Clinical Social Work Journal

https://doi.org/10.1007/s10615-019-00721-3

ORIGINAL PAPER

The Process of Integrating Animal‑Assisted Therapy into Clinical Social

Work Practice
Katherine Compitus1 

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Abstract
Animal-assisted therapy (AAT) is considered an effective treatment model to use with a variety of populations and condi-
tions, from autism to substance abuse, due to its flexible nature. As an integrative model, it often incorporates core modalities
such as psychodynamic psychotherapy, cognitive behavioral therapy, psychodynamic psychotherapy and Gestalt therapy.
Although there is a growing body of research addressing the efficacy of AAT, there is limited information on the actual
process of utilizing AAT in clinical social work practice. Research shows that many clinicians support the use of AAT with
clients but fail to integrate it into their own practice due to a lack of knowledge on the process of utilizing the model. This
paper explores the process of integrating AAT into direct clinical practice and the theoretical basis for utilizing AAT as an
adjunctive treatment model.

Keywords  Animal-assisted therapy · Attachment · Object relations · Integrative treatment · Canine-assisted psychotherapy ·
Mindfulness · Psychotherapy · Psychodynamic · Process · Implementation · Therapeutic alliance

Introduction the human–animal relationship has long been established

Research indicates that the majority of clinicians (91.7%)
have heard of Animal Assisted Therapy (AAT), the integra-
tion of an animal into the clinical treatment of clients, and
view it as a legitimate therapeutic modality (Hartwig and
Smelser 2018). There is a growing body of research on the
benefits of AAT in clinical practice, but many clinicians are
unsure how the process works or how to implement AAT
with their own clients (Hartwig and Smelser 2018). One
of the core values of social work includes the importance
of human relationships (Workers 2008), and animals often
help to build, establish and enhance interpersonal relation-
ships among humans (Compitus 2019). From an evolution-
ary standpoint, humans have been working cooperatively
with animals for 11-16,000 years and the mutual benefits of
Special thanks to Dr. Carol Tosone, Dr. Aminda Heckman-
Chomanczuk, and Dr. Rise VanFleet for their helpful comments
when reviewing this manuscript.
* Katherine Compitus
kog206@nyu.edu
1
Silver School of Social Work, New York University,
New York, NY, USA
(Freedman et al. 2014). Humans are social beings and caring
for, or working cooperatively with, animals may be instinc-
tively gratifying (Compitus 2019). The inclusion of animals
in clinical treatment planning may tap into that long-estab-
lished reciprocal relationship in a way that enhances thera-
peutic healing in humans.
Animal-assisted therapy is multifaceted and works as
both a skill-building and emotionally corrective interven-
tion. The inclusion of a therapy animal in clinical practice
provides a number of benefits to improve patient outcomes.
The primary benefit is within the therapeutic alliance; a
therapy animal may facilitate engagement and strengthen
the r apport between the therapist and the client. The therapy
animal may be perceived by the client as reinforcing the
notion of a safe holding environment and, therefore, may
help to alleviate patient anxiety about receiving treatment
and increase patient adherence to the treatment protocol
(Winnicott 1986). The therapy animal may serve to illus-
trate the parallel process between the animal and therapist
and the therapist and client. If the patient observes that the
animal trusts the therapist, the client may feel more safe and
secure in treatment with that therapist. This may be espe-
cially helpful in trauma therapy (Germain et al. 2018) or
with substance use disorders, where the patients are more

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likely to follow through on their treatment plan when there
is a positive therapeutic alliance (Waite et al. 2018; Wesley
et al. 2009).
Since AAT is such an adaptive model, research has
focused on the outcomes of AAT (Maujean et al. 2015;
O’haire et al. 2015), rather than the process of implement-
ing AAT or integrating it into existing models. This paper
explores whether the direct integration of AAT in clinical
practice can accelerate the therapeutic relationship and be
used to teach behavioral skills, which may facilitate the heal-
ing process. A case study is used to illustrate the direct appli-
cation of AAT. Since not all clients would benefit from AAT,
recommendations will be provided to assess which clients
would be appropriate for an integrated model utilizing AAT.
What is Animal‑Assisted Therapy (AAT)?
Animal-assisted therapy (AAT) is an adaptive treatment
model that has been used to treat a multitude of conditions
from substance abuse to autism spectrum disorder to pain
and anxiety (Fine 2011; Waite et al. 2018; Wesley et al.
