Animal-Assisted Therapy with Children Suffering from Insecure Attachment Due to Abuse and Neglect: A Method to Lower the Risk of Intergenerational Transmission of Abuse?

Abstract

Children suffering from insecure attachment due to severe abuse and/or neglect
are often characterized by internal working models which, although perhaps
adaptive within the original family situation, are inappropriate and maladaptive in
other relationships and situations. Such children have a higher probability than the
general population of becoming abusing or neglecting parents. Besides the usual
goals of psychotherapy, an overall goal is to stop the cycle of abuse in which abused
children may grow up to be abusing parents. Therapy with these children is complicated
by their distrust in adults as well as difficulties in symbolization due to
trauma during the preverbal stage. Animal-Assisted Therapy (AAT) provides
avenues for circumventing these difficulties, as well as providing additional tools
for reaching the inner world of the client. This article gives a brief background of
the connection between insecure attachment and intergenerational transmission
of abuse and neglect as well as a brief overview of the principles of AAT in a play
therapy setting. A rationale for the use of AAT as a unique therapy technique for
children having suffered from abuse and neglect is followed by a number of clinical
examples illustrating AAT.

Full text

Animal-Assisted Therapy with Children
Suffering from Insecure Attachment Due to
Abuse and Neglect: A Method to Lower
the Risk of Intergenerational Transmission
of Abuse?
NANCY PARISH-PLASS
Bayit Lechol Yeled B’Yisrael Emergency Shelter for At-risk Children, Kiryat Ata, Israel and
Megadim Children’s Village – SOS, Migdal Ha’emek, Israel
ABSTRACT
Children suffering from insecure attachment due to severe abuse and/or neglect
are often characterized by internal working models which, although perhaps
adaptive within the original family situation, are inappropriate and maladaptive in
other relationships and situations. Such children have a higher probability than the
general population of becoming abusing or neglecting parents. Besides the usual
goals of psychotherapy, an overall goal is to stop the cycle of abuse in which abused
children may grow up to be abusing parents. Therapy with these children is compli-
cated by their distrust in adults as well as difficulties in symbolization due to
trauma during the preverbal stage. Animal-Assisted Therapy (AAT) provides
avenues for circumventing these difficulties, as well as providing additional tools
for reaching the inner world of the client. This article gives a brief background of
the connection between insecure attachment and intergenerational transmission
of abuse and neglect as well as a brief overview of the principles of AAT in a play
therapy setting. A rationale for the use of AAT as a unique therapy technique for
children having suffered from abuse and neglect is followed by a number of clinical
examples illustrating AAT.
KEYWORDS
abuse and neglect, Animal-Assisted Therapy, insecure attachment, intergenerational
transmission of abuse and neglect, play therapy
I WORK IN THE field of Animal-Assisted Therapy with children who suffer from
insecure attachment as a result of having experienced abuse (psychological, physical
and/or sexual) and/or severe neglect and have been removed from their families.
Because of their experiences with adults within the family, these children tend to distrust
Clinical Child Psychology and Psychiatry Copyright © 2008 SAGE Publications
Vol 13(1): 7–30. DOI: 10.1177/1359104507086338 www.sagepublications.com
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relationships with adults in general. This distrust creates difficulty within the therapeutic
relationship on which therapy is supposed to be based.
Many children who suffered from abuse and/or neglect during the preverbal stage of
development may exhibit difficulty in symbolization (Thompson, 1999). This difficulty
may present problems within play therapy, a preferred therapy method with children,
which often depends on symbolization in order to reach the inner world of the child.
Child victims of severe abuse and/or neglect often suffer from insecure attachment
and are characterized by strategies that were adaptive and of protective value within the
context of their families (Crittenden, 1999) but are maladaptive in normative situations
with other children and adults (who have different response patterns to those of their
abusing parents) and may even put the child at risk (Marvin, 1992). In addition, these
children often have a lower ability to empathize with others (Crockenberg, 1995;
Feshbach, 1989). Without intervention, these factors are likely to result in the child
growing into adulthood and participating in inappropriate and maladaptive relationships
with others, especially in respect to adult–child relationships. Research will later be
discussed that has found that such children have a much higher probability than the
general population of becoming abusing or neglecting parents. Besides the usual goals
of many schools of therapy – emotional expression leading to insight, change and
increase in quality of life, my overall goal for these children is to lower the probability
of the cycle of abuse in which some maltreated children grow up to be maltreating
parents.
Animal-Assisted Therapy (AAT),a type of psychotherapy employing the presence of
animals within the therapy setting, addresses these issues and provides avenues for
circumventing these difficulties, as well as providing additional tools for reaching the
inner world of the client. This article describes various theoretical explanations for
the intergenerational transmission of abuse and neglect, followed by a brief overview of
the principles of AAT and their relevance as a unique therapy technique for children
suffering from insecure attachment due to abuse and neglect, as well as a rationale for
AAT as a possible way to lower the risk of intergenerational transmission of abuse and
neglect. Finally, a description of my therapy setting is presented together with a number
of clinical examples illustrating AAT.
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ACKNOWLEDGEMENTS: I would like to acknowledge Dikla Tsur of Oranim College
(Israel) for introducing me to the world of Animal-Assisted Therapy, the staff (especially the
directors, Itzik Mishnayot and Gil Ganor, and my supervisors, Efrat Beinhacker and Miri
Yarimi) of the Bayit Lechol Yeled Emergency Shelter for At-risk Children in Kiryat Ata
(Israel) for their unwavering belief in and support for me and AAT from the very beginning,
and to my brother Michael Parish for always being there for me.
NANCY PARISH-PLASS received a BA in psychology from Smith College (USA) in 1972.
After graduate studies at the University of Illinois at Champaign/Urbana, she immigrated to
Israel in 1982 and worked in kibbutz early childhood education for 18 years. She then
completed a 3-year academic clinical program in Animal-Assisted Therapy at Oranim College
and later Hebrew University’s Machon Magid School of Psychotherapy. Nancy works as an
Animal-Assisted Therapist with at-risk children, most of whom have been removed from
their families either temporarily or permanently. She is the founding chairperson of the Israeli
Association for Animal-Assisted Psychotherapy.
CONTACT: Nancy Parish-Plass, Kibbutz Usha, Doar Kfar Hamacabi 30031, Israel. [E-mail:
nancyaat@gmail.com]
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A brief overview of the connection between insecure
attachment and the cycle of child abuse and neglect
According to a research-based ecological model of the origins of child abuse and
neglect, a system of risk and protective factors interact across four levels: Individual,
family, community and society. One of the individual factors is abuse of the abusing
parent as a child (Bethea, 1999). Many studies have indeed found that abused and
neglected children are themselves at risk of becoming maltreating parents (Egeland
Jacobvitz, & Papatola, 1987; Kaufman & Zigler, 1987; Kim, 2006; Lyons-Ruth & Block,
1996). A factor in this cycle may be related to problematic mental representations of
abusing and neglecting parents acquired as children through experiences and inter-
actions with their own abusive/neglecting parents. According to Bowlby (1969), secure
attachment depends upon the development of appropriate mental representations, or
what he refers to as internal working models, of the parent–child relationship. The first
component of these internal working models is characterized by information, one’s
expectations and one’s affects concerning other individuals’ behavior in a relationship,
while the second component involves one’s representations of oneself and one’s role
and behavior in one’s relationship with those other individuals. These internal working
models affect how one perceives, remembers, interprets and reacts to experiences in
similar relationships.
Maltreated children, in reaction to their experiences with their parents, form insecure
attachments and develop internal working models that are adaptive within the context
of their relationships with their parents. However, these models become maladaptive
when employed in their relationships with others, and specifically when raising their
own children. Marvin (1992) notes that the adaptive solution in one context becomes
a problematic and even dangerous one in other contexts. In their study on the trans-
mission of caregiving, Kretchmar and Jacobvitz (2002) found that
one possible mechanism for the transmission of caregiving involves the internal-
ization of particular strategies experienced with one’s own significant caregivers;
these familiar patterns are then recreated in the next generation . . . parents are
likely to respond to their children’s attachment-related needs in such a way that
preserves their own representations of attachment. (p. 370)
A number of articles document examples and implications of these problematic internal
working models, generally unacceptable patterns that fit with the parents’ patterns of
interactions with their own caregivers. Howes and Eldredge (1985) found that
nonabused children respond to emotional distress in peers with prosocial behavior,
whereas physically abused children respond to that distress with aggression. Mueller and
Silverman (1989) suggest that abused children defend themselves from experiencing
feelings of pain and threat associated with painful representational models of self or
others by dissociating these negative models. It is possible that when an abused child is
confronted with a peer who exhibits emotional distress, this
may elicit mental images and memories of instances when the maltreated child was
similarly distressed and attachment figures had rejected the youngster or had not
met his or her needs. As these memories and images may be intolerable, the child
might strike out at the peer who exhibits this distress to terminate it and thereby
avoid personal feelings of anxiety and pain. (Pearce & Pezzot-Pearce, 1997, p. 47).
