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Dogs and Human Health/Mental Health:
From the Pleasure of Their Company
To the Benefits of Their Assistance
Jan Shubert, LCSW
Although we tend to identify the 20th century as the
time when dogs and animals in general were first used
to provide assistance to people with a variety of physical and mental diagnoses, this actually is not the case.
The first documented example of the therapeutic use of
animals occurred in 9th century Gheel, Belgium, where
animals were part of the “therapie naturelle” provided
for the handicapped by members of the community.1(p7),2
benefited humans, most of those examples were relatively informal, possibly even coincidental. The dogs did
not receive any specific training, and there were no formal programs. In the 20th century, however, formal programs were developed to train dogs to provide a variety
of services to humans.
Basically, there are 2 categories of dogs that provide
assistance to people with disabilities: service dogs and
therapy dogs. Although the phrase “assistance dog” is
used frequently, and there is an organization called “Assistance Dogs International,” the term assistance dog has
no meaning in law. A recent amendment to the Americans with Disabilities Act (ADA) (42 USC §12101-12213
and 47 USC §225, 611), which became effective March
15, 2011, defines a service animal as:
The first use of animals specifically for the treatment
of the mentally ill occurred in late 18th century York,
England.3,4 After the death of a Quaker in the inhumane
conditions in what was then the York Asylum, a wealthy
Quaker merchant, William Tuke, raised money to open
the York Retreat in 1796 to care for the insane. Tuke’s
methods were quite different from the coercive and puany dog that is individually trained to do work or perform
nitive approaches in use at that time. Patients wore their
tasks for the benefit of an individual with a disability,
own clothing and had the opportunity to work at crafts,
including a physical, sensory, psychiatric, intellectual, or
read books, write, and wander the grounds, which conother mental disability….The work or tasks performed by
tained a variety of small animals. The combination of the
a service animal must be directly related to the handler’s
example set by the York Retreat, the continued efforts of
the Tuke family to improve the treatment of the mentally
ill, and a scathing report on conditions in British mental Whether or not therapy dogs are covered under the
hospitals during the 1830s initiated gradual improve- amended ADA depends on the disability of their handlers, how they are trained, and how they are used, as
ments in the overall treatment of the mentally ill.4
specified in the definition presented above. It should be
The first documented therapeutic use of animals in the noted that the ADA clearly includes psychiatric assisUnited States took place during World War II at an tance as a category for service dogs.
Army Air Corps convalescent hospital in Pawling, New
York. According to Bustad and Hines,1(p19) the hospital Ensminger defines a therapy dog and its work as:
functioned more as a rest home than a medical facility
…a dog that, with a handler, visits individuals or
for patients suffering from “operational fatigue,” which
groups to provide some relief from an institution, such
is probably called posttraumatic stress disorder today.
as a hospital, or condition, such as cerebral palsy or
The facility provided both an academic program and the
Alzheimer’s. Therapy dogs may be used one-on-one as
physical activity of working at the facility’s farm.
part of a treatment program for an individual, which is
Although the history of human-animal relationships
is filled with tales of how animals, dogs in particular,
often called animal assisted therapy (abbreviated AAT),
but mostly therapy dogs in the United States today visit
facilities to help or at least cheer up the populations of
those facilities.6(pxii)
The views expressed in this article are those of the author and do not reflect the views of the US Environmental Protection
Agency, the US Army, or the US Army Medical Department.
April – June 2012
Clearly, under the new ADA definition of service dogs, for visually impaired individuals, there are numerous
dogs used according to Ensminger’s definition do not organizations training and placing hearing dogs.
qualify as service dogs.
Service Dogs for the Mobility Impaired
Service dogs, as defined in the amended ADA, assist individuals with a variety of physical disabilities, including
vision impairments, hearing impairments, mobility disorders, and seizure disorders. As important as these services are to their recipients, the most important service
by far is the companionship that the dogs provide, particularly to individuals who may have been experiencing
considerable isolation because of their disabilities.
