All right, I think we'll get started. We are so appreciative to have you all here today on the last day. We weren't sure being on Wednesdays, sometimes those talks aren't as well attended, so we appreciate you taking the time to come out this morning. So you are in the right place if you are here for this talk, Unleash the Positivity, Using Animal Assisted Activities in Colleges and Universities. So I actually, I didn't tell you this, I think maybe one thing we can do is we can each introduce ourselves and where we're working, and then also what led us to be interested in presenting on this topic. So I can go first, and I'll introduce Colleen as well. So my name is Mira Menon, I am a psychiatrist at Ohio State University in Columbus, Ohio. I used to work at the Counseling Center, but recently switched over to the Department of Psychiatry. So I personally haven't had experience with working with therapy animals directly, but my colleagues have, and have always been excited when I've been in spaces where the therapy dogs come in for those stress-relieving events. I'll also introduce Colleen Tennyson. So she's a psychiatrist who works in the Counseling Center at James Madison University. Unfortunately, she wasn't able to make it in person at the conference, but she did a really good job of kind of like recording herself talking over her slides, so we'll play her section later on, and knock on wood, I hope I didn't jinx it, it should work seamlessly technology-wise. Awesome. Hi, everybody. Can you hear me okay? Fabulous. A little closer. I don't want to be so close that I'm like, okay. So hi, everyone. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. It is an outpatient private practice. However, I spent a very long time working with Dr. Mennon as well at Ohio State's Counseling Program, and worked as part of a therapy dog team there, which is how I got involved. So I'm going to introduce myself. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. It is an outpatient private practice. However, I spent a very long time working with Dr. Mennon as well at Ohio State's Counseling Program, and worked as part of a therapy dog team there, which is how I got involved. So I'm going to introduce myself. Hi, everyone. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. It is an outpatient private practice. However, I spent a very long time working with Dr. Mennon as well at Ohio State's Counseling Program, and worked as part of a therapy dog team there, which is how I got involved. So I'm going to introduce myself. Hi, everyone. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. It is an outpatient private practice. However, I spent a very long time working with Dr. Mennon as well at Ohio State's Counseling Program, and worked as part of a therapy dog team there, which is how I got involved. So I'm going to introduce myself. Hi, everyone. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. It is an outpatient private practice. However, I spent a very long time working with Dr. Mennon as well at Ohio State's Counseling Program, and worked as part of a therapy dog team there, which is how I got involved. So I'm going to introduce myself. Hi, everyone. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. It is an outpatient private practice. However, I spent a very long time working with Dr. Mennon as part of a therapy dog team there, which is how I got involved. So I'm going to introduce myself. Hi, everyone. I'm Lorraine Copley. I am currently the Medical Director at Providers for Healthy Living in Columbus, Ohio. And it was really interesting to see how we could use her dog during appointments and all the rules and regulations that needed to happen for that to happen as well. So I got interested in animal-assisted therapy and loved doing the research for it as a part of this. Great. So in terms of our disclosures, this presentation is one of the designated work products of the College Mental Health Caucus. I'm currently the chair of that caucus. So if you have any interest in being on any of our listservs or communities, please find me after this and I can kind of get your email address so I can send you how to sign up for those things down the line. And we do not have any disclosures. Oh, wait, but we do have one. So there are no clear practice standards for animal-assisted outreach and animal-assisted therapy. And so we've done this based off of our review of the literature, laws, and personal experience. And in terms of learning objectives, one thing we hope for you to get out of this presentation is being able to distinguish between animal-used and animal-assisted activities with different types of assistance animals like service animals and emotional support animals and to learn more about the different neurochemical changes that occur in patients slash clients and in the animals themselves and to discuss what data is out there to support or refuse claims of this type of therapy. And we're also going to talk about the legality and the ethics and discuss ways in which you might consider integrating animal-assisted activities into your clinical practice. All right. All right. I'm going to start us off with a little bit of background. Okay, so I'm going to start off with this question. Actually, before you go, one thing I forgot to mention, our talk is being audio recorded. So if you have a question, we'd love it if you could speak up into the microphone. If you happen to not be able to get there, just talk loud and then we'll repeat your question. Yes, please. Thank you. And it's such a small group, which is really lovely. I wish that I could get all of us to kind of sit right here and we could all just have a nice conversation that doesn't have microphones and all this thing and we could have a great talk about this. So I'm going to start off with this quote from Florence Nightingale because I feel like most people recognize that name. She's quoted as saying, in reference to a small pet, that a pet's often an excellent companion for the sick, especially for long and chronic cases. So we're going to start off with some fun. Let me start with... No, no, no. No, no, no. Hold on. Don't do it. We're going to start off with this. Discover relief from fatigue, depression, and stress. Discover DOG. Prescription strength. Dog is the non-harmful treatment that is shown to lower blood pressure and risk of heart disease, prevent allergies in children, reduce stress levels, decrease anxiety and depression, strengthen your immune system, and increase social interaction. Side effects may include talking to ridiculous dog voices, picking up poop, making funny faces, being jealous of your dog kissing other people, pretending your dog has a job and has to pay rent, excessive social media posts, laying on the floor pretending to die to see if your dog comes to help you, having full-on discussions with your dog, feeling guilty if you don't tell your dog you love them before you leave the house, saying bless you when your dog sneezes, calling your dog by names other than its actual name, congratulating your dog's bowel movements. Discover better health. Ask your veterinarian about DOG. So this obviously cracks us up. We could not do it. Oh, no. Hold on. Wait. Hold on. Stop. Don't skip the end. Okay. So this is from an agency called the Pet Effect, which is lots of fun. And they have one for cat, too, which I find very amusing. Oh, don't play. I'm hitting alt tab. We're going to do it. It's going to happen. I think it's hysterical. We practiced all the things. Okay. You cannot be tested with the computer. Okay. So it's from an agency called the Pet Effect. They have one for cats. They have one for dogs. Go look it up. It's fun. It'll make you laugh when you're having a bad day at work. So it's not a foreign idea to us that animals are part of our culture, part of our world. It's not the case in every culture. It is here in this country. However, that wasn't always the case. So very, very, very remotely, like before the Middle Ages, that was not at all the thing. In fact, there was animism, and animals were considered spirits, and those spirits could contribute to illness, and that's how animals interfaced with medicine or with our concept of medicine. And so the idea that animals could be part of treating a patient was limited to the idea that you might need to appease an animal spirit, and so that's more of the shaman idea. It wasn't, in fact, until the 17th century when, during the Enlightenment, people like John Locke, who was a physician and a philosopher, started talking about the idea that animals could be pets and could actually have a value in treating children or in helping children as part of normal development even to learn how to care for things and learn how to have a sense of responsibility. That was a relatively new idea. And you start to see that in literature. You start to see that as a theme in how children start to understand their world around them and how they start to develop a sense of responsibility. In mental health, there was actually a place called the York Retreat. We're talking now more mid-1800s, where they had this revolutionary idea that inmates, they weren't called patients at the time, if you were insane, I'm putting quotes around that because that's the vocab that would have been used at that time, should be able to wear their own clothes, should be able to roam around the campus of the hospital, should engage in handicraft, should read, should try to be as social as possible. These were very, very new ideas compared to the types of conditions that patients would be housed in at that time historically. And animals were part of that. They became part of that. So on the campus, there would be birds and horses and dogs and cats, and it would increase social experiences. And there's good documentation of that in physicians and other people describing that in these institutions. Bethlehem Hospital also