Author Topic: Therapist and SD  (Read 818 times)

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Offline Poedog

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Therapist and SD
« on: August 21, 2017, 03:50:12 PM »
So I'm not sure where to put this and I hope this is an okay place.

Another thread made me think of this...

What do you do if you feel like your therapist does not know enough about ESA's or SDs to fully give an educated opinion/written recommendation or lack thereof? I feel like it could be detrimental going in either direction. I got the feeling my therapist had very little knowledge on the issuel. When I asked if she would approve my dog being an ESA, she let me write the letter (to be fair, I am getting a masters in a mental health field so I know more than the average person in regards to mental health terminology, etc., though I am certainly no expert at all in ESAs- but I am trying to learn as much as I can) and she just checked and signed it.

She seemed rather annoyed when I told her certain benefits I found from having Poe- is that something I should be concerned about? Should I not have mental health benefits from having an ESA?

When I asked her if she thought I would qualify for a SD, she said she thought the presence of a dog would just be a reminder that "something was wrong" and I felt that this wording was bothersome. If she didn't think my symptoms were severe enough to warrant one, then that is legitimate, of course. If she felt that I would become dependent on one and it would hinder my ability to move forward with therapy, that's also legitimate (and perhaps that is what she meant by her statement? It seems like a stretch to me but perhaps I am reading too much into it?).

I was rather bothered by that statement, because the symptoms that I am experiencing are far more of a reminder that "something is wrong", and a SD would be helping mitigate those symptoms. But apparently not?

Bottom line, she doesn't think I require a SD, which is fine. I am working from home now and, while I'm not sure how I'm going to get through my classes or my internship, since I can order groceries from home, I am able to pay my bills and function "normally". So I don't need one and I'm just being overdramatic.

BUT anyway- the reason for that long tirade... if you feel like your therapist and/or doctor is giving you an uneducated opinion, what do you do? Especially if they are unwilling to educate themselves? And how do you really know if they are truly uneducated?

I hope this is okay that I am posting/asking this! and I hope it was mostly coherent haha

Offline Kirsten

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Re: Therapist and SD
« Reply #1 on: August 21, 2017, 05:53:28 PM »
Well you try to educate them.

I suppose it sounds like there is a need for some sort of guidance directed at mental healthcare providers to educate them about the differences between an ESA and SD, advantages and disadvantages of each and perhaps some guidance or flow chart for determining whether either (and if so which) is a good match for a specific client.

I don't think I've seen this.  So I guess I'm willing to work on creating something for this purpose and then publishing it on the front end of SDC so that people can point to it if they're having difficulty communicating about it with their therapists or other mental healthcare providers, but I'd need help from the community to do it.

I've been concerned for some time about providers being told they cannot write ESA letters by administration, especially at college campuses and those concerned about liability risks.  For this reason we would need to consult some experts in both the legal and mental healthcare professions.  Are you able to hook us up with some mental healthcare professionals willing to discuss and advise?  I think I might maybe talk a lawyer friend into discussing this with me (he's retired and may not want to, but I can try).

We'd also need a lot of participation from you in terms of aiming at our audience, like maybe a lot of participation in the writing of the article since you know the audience intimately from both sides.

Frankly, I am unwell, and could not do a project of this size by myself at this time.  But I could coordinate it and do a big chunk of the first draft with guidance or an editor who knows the audience well.  I've seen a therapist from the client side, but that doesn't mean I understand what makes them tick or their perspective or how to word things optimally so they receive them. 

Another thought....if we make the article too detailed and/or too specific, it would also be a blueprint for someone wanting an accommodation in what to say to their mental healthcare provider to get it.  So I think it should not be a flow chart or advice, just nuggets of information that they can use individually in accordance with their own style of practice to make their own independent, informed decision.  Sadly, I think we do need to address the pet people who just want to loophole a pet into a lease or onto an aircraft.  I mean tell them that this exists and that they shouldn't just give in to them to avoid conflict (because of the potential damage to the disabled) but should only agree when in their professional opinion it is appropriate.

You know, I've even seen some clients wanting to file discrimination complaints against their providers for not agreeing to sign off on an ESA or SD.  That decision has to be based on the professional's expert opinion and a basic understanding of what the two options are plus known potential cost/benefit data.  They're the one in the very best position to advise, so long as they are well informed about ESAs and SDs.  So...yeah.  I think this could be a very helpful project, both for providers and consumers.

