Use of Therapy Dogs in Treating Disabilities, Illnesses and Disease

"The great pleasure of a dog is that you may make a fool of yourself with him and not only will he not scold you, but he will make a fool of himself too."
Samuel Butler

The relationship between dog and master is one of the most profound in human experience. Dogs give much yet ask little in return. To keep a dog happy, all that is needed is scratch behind the ears, a bowl of food and a kind tone. What we give to our pets we get back exponentially. Our best friends satisfy many of our emotional and physical needs. Some are pampered pets and companions. Some work the farm and protect homes, yet without question most dogs are man's best friend and steadfast companion. The question arises are dogs more than affable clowns or loyal sidekicks? Can interaction with a dog make a person feel better? The evidence is becoming clear that besides being our friends, dogs can affect our physical and emotional health in many positive ways. The use of dogs in assisting people in overcoming a variety of disabilities, ailments and traumas is now becoming common place. Does the use of Therapy Dogs work with autistic children? Can they help elderly patients in nursing homes overcome loneliness? Can interaction with a dog help heart patients heal faster or assist in the the treatment of obesity? These are just some of the questions being asked in regards to the use of dogs in healing humans.

Before going forward, the observer must go back and look at the long history of mankind and canines. The relationship between humans and dogs dates back to our earliest records. Primitive man found much use for the wild canines that surrounded human campsites. According to Dr. Stanley Coren in his book, The Intelligence of Dogs, "Canines would eat leftover food, thus ridding humans of the disease that comes with rotting carcases" (34-35).

As the canines became closer to the inner circle, they learned behaviors that allowed them easier access to the food. Soon these wild dogs became domesticated. These domesticated dogs began assisting humans in another way by sounding the alarm with a bark if wild animals or bands of humans with bad intentions came too close to their territory. As Dr. Coren puts it, "This canine burglar alarm was one of the motivations for taking puppies from the wild dogs, bringing them into the home and domesticating them as house dogs" (35-35). The origins of this complex and mutually satisfying relationship continues to this day. Dogs have always been of service to humans, and today the examples of dogs caring for their human companions abound.

There are several different ways in which dogs work for the betterment of humans. For our purposes we will separate them into two categories. The first group is known as Service Animals. "Service Animals are trained to eventually be owned by and assist one person with a specific disability" (Crawford and Pomerinke 168-169). Service Animals such as dogs are legally defined by the Americans With Disabilities Act of 1990. They are trained to meet the disability-related needs of their handlers. Federal law protects the rights of the individuals with disabilities to be accompanied by their service animal in public places (Delta Society Inc.).

Within the group of Service Dogs there are three subsets of dogs. Assistance Dogs International categorizes these groups in the following ways. The first are Guides Dogs. These dogs are "carefully bred and trained for a year by volunteers and then trained again by professionals before they are placed with their blind handlers." German Shepards and Labrador Retrievers are most often used for Guide Dogs.

The next type of Service Dog are Hearing Dogs. They are generally mixed breeds acquired from animal shelters and are small to medium in size. Prior to formal audio response training, the younger adoptees are raised and socialized by volunteer puppy raisers. Hearing Dogs are identified by an orange collar and leash and/or vest.(Assistance Dogs International). They are trained to respond to specific audio so that they can alert their deaf handlers to a variety of things heard in every day life, such as a telephone, a doorbell and a smoke alarm.
Lastly there are dogs who work outside of the realm of the deaf or the blind. They work with people afflicted with all types of disabilities. They are mixed breeds and pure breeds alike. The most important quality of these dogs is a gentle temperament. They are trained to sense medical issues in their handlers. They are trained to sound an alarm if a diabetic handler has low blood sugar or if a handler with a seizure disorder is about to experience an episode (Assistance Dogs International). The tasks are endless, and the way service dogs improve the lives of people with disorders and disabilities are endless. All of the above dogs live and work with the very people they are trained to help. Intensive training and placement with a person in need is at the very heart of Service Dogs.

