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Conceptual Framework for Animal Assisted Therapy

  • Capital Area Intermediate Unit


Animal-assisted Therapy (A-AT) is becoming a popular therapeutic treatment for both children and adults. The author has used A-AT in a school setting with students with emotional disturbances. A review of the literature regarding A-AT reveals a lack of a unified theoretical framework. This paper proposes a conceptual framework that incorporates a physiological, psychological, and cognitive model to depict the functional deficits that challenge students with emotional disturbances. Attachment Theory is then used to describe why A-AT may be effective in improving the socio-emotional and behavioral functioning of students with emotional disturbances. KeywordsAnimal assisted therapy–Attachment theory–Cognitive theory–Students with emotional disturbances
Conceptual Framework for Animal Assisted Therapy
Tracy S. Geist
Published online: 24 March 2011
ÓSpringer Science+Business Media, LLC 2011
Abstract Animal-assisted Therapy (A-AT) is becoming a popular therapeutic
treatment for both children and adults. The author has used A-AT in a school setting
with students with emotional disturbances. A review of the literature regarding
A-AT reveals a lack of a unified theoretical framework. This paper proposes a
conceptual framework that incorporates a physiological, psychological, and cog-
nitive model to depict the functional deficits that challenge students with emotional
disturbances. Attachment Theory is then used to describe why A-AT may be
effective in improving the socio-emotional and behavioral functioning of students
with emotional disturbances.
Keywords Animal assisted therapy Attachment theory Cognitive theory
Students with emotional disturbances
Working with children and adolescents who have emotional disturbances can be a
challenge. Educating them can be even tougher. These students are often viewed as
being too disruptive to the general population in their public schools. Some of these
students have a mental health diagnosis; others have horrible home situations, and
many have both. In a school environment, they usually perform better in smaller
size classrooms that incorporate therapeutic interventions into the educational
In Pennsylvania, the Capital Area Intermediate Unit (CAIU) operates an
emotional support program at Hill Top Academy. This program provides
educational services for students from kindergarten to twelfth grade. Like many
T. S. Geist (&)
Widener University, Capital Area Intermediate Unit, Harrisburg, PA, USA
Child Adolesc Soc Work J (2011) 28:243–256
DOI 10.1007/s10560-011-0231-3
emotional support programs, classes are designed to be small in size. In addition to
the teacher in each classroom, there are educational aids, social workers, speech
therapists, and occupational therapists available to assist each student’s individu-
alized educational need. All students have an Individualized Education Plan (IEP)
that has academic and behavioral goals. All members of the student’s education
team work on stabilizing the student through progress on IEP goals. When students
are able to make sufficient progress on their behavioral and academic goals, they are
often transitioned back to their home districts. What makes the program at Hill Top
Academy unique is the use of five, full-time therapy dogs that assist the school staff
as co-teachers and co-therapists throughout the school day.
It is often the case that students who have been stabilized for a few months can
de-stabilize over night as a result of emotional trauma. For example, one student,
who had been stabilized for 5 months, became unstable when his parents were
arrested for felony charges. Another student, who was progressing smoothly, lost
much of his progress when a friend committed suicide. At times like these, their IEP
goals become unrealistic and a crisis intervention response is needed. One
particularly effective approach to the crisis intervention has been the use of therapy
The CAIU has always been open to new interventions to help the students and
supported the utilization of therapy dogs in the emotional support program
approximately 7 years ago. Currently, the program has five, full-time therapy dogs
with over 20 trained staff as dog handlers. When each of the young men in the above
mentioned examples came to school following the events described, they trashed
their classrooms before being ushered to a social worker’s office containing a
therapy dog. There they collapsed on beanbag chairs. Both were greeted by a
therapy dog, which slowly emerged from its place of rest. Slowly, the dog
approached the students and lay against them. Within half an hour, both boys were
expressing their emotions while petting the dog. Within an hour, both boys had
managed a smile as the result of something silly the dog did. Within 2 hours both
boys were back in their classrooms feeling ready to try some work. Before the
integration of therapy dogs into the program, situations like this typically would
have required the student to be in the social worker’s office for an entire day, if not
several. Therapy dogs do not ‘‘fix’’ the students, but they help them find temporary
healing by helping them de-escalate and refocus enough to get through the day.
Delta Society is a nationally known organization that certifies therapy dogs. They
define animal-assisted therapy (A-AT) as:
Animal-assisted therapy utilizes the human/animal bond in goal-directed
interventions as an integral part of the treatment process. Working animals and
their handlers must be screened, trained and meet specific criteria. A
credentialed therapist working within the scope of practice of his/her
profession, sets therapeutic goals, guides the interaction between patient and
animal, measures progress toward meeting therapy goals, and evaluates the
process (1997, p. 1).
A review of the literature reveals a lack of a unified theoretical framework. This
creates a problem for professionals who realize the importance of A-AT for
244 T. S. Geist
therapeutic purposes but need a scientific evaluation of its effectiveness for
legitimizing and funding a program. This paper proposes a conceptual framework
which incorporates a physiological, psychological, and cognitive model to depict
the functional deficits that challenge students with emotional disturbances and
applies Attachment Theory to describe why A-AT may be effective in improving
the socio-emotional and behavioral functioning of students with emotional
Literature Review
Attachment Theory: Neuro-physiological Features
Allan Schore (2001a,b,2003,2005,2009) has conducted research regarding the
effects of attachment on right brain development, affect regulation, and infant
mental health. Schore focuses on right brain development since it is the right
hemisphere that gives us the sense of being connected to one another. The right
hemisphere also deeply connects into the limbic system which is the center for
processing emotion.
