Qualitative Perspectives of an Animal-Assisted Therapy Program

Abstract

Background:

Recent literature suggests that animal-assisted therapy (AAT) has shown significant results for a variety of clinical populations. However, little is known about how clinicians involved in using AAT frame their practices, understand their roles among other human-service providers, and perceive success when providing AAT services.

Objective:

The goal of this study of AAT providers was to begin a process that could eventually lead to more a broad and national assessment of AAT professionals.

Materials and Methods:

In-depth interviews were conducted with 14 AAT therapists working on a therapeutic ranch in the U.S. Midwestern states. The study examined phenomenological understanding of the therapists' roles, goals of the facility, and how the therapists viewed success. Participants outlined the goals of AAT programs, explained what they hoped clients learned through the therapy process, and shared their perceptions regarding success in AAT (highlighting the importance of tangible behavior change, clients' perceptions of their own accomplishments, and parents' cogent impact on the longevity of success), and described necessary characteristics of therapists who pursue work in AAT. The study's findings are related to previously published research regarding AAT and potential benefits and limitations are provided in this article for practicing clinicians who consider utilizing AAT.

Results:

Six potential effects that AAT could have include: (1) positive behavior patterns, (2) trust, (3) caring for others, (4) empathy, (5) cooperation and responsibility, and (6) unexpected benefits. Success with AAT was defined as (1) seeing client behavioral changes, (2) clients processing feelings effectively, and (3) providing clients with an overall sense of accomplishment. Characteristics needed for therapists interested in AAT were identified as (1) an intrinsic motivation for job satisfaction, (2) an open and vulnerable personality, (3) commitment to the job, and (4) flexibility in working with clients.

Conclusion:

AAT can work when conventional talk therapy fails, is effective at holistic levels, and can be applied at multiple treatment locations. However, AAT is not for all licensed clinicians, requires specific personality characteristics, is not the best choice for all clients, and requires appropriate animal–client matches. Future research could explore regional preferences for specific animals, comparisons of facilities that use various kinds of animals. The current study should be replicated in other AAT milieux.

Introduction

For years, animals have held a unique place in the lives of many people. Schneider and Harley¹ reported that parents often testify about the benefits of animals as companions for children. In particular, parents view animals to be useful for teaching responsibility, encouraging a caring nature, providing companionship and comfort, and offering a means of security. While parents have long encouraged the presence of household pets, the professional, formal use of animals for therapeutic means did not begin until the last part of the twentieth century, thriving in the 1980s.² During the 1980s and 1990s Animal-Assisted Activities (AAAs) and Animal-Assisted Therapy (AATs) became generally accepted forms of therapy, and the practices spread throughout health services into academia.³

Historically, the primary initiator of the use of animals in therapy was Boris M. Levinson, MD, as he used animals to treat emotionally disturbed children at his practice in New York.⁴ Sigmund Freud, MD, along with a number of other psychoanalysts and therapists over the years, had been documented as using animals occasionally, but it was Dr. Levinson who finally established the practice as a systematic means of applying therapy. He found that using his dog, Jingles, encouraged shy children to interact and often calmed aggression in violent children.

Among their many purposes, animals in therapy often serve as a bridge between therapists and clients, lowering inhibitions and reducing anxiety.⁵ Animals have the unique potential ability to help clients to move their focus away from their own problems, which is particularly useful for terminally ill patients.⁶

AAT is used in a number of venues including schools, hospitals, and mental health settings.⁷ The medical world does not always readily accept AAT, sometimes attributing its noted successes to the phenomena of the placebo effect.⁸ Despite these circumstances, animals have played a significant role in hospital settings, particularly with ill children who may be stressed by separation from their parents.⁹ Patients in extended or permanent hospital stays have found that animals can provide companionship and comfort along with a number of other psychosocial benefits.¹⁰ Similarly, schools for disabled and mentally handicapped children sometimes have used animals to calm the children when they are confused or feeling threatened by clinicians who are trying to help them.¹¹ Mental health facilities, both inpatient and outpatient, have utilized animals when treating individuals with disabilities and survivors of sexual abuse.¹² Given that an animal is not judgmental, theoretically, the survivor may learn to trust other people and find goodness in themselves.¹³

The use of animals in therapy has not been successful in all cases.⁴ Noted potential mitigating factors include the client's needs and fears, the therapist's abilities and desires, and the animal's nature. Each factor needs to be addressed prior to forming a healthy therapeutic relationship. Given that AAT generally targets more sensitive populations, such as needy children, individuals with disabilities, or people with chronic illnesses, it is necessary to be particularly aware of clients' needs to avoid potentially worsening their conditions.¹⁴ A notable example¹⁵ of when AAT does not work includes clients known for reoccurring acts of animal cruelty; these individuals often lack empathy and will not adapt easily to caring for an animal.¹⁶ In addition, some clients may require forms of attention that animals are unable to provide, some clients may have previous negative experiences with animals, and some clients may be mentally, emotionally, or physically unable to care for animals. Mallon et al.¹⁷ also note that, when clients generally dislike animals, have allergies, or experience particular phobias, AAT may not be the best fit for these particular individuals.

Just as animal-assisted therapy is not for every client, neither is this therapy model appropriate for every clinician. Successful clinicians in AAT programs generally tend to be flexible, yet have an apt sense of structure and boundaries.¹⁸ It is also advisable that clinicians have a desire to use animals in their work and be interested in finding innovative ways to connect with their clients. Hart¹⁹ noted that a significant number of volunteers who work in these organizations tend to experience pleasure when working with animals and desire to use them to assist people in need.