became an example of that. Now we're talking more late 1800s, after a really critical report came out of the appalling conditions that folks with mental health were living in. And within about 30 years of that report in London, there were routinely animals, quote, on the unit or on the campus. And so we see this cultural shift happening, starting in the Enlightenment, coming into a couple of centuries ago. And now we have videos on YouTube about man's best friend and dogs as treatment and these kinds of things. So we're going to take a minute to do some definitions so that we're all using the same vocab. So we're going to start with service animals, okay? So we're going to talk mostly about dogs, but service animals in this country can be dogs or they can be miniature horses. These are the only two species that can be a service animal in the U.S. And they are protected animals by the law that are defined as individually trained to do a work or perform a task or tasks for people with disabilities, okay? So an example of that might be alerting someone who has a hearing impairment to a particular sound. I think about the sounds that get made across work for someone or the doorbell is ringing or something like that, okay? Protecting a person while having a seizure. I've actually witnessed a seizure dog in my own personal life do their thing and it was pretty darn amazing. I've never seen a dog hop on top of a patient so quickly when somebody tried to move that patient while they were seizing. And the person who was trying to move them was a physician and the dog hopped on top of them in public and basically was like, you're not going to touch my person. It was amazing. Reminding a person to take medication at a particular time every day or as they're going to sleep. Calming a person with PTSD down when they're having a panic attack. Waking a person up if they're having a nightmare who has PTSD. So a question I've gotten asked a lot, I think we get asked a lot, I think psychiatrists and other mental health professionals get asked a lot is, what can I ask about that? In my practice, what can I ask a patient to do or not do? Things like that. So if a patient's telling you they have a service animal, you can certainly ask, is this dog a service animal required because of a disability? And what work or task does this dog do? Or have they been trained to do? Here's what you can't ask. This is particularly important in colleges. Every college I've ever been affiliated with or worked with students who are going to has an ADA office, has an office of disabilities, has some kind of agency like that. I personally would see violations in this all the time. I don't know if you all would see this as well. You cannot ask, what's the disability? You can't say, give me your medical documentation about this dog or the training documentation of this dog. You also can't have, well, show me what this dog can do. Show me what your dog does. You can't test the dog to somehow make the dog perform for you. Okay? Let's compare that to an emotional support animal. I feel like this has been all over the news. Everyone has seen the TikTok video of the emotional support peacock. I think, probably. An emotional support animal provides passive support that helps to improve the effect of the disability that a person has. This is not a protected class of animal. A patient needs additional permission to be allowed into spaces. As a practitioner, you can decide how you want to handle this in your practice, whether or not you wish to allow these animals in your office. Using an animal to ground, for instance, that would be a service. But an animal that makes a patient feel better all the time or keeps them kind of calm all the time and provides support just by being there, doesn't have a particular skill or service it's providing, that's on the emotional support side of the story. Okay? This can be any animal. Raise your hand if you've been asked to write letters for an emotional support, I don't know, parrot. What's the oddest animal you've been asked to write a letter for? Emotional support rat, I think, has been mine. Emotional support snake. Emotional support what? Yeah? A snake, okay. Yeah, so emotional support, it could be any species. I heard someone yesterday mention an emotional support spider. Yeah, okay. But this is not a protected, in this country, this is not a protected thing. You can't walk your emotional support animal, and this is where additional documentation is routinely requested by places like airports and things, and then that's how our professions get involved to provide documentation, because it's not an automatic protection. So many agencies, like TSA or other said agencies, want that documentation to include acknowledgement of a clinician-patient relationship, they want to know what the disability is, they want a description of the animal, they want to affirm or some kind of affirmation that there's an alleviation of the disability in some way, or there's some kind of role in treatment, they want some clarification of where the animal is used and that the animal is necessary. So, for instance, I will tell you that the HSA, I'm using the wrong terminology, but the HUD folk, the HUD folk, Fair Housing Act folks, so the things that I get from students about, like, my landlord wants this, requires me to say that this animal is medically necessary. That's a pretty high bar, right? I personally have not ever seen an APA standard that says if Prozac doesn't work for a patient's depression, you should try a dog. I've never seen that, right? So that's a pretty high bar, right? That's me, that's an opinion. I know that I have colleagues that wouldn't agree with me. Let's define animal-assisted therapy. So animal-assisted therapy is, the key piece is it's a goal-directed intervention, where there are specific things the animal is doing in the treatment process. There are specific goals. This is going to be delivered with an animal and a healthcare professional with a specialized expertise. It's going to be within the scope of practice. So, for instance, the example I would give is I'm practicing psychiatry and there's a dog with me when I'm doing animal-assisted therapy, so I'm not practicing any kind of therapy. I don't, like, know about. We're doing CBT, for instance, and there's a dog that I'm working with at the same time that we're utilizing. So key features, specific goals, specific objectives, documenting and measuring progress. Compare that to animal-assisted activities, which may have a more educational or motivational or recreational kind of benefit. In a college or university setting, a lot of times this may be more related to something like an outreach event or a stigma-decreasing event, something like that. So this could certainly be done by professionals or paraprofessionals or sometimes even volunteers that have specialized training, but this might be for a population of people, so a population, for instance, of students, and it might not be documented in a specific patient's chart or for a specific person but more for a group. And what's going on during that visit might be more spontaneous. It has more generalized goals. So for those of you who are more visual and like the comparison, have at it. Okay. All right. I am going to turn it over to Dr. Singh who's going to go science on you. Okay? All right. All right. Hi, everyone. So I'm going to be talking a lot about the neurochemical changes when what we see in the humans as well as in the dog. So just take a look at these pictures and think to yourself, how do they make you feel? If these dogs were right near you, you could pet them, how would you feel? So some of what I would feel if I looked at these pictures was I'd feel happy. If I was stressed out about something like a big exam or a big presentation coming up, I would start to feel a little less stressed out, and this is some of what we're going to talk about in terms of those neurochemical changes. So the effect on cortisol. Cortisol is a stress hormone that's produced in the adrenal glands. It's released during activities of daily life and more are released during stressful situations. So in this, there's a study that I looked at where cortisol was measured at baseline and then at one hour after healthcare workers either rested for 20 minutes or they visited with a therapy dog for five minutes and 20 minutes. So if you look at this graph, you can see that the black is at baseline before the interventions and then the gray is after the interventions were done. And they found that there was a decrease in cortisol with each of these interventions. And a lot of that could be due to stress relief, even resting will cause some relief in stress, and then also the social bonding aspect. Now to look a little bit at the immediate versus chronic effects. So therapy dogs, when they were compared to quiet reading and healthy adults, like we mentioned before, decreased cortisol and stress is there. There's also a found decrease in blood pressure. So when they looked at quiet reading versus time with the therapy dogs, it was found that blood pressure decreased after a dog visit with mean arterial pressure decreasing from 87.6 to 84.4 after the dog visit. It isn't a significant amount, but it's definitely there. And then there was a study done with about 6,000 patients ages 65 to 84 who had untreated hypertension, and they were followed for 11 years. They found that 36% were current pet owners, and then they looked at how much physical activity these pet owners did, and they found that there was an overall reduction of systolic and diastolic blood pressure, which led to a lower risk of developing cardiovascular disease. So, some of that probably was because these pet owners did more physical activity with their pets, but we also wonder if some of it was a reduction in blood pressure because they had these pets with them. There's also