During the coronavirus pandemic, everyone has had to make adjustments to their home and work lives. Although mental health and allied health therapists are usually considered “essential,” many are not able to work face-to-face with clients for a variety of reasons. The use of virtual therapy sessions is now quite common, and this includes play therapy sessions with children. There are a number of challenges when conducting online therapy, also known as teletherapy, with children–attunement and relationship building when one doesn’t have a clear view of the subtleties of facial expressions, holding children’s attention, and thinking of activities that will help move clients closer to goal attainment, to mention just a few. Increasingly, comments are showing up on social media from therapists about working with therapy animals in the process, as well as involving children’s family companion animals as a means of learning more about pets important to the children. As with anything related to animals, this is not always a straightforward process. This blogpost focuses on three issues that need to be carefully considered before involving animals in teletherapy sessions: reactions of credentialed therapy animals, safeguards with client family pets, and scope of practice of the therapists. Subsequent posts will cover ideas that can be used in sessions.
Trained and Credentialed Therapy Animals
Perhaps dogs and cats are the therapy animals most readily suitable for teletherapy sessions, although others could certainly qualify. They are used to being indoors for their work, and some of them are interested in screens, such as televisions and monitors. Many are comfortable with phone cameras being pointed in their direction. They have the relationships with their therapists/handlers as well as the basic training to remain in a room and interact with clients, and they often have learned a variety of behaviors that are useful in a teletherapy setting. Furthermore, children are often quite interested in animals, even if they have not met them previously during in-person therapy sessions.
Perhaps the most important guide for a therapy animal, already credentialed, to be involved in this work is the animal’s response to screens. While animals need not be looking at screens most, or even any, of the time, they do need to be comfortable around them. Seeing moving images of the clients, hearing noises that are not typical in one’s home, and observing other animals on screen should not create stress or unusual behavioral reactions. A friend’s dog, a terrier mix, lunges wildly at the television whenever animals of any kind are being shown. My friend is unable to watch animal-related programs whenever this dog is present. It is simply too stressful for the dog. To involve this terrier in teletherapy required assurances that client animals would not casually stroll across the camera view. Can you imagine a client interacting with a therapist and their dog, only to have the dog run up barking, lunging, and trying to bite the screen when the client’s cat walked through the room? A colleague’s dog routinely becomes confused during the teletherapy sessions, pricking his ears, looking around the room, and becoming agitated when he does not locate the source of the sounds. Another colleague described how her cat sits on her laptop keyboard whenever she is talking with someone online, purring and walking back and forth, seeking attention. The cat often steps on keys that disconnect this colleague from her conversations. In each of these cases, the animals were either not suitable for, or not fully prepared for, what was expected of them during teletherapy sessions. Since these sessions occupied their human for multiple hours each day, the animals had to be managed, often in a different room, while sessions were ongoing. The animals just described were all therapy animals credentialed with their people as therapy teams, and they did very well in face-to-face sessions. Teletherapy, without the physical presence of the client, turned out to be something very different in the perceptions of these animals.
On the other hand, some animals find whatever is on the screen of interest but do not have their predatory impulses or boundary frustration activated. They might even realize that they recognize the face or the voice. They are responsive to varying degrees without showing signs of stress. Even if they don’t respond to the screen, they can be involved with the therapist as the therapist engages the client in an activity with the animal, such as inviting the client to select various cues that are then delivered by the therapist. In these cases, having a therapy animal present makes sense and can be very valuable as one component of the therapeutic process.
As occurs with most Animal Assisted Therapy (AAT), animals can engage in some unexpected behaviors at times, and it behooves the therapist to expect those and to be prepared with potential responses that are therapeutic in nature. Cats might decide it’s a good time to curl up for a nap; dogs might begin barking for reasons of their own, and animals might refuse to do what the client or the therapist asks of them. While this happens in face-to-face sessions, it is a bit easier to move to other areas of the playroom or office to interact in other ways, whereas in teletherapy that flexibility might not be there. Finally, animals cannot be expected to have sustained contact with a screen, as it simply is not the same for them as interacting with a living, breathing human being.
