Therapy dogs

[gibits]

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Anyone have any experience with them? I got a really broken patient with a severe case of PTSD and nothing seems to work. She is seeing a therapist but it's not doing much good. I'm not sure if he's really doing exposure therapy with her but after 4 weeks in the hospital she's still in bad shape.
I've heard vets with PTSD respond well to dogs, and therapy dogs do come to my hospital for the teenagers. Anyone have any articles that show it's effectiveness against PTSD? Should I just suggest her to get a dog? If I'm going to do this I need some evidence to back me up.

 

[Armadillos]

I think a psychologist or psychiatrist at VCU or Virginia does research related to therapy dogs, I seem to remember she had a somewhat ironic name (like maybe barker)

 

[PsyDr]

The VA states that there is insufficient evidence to support service animals for psychiatric illness.

"Although we do not disagree with some commenters' subjective accounts that mental health service dogs have improved the quality of their lives, VA has not yet been able to determine that these dogs provide a medical benefit to veterans with mental illness. Until such a determination can be made, VA cannot justify providing benefits for mental health service dogs."


Fun Fact: The ADA only recognizes 2 animals as "service animals: 1) Dogs, 2) MINIATURE HORSES!

 

[zenman]

Anyone have any experience with them? I got a really broken patient with a severe case of PTSD and nothing seems to work. She is seeing a therapist but it's not doing much good. I'm not sure if he's really doing exposure therapy with her but after 4 weeks in the hospital she's still in bad shape.
I've heard vets with PTSD respond well to dogs, and therapy dogs do come to my hospital for the teenagers. Anyone have any articles that show it's effectiveness against PTSD? Should I just suggest her to get a dog? If I'm going to do this I need some evidence to back me up.

Go pet a dog and you'll get your evidence. I can't remember any veterans I treat not having any thing other than positive results from having a pet. Just don't recommend a yapper.

 

[Armadillos]

From an anecdotal standpoint I have talked to one patient with PTSD whose new dog made it possible for him to fall asleep at night, wasn't a trained therapy dog, just a pound puppy. If anyone finds any relevant articles please post them, would be interested to see what sort of research is going on

 

[countryboy75]

I have filled out paperwork for a patient in section 8 housing who had ptsd to be able to have a dog. Pt was afraid of the dark and felt that the dog would alert her if someone were to come into the house. She slept better with the dog than with ambien (of course that may have been embelished a bit by the pt who loved the dog)

I guess I can justify getting a regular dog for company and in this case to act as a sentry. Not sure I can justify an 8+ thousand dollar therapy dog.

 

[notdeadyet]

I did a lit search back in the day and therapy dogs did not meet criteria for evidence-based medicine for a treatment modality for depression, anxiety, or PTSD.

That said, while they didn't alleviate or improve symptoms, they can improve quality of life.

Operative word being "can." Some patients are not good fits for dogs, as many dogs are very empathic and can mimic the moods of their owners to detrimental effect. I have two patients who have anxiety spectrum disorders who I'm pretty convinced that their dogs actually accentuate their symptoms.

 

[Therapist4Chnge]

I have seen service animals be helpful in a VA setting w. moderate/severe PTSD (to help calm down, stay present instead of decompensate) as well as w. TBI related seizure disorders.

 

[billypilgrim37]

I'm all for people having dogs, and have 3 mutts myself. I do not see any reason why we should be writing letters for people to have dogs when the rules of their leases or whatever else prohibit them.

Encouraging people who otherwise weren't going to get a dog to get one may be a nice thing, but it might also be a disaster. Dogs are expensive to take proper care of, and the initial costs are much less than the ongoing costs which people discount. We shouldn't be encouraging folks to get dogs unless they were already seriously considering it a good idea. For every great dog story, there can be some bad ones too.

My wife used to manage an open-door animal shelter before she went off to law school. Honestly, between no home and a home that can't properly care for them, I saw way too many animals that were much better off with no home. A euthanized animal doesn't suffer, which is not a heartless thing to say once you've seen enough animals suffering from neglectful homes. (that said, when my 3 geriatric aged dogs pass over the next few years, I'm going to be entirely incapacitated with grief. i can tear up just talking about it.)

