Emotional Support Animals

[cara susanna]

Thanks, these explanations make a lot of sense. Makes me wonder about how the VA bills for C&P.

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[Sanman]

Thanks, these explanations make a lot of sense. Makes me wonder about how the VA bills for C&P.

While I might be wrong, I don't believe they do. These exams really fall under the VBA umbrella, not the VHA umbrella. There really should be a Chinese Wall between these and any VHA work.

 

[erg923]

Thanks, these explanations make a lot of sense. Makes me wonder about how the VA bills for C&P.

Thats VBA. There is no third party payer.

 

[AcronymAllergy]

While I might be wrong, I don't believe they do. These exams really fall under the VBA umbrella, not the VHA umbrella. There really should be a Chinese Wall between these and any VHA work.

Agreed x100.

 

[PsyDr]

@beginner2011

I typically don’t give people that information. Learning how to look those numbers up is an extremely useful exercise that will serve you the entirety of your career.

You should always know exactly how much an hour of therapy pays. And what the percent collections are (ie., how many actually paid?). And how many hours you billed in a given day/week/month/year. That’s a very powerful tool for things like negotiating for business, making plans about your personal life, etc.


There are two surveys that include forensic rates out there that I know about. Feel free to look them up. Keep in mind that some big names are mixed in with that.

Charge too much, and you risk putting yourself in too high a league. It’s like when Hyundai started trying to sell their luxury models at the same price as Audi’s luxury models.

 

[psychRA]

I do not provide ESA letters, and I've also wondered where the welfare of the animal falls into this equation. I've had patients who brought their support animal with them everywhere (despite the fact that ESAs do not have protection to do so), and felt that it wasn't great for that animal's quality of life to be carted around like luggage. That's on top of the fact that, unlike a trained service animal, the support animal did not go through any training or preparation for this role, nor was the animal selected based on their suitability for being carted around. Depending on the patient, it can seem colossally unfair to the support animal.

 

[erg923]

I do not provide ESA letters, and I've also wondered where the welfare of the animal falls into this equation. I've had patients who brought their support animal with them everywhere (despite the fact that ESAs do not have protection to do so), and felt that it wasn't great for that animal's quality of life to be carted around like luggage. That's on top of the fact that, unlike a trained service animal, the support animal did not go through any training or preparation for this role, nor was the animal selected based on their suitability for being carted around. Depending on the patient, it can seem colossally unfair to the support animal.

Very true! I think there is much to be said about the fact that, while most people have a "soft spot" for dogs (the most common animal here), many actually do NOT.

I do not like the fact that a doctor signature should be able annoy a great many people and private business enterprises for the subjective need of ONE person...whatever their perceived need/want. It could be the proverbial "mangy mutt" for all I know. I am very hesitant to overrule the right of others to not be bothered by an animal that could very well be dangerous, annoying, unruly, unsanitary, property compromising, etc. in a shared space. You should be too.

 

[Fan_of_Meehl]

Very true! I think there is much to be said about the fact that, while most people have a "soft spot" for dogs (the most common animal here), many actually do NOT.

I do not like the fact that a doctor signature should annoy a great many people and private business enterprises for the subjective need of ONE person...whatever their perceived need/want. It could be the proverbial "mangy mutt" for all I know. I very hesitant to overrule the right of others to not be bothered by an animal that could very well be dangerous, annoying, unruly, unsanitary, property compromising, etc. in a shared space.

Many proponents of the ESA/ service animal movement get quite offended and irate if people fail to regard their support/service animal as anything other than 'durable medical equipment' that is 'medically necessary' to treat their disabling condition and that needs to be 'prescribed' by a licensed provider via a magic letter. And I'm not even kidding. Well, maybe about the 'magic' letter part (I added that bit myself).

 

[AbnormalPsych]

Very true! I think there is much to be said about the fact that, while most people have a "soft spot" for dogs (the most common animal here), many actually do NOT.

I do not like the fact that a doctor signature should be able annoy a great many people and private business enterprises for the subjective need of ONE person...whatever their perceived need/want. It could be the proverbial "mangy mutt" for all I know. I am very hesitant to overrule the right of others to not be bothered by an animal that could very well be dangerous, annoying, unruly, unsanitary, property compromising, etc. in a shared space. You should be too.

