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Running head: AAP AND ATTACHMENT MODEL, FAMILIES YOUNG CHILDREN 1

Animal-Assisted Psychotherapy with Canine Co-Therapist:

Attachment Model for Families with Young Children

Pamela Pitlanish

Oakland University

AAP AND ATTACHMENT MODEL, FAMILIES2

Abstract

Animal-assisted therapy (AAT) literature cites many references to human infancy. Terms such as

bonding have been borrowed from human infancy research regarding the formation and purpose

of close parent-infant dyadic relationships. Children and animals have natural affective

relationships, and numerous studies have shown that both children and adults develop

attachments to companion animals. There is a body of evidence pointing to positive results of

animal-assisted therapy (AAT) with children, however these are primarily for autism, health

care, or in educational settings rather than in psychotherapy. Professional therapists employing

AAT with the early childhood population are scarce. This paper proposes the development of an

attachment model for animal-assisted psychotherapy with a canine co-therapist for families of

young children, with the assumption that animals can serve as attachment figures for children

and families in psychotherapy. Several key features and cautions for parent-infant work which

includes the addition of a therapy dog are suggested. A quasi-experimental outcome evaluation

could be feasible by comparing 2 groups of families, 1 which chooses to enroll in animal-assisted

psychotherapy, and a control group of families which receive standard family therapy, but

without a therapy animal. Results on attachment on attachment scores, parent-child relationships,

use of therapy animal by parents for increased ability to read their child’s cues, and emotions,

and to respond appropriately can be measured through standardized measures on attachment with

parent-completed Devereux Early Childhood Assessment (DECA) scores, and by 20-question

parent-completed questionnaire.

Keywords: animal, canine, animal-assisted therapy, attachment, psychotherapy, young children, families, infant mental health


Animal-Assisted Psychotherapy with Canine Co-Therapist:

Attachment Model for Families with Young Children

Born into a family which lived in the country on 40 acres, with a barn and many

outbuildings, fields of corn everywhere, and pets of all species, writer considers herself very

fortunate. Born into a family suffering the chaos of one alcoholic parent, one codependent

parent, a mentally ill sibling, and persistent chaos and violence--not so fortunate. But this

combination would prove to direct her life and career choices. Throughout childhood, the

numerous family pets, including dogs, cats, fish, geese, and even raccoons, provided supportive

relationships for this writer. Although she later developed a myriad of self-destructive methods

for drowning out the pain of loneliness, trauma, fear, self-loathing and chronic anxiety, she

realized her parents’ high expectations for her education. She finally succeeded—somehow—to

earn a Bachelor of Fine Arts degree, then continue on many years later to pursue a Master of

Social Work (MSW) degree. Social Work was likely embedded in her psyche and genes from

birth, considering the family life she experienced. But it wasn’t just the field of Social Work that

hooked her. During orientation, someone handed out brochures on the different certification

programs one could specialize in while earning their MSW. She read on the cover of one,

“Graduate Certificate in Infant Mental Health (IMH),” at the then Merrill-Palmer Institute.

Having absolutely no idea what those words meant, she simultaneously had no ability to turn

back from that point on. She began her graduate education with a 9-month-old and a 3 ½-year-

old at home. Their success in childhood and in life, juxtaposed with her painful early

experiences, has maintained a prominent position in her mind since prior to their births.


Daniel Stern, in Diary of a Baby (2008), beautifully describes the purely sensory

experience of an infant within the confines of a crib. He portrays the purity of human life, prior

to the point at which unadulterated sensory experiences of the world and the essence of emotions

become confined by words, definitions, and judgements:

Joey is six weeks old…Joey is looking at the sunlight falling on his wall (“A Patch of

Sunshine”). Then he looks at the bars of his crib and, through them, at the wall beyond

(“Space Songs”). He becomes hungry and cries (“A Hunger Storm”) and, finally, is fed

(“The Hunger Storm Passes”). Like shots in a movie, one moment may be continuous

with the next, or fade into it, or cut abruptly against it, or be separated from it by a blank

pause. It is not clear to Joey how he gets from one moment to the next or what, if

anything, happens between them. (Is it so clear for us?) But all his senses are focused on

each one, and he lives each intensely. Many are the prototypes of moments that will recur

over and over throughout life. (p. 15).

Writer’s earliest memory, being alone in a crib, crying--seemingly forever--with alternating light

and dark vertical lines was triggered by reading about Joey during her beginning studies in IMH

at Merrill-Palmer. Early childhood mental health, critical for later development, was a personal

issue while becoming a professional mission.

Writer’s twenty year long career in Community Mental Health (CMH) was spent

primarily in the homes of at-risk families of infants and toddlers, using the model Selma Fraiberg

developed in the 1970’s. This was a child-centered, psychodynamic, relationship-based model of

parent-infant psychotherapy (Fraiberg, Adelson, & Shapiro, 1975). After the exceptional

professional experiences received within the CMH system, she retired to part-time solo private

practice where she now treats individuals and families from pregnancy through adult. She has


trained her two dogs for certification with Therapy Dogs International (TDI) and uses them in

her practice, particularly with children. The combination of writer’s early experiences in infancy,

the supportive role of the many animals to which she developed attachments beginning in early

childhood, and the professional Social Worker/Infant Mental Health Specialist she became in

adulthood have fused into this plan for the development of a model for animal-assisted

psychotherapy (AAP) using a canine co-therapist with an attachment-based treatment orientation

for families and their young children.