Service Dogs for the Visually Impaired
According to Ensminger,6 the first use of service dogs
for the visually impaired dates to post-World War I Germany where dogs were trained to guide soldiers blinded during the war. In 1927, Dorothy Harris Eustis, an
American living in Switzerland and breeding and training German shepherd dogs, learned of the German program and wrote an article that appeared in the November
5, 1927 edition of The Saturday Evening Post.7 Her article eventually led to the founding of the first American
organization for the training of guide dogs for the blind,
The Seeing Eye, in 1929.8 Since then, a number of other
organizations have been established for the training of
guide dogs for the blind, including Guide Dogs for the
Blind and Leader Dogs for the Blind. According to Ensminger,6 there were approximately 9,000 guide dogs in
the United States as of 1999, most of whom had been
trained by the 3 organizations mentioned above.
Service Dogs for the Hearing Impaired
The first organization to train dogs to assist people who
had hearing impairments was established as a result of
one woman’s efforts to replace a dog that had died. In
1973, Elva Janke contacted the Twin Cities Action News
television program asking for assistance in training a
dog to alert her to sounds that she could not hear.9 A
trainer was found through the intervention of the director of the Minnesota Humane Society. Three years later,
the American Humane Association in Denver, Colorado,
established a national training center. In 1979, a separate
organization, Hearing Dog, Inc, was established. The
name was changed to International Hearing Dog, Inc
after the organization placed a dog in Canada. Since its
founding, the organization has trained and placed more
than 1,100 hearing dogs, all of whom come from shelters.
The dogs are trained to alert their handlers to a variety
of sounds, including alarm clocks, telephones, doorbells,
crying babies, sirens, and smoke alarms.10 According
to Ensminger,6 there were approximately 4,000 hearing
dogs in the United States as of 2001. Now, as with dogs
Today, the efforts of service dogs are not limited to
serving as eyes and ears for individuals with visual or
hearing impairments, they also serve as arms and legs.10
Service dogs for those with mobility impairments can
perform a number of tasks for their handlers, including
retrieving or fetching specific items or dropped items,
opening doors, turning lights on or off, and carrying
backpacks. The larger breeds can also serve as braces to
help stabilize ambulatory handlers, assist them in getting out of chairs, and even pulling wheelchairs.
Service Dogs for Those Suffering from Seizures
There have been reports that some dogs can sense
physiological changes in their owners when a seizure
is approaching and alert the owner ahead of time.6 This
warning allows the owner to move to a safe place and
prepare and/or take preventive medication. Such reports
are primarily anecdotal in nature. In 1999, however, a
British organization, Support Dogs, was reported to have
trained 6 dogs to detect and indicate coming seizures,
providing a warning ranging from 10 to 45 minutes before the seizure.11 The study also indicated a reduction
of seizure activity. More recently (2004), the University
of Florida School of Veterinary Medicine conducted a
study of 29 individuals who had epilepsy and also owned
dogs. Nine dogs reportedly responded to their owners’
seizures, and three of these were also reported to have
alerted their owners before the seizure.12 Nevertheless,
there is skepticism in the scientific community that dogs
can actually be trained to sense coming seizures.
As described earlier, there were informal efforts to include animals in the treatment of the mentally ill in the
18th and 19th centuries. In the 20th century, these efforts became more intentional. The therapist truly considered to be the true father of animal-assisted therapy,
however, is Boris Levinson. He acknowledged that his
discovery of the effectiveness of a dog in building rapport with a child client was purely accidental.13 The child
and his mother arrived early for their appointment, before Levinson had time to confine his dog, Jingles. Until
that time, Levinson had been unable to establish a relationship with the child, but Jingles quickly facilitated
the establishment of a therapeutic relationship between
Levinson and the child. Levinson went on to include
dogs in many of his therapeutic sessions and to write and
speak about the success of this new form of intervention.