However, some clients and clinicians that might at first appear poor fits for AAT may prove successful when strategically matched with the right animals. For instance, use of horses in therapy can be particularly intimidating to clients who are afraid of animals. However, gradually introducing a trustworthy animal to the client has the potential of easing fears.²⁰ Chandler⁴ noted that the spectrum of animals that can be used in therapy ranged from dogs, to horses, to fish, birds, cats, and a variety of small mammals. Following the standards set by the American Veterinarian Medical Association, animals used in therapy should be reliable, predictable, easy to control, and suitable for the therapy objectives.^3,21

Potential benefits of AAT are reported to be both physical and psychological.²² For example, Odendaal^* reported that positive human–animal interaction can lower blood pressure, making positive impacts on reducing fear, stress, and anger, and Yorke et al.²³ reported lowered cortisol levels in patients who participated in AAT. Pets also can be used to treat the symptoms of post-traumatic stress disorder, alleviating some patients' fear and anxiety,²⁴ and companion animals may also help reduce distress in children during stressful events.²⁵

In addition, use of companionship animals has shown some positive results toward success in anger-management programs.²⁶ Given that the animals require gentle touch, various clients with aggressive tendencies and anger difficulties have experienced improved behavioral inhibitions and were less likely to respond aggressively toward people.²⁷ Equine therapy has been shown to potentially build communication skills and trust between clients and caregivers, in addition to fostering character traits, such as empathy, organizational skill development, good spatial relations, and improved body awareness.¹ Structured pet-care programs also can improve patients' pain-management capabilities,²⁸ and supplement therapy for aphasia,²⁹ heart recovery,³⁰ depression,³¹ infections,³² schizophrenia,³³ and other physical and mental health conditions. Animals may provide companionship and comforting support that enhances a client's quality of life, particularly elderly seniors who are unable to live independently.³⁴

Given the potential that AAT evidently has for helping particular populations who seek psychotherapy services, there is a surprising paucity of published empirical studies regarding how AAT practitioners perceive their services. Relatively little is known regarding how these professionals come to frame their practices, understand their respective roles among other human-service providers, and perceive success when providing AAT services. The time is right for a national survey of AAT providers to be conducted, which will help capture needed data regarding normative experiences among clinicians providing such services. However, so little is known empirically to date that such a national survey likely would not be as efficient or effective as it otherwise could be if it were to be grounded in some established data.

Toward contributing to that end, we conducted a qualitative research study of AAT providers in order to begin a process that we hope eventually will lead to more broad and national assessment of AAT professionals. Foundations and other grant-funding agencies often want to see effective published pilot studies that serve as precursors to any relatively significant and expensive undertaking, such as conducting a scientifically valid national survey. The present study is a first step toward that potential objective. In-depth interviews were conducted with a group of professionals who provide AAT with clients at a Midwest facility. The study's objective was to obtain phenomenological perspectives of these individuals and to report their viewpoints regarding how they frame their professional identities and services. Consistent with a typical qualitative research protocol, the current study is context-specific; future qualitative researchers may build on the results from the present study and, over time, generate a relatively comprehensive understanding of the phenomenon.³⁵ As such, the present study is a significant contribution toward a long-term larger objective.

Materials and Methods

Sample

Participants in the present sample included 14 therapists and specialists from an equine therapeutic facility located in the U.S. Midwest. These direct-care professionals had experience with multiple clients, which provided rich data regarding the work of animal-assisted therapists. The therapists in this sample presently worked at a nationally recognized ranch that focuses on helping children with emotional and behavioral issues. These 14 individuals included all the animal-assisted therapists working at this facility, which consisted of an indoor arena, offices, classrooms, a 20-horse barn, a greenhouse, classrooms, and a small-animal room with rabbits, birds, lizards, prairie dogs, and ferrets. Most of the children treated in this program are one step away from incarceration. In order to maintain the spirit and integrity of anonymity, the current authors are deliberately not sharing many details regarding the site or participants' demographics; this protocol was also directed by the institutional review board of the institution that approved the study.

Purposeful sampling³⁶ was used to obtain interviews for selecting participants who met the condition of interest regarding the study's aim. Following completion of ∼12 interviews, the current authors encountered the phenomenon of saturation,³⁷ meaning that adding new individuals to the sample was no longer generating new potential codes that eventually might result in novel themes. Achieving saturation helped to solidify assurance that the size of the sample used in the study was sufficient for accomplishing the study's aims.^38,39

Procedure

Consistent with qualitative research methodology, the study's results are based largely on one-on-one tape-recorded interviews with the therapists, and the data were augmented by some participant observation, viewing the facilities where therapy was conducted, as well as reviewing the literature, websites, brochures, and other literature provided by the facility's administration. Interviews were conducted in two waves, such that each participant also completed a questionnaire detailing his or her past experience as a therapist or specialist and related logistics. The names and all identifying information are disguised through the use of pseudonyms.

Phenomenological⁴⁰ qualitative research best describes the approach used in designing the present study, given that the objective was to reflect the outlooks of the therapists who participated in the study. The results presented are believed to portray the participants' perspectives and to convey how they framed the professional roles that they served on the ranch.⁴¹ Rich and thick descriptions of participants' phenomenological perspectives often are obtained through semistructured interviews,⁴² and this was the data collection process used in the present study. With this method, some general constructs of interests were initiated, but the research participants were allowed to take the interviews in a variety of directions as they best thought themselves able to reflect their viewpoints and share their stories and experiences.⁴³ In this way, it was possible to move beyond only obtaining a shallow understanding of the therapists' perspectives and, rather, obtain more enriched perspectives. All the interviews were tape recorded and transcribed later for further analysis.