AAT literature cites many references to human infancy. For example, use of the term

bond, as in human-animal bond, is referenced as being borrowed from parent-infant relational

terminology (Beck, 1999). This is one of the reasons why this writer finds using animals in

psychotherapy with families of infants and toddlers to be fitting. Parish-Plass (2013) cites a

prominent early parent-infant author in Animal-Assisted Psychotherapy: Theory, Issues, and

Practice when discussing the similarity between D. Winnicott’s terminology and the use of an

animal as a transitional object.

This paper will examine the potential for enlisting the assistance of a canine co-therapist

with families of young children, and will look at the following questions: Whereas animals are

noted for alleviating children and adolescents’ reservations regarding attending therapy (Katcher

& Wilkins, 1998), could the use of a therapy animal—dog, for instance—also be enticing to a

family of infants and toddlers? Should a therapist insure that interventions with a therapy dog are

pertinent to psychotherapy, and not simply employ animal-assisted interventions? But the more

basic question might be, is there even a difference between AAP and AAT? Can AAP play an

important role in family therapy which focuses on attachment relationships? How might one

design specific interventions for a therapist and canine co-therapist in order to assist a family of


young children with their therapeutic goals? Can a therapy dog assist parents in recognizing and

responding to their child’s emotional needs? Might parents model the relationship between

therapist and therapy dog for use with their child? Do attachment scores on a standardized test

rise when AAP is provided to families with young children? Also, does the practice of tuning-in

to a therapy dog’s body language and emotions assist parents in tuning-in to their child? This

exploration has been diagrammed in a Logic Model (Figure 1) with some of these questions

listed as outcomes. They will also be addressed in the section on evaluation, within a client

survey for post-treatment.

Needs Assessment

Mental health challenges in early childhood are common, often overlooked, and

underserved. According to the National Center for Children in Poverty, one in five children

Nationwide from the ages of 0 to 18 has a diagnosable mental health condition (Stagman &

Cooper, 2010). In Michigan alone, 20% of children suffer from at least one mental, behavioral,

social, or emotional condition (The Annie E. Casey Foundation). Genesee County, Michigan has

a population of slightly over 30,000 children ages zero-to-five, with 1,000 of these being

confirmed cases of child abuse or neglect (The Annie E. Casey Foundation). And yet

PsychologyToday.com—a primary referral source on the Internet--lists only 20 therapists serving

Genesee County who advertise on their site, with just 10 treating the birth-to-five population, and

only three of those using an attachment model.

For little ones, social-emotional health is mental health. Social-emotional development is

critical at the early ages, because success in school and in life depends on a child’s ability to

relate well with others, to get their needs met in socially-appropriate ways, and to self-regulate

(National Scientific Council, Center on the Developing Child at Harvard University, 2007).


Clinical treatment of young children is best conducted in as close to the child’s natural

environment as possible, within the family unit that can be both the source and relief of negative

experiences: “The emotional well-being of young children is directly tied to the functioning of

their caregivers and the families in which they live…When children overcome these burdens

[trauma, maltreatment, emotional abuse], they have typically been the beneficiaries of

exceptional efforts on the part of supportive adults” (Center on the Developing Child, Harvard

University). Addressing the issues within the child’s family is therefore essential, and is

considered best practice in the field of child psychotherapy.

The infant mental health model was established in the early 1970’s by Selma Fraiberg at

the Child Development Project in Ann Arbor, Michigan (Fraiberg, 1987). This model uses what

is termed kitchen table therapy, coined from the flexibility of professional boundaries during

home-based sessions, within an attachment model that focuses on the parent-infant dyadic

relationship and on the internal working models of both child and parent (Shapiro, 2009). In

Reflections on the Work of Professor Selma Fraiberg: A Pioneer in the Field of Social Work and

Infant Mental Health, Shapiro (2009) notes Fraiberg’s inclusion of parents in the treatment team,

“Her therapeutic work with parents was aimed at developing a working alliance with them, and

helping them provide a holding environment for their child that was empathic, stable, and

attentive to developmental needs” (p. 48).

In attachment theory, symbolic representations of the attachment object become internal

working models—or templates—which the infant uses to understand themselves, others, and

expectations for relationships. Ribaudo (2014) describes these as “patterns of interactions that,

through repetition and over time, ‘tell’ the infant what to expect from caregivers and the

environment.” One can see in Figure 2 how primary caregiver’s behavior influences the


development of a child’s working model, and in turn, the attachment classification. Like other

animals, humans are “biologically predisposed to seek out and sustain physical contact and

emotional connection to selective figures with thom they become familiar and come to rely on

for psychological and physical protection” (Sable, 2012). Can animals serve as attachment

figures for children and families in psychotherapy? Many believe that this is not only possible,

but have implemented animal-assisted psychotherapy programs around this premise. While a

client’s positive change in psychotherapy can be attributed, in part, to new meanings of self and

others which arise out of a healthy relationship with (human) therapist who is nurturing,

responsive, and empathic (Lieberman, Silverman, & Pawl, 2005), it should not be surprising that

a therapy dog, with their non-judgemental character, can assist a client—particularly a child—in

developing new internal working models. Parish-Plass (2008) recognizes the uniqueness of AAT

for inducing positive change with children suffering from insecure attachment, which includes

the animal’s serving “as a safe haven, as a secure base and as an attachment figure” (p.14).

