Please Keep Your Emotional Support Iguana Off My Couch

Psychotherapists can support patients without inviting animals onto the couch.

Posted Jan 19, 2018

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Ever been in a store or an office, and seen someone with a dog wearing a little vest? Have you wondered, like I do, “Is that a REAL service animal?” It’s become increasingly difficult to tell these days, and in some cases, the boundaries are being pushed well beyond the needs envisioned when the Americans with Disabilities Act (ADA) was enacted.

I was in college when the ADA was passed. In fact, I was once on CNN with Vice President Al Gore and Tom Harkin, as the Act was enacted. As a man with a disability, I considered it a proud and momentous day. The ADA forced us as a society to make our country more accessible for persons with disabilities. Some aspects of this accommodation force inconvenience and even costs on people and businesses, in order to ease the participation of disabled persons in society. One of the most significant provisions of the ADA however, has led to unforeseen consequences, with protections which may not be real accommodations.

The ADA specifically protected those with disabilities who utilize specially trained service animals, to accommodate their special needs. So, people with visual impairments use “seeing eye dogs” as guides, and people with mobility impairments may have the help of dogs trained to retrieve items for them. The original ADA was quite broad in this language, and this where the problems started. Because the ADA when first passed didn’t set clear parameters about how to clarify what was a qualified service animal or not, people began to exploit loopholes in the law.

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In 2010, the ADA was revised, to clarify these requirements. Under the current ADA, only animals which have been specially trained to perform a specific task for a person with a disability may qualify as a service animal. Under current law, service animals cannot be outright banned. Owners and operators of public establishments may inquire if an animal has been trained, and what specific function the animal has been trained to perform. This gets complicated however, when the issue of “emotional support” or therapy animals is raised. A good description of the differences between service animals and emotional support animals can be found on this disability rights site. Numerous recent events have focused on people, such as veterans, upset when they and their pets aren't allowed in public establishments.

At my agency, we started seeing people bringing these animals to our offices a few years ago. Sometimes the dogs wore these nifty little vests that you can buy online, and owners had certificates they had printed out off the Internet, which proclaimed the animal “officially protected.” Then, pet owners even started bringing in letters from other therapists, saying the dog served a therapeutic purpose and should be allowed.

The problems I encountered began to multiply, unfortunately. I had other patients who were highly allergic to animals. Sometimes the pets misbehaved or even growled at other patrons and patients. Sometimes they left messes. I was once in an elevator with a patient who we had made an exception for, to bring her emotional support dog to group therapy. But the dog she had with her that night wasn’t the one we’d approved. “I just thought the people in group would like to meet my other dog today!” she responded, when I asked.

As we started to try to set limits, we encountered unbelievable levels of resistance. One woman tried to sneak her dog into the offices in a baby carriage. Another patient once told me, “If you don’t want my dog, then you don’t want me – we are one.” My staff and therapists were trying to be caring, empathic and supportive. These patients weren’t being malicious or intentionally duplicitous. But, therapists working with them struggled to balance supportive empathy and still respect the rights and needs of other patients.

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Psychiatric service dogs are animals trained to perform a specific function, such as reminding a person to take their medications, or even stop someone from engaging in self-harming behaviors. But, the role, training and effectiveness of dogs for psychiatric issues is still a developing issue: the US Veteran's Affairs Administration covers costs for service animals for physical disabilities, but not for things like PTSD, arguing that the value in these cases hasn't been proven. Being loving, loyal and cuddly is a wonderful component of many dogs and pets. It’s why we love them, and have made them part of our lives for thousands of years. But, being a loving pet is not a qualification of being a legal accommodation for a disability.

Emotional support animals, sometimes called "comfort animals",  are not actually protected under law, except in air travel and certain public housing. Just recently, airlines began pursuing increased restrictions on these regulations, in response to concerns that passengers are using emotional support status as a way to avoid paying freight charges for their pets. Delta Airlines has now issued rules requiring vaccinations, 48-hour notice, and a letter confirming that the animal can behave on a plane. Who writes such a letter? It's certainly not in my scope of practice as a psychologist to assess the behavior of an animal other than humans. 