In an amusing YouTube video, sportscaster Andrew Cotter (channel is mrandrewcotter) holds an online meeting with two dogs which highlights the challenges faced in such meetings, which could include teletherapy sessions. Click on the name of the video (not the screenshot) to watch: The Company Meeting.
In addition to the animal considerations, it is important to ensure that the involvement of one’s own animals in telehealth will be acceptable to parents and children. Some children are fearful of animals, so it is important to discuss with the family to ensure this is not the case, or if the therapist plans to work on fear of dogs, for example, that everyone is in agreement with that plan. Informed consent still applies to such sessions.
In sum, the animals involved in teletherapy should be well behaved, under control, and completely comfortable with the use of computers and phones or other devices around them. Even if they do not have therapy animal credentials, these basic features need to be in place so that the animal’s presence is therapeutic rather than distracting. The animals are not expected to be a form of entertainment, but an integral part of the therapy, even if they themselves are not aware of that.
Safeguards with Client Family Pets
It can be beneficial to see the animals that share their lives with clients and their families. Due to serious liability issues, it is usually not a good idea to have clients bring their dogs or cats or other animals into their office-based therapy sessions. Too much can go wrong with that scenario. With teletherapy, however, some of these liability concerns are less likely to apply, and therapists can meet client animals virtually, and in some cases, with the proper training and relevant goals, help clients interact with their animals in humane and therapeutic ways. I have heard from quite a few therapists that sharing interactions, albeit virtually, with clients and their animals has been very helpful to their own relationships with the clients and with the added dimensions that the animals bring to the process. (We hope to share future blogs with specific ideas for both therapy animals and family animals.).
There are some cautions needed for this aspect of teletherapy as well. Because injuries can occur between children and family pets, it is important that therapists obtain informed consent (including a documented discussion of risks and responsibilities) if family animals will be part of the sessions. Also, certain conditions are needed to ensure the safety of all involved.
Even though the family might allow the child and dog or cat to interact unsupervised, it is not a good idea for the therapist to work with the child and the family animal without adult supervision available in the room. In other words, a parent or caregiver needs to be present when family pets are included in the sessions.
Animal handling skills need to be a key part of any therapy animal program. This is especially true in Animal Assisted Play Therapy® (AAPT) in which animals typically are unleashed and free to move around as they please. Dog leashes in untrained hands can lead to problems, such as when people tug on them and injure dogs’ necks or pull their dog into another dog’s personal space, potentially leading to dog-dog reactivity. The safety controls lie in the therapist’s ability to read their dog’s body language in real time and to take appropriate steps to reduce intrusive human behaviors and animal stress before it escalates.
In families, knowledge of safe handling processes might be missing. The child client might routinely squeeze arms around a dog’s neck, use the cat as a pillow, or try to ride the dog like a horse. These are all potentially risky behaviors. Most children are bitten by familiar dogs, and very often, by the dogs in their own families. Facial bites are common with children, and they can be traumatizing in and of themselves, but also from subsequent injuries and surgeries. Lack of awareness of safe handling practices in the family can result in these devastating situations. [See www.familypaws.com, www.dogsandbabieslearning.com, or www.doggonecrazy.ca for much useful information. The Canine Communication online course from IIAAPT is also a reliable resource.]
Bringing this back to teletherapy, it can be beneficial for a therapist with the proper training to help a child improve interactions and relationships with their family pets. Unfortunately, if the child is alone in the room with the animal, the therapist has very few routes to intervene in behavior that is potentially harmful for the animal and risky for the client. While verbal redirects might work with many children, when dealing with habitual patterns of interacting, the child might disregard what the therapist is saying or behave so quickly that there is no time for the therapist to intervene verbally. This is why a frank conversation with parents about family pet involvement is needed along with their physical presence when the family pet is in the room with the child so they can intervene more fully when needed. If therapists suspect that these intrusive practices are common in the home (and they are common in many homes), it is important to discuss what behaviors would not be permitted (e.g., child picking up the animal or forcing the animal to participate) and what the therapist’s expectations of the parent during the sessions with the child and pet together would be (such as the parent intervening in unwanted child or pet behavior and how to approach that). This needs to be a collaborative effort between therapist and parent in order to keep the family pets and the clients safe.