What is an EXCELLENT thing to recommend to your patients is to volunteer at their local shelters. Most shelters are in need of more and more dog walkers. The shelter my wife managed was almost across the street from the methadone clinic where I worked, and this was a great source of support and recreation and giving back for folks who were seriously into their recovery.

(I had to explain to the staff that when a methadone patient was in the bathroom for a really long time and making terrible grunting noises, it wasn't because she was using (which was what they thought), but because she was very constipated from the methadone. Seriously, I had that conversation.)

 

[Lil Mick]

Haven't found much evidence-based stuff on the matter with any sort of conclusiveness, but a few of my friends and I tried it (all from the VA) and were able to sleep/stay calm... during the worst of PTSD. I know of a few independent PTSD programs that use animal therapy and have had pretty good success rates (but patients self-selected the program).

 

[TexasPhysician]

Getting a dog is great. As a therapy dog that goes everywhere with someone, it is recommended against. Therapy dogs interfere with exposure therapies. People become too dependent on the therapy dogs.

 

[notdeadyet]

As a therapy dog that goes everywhere with someone, it is recommended against.

I get your point, but just as clarification, therapy dogs can not go anywhere (public transportation, restaurants, etc.). They are not afforded the same rights as service dogs.

Just pointing this out because I've had more than one patient that really wanted their dog classified as a therapy animal but quickly lost interest when they heard the differences in rights and training between a therapy animal and service animal.

 

[billypilgrim37]

I get your point, but just as clarification, therapy dogs can not go anywhere (public transportation, restaurants, etc.). They are not afforded the same rights as service dogs.

Just pointing this out because I've had more than one patient that really wanted their dog classified as a therapy animal but quickly lost interest when they heard the differences in rights and training between a therapy animal and service animal.

I try to explain to folks that there's really no such thing as a therapy dog. There are just dogs. There might be dogs that have gone through some sort of made up program and received some made up certification, but it's still just a dog that does not receive any further consideration under the ADA. That doesn't make the dog not awesome and beneficial. But it doesn't mean you get to break the rules just because you don't like them and don't want to deal with them.

My wife is a bit of a specialist with some of the fair housing laws around the country. Judges do sometimes buy the "therapy dog" argument and will make landlords not evict tenants who are breaking the rules about dogs if there is a physician letter. But that's because the judge assumes the doctor knows what he's talking about, and hey, it's a dog. Since we've never been trained in assessing the need for dogs, I don't think we should abuse the court's trust by making unsubstantiated claims.

 

[clusterF]

Bump:

Have any of you written letters to let someone have a therapy dog? Does it have to be a dog? What would you write in the letter to protect yourself? I am concerned because although I want to help the patient, I don't want the letter to cause problems for the landlord etc. It is already difficult enough for patients with mental illness, poverty etc to get housing.

 

[smalltownpsych]

In the town I was in a few years it was therapy cats that the landlords would allow if patient got a letter from a provider. I recall that there was some evidence publicized in the mass media that petting cats can lower blood pressure. I haven't bothered to look into the scientific literature, but we have 3 cats: one is generally quiet but can occasionally snap at you if you don't pet him right, another is annoying and needy but never aggressive, the third is cute, lovable, kills lots of mice and is just a joy to have as a pet. So my pseudo-scientific study says - one out of 3 cats is good for you!

 

[hamstergang]

Have any of you written letters to let someone have a therapy dog? Does it have to be a dog? What would you write in the letter to protect yourself? I am concerned because although I want to help the patient, I don't want the letter to cause problems for the landlord etc. It is already difficult enough for patients with mental illness, poverty etc to get housing.

I have written letters for 2 patients at the VA who requested service dogs. The letters were for the organizations that provided the dogs. All I wrote was that the patient was under my care for however long, suffering from PTSD and whatever else, and despite actively engaging in ongoing treatment, was still symptomatic, and therefore I supported their request for a service dog from the organization. I don't feel I'm open to much liability from this.

 

[gibits]

Wow this thread is still kicking? Just an update, I did recommend a dog for my pt, she got a black lab mut from the shelter.
She says it licks her when she has a nightmare and follows her around and makes her feel safe.
I took a gamble and it seemed to work. Yay for me!

