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Animals as Assistants in a Psychotherapy Practice - A Comprehensive View |
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Professional Practice |
By Patricia Pitta Ph.D, ABPP |
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Animal-Assisted Therapy and Activities: Possible Contributions from Practitioners Lynette A. Hart Ph.D., UC Center for Animal Alternatives, School of Veterinary Medicine University of California, Davis In the early 1980s, animal-assisted therapy grew in many towns and cities of the United States, through individual volunteers taking animals into facilities, usually nursing homes, to bring joy and comfort to the residents. Initially founded on the pioneering work of Levinson (1962) showing that an animal could act as a catalyst in a therapeutic setting, volunteers were inspired by their own anecdotes and the work of a few pioneering health professionals, and then by a growing number of graduate students who conducted their research projects in areas relating to animal-assisted therapy. This social movement of volunteers--animals brought in to visit nursing homes--was expressed at a local level in communities throughout the country and has been widely publicized. Gradually this practice has become more structured with support from some organizations and academic institutions. A growing body of research continues to evolve and recently has been summarized in a Handbook on Animal-Assisted Therapy (Fine, 2000a). New research literature can be accessed on the web by conducting live searches in complimentary bibliographic databases (UC Center for Animal Alternatives, 2001), providing convenient access. Delta Society has developed a certification program that systematically prepares the person and screens the animal to conduct animal-assisted activities. A national task force of scholars in the field is seeking to develop more formalized opportunities for people to study and gain qualifications in this area of work. The field remains young: animal-assisted therapy is rarely offered as a degree programs. Those seeking specific academic training in animal-assisted therapy usually must resort to a patchwork of courses. As it has evolved and is defined today, the practice of animal-assisted therapy presumes that the patient is somehow compromised medically, physically, or mentally, and can benefit from animal companionship. The therapy involves specific goals designed for a person by a health professional who incorporates an animal into the treatment process. Along the lines of traditional animal visitation to nursing homes, animal-assisted activities offer less structured, sporadic contact with animals. These visits may be provided by volunteers and usually are not overseen by a health professional and are not part of a general treatment plan. Since it is an emerging field, there are opportunities in every community for psychotherapists to get involved and contribute by: 1) incorporating animals into their clinical appointments, 2) assisting patients in acquiring animals as full-time supportive companions, or 3) working in an institutional setting to facilitate sporadic or full-time introduction of some animals into the facility. This paper describes some of the benefits and cautions to consider when incorporating animal-assisted therapy or activities. It then discusses these three areas where practitioners may help patients by the therapeutic introduction of animals. Potential Psychosocial Benefits of Exposure to Companion Animals: In a comprehensive review of incorporating animals in outpatient psychotherapy, Fine (2000b) discusses several reasons that clinicians may find animals therapeutically beneficial: as a social lubricant; for building rapport; as a catalyst for emotion; as an adjunct to the clinician; and for role modeling. These practical benefits may be useful to consider when reviewing four types of psychosocial effects of association with animals that are well-documented and reviewed below. Knowing and thinking about these effects can prepare the practitioner to incorporate animals creatively into situations where they could have a high likelihood of solving some patients= challenges. Comfort. Animals can offer meaningful comfort to people, especially those who are in crisis. For someone who is grieving or particularly vulnerable, the companionship of either a dog or cat can effectively stave off depression and loneliness. The positive effect of reduced loneliness when living with a companion dog or cat has been noted among elderly and college women who live alone and are not suffering any particular crisis (Goldmeier, 1986; Zasloff & Kidd, 1994). For someone who is elderly and has recently lost a spouse, the companionship of an animal could provide a comforting step away from depression and toward healing (Garrity, Stallones, Marx, & Johnson, 1989). People with a shrinking number of friends and in declining health due to AIDS can feel comforted with an animal=s companionship, especially a cat that requires less attention than a dog (Castelli, Hart, & Zasloff, 2001). Police officers benefit both in their working roles and at home from the companionship of their canines (Hart, Zasloff, Bryson, & Christensen, 2000). Social contact. In addition to providing companionship throughout the day, an animal elicits attention and social approaches from other people. Someone who is lonely or shy, or who has a disability that may inhibit social approaches from others, can enjoy a more normal level of social acceptance with the magnetic presence of a dog. While any furry animal attracts people, a dog has the advantage of being a companion that is easily and regularly taken out into the neighborhood. This socializing effect is one of the powerful consequences of acquiring a service dog for someone who has a hearing disability (Hart, Zasloff & Benfatto, 1996) or a person who uses a wheel chair (Eddy, Hart & Boltz, 1988). Motivation. Animals inspire their human partners to visit nursing homes, to take walks, and to nurture other creatures. This capability of animals to motivate us to consistently perform activities that we otherwise would not is remarkable, e.g., the volunteers who take animals into nursing homes regularly but would not visit alone. Elderly people who have dogs spend over an hour a day outdoors (Siegel, 1990) where they are more likely to socialize with neighbors. Similarly, people adopting a dog were found to sharply increase their daily walking, a pattern that was sustained over the ten months of the study (Serpell, 1991). Health effects. Having a companion dog is correlated with cardiovascular benefits, including transient reductions of blood pressure in the presence of the dog (Friedmann, Katcher, Thomas, Lynch, & Messent, 1983), improved survival following a heart attack (Friedmann, Katcher, Lynch, & Thomas, 1980; Friedmann & Thomas, 1995), and better triglyceride, cholesterol, and blood pressure levels (Anderson, Reid, & Jennings, 1992). Incorporating Animals in the Counseling Setting: