Counsellors Casebook

Using animal assisted therapy with children

In this article, part of a series on different mental health issues affecting children and young people and counselling, Frances Weston looks at the benefits of an innovative way of working with children and young people.
aving always been very aware of how comforting and rewarding a relationship with an animal can be, I was intrigued and excited to discover, while studying for my Play Therapy Diploma in 2001, that there was an evidence base to support incorporating an animal into therapy sessions to work in partnership with a therapist. I was reminded of meeting a primary school teacher a couple of years earlier, who told me that she took her dog to school with her and of the many positive effects the dogs presence had on the children there. Therefore, I spent some time researching animal assisted therapy (AAT). I discovered that in the US and Canada therapy animals were widely used to assist adults and children with emotional and psychological disorders including depression, recovery from trauma, anxiety and neuroses. It seemed that the presence of an animal helped provide compassionate and stimulating therapy, which facilitates recovery in the client. AAT is defined by Chandler (2005: 5) as follows: AAT utilizes the human-animal bond in goaldirected interventions as an integral part of the treatment process. ... AAT is considered an adjunct to existing therapy. A therapist can incorporate the animal into whatever professional style of therapy the therapist already enacts. AAT therapy can be directive or non-directive in its approach. AAT sessions can be integrated into individual or group therapy and used with a very wide range of age groups and persons with varying ability. AAT is not a practice modality and not an independent profession. Frances Weston isanaccreditedCounsellor andPlayTherapistandrunstheBrighter FuturesCounsellingandTherapyServices practice,PrimroseCottage,31Cheadle Road,Uttoxeter,Staffs,ST147BX Email: frances@brighterfuturescounselling

From this definition it can be seen that AAT is quite different from animal assisted activities (AAA) such as dogs and cats being taken by their owners to visit patients in hospitals or hospices, residents in nursing homes, or children in schools. I decided that I would like to try and introduce AAT into my counselling/play therapy work with children in the NHS and private practice as the potential benefits to children were so great.

The benefits of AAT for children with mental health problems

General observations of a variety of therapy sessions indicate the presence of an animal can make sessions more pleasurable and productive and improve therapeutic outcomes (Table 1). Professor Ahmedzai (2001), Professor of Palliative Medicine at Sheffield University Medical School, stated: There are already data from several small studies showing how human-animal interaction favourably impacts on levels of blood lipids, glucose and thrombotic factors as well as influencing the bodys own production of substances which boost the immune system, relieve pain and generate a sense of well-being.

Spiritual connection

Some children can feel a sense of harmony with life and nature, or spiritual fulfilment, by spending time with animals. This can be hard to define or explain, but can promote a great sense of wellbeing.

Improved self-esteem

Children who suffer from low self-confidence and low selfesteem can benefit enormously from positive interactions with animals involving instructing the animal to complete certain tasks. A therapy dog may be the first creature who has listened and responded to the child with such enthusiasm and compassion. This can result in the child feeling heard and important. (Pichot, 2007) In addition to helping the clients, therapy animals can indirectly help the therapists and other staff in
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mental health care agencies as they experience the same physiological and psychological benefits. The presence of an animal can lift the spirits of staff and temporarily take their focus off the emotionally difficult parts of their work. Further research taught me that the most commonly used therapy animals are dogs, owingto their ease of training and generally even temperament. For AAT to have the best chance of success, it is important to choose a dog with a good temperament, appeal and a reputation for being well-behaved and friendly. It needs to be able to tolerate unpredictable behaviour in children, and perform a few simple tricks. In September 2006, after a careful selection process, I purchased a chocolate Labrador puppy to train and use as a therapy dog; I named her Tilly. Tilly commenced her obedience training at the age of 14 weeks through the Kennel Clubs Good Citizen Dog scheme (and has since been trained up to Gold standard). As well as attending classes regularly and practising homework in between, Tillys training involved general socializing to traffic, loud noises, travelling in a car, being around babies and children, and so on. Pets as Therapy (PAT) is a charitable organization in the UK which regulates the use of dogs and cats in settings such as: hospitals, nursing homes and schools.