2009). The goal of AAT is to improve the social, emotional
or cognitive functioning of a client, as developed in a for-
mal treatment plan with set goals and objectives. The treat-
ment plan must be developed and implemented by a licensed
professional; the directing clinician may be a mental health
therapist, occupational therapist, physical therapist or other
type of clinician depending on the specific needs of the
client. AAT is flexible and adaptive by nature and can be
implemented in a variety of ways in a multitude of settings
(Stewart 2014). Although the sessions must be directed by
a licensed professional, the clinician may choose to include
a separate animal handler in the process, if they do not have
access to their own therapy animal (Stewart 2014).
It is important to note the difference between animal-
assisted therapy (AAT) and animal-assisted activities
(AAA). Although the interaction between a human and ani-
mal almost always has some benefit, AAA may be described
as any social interaction with a therapy animal, while AAT
is the direct and purposeful involvement of an animal in the
therapeutic process (Chandler 2017). AAAs are, therefore,
more informal in nature, and are designed to build upon the
human–animal bond to improve the quality of life for the
target population. Animal-assisted activities tend to be short-
term in nature; an example of an AAA is a therapy animal
visiting people in a hospital or nursing home. AAAs can be
implemented with multiple clients at the same time, since
the visits are more social in nature (Pet Partners n.d.). AAT
is a more structured intervention which must be done by
a licensed health professional (social worker, occupational
therapist, etc.). AAT requires specific treatment plans, is
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Clinical Social Work Journal
goal directed, documented and evaluated; it usually involves
one client at a time (Pet Partners n.d.).
Animals may be a critical source of social support for
people of all ages; the incorporation of an animal into direct
practice may provide a reparative experience for clients. In
a randomized control trial, Berget et al. (2008) found that
when animals are integrated into psychiatric treatment, cli-
ents showed distinct improvements in self-efficacy, coping
ability and quality of life. Jones et al. (2019) systematically
reviewed the incorporation of canines in mental health treat-
ments and found that there was not only an improvement
in the symptomatology but in the overall well-being of the
client. They reported that the benefits of canine-assisted psy-
chotherapy include an improvement in both internalizing and
externalizing disorders (including trauma, stress and anxiety
and anger), an improvement in engagement and socialization
and, finally, a significant improvement in global functioning
(Jones et al. 2019). Research on the efficacy of AAT is still
ongoing and Jones et al. (2019) did not find that there was
sufficient evidence in this study to prove that AAT helped
improve self-esteem, subjective well-being or coping.
As a flexible treatment model, AAT has been adapted
for use with a variety of evidence-based practices to treat
a variety of mental illnesses. AAT can be adapted to work
in conjunction with Cognitive-Behavioral Therapy (CBT),
Adlerian Counseling, Gestalt Therapy, and Solution-
Focused Therapy, among other modalities (Chandler 2017;
Hunt and Chizkov 2014). Wesley et al. (2009) examined the
use of AAT with dual-diagnosed patients (co-morbid diag-
nosis of mental illness diagnosis and substance abuse). They
found that regardless of the substance used (polysubstance,
cannabis, methamphetamine or alcohol) or demographic
of the client (male/female, voluntary/mandated), there was
a significant increase in the success of the treatment with
the experimental group (therapy animal) versus the control
group (no therapy animal). They hypothesized that treatment
would be more successful if a therapy animal was involved
because the animal helped build a stronger therapeutic alli-
ance between the client and clinician.
Research into the Efficacy of AAT​
One of the benefits of AAT is that it can be adapted for a
variety of populations and conditions. The effect of AAT
has been studied on pediatric oncology patients and their
caregivers (Silva and Osório 2018). They found a decrease in
pain, irritability, and stress, with an improvement in depres-
sive symptoms in the pediatric patients. They also found that
there was a significant reduction in the anxiety and stress of
the caregivers. AAT provides important social support for
children, aiding them in the development of empathy (Fine
Clinical Social Work Journal
2011) and helps prevent depression and isolation in older
adults (Peretti 1990).
The benefits of AAT have been studied with schizo-
phrenic clients, children with learning disorders, and people
with depression, anxiety and a multitude of other illnesses
and conditions (Chandler 2017; Virués-Ortega et al. 2012;
Waite et al. 2018). Jasperson (2010) is one of the few clini-
cians who studied the efficacy of the integration of a therapy
animal in treatment with female inmates diagnosed with
BPD and concluded that many inmates found the inclusion
of a therapy animal beneficial to their treatment, including
an increased motivation to attend regular therapy sessions. In
fact, the inclusion of a therapy animal in direct treatment can
help “strengthen social skills, reduce anxiety and encour-
age interpersonal growth” (Jasperson 2010, p. 422) among
clients.