According to Schore (2001a), the human brain has a critical growth spurt that
begins in the third trimester and continues to about 18–24 months of age. Schore
states that this is considered a critical period because this time frame:
prescribes that specific critical conditions or stimuli are necessary for
development and can influence development only during that period. But it
also suggests that during critical periods brain growth is exquisitely
susceptible to adverse environmental factors such as nutritional deficits and
dysregulating interpersonal affective experiences, both of which negatively
impact infant mental health (p. 3).
If the right hemisphere of the brain fails to mature because of a lack of
experience, the child will become vulnerable to losing structural components of the
right hemisphere necessary for affect attunement and connection with others (Siegel
1999). Insecure attachment therefore triggers chaotic alteration in the limbic system
which processes emotion. This creates an unorganized state of mind. Siegel (1999)
defines the mind as the ‘‘flow of energy and information within the brain and
between brains’’ (p. 2). A person’s state of mind (organized or unorganized) is
consequently contingent on attachment interactions with others.
An unorganized state of mind deeply impacts a child’s affect regulation.
According to John Bowlby (1969), an infant’s capacity to cope with stress is
correlated to certain maternal interactions. A child with an insecure attachment and
an unorganized state of mind is unable to regulate arousal states he or she
experiences (Schore 2001a). Arousal states are caused by both familiar experiences
as well as novel experiences. Stress theory asserts that a person will have a ‘‘fight or
flight’’ response when experiencing stress. The first stage of the fight or flight
response is the activation of the sympathetic nervous system. This causes a system-
wide response. Adrenaline and noradrenalin are released leading to increased
Conceptual Framework for Animal Assisted Therapy 245
alertness. Blood is diverted from the internal organs and the skin to skeletal muscles.
The heart rate, force of heart contractions, and respiratory rate are increased. All of
these changes allow the body to exert a large amount of energy over a short period
of time so that the individual may either fight or run away effectively (Spierer et al.
2009). Without the ability to regulate emotion, the child can be in a fight or flight
mode the majority of his or her day, causing socio-emotional and behavioral
Different attachment patterns activate unique groups of neurons. These neuron
groupings create our representation or our experience of reality. Siegel (1999)
The emotionally distant connection of avoidantly attached children with their
dismissing parents can be understood as involving primarily the linear, logical,
linguistically based mode of communication of the left hemisphere. Persons in
whom the left-brain mode of processing predominates have been shown to be
markedly deficient in the ability to read others’ nonverbal communications
and to sense the emotional expressions of others or of the self (p. 161).
This connects with Schore’s earlier statement about the right hemisphere of the
brain being relational and experience dependent. Since the brain is dynamic, new
forms of interpersonal relationship experiences may evoke new representational
processes. Therapists such as Dr. Rise VanFleet (2008) state that therapy dogs can
help facilitate healthy attachment experiences through the human-animal bond and
therefore help change representational processes.
Attachment Theory: Psychological Features
Bowlby (1969) defines attachment as ‘‘an inborn system in the brain that evolves in
ways that influence and organize motivational, emotional, and memory processes
with respect to significant care giving figures.’’ At the level of the mind, Siegel
(1999) states ‘‘attachment establishes an interpersonal relationship that helps the
immature brain use the mature functions of the parent’s brain to organize its own
processes’’ (p. 67). In this way, if a caregiver is attuned to their infant, the child will
have a secure attachment and develop a healthy concept of self. However, if there is
a disruption in the attunement of that attachment process, an avoidant, ambivalent,
or disorganized attachment style can develop (Wallin 2007). An avoidant
attachment style is usually developed with a caregiver who is dismissive of the
infant’s emotional needs. Ambivalent attachment style occurs when a caregiver
fluctuates from dismissive to overly intense involvement while pushing his or her
emotional state of mind onto the infant. A disorganized attachment style develops
when the caregiver, typically reacting to her/his own troubled emotional state, is
frightening to the child. For the purposes of this paper, these three attachment styles
will be grouped as ‘‘insecure’’ attachment. This is done to help describe the use of
A-AT with children who may come from any of these three styles of attachment.
In these attachment transactions, the brain/mind of the caregiver is influencing
the brain/mind of the child in the form of co-regulation. According to Schore
(2001a), Schore and Schore (2008), attachment theory is in essence a regulatory
246 T. S. Geist
theory. A secure mother is, at a non-conscious level, continually regulating her
infant’s emotional arousal. This dyadic regulation of emotion influences the
development and expansion of the infant’s regulatory system which appraises and
copes with stress (Schore 2001a,2009).
An abusive or weakly attached caregiver is inaccessible and reacts to the infant’s
expressions of emotions and stress inappropriately and/or rejectingly, and shows
minimal or unpredictable participation in the various types of arousal regulating
processes. Instead of modulating, she induces extreme levels of stimulation and
arousal, either too high in abuse or too low in neglect. Because she provides no
interactive repair, the infant’s intense negative emotional states last for long periods
of time. Such states are accompanied by severe alterations in the biochemistry of the
immature brain, especially in areas associated with the development of the child’s
coping capabilities (Schore 2001b,2009). Early dysregulating experiences lead to
more than an insecure attachment; they trigger a chaotic alteration of the emotion
processing limbic system that is in a critical period of growth in infancy. The limbic
system has been suggested to be the site of developmental changes associated with
the rise of attachment behaviors. It is also thought to be centrally involved in the
capacity to adapt to a rapidly changing environment and in the organization of new
learning, both critical for school-aged children.
This echoes Winnicott’s concept of the holding environment, described as a place
where the mother organizes perceptions of the infant while bringing the
environment to the child (Greenberg and Mitchell 1983). According to Winnicott,
without this holding environment, the infant is unable to self-integrate. The mother
functions as a mirror, precisely reflecting to the infant their own experience.