Yep, I know people who are allergic to dogs and even have been pretty brutally attacked by dogs as children. They want nothing to do with these animals. Definitely not to be trapped in an enclosed place with them (airplane, store, etc). Curious if there may be some personality ax profile for the ESA folks....

Hyundai

 

[Sanman]

What's wrong with Hyundai?

 

[DynamicDidactic]

What do you think?

Veterans and Service Dogs | Inside Higher Ed

Pets can play a huge role in getting through a stressful situation. In today's Academic Minute, the University of Alaska Anchorage's Ashley O'Connor discusses why. O'Connor is an assistant professor of social work at Alaska-Anchorage. A transcript of this podcast can be found here.

www.insidehighered.com

 

[AbnormalPsych]

Dogs are usually helpful for everything mentioned there - PTSD dx or not. Taking care of and being responsible for some being other than you usually does good things for people and their routines, etc..

And dogs are the best.

The intention and resulting psychological effect appears different than what one would get from - I need my pet owl or I cannot get on this plane.

 

[Fan_of_Meehl]

What do you think?

Veterans and Service Dogs | Inside Higher Ed

Pets can play a huge role in getting through a stressful situation. In today's Academic Minute, the University of Alaska Anchorage's Ashley O'Connor discusses why. O'Connor is an assistant professor of social work at Alaska-Anchorage. A transcript of this podcast can be found here.

www.insidehighered.com

I think it's quite possible (even preferable) to have a nuanced take on the whole 'service/support animal' to help folks with PTSD question (i.e., beyond a 'YES' or a 'NO').

However...

I'm finding it increasingly hard to take seriously any academic (or purportedly academic) article, book chapter, or professional presentation that does not at least (in good faith) ACKNOWLEDGE that:

There are two primary evidence-based approaches (and associated theoretical models) that enjoy the most support in relation to their efficacy in lowering the symptoms of PTSD over the course of the treatment: Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE). Of course there are other valid approaches/models but these two exemplify two areas of focus in the treatment of PTSD (namely, faulty beliefs or 'stuck points' and cognitive/behavioral avoidance) that basic clinical science supports as key maintaining factors for the condition. Likewise, targeting dysfunctional/inaccurate beliefs (such as, 'I HAVE to have my dog watch my back and alert me to danger when going to the store or I am likely to be attacked and injured') and targeting patterns of internal/external avoidance [with associated safety behaviors such as having to have your dog with you when going to the store] have been found to be critical in helping people with PTSD get better over time (especially as it relates to lowering the frequency/intensity/severity of core PTSD symptoms).

The focus shouldn't necessarily be on the dog. The focus should be on whether or not (and to what extent) the dog is supposedly utilized to either (a) beneficial effect via helping the therapist/client utilize empirically-supported principles of behavior change (e.g., behavior activation, physical exercise) to lower psychopathological symptoms--e.g., by having the dog serve as motivation for increasing exercise and counter-acting avoidance (of leaving the house) OR (b) deleterious effect via serving as a safety behavior to maintain/strengthen avoidance or as 'evidence' in support of a dysfunctional belief about not being safe without the dog or even as a focal point around which personality disorder characteristics can organize (e.g., via creating routine interpersonal conflict with store owners, neighbors, family members or others who would question the legitimacy or helpfulness of the dog as therapy for PTSD). Of course, whether the dog is being helpfully utilized to lower symptoms in the individual case can be approached straightforwardly as an empirical question (e.g., through symptom monitoring over time), however, the practicality of what the hell you do if you determine that the dog isn't helpful is notable (e.g., time to get rid of the dog now?).

My practical experience has demonstrated that the kinds of clients who insist on using a service/support animal as the centerpiece of their therapy aren't necessarily open to having their faith in that questioned or empirically investigated but my experiences may be anomalous.

 

[cara susanna]

Yes, the question isn't "are pets beneficial to mental health?" which I unequivocally believe they are. The quesiton is "do animals designated as emotional support or service improve someone's functioning and/or symptoms?"

