A Doggone Good Therapist
Recently, while reading a manual entitled, Animal Assisted Therapy and Activities (Arkow, 2004), I was startled to learn that a survey done in 1986 revealed that 57% of psychiatrists, 48% of psychologists, and 40% of family practice physicians reported that they prescribed pets for their patients to combat loneliness, depression, and other emotional problems including inactivity and stress. Dogs were the most frequently chosen, with cats a close second. Now, in 2006, the momentum toward the use of pets for health and emotional health issues has increased tremendously. In 1970, it would have been unimaginable to expect see dogs in hospitals visiting with patients. Today, most hospitals have programs through which carefully trained therapy dogs and owners visit medical and psychiatric patients in order to lift their spirits. During their hospital stay, patients report feeling more energized, less depressed, and more optimistic when visited by therapy pets. Therapy pets are being used to visit the elderly in nursing homes, children in school, children in library homework centers after school, and in reading programs to further motivate children who are learning to read. Dogs have been successfully introduced into prisons to help rehabilitate hardened criminals and into foster care agencies to bring hope to abandoned and abused children.
In addition to being useful in all the areas sited above, more psychotherapists are using pets in their psychotherapy sessions with patients. The usefulness of pets was noted many years ago when a therapist named Levinson used his dog, Jingles, in sessions with children. He was quick to notice the therapeutic effect that Jingles had on his child patients, regardless of how disturbed or non verbal and non playful they may have been prior to this.
The fact is that pets are amazingly useful in the therapeutic office with adult patients as well as with children.
Why Are Dogs Good Therapists?
There are many limitations placed on what therapists are permitted to do in and out of the therapy room. These limitations are legally, ethically, and morally binding. For example, therapists must be very careful not to touch patients unless a handshake is offered. In that case, it would be rude to refuse to shake hands. In fact, it is better for any therapist who is at all concerned about being accused of behaving in a sexually inappropriate way, to not hug a patient regardless of how happy each may feel about an achievement. It is a cardinal rule for psychotherapists to put feelings into words and not act them out. A therapist's touching a patient can be too easily misconstrued by the patient as seductive behavior on the part of the therapist.
However, a therapy dog is another matter completely. Patients are allowed and encouraged to touch, pet, hug, caress, and stroke the dog. Doing so actually helps anxious and worried patients feel more relaxed, especially if they are beginning therapy and are unaccustomed about what to expect. Therapy dogs do not frown or have any expression on their faces that a patient may misconstrue as criticism or rejection. Instead, they provide unconditional acceptance and love.
Dogs can also provide the opportunity for tension breaking humor during therapy sessions. Mingo, the therapy dog used in my office, will occasionally let out a very human sounding burp. This often brings about gales of laughter even in the most depressed patients.
In fact, part of the point of using a therapy dog is the fact that it becomes very difficult for many patients to remain depressed in the dog’s presence. I have seen extremely depressed patients enter the office, looking forward to speaking to me but also looking forward to seeing Mingo because they know she will make them feel much better. Mingo has an uncanny ability to sense when someone is upset and provide them with the comfort they need.
Dogs are also a "blank screen" onto which patients can project or displace many difficult feelings and conflicts. Patients will make comments about the therapy dog that unwittingly refer to them and their feelings about themselves. For example, one patient was offended when I asked Mingo to sit next to her on the couch, something she had done in the past but was not doing that day. The patient defended Mingo, stating that she does not want to do it and not to force her. Further exploration revealed that as a child, she often felt forced to do things she did not want to do. One was to leave high school before she graduated in order to go to work for the family. Another patient asked Mingo if she "was being a good girl?" When asked, she revealed that she was always told that she was being a bad girl at home. She grew up with the attitude that she was too much trouble. In actuality, her birth was an accident and she was always being reminded of that as a child.
A therapy dog in the office can also reflect back to the patient what effect their behavior is having on everyone. During one marriage counseling session, when the couple started to quarrel with one another, Mingo walked to the door and wanted to leave. When this was pointed out to the couple, they were surprised. The significance of this was the fact that they never stopped to consider how their arguments were affecting their own children at home.