This is most likely a mechanism similar to what happens in interactions between parents
maltreated as children and their own children.
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There is an additional possible explanation to Howes and Eldredge’s (1985) obser-
vations. Cicchetti (1990) outlined a number of deficits found in maltreated children, two
of which are (a) deficits in children’s emotional language, and (b) deficits in children’s
ability to decode facial expression of emotions in others. Price and Dodge (1989) found
that rejected and socially maladjusted boys showing atypical levels of aggression often
exhibit deficits in intention-cue detection. That is,if intentions are ambiguous,these boys
will be more likely to attribute hostile intentions to peers’ natural behavior.
In their discussion of internal working models,Bretherton and Munholland (1999) note
that children with a working model of parents as rejecting and ignoring of attachment-
related behavior suffer from a working model of self as devalued and incompetent.
Pearce and Pezzot-Pearce (1997) cite a number of research studies documenting lowered
self-esteem in children suffering from abuse and neglect. In turn, low self-esteem in
parents has been found to be a factor that increases risk for child abuse (Bethea, 1999).
Thus self-esteem may be seen as a factor in intergenerational transmission of child abuse
and neglect.
Much research has dealt with the relationship between empathy, social behavior and
internal working models, shedding light on the mechanism that turns the abused into
an abuser. Strayer and Roberts (1984) state that higher levels of empathy in children
are associated with greater prosocial behavior. ‘Children may be inhibited from hurting
others by becoming aware of the potentially harmful consequences of their actions.
Inhibition occurs when they have a cognitive and emotional appreciation of the psycho-
logical and physical pain evoked by their aggression’ (Pearce & Pezzot-Pearce, 1997,
p. 291). It is then logical to assume that lack of ability to be empathetic would increase
the likelihood of abusive behavior. Indeed, Feshbach, Feshbach, Fauvre, and Ballard-
Campbell (1983) cite empathy deficits as being associated with the emergence of
aggression. In a later article, Feshbach (1989) states that abusive parents appear to be
more indifferent to emotional pain in others than nonabusive parents. Zahn-Waxler,
Hollenbeck, and Radke-Yarrow (1984) found that the development of empathy in
children is strongly related to parental socialization practices. Low parental empathy
has been found to correlate with low child empathy (Feshbach, 1989): toddlers exposed
to frequent maternal child-directed anger are less empathetic when witnessing others’
distress (Crockenberg, 1985). A strong relationship was found between low maternal
empathy and physical child abuse (Letourneau, 1981). Ascione (1999) writes that ‘in a
climate of pervasive terror, the roots of human empathy may wither or die, or fail to
develop at all’ (p. 51).
Children who receive sensitive, appropriate and consistent care-giving behavior by a
significant other will become securely attached and will be able to enter into loving,
trusting, empathetic relationships. These children will successfully recognize signs of
distress and therefore provide supportive care to their children. Neglected and abused
children, on the other hand, will be more likely to suffer from insecure attachment,
suffer from lack of ability to empathize, will not recognize or will ignore or will become
aggressive at signs of distress,and therefore will have difficulty providing adequate care
for their children. In other words, internal working models, developed through
children’s experiences as victims of abuse at the hands of their parents, play a role in
the low quality of childcare that abuse victims in turn give to their children (Egeland,
Jacobvitz, & Sroufe, 1988).
Fonagy (1999) compares Winnicott’s (1992) theory of sensitive parenting to Bowlby’s
(1969) Theory of Attachment and internal working models. This model may also be
used to explain the intergenerational transmission of parental mistreatment. Briefly, the
mother allows environmental stimuli to reach her child in a gradual fashion, at levels
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appropriate to the child’s ability to handle the frustration and to grow from the process.
Together with the concurrent holding environment (in which the mother contains and
reflects back to the child the child’s self-expression, facilitating the child’s self-
knowledge and self-integration; Winnicott, 1965), this process leads to the child’s
tolerance of ambivalence, emergence of concern, and acceptance of responsibility.
However, if dangerous or frustrating stimuli (originating either from the mother or
from the environment) inappropriate to the child’s stage of development impinge on and
thereby threaten the child, together with a lack of a holding environment supplied by
the mother, the result may be development in the child of higher levels of aggression
and antisocial behavior than in a child of a good-enough mother (Winnicott, 1992). Such
a child would be characterized by a low threshold for frustration, impulsiveness, a
continuing need to be opposed by those in the environment in order to experience or
feel real, self-expression in the form of physical force (Winnicott, 1992), lack of concern
for others (Winnicott, 1965), and loss of personal responsibility (Winnicott, 1992). These
are all considered by Winnicott to be reactions to impingement. In the absence of change,
when faced with the frustrations of parenthood, one possible outcome may be that such
a child may grow up to be an abusing parent.. If the impingement leads the child to
emotional disconnection and withdrawal, the child might grow up to be a neglectful
parent.
A recent theoretical construct deepens our understanding of the connection between
insecure attachment and intergenerational transmission of child abuse and neglect.
According to Crittenden (1999), the theory of attachment is less about security and more
about protection from danger, resulting in affect that creates need for organization of
cognition and behavior into self-protective strategies that will promote safety. A strategy
that is successful in doing so can be considered adaptive.
In a later chapter, Crittenden (2006) looks at internal working models from a memory
systems perspective. She refers to six types of dispositional representations (DRs),
developmental pathways which are the outcomes of the interaction between neurologi-
cal maturation and experience. These DRs are dynamic and ‘a) shape individuals’
perception of the world and b) their relation to it and also guide the transformation of
mental representations to enacted behavior’ (p. 390). In the presence of a stimulus such
as danger, these mental representations result in behavior in the form of strategies.
This theoretical model takes on a developmental or maturational perspective in that
children have fewer and more simple representations compared to adults. As opposed
to Bowlby’s (1969) view of parent-to-child transmission of internal working models,
children do not copy the parent’s representations, but rather ‘parents act, creating an
environment in which infants and children perceive certain stimulation and then
[depending on their simpler DRs, as well as prior experience] generate their own
representation of self to context’ (Crittenden, 2006, p. 398) leading to their own self-
protecting strategies.
In the case of a child brought up in a safe family, the child reacts to any given situation
by reflecting on past use of DRs and the strategies they generated in similar situations.
By evaluating, comparing, contrasting and combining information on these DRs and
outcomes, the child will generate an integrated and comprehensive solution to the new
situation, allowing for the best fit of self to current context. As time passes, one gains
experience in this process of reflective integration, as well as generating a greater
number of alternative and more elaborate DRs, upon which one may draw in later situ-
ations. However, this process takes time, which one may not have in a dangerous
situation. One may have to act quickly, aborting reflection and integrative processing in
favor of more immediate protective action, therefore relying solely on past DRs and
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dispositions to action. The more sophisticated the pattern of DRs at one’s disposal, the
more likely the outcome will be successful. The more experience one has in reflective
integration, the more efficient one will be in coming up with an adaptive solution in a
small amount of time in a dangerous situation. Thus, experience with reflective inte-
gration, together with integrative capacity which grows with maturity, are predictive of
a parent’s self- and progeny-protective action in the face of danger.
However, parents who grew up in an atmosphere of danger will have fewer alternative
and less elaborate DR to draw upon, as well as less experience with reflective integration.
As a result,‘(a) childhood strategies may be applied inappropriately to adult contexts,(b)
errors of attribution and behavioral responses may be carried forward without awareness
[as found in the research on maltreated children and attributional bias by Price & Dodge
(1989) referred to earlier], and (c) new distortion and errors may be added in response
to newly maturing capacities’ (Crittenden, 2006, p. 389). These errors in attribution may
cause parents ‘to over-estimate the probability of danger and more often to abort inte-
grative processing in favor of self- or progeny-protective action’, further preventing
reflective integration as well as the development of alternative and more elaborate DRs.
