Animal-Assisted Psychotherapy

Theory, Issues, and Practice

Nancy Parish-Plass

• Publisher: Purdue University Press
• Year: 2013
• eBook ISBN: 9781612492742
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The integration of animals into the therapy setting by psychotherapists has been a growing trend. Psychological problems treated include emotional and behavioral problems, attachment issues, trauma, and developmental disorders. An influential 1970s survey suggests that over 20 percent of therapists in the psychotherapy division of the American Psychological Association incorporated animals into their treatment in some fashion. Anecdotal evidence suggests that the number is much higher today. Since Yeshiva University psychologist Boris Levinson popularized the involvement of animals in psychotherapy in the 1960s, Israel has come to be perhaps the most advanced country in the world in the area of animal-assisted psychotherapy (AAP). This is true especially in the areas of academic training programs, theory-building, and clinical practice. Great effort has been put into understanding the mechanisms behind AAP, as well as into developing ethical guidelines that take into account the therapist's responsibility toward both client and animal. This book exposes the world to the theory and practice of AAP as conceived and used in Israel. It emphasizes evidence-based and clinically sound applications with psychotherapeutic goals, as differentiated from other animal-assisted interventions, such as AAE (animal-assisted education) and AAA (animal-assisted activities), which may have education or skills-oriented goals. Not just anyone with a dog can call him-or herself an animal-assisted therapist. This volume demonstrates not only the promise of animal-assisted psychotherapeutic approaches, but also some of the challenges the field still needs to overcome to gain widespread legitimacy.

THEORY

1

THE INTEGRATION OF ANIMALS INTO THE THERAPY PROCESS AND ITS IMPLICATIONS AS A UNIQUE MEDIUM IN PSYCHOTHERAPY

Dror Oren and Nancy Parish-Plass

The most visible creatures I know of are those artists whose medium is life. The ones who express the inexpressible … without brush, hammer, clay, or guitar. They neither paint nor sculpt—their medium is being. Whatever their presence touches has increased life. They see and don’t have to draw. They are artists of being alive.

—Anonymous

INTRODUCTION

At this time in the development of animal-assisted psychotherapy (AAP), which is still in its infancy in terms of the state of research and theory development, it is necessary to find a way to understand the mechanisms behind the processes that occur in AAP. Appendix B contains a list of the various roles animals fulfill in psychotherapy, according to various psychological theories, which sheds light on this subject. In this chapter we come from a different direction, describing a unifying model that delineates the implications for the psychotherapy process of the presence of an animal, in all that this presence entails, as a medium through which the process of psychotherapy takes place. This is a model borrowed from the world of philosophy, scientific literature, and cultural literature, specifically pertaining to art. In psychoanalytic writing, the concept medium is borrowed from the world of communication (McLuhan, 1964) and from the world of art criticism.

It is important to remember that almost anything can be used as a medium in the therapy setting in order to express feelings: dreams, inanimate objects in the room, play, and even the therapist him- or herself. Any of these mediums may serve as a mediator, an object of projection, as a way to express one’s inner world. Of course, some of these mediums may be chosen by the therapist. Therefore, it is the responsibility of the therapist to deepen his or her understanding of the potential and the limitations of the medium chosen. This chapter discusses animals and all that they bring with them into the psychotherapy process as the medium in AAP.

From our experience, compared to the mediums of other psychotherapies, the presence of animals in the therapy setting adds a richer and more multifaceted medium, characterized by a width and depth that deserves inspection. This conceptualization of the presence of the animal as a medium, as a source of enrichment for the therapy process, was borne out of our discussions of Ishai, Oren, and Ishai’s article, “Medium for Expression and Medium for Healing: On Medium in Therapy” (in press). These rich discussions eventually led to this chapter.

