The present paper explores the ethical issues involving animal assisted therapy. The American Veterinary Medical Foundation states animal assisted therapy is a goal-oriented intervention that uses animals as a primary resource in the treatment process. As animal assisted therapy continues to grow, it is important that psychologists recognize the legal and ethical concerns relating to alternative therapies such as, misuse, consent, multiple relationships, conflict of interest, competence, cooperation, and culture. These ethical issues must be navigated carefully in adherence to the Ethical Principles of Psychologists and Code of Conduct. If practiced correctly animal assisted therapy can have significant effects on mental health outcomes.
The Use of Animals in Therapy: Therapy Animals and Animal Assisted Therapy
Animals have played an important role in the lives of humans since ancient times. Recently, animals have expanded their roles and have been trained to assist those with physical, mental, social, and educational disabilities. There are three classifications of assistance animals: (i) service dogs, (ii) emotional support animals, and (iii) therapy animals (American Veterinary Medical Foundation, 2018). Service dogs are individually trained to perform tasks for those with a disability (American Veterinary Medical Foundation, 2018). Examples include, assisting individuals who are blind with navigation, alerting individuals who are deaf or hard of hearing to the presence of sounds, providing protection or rescue work, towing a wheelchair, assisting an individual during a seizure, providing physical support and stability to individuals with mobility disabilities, and helping people with psychiatric and neurological disabilities (American Veterinary Medical Foundation, 2018). Emotional support animals are companion animals that help individuals with disabilities without performing any particular task (American Veterinary Medical Foundation, 2018). Although, service dogs and emotional support animals play important roles in the lives of individuals with disabilities, this paper will focus on the third classification; therapy animals and their use in animal assisted therapy.
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Therapy animals are animals that have been obedience-trained and screened for their ability to interact with people and other animals. Therapy animals engage in animal assisted therapy. Animal assisted therapy is a goal-oriented intervention that incorporates animals, such as horses, dogs, cats, and birds, and are used as primary resources in the treatment process (American Veterinary Medical Foundation, 2018). Research has demonstrated notable benefits of the use of animal assisted therapy across settings including, schools, hospitals, and courtrooms (Hart & Yamanoto, 2015). A meta-analysis of 49 studies reporting on animal-assisted therapy found moderate effect sizes in improving outcomes in four areas: Autism spectrum symptoms, medical difficulties, behavioral problems, and emotional well-being (Nimer & Lundahl, 2015). Another study found that animal assisted therapy can be helpful for those suffering from mental illnesses such as, depression, anxiety, schizophrenia, and addiction (Kamioka et al., 2014). As an example of how animals can be used to help those in therapy, is shown in a recent study that found interacting with animals can reduce stress by releasing oxytocin, a hormone that is associated with relaxation and trust (Petersson, Uvnas-Moberg et al., 2017). Given the multitude of benefits, it is important for psychologists and other mental health professionals to be able to recognize and define the legal and ethical concerns relating to misuse, consent, multiple relationships, conflict of interest, competence, cooperation, and cultural considerations regarding animal assisted therapy.
The Misuse of Therapy Animals
Like service dogs and emotion support animals, therapy animals play an important role in the lives of those with disabilities; however, unlike service dogs and emotional support animals, therapy animals do not have as many rights (American Veterinary Medical Foundation, 2018). Therapy animals must be certified and are only allowed in places they have been employed such as courtrooms, schools, and hospitals. Unfortunately, due to the increase in popularity and the lack of knowledge by the general public, some people misrepresent their therapy animals and pets in order to bring them to places where pets are not allowed (American Veterinary Medical Foundation, 2018). This not only has legal implications but also moral. The growing number of fraudulent service or emotional support animals make the lives of those with legitimate service or emotion support animals more difficult. For example, people with disabilities are being asked to disclose their ailment and provide certification papers that are not legally required (American Veterinary Medical Foundation, 2014). Psychologists that knowingly misrepresent their therapy animals are perpetuating the growing issue of fraudulent assistance animals and are indirect violation of Standard 1.01, Standard 1.02, and Principle C: Integrity (APA, 2010).
Informed Consent and Animal Assisted Therapy
Standard 3.10, requires that psychologists obtain informed consent (APA, 2010). Informed consent is a legal procedure that is used to ensure patients are aware of every aspect of treatment in a way that is easy to understand (APA, 2010). This includes, the nature of the treatment, the anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality as indicated by Standard 10.01a (APA, 2010). In order for informed consent to be valid, the client must be considered competent and the consent must be uncoerced and well documented (APA, 2010).
Informed consent may appear simplistic; however, it becomes more complicated when a third party, in this case an animal, is involved. When introducing animal assisted therapy to a client, it is important to establish boundaries before presenting an animal to a client. In order to set these boundaries, a psychologist should inform the client of the possible risks of working with animals; for example, risk of bodily harm due to bites and scratches, or contraction of disease or allergens (Shelton, Leeman, & O’Hara, 2011). Even with thorough training and evaluations, working with therapy animals carry many risks. Although research by Weinstein, Weber, & Rutala (2001) has shown that cross-species transmission is rare, the health of the animal should be monitored to ensure the safety of both the animal and the client in adherence to Principle A: Beneficence and Nonmaleficence (APA, 2010). After reviewing the informed consent form, psychologists must appropriately document consent as stated by Standard 3.10d (APA, 2010).
If a client is legally incapable of giving informed consent, a psychologist should still give an explanation regarding the nature of therapy in accordance to Standard 3.10b and Standard .310c (APA, 2010). These safety measures help ensure that animal assisted therapy is conducted in a safe manner that complies with Principle B: Fidelity and protects both the client and the animal from harm as stated by Principle A: Beneficence and Nonmaleficence (APA, 2010).
