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Article 75

Animal-Assisted Therapy

Best Practices for College Counseling

Julia F. Kronholz, Vanessa F. Freeman, and Randi C. Mackintosh

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Introduction

College can be one of the most exciting times in a young adult’s life. Many students come to college feeling excited, nervous, and unsure of what the next 4 to 5 years of their lives may hold. What some students do not anticipate is just how stressful this period of their lives can be. Students may have their first experiences of anxiety and depression, among other mental health concerns, during this time. According to a study conducted by Watkins, Hunt, and Eisenberg (2011), there has been an increase in overall demand for counseling services on college campuses as well as the types of services provided. Supporting this finding, the annual 2013–2014 survey of college counseling center directors showed the mean number of counseling sessions provided ranged from 857 to 10,388 (Reetz, Krylowicz, & Mistler, 2014). This survey of 499 counseling center administrators reported that some schools served over 6,000 students, highlighting the fact that students are seeking out the counseling services that their campuses provide and that this area of higher education is worth examining and investing in.

The need for services has caused college counseling centers across the country to find various ways of meeting the demands of the students. University counseling centers have implemented wait-lists, initiated limited session numbers (e.g., three sessions), scheduled clients bi-weekly, and instituted a triage system for all initial encounters (Hardy, Weatherford, Locke, DePalma, & D’luso, 2011). These policies and procedures are aimed at helping meet the needs of the center and helping manage the demands on the counselors providing services. Finding new and creative ways to address the concerns of college students has become paramount in helping college campuses keep up with the increase in the need for counseling services. One service that is emerging as a possible option for meeting the needs of students is animal-assisted therapy. The aim of this article is to provide the reader with a clear understanding of animal-assisted therapy, its history and benefits, as well as share current research, best practices, and suggestions for practitioners on how to use animal-assisted therapy in the colligate settings.

Animal-Assisted Therapy

When the phrase “animal-assisted therapy” is expressed, there can be a number of thoughts about what this form of therapy looks like in practice. Oftentimes, the term “pet therapy” is used synonymously with animal-assisted therapy. Both terms may not provide individuals with a clear picture of what takes place when this intervention is used. According to the American Veterinary Medical Association (2011), animal-assisted therapy is defined as:

a goal directed intervention in which an animal meeting specific criteria is an integral part of the treatment process. Animal-assisted therapy is delivered and/or directed by health or human service providers working within the scope of their profession. Animal-assisted therapy is designed to promote improvement in human physical, social, emotional, or cognitive function. Animal-assisted therapy is provided in a variety of settings, and may be group or individual in nature. The process is documented and evaluated. (Definitions, para. 2)

This definition highlights the fact that animals used in this form of therapy must meet specific guidelines and standards and be seen as a vital part of treatment. This helps to clarify the differences between an animal, a family pet, and a therapy animal. For an animal to be considered a therapy animal, there are many rigorous standards that a handler and animal must complete. These standards are determined through organizations whose focus is to oversee the practice of using animals in therapy such as Delta Society, Therapy Dogs International, and Therapy Dogs, Inc. (Rossetti & King, 2010). Requirements for certification for a dog might include possessing a certain temperament or completing an obedience class (Rossetti & King, 2010).

In addition to being used in therapy, animals can be used in animal-assisted activities. Animal-assisted activities (AAA) are defined by Pet Partners (2012) as:

AAA provides opportunities for motivational, educational, recreational, and/or therapeutic benefits to enhance quality of life. AAA are delivered in a variety of environments by specially trained professionals, paraprofessionals, and/or volunteers, in association with animals that meet specific criteria. (para. 8)

Animal-assisted activities differ from animal-assisted therapy in that the interaction may be more casual and there are no identified treatment goals involved in the use of the animal (Marino, 2012). Furthermore, the requirements for animals and handlers involved in animal-assisted activities are less strict than for those who are providing animal- assisted therapy (Marino, 2012). Both animal-assisted activities and animal-assisted therapy showcase the variety of ways animals can be used to enhance the lives of those they touch. To fully understand how these forms of interventions developed, it is beneficial to examine the history of animal-assisted therapy and the human animal connection.