Because of the similarities between young children and animals, particularly their innate ability

for honesty and play, one of the newest modalities combining child therapy and AAT is animal

assisted play therapy (AAPT), where “Play and playfulness are essential ingredients of the

interactions and the relationship” (VanFleet R., 2008).

In 2004, Kruger, Trachtenberg, & Serpell stressed the importance of documenting mental

health interventions when animals are an additional part of the treatment, stating, “Animal-

assisted interventions (AAIs) are currently poorly defined. The lack of a unifying set of practice

guidelines or a shared terminology is hampering efforts to evaluate and gain acceptance for the

field” (p. 2). Whether a clinician chooses to develop treatment interventions prior to sessions

may be a matter of personal preference, more so than a sign of how closely the clinician is


following a specific model. Many mental health therapists conduct sessions as Parish-Plass

(2013) describes animal-assisted psychotherapists in Israel practicing: “the therapist flows with

the client (psychodynamic, client/child centered, non-directive), as opposed to a directive

approach in which the therapist prepares activities ahead of time” (p. xxi). In the Animal-

Assisted Therapy Certificate Program at Oakland University, Rochester, Michigan, one of the

first assignments is to create lesson plans for AAT interventions: “Whether you are using your

pet to counsel, visit a nursing home, help a child practice reading, assist in physical therapy, etc.

there will need to be a specific task or goal to accomplish and the lesson plan will make that

possible” (Johnson, 2013). Embarking upon this newer modality of psychotherapy called AAP,

this writer has been challenged to figure out just how to engage clients with the canine co-

therapist so that treatment goals are accomplished in as short a time as possible, maximum

participation by co-therapist is facilitated, and that maximum benefits of AAP are realized. In

traditional psychotherapy with no canine co-therapist, it is often useful when working with

young children and families to have specific interventions outlined ahead of time that are

designed to facilitate the family’s movement toward their particular treatment goals. Wilson and

Barker (2003) noted the importance of matching proven human-animal interventions (HAI) with

a specific client base: “Once HAI interventions have been standardized and evaluated with

research supporting their effectiveness with specific popultations, practitioners will be able to

select the most appropriate HAI intervention for their client popuation” (p. 23). It is for these

reasons that the challenge of developing a model and eventual guide of specific AAP

interventions for use with families of young children based on attachment theory is being

undertaken.

Methodology


While terminology in this field is often used incorrectly and/or interchangeably, it is

important to define the terms to which this writer is referring for this particular practice and

methodology. Pet Partners (formerly Delta Society) (Pet Partners, n.d.) provides this definition of

animal-assisted therapy on their website:

AAT is a goal-directed intervention in which an animal that meets specific criteria is an

integral part of the treatment process. AAT is directed and/or delivered by a

health/human service professional with specialized expertise, and within the scope of

practice of his/her profession. AAT is designed to promote improvement in human

physical, social, emotional, and/or cognitive functioning [cognitive functioning refers to

thinking and intellectual skills]. AAT is provided in a variety of settings and may be

group or individual in nature. This process is documented and evaluated. (From

Standards of Practice for Animal-Assisted Activities and Therapy)

Parish-Plass (2013) defines animal-assisted psychotherapy as:

…a form of psychotherapy which is conducted with the same rationales and goals as

mainstream psychotherapy Therefore, we are first and foremost psychotherapists, and

together with that AAP therapists, for the client may not always be inclined to take

advantage of an animal’s presence in an active or obvious manner. The client—not the

animal—is at the center and is the focus, the raison d’etre. We, not the animals, are the

therapists, for only we are cognizant of the client’s psychological processes and issues

that need to be worked through and how to do so, according to what is in the best

interests of the client (p. xviii).

The methods for conducting child and family sessions using a therapy dog at Centered

Insight Healing, PLLC (CIH), are based on the practitioner’s professional training and


certification as a Licensed Clinical Social Worker (LMSW), and endorsement through the

Michigan Association for Infant Mental Health as an Infant Mental Health Specialist and

Mentor, (IMH-E®[IV]). This specific early childhood training is founded on principles outlining

healthy social-emotional development of young children. Therapist has a license to practice

independently with 24 years of clinical experience, which includes four years in solo private

practice.

One of two therapy dogs owned and handled by the therapist and certified through TDI,

is chosen for working with specific families if the parent/guardian elects to participate in AAP.

The therapist currently has a 7-year-old spayed female Rottweiler named Izzy, and an 11-year-

old neutered male Border Collie named Buddy. Both were rescued by the therapist/handler over

five years ago, and have been certified through TDI for over two years. Both have participated in

several psychotherapy sessions with children, adults, families, and groups.

This practice is located in an adjacent community to Flint, Michigan, which has suffered

severe financial and population decline subsequent to the withdrawal of auto manufacturing

plants. Population has been halved from 200,000 at the height of manufacturing in the 1960’s, to

100,000 today. Fortunately, 94.7% of Michigan’s children have health insurance (Michigan

Department of Community Health, 2013). CIH receives referrals from several insurance

networks within which contracts have been signed, “word-of-mouth,” and from internet

advertising. The clinic offers a sliding-fee scale for clients paying privately with limited income.