This chapter starts with a general discussion of the term medium in the context of psychotherapy, including its definition and an explanation of the use of a medium, in terms of the therapist, the client, and what exists and develops between them. The use of a medium in psychotherapy, together with its intricacies, implications, and advantages, is also discussed. Next, the chapter focuses on the concept of the presence of an animal (or animals) in the psychotherapy setting as a medium, with all that this entails. The various unique qualities of the animals and their surrounding environments, their effect on therapist and the client, and what they may contribute to the therapy process, are discussed. (In Chapter 2 the implications of the relational qualities of the involvement of animals as a medium are expanded upon. Chapter 9 examines the various dilemmas and issues that need to be addressed when the involvement of animals is used as a medium in psychotherapy.)

THE USE OF A MEDIUM IN THERAPY

Definitions of the word medium are many and varied. According to Merriam-Webster (Medium, n.d.), some of the definitions more relevant to our discussion are (1) a means of effecting or conveying something, such as a substance regarded as the means of transmission of a force or effect, or a surrounding or enveloping substance; (2) a mode of artistic expression or communication, or material or technical means of artistic expression; and (3) a condition or environment in which something may function or flourish, or a nutrient system for the artificial cultivation of cells or organism.

As can be seen, some of these definitions grew out of art and the philosophy of art and its derivations, while others grew out of a biological model. The intent of the model presented in the article “Medium for Expression, Medium for Curing” (Ishai, Oren, & Ishai, in press) is that the medium answers the following definition: “The medium is that through which messages are transferred from the therapist to the client and from the client to the therapist, as well from each to themselves. A medium may be general or unique, consistent or variable, facilitating or restricting, simple or multi-faceted.” According to Ishai, Oren, and Ishai (in press), a medium is a unique means of communication in therapy, a mediating factor through which one’s inner world may be expressed. Different types of mediums influence the experience of therapy in different ways, and mediums may be used in a number of ways. While often it serves as the channel for the communication of messages, it sometimes turns into the content itself (in the case of talking as a medium, talking about how one talks). At other times the medium may stay in the background, part of the general atmosphere, present in case the therapist or client chooses to make use of it. “The client has the feeling of having the right to choose the medium through which he asks to transmit his expressions, and within which he is interested in having contact with his therapist” (Ishai, Oren, & Ishai, in press).

Similar to D. Winnicott, we distinguish between the therapist-client relationship and the communication that exists between the therapist and the client. Communication is based upon the behavioral expression of an idea, a desire, an attitude, or an emotion. A relationship is the specific emotional entity that exists within the context of interpersonal interactions, whereas communication is the mode through which the relationship is created, expressed, and exists. In order to better understand the dynamics of communication, it is essential to explain its elements.

Communication involves different actions, the central ones being expression, transmission, comprehension/listening, deciphering, pausing (experiencing), giving of meaning, reaction, and expression of that reaction. These actions usually occur in this order, simultaneously existing in parallel as a type of echoing which enriches the communication process. There exists between them overlapping and changes in the order of occurrence (e.g., first reacting, and only afterward giving meaning). Various mediums specialize in one or more of these actions. The most efficient medium performs all of these actions. Most of the time, it is acceptable to relate to language, including speech, writing, and reading, as the most efficient mediums. However, different theoretical and clinical approaches might recognize the need for additional, nonverbal mediums in order to reach certain therapeutic goals. These mediums may be used as alternatives or in conjunction with the verbal medium. It is important to remember that everything can serve as a medium. The therapist may suggest various mediums found in the room (e.g., the chair, game, or sand), which are then talked about (“Here one can talk about everything,” or “I see that you always choose to sit in the rocking chair instead of on the couch”) and expressed by asking direct questions (“The dream sounds very interesting. Tell me about it.” Or, “Winning the game seems very important to you. How do you feel when you lose?”), as well as by indirect reference and hints. Not only may objects be mediums, but also a client is likely to use relating to objects in the clinic, to the therapist, to the headlines in the news, or money, as mediums through which the client can express him- or herself.

