Interacting with animals, especially dogs, regularly elicits an immediate rush of the warm fuzzies for me. I also witness this among fellow shoppers when I walk through the pet store with my long-haired German shepherd. “Oh, how beautiful!” they will exclaim as they give themselves permission to pet my dog rather than greeting me.

It makes me chuckle at how quickly some people will jump at the opportunity to engage with animals, and then humans become an afterthought. If I don’t have my buddy with me, my visit to the pet store is much different — less greeting and more shopping.

Throughout history, animals have provided loyalty and companionship to humans. Sigmund Freud noticed that using his dog in counseling sessions helped clients feel more comfortable expressing emotions and sharing personal information about themselves. Several decades later, psychologist Boris Levinson momentarily left a child who was mentally ill with his dog. Upon returning, Levinson found the child interacting with the canine. This incident sparked further research into the use of animal-assisted therapy (AAT) with children.

During the 1980s, the Delta Society started defining formal and informal definitions and interventions incorporating animals into human treatment. Today, AAT is implemented among military veterans diagnosed with posttraumatic stress disorder. AAT has also been used as an adjunct therapy among families referred by child protective services and has facilitated growth in family functioning. Nonprofit organizations have registered various animals to provide mental and emotional support to humans. Approved animals include horses, canines, cats, llamas, alpacas, rats, rabbits and birds.

Dogs and CAT

As a dog lover and dog owner, I am drawn to the use of therapy dogs in various settings. Specifically, canine-assisted therapy (CAT) is a burgeoning treatment modality underneath the umbrella of AAT with a particular focus on canines. Over the past decade, dogs have been used in various settings, including nursing homes, schools, hospitals, libraries and more. Most of the research literature focuses on the impact these animals have on different populations. However, research is lacking on how canine handlers themselves are affected as treatment vessels.

Canine handlers come from a variety of backgrounds ranging from volunteers to trained clinicians. With proper certification, canines can facilitate a variety of therapeutic encounters. However, handlers who are certified or licensed professional counselors may offer even more empathic interactions than do volunteers from career backgrounds outside of counseling.

In the context of a therapy animal team, handlers maintain various characteristics to be successful. AAT is not practiced by everyone, so handlers need to consider personal motives. One characteristic that Michael Firman and colleagues found indicated in a 2016 study was intrinsic motivation. This includes AAT handlers who practice not for monetary benefit but because they are passionate about AAT.

Pet Partners is one of several national nonprofit organizations that registers a variety of handlers and animal teams. Handlers must complete and pass the online or in-person handler course, pass the required in-person team evaluation, and submit required applications and a background check to officially register as a team.

Handler experiences needed

I often wonder what it’s like to provide CAT therapy to people. As a counselor, I’ve experienced rapport building with a variety of people, from young children to older adults. Through my observation of several colleagues, it seems that having a dog present with clients certainly influences human interactions.

According to a qualitative study published by Anna Swall and colleagues in 2016, more studies are needed to explore the experiences of canine handlers involved in providing CAT. Swall’s study further indicated that CAT handlers were able to use canines to build therapeutic rapport between the participant and the handler. Therapy animals are trained to demonstrate Rogerian concepts such as unconditional positive regard. For example, if a child in a reading program makes a mistake while reading aloud, the canine does not laugh at the child or make judgments. It is quite the opposite. Therapy canines are used to decrease discomfort in humans and provide a supportive and loving environment.

In a study conducted by Nancy Eisenberg in 2015, researchers found that an individual’s ability to cultivate an emotional relationship with animals is congruent with their emotional connections toward people. Therapy animals also can serve as mediators when clinicians are attempting to build rapport with particular clients. And with animals included in therapeutic interactions, counselors have an additional model of empathy-like responses to present to clients.

Research has shown that dogs can also display sensitivity to human emotional states, as evidenced by their responding to negative emotions such as crying. Specifically, canines have responded to distress in humans by producing expressions and postures such as a relaxed open mouth and facial mimicry. In AAT settings, animals can supplement traditional therapeutic interactions by demonstrating positive behaviors with humans who are experiencing negative emotions.


My firstborn

I tend to treat my dog as if he is human. I talk to him regularly about what to put on the calendar and ask for his opinion about handling specific client scenarios at work. Sometimes the bonds we share with our pets may seem silly, especially to those who do not have pets, but there is no denying how special and important these bonds are to us.

Handlers also develop a unique bond with their animal. This bond influences the animal and its response to the environment. In a 2019 study, Stephanie Kuzara and researchers identified various handler interaction styles, including authoritative and permissive. For example, CAT handlers working with students displayed increasing warmth behaviors, known as permissive styles, toward their canines when students approached the therapy animal team. In contrast, handlers showed authoritative styles by increasing control over the canine alongside demonstrating warmth behaviors depending upon student personalities.

