Emotional Support Animals: The Therapist's Dilemma

Note - In 2021, in response to complaints about animals on planes, the Air Carrier Acess Act was modified. Presently, no American airline allows emotional support animals on their aircraft. The Fair Housing Act, however, does give people with psychiatric disorders the right to live with emotional support animals in no-pet housing. But, they must obtain a letter from a health professional indicating that the animal is needed for their owner to cope with the symptoms of their mental illness.

Hence, "the therapist's dilemma" remains a serious problem.

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July 19, 2016

I recently saw a woman try to sneak her little terrier onto an airplane. My wife and I were standing at the tail end of the line of passengers boarding a United Airlines flight out of Newark.

I wasn’t paying much attention to the woman ahead of me until I heard the gate attendant say, “Hey, is there a dog in that bag?” The woman said, “Oh, she’s my emotional support animal.” The gate attendant said, “I don’t think there are any emotional support animals approved for this flight. Please show me the letter from your doctor.” Then, I noticed a small “Emotional Support Dog” badge attached to her bag. It was a pet travel carrier disguised as a purse.

The woman whipped out a legal-looking piece of paper that I recognized as coming from one of the many online companies that sells phony certificates for service and support animals. These documents are a scam. In the United States, there is no federally recognized certification process for emotional support animals.

The gate attendant didn't buy the bogus certification papers. She informed the woman that according to United Airlines policy, travelers who request free air travel for emotional support animals are required to provide a letter from a mental health professional testifying that they need the animal to alleviate a recognized psychiatric disorder. Further, she needed to have notified the airline 48 hours in advance of the flight.

The gate attendant was insistent. “I will need to see your letter before you can get on the plane,” she said. The fake-support-dog-lady whimpered, “But the United Airlines gate person in San Francisco said I would not have any trouble getting my dog on this flight.”

Things were getting tense. Clearly, the gate attendant knew she was being gamed, but she was in a tough situation. Technically, she should follow the rules and not let the woman and her dog on the plane. However, making scene over a cute little assistance dog would not be good for the airline’s image. And the plane was ready to take off. Even so, I was hoping the gate attendant would stand her ground and refuse to let the woman and her dog board the plane.

That’s not what happened. The gate attendant rolled her eyes and told the woman to go ahead and take her dog on the aircraft. But she warned, “Now you know the rules. Don’t ever do this again.” Sure.

I had the feeling that the gate attendant had been through this routine many times before—as had the woman with the bogus support dog. Here is picture of the woman and her dog. I snapped it with my phone at the baggage claim after the airplane landed. I expect this scenario plays out every day in American airports.

The Fake Emotional Support Animal Problem

If you think you are seeing an increasing number of animals sporting “service dog,” “therapy dog,” or “emotional support animal” vests, you are right. Researchers from the University of California at Davis recently examined changes in the types of assistance dogs registered by animal control facilities in California between 2000 and 2002 and a decade later, from 2010 to 2012.

They found that the number of animals used for psychiatric services and emotional support had increased ten-fold, much faster than medical or mobility-trained assistance dogs (here).

Federal regulations governing the legal status of “emotional support animals” are particularly loosey-goosey. Unlike a “service dog,” an emotional support animal can be a member of any species, does not have to be trained to do anything, and can be your personal pet. But if you want your parrot or poodle officially recognized as an emotional support animal so you can score a free plane ride or access to no-pets housing, you have to be under treatment for a mental disorder. And you must obtain a letter from a physician or licensed mental health professional certifying the animal is necessary for your mental health or treatment for your psychiatric condition.

There are a couple of ways you can get one of these letters. The wrong way is to purchase it from a bogus outfit like CertaPet. I took their free initial screening which consisted of about 10 questions. The good news is that I was informed that I was an excellent candidate to have my cat Tilly certified as my emotional support animal. The bad news was I would have to pay $159 for the letter.

The right way, on the other hand, is to obtain an emotional support animal letter from the doctor or therapist who is treating you. A recent article, however, in the journal Professional Psychology: Research and Practice suggests that that therapists who provide emotional support animal letters for their patients are treading murky ethical waters. The lead author of the article was University of Missouri psychologist Jeffrey Younggren, past chair of the Ethics Committee of the American Psychological Association.

The Therapist’s Dilemma

Psychotherapists are increasingly being asked by their clients for letters that will allow their pets access to air travel and no-pets housing. Younggren and his colleagues argue these requests pose ethical issues for mental health professionals.

Emotional support animals are supposed to be part of a treatment program. However, the authors maintain that the therapeutic benefits of these animals are unclear. Despite media headlines extolling the curative powers of dolphins, dogs, horses and Guinea pigs, there is little evidence of the long-term effectiveness of emotional support animals for the treatment of mental problems. Indeed, it is possible that they can sometimes have an enabling function which actually prolongs an individual’s psychological issues.

The authors also argue that requests for emotional support animal letters pose a conflict of interest between therapist and patient. Younggren and his colleagues believe that the job of writing a letter that will entitle a patient’s pet for a year’s worth of free air travel requires an administrative determination that can actually interfere with the therapeutic process.

My friend Helen is a psychotherapist who has run into these problems. One of her clients was a 40-something business executive who traveled frequently as part of her job. The woman had recently acquired a small dog and asked Helen for an emotional support animal letter so her dog could accompany her on business trips.

As her client suffered from anxiety, Helen investigated the legal criteria for emotional support animals and for evidence that the presence of a dog would facilitate the therapeutic process. After examining the Federal guidelines, Helen was not convinced that taking the dog on business trips was a legitimate aspect of her client’s treatment plan. So she told the woman that she could not provide the letter. The client was quite unhappy with the decision. And Helen felt that she had been put in a difficult situation which could have resulted in serious conflict with her patient, and possibly, termination of therapy.

In order to avoid these types of conflicts of interests between therapists and their clients, Younggren suggests that clinicians refuse to write any emotional support letters for individuals under their direct care. Rather he maintains the determination of need for an emotional support animal should be made by a neutral third party professional—another trained clinician not involved in the patient’s treatment.

In the Real World, Things Get Complicated

This sounds like good advice. But as illustrated by another of Helen’s clients, sometimes you have to make exceptions. This client was a woman who was applying for acceptance into government subsidized housing. She was poor and had frequent epileptic seizures. She lived with her son who was severely disabled. She was depressed and she felt terribly isolated. And her best friend was a dog. While the apartment had a no-pets policy, the manager said he could make an exception if her therapist would provide a letter saying her dog qualified as an emotional support animal. This time Helen wrote the letter.

I was confused.

“Helen,” I asked, “Why did you write the letter for this woman but not for the business executive you were treating for anxiety?”

Her answer was simple. “Writing the letter was just the right thing to do. Her dog was her only link to the world. She had no other reason to live.”

Sounds right to me.

Post Script

Despite their conflict over the emotional support letter, the business executive continued her therapy sessions with Helen. Helen taught her a series of behavioral techniques including relaxation training and breathing exercises which enabled her to overcome flight anxiety. And the woman was ultimately glad that she did not have to bring her dog along for emotional support every time she boarded an airplane.