Certain mediums are common to most psychotherapists, such as emotional expression and use of the world of emotions in general, the attempt to give meaning, a search for patterns, and use of empathy and understanding. In addition, most therapy is based upon an overall theory that people experience the world according to the way in which they perceive it and then conduct themselves accordingly. Therefore, the goal of therapists’ work is to give clients a perception that they have a higher degree of control over their life than they had before, or were aware of. Furthermore, mediums develop within therapy which are charac teristic of each therapist, client, and approach. When therapists have a unique medium to which they ascribe importance, such as play, art and artistic expression, musical instruments, or an animal and his environs, they will introduce it into the therapy setting. It may happen that a certain client will be referred to a therapist specializing in a certain medium, out of an assumption that that the client will relate to this medium and use it for self-expression. Clearly, the client comes with his or her own mediums, such as physical attributes, perception of the role of luck, personal theories of the way others relate to him or her, and so forth. The therapist may be a medium for the client, due to voice qualities, physical appearance, manner, personality (serious or with a sense of humor), and such. Of course, the therapist may also become the medium through the client’s projections. With some adult clients, and more often with child clients, projection may express itself in concrete touch, which may force the therapist to take his or her body out of the range of possibilities.

In medium-sensitive therapy, it is important to identify the difference between the therapist’s medium and the client’s medium. In addition, it is assumed here that a necessary requirement for the therapy process is, among other things, the creation of the connection, a third unique medium common to both client and therapist which serves as a bridge between their mediums. It is important to understand the differences between various mediums which are generated by distinct theories and types of clinical interventions. This raises many questions, for instance those regarding hierarchy, such as which mode of language is preferable—verbal, pre-verbal, or body; which medium is appropriate; which has more power, or larger influence, on the process of therapy and its results—theory or practice; and whether therapist-client communication should be explicit or implicit. Other questions arise and touch upon experiences of interpersonal and intersubjective partnership, such as, Is it possible to relate to the therapy experience as uniform and homogeneous—that is, involving the use of only one medium? Perhaps the increase in the number of mediums present in each communicative process testifies to the heterogeneous nature of the experience and explains the difficulty of obtaining the internal and continuous sense of development and freedom? And together with this, does the effort to communicate in a therapeutic manner obligate us to create uniformity, unity, and even merging or symbiosis?

According to our conceptual approach, three principle generators create the cure for mental health problems, the change that therapists aspire to achieve in the therapy process: theory, technique, and medium. Theory is the collection of explanations which serve us in our search for understanding. Technique (or intervention) is the practical plane within which the therapist functions in order to create the change. Examples of this would be questioning, body language, reflecting, and interpretation. A medium is the unique mode through which a specific client expresses him- or herself in any given situation. The medium is present in between theory and technique and is neither of them. Our view is that the medium is equal to therapy and technique in the therapy experience. In psychotherapy, the mediums of the client come in contact with those of the therapist. With the development of the therapy process which is medium sensitive, at the center can often be found the creation of a bridging factor, a third medium. This additional medium, discussed later in this chapter, has a unique place in the communication between the client and the therapist within therapeutic space.

From this discussion, it becomes clear that alongside the influences of theory and technique, the medium is a powerful generator of occurrences and situations and thus significantly influences the therapy process. It is important to understand the extent to which the medium determines the nature, progress, and results of the therapy. Therapists must be aware of, and well acquainted with, the medium employed, as well as the medium which was chosen by the client, to discover and understand the nature of the medium common to both therapist and client, to use it, to decipher its messages, and to become acquainted with its potential for dominating the therapy. Therapists must take responsibility for the medium they choose, as well as the client’s medium and any ensuing medium that develops from within the therapy relationship. That is, care must be taken by therapists not to let the medium take over the therapy, nor to become the focus of the therapy instead of the clients, their issues, and their progress in therapy. Therapists must ensure that any medium be allowed to change and evolve according to developments within the therapy process. And finally, therapists must be open to additional mediums throughout the therapy—that is, let their chosen medium live “in peace” with other mediums that might also help the therapy process.