Consistent with Maxwell,⁴⁴ open coding strategies were applied when examining the transcripts. This is an inductive means of exploring the data for recurring ideas, words, and constructs. Chenail⁴⁵ suggested a line-by-line analysis approach to data analysis, which was followed when coding the transcripts. A constant-comparison process⁴⁶ was applied as each new transcript was appraised in comparison with the ones that preceded it. This process was continued throughout the data analysis in a systematic and progressive manner. Concept mapping, asking key questions, visually displaying the findings, and conducting organizational reviews were recommended by Gay et al.,⁴⁷ and these elements were also involved in the coding procedures.

Applying apt rigor, according to qualitative method standards,^48,49 was a commitment made from the outset of the present study. As such, a number of elements were built into the study to help strengthen its internal validity. One component involved having regularly scheduled meetings among the study's various researchers.⁵⁰ As such, the results reported in the present article represent the consensus of multiple researchers—not just 1 or 2—helping to ensure that the viewpoints expressed in the transcripts are represented adequately.⁵¹ The study's internal validity was enhanced through obtaining the expertise of an expert in qualitative research who was outside of the data collection and analysis, member checking,⁵² creating a data trail, and deliberately writing this article using low-inference descriptions.⁵³

Results

Results pertaining to the present study fell into two general domains. First, participants shared their insights regarding AAT itself. Goals of such programs were outlined and participants explained what they hoped clients learned through the therapy process. Individuals in this sample also shared perceptions regarding success in AAT, highlighting the importance of tangible behavior change, clients' perceptions of their own accomplishments, as well as parents' cogent impact on the longevity of success. In addition, participants described necessary characteristics of therapists who pursue work in AAT. Such character traits included an outgoing personality, a willingness to take initiatives, commitment and perseverance, humility, and an innate desire to help the children with whom they would be working.

The Six Elements Involved with AAT

AAT programs are used to assist clients in developing grounded coping skills as individuals learn to process their feelings effectively. As such, the therapists related six particular elements of AAT:

Positive behavior patterns

Therapists explained that teaching children to work with animals was not their end goal. Rather, animals served as potential tools through which children learned and developed an array of positive behavior patterns. Gary described the program's design in terms of goals set for the children involved: “It's using the animals and the greenhouse to help kids do better with basic coping skills, anger-management kind of things…the day-to-day, how to get through the day stuff.” Participants shared that specific goals often involve increasing clients' awareness of their own emotions and their ability to control these emotions. In addition, therapists shared that clients are frequently, at first, unaware of their own shifts in behavior and displays of emotion. That is, clients gradually develop behavior patterns that are gentle and kind toward the animals with which they work—and these shifts reportedly often take place on automatic, “unconscious,” levels. Participants suggested that if animals were not an integral component of therapy with these particular clients, then client behavior likely would not experience such swift, positive advancements.

Rachel explained how interaction with animals was particularly effective for teaching clients to develop anger management and stated that, often, the learning process took place naturally without the clients' full realization of their own shifts in behavior: “A lot of kids we see have aggression problems. But when they are with the animals, unknowingly, they are forced to be gentle. They learn subconsciously how to be gentle.”

Trust

Therapists shared that trust was a key concept they sought to develop with their clients—both on a therapist-to-client level and in terms of lifelong abilities when interacting with others. Participants explained that few clients rarely, if ever, were in the habit of trusting others because of the rough backgrounds from which most of these clients came. However, through the use of animals in therapy, it became necessary for clients to learn trust. This process reportedly served as a unique stepping-stone from which the clients were then able to begin trusting their therapists. Joanne explained:

I think they [the clients] just trust me since the animals trust me. When the kids first get here they don't trust anyone…the animals help to develop that form of trust…they [the animals] help the kids to make that initial connection. Even if they can't make a connection with me, they can make a connection with a rabbit or a bird, or another animal. They learn to trust not only the animals; they learn to trust themselves also.

Participants explained further that, as connections were developed between clients and animals, clients began to realize more fully the associations between their own behaviors and the potential impacts these actions had on animals. For example, clients were said to have realized that treating animals in a nonthreatening manner allowed for mutual connections to form between themselves and the animals with which they interacted. Therapists explained that, as clients began to understand the effects of their own behaviors on other living creatures, clients also further realized the effects of their actions and expressions of emotion in relation to other people. Chuck illustrated this process that reportedly was demonstrated regularly by clients with whom he worked: “A lot of our youth have experienced that, if you exhibit positive behavior to therapeutic pets—such as patience, caring, respecting boundaries, being helpful, using a friendly tone of voice—that those behaviors not only help the animal to trust you but they also help other people to trust you more, too.”

Caring for others

Therapists felt that an important next step in teaching the clients positive behavior patterns included developing an ability to care for others. On one level, participants explained that most clients with whom they worked initially were unable to express caring sentiments toward other people. Connie summarized the concepts of most participants when explaining the importance of, not only learning to trust, but also learning to care for others and the unique ability working with animals has in fostering clients' abilities to do so: “So many of the kids have no clue about nurturing or caring, but when they work with animals that just sort of comes out with instinct. They start to really care about an animal. I just think that's really a developmental skill that they need to know about.”

Empathy

Working with animals reportedly helps clients develop empathy. Through increased awareness of their own emotions, clients are said to relate better with the animals and to become more aware of emotions that the animals might be experiencing, such as fear or excitement. The therapists explained further that working with animals becomes especially effective for teaching empathy to clients when they first arrive.

