This article is written for mental health therapists who are asked to write letters for people to have their pets with them in their residences, on air carriers and in public as their emotional support animals. Hopefully this information will help therapists to consider and navigate this issue ethically. It may not make some people happy but I have considered it for a long time before writing it and I believe that it is the right information to consider.
What is This About Emotional Support Animals and Letters?
As therapists, many of you may have been asked to write a letter for your client’s pet to be recognized as their “emotional support animal (ESA).” Or perhaps the person who has asked you is not your client but rather a person calling you because you are a credentialed, licensed therapist and the person is requesting you to write this letter for them due to their belief that having their pet with them at all times will support them with their emotions and ability to function in society.
If you have not been asked to do this yet, you likely will be at some point.
So what is all this about emotional support animals and letters? First of all, it is important to discuss what an emotional support animal is. An emotional support animal is a person’s pet that can support them emotionally wherever they go. The person must be deemed by a credentialed therapist or physician as having a DSM 5 diagnosis and then the professional must declare that due to the diagnosis, the person is in need of having their pet with them at all times as an Emotional Support Animal. This must be stated in a formal letter and then the animal can live in no-pet housing and fly on some air carriers in Canada in the cabin and not contained in a pet carrier. There are no laws or regulations around whether these animals are screened for their safety in the public and no formal training to do so is required. The person writing the letter most often has never met the pet and would not be qualified to screen it appropriately for its temperament or behavior unless they are an animal behavior expert in the species, which most therapists and doctors are not. This is not an issue as there is no law stating that it must be done this way.
There is copious research to support the fact that animals are good for people who are suffering from mental health issues. There is no dispute about this fact and I firmly believe that animals DO help people who are in need of support. The issue is not whether the animal is a good support for the person but rather: 1). The lack of regulation around declaring a person as suffering from a mental health disorder, 2). The lack of policies and protocols for declaring the animal as safe in public places and 3). The lack of attention to how the animal may feel if they are in busy places all day, on buses or wherever the person may go.
Other issues with Emotional Support Animals in public include the confusion the public experiences in understanding the difference between an animal who is for emotional support an animal who is trained as a service animal. Service animals are trained extensively to be safe in public as they are trained to support one person who depends on them to live and function. Service animals are trained to be quiet, well-behaved, unreactive to other animals and chaotic events in the public as well as to have the skills and knowledge to assist people with a diagnosed disability in many ways (for example, Seeing-Eye Dogs and the Blind). They allow people to live in community and to carry out daily tasks more independently and they are recognized in Canadian Provincial Law as having rights as they are under the human rights act https://open.alberta.ca/publications/s07p5 in many provinces. They are allowed into no-pet housing, on air carriers, in restaurants and hotels and many other places because of their high level of training and capacity to not cause disruption while supporting their person. They typically wear a vest and their process is formally extensive.
Emotional support animals are typically someone’s pet and unless the person goes through extensive screening, training and certification for their pet with a trained professional who can assure that the pet is safe in all public circumstances, the pet is possibly not safe in public. And if the pet is not safe, the public may not be either, nor the person the pet is there to support. These animals often also wear vests and hence the confusion of the public for the type of animal that is present.
Just a thought, but if the pet is emotionally supporting someone and it bites another person while out in the community or gets afraid of a loud noise and is cowering under the table, how will the person in need of support of the pet help the pet or navigate the situation?
ESAs do not have all the same rights as service dogs in Canada but they are allowed into some no-pet housing and on some air carriers. They get into public places like restaurants and other places because business owners are not informed about the differences in the types of animals in public these days. This is causing problems for people who are in dire of a service animal for their functioning. ESAs who do not manage their behavior in public places, bark incessantly or jump on people can lead to business owners banning animals from their premises, which affects the service animal folks.
So what are the ethical considerations for you as a therapist in writing letters for ESA’s?
Scenario 1: The person requesting the letter is your client. You know this client has a diagnosed mental health disorder. This part is easy. Your client asks you to write the letter so their animal can be identified as an ESA.
How can you avoid this from happening? One way is to include a clear statement in your informed consent that you are providing clinical services only and that you do not provide letters for ESAs.
Scenario 2: A person from outside your practice contacts you and asks you to write a letter for them to have an ESA.
Possible solution? This person enters into a clinical relationship with you so you can properly diagnose or confirm diagnosis. This still leaves the problem of ensuring their animal is safe for public access unless you are an animal behavior expert in the species of your client’s pet and also opens that door of possible harm to the client if, in the end, you determine that the pet is not safe as an ESA.
