So, my mom is getting a "therapy" dog

[smalltownpsych]

My persona of adhering to empirically supported treatments overrides my persona of SJW every time. This would be akin to me saying that someone's mTBI is causing their psychological and cognitive problems, resulting in unemployability, despite failed validity tests, and that they deserve a bump up in their service connection. I don't manufacture unnecessary and unvalidated recommendations to try and offset psychosocial injustices.

So pet's aren't beneficial to some people? I agree that there needs to be a clearer distinction as to what constitutes a service animal and that pets don't treat mental illness. On the other hand, the two letters I have written in the last few years both related to a person trying to keep their pet (not get a pet) when circumstances beyond their control led to a change in housing. I had a pretty clear conscience writing those letters especially for the widow who not only lost her husband but also her residence. It would have seemed pretty harsh to make her lose her cat too. Regardless, her PCP could have written the same letter.

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[WisNeuro]

So pet's aren't beneficial to some people? I agree that there needs to be a clearer distinction as to what constitutes a service animal and that pets don't treat mental illness. On the other hand, the two letters I have written in the last few years both related to a person trying to keep their pet (not get a pet) when circumstances beyond their control led to a change in housing. I had a pretty clear conscience writing those letters especially for the widow who not only lost her husband but also her residence. It would have seemed pretty harsh to make her lose her cat too. Regardless, her PCP could have written the same letter.

If you read what I have already written, I have already agreed that pets have a beneficial effect. Calling it an emotional support animal and taking it everywhere, has not been yet shown to have an incremental benefit. In some cases, I would actually strongly argue that they are counter-therapeutic in nature. If someone else wants to write a letter for this, more power to them, just won't be me.

 

[smalltownpsych]

If you read what I have already written, I have already agreed that pets have a beneficial effect. Calling it an emotional support animal and taking it everywhere, has not been yet shown to have an incremental benefit. In some cases, I would actually strongly argue that they are counter-therapeutic in nature. If someone else wants to write a letter for this, more power to them, just won't be me.

I think we're probably more in agreement on this than not. The housing issue is the one sticking point for me and I do agree that that it shouldn't be us making that call anyway, but since it has been left up to me by the local housing authorities, I will continue to use my clinical judgement and write the letter when I deem it appropriate.

 

[Trismegistus4]

I just saw a new patient for the first time this week, who came in with an agenda of wanting a prescription or letter from a psychiatrist to designate his dog as a "psychiatric service dog," so he can carry it into restaurants, stores, and other public places. There was an email in the EMR he had sent to the psychiatrist he had initially been scheduled to see, about 5 paragraphs long, about this, and how the ADA recognizes a "psychiatric service dog" but not a "therapeutic service dog" or some other term, and apparently with an attached photo of a portrait he had painted of him and the dog gazing lovingly into each other's eyes with an angel watching overhead. (Fortunately for me, I couldn't see the attachment.) After listening to this guy talk for 2 minutes, I could tell he had every personality disorder under the sun. He carries the dog with him everywhere he goes, including into our appointment of course, in a sling over his shoulder. He accepted not getting the letter that day, and I stalled by telling him I would need to look into the research behind and indications for such an arrangement. But now I'm wondering what to do at the next visit. Any ideas?

(I have a gut reaction against this kind of thing. When I'm in an airport or other public place, and I see someone, not ostensibly physically disabled, walking around with a little toy poodle in a "service dog" vest, clearly not a guide dog, I want to slap them.)

 

[splik]

I just saw a new patient for the first time this week, who came in with an agenda of wanting a prescription or letter from a psychiatrist to designate his dog as a "psychiatric service dog," so he can carry it into restaurants, stores, and other public places. There was an email in the EMR he had sent to the psychiatrist he had initially been scheduled to see, about 5 paragraphs long, about this, and how the ADA recognizes a "psychiatric service dog" but not a "therapeutic service dog" or some other term, and apparently with an attached photo of a portrait he had painted of him and the dog gazing lovingly into each other's eyes with an angel watching overhead. (Fortunately for me, I couldn't see the attachment.) After listening to this guy talk for 2 minutes, I could tell he had every personality disorder under the sun. He carries the dog with him everywhere he goes, including into our appointment of course, in a sling over his shoulder. He accepted not getting the letter that day, and I stalled by telling him I would need to look into the research behind and indications for such an arrangement. But now I'm wondering what to do at the next visit. Any ideas?

(I have a gut reaction against this kind of thing. When I'm in an airport or other public place, and I see someone, not ostensibly physically disabled, walking around with a little toy poodle in a "service dog" vest, clearly not a guide dog, I want to slap them.)