an increased endorphins with therapy dog visits. So endorphins activate the opioid receptors in the brain and are released when there's stress and pain. Studies show that spending time with therapy dogs can increase endorphins and also have an analgesic effect, which then reduces pain. Further, there's an increase in oxytocin and prolactin with therapy dogs. Oxytocin is produced in the hypothalamus and usually released during labor, and it also plays an important role in social bonding. In this study that compared the reading and the interaction with the therapy dogs, they did find that the levels of oxytocin increased after both interventions, but increased more so with playing with the therapy dogs. The people in this study felt that their stress and pain had both decreased and their mood and social bonding had increased a lot. Also there's an increase in dopamine, which is the pleasure neurotransmitter. There was also a study that Barker did with therapy dog visits to healthcare workers and found that there's a decrease in cortisol level even after a five-minute intervention, which is pretty significant. And then over three months, there were therapy dog visits and more of the chronic effects. In the three months, every other week, therapy dogs visited seniors with dementia. And they found that there was a reduction in chromogranin A, which measures stress by 57%, compared to patients who didn't have these visits and their chromogranin A increased by 19%. So we talked a lot about what are the effects on humans, but what about the dog? So what we found was that visits to humans resulted in the dog having increased endorphins as well, increased oxytocin and prolactin, increased dopamine, but also increased cortisol. So it was found that dog cortisol levels increased on visit days versus non-visit days, and the dog cortisol increased as the number of visits with patients increased as well. So it's important to keep in mind that dogs have to stay on command for long periods of time when they're working, and that sometimes tires them out, which then leads to an increase in cortisol. But you can also see the positives that the dog has when they're interacting with the humans. So it's important for the dog to take adequate breaks when they are working, maybe not having back-to-back patients so they can have time to rest, go out, walk around, possibly doing half days of work rather than full days, and ensuring that the dog doesn't have to work every single day of the week. And these are some considerations that we'll talk about as we go through the talk. Now I want to bring up a little bit of clinical impact research. We talked about some of it, but there's also some specific to college mental health and college students. So looking at this, the University of Sheffield Counseling Center had a pet therapy event, and it was voluntary. The students saw one to two guide dogs for 15 minutes each, and they were able to speak with the dog handler and also interact with the dog. There were 127 students that were looked at, and their blood pressure was measured as well as their state anxiety inventory that they filled out. And in terms of the blood pressure, they found a statistically significant decrease in blood pressure after visiting the dogs. The systolic blood pressure went from 131 to 129. Diastolic blood pressure went from 80 to 78. So while this was statistically significant, it really wasn't very clinically significant just because it was a very small decrease. And then in the figure, you can see the state anxiety inventory scores. On the x-axis is the pre-score before visiting the dogs, and on the y-axis is the post-scores. And all the data points that I've circled there that are below the central line are all the students whose anxiety decreased after seeing the dogs. So overall, as you can see, most of the students' anxiety decreased at least a little bit with visiting the therapy dogs. There was also another study that looked at 55 students at a college in the southeastern United States. The students interacted with the dog between five minutes and two hours, and they found a lower statistically significant self-reported anxiety and loneliness scores. Another study looked at 790 students who were participating in an informal outreach event at a university with the therapy dogs, and they visited them for about 10 minutes each. 694 students completed this survey, and 92.9% reported a decrease in their stress level. There was also a study with 78 students at VCU, and they were randomly assigned to interact with the therapy dog for 15-minute sessions, and 57 completed the questionnaires. And this was done during the week before final exams when stress levels are traditionally pretty high, and they found an improvement in scores on the stress scales, but these were not statistically significant. And then there was also a study done with 51 college students that were selected based on their Beck Depression Inventory Score. And they were either assigned to an animal-assisted therapy plus general therapy group, an animal-assisted therapy only group, or a control. And there were seven 45-minute weekly sessions of treatment that were done. The same dog was used, and the same group moderator was used. And they found that there was a decrease in the BDI scores, especially for the animal-assisted treatment group, and then also a decrease with the animal-assisted treatment plus therapy group, but that was not statistically significant. So thinking about all of these studies that I just prevented, this was only some of them, not everything, but research for animal-assisted treatment and animal-assisted activities can have a lot of difficulties as well. So the first difficulty is questioning, what is the intervention really? Because it's different, and there's not a whole lot of consistency over the studies. Some of them that we looked at looked at minutes with an individual to an hour with a group, one-time exposure to the animal versus ongoing exposure. And then also, was it a therapy that they did, truly in an office, or was it just a general activity that college students did? Further, trying to think about what is an appropriate control? Is it the handler of the animal, or the particular animal that's yielding the effect? That can make a difference, because it's really hard to know what the animal might be responding to, which then affects what the humans might be responding to. And then also thinking about, should interventions be compared to other activities, like quiet time or reading? A lot of studies said that the control was the quiet time or the reading, and at the same time, we also know that that can also impact stress levels and reduce it. Also thinking about, is the study large enough to generate statistical power? A lot of the studies that we saw, or that I presented, were less than 100 people, sometimes even fewer than that. Is the measured outcome a neurochemical change, a vital sign change, or a subject-reported change? That can also vary. And then, is the population being studied a psychiatric population, or is it just a general population of college students? So there tends to be a wide array of research studies on the topic with less consistency in the studies, like I mentioned in the last slide. Some studies have to do with the psychiatric population, but others are in various other places, like nursing homes, or just in general in the college campus. There's not really going to be too many other randomized control trials, but here is information on two big meta-analyses that were done. So the first one by Nymer and Lundahl in 2007 had 49 studies in it, and it looked at animal assisted therapy and the improvement in outcomes in autism spectrum symptoms, medical difficulties, behavioral problems, and emotional well-being. They found that there was a pretty low moderate to a high effect size for each of these, and dogs were the most consistently studied in these studies and seemed to have a moderate effect size. There was another meta-analysis by Sauter and Miller, which had five studies, and they showed overall support for animal assisted therapy and animal assisted activities to treat depression with moderate effect sizes. And that was done in psychiatric patients as well as nursing home patients. So now we will talk a little bit about integration into clinical practice and integrating like animal assisted therapy and animal assisted activities. Dr. Tennyson will be on video since she couldn't make it today, and she'll be presenting this part of the talk. Hi. My name is Colleen Tennyson. I'm a psychiatrist at James Madison University, which is a university located in Harrisonburg, Virginia. In our school, we have around 20,000 undergraduate students and 2,000 graduate students, so predominantly an undergraduate campus. I've been working at Jamie since 2007, and I introduced my dog, Francis, as the first animal therapist in 2011. So I'm going to spend some time today talking about how to integrate animal assisted therapy into clinical practice. So I'm going to start by pulling up our slides. So training the animal and handler is foundational to integration into clinical practice. We also need to keep in mind the legal and ethical points just presented. While there are many organizations offering training or certification, there are no formal standards. We probably think most about training the animal, but training the handler and the clinician is equally important. The International Association of Human-Animal Interaction does have a white paper that discusses both human and animals, though this is focused primarily on animal assisted interventions. The Higher Education Mental Health Alliance produced a guide for animals on campus with contributions from Dr. Menon. Personally, I also found good insights from Cynthia Chandler's book, Animal Assisted Therapy and Counseling, published in 2017. The training you