 

[PsyDr]

With all due respect, unless the core conditions for an animal to have the label of service animal ( or emotional support animal when discussing housing and housing alone), then this discussion is really are about the benefit of pets.

Pets ownership likely requires aspects of behavioral activation, exposure/response prevention, social rhythm therapy, and such. However, there are rules that most have to follow. And it is unfair for a grocer to pay for a health code fine because a guy wanted to take his dog somewhere.

The ADA specifically states that:

1) the animal can only be a dog or miniature horse.
2) the individual must have a diagnosis that creates a specific impairment.
3) That the dog be trained to perform a specific task that ameliorates the specific impairment.
4) Animals whose sole purpose is providing emotional support do not qualify as service animals.

Providing motivation, keeping you on a schedule, forcing exercise, etc are all great. But those are not trained tasks.

And the term emotional support animal confers no special status outside of an apartment or rental house. Or in domestic flights.

 

[deleted480308]

With all due respect, unless the core conditions for an animal to have the label of service animal ( or emotional support animal when discussing housing and housing alone), then this discussion is really are about the benefit of pets.

Pets ownership likely requires aspects of behavioral activation, exposure/response prevention, social rhythm therapy, and such. However, there are rules that most have to follow. And it is unfair for a grocer to pay for a health code fine because a guy wanted to take his dog somewhere.

The ADA specifically states that:

1) the animal can only be a dog or miniature horse.
2) the individual must have a diagnosis that creates a specific impairment.
3) That the dog be trained to perform a specific task that ameliorates the specific impairment.
4) Animals whose sole purpose is providing emotional support do not qualify as service animals.

Providing motivation, keeping you on a schedule, forcing exercise, etc are all great. But those are not trained tasks.

And the term emotional support animal confers no special status outside of an apartment or rental house. Or in domestic flights.

and shouldn't even supply those

 

[Fan_of_Meehl]

With all due respect, unless the core conditions for an animal to have the label of service animal ( or emotional support animal when discussing housing and housing alone), then this discussion is really are about the benefit of pets.

Pets ownership likely requires aspects of behavioral activation, exposure/response prevention, social rhythm therapy, and such. However, there are rules that most have to follow. And it is unfair for a grocer to pay for a health code fine because a guy wanted to take his dog somewhere.

The ADA specifically states that:

1) the animal can only be a dog or miniature horse.
2) the individual must have a diagnosis that creates a specific impairment.
3) That the dog be trained to perform a specific task that ameliorates the specific impairment.
4) Animals whose sole purpose is providing emotional support do not qualify as service animals.

Providing motivation, keeping you on a schedule, forcing exercise, etc are all great. But those are not trained tasks.

And the term emotional support animal confers no special status outside of an apartment or rental house. Or in domestic flights.

This one...

3) That the dog be trained to perform a specific task that ameliorates the specific impairment.

Typically exists without a shred of empirical support from the literature and, oftentimes, the specific 'task' that the dog has been trained to perform actually may or may not be expected to 'ameliorate the impairment.' Many of them just seem to be chosen for their 'aaaaaaw...isn't that sweet' factor.

For example, people with PTSD will say, "My dog Zeus wakes me up from my nightmares (he can detect when I'm having one) so he 'helps' me."

It's just as plausible that waking someone from all their nightmares 2-5 seconds into the nightmare would have deleterious effects through deprivation of REM sleep (and subsequent rebound) and/or just simply breaking up the sleep cycle/architecture continually throughout the night every night (depending on the frequency of the nightmares).

I even had one patient tell me that his dog has some psychic link with him that causes the dog to awaken him BEFORE he starts having a nightmare or before he even starts exhibiting any signs of distress. I dunno...maybe. But I'm not aware of any empirical literature that specifically operationalizes this 'specific task' that 'ameliorates this specific impairment.'

These laws were written by idiot politicians (to spit-shine their public image and pander to the public) and many of the 'specific tasks' enumerated in letters that are authored by unscrupulous clinicians (claiming that these tasks are specifically effective at ameliorating the symptoms of PTSD) are writing checks that the empirical/scientific literature can't cash.