I received approval for Tilly to start working with me within CAMHS in October 2007. At the age of 15 months, she started coming to work there with me 3 days a week. Their guidelines stated that I had to have owned Tilly for a minimum of 9 months before she could be assessed

Table 1. Examples of the potential benefits of the use of AAT with children
Help children to develop empathy Help withdrawn children to interact and open up Increased motivation to attend therapy sessions Develop outward focus Learn nurturing skills Help child and therapist to develop rapport Offer unconditional acceptance Brightening of mood Enables child to receive physical contact Childrencanbetaughttoreadananimalsbodylanguage,andtrytounderstandwhat ananimalisfeeling Animalsaregreaticebreakersandinitiatorsofconversationchildrenoftenbecome veryanimatedwhentalkingabouttheirpets,orinteractingwithatherapyanimal Duetochildsdesiretospendtimewiththerapyanimal Childrenwithmentalhealthproblemsorlowself-esteemtendtofocuson themselvesinteractionwithananimalhelpsthemtofocusmoreonwhatsgoingon aroundthem Forexample,brushingtheanimalscoat,offeringfoodordrink,orexercising theanimal. Thechildmaybeabletoformatrustingrelationshipwiththeirtherapistmorequickly whentheycanobservethetherapisthavingapositiverelationshipwithananimal. Childrenarelikelytoprojecttheirfeelingsandexperiencesontoananimal Ananimaldoesnotcarehowachildlooksorwhattheysay.Theyofferwarmth, affectionandfriendshipunconditionally Thepresenceofananimalisentertainingandenjoyableforachildandincreases opportunitiesforlaughterandplay,particularlyinpotentiallydepressingsituations Touchingatherapyanimalissafe,non-threateningandpleasant.Childrencanenjoy holding,strokingandhuggingananimalwhichcanbeverysoothingandcomforting, particularlyiftheyarefeelingdistressed.Physicalcontactwithananimalalsoallowsa childtoreceivehealingnurturanceandaffection Manychildrenfinditeasiertorelaxwhenananimalispresent.Decreasesinheartrate andbloodpressurecanbedramaticwhenchildrenstrokeorinteractwithananimal. Studieshavealsodemonstratedincreasinglevelsofphenylethylamineandendorphin (bodysnaturalmood-enhancingandpain-relievingchemicals)anddecreasinglevels ofcortisol,asubstanceassociatedwithstress.

Physiological benefits

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by them to see if she would make a suitable therapy dog, and she had to be at least 1 year old before she could start work. My proposal to introduce AAT into my practice in CAMHS had been well received, and my manager and I carried out a detailed risk assessment and consulted with an infection control nurse. The risk assessment covered areas such as heath and safety issues, fire/security risks, in addition to exploring possible risks to the animal concerned. We also covered issues such as patient consent. A set of rules were agreed to (Table 2). In June 2007, Tilly had her Pets as Therapy Assessment with a local vet, accredited as an assessor by PAT. This covered areas such as her ability to walk on a lead without pulling, her emotional state while being groomed all over; her ability to accept restriction by being held by her collar; her acceptance of the assessor stroking and playing with her, and examining her paws, ears and tail; her ability to take a treat gently, tolerate an unexpected loud noise without showing fear or aggression, and her overall health and fitness. The assessment also checked that she had been fully vaccinated, wormed and protected against fleas. Tilly passed her assessment first time, and was accepted by PAT to be a therapy dog. Following this, I received approval for Tilly to start working with me in CAMHS in October 2007. At the age of 15 months, she started coming to work there with me 3 days a week. I also started to incorporate her into sessions with children in my private practice, observing all guidelines regarding health and safety, insurance, Tillys wellbeing and so on.

Evaluation of the AAT project

Table 2. Rules developed following the risk assessment

Iwouldcoverthecosts,includingforexample:insurance,vetirinarys bills,obediencetrainingclasses,food IwouldensureTillyhadregularvetirinarychecksandthatallinoculationswouldbekeptuptodate Beforeworkingintheclinic,Tillywouldhavetopassanassessmentby thecharityPetsasTherapy IwouldensureTillyreceivedongoingobediencetrainingviatheKennel ClubsGoodCitizenDogscheme ContactwithTillywouldformpartofachildstreatmentprogramme followinginitialassessmenttoensuresuitability/appropriateness,and wouldalwaysbesupervisedbymyself IwouldberesponsibleforTillyswelfarewhileshewasintheclinic. Shewouldbetakenoutregularlytorelieveherselfanymesstobe disposedofinaccordancewithcurrentlegislation CAMHSwouldproduceaconsentformforparents/carerstosignto ensuretheywerehappyfortheirchildtohavesupervisedcontactwith adog,andthatweareawareofanyallergies,phobias IwouldkeepTillyawayfromanystudents,visitorsornewmembersof staffwhowerenotcomfortablearoundher,orwereallergictodogs ShouldtheCAMHSclinicneedtobeevacuatedforanyreason,priority wouldbegiventochildrenandadults Iwouldberesponsibleforkeepingtheplayroomcleanandfreeofdog hairs(withinreason),washingherbeddingandbowlsregularly,keeping herawayfromtheclinicwhensheisunwellorinseason,andtransportinghersafelytoandfromwork Tillywouldwearalead,PATIDtagandcollaratalltimesfor insurancepurposes IwouldprovidefireretardantbeddingforTilly,togetherwithametal cratetoconfinehersafelywhennecessary IwouldensurethatcleandrinkingwaterwasalwaysavailableforTilly. Iwouldprovidegroomingequipmentandtrainingaidssuchastitbits,a hooporaball