consider may be impacted by resources, availability, expectations of your employer, or expectations of your insurance. Here are three common resources that have been used to support therapy animals. Therapy Dog International is a volunteer run organization that provides training, testing, and registration of therapy dogs and their volunteer handlers for the purpose of visiting nursing homes or hospitals. Two unique parts of the TDI test include a temperament evaluation and an assessment of the dog's behavior around people using service equipment, for example, a wheelchair. TDI also offers an insurance program, but only if you are working in a volunteer capacity. The American Kennel Club, K9 Good Citizen, is focused on dog obedience and responsible dog ownership. They have different training programs depending on the goals of the owner. The K9 Good Citizen program tests a dog's skill on 10 items. One, accepting a friendly stranger. Two, sitting politely for petting. Three, appearance and grooming. Four, out for a walk. Five, walking through a crowd. Six, sit and down on cue and stay. Seven, coming when called. Eight, reaction to another dog. Nine, reaction to distraction. And 10, supervised separation. AKC has recently developed a new therapy dog title for individuals that have trained with an approved organization. There are over 200 organizations that have been approved. Again, this is just a title, but when you approve volunteer hours, your title changes. So after 400 therapy dog visits, you will earn the title AKC Therapy Dog Distinguished. Pet Partners, which was historically the Delta Society, began in the 1980s with a focus on the human-animal bond. As the name suggests, they work on training a team, the animal and the human volunteer. They also focus on animal-assisted interventions, programs that may serve in a nursing home, school, or library. They recently created an association of animal-assisted intervention professionals, which has a membership, training, and test for certification. When thinking about any training, it is important to consider what you need. Training for your dog, training for the handler, training for both. And as previously discussed, being mindful of ethical and legal considerations. After the formal training, it is also important to informally begin introducing your animal therapist to your work environment. Your colleagues will also need to be introduced to your dog if you work in an environment with other individuals. Spending time with your animal therapist prior to clinical appointments will help navigate simple needs throughout the day. You will need to navigate the expectations your colleagues may place on your animal therapist. You may need to navigate expectations of your animal therapist. Figuring out bathroom breaks for your dog is essential, but it's also important to consider what your dog will do when you need a bathroom break, especially if your bathroom is located further down the hall and you don't want the company. This will also provide you an opportunity to see what supplies will be needed to keep on hand, including a dish with fresh water and a quality stain and odor remover. With the next few slides, I will illustrate how our office incorporated animal-assisted therapy. Again, at JMU, Francis was our first animal therapist, but he has since retired. We have had a total of seven other animal therapists working, and we've learned a lot along the way. Another psychologist working with me on staff has an interest in animal therapy for cats and is currently training her cats. She has also started an equine-assisted therapy program at a local barn. So the options seem endless. Prior to working with any patient, we created signage on our front door and our website that indicate dogs may be in the center. On our website, the dogs even have their own profile. We did get additional air filters in the center, but later learned that they probably didn't fully remove dander. Patient consent and education is generally done prior to meeting with the animal, but this may not always work. When I first started working with Francis, I typically provided consent on the way back to my office from the waiting room. It was rare, but on occasion, a patient would not be interested, and I would leave my dog with another clinician. Considering the purpose of using an animal therapist for a specific goal-directed intervention, our primary goal was increasing patient comfort and establishing rapport. With time, however, we have formalized our consent process to make sure patients provided consent prior to the introduction of the animal therapist. Sometimes this still can't happen, as we would like, when, for example, a patient gets rescheduled on the day an animal therapist is in the office and hasn't yet consented. Making introductions. Some of the most interesting exchanges can come in the first meeting between the patient and the animal therapist. I have had patients lying on the floor with my dog, and I have experienced my dog ignoring my patient and hiding under my desk, both experiences directly related to the patient presentation. When you're orienting a patient to animal-assisted therapists, it can be helpful to alert the patient to how interactions may go with the animal therapist, particularly if there are unusual traits of the animal that should be noted early. It's important to solicit feedback from the patient during the session and toward the end of session. For example, what was it like having a dog with us today? At times, you may make direct observations of the interactions you see. It seems like the dog really likes you, or it seems you are not quite interested in the dog, or it looks like there's something in your bag the dog would like. In my office, this is generally the student's lunch. There may be specific interventions that you consider in working with a student, working with a patient and an animal therapist. For example, you may work on assertiveness or patient, patience. A patient who is struggling with effective communication skills might work on assertively calling the animal therapist in session. I have utilized Frances in an empty chair intervention and once had a patient come out to Frances for the first time. Not only can the animal therapist be a direct influence on the patient, but the patient observing the clinician handler can also be equally impactful. The clinician may model behavior that they are trying to introduce to the patient. I may choose to place boundaries on my interaction with the animal therapist. I may illustrate assertive communication with my direction with the animal therapist. And the patient may see me being empathetic with the animal therapist. Regarding documentation, there are no standards here, but we always document that the animal therapist was in session and highlight any particular goal that was accomplished. The last thing to note is to expect the unexpected when you're working with an animal. There are certainly things that I didn't expect. I didn't expect my dog to mark one of the other counselors' bags. And there were ways that I interacted that I wouldn't have done if there weren't a dog present in the room. There are also ways to incorporate the animal therapist outside of the clinical space. We have created social media content, had our animal therapists participate in suicide prevention walks around town, and worked to engage different underserved or underrepresented populations around our campus. One problem that has developed over the years is how to manage all the requests to work with or engage with the animal therapists. This screen shows a variety of social media posts that we created. Even though some of these statements may be things that we could communicate to students, it makes a world of difference coming from a dog. On our campus, we played on the faculty office hours and held AAT, Animal Assisted Therapy, office hours. These were always a good opportunity to engage with students, promote mental well-being, and decrease stigma. In this picture, you will see us walking around campus in other areas, engaging with students and with our animal therapists. Francis was part of the marketing when we moved offices to a different location on campus. Duke Dog is the JMU mascot, who is pictured with Francis on the right-hand side. In the same picture, Francis also has a Walk for Hope t-shirt that was redesigned to fit him. In the bottom left side, you'll see Wicket, who's advertising Puppy Pride. This was an opportunity for LGBTQ identified individuals to have private time with the dogs. Just a variety of ways that we interact with students and with the dogs. That's what I have to present about integration into clinical practice. Any questions, I know my colleagues will be happy to answer at the appropriate time. And I thank you all for your attention. Okay, so, whew, videos are hard, everybody stretch, you've been sitting here an hour, keep it real. Okay, thank you for your attention, we appreciate that. I know Dr. Tennyson really wanted to be here and it just could not work. So we're going to take a hot minute, talk about the legality and ethics, kind of putting, kind of assembling together some of the things that folks have found have been helpful at their agencies, along with some of the data we know that Dr. Singh gave us information about impact on the dog. We want to also think about setting appropriate expectations, those kinds of things. Okay, so, set the expectation well. You would do that any time you brought any new kind of procedure or treatment or any kind of new professional to your agency. I would urge you to think about this as a new kind of professional at your agency. We have seen a lot of models in, I'm part of a listserv, and we've seen a lot of models about who pays for the dog, who pays for the dog's training, certification, and care of the dog. I will tell you that in my particular experience, I