April 30, 2001 -- It's a beautiful spring day in Brewster, N.Y., and today Steven (not his real name) is learning a thing or two about relationships.
He's a boisterous 10-year-old boy who stands too close, speaks too loud, and doesn't have the foggiest clue when it comes to personal boundaries. This resident of Green Chimneys Children's Services, a state-based agency that combines life on a farm with schooling and counseling for kids in need, is participating in an innovative therapy approach known as animal-assisted therapy (AAT).
Steven charges at the donkeys in the pen, desperate to interact with them. They run. He tries again. They run.
Then his therapist suggests a new tactic -- try approaching the donkeys calmly, quietly, and slowly. It works. The donkeys stand while he happily strokes their muzzles.
The therapist praises Steven on his gentle manner and talks about body language. Steven may not know it, but he's working hard and learning a lot. Later, when he is ready, his therapist will help him see how these same social skills can help him improve his relationships with his peers and the other people in his life.
More Than 'Warm Fuzzies'
Animal-assisted therapy is more than just petting animals, says Patricia LaMana, CSW, a social worker at Green Chimneys. Unlike programs that provide what are known as animal assisted activities (AAA) in hospital and other settings, AAT interactions need to be goal directed, individualized to the patient, directed by a human health professional (like a therapist or social worker), and have documented progress.
"The warm fuzzies are definitely a place to start the work, but it goes way beyond that," says LaMana.
While the results of animal-assisted therapy are just beginning to be documented in the medical literature, those who work in the field use words like 'magical' and 'groundbreaking' to describe the results they are seeing. One of the largest organizations, Delta Society, says their Pet Partners program has over 4,000 human-animal teams in the U.S. and five other countries. The Delta teams provided over 600,000 hours of service, both AAT and AAA, in 2000.
Building a Safe Bridge
Why animal assisted therapy?
If a child has gone through some type of traumatic event -- like the death of a parent, a divorce or separation, or even sexual or physical abuse -- having an animal present can make the therapist, and the therapy process, seem much less threatening, says Ann Howie, ACSW, the founder of Human Animal Solutions and a longtime AAT advocate.
For example, the therapist can ask the child to tell the dog what happened, says Howie.
"Many times children will tell things to an animal that they don't feel comfortable telling an adult or a therapist," she says. "This provides a bridge for the therapist, who of course is in the room hearing the conversation."
Another approach may be to ask the child to draw his or her family, with each member represented by an animal. The therapist can then probe why certain members are certain animals.
"The goals of AAT remain the same as they would with another method, it's just that the technique is altered a bit," says Howie.
Group Therapy Gets a Companion
Animal-assisted therapy is not limited to one-on-one sessions. One AAT team that works in a group setting includes Jenny Hamilton, MS, who has been visiting hospitals with her dogs for 14 years, and her current AAT dog, a golden retriever named Poppy.
Once a month, Hamilton and a freshly washed, clipped, and brushed Poppy visit the psychiatric unit of Providence St. Vincent Hospital in Olympia, Wash., where they participate in a group therapy session led by a therapist. The group sits in a circle and Poppy is free to roam from person to person.
"Her fur is very soft, and I have noticed she has an incredible calming effect on people," Hamilton says.
When Hamilton's other AAT dog died last year, it provided the opportunity for the group to address the issues of grief and loss.
"Everyone in the group had a story they shared about the loss of an animal or person in their own life," she says. "It was very powerful."
In a pre-holiday session, the group focused on learning skills to help them get through the holiday season. With Poppy as a guide, the group practiced steady breathing. They focused on the feeling of calm they felt when with Poppy so that they could return to it in times of stress.
Making the Cut
Animal-assisted therapy doesn't appeal to everyone, says Howie. If a patient has an animal allergy or phobia, the therapist can always choose another method. And patients always have the right to refuse AAT if it does not appeal to them.
"There are people who don't respond to it. Usually they have no frame of reference, and aren't even curious about animals," she says. For these people, a different type of therapy would be a better fit.
And of course not every animal is a good candidate for AAT either, says Marie Suthers-McCabe, DVM, a veterinarian and associate professor of human companion animal interactions at the Virginia-Maryland Regional College of Veterinary Medicine in Addison, Va., and a Delta Society evaluator.
After stringent medical exams and basic obedience skills are mastered, the animals are tested on their reactions to things like walking in a crowd, being petted by many strangers at once, being clumsily hugged, and even their reaction to the sounds and smells of a hospital.
"The therapy animal has to not only tolerate these things, but enjoy them," McCabe says. The concern for the animal's well being is paramount, and McCabe stresses that these animals have to have an aptitude and fondness for the work.
"Handlers need to know their animals well enough to know when it is starting to stress them out. You don't want to do it to the detriment of the animal," she says.
Popularity Breeds Caution
Martha Brewer, the volunteer director of the animal-assisted therapy program at Winchester Medical Center in Winchester, Va., is a firm believer in AAT. But she is also concerned that some hospital administrators, eager to have AAT programs at their facility, may be letting inappropriate animals through the doors.
"There is a great need for a national organization to say, 'These are the standards that must be met' and we don't have that yet," she says. "One of the concerns we have is that any incident that happens as a result of that, even if it isn't an AAT animal, is going to reflect negatively on all of us," says Brewer.
Patients and their families can protect themselves by asking what type of training and evaluation the animal and handler have undergone. They can also inquire how much experience and training the therapist has with AAT, says Brewer.
The Power of Positive Reinforcement
Linda Lyons, MSW, LICSW, a clinical social worker who works as part of an AAT team from Mercy Hospital Medical Center, utilizes appropriate animals at the Forest Park Zoo in Springfield, Mass., to reach special-needs kids. She has seen children with ADHD and oppositional defiant disorder -- some of whom can barely sit still or follow directions for five minutes -- sit calmly and wait their turn to hold an animal during the weekly one-hour get-together.
Over the 6-8-week course they are learning a lot about taking turns, patience, how to work with others, and how to control their impulses, along with other specific therapy objectives.
"It's an amazing achievement for them," she says. "And of course we want to find ways to have those skills transfer to their lives outside the group. A lot of it depends on the ability of the family to follow through on the progress they are making," she says.
Howie says one way to do so may be to involve the entire family in AAT. One such program involves the use of clicker training, a positive reinforcement training method that focuses on what the dog does right rather than what the dog does wrong.
"The entire family learns a whole new way to manipulate behavior," she says. The hope is that after the families go home, they retain the knowledge of how to motivate good behavior through positive means rather than through punishment. Initial results appear promising.
For now, those involved in AAT will continue to move toward publishing research and further documenting the benefits of this approach.
"Animal-assisted therapy is gaining acceptance, but it is still somewhat out of the box," says Lyons. "The next step is to educate people and help them understand that it is more than just petting animals -- it's therapy."
Michele Bloomquist is a freelance writer based in Brush Prairie, Wash. She writes frequently about consumer health.