 

[PsyDr]

I have an “emotional support animal”. We acknowledge him as such because he’s a pit bull and many apartments have arbitrary breed restrictions. There’s no real evidence here (that ESAs are helpful OR that certain dog breeds are worse). My partner and I view this as a (useful) loophole. We would never take him on a plane....

it would be nice to live in a world where this pseudo science Isn’t needed/useful. Alas.

Lying to get something not owed to you. I guess that is a loophole. Reprehensible.

 

[gene_halpert]

I’ve deleted my post because it didn’t say what I was trying to add. Thanks for pointing that out.

Let me give more context; my partner has multiple mental issues (dx by a psychiatrist) and the dog definitely helps with that. Not allowing the dog to live with us would certainly damage his (and mine) well being. He nor I certainly did not “lie”. But there’s not exactly a ton of evidence (as mentioned here) about the benefits of an ESA. It’s interesting for me to sit with that contradiction.

The breed restriction situation I mentioned, though, is a common reason why people seek out getting their pet labeled as an ESA. I’m sure many people do lie and abuse the designation.

 

[PsyDr]

I’ve deleted my post because it didn’t say what I was trying to add. Thanks for pointing that out.

Let me give more context; my partner has multiple mental issues (dx by a psychiatrist) and the dog definitely helps with that. Not allowing the dog to live with us would certainly damage his (and mine) well being. He nor I certainly did not “lie”. But there’s not exactly a ton of evidence (as mentioned here) about the benefits of an ESA. It’s interesting for me to sit with that contradiction.

The breed restriction situation I mentioned, though, is a common reason why people seek out getting their pet labeled as an ESA. I’m sure many people do lie and abuse the designation.

If it is an actual ESA for an actual diagnosis, then I apologize. Your original phrasing indicated it was not.

An animal is either an ESA or it’s not. I can’t see any reason why it would be common for people to suddenly require an ESA, when moving to a place with breed restrictions. So that’s just a common justification for a lie.

 

[gene_halpert]

No, my original post was very flippant and I regret it.

But I think there’s a bit of discussion here. I think the definition of an “actual ESA” is not so clear, because it doesn’t have a huge evidence base (as far as I’m aware).

Our dog is wonderful, he certainly improves my partner and I’s mental health, and we would be devastated if we couldn’t have him. He does help with my partner’s diagnoses. But is he at the same level of efficacy as my partner’s psychotropic medications specifically for his diagnosis?

A sense of panic does happen when a person’s place of living suddenly applies new rules or regulations that means you can’t keep your pet. That is what ultimately happened to us. It’s complicated.

 

[Fan_of_Meehl]

No, my original post was very flippant and I regret it.

But I think there’s a bit of discussion here. I think the definition of an “actual ESA” is not so clear, because it doesn’t have a huge evidence base (as far as I’m aware).

Our dog is wonderful, he certainly improves my partner and I’s mental health, and we would be devastated if we couldn’t have him. He does help with my partner’s diagnoses. But is he at the same level of efficacy as my partner’s psychotropic medications specifically for his diagnosis?

A sense of panic does happen when a person’s place of living suddenly applies new rules or regulations that means you can’t keep your pet. That is what ultimately happened to us. It’s complicated.

I think it's also critical to realize that the main reason that--though legal definitions of service animals / ESA's are legally clearly 'defined'--they are not particularly well-defined from a professional clinical perspective because the popular 'movement' to characterize animals as some form of professional treatment for mental disorders originated with the media, politics and the University of Facebook/Twitter rather than from mainstream clinical and academic psychology/psychiatry. There are pockets of academics/clinicians who are doing some trial research on using animals for therapeutic effect but I have generally been unimpressed with their methodological or conceptual rigor. There was a decent article in PPRP a year or two ago that looked at the impact of service dogs for PTSD in terms of some physiological effects (affected morning cortisol or something) but even these studies and the broader published literature (scant as it is) on this stuff never addresses the serious theoretical flaws in the approach that I outlined earlier (i.e., that most of the 'helpful tasks' are actually embedded in a model of treatment of PTSD that is diametrically opposed to the basic treatment targets of CBT for PTSD--namely, correcting dysfunctional beliefs and reversing avoidance). Nor is it clear to me that--should animals be formally utilized as adjunctive 'treatment' for mental disorders--that it is clearly the role of the psychologist or psychotherapist to lead the application of such efforts. If they are considered 'durable medical equipment' then I'm happy letting occupational therapist colleagues handle the animal-assisted therapy end of things.