Using animal-assisted therapy and animal-assisted activities to facilitate human recovery and health in clinical practice can offer great help to some patients. Initially, these activities were conducted primarily by volunteers as a method of bringing some enjoyment to people with protracted problems, such as those in long term care facilities. By the early 1980s, a few practitioners had already found that an animal could serve as a useful bridge for communication, relaxing both parties in the counseling environment. Practitioners today might reasonably question the value of complicating their work by adding an animal to the counseling setting. Recruiting the appropriate veterinary assistance for selecting and screening the animal may be inconvenient. Most practitioners lack an animal handler to introduce and remove the animal from the clinical setting at the right moment. Some clients do not like animals, or only like certain animals, or are allergic to certain animals. These are some of the real concerns that require consideration prior to beginning to get involved in offering or assisting with animal-assisted therapy. Animals often elicit strong emotional responses, for practitioners as well as clients. In most cases, it will be those practitioners who truly enjoy animals who are motivated to include animals within their practice. If making an animal available during a counseling session, the practitioner will need to consider how to have the animal conveniently at hand and also be able to sequester the animal away from the client if that becomes necessary. Addressing these practical considerations first is essential so that the practitioner and the clients remain comfortable, whether or not the animal is present. For the energetic and resourceful practitioner who truly enjoys animals and prepared to assume the additional effort, incorporating animals can increase the therapeutic effectiveness for dealing with some clients. By developing a capability and comfort level in incorporating animals into therapeutic settings, the practitioner may be able to extend practice into some new directions that had not previously been feasible, such as being more effective in working with certain clients or consulting in residential settings regarding the use of animals. Practitioners who are proficient in this regard can develop a niche practice in which they are recognized as being particularly effective (Pitta & Kirk, 2001). Selection of Clients and Animals for Full-time Companionship: Practitioners often may encounter patients who are isolated and lonely who could benefit from the socializing and motivating aspects of a full-time animal companion. Ideally, such a person would make a carefully considered decision in selecting an animal that is easily manageable and affordable, so as not to increase the patient=s stress and difficulties. This step requires that the patient assume responsibility for the animal full-time. Although a variety of benefits potentially can accrue from full-time animal companionship, adverse relationships with animals can be extremely stressful, just as with human companionship. If the dog becomes aggressive with family members, the cat is scratching the furniture, or the person can never leave home because of the animal, the resulting stress can quickly outweigh the benefits (even though the person may still love the animal). Thus, it becomes extremely important to stage the situation to be a positive one and to optimize the likelihood of success. The practitioner can assist the patient in thinking through the steps of selecting a pet that fits the lifestyle of the family and the implications of taking on the responsibility of caring for an animal. If selecting a dog, awareness of the behavioral predispositions of the breed and gender of the dog can help avoid problems (Hart & Hart, 1988). Planning for the care of the animal during absences is another consideration for the patient. For elderly or ill patients, concern about the animal=s care sometimes inhibits their willingness to have an animal. Pets Are Wonderful Support (PAWS) in San Francisco is an organization that provides practical assistance to people with AIDS from volunteers to assist with the animal=s care according to the clients= needs (Gorczyca, Fine, & Spain, 2000); it can serve as a model for communities seeking to improve support for elderly people wishing to keep pets. Another caution is that while an animal can provide valuable emotional support, it does not supplant human relationships. Some patients may need guidance in avoiding becoming excessively involved with their animals (Entin, 2001). Assisting Institutions: Residential farm, wild, and companion animals can serve as the centerpiece of therapy in an institutional environment, as demonstrated at Green Chimneys in Brewster, New York. The animals at this residential farm-hospital for children are the vehicle for initiating trust and therapeutic treatment for extremely disturbed children (Mallon, Ross, & Ross, 2000). Most institutions do not house residential animals, but many benefit from visitation programs, such as the hundreds of trained volunteers from the San Francisco Society for the Prevention of Cruelty to Animals (2001) who visit myriads of institutions each year upon request. By learning more about the programs used in these and other therapeutic facilities, practitioners can be more effective in providing expertise to the institutions in their vicinity, and can assist them in enhancing their programs. Conclusions: Practitioners are well-positioned to lend professional expertise in their communities and facilitate contact with companion animals for those patients who would benefit. By attending professional conferences, contacting effective programs utilizing animal-assisted therapy, and participating in workshops or short courses, practitioners can increase their effectiveness in adding animals as adjuncts in various therapeutic environments. References Anderson, W. P., Reid, C. M., & Jennings, G. L. (1992). Pet ownership and risk factors for cardiovascular disease. Medical Journal of Australia, 157, 298-301. Castelli, P., Hart, L. A., & Zasloff, R. L. (2001). Companion cats and the social support systems of men with AIDS. Psychological Reports, 89, 177-187. Eddy, J., Hart, L. A., & Boltz, R. P. (1988). The effects of service dogs on social acknowledgements of people in wheelchairs. Journal of Psychology, 122, 39-45. Entin, A. D. (2001). Pets in the family. Issues in Interdisciplinary Care, 3(3), 219-222. Fine, A. (Ed.) (2000a). Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice. New York: Academic Press. Fine, A. (2000b). Animals and therapists: incorporating animals in ooutpatient psychotherapy. In A. Fine (Ed.), Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice (pp. 179-211). New York: Academic Press. Friedmann, E., Katcher, A. H., Lynch, J. J., & Thomas, S. A. (1980). Animal companions and one-year survival of patients after discharge from a coronary unit. Public Health Reports, 95, 307-312. Friedmann, E., Katcher, A. H., Thomas, S. A., Lynch, J. J., & Messent, P. R. (1983). Social interaction and blood pressure: influence of animal companions. Journal of Nervous and Mental Disease, 171, 461-465. Friedmann, E., & Thomas, S. A. (1995). Pet ownership, social support, and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST). American Journal of Cardiology, 76, 1213-1217. Garrity, T. F., Stallones, L., Marx, M. B., & Johnson, T. P. (1989). Pet ownership and attachment as supportive factors in the health of the elderly. Anthrozoos, 3, 35-44. Goldmeier, J. (1986). Pets or people: another research note. Gerontologist, 26, 203-206. Gorczyca, K., Fine, A. H., & Spain, C. V. (2000). History, theory, and support services for people with Aids & other chronic/terminal illnesses. In A.Fine (Ed.), Handbook on Animal – Assisted Therapy: Theoretical Foundations & Guidelines for Practice (pp.254-302). New York: Academic Press. Hart, B. L., & Hart, L. A. (1988). The Perfect Puppy: How to Choose Your Dog by Its Behavior. New York: W. H. Freeman & Company. Hart, L. A. (2000). Methods, standards, guidelines, and considerations in selecting animals for animal-assisted therapy. Understanding animal behavior, species, and temperament as applied to interactions with specific populations. In A. Fine (Ed.), Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice (pp. 81-97). New York: Academic Press. Hart, L. A., Zasloff, R. L., & Benfatto, A. M. (1996). The socializing role of hearing dogs. Applied Animal Behavioural Science, 47,7-15. Hart, L. A., Zasloff, R. L., Bryson, S., & Christensen, S. L. (2000). The role of police dogs as companions and working partners. Psychological Reports, 86, 190-202. Levinson, B. (1962). The dog as co-therapist. Mental Hygiene, 45, 59-65. Mallon, G. P., Ross, S. B., Jr., & Ross, L. (2000). Designing and implementing animal-assisted therapy programs in health and mental health organizations. In A. Fine (Ed.), Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice (pp. 115-127). New York: Academic Press. San Francisco Society for the Prevention of Cruelty to Animals. (2001). http://www.sfspca.org/ Pitta, P., & Kirk, K. (2001). Pets as assistants in a psychotherapy practice – “ A niche practice”. Independent Practitioner, APA, Division 42, Spring, Vol. 21, No. 2. Serpell, J. (1991). Beneficial effects of pet ownership on some aspects of human health and behavior. Journal of the Royal Society of Medicine, 84, 717-720. Siegel, J. (1990). Stressful life events and use of physician services among the elderly: the moderating role of pet ownership. Journal of Personality and Social Psychology, 58, 1081-1086. UC Center for Animal Alternatives. (2001). http://www.vetmed.ucdavis.edu/Animal_Alternatives.main.htm Zasloff, R. L., & Kidd, A. H. (1994). Loneliness and pet ownership among single women. Psychological Reports, 75, 747-752. Therapy Surrounding the Human-Animal Bond Special Considerations for Guide Dog Teams Patricia N. Olson, DVM, PhD Introduction: Animals have been part of the human experience for thousands of years. In addition to providing people with companionship and health-promoting benefits, animals can have extraordinary significance to those who are blind or otherwise disabled. Conversely, when a human-animal bond is broken (e.g., death or retirement of a guide dog or service animal), severe loss and bereavement can be experienced by the handler or owner. Background: It is estimated that dogs became domesticated nearly 100,000 years ago1, and may have been instrumental in the very survival of the human species (alerting, protecting, and guarding). The role of companion animals in American society is seemingly increasing, with more pets now residing in family households than ever. According to the American Humane Association and the American Animal Hospital Association, 57% of American households own either a cat or dog; nine in ten pet owners surveyed say they consider their pet a member of the family; 63% of dog owners and 58% of cat owners surveyed said they give their pets presents at the holidays; 20% of both dog and cat households leave the TV, radio, or stereo on when the animals are left alone, presumably so they don’t get lonely. Further support for animals promoting the well being of human existence comes from results of scientific studies that suggest pet ownership may alleviate stressful life events. The physician utilization behavior of 938 Medicare enrollees in a health maintenance organization was followed for one year2. Those who owned pets reported fewer doctor contacts over the 1-year period than those who did not own pets. Similarly, in other studies, pet owners were reported to have a reduced risk of cardiovascular disease; lower systolic blood pressure, plasma cholesterol and triglyceride values; and increased one-year survival rates following discharge from coronary care units3,4. Allen and Blascovich have studied the value of dogs for those with disabilities5. Forty-eight individuals (24 matched pairs) with severe and chronic ambulatory disabilities requiring the use of wheelchairs were studied. Within each pair, participants were randomly assigned to receive a trained service dog or not. Psychologically, all participants receiving dogs showed substantial improvements in self-esteem, internal locus of control, and psychological well being within six months after receiving their service dog. Socially, all participants showed increases in community integration. Demographically, all participants showed increases in school attendance and/or part-time employment. Economically, all participants showed dramatic decreases in the number of both paid and unpaid assistance hours. Similarly, graduates from Guide Dogs for the Blind, the largest guide dog school in North America, often report that their guide dogs enhance social interaction with the public, including potential employers. Applicants receiving “successor” guide dogs have a higher rate of employment than first-time guide dog trainees. When dogs become an integral part of the human experience, their loss can be a significant life-challenging event. Most guide dog owners love their animals unequivocally. Death or retirement of the animal who “gave sight and freedom” can throw even seasoned guide dog users into feelings of loss and depression. According to work published by Cohen6, New York Animal Medical Center, there are nine themes which place people “at risk” for difficult grief experiences when a human-animal bond ceases to exist. These nine themes have special significance to guide dog users. Nine Themes for Increased Risk for Difficult Grief