Winnicott described this experience as ‘‘When I look I am seen, so I exist’’ (as cited
in Greenberg and Mitchell 1983). ‘‘Imperfections in the reflected rendition mar and
inhibit the child’s capacity for self-experience and integration and interfere with the
process of ‘personalization’ ’ (Greenberg and Mitchell 1983, pp. 192–193). To
further expand on the concept of the holding environment, Schore (2001a) views
attachment as synchrony and stress as asynchrony. If synchrony follows stress and
the infant recovers from the asynchrony, resilience is developed. In this way, a child
will develop a ‘‘true self’’ through the maturation of the experience dependent right
brain. If the attachment is insecure and asynchrony is never resolved, a child is
vulnerable to developing a chaotic sense of self.
Cognitive Theory
Cognitive theory is based on the belief that there is a continuous reciprocal
relationship among a person’s cognitions, behavior, and environment. For an
individual with an insecure attachment style, perceptions of the world can be
marked by shame or rejection. Strong negative emotions are linked to memories of
rejection and therefore the individual develops a model of itself as unlovable and of
others as unavailable, which can then be acted out behaviorally (Siegel 1999). For
instance if a person feels they are ‘‘bad’’, they will behave ‘‘bad’’, and society will
treat them as a ‘‘bad’’ person. Psychological disorders result from discordance
between the internal cognitive system of processing and interpreting external stimuli
Conceptual Framework for Animal Assisted Therapy 247
related to these unhealthy representations (Patterson 1986). According to Aaron
Beck (1976), the founding father of cognitive therapy, psychological problems:
may result from commonplace processes such as faulty learning, making
incorrect inferences on the basis of inadequate or incorrect information, and
not distinguishing adequately between imagination and reality. Moreover,
thinking can be unrealistic because it is derived from erroneous premises;
behavior can be self-defeating because it is based on unreasonable attitudes
(pp. 19–20).
To have a healthy sense of self, the autobiographical memory requires
autonoesis, or self knowing. Autonoesis appears to be dependent on critical
development of frontal cortical regions of the brain which are influenced by
interactions with others (Siegel 1999). In this way, cognitive theory is harmonious
with attachment theory.
According to cognitive theory, people react to events in terms of the meaning
they attribute to the events. According to Patterson (1986), ‘‘the nature of a person’s
emotional response—or emotional disturbance—depends on whether he perceives
events as adding to, subtracting from, endangering, or impinging upon his domain’
(p. 35). A person’s distorted thoughts have the characteristics of automatic thoughts.
These thoughts arise reflexively and seem plausible to the individual but not to
others. Because these thoughts are automatic, they are resistant to change.
From experience, many of the students enrolled in the emotional support program
display insecure attachment, are unable to regulate their emotions, and view
themselves as ‘‘bad’’. Many of the students either become self-destructive as a result
of self-hate or adopt a ‘‘bad’’ persona that is tough, uncaring, and celebrated by
them. The physiological, psychological, and cognitive features are therefore linked
together since developments in one area affect the other two. It is my contention that
intervening in a student’s emotional state with animal-assisted therapy will break
the sequence of negative automatic thoughts and help the student develop a
healthier attachment and self-concept.
Empirical Studies Using Animals in Therapy
Animals can reduce the physiological reaction to stress. Allen et al. (1991)
attempted to gather physiological proof that companion dogs could affect levels of
stress reported by their owners. They conducted an experimental study involving
women who reported high levels of stress in their jobs. All jobs were within the
‘helping’’ profession (i.e. nursing, teaching, medicine, etc.). The women were asked
to perform a difficult mental arithmetic task in one of three conditions. The subjects
were either alone with the experimenter, with their best friend, or with their dog.
Measures were taken of diastolic and systolic blood pressure, skin conductance
response, and heart rate. Women responded as ‘‘challenged’’ when their dogs were
present and ‘‘threatened’’ when their best friends were present. Also, the women
with their dogs performed the difficult arithmetic task considerably better than those
with only their best friend or the experimenter present. As a part of the study, the
researchers interviewed this ‘‘dog’’ group. The women predominately responded
248 T. S. Geist
that with their dog, there were no fears of being judged. The women said the dogs
provided all the desirable qualities of a best friend (listening, empathetic, physical
comfort) without any of the undesirable evaluative traits (Allen et al. 1991).
Friedman et al. (2000) concluded the same outcome in a similar study with children.
‘The presence of a calm, attentive dog apparently moderates the stress responses
more that the presence of an adult and even more than the presence of a supportive
friend when children were reading aloud or having a routine medical exam’
(Friedman et al. 2000).
Kogan et al. (1999) conducted two case studies on the use of A-AT with children
with emotional disorders. Two boys, ages 12 and 11, were chosen for the study.
Both boys were placed in an emotional support classroom with weekly individual
and group counseling, as well as an Individualized Education Plan (IEP) and were
not showing improvement with this added support. The students had individual
sessions with an A-AT therapist. These sessions were videotaped. Goals on which
the A-AT therapist could focus were developed by the IEP team. This treatment
lasted for fourteen sessions, culminating in a presentation to the students’ class of
the commands they had learned with the dog.
Treatment sessions were 45–60 min in length. The first 20 min were used to
talk with the students and build rapport while grooming the dog. Topics were
sometimes introduced by the therapist that related to recent issues in the classroom
but the child was never forced to discuss any of these topics. The second half of
the session was spent working with the dog and utilizing a variety of commands
and training techniques. As sessions progressed, multi-step commands that
required patience and perseverance were introduced. To measure progress,
teachers completed an ADD-H Comprehensive Teacher Rating Scale both pre-
and post-treatment. Each goal was operationally defined and observations were
noted by educational professionals. The videotapes were coded from the first,
midpoint, and final sessions. They were coded for eye contact and appropriate tone
of voice. Progress towards goals on the IEP was monitored. Finally both parents
and child completed a survey discussing their experience. All data sources reported
growth in use of positive comments, a decrease in distractibility, an increase in eye
contact with people, improved appropriateness of voice tone with people, and
increase in sense of control over self and environment. All data sources with the
exception of the teacher rating form showed improved peer relations and a
decrease in tantrums.