Shortly after I introduced AAT at CAMHS a trainee clinical psychologist joined the team on a 6-month placement and he carried out a service evaluation of the AAT project. The evaluation consisted of semi-structured interviews carried out separately with parents and children who were receiving AAT and who had consented to participate in the study. The interviews asked a series of questions about both the parents and childs thoughts on AAT. Feedback was universally positive. All the children interviewed thought Tilly was a lovely dog and said that she made them feel happy, relaxed and calm. They all liked having her in their sessions and felt her presence helped them in some wayto feel welcome, to calm them down if they felt angry or upset, to feel good, and because she made them want to come back and see her again. They all said they would feel sad or upset if they came to a session expecting to see Tilly and she was not there. All the parents/carers interviewed felt that their children had benefited from having Tilly present in their sessions, and some stated that they believed their children would not have wanted to attend CAMHS if Tilly had not been there. In my private practice, the response from children and parents to the offer of AAT has nearly always been enthusiastic and positive.

Case study

In just over 2 years, Tilly has worked with over 50 children, and I have witnessed many incidents of how her gentle, loving nature has enhanced a childs experience in therapy. On one occasion, not long after she had begun working as a therapy dog, I saw a girl of 14 years of age who was talking sadly about how much she missed her father who, since her parents divorce, had not had any contact with her. As she spoke and became more upset the pattern of her breathing changed slightly as she fought back her tears. Tilly, who had been lying in her bed some distance away, spontaneously got up and walked over to where the girl was sitting, then gently laid her head in the girls lap and looked up into her eyes, seeming to intuitively sense her need for comfort. The girl leant forward and embraced
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Tilly, then began to sob. At other times, Tillys playful and gallumphing personality causes great amusement and has definitely helped me to build an alliance with children.

Conclusion

In the UK there are now a handful of counsellors who offer AATmostly with dogsand there are several practitioners of Equine Assisted Therapy. The Huntercombe hospital in Roehampton (which treats NHS patients for addictions and eating disorders) incorporates a corn snake into group therapy sessions. Doctors there say those involved in AAT have already shown an improvement in concentration and mood. My work with Tilly has been featured in Psychologies (Taylor, 2008); Counselling for Children and Young People (Weston, 2010) and attracted interest from counselling practitioners and students, as well as the general public. I would encourage anyone working with children and young people, who genuinely love animals and feel drawn to AAT, to learn more about how they might incorporate it into their work, while observing existing recommendations and guidelines. The positive effects are considerable, for everyone involved. Alternatively, school nurses working in special needs schools might be interested in getting in touch with PAT and possibly organize a PAT dog visit to their school if they feel this would benefit some of the children. BJSN Due to circumstances beyond our control the counsellors casebook article looking at depression will be published in the November issue of the journal instead of the September issue as originally intended.
Frances Weston

In April 2010, Tilly had her first litter of puppies, from which I selected little Gertie to train as a second therapy dog to work with me.
Pichot T, Coulter M (2007) Animal-Assisted Brief Therapy: A Solution Focused Approach. The Haworth Press, New York: 168 Taylor T (2008) Pet therapy. Psychologies magazine March 2008: 14650 Weston F (2010) Animal Assisted Therapy. CCYP magazine (BACP) March 2010: 358

Further information
The Society for Companion Animal Studies TheSocietyforCompanionAnimalStudieswasestablishedover25yearsagotopromotethestudyofhumancompanionanimalinteractionsandraiseawarenessoftheimportanceofpetsinsociety.Theirwebsiteprovidesa wealthofusefulinformation,includingdetailsoftrainingcoursesavailableinAATwww.scas.org.uk Pets As Therapy PetsAsTherapyisacharitableorganizationintheUKwhichregulatestheuseofdogsandcatsinhospitals,nursinghomes,schools,etc.andprovidesguidelinesontheassessmentprocedurerequiredwww.petsastherapy.org Further reading FineA,EisenC(2008)Afternoons with Puppy: Inspirations from a Therapist and His Animals.PurdueUniversity Press,USA FineA(2000)Handbook on Animal Assisted Therapy.AcademicPress,USA ChandlerC(2005)Animal Assisted Therapy in Counselling.Routledge

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