Elaine described a typical example of using the animals to teach children basic relational skills: “Empathy is something that I work on trying to get the children to understand. For example, most of them can empathize greatly with the animals being in a cage, because they [the clients] feel like they're in one, too.” As clients demonstrated empathy, their ability to process the emotions of other people reportedly also increased. Once clients developed emotional connections with the animals and learned to care for them, experiencing the same empathy when interacting with people became significantly less challenging. Jean explained the important role animals play in teaching clients empathy, which, in turn, affect the client's ability to think from an others-centered perspective: “The kids, they learn to think about how an animal feels when they're holding him. How to make them feel, and how they would feel in that situation. They slowly turn and relate that to, ‘oh, if I do that to that person, that person hurts.’”

Understandably, in learning to empathize and care for the animals, each child develops strong bonds with a number of the animals. This may be a generally rare experience for many clients, as most have taught themselves to remain unattached from others because of their abusive histories. Chuck described the cogent effects of human–animal bonds in this regard, summarizing the accounts shared by most participants:

I find it easier for a lot of youngsters to bond to animals than it is for them to bond with people. A lot of youngsters we are working with here are youngsters who feel rejected by their biological parents or feel rejected by various foster parents. So, for a lot of those youngsters, especially if they have had any kind of positive experiences with animals in the past, they are going to be more likely to trust some animals than they are some people.

Cooperation and responsibility

Participants also shared that AAT's central emphasis is placed on teaching clients cooperation and responsibility. Therapists have the goal of integrating these constructs into a variety of activities, such as giving clients individual tasks for which they are responsible, and allowing clients to assist in arranging therapy sessions and various group activities. The therapists also shared that an important aspect of cooperation is learning how to interact appropriately with peers. Alice described the unique learning process that she and most therapists in the sample witnessed as clients improved their ability to cooperate: “In the riding groups, this is one time that you'll see the kids not instigating one another. Instead, their focus is on the horse. I think that's just a really good experience for them, not to be worried about what their peers think or worried about someone picking on them or making them frustrated.”

Therapists also reported extending personal efforts to teach their clients about responsibility and cooperation. Often, this process included the counselors exerting extra effort but, overall, the improvement they witnessed in clients made the extra work well worth it. Specifically, this dynamic entailed ensuring that clients maintained their given responsibilities as the therapists provided the accountability and motivation the clients needed to follow through and develop responsible habits. Martha explained that children are able to understand responsibility better when they fully aware of the expectations that have been set: “[The instructions I give have] got to fall in those guidelines of ‘I prepare my house this way. I put my equipment away this way.’ It gives them a certain amount of structure so they can be aware of their responsibilities.”

Unexpected benefits

Participants shared that clients often learn many of these key behaviors, such as cooperation and responsibility, through unexpected means. While therapists design sessions and activities with particular goals in mind, flexibility also is required. Jim summarized most participants when explaining that the fundamental goal of AAT is to meet the needs of children that arise: “It seems kids will learn from each other. You start out with one set goal in mind, but [sometimes you] don't keep that goal in mind because the kids will take it [the activity] wherever they need to take it, wherever their problems are.”

How Therapists Framed AAT Success

Therapists defined AAT success primarily in terms of (1) seeing client behavioral changes, (2) processing feelings effectively, and (3) providing clients with overall sentiments of accomplishments.

Regarding behavioral changes, Jean summarized the perceptions most participants shared regarding perceived successful AAT: “Just being able to change one kid's life [is worth it]. Being able to help make them see that they're worth something and that they can do something with their [lives]. It's the changes that the children make.” In congruence with the goals of the respective facilities at which participants worked, success also was described by our participants in terms of helping children learn to better process and understand their own feelings. Gary aptly summarized the sentiments of most therapists in the sample when describing the process of success he witnessed with various clients: “If we can help a child learn to process feelings better as a result of coming to our therapies, I think we've done a great service.”

Therapists in the sample also described success in terms of clients' personal sense of accomplishment; successful therapy involved clients' realizations of their own successes. As such, rather than measuring success solely in terms of behavior changes, therapists in the sample also provided care for their clients on deeper intrinsic levels, reportedly contributing to therapeutic success. Jim aptly captured this view of success that participants shared: “As their therapist, I know that them being angry comes from fear, it [comes] from anxiety. If I can teach them about anxiety, then they realize that they allowed it to control their actions and this leads to no more conflict in their [lives]. And, in my eyes, that's success.”

Participants also described the influence that successful AAT had on client's parents and that parent–child connections were associated with more lasting behavioral changes. Joanne explained this connection further and emphasized the importance of showing parents tangible success in the lives of their children: “When [you] have the opportunity to change how that parent sees that child…when you have the opportunity to let that child demonstrate something they've learned for their parents, and you praise the child; you can change how the child is seen in the eyes of the parent. And a lot of times that becomes important [to success].”

While discouragement from parents reportedly stifles success, participants explained that encouragement and other affirmative reinforcements clients receive from their parents tend to affect children's success positively. Elaine summarized most participants when describing the cogent impact of parent–child interactions, and the benefit that potentially results when parents are supportive of the AAT process: “I've seen some of the kids when their parents will come in. The child can show their parents, ‘I made this for the animals.’ Or: ‘Look, Mom, I can pick up this animal. You're afraid of this animal but I can interact with it.’ And that's a cool part of the therapy—to see [the children] show their parents all they've accomplished.”