Writing letters for ESAs could possibly be considered outside the scope of many therapists practice or competence, could have ethical ramifications and could interfere with our service to our clients and to the general public.
All of this does not even consider the animal involved. What if the animal is sensitive to large crowds of people, has transportation issues or does not get along with other animals it may meet in its journeys? If it is suddenly accompanying its owner on all excursions, it may take a toll on the animal’s health and welfare.
As therapists, we have an obligation to our clients and to the general public to do no harm. If we are writing letters for people to bring their pets into the community with or without screening, training and certification to support them emotionally for their DSM 5 diagnosis, we may not be honoring our obligations.
The laws in our country pertaining to ESAs require development and strengthening. In the meantime, it is best for us as therapists to stick to what we know and be cautious about treading into the deep waters this issue lurks in regarding questionable scope of practice and attesting to things we cannot be sure will actually assist our clients and protect them or the public from harm.
If you still want to write letters for ESAs, according to Clay (2016), the letter should be composed of several parts:
I am a huge supporter of the positive impact animals have on people’s mental health. I am an animal assisted therapist and have been practicing with animals to support people’s mental health and clinical treatment for 18 years. I fully support people having their ESAs in their homes but I do not write letters or encourage people to take their animals from their homes into the public to support them. There are just too many ethical issues at stake for the client, the animal and the public.
If my professional opinion is that my clients would absolutely benefit from having their pet with them at all times, I recommend them to get a service animal as these animals can be properly trained to support them while keeping them and everyone around them safe wherever they may go. The research also supports the fact that service animals provide long-term therapeutic support to people with disabilities and mental health diagnoses (Rodriguez, et. al., 2019)
In the United States, the Human-Animal Interactions in Counselling through the American Psychological Association has a position statement on this issue which reads as follows:
“Counselors only work within their boundaries of competence based on education, training, supervision, experience and credentials. As Licensed Professional Counselors, the assessment of DSM 5 diagnoses for human clients is within the scope of practice; however, the added practices of animal behavior, animal behavior assessment, or Human-Animal Interventions and Interactions are (most often) not. Emotional Support Animals may, in some specific circumstances, provide benefits to humans to ameliorate identified symptoms often associated with a DSM 5 diagnoses; however, because of the potential risks and unanticipated outcomes, the HAIC strongly suggests that counselors abstain from writing letters for persons seeking counseling or assessment for the sole purpose of obtaining an ESA recommendation letter.”
I couldn’t have said it any better myself and since we adopted the whole concept of Emotional Support Animals from the US, I recommend we adopt this solution to the problem that ESAs are now causing in the US which is extending to us. Rather than us as therapists taking all the responsibility for the ESAs, let’s lean on our government to put regulations in place to protect everyone involved.
June 7, 2021
January 25, 2021
The 3 Agendas of the Triangle Model of Animal Assisted Therapy (AAT)
I recently read an article entitled “What Horses Teach Us About Systemic Oppression” by Julia Alexander and it resonated with me in regard to this article about the ‘3 agendas in AAT’ that I have been wanting to write for some time now.
Funnily enough, I was going to write the article yesterday, but it was a freezing cold -26 degrees here in Northern Alberta and so my own agenda morphed into having to catch and blanket the horses rather than write about them. It was after I chased them around trying to convince them that the blanket was a good thing that I then came back and saw that article and I had to laugh out loud. Here, I was going to write about respecting the animals in AAT and the importance of being fully aware of the fact that they have their agenda which is not your agenda or your client’s agenda. I was going to write about how we need to ethically ensure we are considering all 3 agendas in the work and to not be allowing our human agendas to lead the session against the animal’s will. And then I chased my mini donkey around the property and finally half lassoed him to get his blanket on. I gave up on my Shetland pony and my Connemara because they refused to be caught and so I allowed them to make the choice to not wear a blanket although it was going to be steep -30’s overnight – so who did I do the right thing by?
Did I do the right thing by the donkey I forced to wear his blanket or by the two horses I allowed to refuse to wear them simply because I gave up trying? I guess if we think about systemic oppression, it does not apply to forcing someone to do something that is for his own good or to do something that he will not decide to do on his own but could be a matter of his life or death, if he is in your care.