Katcher and Wilkins (1994) designed an experimental study at Devereux
assessing the use of animals with residents diagnosed with Attention Deficit
Hyperactivity Disorder (ADHD) and Conduct Disorder (CD). Fifty children were
randomly assigned to one of two voluntary experiences. The control group was
assigned to an Outward Bound (OB) course where they learned how to rock climb,
kayak, hike, as well as learning water safety and wilderness safety skills. The
treatment group was assigned to the Companion Zoo (CZ) program. In this program
they received 5 h of nature education during the school week. After 6 months the
OB group went through the CZ course and the original CZ group transitioned back
to a regular school program but were allowed visits to their animals during free
Conceptual Framework for Animal Assisted Therapy 249
The Zoo contained gerbils, hamsters, mice, chinchillas, iguanas, fish, turtles,
doves, chicks, goats, a Vietnamese pig and the facilitator’s pet dog. In the CZ
program there were two general rules. The participants had to be gentle with the
animals and each other which included speaking softly while in the zoo, and they
had to respect the animals and each other which included avoiding speech that
would be de-valuing. Participants had to learn how to care for and hold the animals
before they were allowed to adopt them. After adoption there were several other
skill areas the students could master including how to weigh and measure their pet,
chart growth, and compute feeding requirements. Katcher and Wilkens (1994) point
out ‘‘the educational and learning tasks of the CZ program are comparable in scope
to the very school tasks which these students experience with antipathy, avoidance,
and repeated failure’ (p. 2).
Attendance at the CZ program was always better than attendance at the OB
program. For the summer term, average attendance at the CZ program was 93%
compared to 71% for OB. In the fall term, attendance at the CZ program was 89%
compared to 64% for OB. When the OB group switched to the CZ program their
attendance increased from 67 to 87%. Education also progressed rapidly in the CZ
group. ‘‘Some students who had made no progress in the regular school program for
as long as 4 years rapidly accomplished learning tasks in the Zoo’’ (Katcher and
Wilkins 1994, p. 3). It is also important to note that no child was ever restrained in
the Zoo. In fact, teachers and staff started to use trips to the Zoo as a therapeutic
intervention to calm children who would have otherwise needed to be restrained or
The Achenbach Child Behavior Checklist (Achenbach and Edelbrock 1986) was
completed at four intervals by the teachers in the students’ regular education
program. These measures revealed a significant reduction in total behavioral
pathology in the Zoo group as compared to the control group. The effects noted
were a decrease in agitated and aggressive behavior, improved cooperation with
instructors, enthusiastic engagement with learning, and improved behavioral control
in the regular education classes. These changes were immediate within the Zoo
environment and generalized into the regular school setting within 6 months.
However these behaviors did not generalize into the less structured settings such as
their resident life. When the children left the Zoo program, their behaviors
deteriorated. Katcher and Wilkins (1994) concluded that ‘‘animal assisted therapy
and education has a large, persistent, and broadly distributed therapeutic effect on
highly aggressive, emotionally disturbed children and adolescents with severe
learning difficulties’’ (p. 3).
Ainsworth (1991) described attachment figures as having four features: proximity
maintenance (physical nearness and accessibility are enjoyable), separation distress
(they are missed when they are absent), secure base (dependable source of comfort),
and safe haven (they are sought to alleviate stress). Previous research has indicated
dog companionship can provide proximity maintenance (Bonas et al. 2000),
separation distress (Stallones 1994), and a secure base (Bonas et al. 2000). In 2009,
Kurdek completed the research on whether dogs can serve as attachment figures by
studying whether owners turn to their dogs to alleviate stress (safe haven).
Participants were 975 adults who responded to an e-mail survey that was advertised
250 T. S. Geist
in newspapers and local news shows in Ohio and Canada. Most participants were
Caucasian and were considered middle class. Ages ranged from 19 to 82 with 47.95
being the average. Kurdek selected five moderator variables of gender, marital
status, involvement in pet care, self-disclosure, and fulfillment of relatedness needs.
Kurdek (2009) found that ‘‘on average, participants were more likely to turn to their
pet dogs when they experienced emotional distress than they were to turn to
mothers, fathers, brothers, sisters, best friends, and children’’ (p. 444). Participants
were less likely to turn to their dogs than to their romantic partners.
Hanselman (2001) measured coping skill interventions with adolescents in an
anger management group with therapy dogs. As previously outlined in the
description of the conceptual framework for A-AT, cognitive behavioral therapy
and attachment theory were the foundational epistemological approaches for the
study. The subjects for the study were seven adolescents who were either court-
referred or self-referred to an anger management group. All participants had been
subject to some form of parent brutality whether verbal, physical, or emotional. All
had also abused animals in some form in their past. The group lasted for 12 weeks
including one ‘‘Scared Straight’’ outing at the local county jail. Two trained therapy
dogs that had been abused and rescued were intermittently brought to the sessions to
compare the differences with other sessions when they were not present. The dogs
were available for petting as well as props for discussion. Their abuse stories were
told to the group, and a video on animal abuse and the link to human violence was
viewed. The stories and video were used for discussion on how one can manage to
still love and be caring after trauma as shown by the animals. The Companion
Animal Bonding Scale (CABS) mean scores showed a significant increase in animal
bonding. In addition, the presence of the dogs increased feelings of happiness,
security, and self-worth, and reduced feelings of loneliness, isolation, and stress.
With the premise that animal abuse in childhood is linked to human violence as an
adult, Hanselman was hopeful that her outcome measures suggested a hopeful future
of less abusive anger from the teen. In a similar study done by Lange et al. (2006/
2007) adolescents involved in an anger management group using A-AT reported
that the dogs had a calming effect, provided humor and an emotional break,
provided increased safety, and provided motivation to attend group. The adolescents
stated they felt they were more empathetic.
