The value of animal-assisted psychotherapy: A gateway to connection and healing

An animal’s eyes have the power to speak a great language.
                                                                                   (Martin Buber, 1923)

Humans have an inherent need to connect, to communicate and to feel heard. Trauma and suffering are an inevitable part of life and a human experience. When there is trauma, existential distress, relational or behavioural difficulties – whether they are physical, emotional, cognitive, sexual or spiritual – there may be a breakdown in communication, at least verbally. For some, particularly those in emotional distress, the presence of an animal appears to have an immediate calming effect, an inexplicable affinity and a sense of grounding perhaps with an echo of a healing ancestral presence or even a preverbal healing space. Animals can ground humans in the present, as an animal by nature does not fret over the past or worry about the future, but is firmly in the moment. In order to enhance therapeutic outcome, animals such as dogs, horses and farm animals are being incorporated into environments such as private counselling settings, occupational care farms, equine centres, and psychiatric hospitals. This is known as Animal-Assisted Therapy (AAT).

Many of us may be familiar with pet therapy; dogs or puppies being brought into care homes for the elderly or into universities for students during exam time as a means to alleviate stress and increase a sense of wellbeing. Animal-Assisted Therapy, however, is quite different. In order to attempt to define what Animal-Assisted Therapy is exactly, I looked to the most established and most often quoted organisation which is Pet Partners in America. They see animal-assisted intervention (AAI) as an umbrella term encompassing animal-assisted activities (AAA) which promote recreational, educational and motivational opportunities to improve the quality of life in a general way. Animal-Assisted Therapy (AAT) differs as it is a goal orientated intervention in which a selected and trained animal is an integral part of a treatment process and is directed by a fully qualified professional (Pet Partners, 2014). AAT can be any form of work with any age group or ability in the presence of an animal that is therapeutic or healing. Different types of animals can be present and involved in AAT, most commonly dogs and horses (Chandler, 2001).

In relation to AAT, Sigmund Freud himself was the first to attribute significance to a dog in a therapy room. Freud sometimes had his dog Jofi in the therapy room with him, at first for his own comfort, but then noticed that the dog picked up on the mental state of his patients. For example, if his patient was experiencing anxiety, the dog would stay at a distance, perhaps sensing their need for personal space, but move closer if the patient was depressed or upset and sensing their need for comfort (Emmens, 2007). Anna Freud cites her father as saying that “dogs love their friends and bite their enemies, in contrast to men who are incapable of pure love and must at times mix love and hate in their object relations” (Braitman, 2014: 1).

Attachment theory – a framework for AAT
Relationships bring meaning to people’s lives and are core to human survival, sustenance and fulfilment. John Bowlby’s attachment theory is highlighted as a significant theoretical framework for AAT (Parish-Plass, 2013).

Bowlby’s attachment theory (1973, 1980, 1982), is based on the premise that the early experiences of a child and their primary caregiver, shapes the brain and later adult relationship patterns. From these preliminary experiences in early human life an Internal Working Model (IWM) or mental representation of relationship is set up. Consisting of a model of self, a model of the caregiver (usually the mother) and a model of relationship, the IWM may have an impact on future mental health, relationships and social responsiveness. When a child is ready to explore the world as a toddler, what’s known as a secure base can facilitate this so that the child can separate, without the fear of feeling totally alone. Bowlby emphasised that being alone is one of the great fears of human life. One of the aims of therapy is to provide a safe environment and a secure base in order for a client to explore their inner and outer worlds; through the therapeutic relationship, the material that stirs in the here and now can then be processed and may lead to transformative healing (Bowlby, 2005).

With Bowlby’s theory in mind, the IWM appears to be vital in how we experience the world and relate to self and others. Issues brought to therapy vary greatly but some may be traced back to the IWM. Bringing a dog into the therapy room may act as a stimulus in the here and now which activates senses and feelings that otherwise may not be brought to the fore (Parish- Plass, 2013). This unconscious way of being, having been set up from a pre-verbal stage of human development, may be deeply difficult to reach and to facilitate significant change.

