I’ve learned that people will forget what you said,
people will forget what you did,
but people will never forget how you made them feel.
            – Maya Angelou

One of the very first things I learned when I started visiting hospitals with a therapy dog was that the people I visited were touched by what they perceived as a random act of kindness. I didn’t know them. My dog didn’t know them. From their perspective, there was no reason for me to take time out of my life to visit with them. My visits are most often with patients who have cancer or spinal cord injury, or who are in hospice care. Over the years, I learned that kindness equals love; love equals hope, and with hope comes healing.

I thought I would start with a story to put things in context.

A woman in her mid-thirties was diagnosed with ovarian cancer. The diagnosis was unexpected. She had four kids aged 6 months to 6 years. She received the diagnosis on a Thursday. On Friday she searched for more answers. Saturday found a new team of physicians. Sunday the new team determined she needed surgery immediately and by that evening she was admitted to the hospital for surgery on Monday. Her life was turned inside out very quickly. Thankfully her husband was able to remain with her the entire two weeks she was in the hospital—which was two-and-a-half hours from their hometown—and their kids went to visit relatives. After surgery, she was in the intensive care unit for several days before she was able to go to the oncology unit.

She has been my friend for a long time, so it was hard to learn she had ovarian cancer. I share her story because her case is not unusual. As we are friends, she knows of my work with animals, so every time we talked or texted while she was in the hospital she had only one question for me: “Where is the dog?”  She knew that if she asked enough times, I would get her a dog, and of course she was right.

It took a little while to get a visit scheduled because she had been in the ICU. But when a dog arrived she was so happy. She got up and out of bed on her own, which was a major accomplishment. At that time it was very hard for her to breathe, so anything we could do to inspire her to move was a good thing. Sometimes an animal doesn’t have to “do” anything—their presence is enough to change the mood, to inspire someone to get up—there is a long list of things that therapy animals accomplish.

My friend’s current treatment plan is to receive chemotherapy as an outpatient. When she is in the treatment center, she looks forward to continued visits with therapy dogs. It has only been a few months since her diagnosis, and we are hopeful.

The difference an animal-assisted intervention (AAI) can make in a patient’s recovery is amazing. There are more than 400 published articles and many books detailing evidence that animal-assisted interventions are beneficial to humans. For every article and book there are countless untold stories of the amazing work these animals and their handlers do every day.

The effect of an AAI on six mood states from a self-report assessment called the Profile of Mood States survey.

How do we know that animal-assisted interventions really work?

There is evidence that one 15-minute visit with a therapy animal team can ease anxiety, loneliness, pain, and also lower blood pressure. All of these negative feelings are common for people undergoing treatment in a hospital, and so it makes sense to include AAI as a complementary care program.

Psychoneuroimmunology demonstrates that higher stress levels decrease healing and recovery. The figure to the left shows how AAI reduces stress and improves well-being. In other words, an animal-assisted intervention can have a positive effect on a patient’s immune system and ability to heal, through the psychological benefits the patient feels during the visit. Since AAI is typically a low-cost program, it is being implemented by more and more facilities. The challenge as AAI increases for behaviorists is to ensure the well-being of our animals as they work in challenging environments.

Why might animal-assisted interventions work?

The prevalence of animals in human lives is reflected in the statistics. Survey data from the Humane Society of the United States shows that almost two-thirds of U.S. homes have a pet, and 44 percent of pets are dogs. Many American owners think of dogs as family members.

It is hardly a mystery, then, that there is a strong presumption that interactions between animals and patients in a clinical setting can provide therapeutic benefit to patients in a number of dimensions.

How does this relate to therapy work? For behavior purposes, humans are removed from an environment in which we are familiar, our routines in which we find comfort are no longer present, and when we no longer have access to family members it can cause anxiety. In 2012, two-thirds of respondents to the survey said that they consider their dogs to be family members, and the data suggest that this proportion will continue to increase.  Bringing a dog (or other therapy animal) in to visit someone who feels like dogs are family members may provide them with a sense of familiarity and comfort.

 A mutually beneficial relationship

In our work as animal behavior consultants, we need to be mindful of two areas of interaction as we observe behavior—the human animal and the non-human animal.