The practice is a suite on main floor within an office building, directly inside of rear entrance. A

large grass area and parking lot are available outdoors for exercising and relieving dog. As seen

in Figure 3, a sign has been placed on suite door notifying visitors of other suites that a dog is on

the premises, thereby alerting those who may suffer allergies.


The following principles guide the AAT psychotherapy with families of young children:

1. Family/relationship-centered practice: The client is the family. Therefore, even

though, for insurance and billing purposes there will be an identified patient (IP), the

targeted unit of change is the family unit.

a. In IMH work, the client is more specifically defined as the relationship

between parent (usually mother) and young child, which is identified as best-

practice (Weatherston & Tableman, 2003), but for which there are no outlined

AAT interventions.

b. For purposes of this practice, “early childhood” refers to the ages of 0 to 5

(SAMHSA, n.d.)

c. Best-practice guidelines for mental health services for young children indicate

focusing on supporting the development of a consistent, nurturing relationship

between child and primary caregiver, so that secure attachment is formed.

This in turn supports optimal social-emotional development, which is seen as

the foundation for mental health for young children (ZERO TO THREE:

National Center for Infants, Toddlers and Families).

d. Young children are best served in the context of family and culture.

2. Hypotheses about the process of AAP with families of young children:

a. Human infants are both social and vulnerable creatures, as are animals, and

the use of an animal in therapeutic work with families of infants/toddlers may

be extremely facilitative of change.

b. AAT offers a unique manner of facilitating goal-attainment by being able to

connect with children through many developmental domains. Parish-Plass

(2008) listed these as: “Enabling connection, Normalcy, Safety and


friendliness of the therapy setting, Acceptance, Reality at a safe psychological

distance, Self-esteem, The animal as an attachment figure, Allowing for the

working through of attachment issues in the ‘here and now’ within the therapy

setting, Development of more adaptive representations and strategies,

Empathy, Need for control, Touch, Regression in the service of the ego,” and

“Separation, loss and bereavement” (pp. 13-15).

c. A therapy animal serves the purpose of attachment figure, meeting the

requirements of proximity-seeking, safe haven, secure base, and separation

distress (Silcha-Mano, 2013).

d. The mere presence of a pet in the office during psychotherapy with a family

does not constitute AAP.

e. The presence of a therapy dog enhances the therapeutic process in order to

increase parent’s awareness and insight about themselves, and about their

relationship with their child. In addition, dependent on the age of the young

child and involvement in play with therapy animal, the child is able to utilize

the dog as a transitional object, in order to create new meanings for and about

themselves (Parish-Plass N., 2013).

f. Therapist maintains self-awareness regarding any potential expectations about

“desired” interactions between family and dog, and follows family’s lead,

being their “dance partner” in the relational dance, entering into the family

dynamics as they enact their truths. In the style of Minuchin & Fishman

(1981): “Family members enact their dance in relation to the therapist [dog


included], who is not only an observer, but also a musician and dancer

himself” (p. 81).

3. Awareness of the animal’s needs, physical, social, emotional, and of paramount

importance, safety:

a. “Companion animals are highly attuned to the family emotional climate and

are very sensitive to highly charged affective states of members…” (Walsh,

2009). This can allow the family therapist a unique tool for assessing and

treating families.

b. Taking note of any suspicions of animal abuse when conducting family

assessments, as the inter-relationship between domestic violence (DV) and

animal cruelty is well documented. While domestic violence may enter into

the themes of families seen for treatment, it is not the sole purpose of families

seeking treatment at CIH. Nonetheless, safety of the therapy animal must be

ensured at all times, with all clients, and especially with those screened as

having histories of animal abuse.

c. Preparing the office environment to maintain HIPAA (Health Information

Portability and Accountability) privacy regulations when needing to take

animal outdoors for relief. While some family members may choose to remain

indoors (in inclement weather, for example) during dog walks, confidential

records must remain under lock and key in therapists absence.

d. Maintaining an expectation that outdoor walks with animal and family are not

breaks from the therapeutic process, but a continuation in different

environment: “The therapist must at all times stay aware of content brought up


during the walk and keep the focus on the therapy process, despite the

surrounding stimuli…” (Parish-Plass & Oren, 2013, p. 255)

e. Supplies for dog are maintained in office, including training treats,

comfortable bed, water bowl, toys, and cleaning supplies in the case of

accidents. Also, hand sanitizer is to be made available to family members for

after-session cleaning.

4. Awareness of the safety of clients, particularly small children:

a. Be extremely mindful of risks to infants/toddlers who may be hyperactive &

frighten or cause anxiety/aggression in the animal, depending upon the

temperamental characteristics of the animal used.

b. Parent/Guardian is required to sign AAT Consent prior to treatment

(Appendix A). This clarifies health, safety, training and certification of

therapy animal, treating veterinarian’s contact information, with attention

toward child/family’s safety, but limitations of liability of practice.

