Introduction

While many clinicians have heard of “therapy dogs”, and even considered integrating them into their practice, fewer clinicians have meaningfully engaged with the specific applications, role, and considerations for this furry therapeutic intervention. Yet counsellors apply canine-assisted therapy (CAT) in environments as diverse as hospitals, schools, allied health and private practice, with growing interest in applying the human-animal relationship specifically to counselling children and adolescents from trauma backgrounds. In this article, we discuss some key developments in CAT, consider its theoretical underpinnings, and offer practical considerations to help you answer the question: “How much is that doggy in the window?”

Who Benefits from CAT?

In 1953, B.M. Levinson stumbled upon CAT in a psychology session with a severely withdrawn child, who relaxed and communicated for the first time to Levinson’s dog, Jingles (Levinson, 1962). Children and adolescents who experience traumatic events such as abuse or violence during their formative years often suffer chronic impairment to their neurological, biological, social, and psychological development. This can induce internalising symptoms such as recurrent flashbacks, anxiety, heightened arousal, and reactivity; and externalising symptoms and behaviours such as self-harm, suicidal ideation, aggression, criminal behaviours, and substance abuse (Mudaly et al., 2014; Muela et al., 2019). Children and adolescents who have experienced trauma often hesitate to engage in traditional counselling interventions due to barriers like chronic stress, mistrust of adults, and avoidance that negatively impact their capacity to engage (Mudaly et al., 2014; Shotwell & Wagner, 2019). CAT effectively circumvents these barriers.

While most available literature on CAT centres children and adolescents, CAT can also benefit clients outside the child/adolescent demographic as counsellors increasingly engage canines to support diverse clients presenting with a wide range of symptoms, including anxiety, depression, loneliness, and PTSD.

Intrinsic Motivator and Medium

How does a therapy dog help? Firstly, therapy dogs provide intrinsic motivation for clients to engage in counselling and increase acceptance and tolerance of the therapeutic intervention. The dog’s presence can also influence clients’ perception of the counsellor as safe and trustworthy, facilitating a developing rapport with the counsellor (Arnskötter et al., 2024; Jones et al., 2018; Tedeschi & Jenkins, 2019).

The therapy dog also acts as a medium through which the client can non-verbally communicate with the counsellor. The dog provides a distraction, which can correlate with reduced pain, anxiety, and negative mood (Parish-Plass, 2013). They also provide clients with a living medium to stimulate their present-moment awareness, with novel sounds, smells, colours, textures, warmth, and tactile sensation that can be engaged within a session (O'Haire et al., 2015; Tedeschi & Jenkins, 2019). Neuroscientific evidence suggests interactions with dogs may decrease activity in brain regions associated with stress (Howie, 2019; Sugawara et al., 2012). Several studies found that the mere presence of dogs can reduce symptoms of anxiety, depression, and physiological markers of stress such as high blood pressure and cortisol (Friedmann et al., 1983; Odendaal & Meintjes, 2003; Shiloh et al., 2003; Viau et al., 2010). Furthermore, oxytocin and serotonin increase during interactions with animals, particularly when petting a friendly or known dog (Handlin et al., 2011; Odendaal, 2000; Odendaal & Meintjes, 2003; Tedeschi & Jenkins, 2019).

Theoretical Underpinnings

Several theories support canine-human relationship, including the biophilia hypothesis, attachment theory, and social support theory.

• The biophilia hypothesis proposes that humans inherently desire connection with nature and non-human lifeforms (Wilson, 1984). Humans subconsciously experience a sense of safety, security, and physiological and psychological relaxation around non-dangerous animals (Parish-Plass, 2013; Tedeschi & Jenkins, 2019).

• Attachment theory suggests that human biopsychology includes a protective system that motivates them to alleviate distress through proximity to attachment figures (Bowlby, 1982). The human-canine relationship often meets the prerequisites of an attachment bond: a relationship of proximity, with a safety-enhancing secure base from which the world can be explored (Beck & Madresh, 2008; Parish-Plass, 2013; Zilcha-Mano et al., 2011).

• Social support theory proposes that animals can provide social support to humans, which then provides a buffer against loneliness, depression, and anxiety; this offers a protective factor to help humans manage stressful or difficult situations (Howie, 2019).

