Therapy Dogs: Preventing Stress and Fatigue, Promoting Welfare

Written by Melissa Schiraldi

In the past four years as executive trainer for the Good Dog Foundation, I have been witness to moments that have left me gratified, awed, deeply moved, and absolutely certain of the substantive healing capacity of therapy dogs in animal-assisted interactions. I have been humbled in the presence of parents being comforted following the recent loss of a child, and seen advanced dementia patients’ eyes show a rare sparkle of recognition as they meet the shining eyes of a dog. I have seen therapy dogs provide child victims with the security they need to trudge the road of healing from trauma and abuse. I have sat with people from all walks of life in stressful and painful circumstances, and felt the palpable relief from their burdens, if only for a few moments, nestled in the warm fur of a visiting dog.

I believe fully in the work I do, and naturally I’m heartened to see the ever-growing body of scientific data that quantifies the healing effects these animals have on so many populations in need.  We know there are many studied physical and emotional health benefits to canine companionship; animal-assisted interactions (AAIs) aim to provide those benefits to people in situations where they are unable to have their own pet. And the scientific data supports that these programs have measurable effects for an ever-widening spectrum of vulnerable populations.

Only recently has science begun to evaluate the effects of AAIs on the animals themselves. Do AAIs have a beneficial or negative affect on the health and well-being of the dogs involved?

The data is promising — some well-executed preliminary studies show little evidence of stress in trained and tenured therapy dogs in AAI sessions. In separate pilot studies (Glenk et. al, 2014; McCullough et. al, 2018), analyzed measures of heart rate, salivary cortisol, and recorded stress behaviors to determine whether therapy dogs were subject to stress during AAIs. Encouragingly, measures of lowered cortisol and increased affiliative behaviors even suggested positive health effects in the dogs, dependent on some important factors.

Table 1 Overview of program definitions in animal assisted therapy

Table 2 - AAI Session Characteristics between session intervals and findings

These tables are from a literature review published by Glenk (2016) showing some of the studies she looked at and what they measured.

The key factor, of course, is hinted at above. Careful and appropriate selection must take place to ensure the right dog is engaged for this specialized work. We know as behavior professionals that social interactions — particularly with strangers and in novel environments — can be among the most significant stressors a dog can endure.

I remind potential volunteers wishing to evaluate their dogs for therapy work that, although the unique human-dog bond has co-developed over thousands of years, it is only recently that the idea of the super-social “friendly to everyone” dog has come into fashion. “Given the fact that dogs have been primarily bred for assisting humans in hunting, herding and guarding, they were supposed to recognize family members and be suspicious of unfamiliar individuals and/or intruders” (Glenk et al, 2014). Not very long ago, our preference was a dog that would perhaps be tolerant and amiable with strangers, but would not seek social engagement with people outside of their family. Accordingly, being approached, fondled, and embraced by strangers in unfamiliar environments may elicit discomfort in dogs, and this is in line with their selective evolution. Ideal therapy dog candidates with their saintly, social-butterfly temperaments, are truly exceptions, not the rule.

Winston the Labradoodle visits young people at a rehabilitation facility

Winston the Labradoodle visits young people at a rehabilitation facility

Along with this understanding of canine ethology and behavior, the emerging research gives us some helpful insight on where potential welfare concerns for dogs in AAI settings may lie, and how we can improve them. Circumstances that elicited stress behaviors and raised salivary cortisol levels in the studied AAI dogs will be less than surprising to behavior professionals: novel environments, tactile stimulation, restraint and handling by unfamiliar people, restriction of free movement, and the presence of young children can all be sources of stress even for an experienced therapy dog.

I warn new student handlers that my title of therapy dog trainer is misleading — candidates for my Therapy Skills class must already demonstrate fairly solid basic obedience and manners, for one, but even still the ‘training’ aspect is a relatively small and easy piece of the whole. What makes a spectacular therapy dog is strongly based on temperament. For simplicity, I’ll use the definition of temperament given by the American Temperament Testing Society, Inc.: “the sum total of all inborn and acquired physical and mental traits and talents which determines, forms and regulates behavior in the environment.” Most canine behavior professionals can agree temperament is to a large degree genetic, established early, and its essence cannot be significantly altered by new learning.

