Studies have demonstrated notable benefits of the use of Animal Assisted Therapy (AAT) with clients (Hart & Yamamoto, 2015; Nimer & Lundahl, 2007). As AAT gains in popularity and becomes more prominently used by psychologists and psychology trainees in mental health settings (Fine, Tedeschi, & Elvove, 2015), it is crucial that the American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (APA, 2010), particularly Standard 2: Competence and Standard 3: Human Relations, be addressed and applied to this clinical practice. This article will summarize the paramount ethical and safety considerations unique to the field of AAT, including therapist training, animal training and welfare maintenance, and client well-being and safety. To educate practicing psychotherapists or therapists in training, a brief explanation of the current terminology will also be provided along with the documented benefits of AAT in healthcare and mental health settings. This article may serve as a preliminary guideline if you are considering incorporating AAT into your therapeutic work.
Throughout the literature, many terms are used to describe interventions in which animals are incorporated to promote mental and physical health in humans. For the purposes of this paper, Animal Assisted Therapy (AAT) will be the term used; however, it is important to differentiate between the following terms. Animal Assisted Interventions (AAI) is an overarching term used to describe interventions involving animals, and encompasses Animal Assisted Activities (AAA) and Animal Assisted Therapy (AAT). AAA are generally informal, recreational or educational activities utilized to improve an individual’s quality of life. AAA occur in many settings and are provided by a “trained professional, paraprofessional, and/or volunteer” (Kruger & Serpell, 2010, p. 34). In contrast, AAT is a goal-directed intervention implemented by a mental health professional, such as a licensed professional counselor, social worker, and/or clinical psychologist. These psychotherapists specifically integrate AAT into their work to facilitate client treatment objectives and goals while monitoring client progress as they (i.e., therapist, client, and animal) work together (Kruger & Serpell, 2010).
Benefits of AAT
The benefits of AAT are documented across a variety of settings, including schools, hospitals, hospice centers, rehabilitation clinics, and residential facilities (Gee, Fine, Schuck, 2015; Martin & Farnum, 2002). AAT can be applied across the lifespan (i.e., from pediatric to geriatric patients), and is most often used in conjunction with other therapeutic interventions to reach client treatment goals and address many medical, mental, and physical concerns. Incorporating an animal into psychotherapy can have numerous positive effects, and has specifically been shown to reduce symptoms of depression and promote emotional well-being (Nimer & Lundahl, 2007). Research has shown AAT is especially useful in treatment for those with “autism-spectrum symptoms, medical difficulties, behavioral problems,” as the presence of an animal can promote safety and allow clients to feel more comfortable sharing their experiences with professionals (Hart & Yamamoto, 2015, p. 59; Nimer & Lundahl, 2007).
As an example of the ways animals may be helpful to humans’ mental health, Tedeschi, Sisa, Olmert, Parish-Plass, and Yount (2015) noted that talking to and petting a dog can reduce stress, in part by releasing oxytocin, which promotes overall well-being. Interestingly, the oxytocin receptor gene helps “fine-tune” an individual’s ability to respond to social stressors, as well as empathize and trust others, which are important aspects of psychotherapy (Tedeschi, Sisa et al., 2015, p. 314). In addition, it is “therapeutically significant that a high degree of similarity has been found between the human and the dog oxytocin system, and that friendly contact between humans and dogs increases oxytocin levels in both species” (Tedeschi, Sisa et al., 2015, p. 314). Given these notable benefits, it is important therapists are adequately trained and provided with the necessary education to properly incorporate AAT into their work.