A second and newer category of dogs that serve are Therapy Dogs. These dogs are usually the personal pets of their handler. The dog and handler work as a team to provide a service to people with disabilities. There are a number of terms used to describe these dogs and the work they do. Therapy Dogs, Animal Assisted Therapy, Pet Therapy and Pet Facilitated Activity are just a few of the descriptions (Crawford and Pomerinke 170). For our purposes, the dogs will be referred to as Therapy Dogs. At this time term unlike service dogs, therapy dogs are not legally defined; however they must go through similiar testing and certification before they can be called Therapy Dog and work in the health care industry.

The term Therapy Dogs cover a broad spectrum of services provided. According to Therapy Dogs International, there are over 19,000 registered dog-handler teams in the U.S. and Canada. These dogs can be the smallest toy breed to the largest sporting dog. They are both pedigreed or simple mutt. DOGS and their handlers go through a training and certification process to ensure the highest quality of care for the population they serve.

There are a number of certification organizations, but the most established and well known is Therapy Dog International. TDI certifies dogs and their handlers in every area of the world. To become a Certified Therapy Dog, TDI dogs must be evaluated and tested by Certified Therapy Dog International Evaluators. Dog-handler teams must be re-certified on a consistent basis to maintain the integrity of the program. Handlers who feel they have a gentle dog that "enjoys contact with other people can start the process of training and then certifying their dog as soon as the animals is old enough to tolerate the contacts safely and well before the animal reaches maturity" (Crawford and Pomerinke 168).

It takes a special disposition to actually be an effective Therapy Dog, however. According to TDI, "Many dogs provide love and companionship in the home but not all dogs are qualified or have the temperament suited to be a Therapy Dog. TDI's standards are extremely high."

Dogs must pass eleven tests on behavior, disposition and training. TDI's official certification test is based on The American Kennel Club's Canine Good Citizen test. This official designation of the AKC is awarded to dogs who demonstrate confidence and control. TDI expands upon these eleven tests to better designate a dog's ability to work in a variety of situations. The eleven tests include basic behavior such as sitting, staying, coming when called and sitting politely when being TOUCHED. TDI also test the dogs for showing confidence when exposed to people walking with an uneven gait, shuffling, breathing heavily, coughing, wheezing or other distractions which may be encountered in a facility (Therapy Dog International).

Therapy Dog candidates are also tested on their reaction to other dogs and to distractions. They are tested on what TDI calls, the "willingness to say hello". Is the dog approachable? Will the dog happily sit on a lap or lean close to allow for petting? The most important test is the attitude of the dog toward children. For safety's sake, children are not used to test dogs, rather dogs are observed as they watch children play and run. If the dog shows any sign of aggression or negative reaction, such as growling or barking, the dog is immediately disqualified. Since the use of Therapy Dogs is a relatively new idea, safety is always at the forefront of every interaction.

This type of treatment is a modern day use of dogs, and until the late seventies there was not a lot of research to support what many health care professionals intuitively knew. The lack of solid data was one of the catalysts in the formation of a non-profit organization known as The Delta Society. Founded in 1977 by doctors, psychiatrists and veterinarians, the group had experiences within their own lives and practices that confirmed their belief in the positive benefits of using dogs with their patients. With mostly anecdotal evidence at their disposal, they set out to fund research to prove their theory. Today thanks to funding by the Delta Society, more institutions and formal research facilities are confirming the evidence that work with animals and dogs in particular help people heal in a variety of ways.

For instance the research is showing that people with mental disorders and illnesses greatly benefit from the use of animals in helping to control their anxiety. According to a study published by the Journal of the American Psychiatric Association, "statistically significant reductions in anxiety scores were found after the animal assisted therapy sessions for patients with psychotic disorders, mood disorders and other disorders, and after therapeutic recreation sessions for patients with mood disorder"(Baker 12-15).