 

[R. Matey]

My practical experience has demonstrated that the kinds of clients who insist on using a service/support animal as the centerpiece of their therapy aren't necessarily open to having their faith in that questioned or empirically investigated but my experiences may be anomalous

I've seen this too so I'll second that, but it begs a question though: The idea of a service animal sets up the belief that the person using the service dog has a disabling condition that is permanent as service animals are usually used for disabling conditions that are permanent. I've wondered if service animals for mental health disorders are actually iatrogenic because they create the expectation that mental health symptoms cannot be resolved. Maybe there are short term, but not long term gains in well-being. Same goes with emotional support animals.

 

[Fan_of_Meehl]

I've seen this too so I'll second that, but it begs a question though: The idea of a service animal sets up the belief that the person using the service dog has a disabling condition that is permanent as service animals are usually used for disabling conditions that are permanent. I've wondered if service animals for mental health disorders are actually iatrogenic because they create the expectation that mental health symptoms cannot be resolved. Maybe there are short term, but not long term gains in well-being. Same goes with emotional support animals.

I think that in most cases they are iatrogenic via a number of pathways/mechanisms...many of which can be rationally elucidated (based on an understanding of basic behavior theory, cognitive theory, and other aspects of understanding psychological science and empirically-supported principles of behavior change as well as models of psychopathology maintenance. To my knowledge, NONE of these specific pathways (nor any supposedly 'therapeutic' pathways via which 'specific tasks' could help reduce symptoms) have been empirically investigated with a specific and critical eye towards rigorous hypothesis testing/falsification.

 

[PsyDr]

No, my original post was very flippant and I regret it.

But I think there’s a bit of discussion here. I think the definition of an “actual ESA” is not so clear, because it doesn’t have a huge evidence base (as far as I’m aware).

Our dog is wonderful, he certainly improves my partner and I’s mental health, and we would be devastated if we couldn’t have him. He does help with my partner’s diagnoses. But is he at the same level of efficacy as my partner’s psychotropic medications specifically for his diagnosis?

A sense of panic does happen when a person’s place of living suddenly applies new rules or regulations that means you can’t keep your pet. That is what ultimately happened to us. It’s complicated.

You again defined it as your pet. And that you got an ESA letter after having new contractual terms.

Seems like you saw some clear definitions.

 

[cara susanna]

As I've mentioned elsewhere (maybe even earlier in this thread), I'd argue that ESAs or service animals for PTSD could actually be harmful as they could constitute a safety behavior. "I'm not safe unless my dog is with me." "I can't tolerate my symptoms unless my dog is here to help me." Etc.

I'm on board with using animals as a step in the exposure or behavioral activation hierarchy, but eventually I'd want patients to "wean" off of them. Of course, that has led to more than one provider change request.

 

[WisNeuro]

As I've mentioned elsewhere (maybe even earlier in this thread), I'd argue that ESAs or service animals for PTSD could actually be harmful as they could constitute a safety behavior. "I'm not safe unless my dog is with me." "I can't tolerate my symptoms unless my dog is here to help me." Etc.

I'm on board with using animals as a step in the exposure or behavioral activation hierarchy, but eventually I'd want patients to "wean" off of them. Of course, that has led to more than one provider change request.

One of the vets I saw back in the day had his pet trained to "check the perimeter" before they went to bed. Simply appalling, training a behavior that would reinforce and strengthen maladaptive behaviors.

 

[R. Matey]

I think that in most cases they are iatrogenic via a number of pathways/mechanisms...many of which can be rationally elucidated (based on an understanding of basic behavior theory, cognitive theory, and other aspects of understanding psychological science and empirically-supported principles of behavior change as well as models of psychopathology maintenance. To my knowledge, NONE of these specific pathways (nor any supposedly 'therapeutic' pathways via which 'specific tasks' could help reduce symptoms) have been empirically investigated with a specific and critical eye towards rigorous hypothesis testing/falsification.