This combination of factors may cause inadequate parenting that would in turn endanger
the child. Thus the cycle of abuse and neglect continues.
This process described by Crittenden provides an interesting explanation to the
mechanism behind Winnicott’s theory of sensitive parenting concerning the effects of
parental behavior and impingement on the child’s representations and behavior.
A brief overview of Animal-Assisted Psychotherapy as an
effective therapy for children suffering from insecure
attachment due to abuse and neglect
The presence of animals as a serious therapy tool was first brought to the attention of
the world of psychotherapy by Levinson and Mallon in a series of articles in the 1960s,
culminating in their book Pet-oriented Psychotherapy (1969/1997). Levinson’s main goal
was to use the animal as a motivator for children who were otherwise resistant to
therapy. It is a tool that has spread in use with a number of populations, for example
children, adolescents, the elderly, prison inmates, psychiatric patients, those suffering
from autism or from chronic and terminal illnesses. In this article, therapy with children
is discussed, but the same principles may be applied to various populations.
Animal-Assisted Therapy (AAT) must be differentiated from Animal-Assisted
Activities (AAA) and Animal-Assisted Education (AAE). AAT is practiced by aca-
demically trained professionals with specific individualized therapy goals in mind for the
child. AAA and AAE are practiced by educators, laymen and volunteers with general
therapeutic, educational or recreational goals in mind. These may have a therapeutic
effect on the participant, but should not be confused with therapy, in which the therapist
explores the child’s inner world with the influence of the presence of an animal as a
therapy tool.
Animal-Assisted Therapy is based on emotional connection and relationship – between
therapist and child, between therapist and animal, between child and animal, between
animal and animal. The child may be an active participant at any point, or sometimes an
observer. Interaction with the animal is only part of the therapy process in AAT. The main
component is the accompaniment and guidance of the child by the therapist, with
mediation by the therapist between the child and the animal, between the child and
his/her own inner processes, leading to reflection, awareness and insight. The presence of
the animal is the tool, and the client is the focus. In short, through AAT, the therapist
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works with the client on cognitive, social, behavioral and emotional issues in order to
bring about change and healthy emotional development.
As in many approaches to psychotherapy, the goal of AAT is to reach the child in
order to understand him/her, lead to emotional expression and insight, bring about
change, and improve the child’s quality of life. AAT, however, has unique qualities that
prove to be a catalyst within the therapy process and aid in the obtaining of various goals
of therapy:
■Enabling connection: Animals have been found to be a catalyst for social interaction
(Corson, Corson,Gwynne,& Arnold, 1977; Mcnicholas & Collis, 2000; Messent,1983).
An animal may act as a bridge for the child–therapist connection, a requirement
necessary for the therapy process to occur. Many children, especially from the at-risk
population, are suspicious of therapy, as well as of the therapist. When the child
observes the authentic, positive, nurturing way the therapist relates to the animals, the
child often perceives the therapist in a more positive light and feels less threatened.
■Normalcy, safety and friendliness of the therapy setting: The presence of the animal in
the room adds a sense of normalcy and encourages more natural and spontaneous
behavior and communication. Research has shown that the presence of an animal
contributes to a positive perception of a situation, one that is friendly and safe
(Lockwood, 1983). The fact that the therapist makes the animal feel safe gives
children the message that they too will be kept safe, a point especially relevant for
population that has learned from necessity to be on constant guard for any sign of
danger. This may enable children to feel more comfortable bringing up the difficult
issues that brought them to therapy.
■Acceptance: A child may be more emotionally open in front of animals, for they do
not prejudge and are not critical, or concerned with the child’s failures, outer appear-
ance, social or economic status and so on. Also, the child perceives that the therapist
accepts the animals and cares for them, with all their characteristics – positive and
negative. Through identification with the animals, children may feel that they will also
receive that same acceptance from the therapist.
■Reality at a safe psychological distance: There are many implications for the therapy
process because of the fact that the animals are living creatures. Their behavior is not
necessarily predictable. They initiate interactions, react, stimulate the senses (touch,
hearing, smell,sight, movement) and create situations that do not usually occur in the
therapy setting. The animals awaken a wide range of associations,memories, emotions
and reactions in the child, yet at a safe emotional distance from the reality of human
interactions. Interactions with the animals in the ‘here and now’ provide an oppor-
tunity for role playing, projection,transference, and reenactment of experiences from
the past, thus enabling emotional content, such as aggression, sexual issues, sickness,
anger, fear, anxiety, sadness, and rejection, to come to the surface and be worked
through. This allows for what Winnicott (1971) refers so as potential space, an inter-
mediate area of experiencing, to which both inner reality and external life, both
fantasy and reality, contribute. The presence of animals is especially useful for this
population, for the animals serve as more realistic stimuli for play, an advantage for
children suffering from insecure attachment who may have a lower ability for symbol-
ization (Thompson, 1999; Winnicot, 1965).
■Self-esteem: The interaction and the creation of a relationship with an animal serve to
raise children’s self-esteem (Van Houte & Jarvis, 1995) and their feeling of capability.
They feel not only accepted and trusted by the animal, but also important to the
animal.
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■The animal as an attachment figure, allowing for the working through of attachment
issues in the ‘here and now’ within the therapy setting: Bowlby (1969) referred to the
existence of an attachment behavior system in which an individual tends to seek
proximity to others perceived as supportive. This system is activated in response to
certain triggers, as in times of uncertainty or perceived threat or danger. In their
discussion of attachment behavior systems, Mikulincer and Shaver (2003) cite certain
functions of an attachment figure: (a) As a target for proximity maintenance; (b) as a
safe haven, facilitating distress alleviation and serving as a source of support and
comfort; and (c) as a secure base from which one may engage in nonattachment
behavior and develop autonomous behavior. In a recent series of studies, Zilcha and
Mikulincer (2007) have shown that an ongoing relationship with an animal can fulfill
some of the same human needs as those fulfilled by a human attachment figure.
Furthermore, it was found that the same individual differences in the activation of
the attachment system that exist in interpersonal relationships are also present in
human–animal relationships. This research has found this to be true in a wide range
of settings, including the therapy setting. The researchers have concluded from the
results of their studies that a relationship with an animal can supply a simpler sphere
for working through contents related to attachment issues. In short, the animal – as a
safe haven, as a secure base and as an attachment figure – is likely to enable and even
serve as a catalyst for the therapy process.
■Development of more adaptive representations and strategies: Marvin (1992) refers to
the strategies of children with insecure attachment as being a result of developmental
pathways ‘gone awry’ due to factors within the family. He suggests that it is possible
to create an intervention which allows the child to experience more normative
behavior patterns, leading to a change toward more normative developmental
pathways. In AAT, observation of the therapist’s social interactions with the animal,
together with the mediation by the therapist between the child and the animal in their
interactions, enables modeling and internalization of accepted social rules, under-
standing natural and logical reactions to various behaviors, acceptance of responsi-
bilities toward others, and development of respect toward the needs of others. This
social interaction also provides opportunities for learning to express and understand
nonverbal language, to decipher intentions, leading to verbal and emotional compre-
hension and expression. Animals tend to be more forgiving than people when
mistakes are made, allowing for children to continue practicing their social and
communicative skills without suffering from permanent rejection as a result of their
mistakes during the process.
■Empathy: The ability to be empathetic is the cornerstone of healthy human inter-
action. In research studying the reliability of a measure of empathy among small
children, Poresky (1990) found that empathy toward other children is related to
empathy toward pets. In other research, Ascione and Weber (1996) found that
children can be taught to have enhanced attitudes toward animals and that quality
involvement with animals is positively related to humane attitudes toward animals.
Furthermore, they found that there is a generalization from these attitudes to human-
directed empathy. The taking-care of the animal that occurs within the meeting,
parallel to the child’s emotional needs being explored and met by the therapist in the
session in appropriate ways, encourages the development of empathy toward others.
Also,the child witnesses the empathy shown to the animals by the therapist, providing
the opportunity for modeling.