Multiple Relationships and Conflict of Interest Associated with Animal Assisted Therapy
Therapy is built around the relationship between the psychologist and the client. The way in which a psychologist conducts themselves during therapy has significant implications. According to the Standard 3.05, psychologists should not engage in dual or multiple relationships when possible (APA, 2010). The most common dual relationships occur when the client is also a student, friend, family member, or associate. however, they may also occur when engaging in animal assisted therapy.
A psychologist who chooses to incorporate animal assisted therapy must be aware of and consider the possibility of creating a dual relationship; especially when the therapy animal belongs to them. This creates a situation where the psychologist serves two roles, as both therapist and animal handler (APA, 2010). Psychologists who choose to engage in this type of alternative therapy become responsible for the well-being of both the client and the animal. This may also make adhering to Standard 3.06 and Principle B: Fidelity difficult (APA, 2010). They must split their attention between the client without impairing their objectivity, competence, or effectiveness in performing their duties (APA, 2010). In order to reduce the impact of these ethical dilemmas, psychologists should regularly check in with their client and redefine boundaries within therapy. This ensures that the client is comfortable with the animal, and that the dual relationship of psychologist and animal handler is not taking time away from the client (APA, 2010).
Competence and Care When Using Animal Assisted Therapy
According to Standard 2.01a, psychologists should only provide services in areas within their boundaries of competence, based on their education, training, and professional experience (APA, 2010). Therefore, health professionals who are interested in utilizing animal assisted therapy should receive proper training. Receiving adequate training minimizes risk and maximizes benefits for everyone involved. This ensures a psychologist is adhering to Principle A: Beneficence and Nonmaleficence, Principle B: Fidelity, and Principle C: Integrity (APA, 2010).
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Psychologists who want to utilize animal assisted therapy need to be competent in order to ensure the welfare of both the client and the animal (APA, 2010; Jegatheesan, 2014). In order to ensure the well-being of a client, they should verify that the therapy animal is qualified under the Guidelines for Incorporating Animals in Therapy (Fine, 2015). In order to qualify as a therapy animal, the animal must have an even and calm temperament, enjoy being around people, and must be able to sit still for extended periods of time (Fine, 2015). This reduces risk and ensures the safety and comfort of the client. General knowledge of animal behavior and interaction is also important when engaging in animal assisted therapy according to Standard 2.01a (APA, 2010). Adequate training allows a person to detect signs of distress and discomfort, as well as put into place regulations that decrease the likelihood of animal burnout and fatigue. Psychologists should also provide resources such as a place to rest comfortably, a place to use the bathroom, and frequent food and water breaks. Similarly, to people, animals are also susceptible to injury; therefore, clients should be given guidelines on how to interact with the animal. With proper training, psychologists can responsibly in accordance to Standard 2.01 and incorporate animal assisted therapy while maintaining an environment that is save for both the client and the animal (APA, 2010).
Cooperation with Other Professionals and Animal Assisted Therapy
Standard 3.09 states psychologists must cooperate with other professionals to ensure the safety and welfare of their clients (APA, 2010). In order to comply to Principle B: Fidelity, a psychologist must educate the other professionals and faculty members within the facility in which the therapy animal will be working (APA, 2010). It is not safe to assume that everyone has experience working with animals. For some this may be their first interaction with a therapy animal; while others may be allergic or fearful. It is essential according to Standard 3.09 that the psychologist communicates the rules and restrictions with their fellow professionals prior to introducing the therapy animal (APA, 2010). This education process should include safety precautions and assurance for those who may be uncomfortable with the therapy animal. In order to ensure compliance, the psychologist should also engage in appropriate behavior. This will ensure everyone feels comfortable and safe around the therapy animal.
The Influence of Cultural and Religious Factors on Animal Assisted Therapy
Culture plays a significant difference in how people view animals (Jegaheesan, 2015). When deciding whether to utilize animal assisted therapy, a psychologist must consider and be aware of individual differences relating to age, gender, race, culture, religion, sexual orientation, language, and socioeconomic status, according to Principle E: Respect for People’s Rights and Dignity (APA, 2010). Some client’s beliefs and fears may not align with animal assisted therapy, which may make the addition of a therapy animal difficult. Therefore, a psychologist should respect their client’s beliefs and consider removing the therapy dog from the treatment plan as stated by Principle E and Standard 3.01 (APA, 2010). If unable to integrate animal assisted therapy, a psychologist should not continue using the method and must offer alternate treatment options or a referral in order to comply to Standard 10.01b (APA, 2010. This ensures the wellbeing of the client and the therapy animal.
Incorporating animal assisted therapy into treatment for mental diagnosis is growing in popularity. If practiced with appropriate education and training set forth by Standard 2.01a, animal assisted therapy can have significant effects on mental health outcomes (Kamioka et al., 2014; APA, 2010). When deciding to incorporate a therapy animal, it is pertinent to understand the risks and benefits and in response set appropriate rules and boundaries in place. Overall, it is important for psychologists to recognize and define the legal and ethical concerns relating to misuse, consent, multiple relationships, conflict of interest, competence, cooperation, and cultural considerations regarding animal assisted therapy. Such preparation ensures a safe therapeutic environment for both the client and the therapy animal.
- American Psychological Association (2010). Ethical principles of psychologists and code of conduct. Retrieved from: https://paloaltou.instructure.com/courses/4491/files/ 267099?module_item_id=85032.
- American Veterinary Medical Foundation. (2018). Service, emotional support, and therapy animals. Retrieved from https://www.avma.org/KB/Resources/Reference/AnimalWelfare/Pages/Service-Emotional-Support-Therapy-Animals.aspx
- Fine, A.H. (2002). Animal assisted therapy. Encyclopedia of Psychotherapy, 1, 49-55.
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