For the patient, the dog was more than a pet. It helped her cope with agoraphobia and panic disorder and got her out of the house when nothing else would. To psychologist Chloe House, PhD, of State College, Pennsylvania, the animal represented an ethical conundrum.
When the patient asked House to write a letter certifying the dog as an emotional support animal, she wasn't sure how to respond. "I felt uncomfortable writing a letter when I didn't understand the guidelines," says House. She wondered how to determine whether the dog had a therapeutic effect above and beyond the positive effect animals often have on people. And she worried about the impact an emotional support animal might have on other people.
"If somebody is going to bring a pet snake to class, how is that going to make other people feel?" she asked. "I feel bad for people on planes who have animal allergies seated near someone who needs an animal to be calm. And I feel for the landlords with no-animal policies that are going to be usurped by my letter."
House is one of a growing number of psychologists whose patients are asking for letters that attest to the need for an emotional support animal, an animal whose presence alone provides comfort to someone with anxiety, depression or other mental illness. But psychologists shouldn't write such letters cavalierly, say experts who have examined the issue. Because writing such letters could damage the therapeutic relationship, psychologists shouldn't write them for their own patients. And even forensic psychologists should tread carefully.
A legal distinction
Emotional support animals make sense, given the large literature on animals' ability to reduce human stress and anxiety and provide other health benefits, says psychologist Aubrey H. Fine, EdD, a professor of education at California State Polytechnic Institute in Pomona and editor of the "Handbook on Animal-assisted Therapy: Foundations and Guidelines for Animal-assisted Interventions" (2015).
But some people are abusing the emotional support animal concept, says Fine. "People are going online, answering a few questions and getting jackets for their dogs that say that they're emotional support dogs," he says (see sidebar). "My concern is some people are misusing this so they can have their pets with them."
That concern has its basis in an important legal distinction. While emotional support animals provide what Fine calls "therapeutic support" to people with mental illnesses, they're not the same as psychiatric service animals.
Service animals are specially trained to work with or perform tasks for people with disabilities, says Fine. A psychiatric service dog, for example, might be specially trained to remind someone to take his or her psychiatric medication, check a room and turn on the lights for someone with anxiety or stop someone from engaging in self-mutilation behavior, for example. Under the Americans with Disabilities Act (ADA), these animals can accompany their owners anywhere the public can go. Emotional support animals, on the other hand, are not specially trained for their emotional supportive roles and so aren't covered under the ADA.
They do have some legal protections, however. The Air Carrier Access Act requires airlines to allow them to fly in airplane cabins for free, although most require them to sit on their owners' laps or under their seats. The Fair Housing Act allows these animals to circumvent no-pets rules in housing, including dorm rooms. But while airplanes and housing are the only places legally required to welcome emotional support animals, a lack of awareness about the law and fears of discrimination claims mean these animals can show up just about anywhere.
In addition to concerns about fraud, there's also not much research to back the claim that emotional support animals help people more than traditional pets, says University of Missouri clinical psychology graduate student Cassandra L. Boness, who co-authored a paper on emotional support animals with Jeffrey N. Younggren, PhD, a psychology professor at Missouri, and Jennifer A Boisvert, PhD, a private practitioner in Beverly Hills and Long Beach, California (Professional Psychology: Research and Practice, 2016). A review of the literature revealed little evidence that emotional support animals are effective, Boness and her co-authors found. "The research we did find was inconclusive," she says.
Also, Boness says, there are no standards for evaluating emotional support animals—a problem if, say, an animal in no-pets housing bites a child and the case winds up in court.
More important, writing a letter means mixing clinical and forensic roles, which is ethically impermissible. "Those roles are incompatible with each other and can damage the therapeutic relationship," Boness says, explaining that both the APA Ethics Code and the Specialty Guidelines for Forensic Psychologists forbid therapists from providing information about a patient's psychological condition to third parties for nonclinical purposes. If you decide a patient doesn't need an animal, for example, you've potentially damaged your alliance and harmed the patient. Boness and her colleagues recommend preventing such situations by including a statement in informed consent materials saying that you provide only clinical services and will refer patients to other providers for forensic services.
If you're playing that forensic role, take the task very seriously, says Younggren. "These letters are formal certifications of psychological disability," he says. "By writing such a letter, you're stating that the person needing an emotional support animal has such a disability and that the presence of the animal addresses that disability."
The letter should contain several elements, say animal law expert John J. Ensminger, JD, and New York City neuropsychologist J. Lawrence Thomas, PhD (Law and Human Behavior, 2013):
- Confirm that the individual has a mental health diagnosis.
- Explain how the animal helps alleviate that condition.
- Describe your observations of how the animal and patient interact and how long you observed the interaction.
- Explain the possible negative effects of the person's not having the animal with him or her.
- Mention any training the animal has received from a qualified trainer, if applicable.
"Ultimately, it comes down to your opinion," says Thomas. "But you need to do due diligence."