Boris Levinson is considered the founding father in the field of A-AT as it relates to
psychotherapy. His work stated that the therapeutic effect animals had with humans
was through their use to us as a transitional object. Levinson was a child
psychologist who based his practice out of his home where his dog, Jingles, would
often be present in his office during sessions. He noticed an almost immediate
benefit having Jingles as a ‘‘co-therapist’’, especially among the mute and detached
children with whom he worked. He wrote extensively about his observations in Pet-
Oriented Child Psychotherapy. Levinson theorized that animals could act as a
Conceptual Framework for Animal Assisted Therapy 251
transitional object between us and our alienation with nature. Levinson (1969)
By destroying nature, man alienates himself from his inner being and in a
sense commits suicide. Throughout the ages, nature and particularly its
animals have assumed for mankind the role of ‘‘transitional objects’’ which
mediate between the known terrors of outer reality and the unknown realities
of the inner world. Unlike the animal, man can adapt himself to all kinds of
nonhuman environments. This is at once his virtue and undoing. By removing
himself from nature by being independent of nature, man also loses part of his
psychological (and physical) strength. Despite man’s ever-increasing power
over the forces of nature, despite the immeasurable increase in our comfort
and wealth for the past 50 years, our feelings of security have not grown
commensurably. Paradoxically, the reverse seems to be true. With the increase
of man’s knowledge and power, there has strangely been a corresponding
increase in tensions, fears, anxieties, and lack of ease (p. 22).
Since Levinson, other researchers have also explored the effects of the human-
animal bond. In an article written for the Delta Society on stress management and
the human-animal bond, Stuart-Russell (1997) shared the same view as Levinson.
He states:
From conception, areas of growth and development are organized around
stress. In infancy the period of separation-individuation is stress laden. Its
resolution leads to the development of resources to be kept in the ready for
future stress needs. During this stage a child’s attachment to an animal can
serve as a transitional object that makes stress manageable. The relationship
will reduce high stress levels that can induce unproductive patterns of
regression to an earlier developmental stage. It can mediate oppositional
stressors that are acting in unison to paralyze developmental movement (p. 1).
With the physiological reduction in stress a companion dog can provide, along
with the ability for it to become a transition object, the dog can become a type of
‘holding environment’’, allowing the individual to integrate themselves with the
environment. During times of stress, a therapy dog can help provide synchrony and
therefore self-awareness.
An important aspect to secure attachment is the amount of attunement between
the individual and their attachment figure. Due to the nonverbal nature of dogs,
attunement with a dog can have a crucial impact. According to Siegel (1999):
Attuned communication involves the resonance of energy and information.
For the nonverbal infant, this intimate, collaborative communication is
without words. This need for nonverbal attunement persists throughout life.
Within adult relationships of all sorts, words can come to dominate the form of
information being shared, and this can lead to a different form of
representational resonance. Such a verbal exchange may feel quite empty if
it is devoid of the more primary aspects of each person’s internal states (p. 71).
252 T. S. Geist
In this way, a dog can be the source of nonverbal attunement to a student who has
not experienced that state of mind. All of the therapy dogs at Hill Top Academy
have been trained to maintain eye contact and to gently rest their heads on the laps
of their ‘‘masters’’. Some of the students in the school become completely nonverbal
when stressed. During these times of escalated stress, our voices seem to heighten
their stress. At these times, the therapist guides the student into the office where
there is usually a therapy dog present. The student will usually slump into a beanbag
chair where the therapy dog will visit them. The dogs lay their heads on the
student’s laps and look up into their faces. The dogs adjust their ears and tails to
magically fit the mood of the student. At times they will even produce a slight cry or
sigh. The therapist does not talk, but sits there and observes. The students will make
eye contact with the dogs and pet them in silence. It is amazing to watch their bodies
relax from their stressed states. Many of the students have written in their creative
writing exercises about how the dogs seem to understand how they are feeling
through their non-verbal communication.
There are students at Hill Top Academy with very disorganized and disoriented
states of mind. They can often escalate into crisis where they need to be restrained
for abusive behavior towards themselves or others. The restraint solidifies their
conception of themselves as being ‘‘bad’’. The restraint with the human contact
almost escalates the student to the point of no return. When a therapy dog is
strategically introduced during these times, the child often de-escalates quickly.
They respond to the dog’s signs of stress and unhappiness when seeing the child in a
crisis, in this way reflecting back to the child appropriate empathy and reflection of
the environment. The child feels safe with the dog since the dog has never been
unresponsive or frightening in the school setting. The dogs are all highly trained to
be gentle and attuned to their ‘‘master’’. In this environment, the therapy dog is used
as a tool for processing the crisis with the child. This assists in promoting synchrony
after the stress and leads to the development of greater self-awareness and
Nelson (2008) describes laughter as an attachment behavior. Laughter is a ‘‘right-
brain-to-right brain’’ behavior that can promote strong social bonding between
parent and child. Laughter can encourage the caregiver to prolonged, positively
arousing, social interaction. According to Schore (2003), positive affect in a
mother’s face triggers high levels of opiates in the child’s developing brain. These
endorphins biochemically link social interactions and attachment as positive
qualities that are desirable. The simple act of a dog bringing a squeaky toy to a child
in distress and attempting to force it into the hand (or sometimes for more comic
effect, the mouth) of the distressed student often prompts a smile and often a giggle
from the student. This interaction motivates the dog to continue their attempts at
play which is usually accompanied by more humorous interactions, which usually
stimulates more laughter. In this way the interaction mimics the right-brain-to-right-
brain interaction that promotes social bonding and attachment. It is this author’s
experience that this attachment behavior to the dog can then be transferred to the
social worker who has been observing this interaction in silence.