We know that the human-animal bond is defined as being a mutually beneficial and dynamic relationship between people and animals. The relationship between humans and animals is one that should positively influence the health and well-being of both the person and the animal.

It is well known that animal-assisted therapy work is not inherently stressful for dogs. In fact, given that it appears that dogs who do enjoy petting and welcome interactions with new people have an almost limitless capacity for it, therefore we can conclude that a carefully conducted and monitored AAI visit can be good for the dog’s well-being too.

When the relationship is no longer mutually beneficial, however, a human needs to intervene and make a change for the animal’s well-being. We, the humans, need to be ever mindful of the mutually beneficial aspect to the human-animal bond as we work with animals.

When we observe an AAI team in action, we should ask ourselves the following:

1.  What is the environment?

2.  What are the humans doing?

3.  What is the animal doing?

4.  What about the animal’s body language suggests that it is comfortable or uncomfortable with the interaction?

A visual example

Flashcards illustrating the “Life is Good” or Green Zone and the “Danger Zone”

This was a staged photoshoot designed specifically to capture certain types of signals. We used volunteers to act as patients. The event was held in a hospital; we were able to access a new ICU area that was scheduled to open in one week. We kept the photo session within the normal AAI visit boundaries (under two hours), and we provided ways to destress the dogs after every stressful session.

I include it here because it is useful for behavior consultants who work with therapy animal handlers to have context-specific resources: pictures of dogs in the hospital environment where the handler is going to be make it easier for the handler to apply the information to their own situation. Flashcards showing what to look for can also be useful when assessing and teaching new AAI handlers.

Charlie the dog (who, by the way, has no eyes) is allowed to be as close to a patient as he is comfortable. There is a lot of background noise and the room is very crowded. The crowd isn’t visible in the photo.

 Scene one: relaxed

The animal is comfortable and in the “Life is Good” or Green Zone. He is not stressed and is welcoming interactions. Both he and the person he is visiting are benefitting from the experience.

When observing body language, it helps to take a systematic approach, starting at the nose and working back. Charts can help behavior consultants structure their observations, and they can be a good visual reminder for handlers to look at the dog as objectively as possible.

Scene two: stressed

As you can see in this photo, Charlie the dog is being coerced to be as close to the patient’s face as possible.

The animal is clearly stressed, and in the danger zone. Here is what an experienced handler or behavior consultant would see:

In this photoshoot, the handler continued to coerce Charlie to move forward and the patient embraced him in a hug. Here we can see even more clear stress signals. The patient is trying to get to the dog, and the handler is trying to make the patient happy. What do you think could happen next?

At this point, the handler should intervene. We cannot expect patients to understand canine body language; but as consultants we can teach handlers to recognize signs of stress and provide ways to make the situation less stressful for the dog before problems arise, and ideally even in a way that allows the patient to continue interacting with the dog.

How do we change the picture for our animals if they are in a stressful situation?

If you can, ask the person you are with to have your animal perform a trick. Maybe you can have them teach your dog a new trick. Visiting with college students during campus relief days is how Ella, my Cavalier King Charles Spaniel, learned how to twirl. Ella loves to twirl so much that she offers twirls before she does any other behavior. You ask her to sit: twirl, sit.  You ask her to down: twirl, down.  Of course, it doesn’t help that we always laugh—so now this behavior has become self-rewarding!  That is the point of tricks—they change how we view the situation. Our body language changes when we ask an animal to do a trick, and when they perform everyone is happy, even if the performance isn’t perfect.

The other thing to do is have a few games handy. Games can range from rather simple to complex tasks. The purpose of the games is to engage the patient or client with the animal, which means that the game does not need to be complicated. The sky is the limit with games—put out an “easy button” and see what happens. The point is that games can defuse stressful moments. Games engage both the humans and the animal, and strengthen the nascent bond between the patient and the therapy animal.

Remember, the work we do should strengthen the human-animal bond, not exploit or deplete it. When the work we are doing stops being beneficial to both the human and the animal, we need to evaluate the situation and make a change.

Patricia Tirrell, CPDT-KA, is a National Program Educator Emeritus and licensed Evaluator for Pet Partners. She loves working with animals that have disabilities—particularly blind or visually impaired dogs. She has a strong belief that education for humans is just as important as education for our animals.