History of Animal-Assisted Therapy

The connection between dog and human began nearly 12,000 years ago (Brodie & Biley, 1999). Many scholars agree that the early relationship between humans and dogs was mutually beneficial (Wendt, 1996), whereby humans relied on dogs to help hunt prey, and dogs relied on humans to provide scraps of food for sustenance. Historians and archaeological findings propose that early cultures, such as the Egyptians, used dogs to guard royal palaces or aid with daily chores, such as pulling carts and herding livestock. Some canines were even declared as having healing powers (Wendt, 1996). With the emergence of domesticated animals, people began to use animals as aids for various tasks. In the 1700s, the Quakers used animals as adjunct treatment interventions in an institution for the mentally disabled. Historic figures, such as Florence Nightingale and Sigmund Freud, have used animals to aid their professional work (Hughes, 2010). More recently, the accessibility mandates within the Americans with Disabilities Act (ADA) have led to a gradual acceptance of services animals in public locations that previously might have been prohibited or unwelcomed (Mossman, 2014). With the advancing emergence of domestication, animals have become a growing presence in human culture.

The 1960s are seen as an impactful time in the development of animal-assisted therapy. Dr. Boris Levinson is credited with the creation of animal-assisted therapy, when he noticed that the therapeutic engagement with his clients became more fluid when his pet dog was in the session (Colombo, Buono, Smania, Raviola, & De Leo, 2006). Since that time, research on human-animal interactions has proliferated, resulting in programs that use animals as collaborators in the therapeutic process. The following section offers a review of the empirical evidence supporting the psychological and physiological benefits of animal-assisted therapy.

Current Research on Animal-Assisted Therapy

Current research provides evidence of the psychological and physiological benefits of animal-assisted therapy. For example, the therapeutic touch of animal-assisted therapy has been found to provide feelings of life, belonging, and security (Boldt & Dellman-Jenkins, 1992). Animal-assisted therapy has been shown to be efficacious in many diverse populations, such as children with autism, psychiatric patients, and patients with somatic disorders and communication disorders (Colombo et al., 2006). Research suggests that animal-assisted therapy has been found to decrease stress and lower blood pressure of heart patients (Stanley-Hermanns & Miller, 2002), decrease depressive symptoms and feelings of perceived loneliness of elderly people (Colombo et al., 2006), and increase self-esteem and social confidence in children (Baumgartner & Cho, 2014) and psychiatric patients (Rossetti & King, 2010). In college students, animal-assisted therapy has been found to decrease depressive symptoms and anxiety (Folse, Minder, Aycock, & Santana, 1994; Stewart, Dispenza, Parker, Chang, & Cunnien, 2014; Wilson, 1991).

The literature regarding animal-assisted therapy practices within college counseling centers is sparse, yet shows evidence that such programs are beneficial for students. For example, a recent study assessing the effectiveness of an animal-assisted therapy program at a small liberal arts college found significant decreases in self-reported anxiety and loneliness scores following the animal-assisted therapy intervention and found that interaction with the dog was identified as the most impactful aspect of the program (Stewart et al., 2014). In another study, Kurdek (2008) found that college students rated pet dogs as secure attachment figures, meaning they viewed pet dogs as a source of support and sought their pets during difficult times. Kurdek (2009) also found that college students were more likely to turn to pet dogs during times of distress than to father figures or brothers.

College counseling centers may often struggle to reduce the negative stigma students possess regarding help-seeking behavior. As such, college counseling center personnel often seek new ways to improve perceptions of the counseling center. One practice shown through research to be beneficial is introducing animals to therapy services. Wells and Perrine (2001) sought to understand the impact of animals on college students’ perceptions of college personnel. In this study, students were randomly assigned photographs of a professor’s office that had a dog, a cat, or no animal present. Students rated the office as more comfortable and the professor friendlier when a dog was present in the office photograph than when there was a cat or no animal present (Wells & Perrine, 2001).