Helping “at-risk” clients: Many persons with various disabilities seek counseling, often referred by a public agency serving people with similar needs; i.e. state agencies for the blind. These clients commonly present with feelings of hopelessness, low motivation, dependency, helplessness and generally a poor self-esteem. In addition, it is not unusual for these people to present with signs of clinical depression. Including an animal in their life may be a turning point for them. As the client and therapist consider the possible benefits that an animal might provide, it is imperative to consider the practicality of including an animal in the client’s life. If the client is already struggling with feeling overwhelmed, adding more responsibility may not be the best course of treatment. The financial cost of caring for an animal must also be discussed; food, grooming supplies and vet expenses can create stress on an already tight budget. Guide Dogs for the Blind provides assistance to it’s blind graduates with medical costs but requires that a person be able to handle the daily expenses of caring for a dog. In addition, a blind person accepted into training at Guide Dogs for the Blind will receive a fully trained guide dog, room and board while training with the dog, and transportation to the training facility at no charge. Including a guide dog in one’s life can provide more than a mobility aid to blind people. Having one of these beautiful animals by one’s side can provide a sense of enhanced pride and self-respect. As the team develops trust and closeness, issues of attachment can also be worked through. Lastly, as the therapist helps the client prepare for training with a service animal, mental and emotional stability is of the utmost importance. The training program is rigorous, which on completion can provide a tremendous sense of accomplishment. However, if the student is not able to complete the program many of their existing issues may be exacerbated and the bond with the dog, which begins forming immediately, is broken creating painful feelings of loss for the client. A well thought out choice to include an animal in one’s life can fill needs never thought possible. Many of the basic therapeutic techniques used to treat clients with issues of grief and loss are appropriate in working with a person who has lost a guide dog. Even though professionals are coming to realize the importance of animals in their clients’ lives, and the pain associated with losing a beloved pet, the issues surrounding the loss of a guide dog is magnified. The significance of this loss is more akin to the loss of a close family member or even a body part. Not only has this creature allowed the blind person to live with more dignity and confidence, but the time spent together is often more than spouses share daily, thus leaving a large empty space when the bond is broken. As with any client experiencing a major loss, signs of clinical depression should be watched for: change in sleep habits, change in appetite, poor concentration, feelings of isolation, and so on. These symptoms are naturally associated with grief and loss, however attention to the depth and duration of the symptoms should be considered. In addition, it is common for relationships with humans to suffer after the loss of a guide dog as the blind person directs the normal feelings of anger and irritability to those closest to them. Even though this is common, the client can be encouraged not to compound the loss by alienating those around them, after all these friends and family members are also likely feeling the loss. As the blind person comes closer to the time when they are beginning to consider a successor dog, Guide Dogs for the Blind has a licensed counselor available to take the person through the next steps. Having said all of this, practitioners know that there are always those people who appear to take a what we would consider a major loss in stride. It would seem that there is no prescribed way of grieving and a person should be allowed to follow their own path as long as it is not destructive to themselves or those around them. In conclusion, one might question whether developing such a strong human-animal partnership is worth the emotional risk for a blind person. Ask most guide dogs users this question, and they will unequivocally state “absolutely!”. The relationship between a blind person and guide dog is the “gold standard” for a human-animal bond, where two partners give to each other in extraordinary ways. The blind person has a new mobility freedom. The dog has human love and contact 24 hours a day. Although separation of partners may be difficult, both members of this incredible team would likely want it to happen all over again. And likely these wonderful relationships will continue, perhaps for many more thousands of years. Is your practice going to the dogs? Develop a Niche Market Alan D. Entin, Ph.D., ABPP Building a niche service that involves pets in the therapy process can boost your referrals in many unexpected ways. With the number of therapists competing in the marketplace, this niche has given me aspecialty that others do not have. People do not come to my office to talk about pet problems. However, the name recognition I have as a “petspert,” regularly fielding animal related questions, such as the role pets play in the family or how pets help reduce stress, for a variety of print and electronic media, has generated referrals for family psychology issues. The media component raises my visibility and credibility as an expert. Pets play a significant role in therapy dynamics. Understanding thehuman-animal companionship bond and the multiple roles the family pet may play in the emotional processes of the family, make it possible for the therapist to intervene more effectively in the family system to affect the growth and differentiation of the individual family members and the health of the companion animal. This paper will help independent practitioners refocus their currentefforts and activities to develop a niche market pet specialty that canhelp enhance name recognition and boost referrals. Animals are taking over. They’re the most popular subjects of photography, far exceeding family and friends, according to Eastman Kodak Company. Pets and the human-animal connection are consistently among the APA Public Affairs Office’s most requested subjects. The ubiquitous nature of thisrelationship is complex and indicative of the many roles that pets play in the emotional life of the family. It is why pets are most always seen asa member of the family. An estimated 58.2 million US households have at least one pet, according to a 1996 report by the American Veterinary Medical Association’s Center for Information Management. Dogs and Cats were the most popular pets, birds,rabbits, ferrets, guinea pigs, hamsters, gerbils, other rodents, turtles,snakes, lizards and fish have risen in popularity as well. Pets are an important part of the emotional life of the family. Decisions from when and how to introduce a pet into the family, what kind of pet to get, to questions about the role that a pet plays in the emotional life and relationship system of its members, from stabilizing shaky marriages to teaching young children about responsibilities and death, from preparing young couples for the transition to parenthood to issues about who will get the animal at the time of divorces, have frequently been the subject ofmedia scrutiny. More esoteric media inquiries raised issues about