■Need for control: While people are born with a basic need to be in control – of oneself,
of others, of various situations – reality often does not allow it, especially in the case
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of children and other dependent populations. This is especially relevant for victims of
chronic maltreatment, who are characterized by feelings of helplessness. Herman
(1997) states that recovery from abuse is dependent on the empowerment of the
survivor. Interaction between the children and the animal in therapy enables oppor-
tunities for the children to be in control – of the animal, of the situation,of themselves
– in a more appropriate and acceptable fashion than they have been exposed to by
their parents,through the therapist’s guidance. This will contribute to the novel feeling
of being in control, as well as the building of a stronger and more positive self-image
and higher self-esteem and self-confidence – all important issues for this population.
■Touch: Although all people are born with a need for human touch, opportunities for
such are sometimes limited. The presence of an animal not only enables opportunities
for warm, soft,intimate touch leading to a psychological sense of wellbeing (Odendaal,
2000) but also gives legitimization for touch from someone else. Simple and natural
touch with another living being takes away the feeling of social alienation, yet touch
may be a sensitive subject for children suffering from abuse. Within the therapy
session, the animal may serve as a transitional object when the client is in need of
physical comforting through touch and it is inappropriate between child and therapist.
■Regression in the service of the ego: Studies have shown that interactions with animals
result in anxiety reduction as measured by blood pressure and heart rate (Friedmann,
Katcher, Lynch, & Messent, 1983), changes in hormonal levels leading to a lowering
of stress and a general sense of pleasure (Odendaal, 2000), and an increased ability to
feel pleasure (Nathans-Barel, Feldman, Berger, Modai, & Silver, 2005), allowing for
the lowering of problematic defenses, enabling personality growth, and the strength-
ening of the ego, thereby strengthening one’s ability to function more efficiently.
These studies show further evidence backing up the theories and research findings in
the above discussion of an animal as an attachment figure. Herman (1997) refers to
child abuse survivors as suffering from as complex form of Posttraumatic Stress
Disorder, these children being in an autonomic state of hyperarousal. This state may
adversely affect the child’s ability to enter into the process of working through issues
from the past. The presence of animals may lower this state of hyperarousal enough
to increase the child’s emotional availability to participate in the emotionally difficult
work involved in the therapy process.
■Separation, loss and bereavement: On a literal level, the presence of an animal in
therapy may remind the child of a pet from the past who died, was lost or was given
away. In addition, because animals are living beings, reality sometimes creeps in and
a therapy animal may die. This may enable the child to touch on issues otherwise
buried concerning separation, loss or bereavement of someone close.
It is interesting to note that many of the aforementioned principles of AAT are remi-
niscent of advantages of group therapy (see Yalom, 1995). The child initiates, observes,
participates in, and reacts to social interactions. The child has a chance to reenact past
social situations in the ‘here and now’ with the support of the therapist. The group,
comprising of the child, the therapist and the animals, serves as a social microcosm, a
relatively safe laboratory in which interpersonal learning may take place, such as
learning to read social cues and appropriate ways to react. Yet in this ‘group therapy’,
the child is the focal point of the therapy meeting.
Through their own observations, the feedback of the animals (via their reactions), and
reflection by the therapist, children come to realize their own personal responsibility in
the shaping of their interpersonal world, thus discovering their power to change it. The
children may then risk new behaviors and then practice them, first within the ‘group’ and
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later outside of it. The children’s interpersonal distortions will diminish and their ability
to form rewarding relationships is enhanced. Social anxiety decreases, self-esteem rises,
the children become more open to others,others respond more positively to the children,
encouraging further change.
AAT as ‘group therapy’ also affords opportunities from the point of view of Object
Relations Theory. The animals may represent additional objects in the room, allowing
for more opportunities for reexternalization of various objects in the child’s represen-
tational world. This might result in a reenactment of more complex social situations
(from past or present) familiar to children and enable them to work through and gain
insight into their role in such situations. The presence of an animal in a therapy setting
may also allow for reexternalization of parts of the self-representation that the child feels
the need to work on. In this case, the animal would serve as a bridge between children
and their own feelings and experiences, allowing the children to say, ‘I don’t feel fright-
ened; it’s the dog that feels frightened’. Children may then work on their feelings ‘from
the outside’ by observation and/or interaction, even taking the part of another object in
a switching of roles.
Both the subject and the presence of animals provide a valuable assessment tool:
1. The Children’s Apperception Test (CAT) is a popular version of the Thematic Apper-
ception Test (TAT) using animal instead of human figures (Bellak & Abrams, 1996).
2. Taking into consideration the proven link between animal abuse, domestic violence
and child abuse (Ascione & Arkow,1999), exploration of pet history within the family
provides information concerning the environment in which the child was raised.
3. Animal abuse is a criterion for the diagnosis of Conduct Disorder (APA, 1994).
4. During intake, questioning children about which animal they are most similar to
provides information concerning self-image. Questioning children about which
animal they would most like to be provides a deeper understanding of the children’s
fears, anxieties, disappointments, feelings of emptiness and lacking concerning their
present reality – both inner and outer.
5. Observing children in their interactions with the animals, together with discussions
with the children about those interactions, may provide information to the therapist
about the children’s understanding of and reactions to social situations and the extent
to which they are adaptive or maladaptive.
Rationale for AAT as a mitigating factor in the
intergenerational transmission of abuse and neglect
In a study by Zimrin (1986) she found that two significant situational variables differ-
entiated between what she referred to as survivors of abuse (those who grew up to be
well adjusted) and nonsurvivors (those not found to be well adjusted as adults). The first
was the presence among the survivors, during the period of childhood, of an adult who
inspired confidence in them, treated them with empathy and encouraged them. The
second variable involved responsibility for someone else, whether it was a younger
sibling or a pet. In other words,experience with an empathetic therapist (working on the
emotional and cognitive components of the client’s internal working models) together
with interactions with animals (a behavioral component allowing the client to implement
and practice the changing of mental representations) may lead to inner change of strat-
egies that will prevent the continuation of the cycle of abuse. The results of Zimrin’s
study directly support the potential efficacy of AAT with child victims of abuse and
neglect.
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Keeping in mind the expected effects of insecure attachment, various clinicians have
published their impressions of an unexpected mitigating effect of the presence of
animals on maltreated children: Abused children develop the ability to exhibit appro-
priate nurturing behavior despite not having experienced nurturance from their parents.
Searles (1960) referred to families in which although the parents were not capable of
nurturing their children, the children showed affection toward animals. Sherick (1981)
described the case of a small child whose mother showed no mothering instinct toward
her daughter, yet the daughter showed a high degree of care and empathy toward her
pets. Sherick claimed that the young girl in his case treated her pet as the cared-for,
protected and loved child that she had longed to be.
In light of (a) the theoretical, research, and clinical support presented in this article of
the psychological causes of the cycle of child abuse and neglect; (b) evidence pointing
to the mitigating effect of a relationship of a maltreated child with an animal on that
child’s future parental behavior; and (c) the principles of AAT and the clinical evidence
(as seen in the clinical examples later cited) supporting the case for its potential efficacy,
there seems to be strong support for the use of AAT as an appropriate approach to
psychotherapy for child victims of abuse and neglect.
Specifically, my overall goals in therapy with this population are:
1. To gain the trust of children who have little reason to trust adults (the therapist’s inter-
actions with the animals tend to inspire the child’s trust in the therapist) and give the
client a sense of being accepted (also a foreign feeling for these children), enabling a
working therapist–client connection.
2. To facilitate change in the child’s mental representations and strategies, for example
perceptions of others’ actions and intentions (through my mirroring and mediation of
their interactions with the animals), their reactions – emotionally and behaviorally –
to behaviors in others (through modeling, mirroring, reflection, insight, and chances
to practice newly learned behavior with the animals in a supportive environment).
3. To raise the child’s self-esteem through interactions with the animals (‘The animals
depend on me, want me, respect me’) and the resulting feeling of ‘I deserve empathy’.
4. To develop the child’s ability to empathize (through discussion of the animal’s as well
as the child’s needs, the experience of receiving empathy, the modeling of empathy
toward the animals, and the chance to practice empathetic behavior toward the
animals).
5. To help the child work through the salient and threatening issues concerning his/her
difficult life situation (having grown up in an abusive or neglecting home, separation
from the family unit, current living situation in the shelter/treatment center, an
unfamiliar and difficult environment, etc.).