His initial efforts to present the results of his animalassisted therapeutic efforts at professional conferences
were met with more than a little ridicule. Despite the
skepticism with which Levinson’s colleagues greeted
his presentations, a survey he conducted with clinicians
in the New York State Psychological Association indicated that more than one-third of the respondents had
themselves used animals in their practices.14 Levinson
persisted in his efforts to interest mental health professionals in the benefits of including animals in their
therapeutic activities, publishing Pet-oriented Child
Psychotherapy15 in 1969 and Pets and Human Development13 in 1973, as well as numerous journal articles. A
principal reason for Levinson’s persistence regarding
the importance of human-animal relationships was his
belief that humans had become totally alienated from
each other and from nature.13
specially trained professionals, paraprofessionals, or
volunteers provide opportunities for motivational, educational, recreational, and/or therapeutic benefits to enhance the quality of life in a variety of settings without
setting specific goals. AAT is an intervention, delivered
by a health/human service professional with specialized
expertise, in which an animal that meets specific criteria is an integral part of the treatment process. Key
features include specified goals and objectives for each
individual and measured practice.20
The term “therapy dog” has been applied to dogs who
provide both AAA and AAT interventions with individuals or groups. Therapy dogs can be trained to assist in a medical crisis (eg, fetching medication, dialing
911), with treatment (eg, alerting someone with intense
startle reflexes to the approach of another person), with
emotional reactivity (eg, physical contact to help ground
someone with an extreme fear reaction), and with security (verifying safe situations, turning lights on for
those suffering from posttraumatic stress disorder).21
Under specific circumstances, therapy dogs providing
this type of assistance to individuals with mental disabilities also can be considered service dogs under the
ADA. Ensminger6 points out that dogs also can empower
individuals with panic disorder or agoraphobia to venture out into the world, and can help ground and orient
someone with a dissociative disorder. There also are anecdotal reports that service dogs can be of assistance to
children who have autism.
Another breakthrough occurred around the same time
that Levinson was promoting the benefits of animal-assisted therapy. Samuel and Elizabeth Corson pioneered
in the use of dogs, first in a psychiatric facility associated with Ohio State University and then with a nursing
home population in the early 1970s.1,6(p104),14,16,17 Corson
et al16 indicated that the introduction of the dogs into the
treatment of patients previously unresponsive to a variety of different interventions increased social interactions among the patients and also improved patient/staff
relationships. Subsequently, several studies were conducted between the late 1970s and the mid 1990s that
not only verified the Corsons’ results, but also made the
mind-body connection, demonstrating the relationship
between the stress relief provided by pets and improved
Animals also can be incorporated into therapeutic
cardiovascular health.14
approaches that focus on an Eriksonian life stage
Around the same time, 2 important organizations were approach.22,23 Fine suggests that AAI/AAT can be inestablished.6 Therapy Dogs International was founded corporated into therapeutic approaches to individuin 1976 by Elaine Smith,18 an American nurse who had als as they move through Erikson’s 8 stages of human
worked in England and observed how patients respond- development.
ed to visits by the hospital chaplain who was accom- THEORETICAL BASES FOR AAT AND AAA
panied by his dog. In 1977, the Delta Foundation was
founded in Portland, Oregon, by several medical and Kidd and Kidd24 acknowledged the lack of an all-encomveterinary professionals who were interested in the ef- passing theory for the human-companion animal bond
fects of human-animal relationships. The organization and examined the potential applicability of animal/anibecame the Delta Society in 1981, and also focuses on mal, human/human, and human/object relations model
training, certifying, and registering therapy and service theories for the development of a theory explaining the
dogs in addition to its continued interest in research into human-animal bond. After examining various theories
in each model group, they concluded:
human-animal interactions.19
The best that can be said is that sometimes, under
some circumstances, and in some ways, human/animal
relationships are analogous to animal/animal, or to
human/human, or to human/object relationships.24(p143)
Over the years, numerous different terms have been
used to describe the act of using animals to assist people.
