“Walk into my office and Moshie, a 3-year-old Maltese Shit-Tzu mix trained in obedience and performing tricks, will likely greet you.  He is a therapy dog, there to help treat others.  Patients comment on how much better they feel with Moshie on their lap.  

I am not surprised.  I am a psychiatrist in private practice for over 20 years on the upper west side of Manhattan.  I have been practicing with a canine for over 13 years. Petting a dog decreases release of cortisol and increases release of oxytocin into the bloodstream. Decreases in cortisol lower blood pressure and facilitate a sense of relaxation, while increases in oxytocin, the same chemical released when a mother nurses her infant, will facilitate a sense of security and well-being. 

The use of canines in psychiatric settings has gained popularity in the last few years, with the advent of therapy dogs partaking in animal assisted therapy programs in hospitals, and assisting mental health specialists in private offices. In addition, canines help owners feel better, either as service animals or emotional support animals. Although the training of these three types of assistance dogs, the therapy dog, the service dog, and the emotional support animal, may overlap, the terms do not.  

Service Dogs vs. Emotional Support Animals

According to the Americans Disability Act of 1990, “a service animal is defined as a dog that has been individually trained to do work or perform tasks for the benefit of an individual with a disability.”  This includes mental disabilities when performance of major life activities, such as learning, working, or communicating, is impaired.  Service dogs, by law, are not considered pets and are exempt from the no pet policies enforced by a multitude of public facilities, including restaurants, movie theaters, and hospitals. Service dogs are not required to be formally trained and places of public access are prohibited from requesting proof of training.

These dogs, however, are expected to perform a specific task to help their disabled handler, and to behave properly in all public settings. The law does not require a service animal to wear any special identifying uniform, nor is there a special required license. Many state agencies do offer service dog licensure, which in the case of an ambiguous disability, like one of psychiatric origin, when presented to staff at public facilities where dogs are banned, satisfies their concerns.  

An individual is also not required to provide medical documentation, although to claim a disability, especially a non-apparent one, without having received treatment by a medical professional, would be considered fraudulent.  In addition, the IRS deems costs incurred in owning a service dog, a tax deduction, only if the costs qualify as medical care and the taxpayer can establish that said expenses would not have been otherwise incurred. The ADA also requires that service animals be leashed in all public spaces, unless the leash interferes with the service animal’s ability to perform its job.  The key words regarding service animals are specifically trained to do a taskto help a person with a disability.

An emotional support animal is different, although also used to provide comfort to its owner; it is solely through companionship and affection.  The animal is not trained to perform any specific task. These animals are affectionate pets whose owners suffer from some mild psychiatric symptoms, usually mild depression or anxiety, and find these symptoms improve in the presence of their pets.

There are two federal laws that grant some special rights to owners of emotional support animals that possess documentation from a licensed psychiatrist that the animal provides therapeutic benefit.  The Fair Housing Amendments Act allows for a modification of a no pet housing policy for individuals who possess a pet for emotional support.  The Air Carrier Access Act allows individuals to travel with an emotional support animal without incurring additional fees, provided that the individual possess appropriate documentation from a medical doctor. 

Using Service Dogs in Psychiatric Settings

The Psychiatric Service Dog Foundation was founded in 2003 to promote use of psychiatric service dogs in treatment, through education of the public, and the facilitation of research proving canines of value in treatment.  As a result, a growing number of mental health professionals are recognizing the value of service dogs in treating patients, especially those only partially responsive to traditional modalities like psychotherapy and pharmacotherapy. 

My patient Sue was the perfect candidate for a service animal. She was a 40-year-old Indian woman who suffered from intractable social phobia, and as a result of disabling anxiety experienced in any public venue, was homebound and unable to work.  She only received minimal benefit from medication, and found side effects intolerable. Psychotherapy was not effective either.

Sue loved dogs, and felt comfortable around them. Dogs, as a result of having more than 220 million olfactory receptors compared to five in humans, can differentiate the various scents people give off under certain psychological conditions, like anxiety. An animal can be trained to perform a task upon detecting a particular scent.

In Sue’s case the dog was trained to comfort her by giving her his paw when detecting her anxiety. In addition, the dog was trained to initiate social interactions with others, so Sue did not feel any attention was placed on her. With the accompaniment of a dog Sue was able to leave home and work. Service dogs have been trained to recognize seizures, and to differentiate a depressed person from a contented one.  They have been used to help distract patients with intractable obsessive-compulsive disorder from performing repetitive rituals, and in comforting soldiers with severe forms of post-traumatic stress disorder.

The Therapeutic Value of Service Dogs

I am a firm believer in the therapeutic value of canines. My patient Elizabeth convinced me.  She was a very disturbed young woman that would talk to me through my dog.  The voices she heard, on occasion would tell her to end her life.  I gave her a picture of my dog to place above her bed at night to remind her of how important she was to him, and as a deterrent to any self-harm.  She stated she would never do anything to hurt herself, with him staring down at her. She lives to tell the same story.

I have founded an organization called Puppies with a Purpose, to help individuals interested in obtaining psychiatric service dogs, as well as those interested in becoming more involved with animal assisted therapies and working with therapy dogs. Further information on service dogs and becoming involved can be found at the Puppies with a Purpose website.

There may come a day when Rover replaces the bottle of Prozac.”