5. Awareness of the relationship and interactions between therapist, animal, and

client:

a. This relationship can serve as a model for the parent-child relationship in the

same way that IMH Specialist models parental conversation with the

child(ren) during sessions, or speaks “for” the baby, in such instances where

it’s critical that the parent be made aware of baby’s needs to which the parent

is not attending. For example, where the therapist recognizes a child’s fear

expression and need for closeness which may be missed by the parent, the

IMH Specialist will be the child’s voice and express their fear and need for


security in words, “Mommy, I’m scared of the big dog! I’ll feel safer if I can

sit on your lap.”

b. The relationship between therapist and animal, as viewed by the client, can

serve as an example of safety, nurturance, acceptance, and love, by the

therapist’s positive regard of the animal and attention to its care. Additionally,

the client may see in the therapist the ability to provide positive regard for the

animal in spite of its negative behaviors, and carry this positive regard to the

client, if they make mistakes (Silcha-Mano, 2013).

6. Development of alternate stories for families:

a. Zilcha-Mano (2013) writes that a therapy animal can “help facilitate processes

by which change occurs through the development of a secure base for the

client, which in turn helps facilitate the progress of exploring the client’s

internal working models” (p. 126). This relies on the clinical expertise of the

therapist to explore and process past relationships with the client, not solely

on the presence of therapy dog in treatment room,

b. In the case of a family where domestic violence is occurring, utilize the

therapy animal to educate on, and reinforce the development of empathy via

observation of the animal’s emotions, identification with these emotions, and

the linking of emotions and experiences of both human and animal in the

cycle of violence.

c. This is particularly potent when there has been a family pet harmed by an

abuser. The program at the YWCA of Greater Cincinnati, which utilizes an

AAT model, has a two-fold purpose, which is to halt the cycles both of animal


abuse and child abuse. “Participants unlearn negative behaviors and contribute

to the prevention of future violence against animals or persons” (Ventura &

Booth, 2007).

d. In addition to use of a therapy dog with the family-as-victim, it would be

extremely useful to use a therapy dog with the perpetrator (in separate

sessions, apart from the victims of domestic violence), in order to increase

their ability to formulate empathy, as they might recall and process their own

early experiences of either witnessing or committing acts of violence toward

animals/humans.

e. Facilitating the grieving process for families upon termination from treatment,

or during, if the therapy animal should die prior to the realization of treatment

goals. An animal allows and encourages parental figures to nurture children

through both life and death, and the presence or absence of a therapy animal

allows the parent to be, in Winnicott’s words, the “good-enough mother”

(Winnicott, 1953), by attending to the emotions and needs of the child in

providing a secure base and holding environment. So, too, does the therapist

act as good-enough mother to the family when being required to prepare them

for the therapy animal’s impending death, or critical illness.

7. The documentation of methods, processes, outcomes for further study:

a. The newness of the field of AAT/AAP, and particularly AAP with IMH,

leaves the therapist the responsibility of insuring that either articles on the

process and methodology get to publication in peer-reviewed journals, or at

the very least, the work is documented with clear outcome data for further


review and clarification of this model. It is important, therefore, to develop a

set of questions for parent/guardians to complete post-treatment, surveying

their experience with the process of AAP and attachment-based family

psychotherapy.

b. Only those families signing consents for participation in research will be

included in any further studies for publication, though any family’s

interventions and responses may be documented for later supervision and/or

review.

c. Client/family response to intervention used will also be recorded, separate

from chart progress notes and process notes, for purpose of further supervision

and/or review, and to maintain separation from chart in the unlikely event of a

court subpoena.

d. Details about specific interventions used, number, age of individual family

members participating, particular specifics about dog involved,

indoor/outdoor activity, etc., shall be documented.

Budget

The budget plan is being based on a part-time practice with one clinician. This practice

was started in 2011 as a plan for retirement from full-time employment, with an initial goal for

practice being ten clients per week. The clientele includes children, adults, and families, and

therefore not all cases are those which would fit into the attachment-based family model outlined

in this plan. Since startup of this practice, approximately 15 clients out of a total of 169 seen for

services, or 11%, have at least one child under the age of 5. Not all of these 15, however, might

be appropriate for the model outlined here. Over the past 12 months this practice had a total


session count of 227. The number and ratio, involving families with a child under the age of 5,

was 110, or 49% of the total treated.

The costs identified in chart (Table 1) are based on the total expenses of operating the

practice, and take into account some 51% of clients not included in the AAT model planned.

Assuming 15 families and 20 sessions per year, and averaging $64.00 per session (insurance

reimbursement rate for family session with client present), the annual revenue based on a

cancellation rate of 20% would be $12,288. Using the 49% ratio of families with children under

the age of 5, and operating expenses of $16,672, the annual cost of operation is $8,169.

Not included in the list of expenses is the initial cost of adopting the dogs, the one-time

startup costs of initial business card and brochure printing, setting up the corporation, office

equipment, or the cost of existing furniture and office decor.

Similar Programs

In spite of there being a number of outpatient therapists using AAT with individuals,

children and families, this writer has not been able to find early childhood family therapists or

IMH Specialists who are working with canine co-therapists using an attachment model, which

makes finding research evidence for AAP with this population and model difficult. In addition,

research articles generally do not include program cost or financial sustainability information.

While funders would prefer to see this type of data to justify contributions, Centered Insight

Healing, PLLC, as a for-profit private practice, is currently sustaining itself through client

insurance claims, and private-pay clients. While the ultimate goal of this writer is the creation of

a manual of specific AAP interventions for use with the early childhood population using

attachment theory, a model for AAP with this population must first be outlined.


