podcasts

Unleashing Comfort: The Role of Emotional Support Animals – Podcast

By Jason Clayden on April 9, 2024

MK Clarkin, a LifeStance Regional Clinical Director joins us for a detailed and enlightening discussion on Emotional Support Animals (ESAs), Therapy Animals, and Service Animals, discussing their roles, benefits, and distinctions.

Explore the enigmatic world of ESAs, comfort companions that profoundly benefit those struggling with mental wellness issues like anxiety, depression, and PTSD. 

Discover common and unconventional examples of Emotional Support Animals and learn how these animals can positively impact mental health through unconditional love, distraction from rumination, encouragement in daily living, and providing a grounding activity.

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Nicholette Leanza:

Welcome to Convos from the Couch by LifeStance Health, where leading mental health professionals help guide you on your journey to a healthier, more fulfilling life. Hello and welcome to Convos from the Couch by LifeStance Health. I’m Nicholette Leanza, and on today’s episode, I’m delighted to welcome back MK Clarkin, a LifeStance Regional Clinical Director, and she’ll be helping us to understand the use of emotional support animals. So welcome back, MK. Great to have you back on.

MK Clarkin:

Thank you for having me. I’m so excited.

Nicholette Leanza:

The use of emotional support animals, or ESAs, has risen steadily in recent years because they can provide valuable support for people’s mental health. I’m really looking forward to the conversation with you today, MK, as you help us understand the role of ESAs and even dispel some of the common misconceptions about them too. So thank you. Let’s jump in. Please tell us a little bit about yourself and your experience with ESAs.

MK Clarkin:

Absolutely. I’ve worked in the animal rescue field and animal care work in some way for the last 10+ years. For the last five years in particular, I’ve been involved with the shelter here in St. Louis, CARE STL, as both a volunteer and lately a staff member. A huge part of our mission is getting involved with the community to keep pets with people, to help educate the community about the therapeutic role that animals, mostly dogs, can play in our lives, and that includes therapy dogs or emotional support animals. It was through that program and that partnership that I really learned the difference between all the different working animals.

There’s service dogs, emotional support animals, there are therapy animals. I learned about those different nuances, of the different legalities, the different roles that those different animals play, that what those titles mean, and how valuable it can be to have an animal just sharing a space with us or just by being trained to offer therapeutic value. Then we’ll get into it, but of course, there’s the really important training of service animals.

Nicholette Leanza:

Yes, definitely. You definitely come to this conversation with lots of experience to talk about this topic, which I appreciate. How do emotional support animals, service animals and therapy animals differ?

MK Clarkin:

I love this question because there is so much confusion and it is really important that we all understand, especially as healthcare providers, what those differences are. I almost think of it as being on different tiers. Service animals, which by definition are now only dogs, there can only be service dogs.

Nicholette Leanza:

Oh, I didn’t know that.

MK Clarkin:

Yeah, the ADA made that official a few years ago. When I say service animals [inaudible 00:02:41] service dogs, so I’ll use those interchangeably. Service dogs are animal that have been specifically and specially trained to help one person with various tests that are related to either a physical or a psychiatric disability. The most ubiquitous version that we know are seeing eye dogs for individuals who have legal vision impairments. There’s also PTSD alert dogs. There are dogs trained to alert their handlers to an epilepsy episode, or a diabetes increase, or drop in their blood sugar, things like that.

These are dogs that are allowed anywhere that the public can go, grocery store, gyms, amusement parks, the convenience store, 7-Eleven. Wherever you are allowed, the public is allowed, I should say, that means their service dog is legally allowed, because it’s considered medical equipment. The only time a service dog can be refused in a space is if it is not housebroken or if the dog is out of control and the handler cannot get it under control. Those are service dogs, very specially trained for one specific person, for one specific diagnosis, or it’s sometimes multiple diagnoses, but it’s just one person.