Another recent study described the outcomes of a dog outreach program at a mid- size college in the Northeast United States. The aims of the outreach were to reduce students’ stress at the end of the term and to increase access and to the counseling center. Counseling center staff brought two dogs to the student union for a period of 2 hours, where students could stop and pet the dogs for as long or short of a time period as they pleased. During this time, counseling center staff offered information to students regarding services available at the center. Surveys revealed that 79% of students found the therapy dogs to be of “exceptional value” and 72% of students rated their stress relief following interactions with the dogs as “high” (Daltry & Mehr, 2015). In regards to the dog therapy outreach program, 36% of students who interacted with the dogs had not heard of the counseling center or were unaware of counseling center services. Additionally, 70% of students reported that were more likely to contact the counseling center as a result of the outreach, and 94% of students stated that if the therapy dogs were not present they would have not stopped at the counseling center information table. Students provided open responses on the survey that described counseling center staff at the outreach as “welcoming” and “friendly,” suggesting that the dog therapy outreach events contributed to a positive perception of the counseling center. Overall, the dog therapy outreach program achieved both of its goals: to reduce students’ stress and to increase positive perceptions of the counseling center.

The scholarly literature base presents encouraging findings in regards to animal- assisted therapy. Because of the host of positive benefits associated with animal-assisted therapies, many university counseling centers are beginning to integrate animal therapy into service delivery for college students (Stewart, Chang, & Jaynes, 2013). Stewart et al. (2014) proposed animal-assisted therapy as a suitable service delivery model for college counseling, citing its cost-effectiveness and time-efficiency. The following section will detail current practices of animal-assisted therapy at a college counseling center in the Southeast United States and detail how the center uses animals in practice and outreach.

Suggestions for Practitioners

While the empirical literature offers support for the use of trained animals in therapeutic settings, there is little information that outlines the translation of research into practice. The following section will describe the efforts of a university counseling center with which the authors are associated in order to demonstrate the integration of animals into a counseling service-delivery model.

Over the past 3 years, the Florida State University Counseling Center (UCC) has expanded its outreach programming to include therapy animals in order to reach a wider audience of students, to reduce the stigma surrounding mental health, and to increase help-seeking behavior of college students. Additionally, in an effort to cut costs related to outreach programming while still reaching a large campus population, the UCC pursued animal therapy as a free, volunteer-based activity to incorporate into its outreach efforts.

Supporting empirical findings, the UCC staff found multiple benefits to having therapy animals at various outreach programs around campus. First, students may have an easier time approaching UCC staff members to ask questions about counseling when they meet them in a more casual setting such as petting dogs at one of the events. While some students may be hesitant to approach a table promoting the Counseling Center and providing information about stress management, it was found that they will gladly travel across campus following signs advertising the popular “Yappy Hour” or “Stress Buster Day” events when it is clear that therapy animals will be in attendance. Second, UCC staff anecdotally reported that students tended to stay at outreach events longer when therapy animals were present than when the UCC hosted a more traditional tabling event where students may stop by and spend a few minutes talking with staff and getting information. This presents an opportunity for rapport building between students and staff, which likely leads to a stronger connection and a higher likelihood that students will follow through and pursue counseling if needed. Third, counseling center staff found that students like to capture their interactions with the therapy animals in photographs, which were immediately shared on social media. This dissemination allows for more widespread publicity of UCC events from a very valuable source: students, themselves. Finally, UCC staff noticed an unexpected benefit of bringing therapy animals to outreach events. Staff observed that when students would go to pet one of the therapy animals, the students and the therapy animal’s owners would engage in lengthy, friendly conversations. These interactions seem to leave both parties with smiles on their faces and an experience of human connection they might not have otherwise had.

The UCC has actively worked to build a strong relationship with the animal therapy program at Tallahassee Memorial Hospital (TMH), a major local hospital in the area. The relationship with TMH has enabled UCC staff to utilize therapy animals at many outreach events throughout the year. This is especially beneficial because the UCC does not currently house any therapy animals “on staff” as other counseling centers (e.g., University of Central Florida, University of Vermont). The TMH animal therapy program is robust and holds strict requirements for their volunteers to ensure that their animals and handlers have been properly trained. As part of their training, animals and volunteers must meet Pet Partner standards established by the Delta Society and animals must pass their nationally recognized skills/aptitude test (TMH, 2015).