Polheber & Matchock (2013) found that even short-term exposure to a non-familiar dog

reduced cortisol, the stress hormone, in a laboratory setting, which speaks to the potential

beneficial effects of therapist’s dog on families in an outpatient mental health office. This

confirmed previous research (Allen, K. M., Blascovich, J., et al., 1991) on the beneficial effects

of pet dogs mitigating stress for their owners. The authors found to be the most influential for the

study of AAT or AAP with families of young children using an attachment model are Risë

VanFleet and Nancy Parish-Plass. VanFleet practices, teaches, conducts research, and publishes

on AAPT (animal-assisted play therapy) and Filial Play Therapy with children. AAPT is used by

VanFleet and others “as an adjunct to other therapeutic modalities such as play therapy, Filial

Therapy, family therapy, parent education, and cognitive-behavioural therapy” (VanFleet, 2010).

Her Playful Pooch training program for therapists integrates animal-assisted therapy and play

therapy in a novel and appealing model for those treating children and families with the aid of

dogs. Several goals have been identified for using AAPT with children and families, including

self-efficacy, attachment and relationship enhancement, development of empathy, self-

regulation, and problem-resolution (VanFleet, 2010). Nancy Parish-Plass also practices,

researches, and publishes on AAT with families of young children, and includes attachment

theory in her practice model. Parish-Plass specifies the multi-faceted relational philosophy of

animal-assisted play pherapy (AAPT) with children being “based on emotional connection and

relationship—between therapist and child, between therapist and animal, between child and

animal, between animal and animal” (Parish-Plass, 2008, p. 12). This is not unlike IMH work, in

which the IMH Specialist is required to be keenly aware of the multiple dyadic relationships in

the room at any given time: Between therapist and mother, therapist and infant, mother and

infant, therapist and mother-as-infant, and therapist and therapist-as-infant.


Many professional journal articles on the topic of AAT and early childhood primarily

focus on children in educational settings, and/or children diagnosed with autism. In fact, doing a

literature search using psychINFO with key words mental health, early childhood, and animal

assisted therapy resulted in only two peer-reviewed journal articles, one on AAT for early

intervention with conduct-disordered children, the other on therapeutic horseback-riding for

children with autism.

Conducting a search of therapists advertising or listed in some way online, finds 2,223

Michigan-based therapists using psychologytoday.com to market their practice. Using the site’s

advanced search to limit the results to only those therapists stating a specific focus on the 0-5 age

group with an attachment-based treatment orientation resulted in a total of five. While animal-

assisted therapy is not an option in the site’s advanced search feature, one can open each profile

and discover that only two Michigan therapists, one of whom is writer, offer AAT with the 0-5

age group using an attachment-based treatment orientation. The American Association of

Psychology’s therapist directory lists 13 Michigan professional psychologists, however, none

identify AAT in their full profiles. Goodtherapy.org is another large online therapist directory,

which lists 41 Michigan therapists identifying “children” as a population category they serve,

and who provide family therapy. This site offers no ability to fine-tune the advanced search for

attachment-based treatment orientation or for early childhood as a popultaion category. It is

unknown, therefore, whether the single resulting therapist advertising on Goodtherapy.org who

listed “Equine and Animal Assisted Psychotherapies” as one of their approaches to therapy

works with the 0-5 population using an attachment model. These results indicate that there is,

indeed, a market for AAP with the early-childhood population in Michigan, if not Nationwide.


Table 2 lists some of the few programs found doing an Internet search for “animal

assisted therapy programs,” and/or “animal assisted therapy practitioners.” The purpose of this

search was to find a number of programs, then to limit those to ones which focused on writer’s

areas of concern: family therapy, young (ages 0-5) children, attachment model, and AAT with

specifically, canines. From this table, one can see that three of the six programs meet all of the

criteria designed for use in the Centered Insight Healing, PLLC program, with two (highlighted)

of the three funded in the same manner, by private pay clients and insurance. These are the

Beech St. Program, which is a program of Risë Van Fleet’s, and Cori Noordyk, LLMSW, who is

in private practice in Michigan. What is not known by this information is which, if any, of the

programs utilize a program evaluation or research component, and therefore, no program

effectiveness is known. This is a component that should be put in place, if the goal of one’s work

is not only to provide quality services to families, and to enhance the field of AAT, but also to

expand knowledge of the efficacy of such programs.

Where The Beech Street Program, Risë Van Fleet, and Nancy Parish-Plass have

succeeded, in addition to their practice of AAP/AAPT with children, is in writing, publishing,

and training of others interested in or practicing AAT. Van Fleet’s Playful Pooch trainings are

generally sold-out well in advance of her conferences, which are held all over the United States,

and are sought-after by AAT/AAPT professionals. The Beech Street Program is an affiliate of

the Family Ehancement & Play Therapy Center, Inc., which produces the professional and parent

training programs on animal-assisted play therapy, filial play therapy, and research, supervision,

and consultation for professionals. There is also an International Collaborative on Play Therapy,

which is promoted partly through Facebook.com group pages. The Beech Street Program’s (Van

Fleet, 2009) website states, “Our goal is to ensure that our services are the highest quality


possible, and this is accomplished by research, clinical supervision/consultation, & training

programs.” This is a unique and creative way to promote animal-assisted therapy practice, as

well as to enhance the field of AAT/AAPT. Unlike Van Fleet’s marketable approach, CIH is

focusing on only direct treatment of children and families with AAT and the resultant outcome

measures in order to maintain a part-time solo private practice, and to increase awareness of

AAP through an eventual guide of interventions.