the useof pets in therapy sessions, such as dolphin therapy from the BBC, which I thought was making a bigger splash in the waiting rooms of therapist’s offices in Britain than America, to pet cloning. And, most articles tend to want to focus on the positive effects of pets in the family and do not want to deal with the negative aspects of pet ownership. While researchers may be “split on health benefits of pet ownership” (Schulze, 2000), conflicts over pets may mask deeper relationship problems (Entin, 1983b; Gavriele -Gold, 2000; Simon, 1982; Vogel, 2000). As a family psychologist, my experience with pets comes from my clinical experience: seeing individuals and families in therapy, discussing their emotional lives and relationships with their loved ones, both human and animal. I view the role of the companion animal in the family through the lens of Bowen family systems theory. The theory is a framework for organizing information about individuals, families and their relationships over time and space. The theory can be applied to a variety of problemsand symptoms in the treatment of individuals, couples and families (Bowen 1971, 1972, 1976, 1978). The Pet Focused Family Using the Bowen framework, Bradt and Moynihan (1971) have developed a model of a “child focused family”. They postulate that when there is excessive concern and preoccupation of parents which “supercede reality, self-functioning, responsibility to each other, to the extended family and to the community, the family is child focused” ( p.2). I believe that when such excessive concern and preoccupation is centered on a companion animal, then the family is “pet focused.” For example, it was just reported in Richmond that a 70-year-old woman had 70 cats, and one of the questions I was asked to comment on is “how many is excessive?” A New York Newsday article declared that “if you find yourself spending 90 percent of your disposable income on designer doggie duds or on gourmet chow to feed 15 cats, you could be one of those people who love pets too much” in defining a petaholics (Enrico, 1993, p. 20). Which, in the language of the late Chicago columnist Sidney Harris, becomes I pamper my pet, you love your cat, but him, he’s a petaholic! Since the dawn of creation animals have been involved in the lives ofhumans; however, only recently has the relationship been the subject ofpsychological inquiry. “Love and sometimes reverence for animals have occurred sporadically since the days of the ancient Egyptians, but in our culture only since Victorian times have animals been accepted as something more than the servants of humans” wrote Psychology Today (Horn and Meer, 1984, p. 60). Psychoanalyst Leonard Simon observes that “(T)his is one ofthose ideas that everyone seems to understand intuitively, but that no one has pursued in a systematic way . ... it is possible to reach conclusions about the most profound and intimate aspects of a person’s life when one looks at his specific relationship with his specific pet (Simon, 1983).” Anthropologist Jay Ruby suggests that in some ways, “pets and the role of snapshots in our lives are similar. They are both so common and ordinary that they are often overlooked as topics for ‘important’ research. They are part of the taken-for-granted of our everyday lives and they are almost invisible (1982).” I have found that information about the pets and photographs because “what is chosen by a family to be photographed, recorded and documented for the family photo album reflects the ideals, traditions and values of the family” (Entin, 1982, 1983). The important question is, what is the “something more” that pets represent in the psychological lives and relationships between pet owners and their animals? I hope that the use of family systems theory will help provide a way of thinking about these important issues. Bowen Family Systems Theory and Pets in the Family The concept of the “triangle” is essential to Bowen’s theoretical system. The triangle, a three-person system, is the “molecule” or building block of any emotional system, whether in a family or a social system. A two person system is an unstable system which immediately forms a series of interlocking triangles” (Bowen, 1971). Thus, triangles help understand the way in which three family members, or two family members and an issue, or apet, which takes on the emotional significance of a third person, relate to one another in an orderly series of alliances and rejections within the emotional life of the family. Triangles reflect definite relationship patterns that repeat predictably in periods of stress. In periods of calm, there is a close, comfortabletogetherness of two people and there is a less comfortable third person outsider. The preferred position is that of the insider. If tension builds in the twosome, one person becomes uncomfortable and initiates a move toward more comfortable togetherness for self, usually by bringing in a third person, or the pet. In periods of stress, each person works to get to an outside position, the preferredposition at that time, to escape the tension from the twosome by “letting the two of them fight it out”. “The calm or harmony in one relationship can be maintained by the conflict in another relationship” (Kerr, 1981, p. 242), which may be why many a frustrated worker comes home and “kicks the dog.” In one family, a woman stated that she and her husband were married in a formal ceremony and “we considered asking my husband’s 9 year old niece to be the flower girl, but we decided against it when we learned that another niece (age 13) felt left out. However, we did have my husband’s dog, Lady, in the ceremony as the ring bearer. Lady is 11 years old and my husband raised her from a pup. Everyone who knows us knows that my husband rarely goes anywhere without Lady. Our friends are still talking about how cute Lady looked trotting down the aisle with the ring box in her mouth. Now, nine months later, we receive this very upsetting letter from my sister-in-law telling us how badly we hurt them by using a dog in the ceremony instead of their daughter. We never promised that their daughter would be in the wedding, we only considered it briefly.” Advice for this particularly difficult triangle was sought from Dear Abby (December 28, 1982). In contrast, Ann Landers had a letter from a woman who “was an only child and envied my friends who had brothers and sisters because they always had ‘company,’ even though they fought a lot. My closest friend was ‘Fifi,’ a beautiful white toy poodle.” When she married she “asked her cousins to be the bridesmaids, but was stuck when it came to the ring-bearer. Suddenly it dawned on me - Fifi! … No bride ever had a more beautiful wedding”(July 15, 2000). Some of the signs that I look for to help determine the extent to which pets are “over focused” in the family include:
These vignettes highlight the extent to which pets become part of the emotional lives, and from a a clinical perspective, the triangles, in thefamily. Who are the people involved? How are they grouped?