While these theories attempt to explain the bond between canine and client, they do not adequately explain the canine’s unique role in the counselling room. Six notable studies examine CAT’s efficacy with the child and adolescent demographic: Muela et al. (2019), Dietz et al. (2012), Balleurka et al. (2014), Hamama et al. (2011), Krause-Parello et al. (2018), and Allen et al. (2022). Participants reported living with one or more of the following conditions: PTSD, anxiety, depression, anger, dissociation, sexual concerns, or a history of physical/sexual abuse.

In support of the above theories, the studies noted significant biopsychosocial benefits in employing CAT to address children and adolescent trauma, including decreased physiological arousal and stress biomarkers such as heart rate, blood pressure, cortisol, and immunoglobulin A (Krause-Parello et al., 2018). Participants reported significantly reduced symptoms associated with PTSD such as anxiety, depression, dissociation, and aggression (Dietz et al., 2012; Hamama et al., 2011; Muela et al., 2019). A dog’s presence increased young people’s capacity to form secure attachments and trusting relationships with adults (Balluerka et al., 2014). However, Allen (2022) noted that the dog’s presence provided a method of avoidance for young people during uncomfortable exposure activities. Rather than discounting CAT wholesale, this may indicate that integrating stories and activities involving the dog into the therapeutic intervention provides the key mechanism for change, not simply the dog’s presence (Dietz et al., 2012; Muela et al., 2019).

Ethical Considerations

When incorporating canines into counselling, the practitioner must consider not only the client’s and public’s safety, but also the dog’s; the therapeutic environment exposes a therapy dog to a client’s unpredictable emotions and reactions in an environment where the dog is powerless to leave when they feel overwhelmed or uncomfortable (Tedeschi & Jenkins, 2019). This necessitates standardised expectations which protects the welfare of both canine and client.

Australia’s animal-assisted therapy industry is not yet regulated; however, Animal Therapies Ltd (ATL) have developed codes of conduct and ethical guidelines for members to apply core values, ethical principles, and standards to their practice with animals, clients, and the broader community. These include practising within the scope of qualifications and experience, the need for informed consent from clients relating to the use of animals in session, and limiting working times to two hours of work per day and seven hours per week (ATL, 2023, pp. 7-9). Ethical work with therapy dogs requires the counsellor to engage strategies that minimise stress on the dog, such as giving the dog a “safe space” to retreat, monitoring the dog in sessions for signs of stress or arousal, and discerning which clients would respond well to the dog (and vice versa).

Practical Considerations

We return to the opening question: Should you introduce a dog into your counselling practice? The following sub-questions address two dimensions of therapy dog ownership: as a pet, and as a business partner. Use them to “paws” and reflect on your preparedness to own a therapy dog.

A therapy dog is … well, a pet. Consider:

• Can you afford a pet? Realistically assess the costs of pet ownership.
• Do you know how to care for a pet, specifically your chosen breed?
• Do you have time to care for a pet?
• Can you provide adequate space for a pet in your home?
• Do you have time to house train them?
• Will a pet fit into your non-work lifestyle and priorities?
• Can you tolerate, even enjoy, the risks a pet poses to your personal space and effects?
• Does your whole household agree to a furry housemate?
• A therapy dog is also a business partner. Consider:
• What you expect from their role; how do you intend to use them therapeutically?
• Is this a good business decision, according to your accountant?
• Do you understand how to work with a business partner, especially from a different species?
• Is your workplace dog-friendly and safe?
• Do you have time to train them for therapy, as they don’t come ready “off-the-shelf” to work?
• Is the work environment conducive to your dog’s productivity?
• Are your non-work rhythms conducive to having a full-time “business partner”?
• Does your whole office agree to a furry coworker?
  

If you can answer “yes” to these questions, you may be ready to integrate a therapy dog into your professional (and personal) life.

Conclusion

An existing body of research provides a strong theoretical base for the “hows” and “whys” of CAT, including therapy dogs’ capacity to support building trust and therapeutic rapport, decrease physiological and psychological stress, and provide a living medium through which clients can explore distressing content safely and even nonverbally. Using therapy dogs with children and adolescents who have experienced trauma may prove especially effective, particularly when integrated alongside stories and activities involving the dog. However, further research is required to determine the efficacy, ethical considerations, and most suitable protocols for CAT with other cohorts. Finally, giving practical and ethical consideration to the therapy dog as pet and business partner may make this compassionate approach to healing appropriate for your practice.