I was thinking about it more from the perspective of outcome expectations in psychotherapy being at cross-purposes: "the mean psychologist wants to take my dog away."

 

[Fan_of_Meehl]

I was thinking about it more from the perspective of outcome expectations in psychotherapy being at cross-purposes: "the mean psychologist wants to take my dog away."

Yeah...that happens, too. As we all know, anything that creates turbulence in the working alliance is bad for the therapy and, ergo, bad for the client.

 

[cara susanna]

I was thinking about it more from the perspective of outcome expectations in psychotherapy being at cross-purposes: "the mean psychologist wants to take my dog away."

Yup - I have found that, with some people, no matter how much you explain your rationale and try to make the process collaborative, and emphasize that you think pets (designated as such) are good for MH, will immediately "fire" you for even having the conversation about service dogs. Of course, they won't actually tell you this and you won't find out until your supervisor tells you about the provider change request (side note: is that a VA thing or more specific to my geographical area where we are known for being non-confrontational?)

 

[R. Matey]

Yup - I have found that, with some people, no matter how much you explain your rationale and try to make the process collaborative, and emphasize that you think pets (designated as such) are good for MH, will immediately "fire" you for even having the conversation about service dogs. Of course, they won't actually tell you this and you won't find out until your supervisor tells you about the provider change request (side note: is that a VA thing or more specific to my geographical area where we are known for being non-confrontational?)

 

[DynamicDidactic]

I was also trying to highlight that an opular academic website is disseminating this information without the necessary nuance and, in turn, reinforcing the use of ESAs despite serious concern from the field.

 

[cara susanna]

I was also trying to highlight that an popular academic website is disseminating this information without the necessary nuance and, in turn, reinforcing the use of ESAs despite serious concern from the field.

Ooh, good point. Too bad IHE no longer allows comments.

 

[R. Matey]

I was also trying to highlight that an popular academic website is disseminating this information without the necessary nuance and, in turn, reinforcing the use of ESAs despite serious concern from the field.

After a year at the UCC, this doesn't surprise me at all. We were inundated with requests for ESAs because client x just couldn't bear to part with Fifi for a year. We didn't do them, but official policy was to refer for an "assessment."

 

[cara susanna]

After a year at the UCC, this doesn't surprise me at all. We were inundated with requests for ESAs because client x just couldn't bear to part with Fifi for a year. We didn't do them, but official policy was to refer for an "assessment."

Out of curiosity, where did you refer them to for said assessment?

 

[foreverbull]

One of the vets I saw back in the day had his pet trained to "check the perimeter" before they went to bed. Simply appalling, training a behavior that would reinforce and strengthen maladaptive behaviors.

Wow, training your dog to engage in a compulsory behavior by proxy to alleviate your own fear...this is very interesting and takes safety behaviors to a whole new level.

 

[R. Matey]

Out of curiosity, where did you refer them to for said assessment?

I didn't refer. But, there was a list of psychologists who did them in the area. Making people aware of the cost of the evaluation was usually enough to dissuade them.

Edit: The assessments cost like $300-400.

 

[futureapppsy2]

On the service dog piece (NOT ESAs), I think there's some misunderstanding of the ADA here. The ADA is civil rights law focused on providing equal access and reducing/eliminating barriers for people with disabilities, not on treatment for medical or mental health conditions. So, the question of if service dogs are potentially iatrogenic for people with PTSD or other psychiatric disabilities doesn't come into play here (it's an important question clinically, of course, but it doesn't change the legal rights piece of it). If a service dog is legitimately trained in a task that reduces the barriers for someone with a disability (medication retrieval, alert behaviors, etc) and isn't causing a threat/major disruption to others, then the dog and handler are protected under the ADA. Do people sometimes rush to get psychiatric service dogs instead of more potentially effective treatments? Yep. Are service dogs potentially iatrogenic for people with PTSD? Very probably. Does this mean that you can decide that the ADA shouldn't apply to them? Nope.