This is something Diana Lee knows well from her work as a therapist. Diana works with patients who suffer from depression, anxiety, post traumatic stress syndrome and addiction. For years she has been a safe haven for her clients to speak openly and work on healing their pain. Recently Diana brought in her dog, a Brussels Griffon named Jerry. Dr. Jerry as he is known to patients is a small, wire haired dog with a smart face and a love of being snuggled. Diana Lee found that having Jerry in sessions allowed people to open up more easily. Diana's patient Debi Demiglio explains, "I'm more easily able to show my vulnerabilities because of Jerry." Dr. Jerry employees a technique only a dog can use. He climbs in Debi's lap, lies down with his belly up and snoozes while Debi stokes his tummy. Jerry's trusting nature and open body puts Debi at ease and allows her to open up. According to Diana Jerry "provides an environment of safety, security, humor and comfort" to her clients. Diana can attest to the fact that therapy with a trusted Therapy Dog can work wonders in the healing process people go through when they embark upon the journey of restoring their mental health(Crawford and Pomerinke 96).

Therapy Dogs are in many realms of mental health care. The story of Loretta Brobst is a case in point. Brobst was a morbidly obese woman with many of the medical complications that come with weighing over four hundred pounds. One of the worse problems Brobst faced was not physical, but psychological. She was suffering from debilitating depression. The hurtful comments and stares of other people went deep in hurting her gentle spirit. She didn't want to venture outside for fear of being harassed, so she became withdrawn and isolated, fearful of new people. Her psychiatrist, Dr. Scott Berman knew that medication alone would not help Brobst with her depression, and that she also needed psycho-therapy. The problem was Brobst's anxiety was preventing her from pursuing a good therapist. Fortunately Dr. Berman recommended Kathy Best, a certified nurse psychotherapist. Best used animals in her therapy as she had found her patients were able to relax and open up with her two enormous and furry Great Pyrenees dogs present (Crawford and Pomerinke 52-58).

The two therapy dogs, Brutus and Kayla were AKC Canine Good Citizens and had earned certification from both Therapy Dogs International and the Delta Society Inc. Brobst connected wonderfully with the dogs as she felt they were not judging her size and accepted her for who she was. This unconditional acceptance was the beginning of her healing process. After many stops and starts Brobst was able to shed 250 pounds over five years. She attributes much of her success to the use of Brutus and Kayla (Crawford and Pomerinke 52-58).

Therapy Dogs have also has been found to help heart patients. According to the Journal of American Association of Critical Care Nurses, "Animal assisted therapy improves blood pressure, hormone levels and anxiety levels" in heart patients (Cole, Gawlinski and Steers 119-120). The nurses at Swedish Hospital in Seattle, Washington, can attest to the facts of this study. It is at Swedish Hospital that Certified Therapy Dogs, Rio, Mandy and Kitty work their wonders. The trio are Portuguese Water Dogs and are handled by Laurie Hardman. The nurses noticed a huge difference after patients were seen by the three curly haired canines. Patients suffering from strokes, heart attacks and accidents WERE worked with. One such patient was an elderly man named Bert Bruce. Bert was recovering from serious heart surgery when Laurie came to visit him in the hospital. Mandy waited for the okay before gently climbing onto Bert's bed awaiting a gentle stroke on the head. Bert felt his pain and anxiety subside for the moment. Mandy had done her job in alleviating the pain and reducing Bert's stress (Crawford and Pomerinke 59-62)

Therapy dogs are also being seen in long term care facilities for the elderly. A recent study published in the Journal of Gerontological Society of America found that patients who spent as little as half an hour a week with a Therapy Dog were significantly less lonely after only six weeks, when compared to a control group (M. Banks and W. Banks 34-35).

Tegan is an Irish Setter who specializes in elderly care. A regular at assisted living facilities and nursing homes around Chicago, Tegan and his handler Fred are quite a pair. Tegan is a cancer survivor himself and only has three legs. The Setter built a special relationship with an elderly woman named Ingrid at Westmoreland Nursing Home in Chicago. Ingrid was wheelchair bound, had no surviving family and was in continual pain. At first she was hesitant to touch Tegan so he patiently waited and greeted her from a distance gradually alleviating her fears. Ingrid would reach out and pet his red silky head and he would in turn gently lick her hands. This tactile experience "stirred memories of other loving touches, of infants once nestled contentedly in her arms. All this was communicated between Ingrid and Tegan" (Crawford and Pomerinke 100-103).

Over a five year period Fred brought Tegan in to visit with Ingrid. The relationship allowed Ingrid to connect with another being and help her forget her current isolated condition if only momentarily. Even when Ingrid was bedridden and unable to move because of constant pain, she would reach out with her hand to touch the soft head of the dog. Tegan's presence conveyed to Ingrid that "there is hope"(Crawford and Pomerinke 101).