Evaluation

A quasi-experimental outcome evaluation could be feasible by comparing two groups of

families, one which chooses to enroll in animal-assisted psychotherapy, and a control group of

families which receives standard family therapy, but without a therapy animal. The control group

families would receive the same psychotherapy services from clinician as the AAP group, just

with no therapy dog interventions. In the case where the therapy dog may be in the office for

other families on specific days, it could be kept in a separate room so that it would not influence

on the treatment or outcomes. The difficulty with this design might be insufficient number of

control group families, simply due to the low client base and part-time structure of CIH.

In order to measure outcomes as occurring in the Logic Model (Figure 1), two separate

measures will be utilized: The first, a standardized, norm-referenced assessment, and a parent-

completed survey. The standardized measures developed by the Devereux Foundation for early

childhood have been validated and reliabilty-tested as measures of protective factors in young

children, ages 0-5. Devereux defines attachment as “a measure of a mutual, strong, and long-

lasting relationship between a child and significant adult(s)” (LeBuffe & Naglieri, 1999, p. 26).

Two separate measures which measure attachment based on child’s developmental age are

needed for the 0-5 age range. The Devereux Early Childhood Assessment, Infant/Toddler


(DECA-I/T) assesses attachment and initiative from 1-month to 18-months, and adds the self-

regulation scale for toddlers, aged 18-months to 3 years. The DECA Preschool Program assesses

attachment, self-control (vs. self-regulation, as in the DECA-I/T), and initiative for the 2- to 5-

year age group. A Total Protective Factors score is also provided for each developmental age,

conceptualized as a combination of attachment and initiatie scores for the 1-month to 18-month

age group, and a combination of attachment, self-control, and initiative for the preschool ages, 2-

5. Devereux recommends, however, administering the DECA-I/T for toddlers up to 36 months.

The DECA assessment measures will be provided to representative parents or guardians

of each family receiving treatment, whether in control or AAP group. Parents complete the

questionnaires, and therapist scores results and collects data on pre- and post-test to compare

results and identify changes in children’s social-emotional development as a result of services

(Fleming & LeBuff, 2014). CIH will not be computing statistical scores or significance, but will

rather collect data for the purposes of identifying whether AAP treatment resulted in greater

positive social-emotional—specifically on attachment scale--scores (5-7 T-Score points =

medium change, >8 T-Score points = large change).

The second outcome measure will be a parent-completed 20-question evaluation at

completion of services. CIH will have the representative parent or guardian for each family

complete an Evaluation Questionnaire (Appendix A), which asks clients to rate 19 questions

about their perception of parent-child relationship and services received with AAP on a five-

point Likert Scale from “strongly agree” to “strongly disagree,” and one open-ended question

for other comments. Questions were specifically designed to examine parental judgement of

improvement in parent-child relationship, modelling of animal-human relationship for parent-

child relationship, ability of parent to assist child with managing difficult emotions, or self-


regulation, and change in parental confidence. Therapist will collect and analyze results of these

parent-reported values for positive or negative views of AAP.

For evaluation, the DECA scores can still be used as an outcome measure for both the

AAP-treatment group and the control group as a measure of attachment strength, but the parent-

completed questionnaire would not be pertinent to the control group.

Conclusion

There is a need and market for AAP practitioners working with the early-childhood

population. The attachment model fits well with AAP, as there are numerous referenced works

citing similar attachment terminology and processes for the human-animal bond, as occur within

human parent-infant pairs. A methodology for outlining AAP with a canine co-therapist has been

suggested. An evaluation of model effects on parent-child attachment using standardized and

non-standardized tools is described. A control group of families receiving family therapy with no

canine co-therapist can be included for more precise conclusions. Future goals should include

publication of AAP interventions for use with families of young children, using a canine co-

therapist.


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TablesTable 1

Budget

Private Practice CostsDescription Pay To Amount Frequency AnnualAdvertising psychologytoday.com $30.00 monthly $ 360.00 Books Miscellaneous $12.00 monthly $ 150.00 Corp. filing MI LARA $50.00 annual $ 50.00 Domain name Gandi $15.00 annual $ 15.00 EMR TherapyNotes $65.00 monthly $ 780.00 Malpractice NASW Assur. Trust $170.00 annual $ 170.00 Oakland U AAT Cert Program $350.00 per session (x5) $ 1,750.00 Office 365 Microsoft $99.00 annual $ 99.00 Office Rent Linden Valley Assoc. $455.00 monthly $ 5,460.00 Office Supplies Staples, Sam's Club $ prn $ 1,000.00 Phone T-Mobile $103.00 monthly $ 1,236.00 MI-AIMH MI-AIMH $190.00 annual $ 40.00 ACSW NASW $220.00 annual $ 220.00 Liability The Hartford $500.00 annual $ 500.00 License MI LARA $65.00 every 3 yrs $ 21.70 Tax filing H&R Block $122.00 annual $ 122.00 Website Moonfruit $108 annual $ 108.00