O’Haire (2013) examined 14 clinical trials that consid-
ered the integration of AAT in treatment with children with
autism spectrum disorders. She found that the children who
underwent treatment involving AAT showed a significant
improvement in 27 out of the 30 the treatment outcomes that
were measured (Herzog 2014). Friedmann and Son (2009)
analyzed 28 AAT research projects conducted with people
with a variety of conditions including schizophrenia, Alzhei-
mer’s disease and developmental disabilities. Each of these
studies found that the subjects involved received additional
benefits from the inclusion of animals in the therapeutic pro-
cess that the control group did not.
Hunt and Chizkov (2014) also found a direct benefit in
the integration of a therapy animal in treatment. Hunt and
Chizkov (2014) examined the impact of having a dog present
when working with trauma survivors. They divided partici-
pants into an experimental group which had a therapy dog
present during an exposure therapy treatment (via an expres-
sive writing paradigm) and a control group which received
the same treatment but did not have a therapy animal present
in the room. They found that, despite no difference in cogni-
tive processing, the experimental group showed a significant
reduction in depressive symptoms at the end of the exercise
(Hunt and Chizkov 2014).
However, not every study on AAT has found it to be an
effective model. Charry-Sanchez et al. (2018) found that,
since many examinations into the efficacy of AAT use a
variety of different scales to measure outcomes, it is difficult
to determine whether the results are truly effective. Virués-
Ortega et al. (2012) also struggled with identifying the effi-
cacy of AAT in their study of AAT with older adults for
the same reason (variety of scales used in studies). O’Haire
(2013) examined 14 clinical trials that considered the inte-
gration of AAT in treatment with children with autism spec-
trum disorders. She found that the children who underwent
treatment involving AAT showed a significant improve-
ment in 27 out of the 30 the treatment outcomes that were
measured (Herzog 2014). Friedmann and Son (2009) ana-
lyzed 28 AAT research projects conducted with people with
a variety of conditions including schizophrenia, Alzheimer’s
disease and developmental disabilities. Each of these studies
found that the subjects involved received additional benefits
from the inclusion of animals in the therapeutic process that
the control group did not. Herzog (2014) reports that AAT
may be an effective treatment model but the majority of AAT
studies thus far have been significantly flawed. He states that
the lack of manualization of the AAT protocol, small sample
sizes, and the “file drawer effect” were the primary reasons
for the invalidation of AAT as an accepted treatment model.
He suggests that future AAT research should focus more
on objective, rather than subjective, outcomes in order to
bolster the claims made by researchers. This is not to say
that AAT is not an effective treatment model but, rather,
that a lot of past research into AAT has been flawed and our
examination of the efficacy of AAT is ongoing.
The Benefits of AAT Integration
The primary function of AAT is to facilitate the therapeu-
tic alliance but AAT may also be used to initiate an analy-
sis of the client’s psyche, address cognitive distortions, or
teach behavioral skills (Chandler 2012). At first, the inclu-
sion of a therapy animal in sessions may help a therapist
to more quickly establish a rapport with their client, since
the initial verbal communication may involve a discussion
of the shared positive attitude towards the therapy animal.
The therapeutic alliance is a complex part of the therapeutic
practice but one which most often predicts the quality of the
overall treatment and the motivation of the client to engage
in treatment. The therapeutic alliance involves the mutual
and shared development of goals and objectives for each
session and establishes an emotional connection between
the therapist and client (VanFleet and Faa-Thompson 2015).
The inclusion of a therapy animal in treatment may help
the client in trusting the therapist more quickly, due to cli-
ent’s observations of the trusting nature of the relationship
between the therapist and the therapy animal. Since the ther-
apy animal trusts the therapist, and the client observes the
positive way that the therapist interacts with the animal, the
client may feel that the therapy animal is a good predictor
of character and if the animal trusts the therapist, so should
the client.
Direct benefits include a reduction in anxiety (for both
the therapist and the client, see Frued, below), and a reduc-
tion in the physiological symptoms of stress such as lowered
cortisol levels (Baun et al. 1984; Beetz et al. 2012). The tac-
tile stimulation provided when a client touches the therapy
animal also helps to reduce cortisol levels, lowers blood
pressure and even reduces cholesterol (Beetz et al. 2012).
