How

Therapy or therapeutic?

 

Most of the contact that inpatients have with animals could be described as ‘therapeutic’. Or simply pleasurable and highly beneficial! (For a quick recap see Why section.) Or, as Nic Higham (our Inpatient Care Project Manager who has worked on wards) puts it:

“Food labelling law states that foods with flavour from real ingredients must be called ‘flavoured’. Foods made with synthetic flavour must be called ‘flavour’ e.g. strawberry flavour. Some aspects of ward life are flavoured by therapy and are therefore classed as formal therapy, while others have the flavour of therapy and are therefore therapeutic.”

Some fortunate patients are able to benefit from a more structured and goal-oriented relationship with animals through Animal Assisted Therapy. My support dog, Buddy, used to come to all my therapy sessions, but she snored her way through these and was usually not the focus of conversation. But let’s say I was very reluctant to take part in therapy, a gentler and more indirect approach to tackling painful emotional issues could have been for the therapist to guide the conversation around Buddy. It could be as low-key as simply talking about how Buddy is doing, how my illness is affecting her and our relationship etc. Having started to trust the therapist, I might then have been more open to branching out to emotional issues. Again, these could be indirectly addressed by reflecting on Buddy’s feelings, experiences, comforters etc.

So in Animal Assisted Therapy, the animal is the bridge between the therapist and patient, and this role can be carried out by a dog, cat or even fish. The wider the range of feelings and experiences the animal has, the easier it can be for the patient to identify these and with these.

In an excellent article about Animal Assisted Therapy in occupational therapy practice, the author lists common goals of pet therapy including:

  • The facilitation of communication and social interactions
  • To facilitate the expression of feelings
  • To brighten mood and affect and lessen anxiety
  • To help to explore grief and loss issues
  • To help to improve reality orientation
  • To help to improve the ability to cooperate
  • To increase the ability to trust
  • To help learn appropriate forms of touch
  • To help to improve self-esteem and self worth
  • To provide an opportunity to show affection

“I regularly bring my Border terrier into the Centre. The single most important change that I have seen with patients is how many spontaneously initiate conversations with me about the dog. This has enabled me to introduce topics important to the therapeutic process with patients in a more informal and collaborative manner, as rapport has been established by virtue of the connection we have through the dog.” Dr Paul Myatt, Consultant Psychiatrist, State Hospital Scotland.

In practice, the boundaries between what is therapeutic and what is therapy can be blurred. The extensive and wonderful animal therapy programme at Scotland’s high secure State Hospital describes the range of intensity and structure particularly well. Here’s an excerpt but it is really worth reading their full, movingly illustrated, account and advice.

Here at the State Hospital we use the term ‘Animals as Therapy’. This is because, at large, the Centre accommodates groups at any one time although we do undertake some goal-directed Animal Assisted Therapy with individuals. Whether therapy is delivered to individuals or groups of patients, the benefits that animals bring are unquestionably therapeutic for many patients. We consider that in having animals in the Unit, we provide a therapeutic environment that can facilitate therapeutic outcomes, without actually applying “therapy”.

Therapy can be in the form of looking, touching, hearing– anything that makes someone feel a little happier, a little prouder, more confident or motivated to do something like ask a question or smile.  It does not have to be directed therapy, but it can be.  Directed therapy means that we look for specific outcomes in a particular patient, and provide an opportunity for these outcomes to take place, monitoring to what extent the goals are achieved.

 

Coping Strategy

The first case of Animals as Therapy being used in the Hospital as a deliberate coping strategy involved James, a patient with a learning disability. James loved all of the animals, and worked tirelessly with them, making great attempts to win their trust. He talked to his Consultant Psychiatrist about them, and we were asked by his doctor to take photographs of what James did while looking after the animals. James now has a portfolio of photographs beside each of which he has written details of his interactions with them and how they make him feel. James uses his portfolio when he feels angry, upset or disappointed. He relives how he feels when he is attending to the animals. Since this was put in place, there have been no reports of aggressive incidents.