Therapy animals, I’ve seen both therapy cats and therapy dogs, they are specially trained to provide therapeutic value to groups of people. These are dogs that you see in hospitals, visiting nursing homes, college campuses during finals week. Those are dogs that have also gone through a lot of the training that service dogs have, like public access and canine good citizen. They’re not spooked easily by things like escalators or noises, but they are meant to provide therapeutic value to groups of people.

Nicholette Leanza:

That’s the key, groups of people.

MK Clarkin:

Other than the handler [inaudible 00:04:20], yes. Finally, we have emotional sport animals, or ESAs. These are animals that are designed to benefit just one person like service dogs, but there is no special training. These are animals that provide comfort just by existing, which as all the animal lovers listening know, animals can be so comforting to our lives. These are animals that provide comfort just by sharing the space with you. There is no special training, no special certification to be an ESA. You provide comfort by existing with your human.

Nicholette Leanza:

Good. Thank you. You clarified that all very beautifully, very clear and concisely, so I appreciate that. As we dive a little deeper into emotional support animals, what are their roles and what are some common types?

MK Clarkin:

The role of an ESA is first and foremost to provide comfort beyond which a pet offers. That’s a little subjective. That is a gray area. It depends on what comfort means. That comfort is brought on by mitigating symptoms of a psychiatric disability or a diagnosis like depression, or PTSD, or anxiety. I’ve seen emotional dogs, emotional support dogs… I have seen emotional dogs. Now, I’ve also seen emotional support dogs. I’ve seen emotional support cats. I’ve even seen emotional support rabbits.

A few years ago there were some articles making the news waves about emotional support peacocks on planes and crocodiles. I’m not in those people’s shoes, so I’m not going to say what they were experiencing. But you’re going to have a hard time convincing me that an emotional support alligator is going to provide the same comfort as an emotional support dog.

Nicholette Leanza:

I agree. Jumping back to service animals, they’re providing a very specific service to an individual. If a person has an emotional support animal, so the support animal, who is helping them with their anxiety per se, and maybe that dog goes on their laps to put pressure on them, could that be seen as a service dog or no, because they are providing a service? Or is that one of those gray areas?

MK Clarkin:

That is a gray area, and I think it comes down to what kind of training that animal ends up getting. I was mentioning earlier, I have lots of pets. I have three dogs, two of them are trained therapy animals. One of my dogs that I didn’t teach her this, she instinctively will do some of that sensory pressure that you just talked about to people who she has sensed are in distress. Could that be something that I train her to do as my service dog? Sure. But unless she is trained to do that, just for me in very specific instances, that’s where the difference is. They can have the same behaviors and you can train a lot of dogs to do that. But context of how and when and who they’re doing it for is what defines being a service dog, or an emotional support dog, or a therapy dog.

Nicholette Leanza:

Great answer to that. No, thank you. Thank you for clarifying that too. I asked that because I think that was a gray area that some people can say, but you handled that amazingly. Thank you. How can ESAs be beneficial?

MK Clarkin:

We generally see the benefits of ESAs as they relate to a specific diagnostic criteria. For example, somebody with anxiety who has persistent rumination might be distracted by their pet by playing with them. Or even the tactile sense of petting our dog or a cat or rabbit, whatever it is, that can be a very soothing and grounding activity to ground us from the rumination and some of the spiraling that happens with anxiety. A lot of times people, of course with depression, feel extreme loneliness, feel a sense of self-worthlessness and judgment. Animals are so often unconditional in they’re non-judgment of us and they’re love of us. Those benefits can offset those specific criteria.

I think especially over the pandemic, many of us have felt loneliness. Now, was it all clinical loneliness that relates to a specific diagnosis of depression? That’s where that context is going to be separated. With trauma, of course, that could be a very pervasive impact on somebody’s life, the impacts of trauma. Sometimes having a dog nearby can also be a source of light in somebody’s life that is recovering from trauma and things like that. Getting them outside, dogs have to be walked and have to be let out to go to the restroom. Those tools can also be a source of self-care enforcing activities of daily living for somebody that is not otherwise able to engage in those because of their clinical diagnosis.