When I think of this in the context of AAT, I think of it on two levels: One level includes the need to ‘force’ an animal to undergo things s/he may not like or want to do to ensure his/her health and wellness and the other level is regarding the agendas that we have as therapists and clients in the medium of AAT. Part of the reason we have to maintenance animals in our care is because they are in our care, simply put. When we bring animals into our AAT practices, we become their advocates, their providers, their ambassadors and we are responsible for all tenets of their welfare. If we do not catch them to trim their feet, do health and wellness checks, give vaccines or medications and/or first aid when needed, then we are not meeting our ethical obligation to care for them. But what if they just don’t want to work the day your client chooses them in your AAT practice? What if their health and welfare is not at stake and it is more of a mood or a choice to do something else that is influencing their refusal to be part of your session? Are they allowed to say no?
This is where the 3 agendas come in and also possibly animal oppression. Let’s do this through an example:
Josh is attending therapy because his mother died and his father is hoping he can express his feelings through working with your horses. Josh has been to traditional therapy and many counselling practices but the mediums have not been effective to get him to open up to anyone yet. Josh is an avid animal lover and his father is hoping that by working with the animals, Josh will be more comfortable and the AAT psychologist who specializes in grief work can help him to process his deep grief.
You are that therapist and you have a horse who is very quiet and gentle by nature. Josh has no experience working with horses and this horse would be perfect for him to begin sessions with. Josh is very excited to brush this horse. When you and Josh go toward the horse, it turns and walks away, indicating that it may not wish to be caught. Here are 3 possible agendas at play: 1. Your agenda is to build rapport with Josh through working with your horse, 2. Josh’s agenda is to brush the horse, 3. The horse’s agenda is to go for a walk, likely toward the food and without you or Josh. What is the best ethical approach to helping Josh in this moment?
There are many ethical options. First off, you could address the horse’s behavior in the context of the horse being a sentient being and having her own thoughts, feelings, wants and needs. You can ask Josh what he thinks you both should do. This would give you a good indication of Josh’s awareness, understanding and depth of empathy; his ability to problem solve; the level of his frustration tolerance and many more important social skills. In doing this, you would be meeting your agenda, which is to build rapport and get to know Josh and you would be meeting the horse’s agenda, as she gets to go off and eat but you wouldn’t be meeting Josh’s agenda as he wanted to brush the horse. Secondly, you could catch the horse and bring her back to brush her, meeting both yours and Josh’s agendas but not the horse’s.
So how can you meet the 3 agendas? Let’s say that the horse was going toward the food. Perhaps you can suggest to Josh that he get some food to offer her to see if she will choose to be with him rather than out in the pasture? If she does, then she gets to eat while you teach Josh to brush her and build rapport. All 3 agendas will have been met!
As a psychologist who has been working in the medium of AAT for 18 years and who offers a certification in AAT and Animal Assisted Wellness (AAW) to helping professionals, it is my professional opinion that we should always be striving to meet the 3 agendas when working with animals in practice. When we partner with animals, we are partnering with a helper in our work who has their own thoughts, feelings, wants and needs and we need to notice these, honor them and meet them as much as is possible and at all times. It is not ethical to not consider our animal’s preferences, likes or dislikes when we are working with them and it is not ethical to not drop our agenda or convince our client to drop theirs if our agendas are disrespecting or dishonoring the agendas of our animals.
I might go so far as to say, now that I read Ms. Alexander’s article, that we may be ‘oppressing’ our horse or therapy animals if we ‘force’ them to do what we want them to do in AAT whether it be because of our personal agenda of that of our client. It is true that horses easily bend to our will when we really want them to or when we behave in certain ways. In fact, in AAT, we are often bigger than many species of animals and we can ‘force’ them to meet our agendas as well if we are so inclined.
It is true that there are ways to get our animals to want to comply with our agendas but often, we have to work harder to ensure this is actually done or we have to ‘give in’ to their agenda in some cases. There are many people who have much pre-knowledge of working with animals before partnering with them in professional AAT practice. It is our due diligence to ensure that we are checking in on our thoughts, beliefs and values of animals before we practice with them and during every single AAT session that we conduct as there is a very good chance that our preconceived notions and pre-lived experiences will be influencing our decisions for what is happening as per our agenda or the agenda of the session. If in fact, we are moving ahead with our human agendas without consideration for our therapy animals’ agendas, then we are very most likely practicing animal oppression rather than animal assisted therapy.
Dreamcatcher Nature Assisted Therapy www.dreamcatcherassociation.com