According to the participants, most families with children in AAT programs are supportive of this unique approach to therapy. Individuals in the sample explained that parents, many of whom had begun to “lose hope,” were again able to see their children make progress. As Emily explained, “I know we get a lot of positive feedback from the parents. We have at least 1 or 2 children right now that are here for their second year [because] their parents literally begged for their child to come back—they knew this was how their child could be successful.” In sum, when both the child and parent are influenced positively by the program, lessons learned through AAT likely will become long-term ways of thinking for clients.

Therapist Characteristics

Not everyone is equipped for the profession of AAT and participants related certain characteristics that they believed it takes to become successful as an AAT therapist. The participants indicated that successful AAT therapists have (1) an intrinsic motivation for job satisfaction, (2) an open and vulnerable personality, (3) commitment to the job, and (4) flexibility in how they work with clients.

First, therapists described the need to find job satisfaction at an intrinsic level. That is, participants repeatedly emphasized the additional, necessary characteristic that successful therapists have—a nonmonetary-driven motivation for the work in which they were engaged. As such, therapists looking for a line of work in which a paycheck was the primary motivating reward largely would find themselves unhappy with investing their lives in AAT. That is not to say participants in the sample reported their work to be unsatisfying; on the contrary, participants warned that nonintrinsic motivators might not compensate for natural difficulties that accompany their work, if money remained one's primary motivation. Jim described the accounts that many participants shared relative to the keystone importance of taking initiative in this field and finding motivation intrinsically, rather than from monetary benefit: “[This work] takes a lot. If you look at your paycheck, and that's why you do this, then you need to get into a different field. You really do. If you look at this as, ‘I need to always be learning. I need to be always looking for new ways to improve and help this. I need to be researching new animals,’ then you're there for the right reasons.”

When working in the field of AAT, participants also described a sense of responsibility for the way in which they contributed to the well-being of the individuals with whom they worked. Alex summarized the desire most participants expressed to help change an individuals' life: “The satisfaction [from this work] blows the other frustration away, or else I wouldn't be here. Like I said, if you're looking for pay, this isn't it. If you're looking at, ‘I want to change a moment in this child's life,’ then the more moments you build on, the more [the children] have to remember. Maybe that is something they'll teach their kids; that's what the whole field is about.”

Second, therapists expect in each other the ability to be open and vulnerable (with humility). Many of the participants mentioned how unpopular it is for coworkers to stress their own “greatness” or personal success. Overall, participants felt that people who are focused on self-promotion and their own gain would be detrimental to the AAT profession. Ethan explained: “It really takes an individual that is willing to put [pride] aside and learn from [others]. Every life experience that we have is something that can help us benefit these kids.” Therapists in the sample explained further that, because of the nature of their work and the children with whom they worked, often the most “technically” qualified individuals were not necessarily the ones who have become the best therapists in AAT practice. That is not to say that participants expressed a negative attitude toward training and credentials but, rather, toward pride or self-serving agendas. Adam explained the connection most participants identified between a true love for the AAT work, for helping change lives, and overall success at helping instill this change:

There's no room here for egos. These kids need help—period—it doesn't matter what the alphabet soup is after your name. It doesn't matter who you are, how old you are, what your gender is. These kids are going to bond or connect with whoever they choose, and that can be anybody. And same with animals. Animals don't care that you have a PhD and you're only 20. They don't care about that at all. [What] they want to know [is] that you care about them.

Just as participants tended to perceive individuals with a dedication to AAT in a positive light, participants conversely expressed disdain for therapists within the field who were thought to be prideful. Participants seemed to feel that, rather than focusing on the “success” of the therapist, the focus instead should be placed on the changed life of the children. Individuals in the sample admitted further that, a particular level of humility, altruistic motivation, and willingness to give up personal “glory” are necessary. Jessica explained: “I really try, as a supervisor, to get people to put aside whatever differences they have in the workplace and to focus on what is the best thing for the kids. Understanding the constraints of a resource scarce environment, you need to really put [the kids] first.…I was just called to do this kind of work. I feel that, from my heart…to me this is the most satisfying work I've ever done.”

Not only was a selfish attitude perceived negatively by the participants, they also seemed to feel that such attitudes actually hinder effective AAT work. That is, when one's focus is perceived to have turned from the child's best interest to what is in one's own best interest, AAT no longer becomes about helping the children, and children are far less likely to benefit. Effective therapy according to the participants, consequently involves humility, a willingness to be open, and a confidence grounded in a willingness to be open and learn oneself. Elisabeth aptly explained the connection between the attitude and the effectiveness of the therapist: “It really helps to have insights into yourself and be very comfortable in where you are and who you are. If you don't have that, then it gets conveyed to the children. They don't need that. They need people that are confident but open and willing to learn from them; learning is supposed to be a two-way street.”

Third, participants expressed a need for AAT workers to demonstrate commitment to the job. In spite of the limited resources or monetary payment, participants expressed the importance of commitment, relative to both personal benefits they might glean from seeing children's lives change. Participants also expressed the importance of commitment on the part of therapists relative to seeing change occur in the lives of the children. Stephanie highlighted this perspective:

[This type of work] takes a big commitment because, a lot of times, you're not rewarded monetarily. You're much more rewarded in seeing the effects that you have on other kids and also your own growth process. They teach us just as much about ourselves as we help to affect their lives. It's very good in terms of that growth, but it is a tough commitment to stick it out…you can't run…sometimes you're the only stable thing in their [lives].

Jason similarly illustrated how important commitment is in order to see success in AAT, including the need of exercising stalwart perseverance: “When you start meeting people [who work here] that are really there, they just give and give. When I talk about people I'm talking about the therapists. They just keep throwing it out there, putting themselves out and expending so much energy because they do want to see that change in the kids. They want to be able to give that child something they can take away.”