13

Stroking the animal may also provide a sense of reassur-
ance, as a child sometimes strokes their favorite blanket or a
stuffed toy, to provide a tactile sense of nurturance. In addi-
tion, the client may feel comfortable hugging the therapy
animal for support, in a situation where hugging the therapist
may not be appropriate. In this sense the therapy animal
may, therefore, function either as a transitional object (Win-
nicott 1986) or as a reparative relationship for the client.
The other benefits of animal-assisted therapy include
the development of empathic skills, facilitating the learn-
ing of interpersonal relationships, modeling skills such as
distress tolerance and mindfulness, and boosting the client’s
confidence. Clients may feel more comfortable discussing
stressful situations, such as a trauma history, when they feel
the holding environment is safe for them (Winnicott 1986);
a therapy animal can increase a client’s sense of safety and
security (VanFleet and Faa-Thompson 2015). Oxytocin has
been established as a feel-good hormone that increases a
person’s sense of well-being (Thielke and Udell 2017) and is
well-known as the hormone that bonds people to each other,
and mothers to their children. Research shows that oxytocin
also increases in both humans and non-human animals when
they interact, providing people with a biopsychological basis
for their increased sense of well-being when spending time
with animals (Thielke and Udell 2017).
Social isolation is considered one of social work’s “grand
challenges” because of the dangers involved in isolation
(potentially leading to death) (Johnson and Bibbo 2015;
Peretti 1990). Animals, as social lubricants, help people
overcome social isolation by providing an immediate com-
mon interest and a subject of discussion for people (Peretti
1990). Animals, as “social lubricants” help people connect
to each other and their communities; veterans often report
that a PTSD service dog is comforting because they are
never alone and always have someone looking out for them
(older adults report similar feelings) (Bleiberg et al. 2005).
Getting Started in AAT​
Despite the therapeutic benefit involved in any contact
between humans and non-human animals, AAT is not as
simple as bringing an animal into a session to play with a
client. A therapy animal should be trained and evaluated by
an established therapy animal organization such as Pet Part-
ners or Therapy Dogs International (TDI). A therapy animal
does not have to be trained to do specific tasks (as a service
animal) but a therapy animal should be trained to have basic
manners such as housebreaking, not biting, sitting, staying
and ignoring distractions. A therapy animal should be well
socialized and comfortable in a variety of settings, should
be comfortable being touched and brushed by people and
should not startle easily.
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Clinical Social Work Journal
Chandler (2012) recommends best practices in AAT
which include basic training for the therapy animal, an
evaluation of the agency or environment for the appropri-
ateness for AAT, networking with colleagues regarding the
implementation of AAT in that agency, adhering to agency
regulations (or establishing policies if none exist) regarding
bringing an animal into an agency, and the evaluation of
client preparedness for AAT. Just as not all animals have
the temperament for AAT (some may be too hyperactive,
distracted, fearful), not all clients may be appropriate for
AAT and the evaluation of clients and client preparedness
are important steps in the implementation process.
Pet Partners and TDI have strict regulations regarding
the evaluation and certification of animals’ appropriateness
for AAT work. Although no laws require the certification of
therapy animals, there are numerous benefits to certifica-
tion, including the liability insurance for AAT work and the
knowledge that an objective outside agency judge the ani-
mal safe to work with humans. The author is also an animal
behaviorist and, therefore, works both as the handler of the
therapy animal and the clinician. However, a therapy animal
does not need to belong to the clinician and the animal’s
handler may be an outside agent who is also integrated into
the therapeutic process. This comes with other concerns
(such as confidentiality), so when clinical work is done with
clients it is suggested that the clinician work with their own
therapy animal.
Although the author has a background in animal behavior,
it is not required to implement AAT. There are currently few
AAT training programs but more are being developed and
several agencies such as NASW are now offering training
classes in AAT. There are also many books on AAT that
can help a clinician get started in AAT, such as Cynthia
Chandler’s Animal Assisted Therapy in Counseling (2005),
the Handbook of Animal Assisted Therapy by Aubrey Fine,
and Animal-Assisted Play Therapy by Rise VanFleet and
Tracie Faa-Thompson. There is also an associated Animal-
Assisted Play Therapy certification course available to cli-
nicians. Many social work schools are now offering AAT
or Human–Animal Bond courses to social work graduate
students.