There is no training or certification of such animals, which typically help a patient to feel better, especially in stressful or challenging situations. Unfortunately, the legal distinctions between trained service animals and “emotional support animals” are sometimes lost on people whose therapist has given them a letter saying that they should be allowed to have the animal due to the therapeutic comfort the person gains from having the pet with them. In comparison, service animals such as seeing eye dogs go through rigorous training that last for years, and for which many animals are not suited. Sadly, people who rely on service animals under the ADA may suffer the most, as they are impacted by these increasing restrictions. 

Therapists who write such letters rarely understand the nuances and complexities of these laws or requirements. They don’t understand that drafting the letter actually serves a legal purpose, that they are attesting to the person having a legal disability, and asserting that the animal is required as an accommodation for this disability. Defending this determination in court could be a challenge, if the therapist is called upon to explain their decision and the ways they reached this opinion. If the animal harms someone, the therapist who attested to the animal’s role as a necessary accommodation could face liability charges and accusations of malpractice. Regardless of the therapist’s positive intent, such determinations are best left to those who are expert and informed about the relevant policy, laws and requirements.

“Therapy animals” are a whole separate, but related issue. Therapy animals are a trend that started a few years ago, again with dogs, often in therapeutic inpatient settings, where a “unit dog” was a way to make the environment more like a home. Some dogs undergo special training to be certified as “therapy dogs,” learning how to offer support to individuals in distress and in therapy. Sadly, I’ve seen countless therapists across the country take advantage of this, and use it as a way to have their own pet with them during the day. Often uncertified, these animals in a therapy situation raise special issues of consent and hygiene. Do these therapists get special consent from their patients, acknowledging the presence of the animal, giving ways to request the animal not be included, and addressing issues of allergies? Often not, in my experience. I have seen a rising number of licensing complaints across the country, related to hygiene issues involving these animals’ presence in therapy offices.

Pets and animals DO help people. They do have demonstrable, powerful calming and soothing effects on people. That is the wonderful thing about them. Unfortunately, for a variety of reasons, we must as a society limit the animals allowed in public spaces, in order to make these spaces most friendly to the greatest amount of humans possible.

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Therapists can best help patients who request emotional support animals by helping the patient to develop alternative soothing and calming strategies. I’ve encouraged therapists to consider meeting the patient outside our offices if the animal seems truly needed, but to help the patient work towards coming to the office without the pet. The treatment plan should then address strategies designed to facilitate the growth of other ways to achieve calming and self-soothing. Sometimes, the supportive animal may serve as a form of a transitional object. As such, the patient may be assisted by exploring other ways to gather such soothing to them – I’ve had patients bring things like stuffed animals to therapy, to help them get through that challenging period when they begin leaving their pets at home.

Ultimately, that’s our job as a therapist – not to certify that a patient shall forevermore need this animal to be calm. Instead, our task is to help people learn and develop the skills and resources needed to move forth in life, successfully, and with a flexible range of strategies, including our pets, to respond to and manage difficult situations. If we as a therapist encourage a person to over rely on a single coping strategy, then we are often doing our patient a gross disservice.

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Our agency once had a patient bring his “emotional support iguana” to a group therapy program. The man then chased people around with the iguana, which was in fact quite distressed by the experience. I suspect the poor animal thereafter saw a therapist and requested an “emotional support human.” Having the iguana was a social thing, an attentional thing, even a therapeutic thing for a man who wanted to share something of his life and family with his professional and peer support group. Unfortunately, these benefits don’t automatically override the law, rights of others, nor do they automatically garner the stamp of “therapeutically-approved.” Otherwise we can easily end up with people carrying around their "comfort cobras." Until laws are changed, and research progresses to better clarify the role and function of supportive animals, patients who request emotional support animals deserve effective clinical support to develop the skills they can use to cope with life and the world, when they cannot have their pets with them.