knew I wanted to do this, so I went and when I got my dog, I did a lot of research about what type of dog I was going to get, what I was looking for in a dog, how I was going to train a dog, and there was a lot of cost in doing that, and I was at a point in my career where I knew I wanted to do that, and I went to my agency leadership and said, I am going to do this. Would you like to be part of it, or am I going to do this in private practice? Because I've always wanted to do this. I had had a very good experience as a resident and fellow in another setting and knew that this was an eventual professional goal. I also have seen situations where it is the agency that owns the dog and pays for those things, and then whomever is caring for the dog and has the dog, it's in their contract that if they were to leave the agency, they have to purchase the dog or they have to pay back the cost of the training of the dog or whatever that looks like, so I've seen a lot of different kinds of setups. Dr. Tennyson hit upon making sure the dog's schedule is appropriate. I would urge you to think about contingent planning for emergencies. I was working in an agency where there would be times that I was the only person who could do a pink slip, that's what we call it in Ohio, or an emergency affidavit for mental illness or emergency hospitalization. I had pretty strong feelings about walking in with a dog to a patient that might be agitated that I didn't know what I was walking into, and so I had kind of that contingency planning for who was going to help with the dog if I could not be with my dog at that time, or where the dog was going to be at that time. I would urge you to have a policy in place as well around if there really is an incident with your dog, a dog scratches somebody, heaven forbid a dog bites somebody, what and how you're going to handle that as an agency. I think that's probably part of any good policy. I would urge you to set boundaries with your leadership, with your students, or your patients, with your staff about how and when your dog and you will be used. I found that people didn't get it until I started saying to people, you are not able to check out my dog like a library book, right, and I kind of come with the thing, like I would have clinicians, very well-meaning clinicians who are great colleagues who would say, oh, we love this, this is fabulous, we can see such value in this, and I would love this dog to come to my group, and I was like, that's great, we'd love to come to your group, and they were like, you can't come, this isn't a closed group. I was like, I get that. That means my dog can't come either though, right, because I'm the one who's reading the situation, and we kind of travel as a team, right, we together provide this. That would be like me saying, here's my TMS machine, take this to group, and use it on your patients, it would be fabulous, right, that's a bad, bad, bad idea, right, or things like I was a psychiatrist, one of just a handful in our agency, and we would have staff members from across the campus call and say, we heard Dr. Copley has a dog, and we would love for her to come in three days, all day long, two hour, welcome for whatever students, and it's like, Dr. Copley's got a caseload, you know, Dr. Copley has, you know, whatever, and so kind of setting boundaries of this is not, you know, like the dog is not the mascot for the Counseling Center, the dog is providing care, and so figuring that out, so setting those boundaries and making sure that's well communicated is going to be really important wherever you're practicing. Making sure we had a lot of people very concerned about like where my dog was going to poop, and I was like, I feel very confused about this, because I can't believe they just recorded the word poop at the APA, and I said it, I just want you to know it just occurred to me. Like, it's not like there's never been a dog on campus before, but that was like a thing, and we had to write a policy for it, and we had to like assure people it was going to be okay. From a student perspective, or a patient perspective, how do patients handle if the dog's not there that day, or they expect the dog to be there that day, how will patients manage it if my dog passes away, or the dog is sick, or the dog can't, the dog is permanently not going to be there for some reason. So we, you know, really need to think about that from a therapeutic setting as well. So I found that my days with the dog in the office, people would say to me things like, oh it's so cool, you get to bring your dog to work, that's wonderful, I want to bring my dog to work, and I was like, the days I bring my dog to work are harder days. These are, like, I'm here longer, I'm working harder on these days, everything takes longer, and it's because everyone wants to come and interact with the dog. I sometimes think that we were doing as much goodness for our staff as our patients, which is fabulous, and it doesn't make for like an efficient, well-run day. And so, you know, I can remember having staff say, well every time he's here I'd be happy to jog with him at lunchtime. Like, no, no, right, so you had to have good boundaries. We would have students who would say, I would love to come see a psychiatrist, that would be great, I hear there's one here with a dog, I only want to see her, right. At the time we had between three and five psychiatrists covering almost 60,000 students potentially. We don't have the bandwidth for that, right, we can't do that. You can't only have the, you know, however many appointments with Dr. Copley on that day with whatever, it can't happen, right, it's not, it's not feasible. My agency, Dr. Tennyson mentioned at one point there were seven dogs at their agency. That's amazing, amazing, right, and you have to be able to manage that and how you message that. Think about what do you do if the dog's having a bad day, because your dog will have a bad day, okay. From a liability, I always get asked this question, tell your malpractice provider, consult with them. Mine directly said to me, your dog's not practicing medicine, so we're good and we don't know anything about it. We've never heard about it, you don't practice, like there happens to be a dog in the room, we don't care, we don't cover it. It would be just like there's like a fish tank in the room. Look at your homeowner's policy. Most homeowner's insurances have a clause in it for dogs or you can put a rider on your homeowner's policy. There are agencies across the country that offer separate liability policies for dogs, so do that. Dr. Tennyson mentioned like TDI offers insurance policy for dogs. It only covers you for volunteer work and so I would urge you for whatever insurance policy, if you do decide to buy one or if you ask your employer to buy one for you, make sure it covers you while you're getting paid to provide a service, not just for volunteer work. Make sure it covers you for both direct work with the patient and I was out on campus and somebody ran up and threw a fizz of beer across my dog and wanted to say hi, okay. I would urge you to document informed consent. She reviewed that. She reviewed posting notice of the presence of a dog. You need to consider potential risk versus benefit to everybody that walks in your office. In our case, we consulted with a vet about the potential for allergies and things like that. Keep your handler certifications current in the area. Keep the dog's health record up. Talk to your lawyers. Most college counseling centers have their own lawyers. Talk to them too. They want to know. Document every interaction a patient has with the dog. Document their responses to it, whether or not they want the dog to come back or not, whether or not there was an incident, document how well it went. And just like if you were doing a particular type of therapy in the room, you engaged in dear man with DBT, you did some other thing, you would document that you did that and how the patient responded to it. You need to see the dog intervention that way as well. And so it would go in my mental status exam. The patient appropriately interacted with the dog. The patient expressed distress because the dog didn't interact with them. Whatever the thing was that happened with the dog. You know, we were encouraged to do that to help protect liability. I consulted with people on campus. We have a big hospital on campus. They had a rule in the hospital that no patient who had not had a physical exam could be seen by the dog. And they were trying to prevent any kind of thing like, oh, we had an allergic reaction to the dog or we got scratched by the dog or we had whatever thing happened with the dog. So thinking about the environment that you're working in and what your policies need to be surrounding that. Any questions about that? Yes, ma'am? Oh, come on up to the hot mic. Or I'll repeat it either way. Okay. My question is, if you say that the malpractice provider tells you to not say anything and the dog just happens to be there, but yet you document it, in the patient's file, how does that work? Oh, it doesn't keep you from getting sued. They just don't cover you. So the question is, the malpractice provider says, the question is about how does your malpractice insurance, your professional malpractice insurance handle it? So they basically made it clear to me that they weren't going to cover it. They didn't regard it as part of their malpractice coverage. However, I wasn't willing to have a situation where something was happening in the room, be it good or bad, that wasn't getting documented. Because I think that that documentation would be the only thing that saved you if you really did have a patient who decided they wanted to sue you for something. Because it would be a, I would assume, a civil type liability. And that documentation would then get pulled by my homeowner's insurance. In the case of