Reason and Lutovsky (2007) highlighted the necessity of proactive community collaboration for college administrators regarding crisis response on campus. The UCC’s collaboration with the TMH animal therapy program was particularly important in the wake of a campus shooting at Florida State University in November 2014. As staff gathered in the early morning hours to devise a triage system for students, faculty, and staff impacted by the shooting in the campus library, the TMH animal therapy program coordinator contacted the UCC to offer volunteers in whatever capacity. As a result, several therapy dogs and their handlers were present at a town hall meeting the UCC hosted that afternoon, as well as in the UCC waiting room throughout the day of the shooting and the following day. The calming presence of the therapy dogs and their handlers helped ease the fear and worry experienced by so many in the FSU campus community, and the significant impact of therapy dogs became clear.

In addition to using therapy animals in response to crisis situations on campus, they have become an integral part of the UCC’s annual outreach programming. Each year in the fall and spring semesters, the UCC hosts a Stress Buster Day during the week before final exams as a way for students to take a break from studying and engage in a variety of stress-relieving activities including free massages, biofeedback, crafts, and board games. The addition of the therapy animals to this event each semester resulted in a noticeable increase in student attendance and students consistently rated the therapy animals as one of their favorite activities on evaluations. The UCC introduced a new outreach event this year called Yappy Hour that was designed to give incoming students an opportunity during the first few weeks of school to meet other students and learn about available campus resources. Staff offered “Pink Poodle” mocktails, a popcorn bar, and had a group of therapy dogs as well as a therapy bird on hand for students to interact with. Having therapy animals present allowed over 250 students to mingle with one another and make new connections in a relaxed, welcoming environment. At outreach events that feature therapy animals, the UCC also provides handouts outlining the benefits of interacting with animals. These handouts also provide information on local animal shelters where students can volunteer, in an effort to encourage students to take proactive steps in managing their stress and establishing a sense of meaning and purpose in their lives.

As with many aspects of college counseling, there are several important factors pertaining to liability that must be taken into consideration when hosting therapy animals at outreach events. First, the UCC completes a permit to have animals on campus that provides proof of the animal therapy program’s insurance policy and agrees to keep therapy animals on leashes and in approved areas at all times. Additionally, students are required to sign consent forms before interacting with the animals as an additional precaution. The UCC has found that students are not bothered by this requirement and will often wait in line up to 10 or 15 minutes in order to sign the consent form to pet the therapy animals. Of course, it is reasonable to assume that some students may not care for animals or may have an aversion towards animals. The UCC is aware of this consideration and therefore is careful to balance the outreach programming to include animal-present and non animal-present events. Other options to accommodate for those who are hesitant to attend an event with an animal present might include designating a specific hour that will include animals. For example, a 4-hour outreach event might publicize an animal presence for only two of those hours within a particular physical space. Students can then make the choice when to attend the event dependent upon their needs and desires. If therapy animals are brought to a particular group (e.g., residence hall, classroom), it would be important to ensure the students in that group be aware of the visit before hand, ideally filling out a consent form prior to the visit in order for them to ask questions or make alternative plans if they so desire.

While the UCC’s integration of animal therapy has been successful over the past 3 years, staff are always looking for ways to grow the program to enhance the overall well-being of students. Future directions for the involvement of therapy animals include using therapy animals in residence halls during the fall semester to alleviate feelings of homesickness and integrating therapy dogs into individual and group counseling at the UCC.

Future Practice and Considerations

While initial evidence suggests the positive outcomes of animal-assisted therapy, there are cautions of which to be aware. Certainly, many pet owners might argue that their pet has therapeutic attributes; however, it is essential that animal-assisted therapy programs solicit the use of trained and certified therapy animals. This is likely to take considerable time and effort (Sanford, 2014). However, for the safety of college students, staff, faculty, and for the safety of the animals, proper certification is absolutely required before proposing animal-assisted therapy in a college setting. Along similar lines, counseling center staff should be aware of zoonosis, that is, the transference of disease between animal and human. Animals who have progressed successfully thought the certification process are required to be healthy and free of disease; however, zoonosis deserves attention as an animal might have an undiagnosed and transferable disease. Organizations that desire to incorporate animal-assisted therapy in a setting such as a college counseling center should ensure that all animals have a recent clean bill of health from a licensed veterinarian.