Such observations led to further questioning about how the handler-canine relationship influences therapeutic outcomes. Researchers recommend studying handler interaction styles and how they affect the therapy animal and therapeutic atmosphere. Few studies currently exist regarding handler-canine dynamics; these studies are needed to better understand handler and canine team suitability and standards.

Ethical considerations

Animal welfare is crucial to AAT interventions. Counselors are trained to manage compassion fatigue and burnout, and therapy animals also have limits. Handlers are trained to be aware of an animal’s stress triggers. For example, a therapy animal engaged in visiting hospitals may experience too much stimulation due to the bright lights, fast-paced environment and medical equipment. In such a case, the handler may instead provide AAT in nonmedical settings such as schools or outpatient settings. Knowing the animal’s window of tolerance will prevent the animal from harming others and allow it to continue performing at full physical and mental capacity.

Furthermore, if the animal is sick or injured, it will not be used in therapy until receiving veterinary approval to resume AAT. Animals that become fatigued, irritable, stressed or frightened are removed from sessions by handlers so that they can rest and take breaks. AAT clinicians also provide antibacterial wipes and soap to use before and after AAT interactions. Providing clients with this information can help establish expectations for AAT and acknowledgment of both animal and human welfare.

The American Counseling Association’s ethics code indicates that counselors are to do no harm. AAT therapists must take the added dynamic of a therapy animal into account so that the animal does not damage the therapeutic relationship. Specifically, AAT clinicians must be sensitive toward individuals who do not like dogs or who have pet allergies. In these cases, most AAT clinicians will leave the therapy animal at home or in another room to avoid causing the client added stress in sessions.

AAT clinicians are also required to include AAT specialization and risk management information when clients complete their informed consent. This information serves as a waiver of safety, meaning that clients agree to the risks outlined in the consent form. Furthermore, animals used in therapy must undergo extensive training to ensure others’ safety and decrease the risk of physical harm from jumping, scratching or biting. AAT training and evaluations are meant to reduce client safety risks and ensure that proper precautions have been taken.

In 2016, ACA released the Animal-Assisted Therapy in Counseling Competencies, which indicate the practice of basic counseling skills in addition to using an animal to enhance therapy. These competencies are the latest breakthrough to provide clinicians with a direction to practice AAT in counseling, but more research studies are needed for practice standardization.

Counselor education and supervision

I am a counselor educator-in-training, and I think it would be exciting to incorporate AAT into accredited course curriculums. For example, counselor education and supervision programs could offer an elective course for students who are interested in this type of adjunct therapy. Furthermore, students who become certified in AAT can conduct research and focus on advancing the knowledge of CAT within the counseling field, just as many other professions have included AAT in their research.

In addition, studies focused on AAT handlers could inform other AAT practices, including CAT. Analyzing handler empathy could also provide new information regarding empathizing with challenging populations. In 2019, Lyndsey Uglow conducted a study to explore the effectiveness of AAT in a hospital setting and concluded that uniformity and treatment standardization were needed to ensure reliability and consistency when practicing AAT among various populations. Therefore, collecting qualitative research data may supplement AAT handler protocols on a broader scale.

Developing settings

Exam time was always exciting for me as a college student because of the therapy dogs that would visit the library at the end of the semester. It was a great way to take a break from the stress and strain of studying, and it also boosted my mood.

Therapy animals have become increasingly popular in other settings, including the workplace. It is not uncommon to hear about designated pet-friendly areas that allow well-behaved animals to interact with employees. Furthermore, Pet Partners has provided therapy animal teams for workplace well-being visits. Animal-assisted workplace well-being (AAWW) is implemented to increase employee satisfaction and productivity. AAWW has proved to decrease stress levels and often leads to effective collaboration between employees.

Therapy animals have also been used recently for animal-assisted crisis response (AACR) to assist in the aftermath of mass shootings, natural disasters and other community crises. AACR is not a mental health intervention per se, but handlers are trained to provide psychological first aid concepts to facilitate recipient stabilization.

Finally, AAT has been offered to patients in minimally conscious states. In a 2019 study by Karin Hediger and colleagues, researchers found that AAT increased patient arousal, indicating possible increased levels of consciousness. Therefore, the AAT application could serve as a breakthrough in neurorehabilitation for patients with disorders of consciousness.

Further research

As a doctoral student, I am currently in the process of conducting a qualitative study that will analyze a variety of handler experiences, from school counselors to licensed professional counselors to marriage and family counselors. Overall, AAT continues to grow as researchers explore various aspects of this adjunct treatment. CAT requires further exploration in the context of a handler’s perspective working with their four-legged co-therapist to promote a positive environment across a wide array of populations and backgrounds. I look forward to contributing to the literature in this area post-dissertation.



Kelly Carapezza is a licensed professional counselor who works in the private practice setting, specializing in trauma therapy and eye movement desensitization and reprocessing. She has experience training her German shepherd in basic obedience and therapy dog classes and anticipates obtaining AAT certification through Pet Partners. Contact her at or through LinkedIn.


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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