Ohio State University, because it's a public university, what our lawyers encouraged us to do was to put into my job description that my job description included wielding a therapy dog as part of my practice. So then in the eyes of the state, I was practicing according to my job description. And so then I had all the protections of Ohio State University. I'm sorry, that I had a therapy dog as part of my practice. So my position description for the state didn't just say the chief of psychiatry is a psychiatrist. It said the chief of psychiatry is a psychiatrist who participates in animal assisted therapies and activities and has a TDI certified therapy dog that participates. And so then the thought, the strategy was that if there really was something that happened on campus with the dog, that then it would be under the purview legally of Ohio State University, as opposed to Ohio State saying, well, it's not in your job description that you use a dog. That's your problem, Dr. Copley, which I would hope would never happen. But that was one of the strategies that was used. I think I've heard across the country of different colleges utilizing different things and doing different things. And I have colleagues who have purchased separate insurance products for their dog in practice. Because the real concern is not necessarily that you are getting sued for medical malpractice because of the dog. You'll get sued for medical malpractice because you didn't do something you should have done and a dog was in the room. The real concern is that your dog bites somebody or hurts somebody or does whatever, which has nothing to do with the medical care necessarily that you are providing. That's the concern. Other questions? Oh my gosh, I stopped the whole process. I didn't mean to. Go ahead, please. No, just two quick questions. To the first, you mostly answered this, but I'm recently out of residency training. And one of the issues I was always told with bringing in a therapy dog was that we could not, or even signing paperwork saying that someone could have an emotional support animal in their living space, was that we could not attest to the safety of the animal. And because of that, there was too great of a legal liability there. Was that accurate? Or was that just coincidence? So I don't write emotional support animal paperwork. In fact, you haven't lived until you are sitting in a room with your therapy dog providing a therapy dog intervention and your patient, who knows that you love dogs and love dogs and knows that they love their dog. And they say, Dr. Copley, couldn't you please write me an ESA later? And you say, no way. And then you explain to them, no, we aren't doing that. Now, in the case of most of the agencies I've worked at, we've actually had policies that are a big old no. And we are lucky that we have providers in the area that do evaluations specific for it. My hang-up has always been that I have never seen either a form that I have to fill out or guidelines that I have to meet that say, this is medically necessary. To me, that's a very high bar. I think your Prozac for your depression is medically necessary. I have no problem with that. I got evidence for that. Your emotional support animal, that's a harder one for me. And I say that very directly to my patients. I say, pets are clearly very good for us, just like getting good sleep, having good nutrition, all these other lifestyle interventions. But for me to say it's medically necessary, I just can't do it. And it's awesome to have to do it while your dog is licking them. But I absolutely do it. And then we have a conversation much like we just had, which is, there's a difference between an emotional support animal and a service animal and a pet. And I have described this animal as a pet. Thank you. That's very helpful. One thing to add to that, so the American Psychiatric Association also just very recently released a resource document on emotional support animals. And also, quick plug, if you happen to still be in town at 345 today, I'm doing another presentation on that. But I think there are some forms that do specifically recommend that the person writing the letter say that they have evaluated the interaction for ESAs, evaluated the interaction between the patient and the animal. But what the APA, and it's not a position statement, but what this resource document kind of acknowledges is that as psychiatrists, we don't have the specific training to evaluate that relationship. And so I don't know that I would encourage someone to kind of make that attestation. And I've definitely seen letters out there where someone I know didn't ever lay eyes on the animal said, this person needs the specific cat named Fluffy, who they have known for x amount of time because of this disability. And I'm like, ooh. Do they, though? Yeah. Thank you. No, that's very helpful. The only other question that I had was primarily I work with patients that have autism spectrum disorder or intellectual disability. And in those cases, while I feel that an animal would be very helpful for them, there's also an incredible amount of impulsivity that I can't account for for those patients. In particular, a lot of times they have staff with them to even prevent them from coming behind my desk and not really having those boundaries established. Do you feel like there would be any way to conduct that in a safe environment? Or do you feel like it would just be kind of at the purview of whatever that patient presented as? So if you know the patient well enough, know that they would be gentle and respectful and boundary appropriate. Do you mean allowing the animal to come into your office? Yeah. I guess I would be concerned about the safety of the animal just given some of my patients and the way that they respond, although I wouldn't be able to predict for sure. So I want to make sure that I'm understanding your question. Do you mean, because I'm hearing two questions there, do you mean the patient already has a pet? No. Or you mean I am recommending they consider getting a pet? Well, if I were to even ask, work with my, I'm sorry, I wasn't very clear what that was. Work with my company and say, could we bring in a service animal for certain patients? Kind of doing, providing, not what you're providing, but similar, but not being able to really be steadfast in, yes, this patient I can 100% guarantee is going to be, you know, I just would worry about the safety of the dog. So how would you want to navigate that? So if a patient has a service animal, in the US, they're protected. So you have to allow the patient to have the animal in unless the animal is destructive, in which case you can bar a service animal. Yes. Yes. OK. If the animal is a ESA, you can set that boundary in your office, right? And so you can say to a patient, I understand that Fluffy is an ESA, and I don't think this is a safe environment for you to have Fluffy in here. So please don't bring him. What if the provider, yeah, the provider has? So if it's a therapy animal? Yes. I'm sorry, I'm still rough with the lingo. So you have the animal. If I had an animal, yes. And you're deciding, I don't want Joe Blow to be in here with the animal, right? Oh, I put a flag on the chart and say, under no circumstances do you have this patient in this office at the same time that Oxley is in here. So I'm sorry, my dog's name is Oxley. And we had Oxley days, and it was on my chart. Tuesday is an Oxley day. Oxley had a schedule. And I had flags on charts, do not schedule with Oxley. And I did not put on it. There was a reason why. Sometimes it was the patient had indicated a no. They don't want to see Oxley. And I had all sorts of reasons, religious, cultural, fear of dogs, allergy, whatever. And sometimes it was, I don't want them to see Oxley. Like, I literally had a patient once who came in. He said, yes, I love dogs. I want to be with the dog, who literally, I'm not kidding, at all, sat in my office for an hour and a half during the first eval after saying, I would love to see the dog. And had never really been around dogs from a different culture than mine, from a different country than me. And I have a 100 pound dog, I should say that, not a little tiny thing. And literally did not think the dog would touch her. Like, and every time he put his nose on her, he, the patient squealed and scared the heck out of my dog. And I was like, this can't happen. Like, we can't do this. And so I tagged that chart and said, do not reschedule this patient with Oxley here, right? Because I can't, it's not okay with me for my dog to be afraid for 30, 45 minutes every two weeks until this patient's more stable. Right, I'm fine with that, yeah. Oh yeah, my dog can't speak for himself. So it's my job to make sure he's safe. Yeah, absolutely. I'm sorry I misunderstood that whole thing. Maybe it's because I could hear a little better here, but I think she's asking if the patient might be able to benefit, like a child with autism, they could potentially benefit from a dog, but there's the unpredictability, potential impulsivity. How do you make the decision when it's appropriate? That's some, that's like. Got you, no, thank you, thank you. I wanna know too. So, you know, I would argue that it's kind of like past behavior predicts future behavior, right? So I would ask the question, what is this child's experience in the past with dogs? I would ask that question to family. I would start there and kind of take that history and get that sense. And then we would try it and I would have a contingency plan. So in other words, like, hey, let's give it a shot. Let's see how it goes. And if it's clear that it's not going well, or if it's clear that maybe the child's having a bad day and we're gonna try it again at a later date, you always have a contingency plan for what you're gonna do if it's not going well with the patient today. Because your dog can have a bad day