The therapy dogs at Hill Top Academy also serve as implements for expressive
therapy. As mentioned earlier, along with attachment disorders many of the students
Conceptual Framework for Animal Assisted Therapy 253
at Hill Top Academy have also suffered traumatic events. Traumatic memories are
stored in the right hemisphere of the brain, making verbal expression of these
memories difficult (Klorer 2008). In a study of patients suffering post-traumatic
stress disorder (PTSD), PET scans showed that when presented with accounts of the
traumatic event, the language area of the left hemisphere of the brain turned off
while there was heightened activity in the right hemisphere of the brain (right
amygdala, areas of temporal and frontal cortex, and right visual cortex). This
suggests a neurobiological explanation for the difficulty patients with PTSD have in
verbally relating their traumatic memories although the memories themselves
trigger a physical feeling of re-experiencing the trauma (Rauch et al. 1996). Since
these experiences are stored in a part of the brain that is non-verbal, it makes sense
to use non-verbal therapeutic treatments. The use of therapy dogs can be the non-
verbal, therapeutic modality. As the students interact with the dogs, the dogs are
looking in the students eyes while either mirroring their behavior to match the
students (playful, subdued, etc.) or stimulate the student into a more playful
interaction. The students get a sense of attunement from this interaction and
therefore a sense of attachment. They then can use this relationship as a safe way to
play out their desires to dominate, love, or master others. In the safety of the
therapeutic environment, they can begin to experience a healthier expression of
attachment from the therapy dog and ultimately the social worker.
Many professionals feel A-AT is not given respect as an effective therapeutic
intervention. Boris Levinson was aware that his work and observations would be
received with skepticism by his colleagues. Foreseeing their doubts, he states ‘‘Do
professionals consider this subject too humdrum, too lowbrow or ‘unscientific’ to
warrant serious consideration and investigation?’’ (Levinson 1969, p. 35). As an
attempt to quiet his skeptics, Levinson (1969) states:
Since the problem of mental disorders in children is so vast, any plausible
measure that promotes diminution deserves investigation and testing. Even
with the enormous escalation of scientific research, little is known concerning
what brings about improvement. Some authorities in the field question
whether therapy of any kind is effective. Furthermore, the current methods of
treatment, assuming their effectiveness, are very lengthy and costly, therefore,
there is a need to develop new ways of cutting down on cost and length of
success treatment (p. 27).
Many professionals in the field of A-AT believe that animal-assisted therapy
could be an answer to these concerns. However, due to the lack of a unified
theoretical foundation, the profession continues to struggle to be seen as legitimate.
The conceptual framework presented in this paper addresses many of the issues
surrounding A-AT. Further research needs to be conducted in each domain as it
relates specifically to A-AT to determine the validity of the framework.
254 T. S. Geist
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... Children with special needs often experience negative emotions because of rejection from peers which can lead to faulty perceptions of oneself thereby also influencing the behavioral problems. This vicious cycle can be dealt with therapy animal wherein animal can help break the sequence of negative automated thoughts and develop a healthier selfconcept (Geist, 2011). Empathy and care can be learned through caring for the animal in the therapy which can also enhance a child's self-care skills, confidence, and responsibility (Evans & Gray, 2012;Koukourikos et al., 2019). ...
... It is our contention that a construct like social competence would require multiple approaches for its improvement and when incorporating animal-assisted therapy, practitioners should draw knowledge from all the possible theoretical foundations including attachment theory, cognitive-behavior theory, learning theory, social theory, as well as the neurobiological basis of human-animal bond. Nevertheless, the field of animal-assisted therapy lacks a common theoretical framework (Geist, 2011) and exploration of these should help provide solid evidence for the same. ...
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Developmental disorders have a substantial effect on the social competence of children affecting their overall psychosocial functioning. Social competence entails the process of being socially mature by establishing stable and adaptive patterns of social behavior. Animal-assisted therapy, as an alternative treatment modality, has offered some new prospects for improving social cognition. This conceptual paper, thus, attempts to throw light on how animal-assisted therapy can help improve social competence. The paper draws its knowledge from the existing theories and empirical work done to propose a conceptual framework that can enhance social competence by incorporating therapy animals. It can be concluded that animal-assisted therapy has found to improve different dimensions crucial for development of social competence. This further suggests the dire need to explore the effectiveness of human-animal interactions by utilizing it for improving social competence.
... The concept of attachment between humans and animals seems to be a valid phenomenon since humans often view pets as being more relationally secure than bonds with people (Cromer & Barlow, 2013). A human being's ability to develop a connection with animals can increase secure attachment behaviors and occur in many environments (Geist, 2011). Rocket and Carr (2014) stated that animals incorporated in AAIs might assist with the development of a secure attachment between client and clinician. ...
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Animal-assisted interventions (AAIs) have become widespread, with programs targeting various populations and mental health conditions. Despite its popularity, AAI’s operational definition and its efficacy are unclear. This systematic review aims to assess the utility of AAIs in decreasing depressive symptoms in adults based upon results of empirically validated depression assessment scales used by researchers. A systematic published literature search was conducted using Web of Science, PsychInfo, PubMed, ProQuest, SCOPUS, CINAHL, Social Work Abstracts, Web of Science, and Google Scholar. Peer-reviewed research articles on the effectiveness of AAIs on depressive symptoms in adults using empirically validated depression scales published from 2010 through October 2020 were chosen for this systematic review. Search results were filtered to include only quantitative, peer-reviewed articles for adults 18 and over; those were reviewed, and only journal articles using an empirically established depression evaluation tool were chosen. A total of 10 quantitative articles met these inclusion criteria. Overall, research design quality was low, but AAI had a statistically significant effect on outcomes in most studies. Results are moderately favorable but more thorough, standardized, and controlled research is needed.
