that the disease had progressed and Lily’s quality of life had suffered drastically, but I still experienced pangs of guilt.

Denial: The first few days were the most grueling. Walking in a daze, I still held some hope that this was all just a nightmare, and as I tripped over Lily’s misplaced toy, I would awaken to find both of our dogs curled at the foot of the bed.

Sadness: It is immensely sad to lose a love one — even a curly headed, wet-nosed, tail-wagging one. I am free with my tears in general, so I just let the emotions stream down my cheeks. Sadness, like grief, looks different for each individual. I am an emotional griever. I emote. My husband is an instrumental griever. He does research on the internet to seek answers. He walks our dog, schedules doggie play dates and arranges activities to help our other dog, Max, with his grief.

Acceptance: Ultimately, the hope is that there will be a sense of peace and understanding at some point and time. This may be experienced in fleeting moments rather than in an arrival at a destination, however.

4) Grief is individual. For me, Lily’s death overshadowed any other event occurring in the world. My Lily had died. Nothing else mattered to me. I crafted my coping strategy selfishly without concern for the feelings or needs of anyone else, including my husband, who had experienced the same loss.

It quickly became apparent that my grieving was more expressive and ritualistic. I made a scrapbook, displayed sympathy cards on the mantle with Lily’s urn, wrote blogs and lit candles in memory of our little rescue. My husband’s grief was more privately experienced, with an occasional shared story and shed tear. It was important not to trip over each other’s grief experience.

5) Grief grows out of a relationship. Some people (and even some therapists) may dismiss the death of a pet as a lesser loss. However, as with any relationship, it is important to understand the meaning ascribed to this relationship. Often a pet serves as a companion who provides unconditional love and affection. Many clients have told me stories of the richness and depth that surrounded their interactions with their pets. For me, Lily was the piece that completed our family puzzle.

 

Conclusion

The death of a pet can be such a huge loss. These fur-family members may serve as faithful friends and playmates, enriching our lives with their magnificent and comical personalities. It is important to honor their story as it intertwines with our own narrative.

I still tear up every time I hear Eva Cassidy’s version of “Somewhere Over the Rainbow.” I imagine my curly white bundle of pure love bounding across a green field to greet me … just around the Rainbow Bridge.

 

 

 

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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 working on a book titled Homegrown Psychotherapy: Scientifically Based Organic Practicesthat speaks to nature-based wisdom. Contact her at cyfisherphd@gmail.com.

 

 

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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.