too. Yeah, I mean, it's probably impossible to eliminate all risk from either the patient or from the dog, right? Yes. I was just gonna add, I saw the trainings that there were for the AKC's program, the Canine Good Citizen. There's actually also a second test for more, I think it's called the CGC Community Canine. Yes, there's a Community Canine. Which is the advanced and it's another 10 items, including I think the hardest one. It's like an advanced obedience test. I feel like the AKC is always putting out different, it's an advanced obedience test. I think it actually has the owner leave the room and have the dog still have to stay. So yeah, the more advanced. Yeah, and the tests really vary widely if you talk to people who have been certified by different agencies. So for instance, in the TDI test, your dog has to be able to be off leash and take commands from like 60 feet away. And so my dog would be able to be in this room and take commands from me, like by eye contact and hand command and would not take a piece of food from each of you. Like that's what he has to be able to do. I would not attest that he could do that right now because we don't keep up with that practice. But that's meant for safety in the hospital. In case somebody were to hand him a piece of food. So thank you for clarifying that because I really was not understanding. Okay, so, okay, are we good? Okay, go ahead. No, I appreciate the question very much because we find that the more people start thinking about how this would actually get implemented in their agencies, the more questions we get. Yeah, I especially like questions in the middle because it makes it more interesting too. So, okay, so some case discussion. In the interest of time, I won't have you break off into small groups, but I might have you all kind of call out your thoughts to the case. And this is something that can kind of illustrate an example of animal assisted therapy in the session. So Claire is a 22 year old woman with a history of sexual trauma. She's been engaged in weekly therapy and psychiatric care for about two months. She's been adherent to Sertraline 100 milligrams daily with partial symptom relief. She does not have pets at home or in her apartment, but expressed interest in working with therapy dog Francis. In the waiting room, Claire is noticeably excited. She is smiling and talkative on walking back to the office. She sits in the chair and Francis sits at her feet. She pets and talks to him. He licks her fingers affectionately. She remarks that he is so sweet. And as a clinician, one can witness the reciprocal exchange of affection. So these are kind of examples of things that you might even notice from the time of bringing the patient back from the waiting room and those initial interactions with the therapy dog. And so case continued. So as the clinician begins to check in, the patient focuses her attention away from the dog. The dog retreats to his bed and lies down. Patient asks, is he tired? No, call him over to you. It's okay to ask him to come to you. He must be tired. Would you like to have him near you? Patient pauses. Yes, I would like him to be near me. The clinician asks, what would it feel like to call him over to you? The patient asks, I worry that he might not want to. The clinician responds. He might not want to come over and he might not know that you want him to come over to him. Timidly, the patient calls the dog by name. The dog lifts his head and looks to the patient but does not move. He puts his head back down. Clinician asks, how are you feeling? Patient says, lonely. Call him again. Patient says quietly, or says quietly, come here boy, but the dog remains in his bed. Clinician says, take a breath, close your eyes, and imagine calling him with the desire that you have to be close to him. The patient closes her eyes, takes a deep breath, and calls him confidently. So what happens next? And I'm curious, from the audience, how would you use the reaction of the dog in a therapeutic manner? And how might the patient respond to the dog's response to whether or not her trying to call him assertively? Any thoughts? It's kind of a nice discussion and interaction with this individual with a history of sexual trauma who seems to kind of have that timidness and is also working on assertiveness in her life. It's a nice practice to kind of have her express her needs assertively, but then also deal with whether or not the dog actually decides to come, and either response being something that she can tolerate. So next on the case, so she called him assertively, and he comes back to her feet and sits. The clinician shows the patient how to call him onto her lap. She pats her knees, and he jumps up. She embraces him. So the clinician asks, how can you honor your desires? What can you do by, what do you learn by voicing your desires? Will it always work this way? When you're communicating your needs and desires and it's not being understood, is the issue with the person listening or the person speaking? How can we work on voicing needs and desires more clearly? So as you can see, this interaction is a nice way to kind of work on all of these different concerns that the patient is working on. Well, and that brings us to the end of our talk. But we have plenty of time for questions. We have about 11 or so minutes. So if anyone has any questions, we'd love to hear from you. And just as a reminder, yeah, if you're asking a question, please come up to the microphone so we could hear your response on the recording or your question on the recording. Hello, my name is Brianna Sheridan and I am a licensed professional clinical counselor. So not in psychiatry, but really interested in animal-assisted therapy and reflecting on my board's requirements, at least in the state of Ohio, for writing ESA letters, which is just have training, like prove that you have training to do it, having clients that have asked, and then also dealing with the ethical, I guess, dilemma of like letter mills, as we all know, right? Like I've had a lot of clients, like, it's okay, I got one from, I don't know, letters.com. And I'm like, great. You're, you know, seeking not medical or people professions to do this. So I just wonder what your guys' thoughts were of like, isn't it like liabilities, like just don't do it, in my mind too, but also like, but now they're outsourcing to randos and like where we as profession, psychiatry and counseling can like keep that from happening or I don't know, better intercede. It is really tough. I think, I think there are all sorts of, I feel like I have more experience with individuals coming with maybe more of that, like bent towards like disability fraud and like kind of towing that line and not necessarily with a concern that's meeting that level of psychiatric disability. So it is kind of hard to see a lot of these different kind of letter mills coming out. One thing I would say about, when it comes to emotional support animals, I think there's about 33 states in the United States right now that have specific laws against fraudulent letter writing for emotional support animals, where the clinician can be held liable. To my knowledge, the only cases so far with emotional support animal liability are for like, specifically for like, you know, the fraudulent writing of letters. So without a sufficient examination, without, like one of them was a clinician who was writing letters for people out of state when, you know, when that's the case. So some states do, so Ohio where I live, there's not a specific law that you need to have known a person for X amount of time in order to write that letter. But other states like Michigan, for example, you need to have like a, you know, a clinician client relationship for X number of days and have, and even some states say you need to have evaluated them in person in order to write that letter. So it is really tough. Honestly, when people have asked me to write a letter, it's kind of in, we still, it's still a really good opportunity for a discussion about, you know, how I'm glad they're expressing their needs and also like discussing the nature and the impact of the mental health concern that they're having. But a lot of times when people come to me, they'll say, you can save me 40 bucks if you write this letter for me. And so that's kind of already like, you know, that's not the purpose of the letter necessarily, you know, opening those doors to saving money, but rather to treat the psychiatric disability. Amy. Hi, thank you very much for this presentation. To answer your question about like, how could you could use this dog in therapies? One thing that came to mind was, oh gosh, back when I was a trainee, I had my therapy patient that I saw every week. And one week he spent, he had just lost his dog. And so he was tearful and he spent pretty much the whole session processing the loss of his dog. And I was, besides validating him, I wasn't quite sure like what to make of that. And so I remember discussing it with my psychodynamic supervisor. And so she had really good feedback and guidance. She's like, well, this is like an internalized object. You can actually analyze that, you know, that that's what the dog represents, an internalized love object. So actually, you know, there's probably opportunity to explore the dynamics. Like how does it make you feel that the dog doesn't want to come to you or that you are concerned, you're worried that it's tired. I think there's actually a lot, but yeah, dynamically. Yeah, what does the dog represent about your, you know, growing up experiences and your relationship with your family? Yeah, whether or not you had a dog growing up. Yeah, what's the deeper meaning? What's the meaning of this? How does it make you feel? Yeah, so anyway. That's great. That's great. Thank you guys so much for this talk. One thing I was wondering about, you had kind of mentioned doing a lot of