 

[Shikima]

Any kind of therapy/service animal seems to provoke angst in providers, in general. Personally, I've always said no to these requests as I've found it to be similar to enabling. However, I've never said no to anyone who wanted a pet.

 

[nancysinatra]

In this day and age you can get a therapy hamster if you want. Or a therapy rabbit or turtle. I personally don't mind filling out forms for my patients regarding animals. Although this thread has focused on the evidence base for therapy animals, come on, how much is done in the name of psychiatry in this country that is actually "evidence based?" For every non-evidence-based therapy animal out there there are probably ten thousand examples of patients taking benzos together with stimulants for very dubious cases of "anxiety and concentration problems." Adding a therapy cat or two to the mix is hardly going to taint the practice of psychiatry.

I would much rather fill out a form for someone to give to their landlord than fill out disability forms. I don't think animals are "enabling" at all. The patients I have who want therapy cats are generally my higher functioning patients. I'm not saying I would encourage all my patients to get pets because some of the clearly aren't responsible enough, but I usually consider it a sign of higher functioning when a person has a pet or a job. (When they have kids, no way. Possession of kids tends to be inversely proportional to responsibility levels, is what I have observed.)

Here's an idea - a therapy tarantula for people with phobias. And a therapy treadmill for those who won't exercise.

 

[smalltownpsych]

In this day and age you can get a therapy hamster if you want. Or a therapy rabbit or turtle. I personally don't mind filling out forms for my patients regarding animals. Although this thread has focused on the evidence base for therapy animals, come on, how much is done in the name of psychiatry in this country that is actually "evidence based?" For every non-evidence-based therapy animal out there there are probably ten thousand examples of patients taking benzos together with stimulants for very dubious cases of "anxiety and concentration problems." Adding a therapy cat or two to the mix is hardly going to taint the practice of psychiatry.

I would much rather fill out a form for someone to give to their landlord than fill out disability forms. I don't think animals are "enabling" at all. The patients I have who want therapy cats are generally my higher functioning patients. I'm not saying I would encourage all my patients to get pets because some of the clearly aren't responsible enough, but I usually consider it a sign of higher functioning when a person has a pet or a job. (When they have kids, no way. Possession of kids tends to be inversely proportional to responsibility levels, is what I have observed.)

Here's an idea - a therapy tarantula for people with phobias. And a therapy treadmill for those who won't exercise.

Agree completely. I think that the distinction has to be made between a "therapy animal" and something that is therapeutic. Half of what I do with many of my patients is work with them to find therapeutic pursuits for them. Things such as hobbies, pets, interests, relationships, social groups, volunteer groups, advocacy organizations, employment...

 

[MacDonaldTriad]

I think the biggest danger in getting involved in recommending therapy animals is just looking silly. Patients can have pets without our blessing. If their living situations preclude pets, do we really want to throw our weight in and change rules? Once we go there, it becomes an expectation. Medical THC anyone? Maybe we should stick to recommending Atkins friendly, gluten free, free range pet rocks.

 

[OldPsychDoc]

Agree completely. I think that the distinction has to be made between a "therapy animal" and something that is therapeutic. Half of what I do with many of my patients is work with them to find therapeutic pursuits for them. Things such as hobbies, pets, interests, relationships, social groups, volunteer groups, advocacy organizations, employment...

And this is what I typically do when I'm asked for a letter: emphasize that the pet in question is therapeutic in that sense, and benefits the patient, but is not a trained Therapy Animal. It allows me to provide some support for the patient, especially where they are requesting a privilege from a landlord, for example, while making clear that I am not prescribing the animal as medically necessary.

 

[clusterF]

If I am not prescribing the animal as medically necessary, then why write a letter at all? It just seems that if I write the letter, I AM prescribing the pet.

What rights does this pet now have. Must this pet be allowed where a landlord says no pets? How about a restaurant? If the pets has absolutely no rights on the basis of the letter, what is the point of the letter?

 

[OldPsychDoc]

If I am not prescribing the animal as medically necessary, then why write a letter at all? It just seems that if I write the letter, I AM prescribing the pet.

What rights does this pet now have. Must this pet be allowed where a landlord says no pets? How about a restaurant? If the pets has absolutely no rights on the basis of the letter, what is the point of the letter?

To support the patient.