One young woman, suffering from agoraphobia and panic attacks experienced Mingo's presence as very calming and relieving. She decided to buy a puppy for herself, hoping it would calm her at home and in public, just as Mingo did in the office. She purchased an adorable puppy, which she brought to the session. As weeks went by and she and the puppy grew more attached, she talked playfully to it in the session, calling it a "stinker" and saying the pup was a real problem because she was curious and getting into everything. All of this turned out to be projective in nature as she described how her family always treated her as though she was a "stinker," a problem and an imposition.
East Coast Assistance Dogs: Dogs Helping Others
One of the most dramatic examples of dogs being used for therapeutic purposes was what I witnessed during my training with Mingo at East Coast Assistance Dogs (ECAD). A not for Profit Company, ECAD trains assistance dogs for the physically handicapped and also places therapy dogs with facilities and with private psychotherapists. In effect, the dogs trained by ECAD become the arms, legs, and even the memory for people with serious physical handicaps. These dogs are trained to open refrigerators, retrieve food for the owner, pick things up that have fallen to the floor, remind owners when to take medications, bring the medications and, most remarkably of all, alert a sleeping person who is at risk of not breathing to awaken and adjust their ventilators. Other kinds of alerting involve letting the person know that the dog senses they are having a diabetic crisis and need to eat something before they run the risk of going into shock or alerting a person about a pending seizure or cardiac episode.
However, as impressive as it is that these dogs can provide these types of assistance, even more impressive is how they are trained. One of ECAD's major programs is located on the campus of The Children's Village in Dobbs Ferry, New York. The Children's Village is located on a lovely campus in Westchester. The campus provides housing, education, medical, and psychological treatment and full psychiatric services for children who have been remanded there by the New York City courts because they have either been abandoned by their families, no longer have any family left living, have been abused, or have committed anti social acts due to serious mental illness. In other words, these are at-risk children who would face extremely bleak and hopeless futures were it not for the services provided by The Children's Village. ECAD has its own training center on the campus and its staff works cooperatively with the Children's Village staff to provide an inspiring program of dog therapy and skill building for the children of this foster care agency.
The way this works is that children who want to learn about all aspects of raising and training dogs volunteer to be in the ECAD program. They are then screened by the Children's Village staff to see if they can get the most from what the ECAD program has to offer. The children then meet Lou Picard, the Executive Director and Founder of ECAD, who, along with a few adult staff members, begins to teach the children how to care for, train, groom, protect, and love these dogs. The purpose of the training is carefully explained to these students so that they understand that the dogs will go to people of all ages who are seriously physically handicapped. Each youngster is then assigned a dog which will be his to train for a year. The full training of each dog takes approximately two years. The only limitation is that the dogs are not allowed to live in the cottages with the children.
What is so inspiring about this program is to witness how these youngsters, who were raised with little or no nurturing, now have this animal to feed, wash, brush, groom, and train for a noble purpose. The group of youngsters is carefully taught by Lou Picard or one of her staff on how to train the dogs to perform each of the skills necessary for a service dog. This is a complex process as the dogs must learn how to walk beside a person who is sitting in a wheel chair. They must learn how to enter and exit elevators with a wheel chair next to them, how to sit silently under a table in a restaurant, and how to ignore distractions. As the dogs’ training progresses, the students learn an entire host of skills having to do with dogs but also having to do with mutual cooperation, respect and responsibility, as everyone works toward a common and worthwhile goal.
At the final steps, the disabled individuals who are being partnered with these assistance dogs come to the campus and are taught by ECAD staff and students how to handle the dogs. The Children's Village students in the ECAD program actually meet and work with the people who will be teamed with the dogs. Ultimately, there is an annual graduation where the newly trained assistance dog teams, the student-trainers, and the staff meet in a ceremony where the "leashes" are passed to disabled clients. Attending this moving ceremony are past student graduates and past clients who received assistance dogs and are living more independent lives because of their dogs.
Can a dog be a good therapist? You bet: A "doggone" good therapist!
Allan N. Schwartz, LCSW, Ph.D.