The Implementation of AAT into Treatment
Since animals have the appearance of providing uncondi-
tional acceptance without judgement (VanFleet 2018), the
client may find it easier to trust the animal first and, later,
form an alliance with the therapist based on the shared trust
of the therapy animal (if the client trusts the dog and the dog
trusts the therapist, then the client may feel more comfort-
able trusting the therapist). The paired association of the
clinician with the animal, may help the client transfer their
Clinical Social Work Journal
positive feelings about the animal onto the clinician. This
may aid the therapist to position themselves as both a safe
object (Scharff 1996) and a secure base (Ainsworth 1991)
for their client, since the therapy animal has deemed them
trustworthy. The client may see that the clinician takes good
care of the therapy animal and may then experience a form
of transference which includes viewing the clinician as the
“good enough” parent that they never had (Winnicott 1986).
The positive relationship as created between the therapist,
therapy animal and client may, therefore, develop into a
reparative relationship for the client (Blum 2004; Bowlby
1982). A skilled clinician can help their client to internalize
these experiences and use them to build up the client’s ego
strength (Scharff 1996). In addition to a psychological sense
of safety, therapy animals may also provide a sense of physi-
cal safety to patients, which is especially crucial in clients
with a trauma history.
When formally integrating AAT into therapy, it may be
useful for the clinician to promote the therapy animal as a
model of appropriate behavior (such as emotional regulation
or interpersonal skill building), as suggested by Hunt and
Chizkov (2014) (which has been described in the review sec-
tion). Although they did not specify a cause for the reduction
of symptoms, it is possible that participants may have looked
to the therapy animal as a model for distress tolerance since
the therapy animal was a model of resiliency. Similarly,
González-Ramírez et al. (2013) found that the presence of
a therapy animal in the room during a therapeutic interven-
tion “reduced the physiological indicators of stress” (p. 275).
This would also suggest that there is something in the ani-
mal’s behavior that is leading the participants to behave in
a similar fashion.
The therapist can also encourage interactions with the
animal which teach emotional regulation and interpersonal
skills. Chandler (2017) discusses the way a therapy dog
models emotional regulation to clients by waiting to receive
food or a toy when asked to wait by the therapist. Clients
may learn self-control and self-regulation by reflection on
the behavior modelled by the therapy animal. The thera-
pist can ask the client to interact with the therapy animal in
a way that alternates between exciting and calming (Van-
Fleet and Faa-Thompson 2017). This provides them with
the experience of practicing self-regulation and afterward
they can process the experience verbally with the therapist.
The physiological piece of AAT is important because it is
phenomenological and the client learns physiologically what
each internal state feels like as they develop a sense of con-
trol (VanFleet and Faa-Thompson 2017).
In addition, people are motivated by social relatedness
and many clients in therapy report having interpersonal
problems and may have difficulty with social interactions.
This may leave the clients feeling lonely and isolated and
may feed into the stigma of mental illness, worsening their
condition. The integration of a therapy animal in treat-
ment may help clients reflect upon, understand and adapt
their social interaction style for optimal success (Chandler
2017). When the therapy dog shows stress signals (licking
lips, yawning, ears pinned back), the clinician may pause
the session to point out these stress signals to the client to
discuss and process this interaction. For example, one client
noted that the therapy dog would move away from her when
she became dysregulated, but would return when she was
calm. This may also illustrate to the client that the method
of interacting with others (tone of voice, body language,
etc.) can help identify and process the way she interacts with
others that can help or harm her interpersonal relationships.
The integration of AAT into clinical practice does not
only involve a psychodynamic aspect but also skill learning;
the establishment of new behaviors and habits allows the cli-
ent to self-validate, self-regulate and self-soothe when not
in the therapist’s office. Finally, clients may see the animal
as a vulnerable being that they want to protect, in a way that
they, themselves, did not feel protected as a child. Even if
they do not feel like attending therapy on a regular basis, a
client may return each week to check if the therapy animal is
well. Once in session, the client may then be encouraged to
do the work since the core skills are modelled by the therapy
animal that they care so much about.
Case Study
The following case study is a composite of multiple cases
involving AAT. The clinician’s own therapy dog, Chompy,
who is registered with Pet Partners, was involved in each
session.
Jane is a 16 year old girl who purposely hurt herself for
many years; she would use a knife to cut her skin, which
she said would help stop any emotional pain she was feel-
ing. Jane can sometimes be very insightful about her own
emotions and at other times appears unable to see past the
surface. She reports a very troublesome and upsetting child-
hood, explaining that, for several years, she was molested by
an uncle that was only slightly older than herself. She only
recently reported the sexual assault to her family, since she
was worried that they would not believe her.