It carries no mandate that a landlord change a policy, or that the animal "must be" allowed anywhere--but I believe it does communicate to others that the animal in question has a purpose in relationship to the patient, and that the patient is willing to be responsible about their life and actions.

 

[hamstergang]

If I am not prescribing the animal as medically necessary, then why write a letter at all? It just seems that if I write the letter, I AM prescribing the pet.

What rights does this pet now have. Must this pet be allowed where a landlord says no pets? How about a restaurant? If the pets has absolutely no rights on the basis of the letter, what is the point of the letter?

In my letters, I make sure to state that I support the patient's request for the dog, as that way I'm not stating that I'm prescribing the dog or anything like that.

I write the letters because the organizations that provide the service dogs require my letter.

 

[TexasPhysician]

To support the patient.

It carries no mandate that a landlord change a policy, or that the animal "must be" allowed anywhere--but I believe it does communicate to others that the animal in question has a purpose in relationship to the patient, and that the patient is willing to be responsible about their life and actions.

I am not sure this is legally correct in all states. If service animals are allowed due to a medical problem, I could easily see a judge in certain regions agreeing that a therapy animal equally treats mental problems thus allowing it. Just because we don't mean it to carry legal weight, doesn't mean it won't.

Rarely would I sign anything for a "therapy" animal because usually these patients want to take the animal everywhere. They use my letter to enforce it. Many places will not 2nd guess it. I know there are patients with social anxiety that will not leave the home without their "therapy animal" and discontinue treatment. These people continue to be unable to hold a job or function without the animal. Thus it is enabling in my opinion.

Cases are always handled on an individual basis, and I strongly urge everyone to evaluate the possible downsides of "therapy" animals in individual cases. I agree that it is perfectly fine to purchase a pet and train it. You don't need my signature for that.

 

[notdeadyet]

I think folks are misusing terms here...

A "service animal" goes through standardized training and is recognized by the state and federal government. Think seeing eye dog. A physician has no involvement with this process other than indicating one is needed to get a patient on the queue to have a patient apply for one. They are recognized by the ADA and can go into restaurants and the like.

A "therapy dog" also goes through training as well, though it is less lengthy and varies. These are dogs that you see in the hospitals to provide care to others. They lack the rights of service animals.

I think folks in this thread might be using this this latter term when they mean "emotional support animal." These are animals, typically dogs, that are intended for use to provide comfort and emotional regulation to mentally ill patients. All that you need is a recognized mental illness and a recommendation by your psychiatrist. These dogs need no training but are federally recognized. If you see a dog on an airplane with no service animal tags, it is likely an ESA. Psychiatrists are prone to abuse this and if a letter is written, landlords ARE required to let the dog live there regardless of lease.

I'd caution docs to write these letters VERY specifically. If you write a therapy dog letter for a mentally ill patient, it is likely going to be seen as an ESA, regardless of your intent. If you just want to write a letter of support to recommend landlords and workplaces CONSIDER allowing the dog (instead of be legally required) you need to choose your words carefully.

 

[nancysinatra]

Rarely would I sign anything for a "therapy" animal because usually these patients want to take the animal everywhere. They use my letter to enforce it. Many places will not 2nd guess it. I know there are patients with social anxiety that will not leave the home without their "therapy animal" and discontinue treatment. These people continue to be unable to hold a job or function without the animal. Thus it is enabling in my opinion.

Can you explain more why you think the animal is "enabling?" I can see how it would be "useless" or "ineffective" but in what way does it enable the patient's dysfunction?

I personally see therapy animals as being similar to Buspar or maybe Neurontin. These medications may help a small segment of patients by legitimately exerting a pharmacological effect, and they may help another, probably larger segment of patients by placebo effect, but they are rarely curative, and what's more, the vast majority of the time they do nothing at all yet psychiatrists continue to prescribe them.

I don't really care if something I vouch for or recommend inconveniences a landlord. Why should that enter into my decision at all? Similarly when I'm asked to sign work release forms - sometimes I sign them and sometimes I don't, but I never base my decision on the needs or wishes of the employer. Employers, like landlords, will always want things to be decided in their favor. They have many ways of asserting their own interests, and do not need my help, nor is it my job to worry about them.