Nicholette Leanza:

Right. Thank you for how they’re beneficial. Let’s jump to the other hand and talk about how some of the common misconceptions can really confuse people about them.

MK Clarkin:

There’s a few that I think are really important to highlight in the mental health field. One big misconception about ESAs is that just because you have a pet or just because you have a mental health diagnosis, that you can make your pet an ESA. Again, all of us have felt scared, or lonely, or anxious throughout the course of the pandemic. However, the comfort that the ESA brings has to be in relation to a specific diagnosis beyond the comfort that a pet can offer. Like I said, I have three dogs and I love them dearly, but not all of my dogs bring me comfort because they have behavioral challenges and they have a lot of undesirable quirks that I don’t really find very comforting. That would not be comfort beyond which a pet offers.

I love my pets, but not all of that is comforting as it relates to a mental health diagnosis. Sometimes it can actually be more of a strain because it is so challenging to navigate the pet care that is sometimes required of us. Then another one is that getting a badge or a vest for your dog makes them legally allowed to go anywhere you want to take them. The availability of ESA or therapy dog badges on the internet has really perpetuated this misconception that if you get this badge or your vet, this vest rather, nobody can question the role of that animal, and you’re suddenly allowed to bring it into Whole Foods or music festivals, both of which I’ve seen done, even though the animal has no training, and that can actually invalidate the role of trained service dogs.

Nicholette Leanza:

Definitely. I agree. You mentioned briefly about anxiety, depression. But as we go more into the mental health conditions that might enable a person to have an ESA, which mental health conditions do ESAs most benefit?

MK Clarkin:

I see most often people with depression, anxiety, and anxiety-related disorders like social anxiety or agoraphobia benefit, and also post-traumatic stress. Post-traumatic stress is one of those interesting diagnoses where you can either have an ESA or a service animal. I would say PTSD is the most common psychiatric diagnosis that I see service animals with. But also, ESAs can also be beneficial for those living with PTSD. I think in particular, the depression and the agoraphobia are the two biggest ones that I see having the most benefit from an emotional support animal, just because of the nature of how those diagnostic criteria present.

Depression and agoraphobia make you want to stay inside, separated completely, and humans are connected creatures. We, by evolution, need to connect with each other. Having these ESAs around us allow those people with those diagnoses to feel connected to the outside world in a really beautiful way.

Nicholette Leanza:

Well put. Can you share with us what is the process to qualify for an ESA?

MK Clarkin:

Yes. The process to get an ESA is both simple and also convoluted at the same time, because it’s a very gray area. It’s very subjective to navigate. Somebody wanting to get their animal, or their pet rather, qualified as an emotional support animal doesn’t need to do any special training because by definition, there is no training. It’s just an animal that provides comfort beyond which a pet offers. If a landlord says, “Where is its training papers,” there’s no such thing. I’ve had that happen. But that person should be working with a healthcare provider with whom they’re actively engaged in treatment.

When I am assessing the need for an emotional support animal, or when I am offering coaching to other clinicians, I always say, “You need to look at a few items.” Is this person a new patient, or are they an established patient, so they’re not coming to you in session one saying, “I’m here to get an ESA letter.” That’s a red flag. Number two, are they actively engaged in treatment? Are they showing up every once in a while or are they actively working on their treatment goals with you? Number three, does this person have a psychiatric mental health diagnosis? If not, then that’s going to be harder to qualify. Then finally, are they wanting to make their pet an ESA for either financial housing or flying accessibility purposes?