Since reporting the assault to her family, her family
has been very supportive, but the assault was not the only
stressor in Jane’s childhood. Jane’s mother is emotionally
volatile; she can be loving and kind one moment and angry
and emotionally abusive the next. Jane never knows what to
expect. Her mother is often emotionally invalidating, which
is why Jane waited so long to report the sexual assault. Jane
laments that she has grown numb as a result of her mother’s
mood swings. Jane’s father is a drug addict and has been in
prison. Although Jane reports that he is the more nurturing
13

of the two, she reports that, due to his drug use, he was an
absent and neglectful parent. Jane stated several times that
she feels alone in life.
Chompy is a Staffordshire Terrier and Bulldog mixed
breed dog who was found, starved and near death, on the
street in a nearby city. Chompy was rehabilitated, social-
ized and trained by the clinician to work as a therapy dog.
The clinician has other dogs but Chompy’s temperament and
personality made him an exceptional candidate for therapy
work.
In addition to his innate desire to help people, Chompy’s
own story of trauma and resilience is often helpful when
working with clients. Jane was very hesitant to start therapy
and, at first, behaved as a mandated client would, stating
that she didn’t want therapy. However, Jane would return to
therapy each week and would report that she was there to
see Chompy. While in session, she did valuable therapeutic
work and she reported that Chompy’s own trauma narrative
helped her feel connected to him from the first session. Jane
showed insight in recognizing that during the initial ses-
sions she felt more comfortable with the therapy dog present
because trusting the dog and trusting the therapist became a
parallel process. She reported that she had difficulty trusting
previous clinicians and she never felt that she established
a lasting connection with them. Since a rapport was more
quickly established with Jane, we were able to move into
the integrative model using AAT after only a few sessions.
Some core skills that we work on when integrating AAT
with behavioral therapies are mindfulness skills, interper-
sonal effectiveness skills, emotional regulation skills and
distress tolerance skills (Linehan 2014). However, theses
subjects may also be discussed when using a psychodynamic
approach, since the psychic basis for the client’s emotional
difficulties can be analyzed as they come up in the client’s
interactions with the therapy animal. The most important
(and often forgotten) aspect about integrating AAT into
clinical treatment is the development of goals and objec-
tives that integrate the therapy animal into the treatment
model (Compitus 2019; Chandler 2017). Keeping in mind
the goal for each session, I developed individual objectives
for each of the skills that included the therapy animal in the
skill-based lessons.
In learning about mindfulness skills, I encouraged Jane to
identify ways in which the dog utilized mindfulness skills.
For example, I pointed out that when Chompy was eating,
he was only focused on eating, when he was playing, he
was very interested in his toys and when he was out on a
walk, he was utilizing all of her senses to listen, smell, see
(and sometimes taste) the world around him. I built upon
the dog’s focused attention on his food or toy to open up a
conversation with Jane about the concept of mindfulness
and the benefits of living in the moment, rather than feel-
ing depressed about past mistakes or worrying about an
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Clinical Social Work Journal
uncertain future. We were able to discuss the benefits of
mindfulness and analyze what situations in her past may
have caused her to dissociate, rather than be mindful; we
also discussed the reasons why mindfulness may be helpful
to her in the present. We discussed the causes of her psychic
pain, how certain maladaptive coping techniques were useful
in the past but now cause her more distress than help and,
finally, how mindfulness brings and increased awareness and
enjoyment of life. We then closed each session teaching the
therapy dog new tricks, to improve Jane’s feelings of mas-
tery and self-efficacy, so that she would not leave the session
feeling raw but rather feeling in control of both her emotions
and her environment.
The spontaneous nature of animals is a helpful aspect of
AAT which was utilized in sessions. Whenever the therapy
dog had any (minor) behavioral problems (such as pulling
on the leash), Jane and I were able to discuss possible causes
for the behavior and possible resolutions that involved a non-
judgemental evaluation of the situation. This often helped
Jane pay more attention to her own body language and
behavioral challenges in a way that felt non-threatening to
her. We discussed her childhood growing up in an abusive
environment and that the judgements expressed by her nar-
cissistic father were not usually accurate assessments of the
world. Jane often felt extreme shame and guilt for everything
that she did that she decided was “wrong”. We built on this
analysis when I explained to Jane that if Chompy pulled on
the leash, he wasn’t a “bad dog”, but he was excited to smell
something and it was my job to work with him to understand
what he needed and how to redirect his attention. Jane used
this example and applied it to her own childhood, realizing
that her father’s actions were inappropriate and that when
she was a child, and acted as a child, she was not being
“bad”, as her father told her. She learned that the judge-
ments of her father did not have to linger in her psyche as
self-criticisms in her adulthood.