Another consideration is one of training, in that animal-assisted therapy is not commonly addressed in the training or curriculum of graduate level psychology training programs, doctoral internship or postdoctoral trainings, or professional level continuing education. While there are examples of specific training at various sites, the majority of training programs do not explicitly address the practice of animal-assisted therapy. Likewise, many clinical supervisors may be unfamiliar with this area and should encourage and assist interested trainees in researching the available literature and consulting with professionals who incorporate animal therapy into their clinical work. People who are interested in receiving further education on animal-assisted therapy can participate in certification programs, such as the Animal Therapy Certification through the Animal Behavior Institute (ABI; 2015). Supervisors can also encourage interested trainees to seek out certification on their own, through programs like Therapy Dogs International (TDI), a national organization that works through local chapters to help educate and train person-animal volunteer pairs (Therapy Dogs International, 2015).

Stewart et al. (2014) reflected that animal-assisted therapy is a growing discipline within the mental health field. The small number of existing studies on this topic supports the use of animal-assisted therapy in college counseling; however, there is very little empirical evidence to draw upon. The newness of this topic reveals challenges for practitioners in defining interventions and clinical applicability (Stewart et al., 2014). Further research investigating the psychosocial and physical benefits of animal-assisted therapy will prove essential in development of intervention and outreach for college counseling practitioners.

Resources

Professional organizations offer a plethora of important resources for those interested in incorporating animal-assisted therapy into a therapeutic setting. Some organizations offer information on one specific animal (e.g., dogs), while others are inclusive of other animals used in therapy (e.g., birds, goats, horses). For example, the American Kennel Club (http://www.akc.org/) offers a tremendous amount of national, regional, and local therapy dog organizations. These organizations provide educational materials from experts, screen and train volunteers and dogs, and provide liability insurance for dog and handler while volunteering in a therapeutic setting. Therapy Dogs International (TDI) is a major dog therapy volunteer organization dedicated to “regulating, testing and registration of therapy dogs and their volunteer handlers for the purpose of visiting nursing homes, hospitals, other institutions and wherever else therapy dogs are needed” (TDI, 2015). TDI is a national organization and boasted over 24,750 dog/handler registered pairs in 2012. The American Society for the Prevention of Cruelty to Animals (ASPCA) is a well-known national organization that also offers information about animal-assisted therapy and collaborates with Pet Partners to offer therapy certifications for many animals, such as dogs, cats, guinea pigs, rabbits, domesticated rats, horses, donkeys, llamas, alpacas, pot-bellied pigs, and birds (Pet Partners, 2015). This is a resource for those who wish to become certified in animal-assisted therapy with their pet, or for those looking for animal/handler volunteers to bring therapy animals to a workplace, home, or clinic.

Conclusion

The increasing prevalence of stress, anxiety, and significant mental health concerns among college students—combined with a reduction of college counseling center resources (e.g., budget, staffing)—creates a need to develop innovative strategies to help students (Ratanasiripong, Sverduk, Hayashino, & Prince, 2010). Empirical research and practical application of animal-assisted therapy suggests that this is one resources for college counseling centers in meeting the growing demands of services from students, administrators, and policymakers.

This manuscript sought to supply the reader with a brief history of animal-assisted therapy, offer one example of the real world applicability of animal-assisted therapy at a university counseling center, and provide resources for readers interested in further information on the topic of animal-assisted therapy. In addition to traditional methods of service delivery (e.g., individual counseling, group counseling), animal-assisted therapy appears to be an effective intervention to decrease mental health concerns among college students. Furthermore, the inclusion of certified animals during counseling center outreach events has shown to increase student attendance, decrease stigma of college counseling centers and mental health services, and create an atmosphere of support and comfort for attendees. While this is not yet a standard approach to college counseling center service delivery, initial evidence provides support for inclusion of animals in practice and outreach. The flexibility of animal-assisted therapy programs is ideal for the fluid and dynamic environment of higher education.