Now, I own my home. I’m lucky in that I don’t need to travel with my pets to offer me comfort during those times. If I wanted to make my pet an ESA, there’s no real need for it, because I’m not renting my home from anyone. I don’t need to prove that I need this ESA to anyone but me. I’m able to fly without my pets. That would actually be far more stressful than flying without them in my case. There’s no real need to make it an ESA. If somebody is able to afford the pet rent or the pet deposit, and if their building allows pets, then there’s not a lot of reason to make that pet an ESA.

Now, that said, if all of those criteria are met, then to qualify, you should ask your provider about this. There should be a documented history of this animal providing comfort related to the clinical criteria, so it’s not just, “I love my pet and, by the way, I’m moving and I want it.” There should be a documented history of expressing how this animal has helped you reach some of your treatment goals and objectives that you’re working on with your provider.

Nicholette Leanza:

Which leads me to this question then. What are the negative consequences of people falsely claiming their pets to be working animals or emotional support animals?

MK Clarkin:

That’s one of my pet peeves. Yes. Thank you for asking this. First and foremost, it invalidates all of the hard work and the special training that service dogs go through. Somebody with a service dog has gone through quite literally years of training and thousands upon thousands of dollars to screen this animal, to get it the right kind of safe and appropriate and ethical training, to train specific to what your mitigated needs are for your disability. Or even a service dog badge that you can buy online, unfortunately. You’re really, I think, discrediting all of the hard work that animal has done.

You’re also presenting a behavior challenge or a safety risk, because while your pet might be very well-behaved, you haven’t done the training with your dog, for example, to not sniff somebody else’s service dog. You’re opening yourself up to liability and it just puts everybody at risk. I have seen a pervasive distrust, understandably, of institutions seeing service dogs walk into their building and questioning people with very real psychiatric diagnoses because they’ve seen so many people falsely framing their dog or their pet as a service animal. It really makes it harder, ultimately, on the humans who are trying to live their lives to the best of their ability using their legally-allowed service dog.

Nicholette Leanza:

I agree. What it comes down to, just don’t do it. If you have to move and you’re going to an apartment and it doesn’t take dogs or whatever, it does, it just [inaudible 00:16:07]. I agree. I agree with you. Any other takeaways you’d like to share?

MK Clarkin:

Yeah, I want to encourage healthcare providers to don’t shy away from the conversation, because doing the psycho education with clients is going to help, I think, mitigate or I hope mitigate some of what I just talked about. Don’t be afraid to have the conversation with your clients if they ask for an ESA letter. Don’t say no right off the bat. The answer might still be no at the end of the conversation, but get curious. Probe a little bit into why they want that emotional support animal. Can they afford it? Yes. Do they not want to pay it, but they can afford it? That’s time for some tough love, I think. What other tools do they have? Ask them how do you envision your ESA supporting your mental health treatment goals? Maybe it’s to help ground me, to help soothe me.

What other tools have we worked on? You have other tools in your toolbox. You have self-regulation, you have parasympathetic nerve stimulation, and all those good things that we work on in therapy. We have communication skills. Then if it comes down to it, don’t be afraid to refer to other providers who might be more comfortable and eligible to write those. I refer people to their primary care providers if I am not comfortable writing an ESA letter. I will refer them to their psychiatrist if I feel like they’re more engaged with other types of healthcare. Just don’t be afraid to educate your clients and advocate for that realm as a whole by doing some education, and counseling, and dialogue with your clients.

Nicholette Leanza:

Oh, I love that. Oh, my gosh. Thank you, MK. Thank you for joining us today and helping us to understand the role of ESAs and clarifying some of the misconceptions about them. I know our listeners learned a great deal from you today. Thank you again.

MK Clarkin:

Thank you so much for having me. I’ve loved this conversation. I appreciate it.

Nicholette Leanza:

Same here. I’d also like to thank the team behind the podcast, Jason Clayden, Chris Kelman and Juliana Whidden, with a special thanks to Jason Clayden, who edits our episodes. Thank you for listening to this episode of Convos from the Couch. Take care, everyone.