The elderly are not the only people who benefit from exposure to dogs. Children with autism seem to have a special connection to these animals. According to the National Autistic Society (NAS) autism is a "disorder with no single known cause or cure, however it is treatable." As Richard Mills, the director of research at the NAS puts it, "unlike many treatments for autism such as mainstream drugs and alternative therapies, it [the use of dogs] involves no risk" (Fielder). Perhaps the dog is sensitive to the needs of a child who is different than most and does not communicate in a normal way. The patience displayed by Therapy Dogs allows autistic children to open up at their own speed.

One such child was a severely autistic three year old boy named Matthew Smith. Matthew displayed many of the common symptoms of autism. He did not talk except for a few monosyllabic sounds. He would not make eye contact or allow himself to be touched. He used repetitive movements constantly and had a very difficult time sitting still. Along with his mother Melinda, Matthew's special education pre-school teacher Dana Romary arranged for Matthew to meet with a Therapy Dog. Jeb was a large yellow retriever mix owned by Deb Sellers. After careful planning Jeb and Matthew finally met. Not surprisingly Matthew completely ignored the dog, who sat patiently with Deb. Matthew ran around the room, climbed on furniture, jumped off and sat down. He did this repeatedly, oblivious not only to Jeb but his mother, teacher and Jeb's handler. Finally Dana corralled Matthew into his lap holding him firmly but gently. Deb signaled for Jeb to walk over to Matthew and put his head in Matthew's lap. Dana guided Matthew's hand over Jeb's silky head and let the boy pet the dog. This was a big step for Matthew as any tactile contact was extremely difficult for him to stand. Hearts sank in the room however as Matthew didn't look at the dog at all. Dana signaled for Jeb to go get a ball which Jeb happily obeyed. Jeb brought the ball back to the pair and dropped it in Matthew's lap. Dana put his hand over Matthew's and together they clutched then threw the ball for Jeb to fetch. Jeb ran, retrieved the ball and brought it back to Matthew's lap several times. Each time Matthew ignored Jeb until finally the boy became restless and started squirming in Dana's lap. His discomfort was becoming very apparent when one last time Jeb dropped the ball in Matthew's lap. Miraculously this time proved to be effective because Matthew grabbed the ball by himself, leaned over and faced Jeb. He looked the dog in the eye and offered the ball to his new friend. Jeb gladly took the ball and a connection, though small, was made.

As all the participants were rounding up their things and congratulating themselves on the small step Matthew had made that day, they didn't notice the little boy had gotten up and lay across Jeb's body. Matthew continued playing with a toy, his little elbows dug into Jeb. Jeb didn't move and at one point the boy looked deeply into the dogs eyes and seemed to connect with another being outside of himself for the first time in his life (Crawford and Pomerinke 124-130).

Even healthy children benefit from the use of a dog in a medical setting. In a study published by the Journal of Pediatric Nursing, healthy children were examined by a doctor. Those that had a dog present during the exam showed "Significantly greater reductions in behavioral distress, and psychological parameters of stress including decreases in systolic blood pressure, mean arterial pressure and heart rate" (Nagengast 323, 328-329).

If a healthy child shows significant calming behaviors, imagine how a child who is struggling with cancer would benefit from a Therapy Dog. The story of a boy named Scooter only confirms what the studies are bearing out. Scooter Ross was diagnosed with an inoperable brain tumor in 2000. Scooter had to face separation from his family while receiving numerous chemotherapy treatments. Although his mother was able to stay at the Ronald McDonald House in Dallas, Texas, Scooter missed his dad and siblings back home which made it harder to fight his deadly disease.