To simplify matters, the Delta Society divided the types They called for research to establish a database that
of activities into 2 categories: animal-assisted activities could be used to develop theories relating to the human/
(AAA) and animal-assisted therapy (AAT). In AAA, animal bond.
April – June 2012
Kruger and Serpell20 also discussed the lack of a unifying theoretical framework for human-animal relationships or animal-assisted interventions. They divided the
various theories that have been proposed into 2 categories: those that are based on the intrinsic characteristics of the animals that contribute to therapy, and those
that focus on the animals as tools that can foster client
change. In the first category, they cite the “biophilia hypothesis,”* learning theory, and social mediation theories, attachment theory, object relations theory, social
provisions theory, and nondirective or Rogerian theory.
In the second category, that of the animal as a tool to foster or facilitate client change, we find cognitive and social cognitive theory and role theory. Animals are seen
as useful in changing such behavior because, unlike
many people, their feedback is both quick and honest.
In addition, working with animals can lead to increased
feelings of self-efficacy and accomplishment, which, in
turn, lead to more positive self-regard. In role theory,
as opposed to role playing, a person actually takes on
the new role and its responsibilities (eg, dog training
in a juvenile detention center). Success in the new role
is believed to lead to an improved self-image and selfconfidence.
In discussing attachment, Bowlby stated:
To say of a child that he is attached to, or has an
attachment to, someone means that he is strongly
disposed to seek proximity to and contact with a
specific figure and to do so in certain situations,
notably when he is frightened, tired, or ill….The
theory of attachment advanced is an attempt to
explain both attachment behavior, with its episodic
appearance and disappearance, and also the enduring
attachments that children and older individuals
make to particular figures.25(pp371-372)
Following Bowlby then, the relationship that many children and adult pet owners have with their pets can be
said to be a form of attachment behavior, particularly
when the animal serves as a confidant and provides solace during times of stress. According to Crawford et al,26
the aspects of attachment theory that are equally applicable to both human-human attachment and human-animal attachment include “emotional bond, goodness of
fit, secure base, seeking proximity, and representational
models.” To Siegel,27 a relationship with a companion
animal represents one of many potential social bonds.
*A hypothesis put forward by Edward Wilson, PhD, that humans evolved as creatures deeply enmeshed with the intricacies of nature, and that we still have this affinity with nature
ingrained in our genotype. Information available at: http://
Among the aspects that contribute to the benefits of the
human-companion animal relationship are the nonjudgmental characteristics of the animal’s regard for its owner, the childlike qualities of the animal (ie, neoteny), and
the touching that is involved in the relationship (ie, it is
akin to Rogerian therapy with the benefit of touch).
Parish-Plass,28 in particular, provides an example of the
application of attachment theory through the means of
AAT in an innovative program for abused and neglected
children in Israel. She describes how the use of AAT
can allow abused and neglected children to form stable
relationships with animals (ie, attachments) with the assistance of a therapist, thereby helping them to develop
healthier ways of relating to others and, hopefully, reduce the likelihood of them becoming abusive and neglectful parents themselves.
On a lighter note, Beck and Madresh29 compare attachments to romantic partners and attachments to pets,
concluding that “pet owners experience more security
in relationships with their pets than with their romantic
partners.”29(p52) Interestingly, this conclusion is at least
partially confirmed by an Associated Press poll in 2010
that asked pet owners whom they would choose if one
had to go: their significant other or their pet. The poll
found that 14% of those interviewed (n=1,501, nationwide) would choose their pet!30
Discussions of the benefits of pet ownership, AAA, and
AAT are frequently met with skepticism largely because
of the relative paucity of scientific documentation (ie,
randomized controlled trials) and the heavy reliance on
anecdotal accounts. Over the last 25 years, a number of
reviews of the state of research in the animal-assisted
intervention field have been conducted. In 1984, Beck
and Katcher31 reviewed claims of therapeutic benefits of
pets and also examined the research approaches to test
that hypothesis. They found primarily descriptive studies that presented but did not test …
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