When considering the role of the companion animal in the family, similar questions can be raised. Sometimes these triangles may even provide eerie clues about the future. One snapshot showed a lawyer hugging his two children tightly, at a distance from his wife. The dog was in an affectionate embrace with her. A few months later, to everyone’s shock, the “happy couple” split up. He won a legal battle for joint custody of the youngsters; the dog stayed with the wife (Brody, 1984). The question “who’s in the bedroom with you?” in the treatment of sexual problems in a marriage (Kaslow, 1979) usually elicits responses of extended family members, such as mother and/or father, present through their photographs, However, Ruby cites research reporting “650 of the animals sleep in their owners bedrooms and 450 of these sleep on the bed (1982). In this manner, again, the pet functions as a part of the triangle of the marriage and usually inhibits sexual activity. In these instances, the pets’ role in the family is to help the couple connect with each other, that is, they relate to each other through and about the animal, yet do not relate to each other in a person to person manner and so maintain their distance from each other. For example, when the dog slept in the bed between the couple, their lovemaking was limited by the presence of the dog. And, when the dog died suddenly, their distance and emptiness previously dealt with through avoidance and focusing on the dog rose to the foreground and the couple separated shortly thereafter. Differentiation of self is a concept describing people according to their tendency toward emotional fusion or togetherness with others versus their tendency to separate their thinking and feeling systems to take responsibility for themselves and their behavior. Since individuals choose others who function at the same level of emotional maturity for friends and marital partners, how does their choice of pets reflect their level of emotional differentiation? Even the disclaimer that “you do not choose a cat, a cat chooses you”, does not hold up since you are responsible for your part in allowing yourself to be chosen to adopt the cat. In one family, a woman took a “no self position” in relation to her husband, and altered the relationship between them by adopting a cat. Now, she opposes her husband, but only on behalf of her cats and not herself. The nuclear family process describes patterns used by parents to control the intensity of their emotional fusion and how this may be projected onto a child or children who then develop problems. What are the similarities between child focused and pet focused families who attempt to “solve” their problems by projecting it onto the child/ren or pets while thus attempting, as in any triangle, to live with the conflict and tension while avoiding change? As the family changes from a two-person system, husband and wife, to a three person system with the birth of the first child, the relationship between the spouses also changes. There are more triangles in the family. Similarly, with the birth of the second child. Previously established relationships are altered. What happens to these patterns as pets are introduced into the family? Or, if a single pet owner acquires a spouse? The characteristics of the processes between the introduction of a new child, sibling, or a pet appear similar; furthermore, differences in expectations and differential reactions to boys or girls may have implications for understanding differences in pet ownership, as between the personalities of those who choose a more affectionate and reliable animal as a pet and best friend compared with those who may choose a more independent , or less interactive companion animal. Typically, first born children are photographed more than later born children, and most photographs are taken while the children are relatively young and changing (Entin, 1980). Is there a parallel process with pets and their owners? The multigeneration transmission process posits how problems move across generations as parents transmit varying levels of undifferentiation or emotional immaturity to their children over multigenerations. It can also be projected onto the family pet, who in turn, may develop physical or emotional symptoms. Conclusion In my clinical work, emphasis is placed on family systems theory as an organizing framework to help individuals understand the part that each family member and their pets play in the relationship system and emotional life of the family. Although I have not focused on the many different benefits attributable to pet ownership, I think that although pets are seen as members of the family by pet owners, others tend to undervalue the contributions of pet ownership as contributing to the physical, social and emotional well being of their owners. I hope that this presentation has provided some framework to understand the role and functions of the pet in the family system. By understanding the human-animal companionship bond, and the multiple roles the family pet may play in the emotional process of the family, it may be possible for the therapist to intervene more effectively in the family system to effect the growth and differentiation of the individual family members and the health of the companion animal. For independent practitioners interested in adding pets to develop a niche practice, remember:
Bibliography American Veterinary Medical Association, 1931 North Meacham Road, Suite 100, Schaumburg, IL 60173. Bowen, M. Family and Family Group Therapy. Comprehensive Group Psychotherapy. Kaplan, H. and Sadock, B., eds., Baltimore: Williams and Wilkins, 1971. Bowen, M. Toward the Differentiation of a Self in One’s Own Family. Family Interaction - A Dialogue Between Family Researchers and Family Therapists. Framo, J., ed., New York: Springer Publishing Co., 1972. Bowen, M. Theory in the Practice of Psychotherapy. Family Therapy: Theory and Practice. Guerin, P., ed., New York: Gardner, 1976. Bowen, M. Family Therapy in Clinical Practice. New York: Aronson, 1978. Bradt, J. and Moynihan, C. Opening the Safe: A Study of Child FocusedFamilies. Systems - Therapy. Washington, D.C.: Georgetown Family Center, 1971, p. 1-24. Brody, J. Photos Speak Volumes About Relationships. The New York Times, Science Times, July 17,1984, C1. Entin, A.D. Photo Therapy: Family Albums and Multigenerational Portraits. Camera Lucida, 1980, Vol. 2, No. 2, p. 39 - 51. Entin, A.D., Family Icons: Photographs in Family Psychotherapy. The Newer Therapies: A Sourcebook. Abt, L. and Stuart, L., eds., New York: Van Nostrand, 1982, pp. 207-227. Entin, A.D. The Family Photo Album as Icon: Photographs in Family Psychotherapy. Phototherapy in Mental Health. Krauss, D. and Fryrear, J., eds., Springfield, Illinois: Charles C. Thomas, 1983 (a) pp. 209-232. Entin, A.D. Pets, Photos and Family Theory: Triangles in the Family, Paper presented at the 1983 Annual Convention of the American Psychological Association, Anaheim, California, August 27, 1983 (b). Enrico, D. Fixated on Fido. New York Newsday, February 6, 1993, p19 -21. Gavriele - Gold, J. When Pets Come Between Partners. Foster City, CA: Hopewell Book House, IDG Books, 2000. Horn, J. and Meer, J. The Pleasure of Their Company - A Report onPsychology Today’s Survey on Pets and People. Psychology Today, Vol. 18, No. 8, August, 1984, pp. 52-58. Kaslow, F. What Personal Photos Reveal About Marital Sex Conflicts. Journal of Marital and Sex Therapy. Vol. 5, No. 2., 1979. Kerr, H.E. Family Systems Theory and Therapy. Handbook of Family Therapy. Gurman, A. and Kniskern, D., eds., New York: Brunner/Mazel, 1981, pp. 226-264. Landers, A. Dear Ann Advice Column. Richmond Times Dispatch, July 15, 2000. Ruby, J. Images of the Family: The Symbolic Implications of