Nancy Parish-Plass, a leader in the field of AAT, suggests that the senses such as touch may reach these underlying emotions. Touch can bring up strong emotions and memories which sometimes cannot be reflected on by the patient and expressed in words, just felt – “when memories of past experiences cannot be mentalized, they can be felt, because touch is much more basic, coming from a more primitive place” (Parish-Plass, 2013: 24). Touch is a basic need and a social experience. A dog in a therapy setting may provide both and aid in reducing anxiety, facilitating a client to open up. The presence of an animal and a psychotherapist during AAT can help with emotional expression for the client and possible emotive re-experiencing resulting in changes to the IWM. This connection in the here and now is one aspect that enables AAT to be powerfully integrated into the therapeutic process.

The presence of the dog can provide the therapist with a multifaceted and rich context in which to work with their client (Parish-Plass, 2013). Two vignettes follow to showcase how it is possible to facilitate processing of strong and sometimes overwhelming feelings of sadness with AAT. The first vignette is from an interview in my thesis on Animal- Assisted Logotherapy (Sutton, 2015). It relates to a dog in a private psychotherapy setting with a client who was attending due to relationship difficulties with his wife. According to the interviewee the client had told his ‘story’ and background during the first session. As the therapy dog is never present during the first session, the client was then asked if he would like the dog to be present for the next session and he agreed. During the first session the client had become extremely emotional, was crying and overwhelmed. During the second session the dog was present and the client spent time stroking her throughout as he talked about his difficulties, emotions and challenges. This almost ‘poured’ out of him and while he stroked the dog, he didn’t cry. At the end of the session he said ‘thank you for letting the dog be here in the session.’ It was clear that it was important to the client not to cry and that by stroking the dog he had been able to channel his overwhelming emotions and talk through them exploring them more. For this client, being able to contain his overwhelming emotions by having the calming effect of the dog present, allowed him to slow down and connect to his inner thoughts and feelings.

The animal can represent unconditional acceptance, interaction and nurturance. Indeed, a comment in my thesis by one of the psychotherapists who works professionally with teenagers re-iterated this as she explained how having an animal present adds another dimension to the work: sessions are additionally relaxed and informal and clients seem to open up more often when an animal is present. The participant stated that the female adolescent who was grieving the loss of her father was becoming overwhelmed as she spoke of her loss. As the teenager talked, she became more distressed and with this her breathing changed. As this was happening, the dog spontaneously moved from the other side of the room towards her. He gently lay his head on the adolescent’s lap and looked into her eyes as if sensing her need for comfort. The therapist stated that “having the dog present definitely helped this girl to access and express her deep grief in a way I do not think she would have done if I had not incorporated Animal-Assisted Therapy into her sessions” (Sutton, 2015).

Shared biology with animals – a kinship in life!
Dr Jaak Panksepp, the behavioural neuroscientist who has spent over 50 years doing research into affective neuroscience, explains that we hold the same survival instincts that animals do by sharing the reptilian or bottom part of our brain (Panksepp, 2014). This affects our emotions and is fundamental to our everyday living. Emotional affect is actually anticipating the future by learning and through memory. We share these affective emotional processes with animals. Panksepp emphasises that “without emotions, we are empty of values” and that “feelings support survival for humans and for animals”. According to Panksepp “if we try to understand the feelings of animals neurologically, maybe we can begin to understand human emotions at a deeper level”(ibid, 2014). Panksepp highlights that touch alleviates psychological pain, as it activates brain opioids through the hormone oxytocin. Additionally, separation anxiety is neurologically comparable for animals and humans when levels of opioids drop with physical distance (ibid, 2014).

Mirror neurons are also something that humans and animals appear to share (Cozolino, 2010). Mirror neurons are motor cells in the brain that fire when performing any movement or action and will fire in an identical way while watching someone else do the equivalent action. These mirror neurons form our ability to empathise, to learn new skills and activate automatic behaviour. They are also responsible for our capacity to attune on an emotional level with others. Mirror neurons are fundamental elements to developing the social or right side of the brain. Re-iterated by Dr. Christian Jarrett, a cognitive neuroscientist, he has also suggested that mirror neurons may indicate a scientific reason for empathy among humans (Jarrett, 2013). This research however is in its infancy and is extremely complex; in addition there are many levels to mirror neurons which are not fully understood. Nonetheless, it does point to a possible bridge to the connection between humans and animals (Jarrett, 2013). Dr Louis Cozolino, a prominent American professor of psychology, states that mirror neurons “are a royal road to interpersonal implicit memory”(Cozolino, 2010: 19) which is important to note and a key connection we seem to share with animals. In other words, memories and perceptions created in our social or right side of our brain can be stored in our body implicitly, as well as in our conscious awareness. Talk therapy may in some cases be limited, as memories can be embodied suggesting that sometimes interventions involving movement or action may be considerably more powerful.