Fourth, participants described the importance of flexibility in AAT. To the participants, AAT generally is a field that is open to change and, in addition, the work on a daily basis can be contrastingly different from day to day. Consequently, therapists who wish to excel in this field should embrace the variable nature of the work, as Arthur explained: “You have to be willing to change and compromise. If everything is black and white for you, this is a very tough occupation and place to be in. It's never going to go as you've planned. You can help steer it in a direction you want to go to, but most of the time you've got to be willing just to grab onto the tail and go with it.”

Participants stated further that the need for flexibility of therapists is, at least largely in part, because of the nature of the individuals with whom they work. Therapists repeatedly emphasized the importance of this character trait as a therapist relative to the work with the children and the effect that the attitude of the therapist has on the children with whom they are working. Participants admitted that the demands they placed on themselves in order to serve the children better were high; however, most participants simply viewed this as a necessary part of “doing their job” if they were going to truly help change the lives of these children. Cindy shared: “Some of these kids are from very tough homes, and they have a strong street survival mentality. They're not used to listening to what adults say; they're used to taking care of themselves and they truly feel that, if they don't listen to themselves, then their [lives are] at risk. Trying to break down those barriers often is quite challenging, and you have to have a thick skin.”

Discussion

Relating the Study's Findings to Published Literature

AAT is quite distinctive in its approach, especially compared to traditional therapy models. One unique dynamic relating to AAT is the change in environment that clients experience. In contrast to conventional means of therapy, wherein children meet in an office or some other institution, AAT provides a means by which a child may “escape” the presenting problems of his or her own world and enter into a new milieu. Therapists working in AAT programs seek to create unhurried, accepting environments in which children feel free to try new experiences, such as the care of animals. In such environments, children reportedly are able to make significant progress toward positive behavior changes and emotional control.

Interestingly, the AAT therapists felt that clients often were unaware, at least initially, of the behavior changes that were occurring, and the current authors suspect that many social psychologic principles factor into this dynamic of AAT. Hart,¹⁹ for instance, found that animals generally prove to be a stimulant in producing conversation between clients and therapists. That is, discussing the animal provided open lines of communication in an interesting, unbiased way. Overall, effective AAT seems, at least in part, contingent on the client's openness. In addition to openness experienced when dialoguing with a therapist, clients also seemingly were open to new experiences and change. The current authors suspect that these tendencies were increased because of the presence of animals. For example, as part of their interaction with the animals, clients are made personally responsible to care for the needs of a particular animal. Were a therapist in a conventional setting to give a client responsibility X, the current authors suspect that the child's interest, openness, and follow-though to fulfill that particular responsibility would not be as great. In sum, AAT seems to owe its success, in part, to its under-the-radar approach regarding behavioral and emotional shifts.

With empathy comes the skills of being nurturing and caring. There is no specific method used to teach these skills other than enforcing a deep human–animal interaction. The animals are the ones who teach the skills, and the therapists seek to reinforce this. During these interactions, strong bonds occur between the clients and the animals, which help ensure a deep impact in the child's learning process. The current authors suspect that a phenomenon known in social psychology as the “common enemy effect”⁵⁴ occurred between clients and therapists. When this phenomenon occurs, 2 parties, who otherwise typically would not experience a deep connection, form an attachment while united in overcoming a common “enemy.”

In the case of AAT, the current authors suspect that clients, at first, generally were intimidated, if not scared, of working with animals such as horses. Such animals respond negatively to harsh treatment, necessitating clients to learn constructive ways of interacting with these animals. The initial emotions experienced by clients when faced with such intimidating animals may, in fact, have increased the clients' openness and willingness to connect with their therapists—as they worked together to achieve the common goal of caring for the animals. In this way, clients seemingly were able to view the therapists as being “on their side,” which, in turn, strengthened the potential bonds clients experienced with their therapists.

As previously noted, the responses of parents proved to be influential when assessing the potential impact of AAT in the life of a particular client. Serpell² noted that many parents testify about the benefits of animals as companions for their children. Serpell also found that animals were useful when teaching children responsibility, to provide companionship and comfort, and to care, and that the animals provided children with a means of security. In this light, pairing animal care with therapy generally would be perceived by parents as yielding results similar to the ones just mentioned. Outcome assessment by Kaminski et al.⁵⁵ indicated that AAT produced tangible results for most clients involved in the programs. The current authors suspect that parents' preconceived notions that interaction with animals benefit their children, combined with the track record of positive, tangible results AAT seems to generate, lead many parents overall to support this therapy approach. Gaining parental support seems a prudent, if not necessary, step AAT programs and therapists should take in seeking to establish AAT in the field of therapy as well as implementing the long-term potential benefits clients could receive.

Conclusion

Potential Benefits and Limitations of AAT for Practicing Clinicians Considering AAT

There are three benefits and three limitations of the therapy modality. One benefit of AAT is that it has empirically been shown to work successfully in some populations where traditional talk therapy has not been successful. For example, juvenile delinquents often do not respond well to counselors' attempts of verbal exploration and articulation of feelings (including anger). For some individuals, however, AAT has been shown to reach and help therapists connect with such clients—in ways that otherwise might not be possible or feasible.

A second benefit of AAT is that it has been shown to be effective at holistic levels. As such, effectiveness has been demonstrated at behavioral, psychologic, and affective levels. By its nature, AAT involves multisensory modalities. AAT also has been shown to augment conventional talk therapies successfully in some cases involving a wide spectrum of conditions such as pain, aphasia, heart recovery, depression, infections, schizophrenia, and juvenile delinquency.

