Using animals in therapy

Human–animal interactions can have a profound effect on human mental health: Decades of research suggest that contact with animals can lower stress, reduce anxiety, and foster feelings of safety (Matijczak, A., et al., Emotion, Vol. 24, No. 2, 2024). For example, studies show that adopting dogs reduced loneliness, cortisol levels, and negative emotions in war veterans (Adler, R. H., et al., Traumatology, Vol. 30, No. 4, 2024); visits from animals reduced anxiety in men undergoing inpatient substance use treatment (Scott, T. M. T., & Kirnan, J., The Humanistic Psychologist, Vol. 51, No. 2, 2023); equine interactions in therapy helped kids with ADHD improve executive function (Helmer, A., et al., Clinical Neuropsychiatry, Vol. 21, No. 1, 2024opens in new window); and college students who petted dogs or cats for 10 minutes saw a significant drop in cortisol levels (Pendry, P., & Vandagriff, J. L., AERA Open, Vol. 5, No. 2, 2019opens in new window).

Findings like these help explain why psychologists and related health care professionals are increasingly integrating animals—dogs and other domesticated species—into a range of therapeutic settings, including individual counseling, inpatient psychiatric units, schools, and hospitals.

“While therapy animals are not necessarily an intervention by themselves, when you use them appropriately in therapy with evidence-based care, they can really have some great results,” said Erica Force, PhD, a licensed psychologist and a lead psychological services provider for the U.S. Olympic & Paralympic Committee (USOPC).

“Therapy animals” is a catch-all term describing animals that are integrated into one-on-one or group therapy with a trained mental health professional or animals that interact with humans at places such as residential treatment facilities, schools, or airports. Phrases like “dog therapy” or “horse therapy” are misleading because the animal is not the therapist, said Nina Ekholm Fry, director of equine programs at the University of Denver’s Institute for Human-Animal Connection. The definition of the service is “always based on the credential of the person,” she said (see sidebar below).

Thus, many mental health professionals prefer a description that focuses first on the intervention, such as “psychotherapy with animal interaction” when talking about bringing animals into practice, or “visiting animals” to describe support animals that aren’t involved in a specific intervention. For trained psychologists, this framing highlights the idea that animals are a way to enhance other evidence-based treatments rather than treatments unto themselves.

One common place for a therapy animal is within one-on-one therapy. The psychologist or other mental health professional has control over the space and can customize it to accommodate both animal and patient. Well-trained animals bring a perceived nonjudgmental, friendly presence to the room, making individual therapy more emotionally comfortable for patients and help establish trust, said Katherine Compitus, DSW, LCSW-R, a social worker and certified animal-assisted intervention specialist at New York University.

“It’s like fast-forwarding the therapeutic alliance,” said Compitus, whose pit bull, Chompy, is a regular presence in her office.

However, it’s important to prepare for integrating the animal, said Compitus. The therapist should seek training from a reputable organization such as the Association of Animal-Assisted Intervention Professionalsopens in new window or the Institute for Human-Animal Connection at the University of Denveropens in new window. It’s important to pursue training geared toward professionals rather than volunteers, as volunteer certifications cover limited activities and typically only include liability for animals working for a few hours at a time.

When deciding whether animal interactions in therapy are appropriate, psychologists should ensure that their animal is calm and friendly, is able to ignore distractions, and otherwise behaves safely in a clinical environment, Force said. Therapists should check to see if the patient has any allergies, animal phobias, or whether they or anyone in their family has been bitten or attacked by an animal in the past. Patients should have the opportunity to consent to an animal being present before the animal is there. It’s also important to keep in mind potential cultural influences regarding relationships with animals, said Melissa Trevathan-Minnis, PhD, a counseling psychologist at National University in San Diego and animal rescue worker whose rescue pup and trained therapy dog, Athena, often sits with her in sessions in her private practice in Austin, Texas. For example, some interpretations of Islam view dogs as being unclean.

If the patient gives their consent, the therapy animal’s presence should be intentionally incorporated into treatment, Compitus said. For some practitioners, the animal’s presence simply acts as an icebreaker, giving patients something to focus on during difficult conversations. Other providers will establish particular tasks and activities, such as teaching the animal a new trick in order to help the patient develop self-efficacy. Petting a dog, cat, or guinea pig can be part of a grounding exercise in body awareness.

“There is such a physiological connection to petting a dog,” Trevathan-Minnis said. “Having that touch, that tactile sensation, the rhythm.”

Animals should be carefully selected and trained to be willing to interact, as patients might experience a disinterested animal as a rejection. If the animal needs a break or refuses to participate in a particular exercise, however, it’s important not to force anything, Trevathan-Minnis added. This flexibility is both basic ethics for animal welfare and important for building trust with the patient, who is watching how the psychologist treats their pet partner.

“We’re not modeling good consent and good consideration of the comfort of everyone involved if we don’t prioritize the animal,” Trevathan-Minnis said. Forcing an unwilling animal to participate could send a message to the patient that their boundaries won’t be respected, either.

Once such considerations are met, animals can bring important extras to the therapy interaction. Compitus once worked with a teenage boy with an extensive trauma history who had a hard time articulating his story to her. “But he told Chompy,” Compitus said. “And I just happened to be in the room when he did that.” The dog acted as a buffer to the initial conversation, making it easier for the boy to continue opening up to Compitus herself.

Animals can also work magic with elite athletes, who are often under pressure to balance the challenges of competition with other life responsibilities, Force added. Animal interaction “activates our parasympathetic nervous system so emotions are regulated better and anxiety goes down,” Force said. “And when that happens, there’s an openness in the therapeutic process.”

Animals also have the potential to expand the settings for psychotherapy, said Ekholm Fry. Integrating equine interactions, for example, can mean getting the patient outside into a natural environment. “All of a sudden you have all this potential for more people to be or become comfortable in therapy,” she said.