 

[nancysinatra]

I think the biggest danger in getting involved in recommending therapy animals is just looking silly. Patients can have pets without our blessing. If their living situations preclude pets, do we really want to throw our weight in and change rules? Once we go there, it becomes an expectation. Medical THC anyone? Maybe we should stick to recommending Atkins friendly, gluten free, free range pet rocks.

I think that boat sailed long ago. Social phobia, anyone? And that new thing in the New York Times - sluggish cognitive tempo? Yeah if we look silly as a profession, please don't blame it on some cats and dogs.

 

[TexasPhysician]

Can you explain more why you think the animal is "enabling?" I can see how it would be "useless" or "ineffective" but in what way does it enable the patient's dysfunction?

I personally see therapy animals as being similar to Buspar or maybe Neurontin. These medications may help a small segment of patients by legitimately exerting a pharmacological effect, and they may help another, probably larger segment of patients by placebo effect, but they are rarely curative, and what's more, the vast majority of the time they do nothing at all yet psychiatrists continue to prescribe them.

I don't really care if something I vouch for or recommend inconveniences a landlord. Why should that enter into my decision at all? Similarly when I'm asked to sign work release forms - sometimes I sign them and sometimes I don't, but I never base my decision on the needs or wishes of the employer. Employers, like landlords, will always want things to be decided in their favor. They have many ways of asserting their own interests, and do not need my help, nor is it my job to worry about them.

I've seen patients with social phobia/anxiety disorders that initially seek therapy/medications request a therapy dog. The therapy dog will allow some social interaction but only in the presence of the animal. Some of these patients (on disability or financed by spouse) are pleased with this benefit and then quit therapy/medications.

Minimal benefit only in the presence of the animal thus can result in continued dysfunction/disability and no effort to improve. It reinforces that the patient needs the animal to socialize or enter public environments. The few I've seen re-enter tx afterwards have a worse prognosis in my experience.

 

[notdeadyet]

I personally see therapy animals as being similar to Buspar or maybe Neurontin. These medications may help a small segment of patients by legitimately exerting a pharmacological effect, and they may help another, probably larger segment of patients by placebo effect, but they are rarely curative, and what's more, the vast majority of the time they do nothing at all yet psychiatrists continue to prescribe them.

Your argument for therapy animals is that they're like Buspar? The problem with that analogy is that when the Buspar doesn't work, they can just stop taking it. This doesn't happen with pets.

I don't really care if something I vouch for or recommend inconveniences a landlord. Why should that enter into my decision at all? Similarly when I'm asked to sign work release forms - sometimes I sign them and sometimes I don't, but I never base my decision on the needs or wishes of the employer. Employers, like landlords, will always want things to be decided in their favor. They have many ways of asserting their own interests, and do not need my help, nor is it my job to worry about them.

Unfortunately, physicians have a long history of ignoring systems issues and restricting their logic to the most immediate level. That's why we have antibiotic immunity.

If every psychiatrist was as loose with making their patients dog an Emotional Support Animal without considering the bigger picture, we'd be further stigmatizing the mentally ill, and particularly when it comes to housing, where they already have trouble. Putting patients on work release and disability sure makes you popular with your patients but it also contributes to stigmatization and also drains a very finite resource. You can write for handicapped placards because your patients have fatigue and they'll love you for it, but it makes it harder for those who need it more. Isn't Justice one of the big four in bioethics?

We need to approach dogs and disability like anything else: is it good treatment for their mental illness and what is the risk/benefit? And not taking the systems level issues into account is exactly why we have so much trouble getting help to those that actually need it.

 

[nancysinatra]

Your argument for therapy animals is that they're like Buspar? The problem with that analogy is that when the Buspar doesn't work, they can just stop taking it. This doesn't happen with pets.

Unfortunately, physicians have a long history of ignoring systems issues and restricting their logic to the most immediate level. That's why we have antibiotic immunity.

If every psychiatrist was as loose with making their patients dog an Emotional Support Animal without considering the bigger picture, we'd be further stigmatizing the mentally ill, and particularly when it comes to housing, where they already have trouble. Putting patients on work release and disability sure makes you popular with your patients but it also contributes to stigmatization and also drains a very finite resource. You can write for handicapped placards because your patients have fatigue and they'll love you for it, but it makes it harder for those who need it more. Isn't Justice one of the big four in bioethics?