... bond of attachment is one important element in the efficacy of AATs (Balluerka et al., 2014;Dunlop & Tsantefski, 2018;Geist, 2011). ...
INTRODUCTION: There is an undeniable connection between humans and animals, with the relationship between the two being well documented across the centuries of history and storytelling.METHODS: This article outlines a scoping review of the literature and research exploring the history, efficacy, and currency of animal assisted therapies (AATs) as they have developed in recent decades within human services and social work programmes.FINDINGS AND IMPLICATIONS: Archaeological research suggests a mutualistic relationship has existed between canines and humans dating back 140,000 years evolving to deepened connections between animals and behaviourally modern humans including 15,000 years of animal domestication. These connections have generated relationships where animals both work for and with humans, assuming diverse roles ranging from service animal to companion pet, from livestock to live entertainment, from symbolic idol to science experiment and, as demonstrated in this article, as co-therapist or therapeutic medium in psychotherapeutic, human services and social work practice processes.
... It provides a series of therapeutic sessions where a person and a trained animal can interact with assistance provided by the pet's handler. The benefits of the AAT include improved self-worth, increased verbal communication, decreased depressive and anxiety symptoms and loneliness, increased motivation, and enhanced social skills [18,19]. Animal-assisted therapy does not depend on any specific theory in particular. ...
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Stressful life events can cause enormous stress on individuals, making them feel hopeless, isolated, and distressed. During these moments, a vulnerable person may end up attempting suicide that could result in death. Suicide is a challenging issue that involves multiple factors, yet prevention is possible with prompt measures. Many humans have an innate desire to engage with and interact with animals, and the bonds they form during this interaction could provide them with a relaxing experience, decrease psychological pain, increase the sense of purpose and engagement. Combining Animal Assisted Therapies with other supportive therapies might help to interrupt suicidal thoughts and prevent suicide. Therefore, we wall for studies with AAT in patients with increased risk of suicide. Studies should also examine not only the efficacy of such therapies, but also what species and breeds are the most beneficial.
... Theory of attachment is one of the theories that tries to explain this. Accordingly, attachment is a stable and emotional bond between two individuals [37,38]. In the case of relationship between man and animal, the emotional bond is formed with the animal. ...
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Objective & background: Human-animal interactions are considered as being valuable and beneficial for the psychological health. Recently Animal-Assisted Therapy (AAT) has been included for client-therapist interaction. The purpose of the present study was to assess the effectiveness of animal-assisted therapy in alleviation of anxiety in pre-school children. Method: The study was carried out as a randomized controlled trail with pre-test and post-test design and control group. The trial was registered in the Chinese Clinical Trial Registry with the registration id of ChiCTR2000034145. The study consisted of 33 anxious 5-7years old children (participated in a welfare anxiety screening plan held by Counseling Center, Tehran-Iran) between 2018 and 2019. The participants took part in the study voluntarily. The subjects were randomly divided into experimental and control groups (10 in each group). The experimental group was exposed to 8 sessions of animal therapy. The research instrument used in the present study was Spence Preschool Anxiety Scale (Parent Form) and the data were analyzed on SPSS 21 software. Results: The results showed that animal therapy had a significant effect on general anxiety after adjusting for post-test assessments (f = 32.49 and p = 0.001) with the effect equal to 0.70. In addition, the effect of animal therapy on anxiety of separation (f = 5.63, p = 0.03), generalized anxiety disorder (f = 8.56, p = 0.01), social phobia (f = 14.58, p = 0.002) and specific anxiety (f = 11.63, p = 0.005) was significant with effects equal to 0.30, 0.40, 0.53, and 0.47, respectively. The results also showed that the effect of animal therapy on obsession was not significant (p > 0.05). Conclusion: Therefore, it can be concluded that Animal therapy is effective in alleviating anxiety in children. It supports for the inclusion of AAT in therapeutic practice with children having anxiety.
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An increasing number of studies in the field of Social Work (SW) address the incorporation of animal presence in practice and improved understanding of social support and therapeutic components. Education programs on the ethical and practical principles of animal-assisted interventions, including models and theories supporting the psycho-physiological effects of human-animal interactions (HAI), are being implemented around the world, especially in the US. While designing and implementing a new interdisciplinary curriculum can be time-consuming and, depending on the many variables, integrating elements of HAI components in existing curricula can be a more efficient approach. We present a step-by-step approach for inclusion of HAI knowledge and practice in teaching Yalom's principles and therapeutic factors of group therapy to SW students. Based on a qualitative analysis of the existent literature and on the results of several research projects in the field of HAI, we propose an approach for infusing research-informed examples and theories supporting the beneficial effects of HAI in the direction of the interdisciplinary understanding of the Yalom's primary factors in the therapeutic process, such as: instillation of hope, corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, and group cohesion. Applied values of HAI are discussed for each factor, emphasizing the added value of animal presence in group therapy settings from the perspective of the dynamic of interspecific social networks, i.e., animal-handler-group members.
This chapter explores the relationship between animal-assisted interventions (AAI) and veterinary social work. AAI has historical roots in aligned helping professions, such as nursing and psychology; social work has embraced the challenges associated with preparing students and professionals to engage in this work, including its ethical, educational, and practical dimensions. AAI rests on a strong theoretical foundation, drawing from the biophilia hypothesis, attachment theory, and the biopsychosocial framework. The inclusion of animals in the therapeutic process decreases treatment resistance, increases social rapport, and helps promote favorable treatment outcomes. The chapter concludes with suggestions for future opportunities. An appendix provides a listing of resources for continued learning.