AAT Training and Integration for Psychotherapists
Formal AAT education can aid in developing a unique specialty area to strengthen a psychotherapist’s primary training focus in a mental health profession (i.e., psychology, counseling, psychiatry). There are many educational programs individuals can attend to acquire the competence needed to ethically incorporate animals into their work. For example, the Pet Partners Program in Denver, Colorado (developed by the Delta Society; http://www.denverpetpartners.org) offers a valuable introductory course, including in-service trainings that provide appropriate guidelines for quality practice (Tedeschi, Pearson, Bayly, & Fine, 2015). However, it is up to the individual to embrace and properly apply this acquired knowledge, as the field of AAT evolves and the necessary guidelines are developed (Fine, Tedeschi, & Elvove, 2015). Receiving adequate training minimizes risks and maximizes benefits of the human-animal interaction, to both human and animal participants. Additionally, client well-being and safety is a core focus in the field of psychology. Therefore, it is essential that safety measures are in place when utilizing AAT. Therapists interested in incorporating animals into their clinical practice must seriously consider many factors, including: 1) the safety and welfare of the animal and client; 2) the APA Ethics Code (2010), including Standards of Competence and Human Relations, and the five Ethical Principles (Beneficence and Nonmaleficence; Fidelity and Responsibility; Integrity; Justice; and Respect for People’s Rights and Dignity); 3) the most applicable AAT delivery model; and 4) educating members of the therapeutic environment.
The introduction of the animal to the therapy sessions must be a gradual transition, in which boundaries are established and limits set for both the client and the animal. Prior to introducing an animal to the client, therapists must provide informed consent, verify the absence of any breed-specific allergies, and determine whether the client has fears or phobias about animals or prior traumatic experiences, such as being bitten by a dog. Although research has shown the risk of transmission of zoonotic diseases is minimal, simple precautions (e.g., rigorous health care monitoring for the animal) must be taken to ensure the safety of both the animal and the client, especially for high-risk clients, such as immune-suppressed patients and hospitalized patients (Fine, 2015). Furthermore, some clients’ beliefs (e.g., religious, cultural, ethical) may not align with the principles of AAT, which may make the integration of AAT into psychotherapy challenging or impossible (Jegatheesan, 2015; Standard 3.01: Unfair Discrimination; APA, 2010). In such circumstances, therapists must have alternative treatment options. Such safety measures help ensure that the addition of the animal will enhance, and not complicate, psychotherapy, as well as ensure compliance with the five Ethical Principles of the APA Ethics Code (2010).
Given the unique client-therapist-animal relationship, the therapist must be aware of and consider the potential impact of Multiple Relationships (Standard 3.05: Multiple Relationships), and/or impaired objectivity (Standard 3.06: Conflict of Interest) on the client’s treatment (APA, 2010). Psychotherapists must develop the skill to split their attention equally between the client and animal “without compromising the quality of service being offered” (Fine, 2015, p. 163). Therefore, the therapist’s role becomes to both protect the animal’s safety and well-being and to stay attuned to and be protective of the client’s experience (MacNamara, Moga, & Pachel, 2015). Regular check-ins with the client regarding relationship status and comfort level with the therapy animal, as well as check-ins on the impact of the therapist’s own relationship with the therapy animal, are imperative. As animals, like humans, are susceptible to injury, illness, disease, and death, clients (and co-workers) must be appropriately educated, prepared, and allowed time to process the temporary or permanent, absence of the therapy animal.
Therapists can serve multiple roles in AAT and training can provide education about the delivery approaches most suitable to unique client needs. Two common delivery approaches fit the needs of most client, therapist, animal, and overall environment combinations (MacNamara et al., 2015). First, the Diamond Model consists of four individuals: the animal, the trainer, the therapist, and the client. The role of trainer is typically fulfilled by an individual with ample training (which could include an appropriately-trained therapist), and the trainer is the person primarily responsible for the animal’s safety and well-being (Standard 2.05: Delegation of Work to Others; APA, 2010). This approach is most often used with large therapy animals, such as horses, or when psychotherapy is offered in a group setting. Second, the Triangle Model consists of three individuals—the animal, the therapist, and the client—and the therapist, therefore, serves dual roles, as both therapist and animal handler (see Standard 3.05: Multiple Relationships and 3.06: Conflict of Interest; APA, 2010). This model is frequently used in the therapist’s professional environment (e.g., private practice, hospital, school, or community mental health facility) and with the therapist’s own animal that has been trained to serve as a therapy animal.