We need to approach dogs and disability like anything else: is it good treatment for their mental illness and what is the risk/benefit? And not taking the systems level issues into account is exactly why we have so much trouble getting help to those that actually need it.

Ok I see what you are saying about the systems issue - the handicapped placard is a good example. But cats and dogs are a different "system." Dogs and cats are a commodity that may overpopulate itself. Whereas handicapped placards are finite and we need to distribute them fairly. But, in theory, anyone can have a cat or a dog. In fact, from an animal welfare perspective it is helpful for stray animals to get adopted.

I do see that there would be limitations on this - i.e. if every psychiatric patient had a cat or dog the world would be overpopulated with pets, and if irresponsible patients have cats and dogs the pets may be mistreated. The former is an animal population issue and the latter is an animal welfare issue, I think. They all relate but they are not exactly analogous to the handicapped placard. And for the record I wouldn't recommend a pet for every patient. I take it about as seriously as I take recommending that the patient volunteer at the Humane Society.

That's the key here - I'm not labeling these animals as Emotional Support Anything. I'm just filling out a form that has two or three questions: 1) does the patient have some illness, 2) is the animal needed or helpful. I answer by saying 1) yes. and 2) maybe it's needed and probably it's helpful. Society can decide what to do next with these forms.

As for the landlords and employers, I'm just saying I don't care about their financial plight. The landlord isn't my patient. The patient is. It would be way beyond my scope of practice to contemplate whatever "systems" issues are involved in the landlord's reasoning for prohibiting dogs and the impact on the world economy that might occur if said landlord has to change that policy because too many psychiatrists fill out these forms. That's like asking me to think about the impact on the groundwater with each prescription for prozac that I think about writing.

I often say no to work release requests, if I think the patient will actually benefit more from working than from sitting around at home. But I don't refuse them because I am worried about the employer's bottom line. I'm not an advocate for the Landlord Association or the Boss's Association. And furthermore, sick leave practices are culturally and economically based. I could certainly reason that, well, in Germany they take 2 weeks off when they get a cold so my depressed patient ought to get 2 months off, or I could reason that, well, there are countries in Africa where people live on a subsistence basis and they don't get any "sick leave" at all so really, my patient shouldn't either. I'm not sure I'll ever figure that one out.

I absolutely almost never fill out disability paperwork. I don't believe the treating physician should generally do that.

I realize you can't get rid of a cat or a dog as easily as you can stop taking a medication. I'm just saying it might help for some but not all patients. That's where I see the similarity with buspar and neurontin. Beyond that I would not compare them.

 

[nancysinatra]

I've seen patients with social phobia/anxiety disorders that initially seek therapy/medications request a therapy dog. The therapy dog will allow some social interaction but only in the presence of the animal. Some of these patients (on disability or financed by spouse) are pleased with this benefit and then quit therapy/medications.

Minimal benefit only in the presence of the animal thus can result in continued dysfunction/disability and no effort to improve. It reinforces that the patient needs the animal to socialize or enter public environments. The few I've seen re-enter tx afterwards have a worse prognosis in my experience.

Hmmm, that's interesting - I guess I just haven't seen that. Like I said above I see this as low stakes because I am given a form that doesn't say a whole lot on it and doesn't ask me to cough up much information or make any great proclamation about what the purpose of the animal is. Your same patient could always move to a building that allows pets, get a therapy dog without your blessing, and still stop their meds or stop coming in to see you.

Honestly if someone thinks a cat is better for their health than seeing a psychiatrist, I have to ask, maybe they're right? I mean if the patient is rehabilitated to the point that they don't want to come see me anymore, that may be a good thing. I'm not going to start prescribing cats and dogs but I don't want to be telling people they should't have them either.

 

[nancysinatra]

I think it would be interesting if we had this same discussion but changed the word from "therapy animal" to "really loud and heavy therapy gym equipment."

 

[Indodo]

If every psychiatrist was as loose with making their patients dog an Emotional Support Animal without considering the bigger picture, we'd be further stigmatizing the mentally ill, and particularly when it comes to housing, where they already have trouble. Putting patients on work release and disability sure makes you popular with your patients but it also contributes to stigmatization and also drains a very finite resource. You can write for handicapped placards because your patients have fatigue and they'll love you for it, but it makes it harder for those who need it more. Isn't Justice one of the big four in bioethics?