Subtotal: $12,081.70Dog(s)Description Pay To Amount Frequency AnnualFood Magoo's $1,000.00 annual $ 1,000.00 Grooming Groomingdale's $115.00 quarterly $ 460.00 Certification Therapy Dogs Int'l $70.00 initial $ 70.00 TDI Therapy Dogs Int'l $40.00 annual $ 40.00 Toys, Extras Misc. $10.00 monthly $ 120.00 Veterinary Pierson Pet Hosp. $2,900.00 annual $ 2,900.00

Subtotal: $ 4,590.00One-time, or Non-recurring feesDescription Pay To Amount Frequency AnnualAdvertising Varies $726.00 Initial invest. $ 726.00DECA Kaplan $410.00 Once $ 410.00Office Equip. T-Mobile $29.00 Monthly $ 303.00 Set up LLC Accountant $500.00 One-time $ 500.00

Subtotal: $ 1939.00Grand Total: $18,610.70


Table 2

Program Comparison

Key program Features

Family therapy

0-5 Attachment model

Canine Funding Notes

ProgramName AAT Programs of Colorado1 Donations

Non-profitAlso trains professionals

Banbury Cross2

Private pay Grants Donations

Equine

Beech St. Program3 Private pay Insurance

Also trains professionals

Cori Noordyk, LLMSW4 Private pay

InsuranceHuman-Animal Solutions5 Private pay

InsuranceMI Community Mental Health, IMH Model

Medicaid

Note. 1Animal Assisted Therapy Programs of Colorado. Retrieved from

http://www.animalassistedtherapyprograms.org/. 2Banbury Cross Therapeutic Equestrian Center. Retrieved

from http://banburycrosstec.org/. 2Family Enhancement and Play Therapy Center: Beech Street Program.

Retrieved from http://www.play-therapy.com/parents_beechst.html. 4Cori Noordyk Therapy, LLC. Retrieved

from http://www.corinoordyk.com/. 5Human-Animal Solutions. Retrieved from

http://humananimalsolutions.com/.

http://www.animalassistedtherapyprograms.org/


FiguresFigure 1

Logic Model

Board of Regents of the University of Wisconsin System. (2008). Developing a logic model: Teaching and training guide.Harrell, A., Burt, M., Hatry, H., Rossman, S., Roth, J., & Sabol, W. (n.d.). Evaluation strategies for human service programs: A guide for policymakers and

providers. Washington, D.C.: The Urban Institute. Retrieved June 17, 2015, from https://www.bja.gov/evaluation/guide/documents/evaluation_strategiesWesley, M. C. (n.d.). The logic model in mental health program development. Lindsey Wilson College.

https://www.bja.gov/evaluation/guide/documents/evaluation_strategies


Figure 2

Attachment Styles & Working Models

(Bretherton, & Munholland, 1999)


Figure 3

“Dog on Premises” Sign

]THANK YOU!+


Appendix AEvaluation Questions

Consider each of the following statements as you now complete treatment. Your answers will help toimprove the services provided at Centered Insight Healing, PLLC. Please answer honestly, using a5-point scale, on the degree to which you agree with each statement. A response of “1” equals“disagree completely,” and “5” equals “agree completely.” A response of 3 equals “neitheragree nor disagree.” The first statement is a sample. The response circled is a 2, meaningthe person “mildly disagrees.”

Sample Question:

I had a terrible time trying to find the office the first time here. 1 2 3 4 5

1 The availability of a therapy dog was a positive influence on my decision to bring my child and family to this practice for therapy.

1 2 3 4 5

2 We would have come here for services even if animal-assisted therapy wasn’t offered.

1 2 3 4 5

3 Therapy has not been helpful. 1 2 3 4 5

4 My child looks forward to coming here for therapy because of the dog. 1 2 3 4 5

5 The relationship between humans and therapy animal served as a model for my relationship with my child.

1 2 3 4 5

6 My child communicates with me better since we’ve been coming to therapy.

1 2 3 4 5

7 The availability of a therapy dog helped my family to feel comfortable working on difficult issues.

1 2 3 4 5

8 My child likely feels they were able to trust the therapy dog. 1 2 3 4 5

9 Animal-assisted therapy helped us make the changes we hoped for. 1 2 3 4 5

10 I understand my child better now. 1 2 3 4 5

11 I’m able to read my child’s emotions better. 1 2 3 4 5

12 The relationship between my child and I has improved. 1 2 3 4 5

13 My confidence as a parent has increased. 1 2 3 4 5

14 I am more able to provide consistent, nurturing parenting now. 1 2 3 4 5

15 My child talks about the therapy dog to others outside of therapy. 1 2 3 4 5

16 I am better able to help my child manage difficult emotions now. 1 2 3 4 5

17 The therapy animal showed unconditional acceptance to my child. 1 2 3 4 5

18 Our family believes that teaching children about humane education is important for developing empathy.

1 2 3 4 5

19 I would recommend animal-assisted therapy to other families with young children.

1 2 3 4 5

20 Other comments?

Strongly agree

Mildly agreeStrongly disagree

Neither agree nor disagreeMildly disagree


Appendix B

animal-assisted psychotherapy with canine co … file · web viewanimal-assisted psychotherapy with...

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