As an aside, it is also important to understand that assistance (service) animals are not the same as therapy animals or family pets. Their function is very different, and it is generally not advised to involve them in teletherapy sessions in ways other than their actual service function, as it might distract them from that work. For example, a child’s seizure alert dog needs to remain attentive to signs of seizure activity in the child, so therefore should not be pulled into other session activities.
Therapists’ Scope of Practice with Animal Assisted Interventions
Most mental health and allied health professions have scope of practice provisions in their ethical principles. For example, Standard 2.01 of the Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2010) states, “Psychologists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience.” The standard goes on to explain that when psychologists enter a new or emerging area of practice, they must acquire the relevant training, supervised experience, or consultation in order to ensure that the best interests of their clients, students, supervisees, or other recipients of their services are protected and not harmed. Similar provisions guide other professions. The involvement of animals in their work is an area requiring adherence to these standards.
This can be confusing for therapists who have lived their whole lives with animals. It feels as though they know their animals well and can therefore simply bring their nice family dog or cat or horse into their therapy sessions. Unfortunately, there is much more to the ethical, effective practice of AAT. Competencies for scope of practice for AAT have been established by the American Counseling Association (based on the research of Dr. Leslie Stewart), are under review for adoption by the American Psychological Association, included in statements and white papers of the International Association of Human-Animal Interaction Organizations, and set forth by the International Institute for Animal Assisted Play Therapy®, and enumerated in the award-winning book by Dr. Risë VanFleet and Tracie Faa-Thompson, Animal Assisted Play Therapy (2017, Sarasota, Florida: Professional Resource Press) and other articles and chapters of theirs reaching back as far as 2004. In addition, there are standards of practice for AAT with dogs established by the Animal Assisted Intervention International organization.
The commonalities among these approaches show the importance of meeting a wide range of competencies to ensure best practices. These include, but are not limited to, knowledge, skills, and attitudes in areas such as animal behavior; humane practices; human-animal relationships; professional facilitation of therapy sessions; ability to read body language of animals in real time and to respond appropriately; use of split attention, peripheral vision, and proactive attention; the planned, creative, and sometimes spontaneous application of client-animal interactions to client goals; the assurance of animal welfare and well-being at all times; and the integration of multiple theoretical frames and derivative interventions to offer high level, empirically-based services.
When the coronavirus pandemic required substantial and rapid adaptation of therapeutic methods for everyone, there was considerable discussion in some professional social media groups about the need to develop competency in using teletherapy approaches. Many therapists unfamiliar with teletherapy took one of the growing number of online telehealth training courses. Due to our own backgrounds in disaster mental health, and recognizing the traumatic aspects of COVID-19, some colleagues and I also urged supervisees and other therapists in online forums to obtain some training in disaster and traumatic events work. These suggestions were made with an eye toward scope of practice. The same thinking applies to the use of Animal Assisted Interventions across the board, particularly because it represents an intervention that is new for many practitioners and because of the potential risks involved. This is true for teletherapy sessions just as much as it is true of in-person sessions.
According to medical and epidemiological experts, we are not likely to emerge from this pandemic for quite some time. There remain many uncertainties. Animals can be useful assistants for some of our teletherapy sessions, but the full range of considerations required in office-based work with animals must be incorporated into teletherapy work with animals as well. Obtaining the necessary training can begin online (as with the online courses of IIAAPT and many others). As therapists see the value of animals in working with their clients of all ages in teletherapy, they might consider involving animals in their in-person work in the future. Getting at least some online training now, followed by skill-building workshops when it is safer to do so will start them on the journey toward the ethical and effective involvement of animals in their work in the future.
The International Institute for Animal Assisted Play Therapy® offers online and live training courses for those interested in the many aspects of involving animals in a voluntary and reciprocal way in their mental health, allied health, and education services. www.iiaapt.org.
Article and photos © 2020, International Institute for Animal Assisted Play Therapy®,
www.iiaapt.org. All rights reserved.