Jane and I discussed how she related to the therapy dog
(and how he interacted with her) during her various moods
(angry, sad, happy), to help illustrate and practice interper-
sonal effectiveness skills. As stated above, she learned that
patience and kindness would bring Chompy closer to her,
as would a happy mood and playing with him. She learned
that the dog would disengage in their interactions and move
away from her when she would become anxious or (mildly)
dysregulated but would return when she would become calm
again. Chompy would not play with her when she would
demand that he played, but he would happily play with her
when she kindly engaged him in play or called to him in a
happy voice. He also would move away from her when she
became overly affectionate, but would enjoy interacting with
her when she was just affectionate enough. We discussed
the interactions with Chompy and compared them to her
relationships with friends and family. She reported that she
Clinical Social Work Journal
found it easier to understand the limitations and expectations
of other people when illustrated by her interactions with the
therapy dog.
Working with AAT also helped Jane to learn and practice
the skill of emotional regulation. She reported that she felt
more motivated to regulate her emotions because she did not
want to scare the dog when she was angry or upset. Jane and
I established goals and objectives that integrated the dog into
the development of both emotional regulation and distress
tolerance skills. When she would start to feel dysregulated
(or when she would see the therapy dog showing signs of
her dysregulation, such as moving away from her), she could
speak softly to the dog, stroke the dog’s fur, hug or play with
the dog in order to calm herself. In addition, she brought
a fluffy stuffed animal that looked like Chompy and would
keep it at her bedside, so that when she felt in distress at times
when she was away from the therapy dog, she could use the
toy as a transition object by stroking it (Winnicott 1986). The
stroking of the toy reminded her of petting the dog and the
secure attachment and bond that she formed with the therapy
dog (Bowlby 1982); this helped her return to a more calm,
less distressed state of mind. When she returned to session,
we were able to discuss the types of attachment, the reason
why she had developed a disorganized attachment style, and
discuss ways of repairing her method of attaching to others
(Ainsworth 1991; Bowlby 1982).
Jane and I practiced increased empathy and understand-
ing for others through her interactions with the therapy dog
by teaching her how to pet, massage and groom the therapy
dog. The physical interactions with her dog, and focusing
on the dog’s feelings of wanting or disliking to pet touched
in certain ways, helped Jane understand that others may
have limitations and feelings that are different from what
she expected. The physical interactions with the dog was an
opportune moment to discuss the importance of boundaries.
We were able to discuss the emotional limitations of indi-
viduals and that Chompy also had days where he felt more
playful and days when he just wanted to sleep. We discussed
that the dog’s unwillingness to play did not mean that he did
not love her, but that sometimes for self-preservation we
must ask for space and time to rest.
Finally, the dog provided Jane with a physical sense of
safety. Due to her physical, emotional and sexual abuse history,
she often had difficulty sleeping and rarely felt physically safe.
Jane reported that before working with the therapy dog, she
had frequently slept with the lights on and never slept soundly.
After starting the integrated model with AAT, she began to
sleep with the lights off, slept restfully and felt the safest she
had ever felt in her life. It is important to note that a positive
relational experience with an animal can then be more easily
generalize to more positive relationships with other humans.
Jane had reported that in the past she had a strong reluctance to
participate in therapy. When Jane understood her relationship
with the therapy dog could serve as a model for healthy rela-
tionships with other humans, she began to embrace therapy in
a way she previously had not. She began to thrive and prac-
tice her new found skills daily and, over time, her relationship
with her family and friends slowly began to improve and she
reported an increased sense of peace.
Limitations and Future Directions
Clinicians should pay special attention to the limitations in
implementing AAT with select clients; not all clients are
suitable for the integration of a therapy animal in treat-
ment. Some clients may have a fear of animals, others may
have traits of antisocial personality disorder and may pose
a potential risk to the physical or emotional welfare of the
therapy animal. The client or therapist may eventually ter-
minate therapy and it is important that the client develop
strong emotional regulation skills in order to separate from
the dog without maladaptive feelings of loss (VanFleet and
Faa-Thompson 2017). Clinicians should also be cautious
of utilizing AAT with clients who have severe attachment
disruptions. The client may form a bond so strong to the
therapy animal that when service is terminated or the animal
dies, it may trigger feelings of abandonment. It is important,
when utilizing AAT with clients with insecure attachment
styles that the clinician continually encourage the client’s
self-reliance rather than dependence on a therapy animal.