When I evaluate a potential therapy dog team, I am looking for a certain temperament in the dog — the type who instantly befriends strangers, adores being petted and handled, is calm and comfortable in the unfamiliar and distracting testing environment. If the dog’s body language is permitting, I will infringe upon them in all manner of ways I would never normally do to a dog upon first meeting! The dog should have no personal space issues and show no offense to my rude behavior.

In this initial meeting and throughout classes, I am evaluating the handler as much as the dog. An effective therapy dog handler truly enjoys interacting with people and can simultaneously communicate with and proactively read their dog. The strength of a therapy dog team — and the welfare of the working animal — lie in the connection between a well-suited, friendly dog and a patient, observant, empathetic and tuned-in human partner.

Teaching handlers to recognize and defuse stress in their dogs is a major component of Therapy Skills class. I want to give them an understanding of calming and displacement signals in dogs, but most importantly, I want to know the handler is aware of their dog’s particular baseline and stress signals. I start the conversation by asking each student how their dog expresses it when the dog is feeling anxious, stimulated, insecure? This is done in the very first class, and usually the dogs, understandably unsure as to why they are sitting in a room full of new people and dogs, are exhibiting some mild stress signals; they may be panting a bit more or have their ears just slightly back. It is a good time to point out that stress is inherent in any new experience, and it is important to recognize and defuse the subtler signs of moderate stress before they accumulate. (Inevitably there’s one Lab already asleep on his back, snoring contentedly, and we all have a laugh.)

Know your dog

Therapy Dog Brooklyn comforts a hospital patient

Therapy Dog Brooklyn comforts a hospital patient

As I go around the room asking each handler about their dog’s stress signals, we begin to compile a list of the subtle to overt signs of stress. Throughout the six hours of class I will regularly ask handlers to describe what they observe in their dog — what do their eyes, ears, mouth, tail, body posture look like?

Selecting an appropriate facility or activity to participate in with their dog is another key component to avoiding stress and fatigue. Studies that measured salivary cortisol and recorded behaviors in AAI dogs found that dogs showed more affiliative gestures when participating in certain activities — for instance when being talked to by a child or playing with a toy — over others, like being brushed or read to by the child. This may not be groundbreaking news, and we know as behavior professionals that ritualized behaviors, and even cortisol measures can be indicative of “good” or “bad” stress entirely dependent on context. Further, many behaviors such as lip-licking, ground-sniffing, and our Therapy Skills class favorite, the shake off, can actually be healthy self-regulating strategies by the dog. So the real takeaway is to be aware of your dog’s individual preferences, as well as what activities or types of stimuli are more likely to stress or calm them. Some of my certified therapy dogs are never happier than to lie in one spot and be visited by children in a reading program; others would become restless in such an environment, and perform much better in a hospital setting where they are moving from room to room.

Studies repeatedly suggested that novelty of the environment was among the most stress-inducing factors for AAI dogs. Student therapy dog handlers are instructed to arrive for therapy visits 10-15 minutes early to allow their dog adequate time to process their new surroundings. Choosing to visit a facility such as a residential assisted-living or a children’s classroom program, where the space, routine, and clients remain stable and will become familiar, can be an ideal choice for acclimating a new therapy dog to AAI.

Another recurring theme of the research that shouldn’t surprise any professional dog trainers: Time and practice were stabilizing influences. Older and more-experienced therapy dogs consistently exhibited less stress than their younger and less-experienced conspecifics.

Advocate for your dog

Although the results of preliminary studies were overwhelmingly positive in regards to therapy dog welfare, there were instances of rough handling by clients, which elicited avoidance and appeasement behaviors in the dogs. The experienced handlers in the studies promptly removed the dogs from the situation. Although dogs in Therapy Skills class must be tested for an appropriate response to unpleasant handling, it does not mean that we allow clients to manhandle our dogs.

Student handlers are asked to be aware of the kind of handling their dog does and does not like. We know there is evidence that many physical interactions enjoyed as affectionate by humans (e.g., petting the head, face-to-face contact, hugging, kissing) are not equally perceived as pleasant by dogs. A dog can still be a wonderful candidate for AAI even if they belong to the “don’t like hugs” club. Handlers are coached how to gently and politely educate clients to pet their dog appropriately: “He doesn’t love his tail being pulled like that, but he really likes when you scratch under his chin, just like this!”