Clinical examples of Animal-Assisted Therapy with children
suffering from insecure attachment due to abuse and neglect
I work in the field of Animal-Assisted Therapy with children aged 5–13 who have experi-
enced abuse (psychological, physical and/or sexual) and/or severe neglect and have been
removed from their families. Some of these children currently reside in an emergency
shelter. During their stay (averaging 6 months), the childcare staff provides a stable,
caring, therapeutic environment. At the same time, the therapy staff evaluates both the
child and the family, conducts therapy, and makes recommendations to the government
offices for child welfare. I also work in a group home for children who have been
removed permanently from their families due to abuse and/or neglect. In addition, I have
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worked as a therapist in an elementary school located in a wealthy suburban community
where the presence of animals in therapy was instrumental in detecting previously
unrecognized cases of abuse.
Therapy approach
My approach to AAT is typified by nondirective play therapy (Axline, 1969) in which the
child chooses the activities, materials, toys and themes, while the therapist flows with the
child in an attentive and interactive manner. The therapist mirrors and reflects the child’s
actions, emotions and processes in order to encourage insight as well as to further the
development of themes within the play context. During the process of role play, the
therapist may seek clarifications of the child’s intentions and may request and/or receive
instructions from the child as to how to act or react. This is especially important in
therapy with a maltreated child who needs to be empowered. According to the situation
and ability of the child, the therapist may enter into discussions with the child about
his/her intentions, emotions, memories, and thoughts.
The question is often asked as to which children should or should not be referred to
AAT. In the shelter, I have had much success with children referred to me who were
nonverbal or nonco-operative in therapy, or were avoidant in interactions with adults in
general. Children whose high level of anxiety prevents their ability to work through
issues in therapy would benefit from the calming effects of the presence of animals. A
child who has the need to be concrete or lacks the emotional ability to symbolize
emotions or interactions through inanimate play objects may benefit through inter-
actions with animals in a therapy setting.
History of animal abuse is not a contraindication for AAT. Such behavior is often a
sign of the child having been abused and shows an ability and even motivation to work
through one’s interpersonal issues and past experiences through interactions with and
the presence of animals. The presence of and mediation by the therapist will encourage
a more adaptive way for the child to work through relevant PTSD issues.
I would not recommend AAT for children with an aversion to animals unless the
express goal of therapy is to relieve the child of a phobia of animals.
Therapy setting
The room contains the typical items found in play therapy (e.g. doll house, dolls and
accompanying accessories, toy weapons, plastic characters and animals, costumes,
kitchen toys, building toys, board games, card games, pictures to stimulate projective
story telling, toy cars and trucks, and various art supplies). In addition, a number of
animals (all raised in my home so they are used to interactions with people) are present,
together with a number of accessories, such as a leash, chew toy, dog brush and hair
bands, bowls, dog food, and cornflakes (as snack food for the animals). There is access
to a sink with running water.
The following animals are present in each session:
■Mushu, a multi-colored female Tibetan Terrier with long, fluffy fur, has a friendly, soft
personality, and usually receives the child with great excitement yet may sleep during
most of the meeting when not being played with. She follows various orders ‘when
she feels like it’ and is avoidant when she senses aggression from a child (as when a
child points a toy gun at her). For many children, Mushu is a source of acceptance,
warmth, comfort and security.
■Mali (present in the shelter), a female cockatiel, is generally social but sometimes shy.
She does not like to be touched. The child is told that just like some people like
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spaghetti and others do not, some people like to be touched and others do not. Mali
is allowed to say ‘Don’t touch me.’ We respect Mali’s desire not to be touched. This
is an important message to children who have been physically or sexually abused.
■Cuddly (present in the group home and the school) is a male cockatiel who
sometimes loves massages and kisses and sometimes ‘turns into’ Grumpy when he is
threatening and biting. Much ambivalence surrounds children’s feelings and
behavior with Cuddly as they deal with the different parts of Cuddly’s personality
and his unpredictable behavior. The child must learn to read his body language in
order not to be bitten.
■Three laboratory rats – Peek-A-Boo (black), Snowy (white) and Squeaky (black and
white) – are very social and very active. Each tends to have her own individual person-
ality (more or less active, more or less interactive with people, more or less shy or
brave). They are very social and co-operative with each other. With people, they are
curious, interactive, cuddly, and playful. At first sight, they may bring up many fearful
associations for some clients. Yet most children come to see that the rats do not
deserve this stereotype.
■Two Siberian hamsters (sometimes accompanied by offspring) look soft and cute, yet
they tend to hide from social interaction and may bite. Fights sometimes break out
between them. The male hamster must be separated from the female and their
offspring, for the father may eat the young. This often brings up themes in the
children’s play of domestic violence, divorce, and dysfunctional family dynamics.
All the animals (except for Mushu) are in cages at the beginning of the session. The child
decides which animals to take out and when. The child’s choices may create a complex
social situation in the session because of the interactions between the animals. Mushu
shows friendly interest in and curiosity about the other animals in the room, never
threatens them, but is quite annoying to the hamsters. She tends to have a special, playful
relationship with one of the rats. While the rats are very friendly with the children and
with Mushu, they see the bird and hamsters as prey. This adds a sense of actual danger
that must be dealt with. The bird and the hamsters pose no danger to each other, yet do
not interact with one another. This complex social situation is fertile ground for themes
to surface in the play therapy situation. The issues of danger vs. safety, violation vs.
protection, and respect vs. disrespect for another’s needs, that arise in the interactions
between the animals or between the people and the animals (in the stage set up by the
children according to their agenda) are especially salient for the maltreated child and
present many opportunities for working on internal working models, as well as issues
from the child’s past. Even the existence of the cages themselves brings up issues. For
some clients, a cage may represent a home or a shelter from danger, while for others it
is perceived as a prison or a trap.
A therapy room that allows the subject of danger to arise and be worked through (in
the presence of a ‘good-enough therapist’ that ensures ultimate safety, regulates
animal/animal or child/animal interactions in the room so as to be appropriate for the
ability of the child to emotionally handle them, and mirrors and contains the child’s
reactions) serves as a laboratory for the creation of alternate and more elaborate repre-
sentations and strategies. This is reminiscent of Winnicott’s theory of sensitive parenting
mentioned earlier.
It is important to emphasize that despite the aggressive and sometimes violent themes
that arise in the child’s projective play, emotional or physical harm to the animals, as well
as destruction of items in the room, is strictly prohibited. The message must be that
everyone and everything in the room should both feel and be safe.
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The therapy room is only part of the setting. Following Levinson and Mallon’s (1997)
example, I allow the child to choose for us to leave the room for an outing with Mushu.
Many issues have been raised during these outings that may not have arisen within the
four walls of the therapy room.
At the petting zoo near the group home, the therapy setting was further widened.
Besides the intimacy of the therapy room, the child had the choice of wandering through
the zoo. The zoo animals included caged and fenced-in animals such as goats, raccoons,
ferrets, porcupines, various types of birds, foxes, turtles, snakes, fish, guinea pigs, rabbits,
laboratory rats, mice, hamsters and calves. Wandering freely were peacocks, chickens,
ducks, geese and pigeons. An important figure for the children was the zoo keeper, a
young man of 21 years. His relationship with the animals came up often in therapy.
Children often projected onto him the role of nurturer, neglecter, or abuser.
Clinical examples of Animal-Assisted Therapy
Mickey
Mickey1(aged 10) came from a cruelly abusive home and exhibited violent behavior
within the shelter. He was able to work through his daily experiences of being thera-
peutically held by the childcare workers through his interactions with Mushu in therapy.
For four sessions, Mickey ‘held’ Mushu and felt the experience of doing the holding in
order to understand the intentions of the holder. Previously he had assumed the holder
had aggressive intentions toward him. At the end of this process, Mickey came to under-
stand the positive intentions of the holder: ‘I don’t want her to hurt herself or others. I
love her and I’m holding her to help her!’
Danny
Danny (aged 6) was born to a single mother with drug addiction. She severely neglected
him both emotionally and physically, consistently rejecting him (as a toddler, he was often
locked out of his house for hours at a time) and choosing to fulfil her own needs over his.
Within the shelter,Danny’s behavior was characterized by constant cries for attention and
aggressive, often violent, interactions with the caretakers and children.