The key to AAT with clients with an insecure or disorgan-
ized attachment style, is to transfer the relational abilities
that the client developed in therapy to the real world (Van-
Fleet and Faa-Thompson 2017). These clients may still be
candidates for AAT, but should be guided through the termi-
nation process in order to therapeutically handle the endings
and loss and generalize these skills to the real world.
Therapy Animal Welfare
Finally, the welfare of the therapy animal must always be an
important consideration in the implementation of AAT with
any client (Fine 2015; Glenk 2017). Serpell et al. (2010)
explain that a concept of animal welfare should be multi-
factorial and include negative feelings that the animal may
experience, the ability to express species-specific behaviors,
the animal’s resiliency, adaptability and capacity to cope, as
well as their overall well-being.
There is some concern that clinicians often do not receive
adequate training in animal behavior to understand the spe-
cific welfare requirements of the animals that they work
with (Serpell et al. 2010). Therapy animals must have time
to habituate themselves to the therapeutic process (Serpell
et al. 2010) and should not be involved in direct clinical
13

practice without sufficient preparation. Every clinician uti-
lizing AAT should be knowledgeable about the “Five Free-
doms” establish guidelines for working with animals that
protect the animal from harm. These include the right of
the therapy animal to determine when it wants to work or
when it needs a break (Barber and Mellen 2013). Not only
should the therapy animal be allowed to choose their level
of interaction with the client (which can be encouraged by
the clinician), the clinician must be aware of signs that the
animal is uncomfortable or in distress (such as yawning, ears
back, or trying to leave the room) and must have a plan for
situations when the therapy animal needs to leave the ses-
sion before the session is over (VanFleet and Faa-Thompson
2015). In this case a covered dog crate or cat carrier may be
particularly useful in a clinician’s office. The clinician must
make sure to explain to the client that the animal needs a
break and that it is no reflection on the client but that the
animal simply requires a break to self-regulate. In addition to
establishing a safe environment for both the animal and cli-
ent, paying attention to the therapy animal’s needs can easily
be turned into a teachable moment where the clinician and
client discuss effective interpersonal skills such as assertive-
ness and emotional regulation skills, including walking away
from a stressful situation without becoming dysregulated.
Conclusion
Although research on the efficacy of AAT is varied, it is
potentially a very effective adjunctive treatment model.
Often clinicians who want to implement AAT are unaware
of how to start the process. This paper has outlined the pro-
cess of implementing AAT as an adjunctive model that can
be used in conjunction with CBT, DBT, Psychodynamic
Psychotherapy, or other models. The primary reason to inte-
grate AAT into clinical practice is to build a faster rapport,
to encourage the parallel process, to increase the client’s
sense of safety and security, and to build a stronger holding
environment. Other reasons may be that the therapy animal
serves as a motivation for the client to return to therapy each
week, interactions with the therapy animal may service as a
discussion point for psychoanalytic work, may help illustrate
behavioral skill building, or help the client more quickly
alter cognitive distortions. The presence of a therapy animal
may be more fun for clients and clients may feel less stigma-
tized if they return each week to visit the animal, rather than
admit early in the process that they may need psychotherapy.
In addition, clients may feel overwhelmed or threatened
when asked to practice the skills for themselves (due to their
feelings of low self-worth) but may be more inclined to learn
the skills for the benefit of an animal. Clinicians must, how-
ever, be aware of the welfare implications of the animal and
they need to be reminded that simply playing with an animal
13
Clinical Social Work Journal
does not qualify as AAT. Goals and objectives involving the
therapy animal must be included when developing a treat-
ment plan. More research must be done on the efficacy of
AAT in order to establish it as an evidence-based practice,
but there appears to be a lot of promise in utilizing AAT as
a treatment model in the treatment of various mental and
physical illnesses.
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Publisher’s Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
Katherine Compitus  LCSW, MSEd, MA is a DSW Candidate and
adjunct lecturer at the Silver School of Social Work, New York Uni-
versity. Katherine specializes in the human–animal bond and clinical
social work practice.
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