Autism Spectrum Disorder (ASD) – finding a motivation to connect
Why these biological connections are important is highlighted by another two findings (Sutton, 2015) in relation to how meaning and the motivation to communicate can make all the difference. Firstly, in an occupational care farm designed to facilitate education and occupational therapy for children, a four-year old boy with Autism Spectrum Disorder (ASD) attended under the guidance of an occupational therapist for six months. The boy found it hard to concentrate and use language and struggled with motor skills. His goals included: increase language development, grading the forcefulness of his movements, and improving his concentration and attention (he had a very short attention span). He lived in the city, had no experience of pets and was initially quite rough with the animals, pulling at them without realising how this would feel for the animal. The boy soon noticed that when they were in the field or stables, the animals would run up towards the therapist but not to him and he became very impatient. This seemed to give the boy the motivation or incentive to learn about the animals so that he could have a similar connection with them – a connection he noticed the therapist had. The therapist spent time explaining, through social storybooks she had written, why it was important to be kind to animals. Week after week the boy followed her cues with the animals. He began to take his time petting the animals, talking to them and being really gentle with them. Although this was a learned behaviour and not something that was natural to him, the motivational process behind these improved interactions indicated the presence of a bond. This child demonstrated the ability to stroke an animal gently for more than five minutes. It appeared that it was the value and meaning he found in wanting to connect with and learn about the animals that proved to be his main motivation. In the process, the animal helped the therapist and the parents to understand his potential to reach his goals.

The second vignette from my research entailed a 12 year-old boy with ASD who came to a therapeutic equine centre. His behavioural issues were becoming unmanageable by his parents at home and within his classroom environment he was getting involved in fights. He was very unwilling to undertake any tasks asked of him. His speech was incoherent and he appeared to his parents to be angry and frustrated. Initially, the boy was nervous about animals. However, with patience, instruction and time he mastered how to use his body language and voice in order to get the horses to respond and take instruction from him. This enabled him to increase his confidence, improve his relationships and have more focused communication with the horses and in turn others. From a physical perspective, he even began to stand taller, prouder and could give and hold more eye contact. He became fitter and undertook any task asked of him with enthusiasm. The animal-assisted approach worked for this particular boy and he was re-integrated into his school environment having learned a whole new approach to communication. This made for a more progressive schooling and better relationships at home.

Working with animals – contra-indications
Many aspects of animal-assisted therapy and interventions have been found to make a difference in therapy however there are contra-indications and ethical issues to be aware of. Not every person will be an animal lover and some may even have a phobia of animals. Adequate screening for potential therapeutic work with an animal would be imperative. Issues such as allergies, fears, or a history of animal abuse, must be assessed. In relation to the animal, all vaccinations and satisfactory training must be in place. The chosen setting needs to be well prepared and approved with high standards of hygiene and safety ensured. The well- being of the animal would include a duty of care by the therapist or handler to ensure that the animal does not become stressed or overworked, “for the therapist must be equally attentive toward the rights, safety, and emotional and physical welfare of both client and animal” (Parish-Plass, 2013: 24). It is also paramount that zoonoses or the transmitting of disease from animal to human such as viruses or parasites should be at the forefront of awareness when implementing any type of animal-assisted therapy programme (Hatch, 2007).

The animal must have the right temperament for this work, be well-behaved and obedient (Chandler, 2001). A nervous, aggressive or unresponsive animal would certainly not be considered as part of the therapy. Highlighted in a paper by psychologist and animal trainer Dr Wycoff, a mismatch of an unsuitable animal in a therapy setting could pose potential dangers (Wycoff, 2014). Examples include a ‘therapy dog’ who growls at clients when greeting them with the therapist failing to see this behaviour as a problem. Or the ‘comfort canine’ dog who accompanies a handler to disaster sites who gets anxious and overwhelmed by the experience (Wycoff, 2014). Matching the handler with a suitable dog is crucial for the animal and to maximise the therapeutic benefit for the recipients of the animal-assisted interventions.

Psychiatric care – incentive to come out of isolation
Patients in psychiatric care can also benefit from contact with animals, as shown in the following selected statistics and studies.