 

[R. Matey]

On the service dog piece (NOT ESAs), I think there's some misunderstanding of the ADA here. The ADA is civil rights law focused on providing equal access and reducing/eliminating barriers for people with disabilities, not on treatment for medical or mental health conditions. So, the question of if service dogs are potentially iatrogenic for people with PTSD or other psychiatric disabilities doesn't come into play here (it's an important question clinically, of course, but it doesn't change the legal rights piece of it). If a service dog is legitimately trained in a task that reduces the barriers for someone with a disability (medication retrieval, alert behaviors, etc) and isn't causing a threat/major disruption to others, then the dog and handler are protected under the ADA. Do people sometimes rush to get psychiatric service dogs instead of more potentially effective treatments? Yep. Are service dogs potentially iatrogenic for people with PTSD? Very probably. Does this mean that you can decide that the ADA shouldn't apply to them? Nope.

So maybe informed consent then? Treatment, which resolves your PTSD symptoms might render the service dog useless to you. I don't know if you could still keep them as pets...

 

[futureapppsy2]

So maybe informed consent then? Treatment, which resolves your PTSD symptoms might render the service dog useless to you. I don't know if you could still keep them as pets...

That's an interesting question. I have several friends/colleagues with service dogs for physical disabilities, and I know service dog owners usually keep their dogs for a couple of years after the dogs "retire" from working, largely because the bond is so incredibly strong by that point.

ETA: Thinking of the actual text of the law, the question is specifically if the dog is a service animal required because of a disability and if the dog has been trained to perform a task that alleviates impairment or barriers due to a disability. I think trained but retired service dogs could conceivably fit under that. IANAL, though,

 

[cara susanna]

On the service dog piece (NOT ESAs), I think there's some misunderstanding of the ADA here. The ADA is civil rights law focused on providing equal access and reducing/eliminating barriers for people with disabilities, not on treatment for medical or mental health conditions. So, the question of if service dogs are potentially iatrogenic for people with PTSD or other psychiatric disabilities doesn't come into play here (it's an important question clinically, of course, but it doesn't change the legal rights piece of it). If a service dog is legitimately trained in a task that reduces the barriers for someone with a disability (medication retrieval, alert behaviors, etc) and isn't causing a threat/major disruption to others, then the dog and handler are protected under the ADA. Do people sometimes rush to get psychiatric service dogs instead of more potentially effective treatments? Yep. Are service dogs potentially iatrogenic for people with PTSD? Very probably. Does this mean that you can decide that the ADA shouldn't apply to them? Nope.

So that applies to, like, having the dog present in the clinic and stuff. But would it apply to the provider in terms of the treatment plan or providing documentation? Would it be an ADA violation if we refused the request or encouraged the patient not to use their service dog for PTSD?

 

[Fan_of_Meehl]

So that applies to, like, having the dog present in the clinic and stuff. But would it apply to the provider in terms of the treatment plan or providing documentation? Would it be an ADA violation if we refused the request or encouraged the patient not to use their service dog for PTSD?

Well...the upside is--if the law truly does COMPEL me to practice pseudoscience, false (unfounded) claims, and iatrogenesis...at least I can charge $300-$400 per 'assessment' for it according to some anecdotal evidence from earlier in this thread.

 

[R. Matey]

Well...the upside is--if the law truly does COMPEL me to practice pseudoscience, false (unfounded) claims, and iatrogenesis...at least I can charge $300-$400 per 'assessment' for it according to some anecdotal evidence from earlier in this thread.

You could work for certapet, it's only $149 a pop though

How to Get a Legitimate Emotional Support Animal (or ESA Letter)

Learn how to get a legitimate emotional support animal, legal requirements for an ESA letter, and how to avoid a registry scam.

www.certapet.com

 

[gene_halpert]

In an attempt to contribute something useful here I came across this article.

APA PsycNet

doi.apa.org

There’s a nice summary of the issues, many that have been brought up here, including possible effect on alliance. It focuses mainly on risk mitigation/liability rather than empiric evidence regarding efficacy (because there is little).

I don’t wish to speak further about my *personal* history with this topic, although I will say I have certainly been thinking about it in a more critical manner. Thanks for making me reflect on these things.