This has got nothing to do with psychiatry. Service animals have to be specially trained and in good behavioral control in order to recognized as a service animal. That is not something a psychiatrist can do. There is no such a thing as a "psychiatric service animal", there are only service animals. He is trying to con you in to writing a letter that has no legal basis. However there is nothing stopping him going anywhere and pretending the dog is a service dog as it is unlawful to require proof. Though I think it most states it is a criminal offense to pretend to own a service dog.

 

[cookymonster]

Is getting the letter his only reason for seeing you? Does he expect you to just give him a lifetime pass to take his dog everywhere without ever reassessing his symptoms? Is he even getting any other psychiatric treatment?

Personally I'd fall back to saying that your job is to make him better and that your clinic isn't set up for that. If he just wants a letter he can google 1-800 numbers and pay someone else with a master's degree $50 for that.

 

[DJspreadsheet]

I've done these in residency, mostly because to not would be more painful than to just do it (plus with some prior residents have done it, and now it's up for "renewal"). I feel like a charlatan afterwards, but I also know nothing's truly clean in this life. Been having an internal debate on how to deal with it once I'm out of residency.

 

[keifernny2]

It sounds like you haven't come up with a treatment plan for this person yet, and he ostensibly isn't interested in treatment. It seems as though the letter would only be necessary if standard care fails (i.e. He attends psychotherapy and med therapy apps and they are ineffective).

It may be worthwhile to put a set of requirements upon him to work toward 6 or 12 months of treatment goals prior to writing the letter.

It's not much different than someone asking you to fill out disability paperwork on the first visit, when you haven't had time to help them "recover."


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[Jules A]

Dunno what to say.

Some people's lifespans are measured by the years left their pet has.

Yeah and kinda sad everyone's being such a hard ass about Nana having a 5lb pooch in her purse when she goes to Walmart. I get that it isn't about psychiatry but nonetheless there is the ever present underlying theme of disparity. I'm not interested circumventing the system so I can bring one of my big smelly mutts to the bodega but feel fortunate that I'll always have enough money stashed to afford housing where my pets are allowed.

 

[cookymonster]

http://thedogtoronline.com/make-a-payment/

Wish I saw the $199 compassion plan before I moved. Considering how much it costs to fly a pet across the country and the monthly fees at my apartment, the NO EXPIRATION housing and travel letters would have paid for themselves in just a few months.

 

[Zenman1]

Why do you hate you mom so much?

This is where you bring in genetic loading...

It is very calming to pet my black lab but I don't carry him everywhere I go. He has taught me that Black Labs Matter and routine lab monitoring is beneficial.

 

[Fan_of_Meehl]

There's a fairly recent article from a decent journal (Professional Psychology: Research and Practice) on the ethical/medico-legal pitfalls of the practice of 'prescribing' service-animals--at least from the standpoint of professional psychology.

It's behind a paywall but if any of you work for VA or other government agencies you probably have free access to the journal through your workplace.

Examining Emotional Support Animals and Role Conflicts in Professional Psychology

http://psycnet.apa.org/psycinfo/2016-27335-001/

I also as I was writing this remembered that I have a .pdf copy of the article that I suppose it's okay to post under 'fair use'

The article doesn't even touch on the potential for iatrogenesis (in the case of the anxiety disorders) in the form of 'safety/avoidance behaviors' that will serve to maintain the anxiety disorder.

The 'use' of the emotional support animal (or service animal, for that matter) with a patient who has PTSD and is undergoing one of the evidence-based treatment protocols (prolonged exposure or cognitive processing therapy) would appear to be counter-therapeutic.

In the case of CPT, the belief, "I can't be safe going to the local grocery store without Fido to be there with me to search the aisles for threats and to 'block' the space between me and other people" would actually be properly conceptualized as a maladaptive 'stuck point' that keeps the veteran from being able to recover from PTSD.

In the case of PE, the service dog would serve as a 'safety behavior' that interferes with the exposure process (and associated maladaptive beliefs regarding safety).

 

[Fan_of_Meehl]

Because the designation of an emotional or support animal conveys certain legal protections (e.g., animal in buildings, free or discounted pet travel fees, etc). If someone merely wants to have a pet, they can go down to the pound or pick up a stray. If they can't afford that for some reason, plenty of other free activities abound that can positively alter mood that do not require continued upkeep costs. Emotional support animals are neither good sense nor good medicine in many cases. Just people who want pets, but want them subsidized.

Right. A patient with an anxiety disorder doesn't really need a 'prescription' for a dog from a psychologist/social worker any more than someone with cancer (who believes, based on research from the University of Facebook/Twitter that bananas cure cancer) needs a 'prescription' for bananas (or special permission to grow a banana tree outside their apartment).