In therapy that is medium sensitive, the therapist must become acquainted with the various appearances, uses, and levels of the medium. For instance, in the case of speech as medium, not only must the therapist be aware of talking and language, but also of the elements of language, as well as a variety of representations and the way in which they are created. This demands sensitivity and attention to the material and physical properties of the medium, to its effect on the senses, and to its design and technology (activating and operating). In this example, the technology is language structure, syntax, semantics, and experience of language. Sometimes it is the musical quality of the voice, its harmony and disharmony, and sometimes it is the activity of quietness, of being quiet, of listening. This medium, which operates from within the therapy, may be joined by other language-related mediums from without: text messages, communication by telephone, e-mail, writing, and so forth.

Opportunities Afforded by the Medium—a Window to That Which Cannot Be Expressed

There are many barriers to communication in therapy, as in any social situation. Clients may or may not agree to talk about or express various content or emotions, or even be able to do so. The source of these barriers may be cognitive or emotional in nature. Clients may not be able to express to others, or to themselves, due to anxiety level, fear of the emotional reaction of others (e.g., anger, disappointment, sadness, humiliation), out of loyalty (fear of hurting a loved one), and so forth. In addition, within the therapeutic discourse, the therapist might discover the “treason” of talking: Inexact words and thoughts that are incomplete may be impossible for some to express, and accompanied by tense behavior and body language incongruent with verbal expression. Thus is established a barrier to connection, because despite the fact that the medium of talking is supposed to bear the content and pass it on to the psychotherapist, in this case communication through the use of the medium of talking is blocked or distorted.

Here one can see that it is essential that the therapist distinguish between interactions/relational patterns (in this case, talking) and communication (in this case, body language and tone of speech), and understand the relationship or correspondence between the two. The medium of body language served as a threshold into the client’s inner world, allowing expression—consciously or unconsciously, to self or to the therapist—of that which lay behind the barrier. The body language belied the client’s verbal language, presenting an alternative channel of communication. The fact that the client was unintentionally passing on messages to the therapist through nonverbal means, despite his or her not wanting or the inability to do so verbally, illustrates that one medium may be more dominant (expressing truer content) than another. It is essential that therapists recognize and are well acquainted with the qualities and potential for expression of the mediums they choose to employ, as well as of those of mediums which exist in every therapy setting, and even of the unique relationships and interactions between mediums for each client.

As was mentioned earlier, a medium may be a condition or environment in which something may function or flourish, or a nutrient system for the artificial cultivation of cells or an organism. In other words, the presence of the medium serves as a given as a field of communication, about which may be spoken or unspoken, known or unknown, sort of like the air we breathe, or like speech that we take for granted and use without thinking about it. It is present, whether we use it or not, at any given time, enveloping us whether we are aware of it or not. It is exactly this seemingly simple, naïve nature of a medium which allows clients to use it unself-consciously, without feeling defensive, thus feeling that they are not letting their defenses down. They continue to feel safe, while unaware that they are expressing that which is within.

It is essential to identify and distinguish between that which has been till now left outside of expression and communication, yet is deserved of discovery and needs to be expressed, stated, and worked through, and that which is psychologically dangerous to the client and will (should?) not be said and exposed under any circumstance. Such co...

Table of contents

• Cover Page
• Halftitle Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Acknowledgments
• Preface
• Introduction
• Theory
• Issues
• Practice
• Conclusion
• Appendix A. The Child and the Animal and the Potential Space Between: A Comparison of Animal-Assisted Education and Animal-Assisted Psychotherapy
• Appendix B. Roles of Animals in Animal-Assisted Psychotherapy
• Appendix C. Code of Ethics: The Israeli Association of Animal-Assisted Psychotherapy
• Appendix D. The 18th Session of the Israeli Knesset
• Appendix E. Representative Certificate Program in Animal-Assisted Psychotherapy
• Contributors
• Index