Trust your dog

Dogs in Therapy Skills class are evaluated for social-seeking behavior with many different strangers, and further exposed to different medical equipment, disguises, surgical masks, prosthetics, odd movements, and unfamiliar affectations, to identify any hesitation or worry and instruct the handler how to compose and comfort the dog. Still, it may happen on a visit that a dog avoids interacting with a certain person. If these situations arise, we don’t want to hurt the feelings of the client, but our first priority is to advocate for our therapy dog partner. Handlers are given different training techniques and practices that may help facilitate a consensual and pleasant interaction for the dog. But we never coerce or physically push our dogs into a greeting. It is always acceptable and appropriate to say, “Please excuse us — I think Max is saying he needs a potty break!” Therapy dog handlers are encouraged never to underestimate the power of space. That may mean giving their dog just an extra moment to process their situation, or moving into a more open space to allow the dog to shake off and set their body, mind, and tail right again.

At this stage of the training process I remind handlers-in-training of what I told them in the beginning of the process — that so much the skill of a great therapy dog is inborn, and their handlers must increasingly learn to trust and respect what their dog tells them. This trust will grow reciprocally, and will continue to strengthen their enjoyment and the effectiveness of their AAI work together. A respectful and supportive owner represents a safe base of guidance and reassurance for a securely attached dog to regulate their arousal by transmitting their feelings of stress.

Therapy dog skills

Training for therapy dogs should be, above all, based on a strong relationship of mutual communication and trust between the dog and handler. Specialized operant training should incorporate choice and consent, and teach the dog that their handler will recognize and act upon the dog’s signals and cues.

Gentle leash pressure

Dogs in AAIs who were unleashed, and thus could freely move around the room, showed lower measured cortisol levels than dogs on leash. Most certifying and insuring organizations, however, do not allow for therapy dogs to be off leash during visits. Dogs trained to be responsive to very gentle directional leash pressure can be easily and fluidly guided through tight spaces while keeping a loose leash. But also, this subtle leash communication system can work both ways. When the slightest tension on the leash conveys meaningful information, the dog also has a means of communicating to their astute handler.


A hand targeting cue can be another way to maneuver the dog smoothly through tight spaces and/or subtly direct the dog’s attention toward a client in a way that allows the dog to give consent.

Remain in position for petting

Therapy dogs should be taught to remain still in position for petting and handling. This is not a skill we often teach pet dogs outside of competition obedience, but even a friendly dog rising from a sit to say hello could frighten or disrupt some of the fragile populations we visit. It is helpful to teach a hand signal which cues the dog to remain in position and that they will be touched and handled. Similar to cooperative care protocols, dogs may also be taught to give a ‘cut-off’ cue whereby by the handler will politely and skillfully end the interaction.

A graduating Therapy Skills class in Westchester, NY

A graduating Therapy Skills class in Westchester, NY

Response to name with eye contact

Handlers in Therapy Skills class are taught to practice saying their dogs name in a conversational tone, and praising and rewarding for eye contact. It is nice for clients when a visiting dog responds with eye contact to their name, and the dogs should be conditioned positively to prolonged eye contact so it is not disconcerting or threatening for the dog.

Fun tricks

We know that fun tricks can quickly become self reinforcing behaviors for dogs, and tricks can be a wonderful tension-reducer for therapy dogs and clients alike. Handlers are advised to be sensitive to the emotional and physical frailties of many of the clients we visit. “Bang bang, play dead” or “Give paw” are not advisable choices. “Speak” is not an appropriate trick, as therapy dogs should not bark, even on cue. A cute “Spin” or “Bow” or “Roll over” are more AAI-friendly behaviors.

With increasing popularity and the body of scientific evidence mounting to back up what we in the field already experience as an incredible capacity for healing and recovery, standards of practice are being worked on to legitimize these very special working dogs and protect their right to safely enjoy their work. The keys to ensuring the welfare of AAI dogs will be: selecting proper candidates based on temperament, thorough training and evaluation of both dog and handler, and a human teammate who astutely and objectively observes, understands, respects, and seamlessly communicates with and supports their working partner.


In loving memory of my therapy dog partner, Tino

In loving memory of my therapy dog partner, Tino

Melissa Schiraldi believes passionately in the healing power of the human-canine bond.  She began her training career with East Coast Assistance Dogs, where she became an ADI-Certified Service Dog Instructor. She is currently the Westchester-Fairfield Executive Trainer for The Good Dog Foundation, and takes a relationship-based approach to training companion dogs with her business, True Love Dog Training.