Educating facility personnel, co-workers, and staff (essentially everyone) within the facility in which animals are integrated is essential for environmental safety and for adherence to ethical standards (Standard 3.09: Cooperation with Other Professionals; APA, 2010). The therapist must ensure fellow co-workers feel comfortable and safe around the animals. Obviously, in environments integrating many types of animals (e.g., farms), employees are typically comfortable and motivated to work with a wide variety of animals. However, in more traditional psychotherapeutic environments (e.g., clinics, hospitals, community mental health centers, and educational facilities), there is likely to be greater variability in receptivity to the presence of animals. Some individuals may have grown up with animals; others may be allergic, fearful of the animal’s presence, and/or concerned about the potential for various health or liability issues. Therefore, it is essential therapists communicate with the facility personnel, co-workers, and staff prior to introducing the animal to the clinical setting, and then, upon approval of the animal, educate them on how appropriate care of the animal will be maintained. This education should include details regarding animal grooming, the animal’s health care routine, safety precautions, and assurance of procedures in place to protect any individuals who are uncomfortable with the animal’s presence. The therapist must model healthy and respectful behavior toward the animal for the benefit of the animal, co-workers, and clients (VanFleet, Fine, O’Callaghan, MacKintosh, & Gimeno, 2015). As Tedeschi, Sisa et al. (2015) noted, “It is highly significant that the behaviors and stimuli that work best in the creation of these wonderful service dogs are the same positive, nurturing behaviors on which all human friendship and families thrive” (p. 316).
Animal Training and Welfare Maintenance
Functional knowledge of not only the principles of AAT, but also animal behavior and animal welfare, is essential to competently and safely integrate AAT. General knowledge of animal behavior and appropriate human-animal interaction facilitates the therapist’s ability to detect the animal’s signs of discomfort and stress, as well as to distinguish appropriate from inappropriate human behavior towards animals (e.g., children jumping and bending over animals, pulling tails/ears, and/or sitting on the animal), as such knowledge minimizes risks for both the animal and the client (Jegatheesan et al., 2014).
Fine’s (2015) “Guidelines for Incorporating Animals in AAT” outlines how dogs are judged by trained professionals in well-qualified organizations (e.g., Canine Companions, 2016) and, thereafter, selected as a co-worker in AAT (p. 151). These guidelines include animal selection requirements, preparatory training requirements, and safety and comfort guidelines. Dogs with excellent temperament, calm and gentle natures, who enjoy being around people, are able to sit quietly for extended periods of time, are able to handle unusual circumstances, and have adequate obedience and training are judged to be well-suited for therapy animal work (Fine, 2015). These animals must then earn an obedience training certificate by demonstrating mastery of several skills (e.g., comfort around strangers, the ability to walk in the heel position on a leash and ignore a neutral dog, and the ability to obey commands). If animals meet all these requirements, they are then matched with a trained AAT specialist (e.g., a therapist).
It becomes the responsibility of the therapist to adhere to the following animal safety and comfort guidelines: a) always protect your therapy animal; b) remove your animal from all stressful situations until they become more comfortable with the situation via time and training; c) give your animal consistent breaks; d) provide walks and play breaks to reduce the animal’s stress; e) always have fresh water available and present favorite toys during breaks; and d) have a safe, low stimulus resting spot available in the therapy environment (Fine, 2015). With specialized training, therapists can learn how to properly incorporate AAT, and thereby create and maintain a healthy therapeutic environment for both the animal and the client.
As animals continue to be incorporated into the therapeutic work of mental health therapists, it becomes crucial that ethical and safety best practices, as well as adequate training for both the therapist and the animal, be implemented and maintained (Tedeschi, Pearson et al., 2015). As AAT evolves, the development of formal training guidelines and practices are needed to ensure therapists are indeed trained in a manner ensuring the safety and well-being of not only clients, but animals as well. Additionally, it is imperative therapists continue to explore the human-animal bond and conduct rigorous empirical studies examining the therapeutic benefits of AAT across different populations and settings. As Tedeschi, Sisa et al. (2015, p. 316) note,
Our increasing awareness of the similarities between the neural, neurohormonal, and genetic mechanisms that regulate stress and social behaviors in an all mammals, specifically the oxytocin system, supports the hypothesis . . . that oxytocin’s ‘calm-connect’ effects underlie the evolution of the human-animal bond . . . [and] illuminates how and why the human-canine bond can be so emotionally and therapeutically powerful . . .