research on the breed of dog and like, you know, what kind of dog you were going to get before going into this. And obviously you talked about like the AKC trainings, but what does that, you know, what kind of qualities do you look for in a breed or in a dog that you pick out? And then what does the like socialization and training look like early on before doing those courses or the more official training courses? Oh, well, I can just speak to what I did. I'd have to stand up for that. Can you hear me okay? So I would say there's nothing official out there. I didn't like read a paper in a journal, but I talked to a lot of people about their experiences. And I talked to a lot of vets because I was very concerned about wanting a dog that was going to be a pet in our home and that was going to be a, met things that we needed for our family, but also a dog that had a really good chance of becoming a therapy dog. There are definitely dogs that just aren't good therapy dogs, right? You can do all the things that you are supposed to do and they're just not very well socialized or they just don't have the correct traits. And so things like we went to see our dog in a litter of puppies and see how the dog interacted as a young, young, young dog. We decided to work with a breeder because we knew that we wanted a sheep, a doodle. And that was based on our desire to have a very large dog that was not going to pass away in seven years, like a Great Dane. We knew we wanted a very large dog and I do have an internalized love object in my dog. And so I was not gonna be able to tolerate that. So we looked at a lot of things. A big thing for me is people will say, this is a hypoallergenic dog. That is a lie, lie, lie. So we knew that we wanted to have a dog that came from two different breeds that required grooming because they had a much lower chance of shedding. If you get a dog where one breed is a poodle, if he doesn't get poodle skin, he'll still shed. And I had personally had a pretty difficult experience with allergies as a child to the point where my family had to have a dog rehomed and I thought that that would be heartbreaking if that happened. And so I wasn't willing to take that chance. With that being said, I know I have multiple colleagues within the larger community of volunteers who had their dog from the pound, if you will. So the things you wanna look for in a well-socialized dog are they're not the dog that is sitting in the corner and doesn't interact with other dogs. So people will say, oh, he's so calm, he's so quiet, he just wants to sit in the corner and do the thing. That's actually not the dog that is well-socialized. That actually is the dog that's more likely to be afraid or anxious. And it's not the dog that responds to lots of changes around them well, typically. That is something that consistently, every single person I talked to about this told me. And so we were looking for kind of like the average dog, the middle dog, not the dog that was the most like aggressive leading the pack and not the dog that was kind of like in the corner. We were looking for the middle-of-the-road dog. And I literally sat in a room with literally 12 puppies for an afternoon. And that's how I picked out my dog. And it turned out okay. I learned really quickly that I don't know how to train a dog. And he was growing faster than his brain. And he was a third grader with a mustache. And there was definitely like a point in my experience where I would turn to my husband every day and say like, I don't know if we're gonna make it. Like he was so big that we were just unable to pick him up and say no. I learned that people don't give dogs, big dogs, a pass. Kind of like for those of you who are child psychiatrists, like you all know that a young person who's big for their age gets assumed to be older. And they have higher expectations. Same's true of dogs, right? A big dog has to be well-behaved, has to be well-behaved. Whereas a little dog, a little yapper thing, if you will, I grew up with little dogs. You just, if they're misbehaving, you pick them up, say no, and walk away with them, right? My dog was a couple months old and we couldn't pick him up anymore because he was too big. And so we actually ended up hiring a trainer to help us because we needed it. We did basic obedience, we did canine good citizen, we did puppy training, we did all the things to make sure he was as socialized as possible. We did all the things they tell you to do, take him in the car, introduce him to 100,000 people. All the stuff, and at the end of the day, it was a very hard test to pass. It is hard to walk your dog next to a hot dog and he, like, if he touches it with his nose, he fails the test. And so that's a hard thing. So we worked with a trainer who, and it was expensive, but we just didn't know enough about how to train a dog. There are definitely people who do it in different ways. There are certain, I think, pet partners offers classes to help you with the training for this. If I could recommend one thing, the only reason that I did TDI was because the leadership at my agency, that was the only organization that the leadership had experience with. And so that was all that they were open to me being part of at the time. Do research about your area and figure out where the biggest community is because I felt like I kind of had to build it totally. But if I had just, like, if I had been able to figure out the community of people around me, I would have a lot more friends with therapy dogs, you know, and we would have a bigger volunteer group and it would be more fun and you would know, like, who are the best trainers to go to, who are the best folks to work with, and you would have this larger community. Like, if I could recommend that, that would be the biggest thing I would recommend. Who are your reputable breeders if you're gonna do that, things like that. So figure out who's the most prominent in your area because they all compete, by the way. They usually are mutually exclusive. So that was a really long-winded answer, I'm sorry. And I wonder if we can even share, I know you mentioned that there's a listserv for individuals who, you know, have therapy animals. Maybe we can, you know, if you're interested in getting more information about that, Dr. Copley can provide that at the end. Please email me. I'll be happy to share that with you. We have a listserv that's kind of getting up and running and going with one of my colleagues from Illinois. Yeah, you can come up after and we can help you. Yeah, to do that. Okay. I can add just a few quick comments. Like, up here, I don't know where you're from, but like here in the Bay Area, what is the, it's a seeing eye dog. There are breeders that will breed golden retrievers and Labradors and what's more popular now is like a mix of the two. And so some of those breeders donate to the, what is this, what's the group up here? The seeing eye dogs. Guide dogs for the blind. So those are breeders that are breeding for temperament. It's still, I mean, it's an animal. It's like a kid, like it's not 100% predictable, but they could tell you that like their siblings or the, you know, puppies from these parents have had good success. So it's, yeah, it's still hard to say 100% because you never know, but you could get a better chance like that potentially too, but it doesn't have to be a breeder. I feel like it's really hard to figure it out. So one of the things that you can do, I trained as a service dog trainer. The organization's just about a 60% fail rate for service dogs because of random issues, like squirrel drive or like, you know, they have, they like peppermint or something, you know, who knows, it's a bad thing. So a lot of the organizations do the, one of the therapeutic parts is to career change the dog. These are typically labs and golden retrievers who are affable, they're friendly. They don't have a high, they're loyal to people. They're not particularly, they don't have a lot of guarding behaviors. So if you, they're hard to get, those are like the esteemed dogs to get, these rejects, they say. However, if you say that you want to use it as a facility dog, which could be a type of therapy dog or a therapy dog, and you want to repurpose it to actually the benefit of a college campus and students, those dogs typically are safe. They fulfill a mission for that dog, as you were mentioning earlier, not all dogs. You can't like tell your child, be a doctor, and then it wants to be an engineer. You can't tell your dog to get certified. So that's a good way to go. It's hard to get on those lists, but they like to repurpose. And the other thing is that a lot of people want to get rescue dogs, and this is big, versus getting a career change versus a rescue dog. A rescue dog inherently has some abandonment. You know, they've developed with one person and have to reattach to somebody new. So sometimes the purpose-bred dogs can be better for, not all, I mean, every dog can do anything, you don't know, but a purpose-bred dog or a dog that's been socialized by someone that you know from the beginning doesn't have that extra layer of attachment issues. And that's a really interesting thing to talk to patients about, the law of the attachment theory. You don't have to get too psychodynamic, but it can be revealed. So those are some places to start. Thanks. I so appreciate the discussion and the attention on the last day of the conference, and I hope you've had a great conference. Thank you. I appreciate it. Yeah, thank you so much. I think that's our time for today, but please feel free to approach the bench with other questions. Absolutely. Thank you.

animal-assisted therapy

college stress relief

therapy animals

Mira Menon

Lorraine Copley

Ohio State University

neurochemistry

Colleen Tennyson

handler training

legal guidelines

emotional support animals

therapeutic interactions

campus environments