This chapter will provide a brief overview of the history and counseling theories associated with animal-assisted interventions and how school counselors can incorporate the use of animal-assisted interventions into their school's trauma-informed counseling program while examining the benefits of using animal-assisted interventions to promote trust, rapport, and healing for students experiencing any type of direct or indirect trauma. This chapter will also review potential problems, issues, and controversies that may arise in using animal-assisted interventions in the school setting. Finally, the author will offer strategies and ideas for encompassing living and other alternative modalities of animal-assisted interventions within an elementary school counseling program.
Animal‐assisted Interventions (AAIs) have been used as therapeutic interventions aimed at improving psychological well‐being, often for young people with mental health and educational difficulties. This qualitative study explored how three students (male and female), aged 12–15 and with ASD and/or ADHD diagnoses experienced AAI at an alternative education provision. Semi‐structured interviews with each participant were conducted and analysed using constructivist thematic analysis. Three themes and four sub‐themes were identified. The themes were: (1) Self‐esteem, with sub‐themes motivation and reward, and self‐awareness, (2) Emotional benefits with strategy building, and support and (3) Identification. Participants valued AAI as a positive intervention which aided their psychological well‐being. Findings emphasise the effectiveness of AAIs for young people with neurodevelopmental disorders in both a therapeutic and an educational context.
Background The physical benefits for patients who spend time with a therapy dog have been reported, including decreased anxiety. Pet therapy has decreased anxiety in various hospitalized patient populations. The human–animal bond is the foundation for the positive interaction therapy dogs create. Objective This study’s purpose was to explore the use of pet therapy as an intervention to decrease patients’ anxiety levels on two diverse inpatient units: Behavioral Health (BHU) and Pediatrics (PEDS). Study Design This was a quantitative study using a convenience sample, with systematic assignment to the experimental and control group. The State Anxiety Scale (SAS), a 6-item, Likert-type Short Form version of the State-Trait Anxiety Inventory, was used with adults and children; a Pediatric Emoji Method was constructed to assist children with the SAS. After consent, both groups completed the SAS pretest. Intervention patients then spent up to 15 minutes with a therapy dog and handler. The SAS posttest was completed 1 hour later by the experimental and control group. Descriptive and inferential statistics were used, including an independent samples t test, paired-sample t test, Wilcoxon signed rank tests, and Spearman correlation coefficients. Results Findings revealed that the therapy dog visitations had a positive effect on lowering anxiety supporting the hypothesis. Both the PEDS and BHU participants experienced a significant decrease in their anxiety level following the dog visits. Conclusion Patients on the BHU and PEDS units benefitted from their visit with a therapy dog by experiencing a decrease in their anxiety level.
Background: Previous studies have used symptom provocation and positron emission tomography to delineate the brain systems that mediate various anxiety states. Using an analogous approach, the goal of this study was to measure regional cerebral blood flow changes associated with posttraumatic stress disorder (PTSD) symptoms.Methods: Eight patients with PTSD, screened as physiologically responsive to a script-driven imagery symptom provocation paradigm, were exposed sequentially to audiotaped traumatic and neutral scripts in conjunction with positron emission tomography. Heart rate and subjective measures of emotional state were obtained for each condition. Statistical mapping techniques were used to determine locations of significant brain activation.Results: Increases in normalized blood flow were found for the traumatic as compared with control conditions in rightsided limbic, paralimbic, and visual areas; decreases were found in left inferior frontal and middle temporal cortex.Conclusions: The results suggest that emotions associated with the PTSD symptomatic state are mediated by the limbic and paralimbic systems within the right hemisphere. Activation of visual cortex may correspond to the visual component of PTSD reexperiencing phenomena.
Pet Therapy reduces apprehension and is, therefore an important tool in working with children and adolescents. Treatment of animals by children is also indicative of their mental health and healthy development. Cruelty to animals may foretell later abuse to humans providing the link between child and animal abuse. Understanding the role of pets as indicators of individual and family problems enable therapists and other professionals to provide the proper counseling for the situation. This paper presents a describes a group work program cognitive behavioral approach with adolescents in pet therapy as an adjunct to treatment in anger management.
The therapeutic potential of animal-assisted therapy (AAT) was assessed in two case studies of emotionally disturbed children. Two boys (11 and 12 years of age) participated in weekly AAT sessions for 12 weeks. Progress of individual goals was assessed through The ADD-H Comprehensive Teacher Rating Scale (ACTeRS), direct observation and videotapes of the therapy sessions, Individual Education Plans (IEP), and post-intervention interviews with the participants, their families, and educational professionals. Data analysis revealed progress in most identified goals.
Research has demonstrated that the use of animals in counseling provides beneficial effects to clients. This article presents literature on Animal-Assisted Therapy (AAT), and details an exploratory study that applied AAT in an adolescent anger management group. Consistent with other research, beneficial effects noted in this study included a calming effect on the adolescents, humor relief during sessions, increased feelings of safety in the group, experiencing empathy, and motivation to attend sessions. Implications of the research and practical applications are provided, including considerations for using AAT in the counseling process.
A primary interest of the field of infant mental health is in the early conditions that place infants at riskfor less than optimal development. The fundamental problem of what constitutes normal and abnormal development is now a focus of developmental psychology, infant psychiatry, and devel- opmental neuroscience. In the second part of this sequential work, I present interdisciplinary data to more deeply forge the theoretical links between severe attachment failures, impairments of the early develop- ment of the right brain's stress coping systems, and maladaptive infant mental health. In the following, I offer thoughts on the negative impact of traumatic attachments on brain development and infant mental health, the neurobiology of infant trauma, the neuropsychology of a disorganized/disoriented attachment pattern associated with abuse and neglect, trauma-induced impairments of a regulatory system in the orbitofrontal cortex, the links between orbitofrontal dysfunction and a predisposition to posttraumatic stress disorders, the neurobiology of the dissociative defense, the etiology of dissociation and body- mind psychopathology, the effects of early relational trauma on enduring right hemispheric function, and some implications for models of early intervention. These findings suggest direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health.