In the therapy setting, Danny was extremely impulsive, busy with fulfilling his own needs
at the expense of each and every animal and object in the room. The danger of abuse to
the animals and of destruction of property was ever-present. During one session, Danny
became extremely threatening to the animals and I was not sure I would be able to protect
them. Whereas I would usually remove the child in such situations, I decided that this
would be understood by Danny as one more rejection in favor of another’s needs. I instead
removed the animals for their own safety, putting them into the secretary’s care, for the
remainder of the session. Danny stayed the center of the session, seeing that while
everyone’s needs were being fulfilled, he still remained deserving of special attention. In
later sessions, Danny played endless games of hide-and-seek, busy with his question if I
cared enough to find him, and later if I would disappear from him. Meanwhile, Danny’s
attempts at abusive behavior toward the animals continued but were more moderate.
Throughout therapy, Danny seemed to identify with the hamsters, both he and they
being small and in constant movement. They were a constant focal point of his attention.
In a session that was a turning point in Danny’s therapy, he inadvertently did something
to a hamster that he thought was abusive, but was actually pleasant. Instead of rebuking
him as he had expected, I congratulated him for making the hamster feel good. (He had
enclosed the hamster in a very small container, and I explained to him that hamsters feel
happy and safe in small, dark places.) He froze in place and asked, ‘I made him feel good?
What else makes him feel good?’ Danny was incredulous that he was capable of beneficial
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behavior, as well as that I recognized that in him. He was busy for the next few sessions
searching for ways to make the various animals in the room ‘feel good’. Danny slowly
became less impulsive, more organized and more focused in therapy.
Because of Danny’s experiences with his mother,his representation of adult–child inter-
actions with others were problematic. He neither understood nor trusted others’ behavior
or intentions toward him, nor did he understand the effect of his behavior on others. He
had received little empathy in his life and therefore was incapable of feeling empathy for
others, as well as recognizing empathetic behavior in others. Through Danny’s therapeutic
connection with me, he was able to experience empathy and acceptance. Through his
identification with a hamster, Danny slowly changed his behavior from abusive to
empathetic and caring.
Rachel
Rachel (aged 11 at the beginning of therapy) was physically and emotionally abused by
her father and severely emotionally rejected by her mother. At the group home, Rachel
exhibited frequent mood swings, expressed suicidal intentions ‘because my housemother
doesn’t care about me’, was sometimes clingy in her relationships with various adults in
her life at the group home and at school and at other times angry at them. She expressed
a great amount of anger toward her housemother, who in reality did not show her empathy
in a consistent fashion, making it easy for Rachel to transfer her anger at her own rejecting
mother to the housemother.
In therapy, Rachel was consistently occupied with the subject of parent–child relation-
ships. In conversations about her family, she easily expressed anger at her father, who was
divorced by her mother, but tended to idealize her mother. Transference was obvious in
her description of me as the ideal mother of all the animals in the zoo. While interacting
with the animals, we had many discussions about appropriate care and ways of relating to
the animals, which was very important to her.
Shortly before the impending birth of Rachel’s baby sister, her mother suggested to her
that she return home. The mother’s intention was for Rachel to baby-sit in order to enable
the mother to go back to work. The social worker immediately made it clear to Rachel
that she would not be allowed to return home, and I helped her work out her feelings
concerning her desire to return home versus her recognition that her mother was not
interested in her as a daughter but rather as a baby-sitter.
In reaction to the difficult situation she was now in emotionally, Rachel slowly started
to notice discrepancies between the care and respect we showed toward the animals and
their needs and the (lack of) care and respect she received from her mother, which served
as an opening for her to start expressing a limited degree of anger at her mother. At this
point, Rachel decided to ‘arrange a wedding’ between me and Noam, the zoo keeper. She
then announced that since she did not feel accepted anywhere else, she wanted to come
live at the zoo. My therapy room would be her bedroom and she would join the zoo family,
helping Noam and me to take care of the animals. We were now her representation of the
ideal family, yet the only way she could think of joining us was by offering to take care of
our ‘children’.
The following year, Rachel started to spend a few hours a week at the small zoo at her
school. Rachel entered into a split between the two ‘zoo mothers’. It was too threatening
for Rachel to recognize and express the great amount of sadness and anger she felt toward
her own mother, who was already so rejecting toward Rachel. Yet she was at this point
sure of her place at our zoo, knowing we would not reject her. This allowed her to adopt
the school zoo keeper as the ‘good mother’ and to see Noam and I as the ‘unfit parents’.
Rachel expressed toward us all the intense anger and rejection she felt toward her parents,
accusing us of neglecting and abusing the animals at our zoo. She threatened to leave
therapy and never come back to the zoo – yet she never missed a meeting.
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The third year, Rachel was given the choice of continuing with me in therapy or
receiving art therapy at her school. As a final rejection, she chose to end therapy with me.
However, we continued to run into each other weekly near my office at the group home.
Despite her initial anxiety, she came to see that her anger toward me did not result in my
rejecting her, but rather in my continued acceptance and interest in her. In our short
conversations on the path, Rachel now seems to have reached integration, being able to
admit both her positive and negative feelings toward both me and the school zoo keeper,
knowing that she can separate from me without losing me.
Through her projections onto the ‘family’ at the zoo, Rachel worked through issues of
denial, and later anger, finally exhibiting major improvement of her representations of
healthier intrafamily relationships. Her suicidal tendencies subsided within 3 months after
the commencement of therapy, probably due to her transference to me of the role of
‘mother who cares’.
Ben
Ben (aged 6 at the beginning of therapy) was abandoned by his mother (who was soon
after hospitalized in a psychiatric institution) as an infant and experiences ongoing
rejection by his violent father. At age 3, Ben was removed from his home and since then
has resided in the group home. Ben has great difficulty expressing emotions, as well as
even talking about them. He is characterized by violent and angry outbursts, toward both
adults and children, set off by the slightest frustration.
Through his interactions with a calf separated from his mother and projection onto me
of the role of substitute mother (‘Nancy – he’s crying. Nurse him!’ – his intention being
for me to put my finger in the calf’s mouth as a pacifier to satisfy the calf’s frustrated
sucking instinct) and his reaction to having found an abandoned egg (‘We have to prepare
a clean, warm and safe cage for the egg, for his mother will never come back’), Ben was
able to work on more normative representations of what care an infant deserves. At a later
point in therapy, Ben was fascinated by a mother goat and the kid that she had rejected.
He worked on his personal issues of abandonment and rejection by parental figures by
trying various manipulations to force the pair to stay together, efforts that proved to be
in vain. Together with expressing his understanding of the kid’s distress and needs, he also
expressed his deep anger at the mother for her behavior – an anger he has yet to be able
to express toward his own parents.
Jonathan
Jonathan’s father was murdered in Jonathan’s teenage mother’s presence while she was
pregnant with Jonathan. Jonathan (aged 9 at the beginning of therapy) grew up with his
drug-addicted mother, often homeless. He took on the responsibility for his mother’s life,
often handing her a bag to breathe into as she suffered from panic attacks. He was twice
in the presence of his mother as she attempted suicide.
During therapy while in the emergency shelter, Jonathan utilized play therapy with the
animals to work through his inappropriate experiences of parenting his mother and
feelings of responsibility for her emotional wellbeing. Throughout one session, for
instance, Jonathan took the doctor’s kit, pretending to be a veterinarian. He told me to
bring an animal to him who had been very sick or had even died. I was told to be extremely
distraught. He then said, ‘The situation is very grave. I don’t know if I can do anything,
but I’ll try. Come back tomorrow and we’ll see’. I was then to go to the opposite corner
of the room ‘till tomorrow’. He then happily said in a stage whisper, ‘She’ll be so happy
when she comes back tomorrow and finds the animal alive and well!’ I then was to return
to him and be thrilled to see that I had my animal back who I thought had died. I was then
to repeat the scene with each of the animals, one by one. Jonathan was perhaps working
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through his wish to make his mother happy and relieve her pain by bringing her pain by
bringing her loved one back to life.