One of the things that made his struggle more palatable was Timmy the Rottweiller. Timmy was an enormous dog owned by Linda Smith. Linda knew that the appearance of a menacing looking Rottweiler could sometimes scare the children, she was dedicated to working with at the Ronald McDonald House. To overcome this problem Linda dressed Timmy up in a variety of costumes that the dog willingly allowed. One such ensemble had Timmy dressed as a cowboy complete with a hat, a vest with an American flagged in a pocket, a neckerchief and sunglasses! Scooter and Timmy immediately became fast friends. Scooter's mom Michelle was convinced of the power of the use of Timmy in helping raise the boy's spirits and keep his outlook positive. During the difficult times after chemo when Scooter was nauseous and vomiting, Timmy would gently sit by his side and wait for a sign that Scooter wanted to play. If Scooter wasn't up for it, Timmy would just sit and wait. Sadly Scooter lost his fight against cancer in 2003 but his family, the nurses at the hospital and the volunteers at Ronald McDonald House knew that the big dog with the funny outfits made a huge difference in Scooter's short life (Crawford and Pomerinke 136-142).

These are just a few of the thousands of personal accounts that corroborate the overwhelming scientific evidence on the many positive therapeutic, uses for animals and specifically dogs.
My own experience with the healing power of dogs isn't clinical or scientific. It is however very powerful and very heart felt. In 2002 when my daughters, now 21 and 19 were in the grips of adolescent angst and all the troublesome problems that accompany it, I noticed a profound and touching thing. My yellow Labrador Retriever, Stella would wait at the door every day around 2:30 P.M. with hopeful anticipation of her girls homecoming. Sometimes they would bound in the door and walk right past the wagging tail and smiling face. Completely self absorbed and caught up in their own difficult days spent in middle school, they didn't always notice the solid loving gaze of Stella. But Stella never cared and always waited faithfully for the days when one or both of the girl would come home, throw their packs on the floor and collapse into the dog, hugging her body and stroking her ears. Slowly the stress of the day wold leave their faces and Stella and her humans would be content for now.

Sometimes nothing I could say or do a a mom soothed those emotions as well as the yellow dog with the sweet brown eyes and unconditional loving heart. Whatever one's belief in a higher power or a God, there is no denying the gift to humankind that is dog. The use of Therapy Dogs in helping humans with all our trials and tribulations is the logical evolution sprung forth from our earliest days with our closest allies, the dog.

Works Cited
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(assistancedogsinternational.org)

" American With Disabilities Act 1990." ADA Home Page April 30, 2009 April 2009 (www.ada.gov)

"AKC Good Citizen Designation." American Kennel Club 2009, April 2009 (akc.org/events/cgc/program)

Barker, Sandra B. Ph.D and Kathryn S. Dawson Ph.D. "The Effects of Animal-Assisted Therapy on Anxiety Ratings of Hospitalized Psychiatric Patients." Journal of the American Psychiatric Association. (1998) 12-15

Banks, Miriam R. and William A. Banks. "The Effects of Animal Assisted Therapy on Loneliness in an Elderly Population in Long Term Care Facilities." Journal of Gerontological Society of America, (2002) 34-35

Burrows, Kristen E and Cindy L. Adams and Suzanne T. Millman.
"Factors Affecting Behavior and Welfare of Service Dogs for Children with Autism Spectrum Disorder." Journal of Applied Animal Welfare Science, Department of Population Medicine (Jan-March 2008) 19-23

Cole RN, MN, CCRN, Kathie M. and Anna Gawlinski RN, DNSc and Neil Steers Ph.D. "Animal Assisted Therapy in Patients Hospitalized With Heart Failure". Journal of American Association of Critical Care Nurses, (2007) 119-120

Coren, Dr. Stanley. "The Intelligence of Dogs" . New York, NY, Bantam Books, April 1995

Crawford, Jacqueline J., Pomerinke, Karen A. "Therapy Dogs: The Animal Human Healing Partnership" . Amherst, NY, Prometheus Books 2003

"What is a Service Animal/Dog" The Delta Society-The Human-Animal Health Connection. 2009, April 2009 (www.deltasociety.org/page.aspx?pid=303)

Fielder Julie "Dogs Heel Autism" NBC New York May 5, 2009, May 8, 2009(www.nbcnewyork.com/health/topics/Dogs-Heel-Autism)

Nagengast, Sunny Lynn. "The Effects of the Presence of a Companion Dog on Physiological Arousal and Behavioral Distress in Children During Physical Examination". Journal of Pediatric Nursing (1997) 323, 328-329.