We need to approach dogs and disability like anything else: is it good treatment for their mental illness and what is the risk/benefit? And not taking the systems level issues into account is exactly why we have so much trouble getting help to those that actually need it.

In a negative sense, enabling is also used to describe dysfunctional behavior approaches that are intended to help resolve a specific problem but in fact may perpetuate or exacerbate the problem...from wikipedia but sounds about right.

That's the key here - I'm not labeling these animals as Emotional Support Anything. I'm just filling out a form that has two or three questions: 1) does the patient have some illness, 2) is the animal needed or helpful. I answer by saying 1) yes. and 2) maybe it's needed and probably it's helpful. Society can decide what to do next with these forms.

As for the landlords and employers, I'm just saying I don't care about their financial plight. The landlord isn't my patient. The patient is. It would be way beyond my scope of practice to contemplate whatever "systems" issues are involved in the landlord's reasoning for prohibiting dogs and the impact on the world economy that might occur if said landlord has to change that policy because too many psychiatrists fill out these forms. That's like asking me to think about the impact on the groundwater with each prescription for prozac that I think about writing.

We are experts when it comes to prozac although we cannot control an individual's behavior once they leave the office. We are not experts when it comes to pets. A better analogy is if you are prescribing prozac to someone because they tell you dumping it in the toilet makes them feel better and still not considering the impact on groundwater/public safety. It isn't just about the financial plight of the landlord/employer/business owner, you are harming or potentially harming the very person you are trying to help with no evidence that you are actually providing any benefit.

 

[nancysinatra]

In a negative sense, enabling is also used to describe dysfunctional behavior approaches that are intended to help resolve a specific problem but in fact may perpetuate or exacerbate the problem...from wikipedia but sounds about right.



We are experts when it comes to prozac although we cannot control an individual's behavior once they leave the office. We are not experts when it comes to pets. A better analogy is if you are prescribing prozac to someone because they tell you dumping it in the toilet makes them feel better and still not considering the impact on groundwater/public safety. It isn't just about the financial plight of the landlord/employer/business owner, you are harming or potentially harming the very person you are trying to help with no evidence that you are actually providing any benefit.

Ok but you could use that argument to deny everyone a therapy dog. So in your opinion, in what situations is a therapy dog a reasonable thing to support?

I know we're not experts in pet ownership. But we're not experts in physiology either but we "recommend" exercise all the time. Ok so next you will say, "clinical trials have shown that exercise is better than placebo." I confess I am not knowledgeable about the "literature" on therapy animals, but I doubt it's very highly evolved. I would assume that the jury is still out on that. There are so many variables.

All the requests I've gotten - and there have maybe been two or three in a year - were for therapy cats. This discussion has made a point of differentiating therapy dogs from service dogs. Service dogs, of course, are very specialized, highly trained, and indicated for certain things. Compared to them, therapy dogs seem kind of questionable. But see, if your patients are only requesting cats it's different. No one would ever argue that a cat is going to do much for a patient, because cats are not trainable. But they might help a bit. Same with rabbits or turtles or hedgehogs or whatever. So to the extent that I would "recommend a therapy animal" it's basically the same people to whom I would "recommend a pet." I don't "recommend a pet" to all my patients. I wouldn't sign the form for just anyone. But when I do sign the cat form, it's not neurosurgery.

 

[nancysinatra]

In a negative sense, enabling is also used to describe dysfunctional behavior approaches that are intended to help resolve a specific problem but in fact may perpetuate or exacerbate the problem...from wikipedia but sounds about right.

I guess I still don't get how people are jumping from "a therapy animal may not be right for all patients" to "all therapy animals enable dysfunction." Yes there will be cases like that, but some patients will respond to the responsibility entailed in owning a pet in a good way. And plus if people are going to argue that there is not clinical evidence supporting therapy animals, then if you intend to argue that therapy animals enable dysfunction, ok, where is the evidence for that? It's not enough to use anecdotal evidence to support one side of the debate, but demand clinical research results on the other side.