AnimalPhotography, Phototherapy, Vol. III, No. 2, Summer, 1982, pp. 2-7. Schulze, A. Researchers split on Health Benefits of Pet Ownership. VetCentric.com, July 3, 2000. Simon, L. The Pet Trap: A Psychoanalyst’s Observation On Some Negative Effects of Pet Ownership on Family Relationships and Individual Growth. Paper presented at the Conference on The Human-Animal Bond, University of California, Irvine, June, 1983. To be published in the Conference proceedings (1984). Van Buren, A. Dear Abby Advice Column. Richmond Times Dispatch, December 28, 1982. Vogel, T. When the Kids Beg, “Can We Keep Him?” VetCentric.com, July 11, 2000. “Dogs Help Children Overcome Fears of Animals” By Patricia Pitta Ph.D., ABPP – Private Practice Manhasset , New York- Adjunct Professor – St. John’s University, New York Kevin Kirk- Binghamton University, New York Animals have been utilized to help people deal with both mental and physical challenges as far back as the 1700’s (Beck & Katcher, l996). An exact date has not be noted as to the use of animals to help people in distress, but if one looks to Greek mythology, Chiron-a centaur, or half man-half horse-was the first physician and the teacher of Aesculapius and could be considered the first “ Pet Therapist” (Beck & Katcher). In the 1700’s horses were used in therapy for a variety of diseases. In l792 the Society of Friends conducted a retreat that utilized rabbits, chickens, and other farm animals from which emotionally ill patients could learn self control by positive reinforcement. In l867, pets were part of treatment for epileptics at Bethel, in Biefeld, Germany. A well documented use of animals in the U.S. was reported by the American Red Cross in rehabilitating airmen at an Army Air Force Convolescent Center in Pawling, New York (l944-1945). In l966 Erlez Stordahl, established Bertostolen in Norway for the rehabilitation of the blind and those with disabilities. Dogs and horses were used to encourage patients to exercise. Patients learned to ski, ride horses and live more normal lives. Animals have been used as socializing agents with chronic psychiatric patients and autistic children. Animals have also been noted to help people with depression, loneliness and isolation (Mc Culloch, l978, l983). Animals are regularly used with the elderly to help manage their feelings of isolation and loneliness as they improve people’s feelings of self esteem and provide hope and interactions ( Fine, 2000). Pat Olson DVM, a veterinarian, is the director of Guide Dog Schools founded in l942 located in San Rafael, California and Oregon which trains blind and visually impaired people to use mobility dogs. In my practice I treat children, adolescents and their families. It became apparent that some children who are my patients have fears of animals and particularly fears of dogs. Their reasons for coming to therapy were depression, anxiety, obsessive compulsive disorders, conduct disorders, ADHD, ADD and oppositional behaviors. As a result of having animals available in my practice, their fear of animals became apparent. Through observation and familial history of children I am able to identify three causes for animal phobias:
These patients are not able to reap the calm and safety benefits that many patients are able to acquire when having animals present in the therapy setting (Pitta & Kirk, 2001). My approach to therapy is an integrative one (Healing Integrative Therapy©) which incorporates many schools of thought (systems, psycho-dynamic, behavioral, cognitive behavioral and communications theories) with the premise that understanding the individual’s problems and their underlying issues; and the connection between the individual’s issues and the system’s functioning is an effective way to help patients learn new perceptions, thinking and resolve their problems (Pitta, l996, l997, l998, l999). Phobias have been discussed and theorized by many schools of thought (psychoanalytic, behavioral, cognitive behavioral and psycho-biological approaches). One basic premise of overcoming phobias is to change the thought in order to change the experience (Beck & Emery, l985). Another approach is through the use of reciprocal inhibition – pairing a pleasant image or situation with the feared object-until the feared response is “de-conditioned” (Pavlov, l927). The person then learns a new response and cognitions change. Working with children in individual and family therapy models where their individual needs for safety, connection and working with intra-psychic and inter-systemic issues are paramount I hypothesized: Through appropriate modeling of behaviors with dogs by a animal handler and a therapist within the therapy process, the child would change his/her cognitions and learn less fearful behaviors in relationship to dogs and hopefully generalize to other animals. With the permission of the parents, I conducted with the assistance of an animal handler a 12 week program to help desensitize children’s fears particularly to dogs. As part of their treatment, the parents and I saw child’s reaction to dogs as symbolic of their view of the world as very threatening and non safe place. The hope being that if the child could become more comfortable around a non threatening dog there would be generalization to other animals and possibly seeing life through a less negative lens. Procedure: After discussing the process with the parent(s), the child was informed that the animal handler would sit in the waiting room with the child and the parent for 15 minutes before the therapy session would begin. The animal handler was instructed to hold the dog and demonstrate appropriate behaviors between dog and handler. At the same time, the handler would talk to the child and mother about whatever subject (as introduced by the parent or child). If the child or parent wanted to hold the dog or touch it, the handler would allow such touch. With the four children (ages 6 –a boy and girl; ages 7- 2 boys) that participated in this procedure there was a noticed differences in their demeanor in reaction to the dog (toy poodle) by the third session. Some children after appropriate parent modeling with the dog would begin to touch the animal. The handler modeled appropriate talking and touching the dog. He also had conversations with the dog. He demonstrated a positive emotional experience with the dog. At the sixth session, the handler was invited into the therapy room and would sit with the dog and continue to demonstrate positive interaction between the handler and the dog. At times, the dog was placed on the floor and if the child patient reacted in a non fearful manner, the animal would be left to roam in the therapy room. Invariably, by about the 2nd or 3rd session of the dog in the therapy room, the child usually would make some positive advance towards the animal. The therapist would also interact with the dog (eg. If playing a board game, the therapist would make a position for the dog. The dog would sit on the therapist’s lap and become part of the treatment). There would invariably be conversation between the patient and the therapist about the dog. The therapist asked the animal handler to leave if therapist felt the child could tolerate the dog without the handler’s presence. There were 12 contact (sessions) for the patient with the dog (six of the contacts were in the waiting room only-for 15 minutes before the sessions with the animal handler and parents; the last 6 contacts took place in the waiting room and therapy room combined). By the 4th session of the handler bringing the dog into the therapy room, the handler was dismissed within 10 minutes of the 45 minute session. The last 6 contacts were waiting room and therapy room combined. The handler met with the child and parent for twelve session in the waiting room before