Cynthia Chandler, a prominent professor in America who is a leader in this work of AAT (Odendaal, 2000), states that psychophysiological health can be enhanced by positive human-animal interaction and important physiological changes were found, specifically, a reduction in blood pressure and the stress hormone, cortisol. Consequentially these human- animal interactions are shown to increase dopamine, endorphins and oxytocin levels which are well known neurochemicals affecting the body and mind creating a great sense of well- being. Oxytocin is the hormone found in the body when human and animal mothers bond with their offspring or when humans are in a loving relationship (Chandler, 2011).

Sound theoretical research was conducted to gain medical support for AAT, by scientifically measured physiological parameters:

Six neurochemicals associated with a decrease in blood pressure were measured in humans (n=18) and dogs (n=18) before and after positive interaction. Results (P<.05) indicated that in both species the neurochemicals involved with attention-seeking behavior have increased,
                                                                                    (Odendaal, 2000: 1)

These results can be used as a rationale for animal-assisted therapy (Odendaal 2000). Furthermore, on the topic of ‘corrosive’ cortisol, in Sue Gerhardt’s book Why Love Matters, the stress response studies “are underlining the importance of our biochemical responses in our emotional lives” (Gerhardt, 2004: 58). When events or experiences prove too emotionally overwhelming a cascade of chemical reactions flood our bodies to which the end product is the stress hormone cortisol. Gerhardt emphasises “the way that we manage stress is actually at the heart of our mental health” (Gerhardt, 2004: 57). Interacting with animals may help to play a part in keeping cortisol levels down and managing our affect regulation.

In a study by Chandler, AAT has been reported to serve as a source of motivation for client participation in therapy. Over a two-year period, an animal-assisted therapy group led by an occupational therapist attracted the highest percentage of psychiatric inpatients voluntarily choosing to attend (Chandler, 2011 citing Holcomb et al., 1989). Examples of OT groups offered included Hug-a-Pet (the ATT Group), Assertiveness, Chemical Dependency and Exercise among others. The AAT group was the most effective in attracting isolated individuals to participate regardless of diagnosis.

Human-animal interaction and interventions may also “facilitate improvement of self- esteem and self-efficacy” (Berget & Ihlebk, 2011: 9). The 2007 guidance report from the National Health Services (NHS) on animals as therapy in mental health settings cited in their evidence section

In 1987 a psychiatric social worker in a forensic psychiatric hospital in the United States carried out a year-long study of the effects of Animal Assisted Therapy. A 50% reduction in medication for the Animal Assisted Therapy group of participants was recorded, compared with the group who did not receive Animal Assisted Therapy. On the ward where there were no pets, eight suicide attempts were recorded, and none on the ward with pets. Lower levels of violence were also recorded in the Animal Assisted Therapy group.
                                            (Lee as cited in The State Hospital, 2007: 12)

In the high security State Hospital, which is part of the NHS in Scotland, patients with schizophrenia and some with severe depression are being very successfully treated with AAT. A sanctuary has been established consisting of over fifteen different animals being cared for onsite. One of the in-patients stated that “it’s good to see the animals safe and have animals as pets; it gives you something to look forward to, as they trust you” (The State Hospital, 2007: 6). Having a focus and a meaning to their day appears to help the in- patients progress more rapidly. When animals are present, opportunities for meaning can be found and can also help to create a bridge to communication. A comment from one of my participants illustrated this simple yet powerful connection: “A therapeutic intervention can be as small as standing and stroking an animal whilst you let your thoughts wander or control your breathing just to be in that moment” (Sutton, 2015). As stated by Viktor Frankl, “… man’s freedom of will belongs to the immediate data of his experience” (Frankl, 1985: 2).

Conclusion
Animals are part of our everyday life. They live in our environment, are grounding, can occasionally have a profound effect on our biology, our mental health and sometimes our sense of humour and even our soul. In relation to the therapeutic value of working with animals, those who have ‘felt it’ and ‘experienced it’, understand its power to heal. Indeed animals and their bond to humans are captured time and time again in anecdotal stories particularly in relation to mental health.

There is an evolving body of research heading towards the wider acknowledgment and collaboration of working therapeutically with the natural world of the human-animal bond. How we as therapists can harness this innate connection depends upon our openness, belief in the bond and its potential to spark transformative healing.