I tend to take a broader view on the term therapy, especially when it’s offered in conjunction to primary treatment elements like med management and evidence-based psychotherapy and done with intention and care.
When this is offered as the only/primary recovery option, I become more skeptical.
As well as when something is just thrown together half-assed (think rec therapy where the rec therapist is playing an active role in helping to process emotions versus putting people in a room with crayons and coloring books for 45 mins and leaving).
Overall, I think one of the biggest benefits of things like equine or rec therapy is getting people more engaged with working on/experiencing their mental health, which doesn’t happen exclusively through meds and/or psychotherapy for many people. Or isn’t happening organically in more traditional forms of treatment.
But some of these people may be open to something like exposure through horses or art or something else, which can then be built upon in talk therapy so having it be on the table as a case by case decision process makes sense to me.
Agreed.
I tell myself that it should be clear WHAT I am claiming to offer AS MEDICAL TREATMENT vs. what I might suggest (or agree with) in terms of self-initiated behavior change that may--though not treatment, per se--be reasonably expected to be beneficial for the patient but is NOT something that I am initiating, providing, or 'prescribing' as a 'treatment' per se.
Depressed patients would benefit from exercise, a breakup of their depressive daily routines, and behavioral activation (as well as a little sunshine and vitamin D). If in the course of our therapy session, a patient decides to take up gardening and scheduling 30 mins of gardening three times per week, then this is consistent with a 'behavioral activation' process that may--as a process--constitute components of cognitive behavioral treatment for depression. As a therapist, I may suggest behavioral activation as a component (even, dare I say, an 'evidence-based' component) of psychotherapy for that condition. However, the choice to garden is the patient's. So, for instance, if the patient lived in a neighborhood whose HOA prohibited gardening, I would NOT write a letter 'prescribing' gardening as a 'medically necessary' intervention for their medical condition and, thereby, attempt to compel (intimidate?) the HOA into ignoring their rules and making an exception for the patient. The key treatment component is behavioral activation and could just as easily be implemented should the patient take up walking or woodworking or yoga.
This is why, for the veterans I see in therapy, I will NOT put anything in writing with any language to the effect that I am 'prescribing' a dog for any purpose or that anything is due to 'medical necessity.' If a local service (that trains service dogs) requires some 'paperwork' from a provider--since I don't wish to be a *barrier* to a veteran pursuing this avenue--then I will fill out the paperwork (including such info as diagnosis, how long he has been a client, etc.). Some of the answers I explicitly refuse to answer and clearly state why I refuse to answer them (e.g., 'I certify that this patient does not have a mental health condition that would impair his ability to properly care for a dog' or 'this patient is not taking any medications that would impair his ability to take care of a dog'). I have no problem *providing information* (that I can, in fact, straightforwardly provide) however state explicitly in writing that 'I am not prescribing an animal to treat/manage any condition' and I 'am not asserting it's 'medical necessity' (these are, apparently, the two components of the legal act of 'prescribing a service-/emotional support animal'). I generally ignore their little 'questionnaire' that they've typed up (complete with their own invented phrases and Likert scales for me to rate agreement with THEIR chosen phraseology and their 'checkboxes' or 'yes/no' horsecrap). Instead, I write my own letter explicitly saying what I AM SAYING, what I AM NOT SAYING, and my basis for SAYING or NOT SAYING certain things with reference to professional ethics, research, etc. pertaining to the practice of professional psychology.
I basically answer the questions (as to facts) and say that the veteran believes that he may benefit from having the animal and that I do not wish to be a barrier to that process.
I also explain (to the veteran, not in the letter) the potential iatrogenic effects of having the service animal on utilization of cognitive-behavioral techniques and processes generally found to be effective in treating PTSD according to the medical literature (i.e., exposure and cognitive restructuring)--mainly in the form of possibly serving as a barrier to full engagement in the CPT/PE protocols (but all of the veterans asking for this documentation and, on their own, pursuing a service dog through this process have already refused these protocols).