Later, Jonathan was confronted with reality with the death of the mother of 2-week-old
hamsters. Through his thoughts surrounding the death in the hamster family, he struggled
with his own assumption that family members must die, the only questions remaining
being who, how many, and when. Through projections onto the hamster family, Jonathan
struggled with his fantasy that it might even be possible to substitute his own death for his
mother’s in order to save her. Later on, he projected onto me not only the responsibility
for the death of the mother, but for the possibility of the death of the whole hamster family,
thereby clearing himself of responsibility for another’s fate. Jonathan was clearly working
through his feeling of being responsible for his mother’s suicide attempts and the dis-
solution of his family, still feeling that death was inevitable. He finally came to the
conclusion that neither he nor I need to be responsible for the life or death of family
members.
David
David (aged 8 at the beginning of therapy) resided at the group home, together with
his two older brothers, for 3 years before coming to me for therapy. His parents divorced
due to violent interactions and his oldest brother, the only warm, nurturing figure for
David, was transferred to another group home. David’s father, his primary caretaker,
shows little emotional interest in David, has a history of violence toward him, as well as
a history of drug abuse and imprisonment due to criminal activities. His mother claims
to want no contact with David and sees him only when forced to. David is a highly
intelligent child who has a fear of abandonment and uncertainty as well as an aversion
to connection with adults. He is known for having a very low threshold for frustration,
for his extremely violent outbursts toward both adults and children, is considered
dangerous, and has refused any meaningful connection with any adult at the group home
or at school.
My initial goal in therapy with David was the creation of a connection. The first year,
he established connection with me through Mushu, as well as through endless games of
hide-and-seek in the area surrounding the zoo. Mushu was to help me find him, and she
was also to help him find me. If we had trouble finding David, he always gave us hints –
he wanted to be found. During the second year, the game continued, but peppered with
quiet discussions about the meaning of friends, family, feelings, values, various life issues.
Many of these discussions occurred while he cuddled quietly with Mushu. It quickly
became clear that fear and distrust were issues for him, but what came out most strongly
was his anger at not being respected, listened to, and believed. He became intrigued with
the idea that in therapy, he was respected, listened to, believed.
In light of David’s sometimes misattributions of others’ intentions (often misconstruing
others’ attempts to help him as threatening), it is interesting to look at the development
of a fascinating relationship between David and Cuddly, the cockatiel who can be
very sweet, warm and cuddly with those he trusts, but quite aggressive when he feels
threatened – both characteristics found in David. Both David and Cuddly rarely show the
former, for they trust almost no one. David was the only child that Cuddly was willing to
play at threatening without meaning to bite. At the same time, David could participate in
the game with Cuddly and would never lose his temper, even if he got scratched every
once in a while. They came to understand and trust each other.
This understanding led David to a certain identification with Cuddly. One role play
resulting from this identification lasted for three sessions. David ‘called’ me numerous
times on a ‘telephone’,only to hang up on me. During the next session,the calls continued.
When I asked David’s advice about the intentions of ‘the person’ calling me, he simply
shrugged his shoulders implying that he also did not know. I said,‘Maybe someone is trying
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to annoy me or maybe is looking for help’. ‘The person’ called back saying he was calling
from the Animal Shelter and he had an abandoned baby cockatiel. He had heard that I
knew how to take really good care of abandoned baby birds and hoped I would come
and take the baby bird and save him. When I asked for details, ‘the person’ gave me the
address of the group home and the name of David’s housemother, saying the baby
cockatiel was waiting there for me. My reaction was, ‘That baby cockatiel feels he really
needs to be saved!’ The next meeting,‘the person’ called back extremely angry that I had
not come to save the baby cockatiel, who had subsequently died. David then immediately
launched into extremely aggressive role play with violent content. He told the story using
three dolls as brothers and he as the father, in which the father violently physically and
emotionally abused all three sons over and over. I asked where the mother was. ‘The
mother died after the birth of the youngest son, but it doesn’t matter since she didn’t care
anyway’. He gave me the role of the social worker who tried to help the sons, but in the
end she was powerless. In the end, he said that the sons loved the father, because he is
all they had.
Previously in sessions with David, I had heard bits of information about his relationship
with his father (including a memory of his father threatening to throw him out of the
window of his 10th-storey apartment), but through David’s identification with Cuddly and
the disappointment of the ‘abandoned baby cockatiel who wasn’t saved’, David was able
to for the first time to describe his perception of his family history. It is important to note
that David’s social worker had suspected child abuse on the part of the father, but David
has refused to discuss his father in any forum except for in therapy with me.
It is clear to me that David has been able to express himself through AAT due to his
presence in the world of animals: the security, warmth and acceptance provided by Mushu,
David’s identification with Cuddly along with his experience of building a mutual under-
standing with Cuddly, the play with and caring for the rats and hamsters, and finally his
perception that I am part of that warm, accepting, trusting, respectful world, which allows
him to trust me also. This trust has allowed David to then work on many issues in therapy,
as well as to change his representations of what is possible in a positive child–adult
relationship.
Hannah
Hannah (aged 7) was referred to me by the psychologist of her elementary school for
being a generally sad child as well as socially isolated. She had been in behavioral therapy
2 years before for a year because of behavioral problems at home. Her parents also
described her as an extremely anxious child. In the therapy room, she was inappropriately
uninhibited with me from the first session, hugging me and smiling at me adoringly,
showing signs of insecure attachment. Her anxiety in the room expressed itself by her fear
of closing the door of the room and by her preoccupation with the rats as dangerous to
Cuddly the cockatiel.
Hannah showed a great interest in Cuddly. In one of our early sessions, in reaction to
her poking the bars of Cuddly’s cage and scaring him, I asked her if anyone had ever
scared her like she had just scared Cuddly. Breaking out crying, she answered,‘Yes, like
this morning when my Daddy caressed me on my bottom. I don’t like it when he
does that. He does that sometimes’. ‘Do you tell him to stop?’ ‘No, I can’t’, ‘Why
not?’, ‘Because I’m sleeping and I can’t move’. I believe she was describing a sense of
emotional paralysis due to the situation of sexual abuse on the part of her father.
Hannah’s identification with Cuddly as endangered and frightened allowed her to discuss
her own experiences.
In later meetings, Hannah changed her use of Cuddly to represent her parents as
opposed to herself. While she sometimes told me happily of her parents’ loving behavior,
at times when Cuddly turned into Grumpy with his threatening behavior, Hannah told of
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her parents’ similarity to Grumpy when they would hit her, sometimes all over her body.
She also showed me how her father sometimes choked her. Her parents had two sides to
them, as did Cuddly.
Interrogations of Hannah,her younger brother and their parents revealed an ongoing
picture of abuse from the time Hannah was very small. I spoke to Hannah’s previous
psychologist, who said that nothing during the year of therapy with Hannah raised his
suspicions that abuse was occurring in the home. Early in therapy with me,Hannah spoke
of family secrets that were not to be revealed. However, through her early associations of
Cuddly as threatened and her later preoccupation with his volatile behavior, she was able
to voice both her experiences and her emotions, leading to opening of family secrets and
eventual changes within the family.
Simon
Simon (aged 8), a highly intelligent and verbal child suffering from symptoms of ADHD,
was brought to the shelter after being cruelly physically and emotionally abused by his
mother in her attempts to discipline him. His mother reported herself to the authorities
for fear of further hurting her son. His parents had divorced 3 years previously due to
physical violence by his drug-addicted father toward his mother. It is still unclear if Simon
was also a victim of his father’s violent behavior. Simon’s behavior was considered to be
violent and uncontrollable both at home and in educational settings from the time he was
3 years old. Simon is an anxious child whose behavior is characterized by extreme mood
swings, impulsivity, and jumpiness at sudden movement or sounds.
At the beginning of therapy, Simon showed a natural affinity for the animals, especially
for Mushu and the rats, and enjoyed softly playing and cuddling with them. There were
many instances, both real and imagined, that he almost hurt the animals due to careless
movements, each time showing remorse – which I felt to be authentic. Despite this, he
freely told me of his habit of abusing stray cats ‘for fun’.
After a short time, the therapy moved into a new phase in which Simon gleefully chased
and attempted to startle the rats and Mushu, for whom he expressed great love. Simon
was able to explain that he knew very well what fear feels like and that he enjoyed seeing
what it looked like from the outside. This paralleled his attempts to hurt the shelter’s
resident dog, whom he also loved. When a caretaker asked him why he wanted to hurt
someone he loved, he answered, ‘What’s the connection?’ His answer was not surprising
considering his background.