 

[PsyDr]

The service dog rules of the ADA do not use the term “barrier” at all. That term has a specific meaning in the disability literature.

 

[WisNeuro]

Well...the upside is--if the law truly does COMPEL me to practice pseudoscience, false (unfounded) claims, and iatrogenesis...at least I can charge $300-$400 per 'assessment' for it according to some anecdotal evidence from earlier in this thread.

I'll quit the profession before I do an ESA eval or write a letter for it. Luckily, only had a handful of requests for letters over the years. No one has pushed back after being told I don't do that and they should ask their PCP.

 

[Sanman]

I'll quit the profession before I do an ESA eval or write a letter for it. Luckily, only had a handful of requests for letters over the years. No one has pushed back after being told I don't do that and they should ask their PCP.

Well, ESA is not a service dog, so I don't think anyone will be forced to do it. I personally don't do them at the VA and most people that want an ESA letter really want a service dog they are allowed to take places. I simply educate them on the realities of getting a service dog (long wait list, 4-6 weeks of training in person they would have to attend, etc) and it usually quiets them right down. Now, for $400 cash an assessment, I can evaluate and write an ESA letter.

 

[WisNeuro]

Well, ESA is not a service dog, so I don't think anyone will be forced to do it. I personally don't do them at the VA and most people that want an ESA letter really want a service dog they are allowed to take places. I simply educate them on the realities of getting a service dog (long wait list, 4-6 weeks of training in person they would have to attend, etc) and it usually quiets them right down. Now, for $400 cash an assessment, I can evaluate and write an ESA letter.

Very true, my comment was somewhat hyperbolic for effect. But, for that matter, no one tells me what evaluations I will perform. I don't do ADHD evals. If my hospital told me I needed to do them now, I will ask where I should submit my letter of resignation. I refuse evaluations often with explanations of why testing is not important at this time, or at all (e.g., your patient is clearly delirious and moderately hyponatremic, why don't we wait until they stabilize at least, etc). I'm simply at the point in my career, in addition to my personality, that I don't need to be told what to do to complete my job, and I will not provide clinical services or recommendations for which there is clearly no clinical indication or no extant literature supportive of said recommendation.

 

[Sanman]

Very true, my comment was somewhat hyperbolic for effect. But, for that matter, no one tells me what evaluations I will perform. I don't do ADHD evals. If my hospital told me I needed to do them now, I will ask where I should submit my letter of resignation. I refuse evaluations often with explanations of why testing is not important at this time, or at all (e.g., your patient is clearly delirious and moderately hyponatremic, why don't we wait until they stabilize at least, etc). I'm simply at the point in my career, in addition to my personality, that I don't need to be told what to do to complete my job, and I will not provide clinical services or recommendations for which there is clearly no clinical indication or no extant literature supportive of said recommendation.

No need to give up a paycheck. I have simply pointed out to patients and my boss that at this stage of my career there are things that I simply will not treat due to my level of competence compared to other treatment options. I am a specialty provider who has not practiced in other areas in years and will not do things like accept complex PTSD patients due to overflow problems. Can I manage the basics? yes. Am I a certified EBP provider? no. The VA backs me up on this by denying my EBP training applications. No need to risk my license for the benefit of others.


EDIT: Sidenote, I just noticed I got my20+ year member tag. God, I feel old now.

 

[deleted480308]

Very true, my comment was somewhat hyperbolic for effect. But, for that matter, no one tells me what evaluations I will perform. I don't do ADHD evals. If my hospital told me I needed to do them now, I will ask where I should submit my letter of resignation. I refuse evaluations often with explanations of why testing is not important at this time, or at all (e.g., your patient is clearly delirious and moderately hyponatremic, why don't we wait until they stabilize at least, etc). I'm simply at the point in my career, in addition to my personality, that I don't need to be told what to do to complete my job, and I will not provide clinical services or recommendations for which there is clearly no clinical indication or no extant literature supportive of said recommendation.

Yeah, for every ESA request I have (not nearly as much as you so far likely), the real problem was “I want this apartment to either let me stay or not charge a pet deposit “

Nope