A third potential benefit of AAT is that it can be applied at multiple treatment locations. Given the relatively wide cross-section of applications, AAT has shown success in locations such as hospitals, psychiatric treatment centers, hospices, schools, and centers for treating juvenile behavioral problems. Particularly when using small animals, AAT can be transportable to where clients are located at the time of needed interventions. The same animal also can be used for different treatment objectives across multiple clients. A significant limitation of AAT is that it is not a treatment modality for all licensed clinicians. As a specialized form of psychotherapeutic treatment, advanced training is required.

In addition, not all therapists possess personal qualities that have been noted as requisite for applying the treatment successfully. AAT is not the treatment mode of best choice for all clients. Most notably, AAT should not be utilized with potential clients possessing histories of animal cruelty (which sometimes can be common among juveniles diagnosed with conduct disorder). Some clients who are more intellectually oriented may benefit more from conventional talk therapies than they potentially would benefit from AAT. And finally, successful AAT requires an apt client–animal match. In the time required to try various animals with potential clients, they may lose interest in the therapy or otherwise disengage in the process. A prior poor experience with 1 animal (e.g., horses) might taint the potential success negatively with other animals (e.g., puppies) as AAT therapists expose clients to various animals while seeking the optimal match.

Limitations and Future Research

The current sample was taken from the Midwest area of the United States, near a semirural area. Future research should investigate the success of AAT in various regions of the country, considering the effects of familiarity with particular animals on clients' overall success. In addition, researchers may wish to investigate whether the use of the same type of animal proves to be equally effective in all regions of the United States. Better understanding of regional differences in relation to AAT success may help therapists to pair clients and animals most effectively. Future researchers also may wish to compare various facilities that utilize various types of animals in their therapy, for instance, facilities that primarily use horses and those that use smaller animals such as dogs and rabbits. Such comparison studies may shed insight on the differences between animals utilized and the positive or limiting effects of one animal type over another in light of specific therapy needs. Finally, the therapists we interviewed in the present study worked with children in a ranch setting. The present study should be replicated in other AAT milieux such as hospitals and also with therapists who provide services to adult populations. ■

Footnotes

References

Schneider

, Harley

. The impact of therapeutic riding for people with disabilities on variables related to mental health. Anthrozoos, 2016; 29:59–72.

Serpell

. Animal companions and human well being: An historical exploration of the value of human–animal relationships. In: Fine

, ed. Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice, 2nd ed. San Diego: Academic Press, 2006:3–20.

Altschiller

. Animal-Assisted Therapy. Santa Barbara, CA: ABC-CLIO Press, 2011.

Chandler

. Animal Assisted Therapy in Counseling. New York: Routledge, 2012.

Dietz

, Davis

, Pennings

. Evaluating animal-assisted therapy in group treatment for child sexual abuse. J Child Sex Abus, 2012; 21:665–683.

Virues-Ortega

, Pastor-Barriuso

, Castellote

, et al. Effect of animal-assisted therapy on the psychological and functional status of elderly populations and patients with psychiatric disorders: A meta-analysis. Health Psychol Rev, 2012; 6:197–221.

Pichot

. Animal-Assisted Brief Therapy. New York: Routledge, 2012.

Fiksdal

, Houlihan

, Barnes

. Dolphin-assisted therapy: Claims verses evidence. Autism Res Treat, 2012; 2012:83979–2.

Evans

, Gray

. The practice and ethics of animal-assisted therapy with children and young people: Is it enough that we don't eat our co-workers?. Br J Soc Work, 2011; 42:600–617.

10.

Ernst

. Animal-assisted therapy: Paws with a cause. Nurs Manage, 2013; 44:16–19;quiz:20.

11.

Grandgeorge

, Tordjman

, Lazartigues

, et al. Does pet arrival trigger prosocial behaviors in with autism?. PLoS One, 2012; 7:e41739.

12.

Perry

, Rubinstein

, Austin

. Animal-assisted group therapy in mental health settings: An initial model. Altern Complement Ther, 2012; 18:181–185.

13.

Jasperson

. An animal-assisted therapy intervention with female inmates. Anthrozoos, 2013; 26:135–145.

14.

Horowitz

. Animal-assisted therapy for inpatients: Tapping the unique healing power of the human–animal bond. Altern Complement Ther, 2010; 16:339–343.

15.

Iannuzzi

, Rowan

. Ethical issues in animal-assisted therapy programs. Anthrozoos, 1991; 4:154–163.

16.

Miller

. Childhood animal cruelty and interpersonal violence. Clin Psychol Rev, 2001; 21:735–749.

17.

Mallon

, Ross

Jr , Ross

. Designing and implementing animal-assisted therapy programs in health and mental health organizations. In: Fine

, ed. Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice, 2nd ed. San Diego, Academic Press, 2006:115–127.

18.

Kirby

. An Introduction to Equine Assisted Psychotherapy. Bloomington, IN: Balboa Press, 2016.

19.

Hart

. Psychosocial benefits of animal companionship. In: Fine

, ed. Handbook on Animal-Assisted Therapy: Theoretical Foundations and Guidelines for Practice. San Diego, CA: Academic Press, 2006:59–78.

20.

Holmes

, Goodwin

, Redhead

, Goymour

. The benefits of equine-assisted activities: An exploratory study. Child Adolesc Soc Work, 2011; 29:111–122.

21.

Vredenburgh

, Zackowitz

. When a dog is just a dog? A case study evaluating the ADA service animal rules [presentation]. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2011; 56:720–723.