At about the same time, there was the birth of four hamsters. Simon watched intensely
as the mother carried the babies to different places in the cage. He perceived the mother’s
behavior as abusive (she grabs the babies with her mouth and drags them), and this feeling
was intensified when he noticed a scratch on the stomach of one of the babies. When I
asked him about his thoughts and feelings about this behavior, he answered ‘No big deal.
She’s hurting her babies, that’s what parents do’.
In the meantime, I often showed Simon the fact that the animals ran to me whenever
they felt threatened, and that they knew I was always there to protect and soothe them.
When I once said that I felt he allowed himself to try to startle the animals because he
knew I would stop him, he was pleased that I saw that. He said that he, too, tried to get
away from his mother when she hit him. When I asked what would happen if I did not put
limits on his behavior with the animals, he became very upset and said, ‘It would be a
terrible situation!’ I felt he was grappling with issues of abuse vs. protection, and possi-
bilities new to him were emerging. The real change in his behavior came when I reflected
that the animals were less willing to be with him because of his threatening behavior, that
they would rather be with someone with whom they felt safe. He looked troubled and said
he was dismayed that the animals he so loved didn’t want to be with him. Soon after,Simon
announced that he had had enough of seeing what fear looked like, and he need not try
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to startle them anymore. We discussed how he could make them feel comfortable with him
once more and the overt aggressive behavior toward the animals disappeared.
Now, for the first time,Simon started expressing anger at abusive parental behavior. He
once screamed at the mother hamster, ‘I’ll kill you if you hurt your babies again!’ Till this
time in the therapy, Simon was not capable of entering into imaginative role play. Each
time that he would inspect one of the toys and I would gently enter into role play, he would
get quite upset and scream, ‘Stop it!’ Also in this area Simon showed change. Once he
picked up a plastic knife and started poking at the rats’ cage. I said,‘Oh, no, what are you
doing to the rats?’ He answered, ‘Killing them’. ‘Who are you?’ I asked. He answered,
‘Their son!’ This was two meetings before he was transferred to a group home. In the last
meeting, he claimed that he thought he would not abuse any more stray cats.
Simon showed signs of PTSD by his state of constant hyperarousal and by the fact
that he was caught in cycle of continual reenactment of his traumatic family reality. The
externalizing of his fear onto the rats and of his having been abused by his mother onto
the baby hamsters, together with my constant mirroring of Simon’s thoughts and feelings,
helped him find words for many of those thoughts and emotions. This contributed to his
working though his experiences, thoughts, feelings, and behavior – both from the past and
in the therapy situation – as well as contributing to his change from acting out to being
able to discuss. At the beginning of the therapy process, Simon sensed potential danger,
not only toward him but also emanating from himself. My insistence on safety for everyone
in the room allowed him (a) to feel safe, (b) to feel protected from the consequences of
his own potentially dangerous behavior, and (c) to have the ‘luxury’ he had not previously
been used to in order to reflect on the situation and his role in it and to work through his
issues. My mirroring, together with the sense of safety he slowly began to experience,
probably contributed to his ability to enter into imaginative role play, through which he
could safely start to work through his anger at parents.
This process may have enabled Simon to recognize, as well as practice, a model, or
pathway, alternative to the one he had previously known. He discovered that he might
lose those he loves if he is abusive toward them, whereas those he chooses to protect and
act lovingly with will want to stay close to him. He discovered the normative connection
between the quality of interpersonal behavior and interpersonal connection, a model
which will help him in more normative contexts.
Simon’s therapy process was prematurely but unavoidably terminated by his move to
the group home. Processes were initiated and insights were gained in a short period of
time to an extent that I doubt would have taken place in a more traditional play therapy
setting. As in any psychotherapy, additional time in therapy would be needed for Simon
to internalize and therefore maintain the changes that happened in the room, to establish
change in his mental representations of interactions with others in various situations,
which would then translate to change in his interactions with others outside of the therapy
setting. The group home has taken into consideration the processes and insights that took
place in Simon’s therapy with me and are building on them in his current therapy. On my
recommendation, Simon will soon take part in group therapy in the petting zoo at the
group home,which will hopefully allow him to continue the process started in the presence
of my animals, in the therapy language that was so enabling for him.
Conclusion
The examples brought up in this article illustrate some of the strengths of AAT with
children who have suffered from abuse and/or severe neglect. Mickey was able to change
his perceptions of others’ intentions toward him through role play using Mushu. Through
his interactions with the animals and my mediation and mirroring, Danny was able to
change his internal working models, change his self-concept and develop his ability to
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be empathetic. Through projections onto the animals in the zoo as family members, Ben
and Rachel were able to work through their feelings toward their relationships and
experiences of neglect and rejection by their mothers toward them and also explore
more appropriate models of mother–child interactions. Through his play as doctor
tending to the animals, Jonathan expressed his wish to prevent death as well as his
feelings of being a parentified child. The unavoidable reality of death of the mother
hamster catalyzed his working-through of feelings of responsibility for his father’s death
and for his mother’s suicidal behavior, ending in his giving-up of that responsibility.
Through projective play catalyzed by his identification with the cockatiel in therapy,
David expressed his psychological states of anxiety and despair alongside of hope.
Cuddly served as a vessel for Hannah to express her difficult experiences of being abused
by her parents,eventually leading to family therapy and a change in the family’s patterns
of behavior and communication. Simon was able to externalize his experiences, work
through them and their accompanying cognitions and affect, develop an alternate
strategy and more normative model of interpersonal behavior, and practice it within the
therapy setting.
In short,AAT provides a number of advantages for therapy with abused and neglected
children suffering from insecure attachment and the effects of trauma. The presence of
the animals provides a calming and less threatening atmosphere for therapy, enabling the
child to work through traumatic issues. The relationship between the therapist and
the animals makes the therapist less threatening and more trustworthy in the eyes of the
at-risk child, who has good reason not to trust adults. Thus, the initial child–therapist
relationship will be more easily established than in other therapies.
AAT takes place in that twilight area between reality and play. It has aspects of both
and therefore allows the child to navigate between the two according to his/her needs
and inner processes. The child may take advantage of either play or reality, or combine
the two. If one becomes too harsh, the child may take refuge in the other in order to rest
and regain strength for further work within therapy. Likewise, therapists may use their
discretion to emphasize reality, to stimulate imaginary play, or combine the two –
depending on the state of the children’s defenses, the contents of the children’s inner
world, the stage in therapy, and the state of their current inner strengths. This flexibility
to pass between play and reality is especially important for maltreated children whose
levels of anxiety tend to be so high and who often have a lower ability to use symbol-
ization in play in order to work through their issues.
From the point of view of Bowlby’s theory of attachment,AAT provides a number of
avenues, through work on cognition, affect and behavior, for the change of internal
working models of parent–child interactions as well as of general interpersonal inter-
actions. Related to these changes is the positive effect of AAT on self-esteem and ability
to empathize.
The interpersonal relationships between the child, animals and therapist in the therapy
process provide more opportunities for interpersonal experiences and situations. In
terms of Object Relations Theory, the presence of the animals enables the child to
project objects onto the animals and reenact social situations that will help children work
through issues and gain insight into their roles. From the point of view of Crittenden’s
theory of the effect of DRs on self-protecting strategies,these experiences, situations and
the child’s ensuing affect, accompanied by the therapist enabling awareness of and
reflection on the emotions and content brought up in therapy, encourage the develop-
ment of alternate and more elaborate dispositional representations. The therapy experi-
ence, conducted in a safe, containing and enabling environment, allows for the time
needed for this process to lead to reflective integration and therefore more appropriate
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and adaptive strategies, less errors of attribution, behavioral responses carried forward
with awareness,and therefore more appropriate responses to newly maturing capacities.
In the context of these theoretical frameworks, AAT allows for more opportunities
for change in the maltreated child in the therapy setting that will hopefully minimize the
intergenerational transmission of abuse and neglect.
This article has brought forth theoretical as well as clinical evidence that might lead
to the justification for the introduction of animals into psychotherapy with children with
insecure patterns of attachment. What is sorely lacking is literature on the clinical assess-
ment of Animal-Assisted Psychotherapy. My hope is that this article and others like it
will stimulate academic research in the field that will in turn help us better understand
the possibilities afforded by AAT.
Note
1. All names have been changed to protect the anonymity of the children.
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