Course excerpt from Ethics & Risk Management: Expert Tips 8
Most people enjoy dogs and find great pleasure in having them around. All of that is fine, but there is a growing trend among those who want to be with their dogs that should be of particular concern for therapists.
Therapists are frequently being asked by their patients to attest to their need for an Emotional Support Animal (ESA) for mental health purposes, which allows that animal to be present in what previously would have been a restricted environment.
Theoretically, the presence of the ESA has positive psychological impact on the owner and reduces the impact of a diagnosed psychological disability from which the owner suffers. In order for an ESA to be classified as such, a mental health professional must write a letter stating that presence of the pet mitigates symptoms of that disability.
Most mental health professionals do not know the complexity of this area of regulation. Yet, many seem more than happy to certify their patients as being in need of an ESA. Under the law, ESAs are not the same as psychiatric service animals and they do not require the training that is necessary to certify an animal as an American’s with Disabilities Act (ADA)-compliant service animal.
However, ESA status does allow the animals to be in otherwise restricted areas such as aircrafts and housing that otherwise prohibit pets. The Air Carrier Access Act (ACAA, 14 CFR 382, 2003) specifically requires airlines to allow service animals and ESAs to accompany their handlers in the main cabin of an aircraft at no charge.
While appropriate documentation from a therapist does not allow the ESA access everywhere, it requires waiving a no-pet rule and also any related damage deposit in housing that does not otherwise allow pets. This is because, under the Fair Housing Act (FHA) (42 U.S.C. 3601), an emotional support animal is viewed as a “reasonable accommodation” in a housing unit that has a “no pets” rule for its residents and the imposition of a fee would be contrary to the purpose of the law (https://www.animallaw.info/article/faqs-emotional-support-animals).
Given this information, we make the following suggestions to therapists who may find themselves in the situation where a client is requesting an ESA support letter:
- Such an activity is considered extra-therapeutic and is similar to providing disability statements for clients. Consequently, it is not without administrative risk and can significantly complicate therapy if not handled properly. This complication includes the development of role conflicts and related conflicts of interest that place the therapist’s job as a treating professional in conflict with the role as evaluator.
- The APA’s Specialty Guidelines for Forensic Psychologists consider extra-office practices, like writing an ESA letter, to be forensic-like activities because they are providing administrative information to others to assist them in addressing the patient’s psychological condition for a non-clinical purpose. Therefore, this is arguably not a clinical activity and frequently has nothing to do with treatment.
- Be mindful in writing ESA-support letters. It is a crime to fraudulently certify an animal as a service dog or an emotional service animal, putting the therapist who does so in potential legal trouble. Further, should the special accommodations recommended in the letter written by the therapist become a matter of legal dispute, they may be called upon to justify statements in a deposition or in open court.
The research evidence is limited. Very few controlled empirical studies support the conclusion that the presence of animals impacts loneliness and is actually longitudinally therapeutic. In fact, the empirical research on this topic is inconsistent and is clearly in the early stages of development (Ensminger and Thomas, 2013). While patients might want their animals to travel with them, and even feel that they need the animal to feel safe or better, there is questionable evidence that this does anything therapeutically.
Treating therapists have an important role in recommending that a patient has an ESA if that recommendation is part of a treatment plan. However, the therapist must remember that the recommendation for an ESA could result in a permanent state of affairs that could carry potential legal consequences if that certification becomes disputed and the animal is no longer clinically necessary.
The easiest way to avoid the dilemma of being asked to provide an ESA support letter is to clarify the limited evaluative activities the therapist is willing to perform as part of the initial informed consent. This type of clarification at the outset of treatment can go a long way in reducing problems that stem from patient requests for extra-therapeutic services.
Whether one agrees with the author’s conclusion that these types of evaluations are forensic, one must agree with the conclusion that separating the treatment issues from those that are administrative in nature avoids any potential role conflict and is in the best interests of the therapy. Remember, this is an official disability determination and not simply something designed to make the client happy.
Ethics & Risk Management: Expert Tips 8 is a 3-hour online continuing education (CE) course that addresses a wide variety of ethics and risk management topics, written by experts in the field. Course #30-99 | 2017 | 49 pages | 20 posttest questions
Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).