If I am being asked to write a letter for one person (the patient) to trample on the rights of another person (the apartment complex property owner), there better be some damn good and solid clinical science behind the conclusions (and reasoning) I provide in my letter to justify the breach of rights of the property owner. It's a matter of personal and professional integrity.

It's also why the treating provider is probably not the best professional to make this determination because of the inherent conflict between treatment vs. forensic roles.

 

[Shikima]

I think I'm going to allow for "therapy Hamsters" in the future.

 

[Ollie123]

I imagine that a therapy tarantula could be a very effective treatment for certain anxiety disorders...

Maybe we should start prescribing those?

 

[Fan_of_Meehl]

I imagine that a therapy tarantula could be a very effective treatment for certain anxiety disorders...

Maybe we should start prescribing those?

The only valid 'single-session' treatment in professional psychotherapy, baby...

'Flooding' or intense exposure for Specific Phobias (a la Lars Ost et al.)

 

[WingedOx]

I think I'm going to allow for "therapy Hamsters" in the future.

Well, now we know who wrote this girl's letter.

Student says she flushed 'emotional support hamster' after Spirit Airlines denied passage

 

[Shikima]

Well, now we know who wrote this girl's letter.

Student says she flushed 'emotional support hamster' after Spirit Airlines denied passage

His name was cuddles.

Let's remember cuddles.

 

[MacDonaldTriad]

Therapy pets are the new "teddy bear sign". "Cuddles loved everyone but me" .

 

[OldPsychDoc]

His name was cuddles.

Let's remember cuddles.

 

[thoffen]

I just saw a new patient for the first time this week, who came in with an agenda of wanting a prescription or letter from a psychiatrist to designate his dog as a "psychiatric service dog," so he can carry it into restaurants, stores, and other public places. There was an email in the EMR he had sent to the psychiatrist he had initially been scheduled to see, about 5 paragraphs long, about this, and how the ADA recognizes a "psychiatric service dog" but not a "therapeutic service dog" or some other term, and apparently with an attached photo of a portrait he had painted of him and the dog gazing lovingly into each other's eyes with an angel watching overhead. (Fortunately for me, I couldn't see the attachment.) After listening to this guy talk for 2 minutes, I could tell he had every personality disorder under the sun. He carries the dog with him everywhere he goes, including into our appointment of course, in a sling over his shoulder. He accepted not getting the letter that day, and I stalled by telling him I would need to look into the research behind and indications for such an arrangement. But now I'm wondering what to do at the next visit. Any ideas?

(I have a gut reaction against this kind of thing. When I'm in an airport or other public place, and I see someone, not ostensibly physically disabled, walking around with a little toy poodle in a "service dog" vest, clearly not a guide dog, I want to slap them.)

Did you know of this intention before his visit to you? I think if I were in your shoes I would have made contact and clearly stated the boundaries of your treatment and the likelihood that his request would be denied (if indeed true). I wouldn't have seen him if I had sufficient time that this was the nature of his visit and I did not do any required research ahead of time.

If he caught you off guard because you didn't know until the visit, that's one thing. I think it would be important to discriminate between your position on psychiatric service dogs as a whole from your impressions of him and otherwise to be honest and not withhold your assessment unless you legitimately need more time to make one.

 

[Liquid8]

Therapy pets are the new "teddy bear sign". "Cuddles loved everyone but me" .

Heh. I definitely have a feeling that a therapy dog is going to replaced stuffed toys as the new transitional object for BPD patients. One of the day therapy programmes I refer to has had a spate of DID/BPD patients suddenly requesting access for therapy dogs to the point where they've had to quickly formalise new policies and send them all off to get training, go through formal proper accreditation processes and get all the relevant vet checks. One of the new policies was to limit therapy animals to one per admission at any one time, which in the long term may have the effect of keeping BPD from seeking admissions together when their friends are in crisis if they go down the therapy dog route.

 

[Shikima]

Heh. I definitely have a feeling that a therapy dog is going to replaced stuffed toys as the new transitional object for BPD patients. One of the day therapy programmes I refer to has had a spate of DID/BPD patients suddenly requesting access for therapy dogs to the point where they've had to quickly formalise new policies and send them all off to get training, go through formal proper accreditation processes and get all the relevant vet checks. One of the new policies was to limit therapy animals to one per admission at any one time, which in the long term may have the effect of keeping BPD from seeking admissions together when their friends are in crisis if they go down the therapy dog route.

Linus was ahead of his time.