22.

Farias-Tomaszewski

, Jenkins

, Keller

. An evaluation of therapeutic horseback riding programs for adults with physical impairments. Ther Recreation J, 2001; 35:250–257.

23.

Yorke

, Nugent

, Strand

, et al. Equine-assisted therapy and its impact on cortisol levels of children and horses: A pilot study and meta-analysis. Early Child Dev Care, 2013; 183:874–894.

24.

Selby

, Smith-Osborne

. A systematic review of effectiveness of complementary and adjunct therapies and interventions involving equines. Health Psychol, 2013; 32:418–432.

25.

Young

. Pet therapy: Dogs de-stress students. J Christian Nurs, 2012; 29:217–221.

26.

Kelly

, Cozzolino

. Helping at-risk youth overcome trauma and substance abuse through animal-assisted therapy. Contemporary Justice Rev, 2015; 18:421–434.

27.

Busch

, Tucha

, Talarovicova

, et al. Animal-assisted interventions for attention deficit/hyperactivity disorder: A theoretical review and consideration of future research directions. Psychol Rep, 2016; 118:292–231.

28.

Marcus

, Bernstein

, Constantin

, et al. Animal-assisted therapy at an outpatient pain management clinic. Pain Med, 2012; 13:45–57.

29.

Macauley

. Animal-assisted therapy for persons with aphasia: A pilot study. J Rehabil Res Dev, 2006; 43:357–366.

30.

Cole

, Gawlinski

, Steers

, Kotlerman

. Animal-assisted therapy in patients hospitalized with heart failure. Am J Crit Care, 2007; 6:575–585;quiz:586;discussion:587–588.

31.

Pugh

, Hadjistavropoulos

, Dirkse

. A randomised controlled trial of therapist-assisted, internet-delivered cognitive behavior therapy for women with maternal depression. PLoS One, 2016; 11:e014918–6.

32.

Novotny

, Deibner

, Hermann

. Animal-assisted therapy to promote ambulation in the hospital setting: Potentially effective but is it feasible?. J Nurs Educ Pract, 2015; 5:123–130.

33.

Kovacs

, Bulucz

, Kis

, Simon

. An exploratory study of the effect of animal-assisted therapy on nonverbal communication in three schizophrenic patients. Anthrozoos, 2006; 19:353–364.

34.

Bernabei

, Ronchi

, La Ferla

, et al. Animal-assisted interventions for elderly patients affected by dementia or psychiatric disorders: A review. J Psychiatr Res, 2013; 47:762–773.

35.

Grbich

. Qualitative Data Analysis. Thousand Oaks, CA: Sage, 2013.

36.

Suri

. Purposeful sampling in qualitative research synthesis. Qual Res J, 2011; 11:63–75.

37.

Silverman

. Interpreting Qualitative Data, 4th ed. Thousand Oaks, CA: Sage, 2011.

38.

Guest

, Bunce

, Johnson

. How many interviews are enough? An experiment with data saturation and variability. Field Meth, 2006; 18:59–82.

39.

Neuman

. Social Research Methods: Qualitative and Quantitative Approaches, 6th ed. Boston: Allyn & Bacon, 2006.

40.

Creswell

. Qualitative Inquiry and Research Design: Choosing Among Five Approaches, 2nd ed. Thousand Oaks, CA: Sage, 2012.

41.

Marshall

, Rossman

. Designing Qualitative Research, 4th ed. Thousand Oaks, CA: Sage, 2010.

42.

Alvesson

. Interpreting Interviews. Thousand Oaks, CA: Sage, 2011.

43.

Atkinson

, Delamont

. Analytic perspectives. In: Denzin

, Lincoln

, eds. Collecting and Interpreting Qualitative Materials, 3rd ed. Thousand Oaks, CA: Sage, 2008:285–312.

44.

Maxwell

. Qualitative Research Design, 3rd ed. Thousand Oaks, CA: Sage, 2012.

45.

Chenail

. Conducting qualitative analysis: Reading line-by-line, but analyzing by meaningful units. Qual Rep, 2012; 17:266–269.

46.

Berg

. Qualitative Research for the Social Sciences, 8th ed. Boston: Allyn & Bacon, 2012.

47.

Gay

, Mills

, Airasian

. Educational Research, 10th ed. Upper Saddle River, NJ: Pearson, 2001.

48.

Sin

. Considerations of quality in phenomenographic research. Int J Phenomenographic Res, 2010; 9:305–319.

49.

Tracy

. Qualitative quality: Eight “big tent” criteria for excellent qualitative research. Qual Inquiry, 2010; 16:837–851.

50.

Bogdan

, Biklen

. Qualitative Research for Education, 5th ed. Boston: Allyn & Bacon, 2007.

51.

Saukko

. Methodologies for cultural studies. In: Denzin

, Lincoln

, eds. The Landscape of Qualitative Research. Thousand Oaks, CA: Sage, 2008:457–477.

52.

Mero-Jaffe

. “Is that what I said?” Interview transcript approval by participants: An aspect of ethics in qualitative research. Int J Qual Meth, 2011; 10:231–247.

53.

Chenail

. Conducting qualitative data analysis: Managing dynamic tensions within. Qual Rep, 2012; 17:1–6.

54.

, Konrad

, Morath

. Brothers in arms—an experiment on the alliance puzzle. Games Economic Behav, 2013; 77:61–76.

55.

Kaminski

, Pellino

, Wish

. Play and pets: The physical and emotional impact of child-life and pet therapy on hospitalized children. Children's Health Care, 2002; 31:321–335.