Beyond independent practice, there are numerous other settings where psychologists are, or could be, incorporating animals into practice, including inpatient psychiatric units, schools, hospitals, and assisted living facilities. When animals are part of therapeutic interventions in these settings, they are generally considered therapy animals. When they are in the role of a visitor to lift moods, many professionals prefer to call them “wellness animals” or “visiting animals.”

Either way, research shows clear benefits of bringing animals onto the scene: In outpatient occupational therapy, for example, therapy dogs have been shown to improve social interactions for children with Down syndrome (Gomes, C. M. S., et al., Anthrozoös, Vol. 37, No. 6, 2024opens in new window). For dementia patients who are reluctant to eat, adding a fish tank to the dining room of an extended care facility has been shown to increase food consumption, leading residents to gain an average of 2.2 pounds from before the fish tank was added (Alzheimer Disease & Associated Disorders, Vol. 27, No. 4, 2013opens in new window). The fish tank had a noticeable social impact on residents, as well, said Alan Beck, ScD, a professor emeritus of the human-animal bond at Purdue University who co-led that research. For instance, some residents broke their usual mealtime silence to comment on the fish.

In schools, meanwhile, a recent review found that interactions with school support dogs improved students’ self-perceptions, decreased their cortisol levels, and fostered greater empathy and more positive social behavior toward fellow students (Wintermantel, L., et al., Educational and Developmental Psychologist, Vol. 41, No. 1, 2024opens in new window).

Dogs have even been associated with improved reading scores in young children: Elementary students who read aloud to dogs in a school program showed higher reading scores and more enthusiasm for reading compared with same-grade students at those schools who were not in the program (Early Childhood Education Journal, Vol. 46, No.1, 2018opens in new window). The intervention was particularly helpful for kids who struggled to read and those learning English as a second language, said Jean Kirnan, PhD, an industrial and organizational psychologist at the College of New Jersey who led that research. “The dog is nonjudgmental,” Kirnan said. “The dog just loves you.”

Although research on the therapeutic use of animals other than dogs and horses is slim, this particular intervention has been expanded to include other species. For example, a mother-daughter team in Denver brings their registered therapy bunny to the library once a month so kids can read to it, said Laura Ackerman, vice chair of the board of directors at Denver Pet Partners, a local affiliate of the national Pet Partners organization that provides education and training for volunteer-animal teams, composed of a volunteer and their therapy-delivering pet.

A volunteer-animal team can sometimes support psychologists who don’t have their own animal in their interventions in these settings, said Susan Horecki, director of programs at Denver Pet Partners. These settings all have different protocols and confidentiality and safety considerations. Many schools send permission slip–style consent forms home to parents, said Taylor Chastain Griffin, PhD, a research psychologist and national director of animal-assisted interventions advancement at Pet Partners. In hospitals and nursing facilities, where patients and residents may have weakened immune systems, it’s important to take precautions to reduce the risk of zoonotic disease or other germ transmission. These precautions include ample hand sanitization, bathing the animal before and after visits, and making shorter visits so that animals see fewer patients at one time, Griffin said.

Even therapists who don’t integrate animals into practice may need to be familiar with the human-animal bond because of how their patients lean on animal companions at home. In some cases, patients may ask psychologists to write them a letter documenting their need for an emotional support animal (ESA). Under the Fair Housing Act, ESAs are defined as animals that provide emotional support or alleviate a symptom or effect of a disability. Patients with a disability may benefit from having an animal for comfort and companionship, or simply because the animal motivates them to get out of bed each day.

Clinicians don’t need specific knowledge about the individual animal to write an ESA letter that is ethically and legally acceptable according to federal guidance, said Ekholm Fry. Their role is simply to document that the person indeed has a disability, as defined under the Americans with Disabilities Actopens in new window (ADA). The letter must also demonstrate that there is a relationship between the disability and the need for an assistance animal. For example, a patient with depression might benefit from having a dog because the dog requires care each day, motivating the person to stick to a routine and go outside for walks.

Clinicians are not generally legally liable for their patients’ ESAs as the animal is owned by the patient, said Ekholm Fry. Federally, ESA accommodations are limited to housing access. State law and individual entities, such as colleges, may allow other accommodations.

That said, some states put restrictions on who can provide an ESA letter. Colorado, for example, requires that the mental health professional has seen the patient in person. California requires a 30-day preexisting patient-provider relationship.

Once you know the appropriate regulations, composing the letter requires information that mental health professionals can gather by using tried-and-true clinical interview skills, like how the animal makes the person feel and how the animal alleviates the symptoms of their disability, Ekholm Fry said.

“We ask the client: What feels easier when your animal is around? What does your animal help you manage? What would change if your dog could not live with you?” she said. “It’s all based on the research pointing to the importance and impact of having animals in our lives.” 

There is no single agreed-upon terminology for animal roles in human health care settings, but some categories do have legal definitions. Others can be used interchangeably depending on the setting and provider.

Service animals: Dogs and miniature horses trained to perform specific tasks for a person with a disability as defined in the Americans with Disabilities Act (ADA). They may accompany a person with a disability at home and in public and are protected under several federal laws, including the ADA, the Fair Housing Act, the Air Carrier Access Act, and the Individuals with Disabilities Education Act.

Emotional support animals: These animals require no training but alleviate a symptom or effect of a disability as defined in the ADA.

Therapy animals: These trained animals are integrated into the work of a qualified health professional in the provision of a structured, goal-directed treatment.

Wellness or visiting animals: These are alternative names for “therapy animals” that are not part of an evidence-based care plan but provide social interaction or comfort at places like hospitals, schools, airports, or extended care facilities.