session for fifteen minutes. For the last 6 session, the handler was invited into the therapy room and asked to leave upon the therapist’s discretion. By the time the 12 sessions ( one per week) were completed, the dog was walking freely in the playroom and participating in interactions between patient and therapist. All children participating in these procedures demonstrated a decreased fear of animals. All children continued in therapy for their individual issues and it was noted by parents, therapist, and handler that patients fears diminished significantly. Parents reported that some children would not go to play at friend’s houses where there were pets. After this desensitization experience and therapy including the dog, the children were able to generalize their gains to larger dogs and other animals. This is a very small sample which needs to be reproduced in larger numbers. Many people in our audience at the APA presentation expressed a great deal of interest in this area. Maybe an interested student or psychologist could use this as a model and look at the efficiency of this process using larger numbers, anxiety standardized measures and statistical analyses. It is a well proven fact that animals help children deal with challenges (Levinson, l962) and what a distinct advantage to be able to have the benefits of animals assisting a therapist to provide a child a safer and calmer view of himself/herself and the world around them. References Beck, A. T., & Emery, G. (l985). Anxiety disorders and phobias: A cognitive perspective. Basic Books, New York. Beck, A., & Katcher, A. (l996). Between pets and people. Purdue University Press, West Lafayette, Indiana. Fine, A. (2000). Handbook on animal-assisted therapy. Academic Press, New York. Graham, B. (l999). Creature comforts. Prometheus Books, Amherst, New York. Jacobs, A. (l994). Freud and the interpretation of the wolf-Man dream1-A dog story. Contemporary Psychoanalysis, 30:845-854. Levinson, B. (l962). The dog as co-therapist. Mental Hygiene, 45, 59-65. McCulloch, M. (l981). The pet as prothesis-Defining criteria for the adjunctive use of companion animals in the treatment of medically ill, depressed patients. In Inter-relations Between People and Pets, edited by B. Fogle, 101-23. Springfield, Ill. Olson, P. (l999). Guide dog schools: a model for interdisciplinary collaboration. National Academies of Practice Forum October. Pavlov, I. P. (l927). Conditioned reflexes. Oxford Press, London. Pitta, P.(l996). Psychodynamic and systemic integration theory: application to the individual. Psychotherapy Bulletin, APA, Div. 29, Summer, Vol.31, No. 3. Pitta, P.(l996). Marital therapy - A search for the self and each other a systemic – psychodynamic integrated approach. Psychotherapy Bulletin, APA, Div. 29, Fall, Vol. 31, No. 4. Pitta, P.(l996). Family therapy treatment issues. Family therapy integration. Independent Practitioner, APA, Div.42, Summer, Vol. 6, No. 3. Pitta, P.(l996). Psychodynamic-systemic integration in family therapy. Family Matters, New York Association of Marriage and Family Therapy, Fall/Winter. Pitta, P.(l997). Marital therapy: a systemic psychodynamic integrated approach: a case study. Psychotherapy Bulletin, APA, Div. 29, Winter, Vol 32, No. 1. Pitta, P. (l999). Marital therapy niche guide. APA, Division 42. Pitta, P., & Kirk, K. (2001). Pets as assistants in a psychotherapy practice- “A niche practice”. Independent Practitioner, APA, Division 42, Spring, Vol.21, No. 2. Reflections of a “Animal Handler” Kevin Kirk Working within a psychotherapy practice, it is essential to read about how to handle, care for and work with animals and patients. This is accomplished by reading literature on this matter (Beck & Aaron, l996, Fine, 2000, Graham, 2000 The Delta Society (www.deltasociety.org, email: info@deltasociety.org), UC Center for Animal Alternatives, 2001 (http://www.vetmed.ucdavis.edu/ Animal_Alternatives.main.htm) and taking courses in animal handling offered by the Delta Society. I had the fortune to have a father who is a veterinarian who taught me how to handle, maintain, respect animals and to also in some form to “talk to the animals”. The physical and emotional well being and maintenance of the animals is an essential component to having an animal function appropriately within a psychotherapy practice (Fine, 2000). The animals must be fed, cleaned and cared for medically in a routine and responsible manner. Animals also need interaction on a daily basis to provide them with a nurturing environment that enables them to interact in a positive manner with humans. A handler needs to learn about the personality and temperament of the animal. In a psychotherapy practice animals that are calm and quite interactive seem to be the best fit for the children. One needs to also consider the safety of the animals. Animals should be protected from all abuse by patients and the animals should be given time to rest during the day. I would estimate that appropriate care of animals used within a psychotherapy practice would require a commitment of an hour a day per animal. It is recommended to take a course( one day workshop or a home study course) with the Delta Society which prepares one to apply AAT (animal assisted therapy) in an appropriate fashion to get desired results with patients. I know my situation was special having a father who could teach me about animals on a daily basis throughout my childhood. I worked with children and their parents who were coming to a psychologist by presenting the animals in the waiting room . Children could relate to the animals to calm their anxieties and could interact with me and the animals before going into a psychotherapy session . Children that were aggressive and who seemed quite agitated became quite calm when they interacted with the animals. Children who were more withdrawn felt comfort with animals would become more animated while waiting for the therapist. The animal interaction readied the children for the upcoming psychotherapy session. Rabbits and very calm dogs seemed to be the most therapeutic for children coming to see a psychologist. I also participated in a project with children who demonstrated fear of animals. With these patients I would sit in the waiting room and talk to the children and their parents while modeling appropriate interactions with animals. At times, upon the psychologist’s request (with permission of the child’s parents) I would join her and the child in the therapy room and model appropriate behaviors and teach the child how to interact with the animal within a playing environment. For the children who have fears of animals I initially brought a dog to the waiting room for 6 consecutive sessions which was followed by 6 consecutive sessions within the playroom (see “Dogs help children who have fear of animals”, Pitta & Kirk). It was a wonderful and satisfying experience for me to see the child’s fears diminish within 6-12 sessions and for some children their fear to totally diminish. What I realized was that the children were attaching to me and looking forward to seeing me with the animals. To be an animal handler means making a commitment to become educated to how to care, maintain and love the animals. Being consistent on a daily basis for maintaining an appropriate living and emotional environment for the animals is a necessity. References Beck, A., & Katcher, A. (l996) Between pets and people. Purdue University Press, West Lafayette, Indiana. Fine, A. (2000). Handbook on animal-assisted therapy. Academic Press, New York. Graham, B. (l999). Creature comforts. Prometheus Books, Amherst, New York. UC Center for Animals Alternatives.(2001) https://www.vetmed.ucdavis.edu/Animal_Alternatives.main.htm. Footnotes
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