In your own situation...you are articulate.  I think if you have a communication that is not clear to you then you need to set aside some of your therapy time to address this with your therapist directly.  Ask about her thoughts and the basis of her decision instead of trying to guess.  Then try to inform in areas where she seems misinformed.  I dunno.  Maybe working on this project and telling her about it would be an opening for a discussion with her about it.  "I was asked to help write an article explaining ESAs and SDs for mental healthcare providers because I am articulate and have some experience in the field and I'd like to discuss this project with you." 
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Offline ccunnin3

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Re: Therapist and SD
« Reply #2 on: August 21, 2017, 07:12:24 PM »
I'd be happy to help with this project. I only have experience from the client side but I agree it is needed.
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Offline SandyStern

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Re: Therapist and SD
« Reply #3 on: August 21, 2017, 08:02:12 PM »
Chiming in on the issue of administrators saying "no ESA/SD letters."  I used to represent a lot of doctors, so I still hear the stories. I got a call recently from a cardiologist who is terribly upset.  He saw a regular patient and she told him she was going into elderly housing and could not keep her pet dog unless it was a service dog, so could he write her a letter saying that Rover was a service dog? This man knew nothing at all about service dogs. He thought he was just saying that she should be allowed to keep her pet.  But he wrote what she asked: "To whom it may concern, Mrs. Smith has a service dog named Rover and should be allowed to have him in her new apartment."

Well, the housing authority did not know any better, so they just allowed the dog.  Rover bit a kid in the face. Permanent disfiguring scars. The housing authority and the doctor have been sued. The housing authority cross-claimed against the doctor (which means they are saying, "we might have done something wrong, but if we did it was your fault and you have to pay for any award against us." The doctor's malpractice insurer has disclaimed because -- duh-- saying "Rover is a service dog" has nothing to do with the practice of medicine.  So here's this guy personally on the hook for the entire award, which is substantial!  So word is spreading, and administrators are doing what they do best, which is limiting liability by blunt decision.  It would be much better if they learned their role and executed it properly.

Offline Kirsten

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Re: Therapist and SD
« Reply #4 on: August 21, 2017, 09:32:08 PM »
Well one issue is that a doctor cannot determine or declare a dog to be a service dog.  They can make a professional judgment about whether the patient is substantially limited and whether they need assistance such as a trained service dog (or ESA) might provide, and then offer that opinion only.  That's something I think we should spell out in the article.  A professional who is treating a person for X is qualified to make a determination about the extent to which X affects their patient's ability to function and whether they require assistance because of X condition.  That medical opinion (1) shouldn't get them into legal trouble unless it's their own patient disagreeing with them and thinking they were misdiagnosed or something, in which case (2) their malpractice insurance should cover that possibility.
« Last Edit: August 21, 2017, 09:34:11 PM by Kirsten »
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Offline Moonsong

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Re: Therapist and SD
« Reply #5 on: August 21, 2017, 11:27:20 PM »
I had a similar issue with a therapist once - she happily wrote me an ESA letter, but refused to write a SD 'prescription' because I "wasn't disabled" (which my ADA-educated doctor agreed that I was). I asked her why she wrote the ESA letter if I "wasn't disabled", and she said that anyone who's afraid of flying can have one regardless of whether they are disabled :facepalm:.

My friend is currently struggling with this badly. She is disabled beyond doubt, and her doctor knows it as well. She has asked them to write her a note and they keep telling her that they "don't provide that service" and send her to someone else who just does the same thing over and over again until she's back at the first doctor. I'm actually planning to go with her to her next appointment to advocate for her because she has difficulty speaking for herself in the moment.

But something like the project that you described would be incredibly helpful! I would be willing to help out wherever I possibly can; just let me know what I can do!
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Offline Poedog

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Re: Therapist and SD
« Reply #6 on: August 22, 2017, 07:53:27 PM »
Kristen, that's definitely something I would be interested in! Where would it be published?


Offline Kirsten

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Re: Therapist and SD
« Reply #7 on: August 22, 2017, 08:01:32 PM »
It would be published on the front end of SDC.  We've got pretty good SEO which means it should appear in the first page of search results if a medical professional decides to search for it.

If you're thinking of publishing in a professional journal, I would support that in any way I could but I don't have the professional credentials that would make me publishable in that type of journal.  I've been published as a co-author as an engineer, but not on SD law or medical practice since I have no degree in medicine or law (only in engineering).

If you know a medical expert who would be interested in publishing such a journal article, I could supply background information, legal citations, and can answer questions or critique.  I'd still be publishing our own article here on the front end of SDC.
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"The one absolute, unselfish friend that man can have in this selfish world -- the one that never proves ungrateful or treacherous -- is his dog." -George G. Vest

Offline Poedog

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Re: Therapist and SD
« Reply #8 on: August 23, 2017, 05:02:12 AM »
Moonsong, I just realized I totally overlooked your response- I am so sorry! That is so frustrating :sad: I hope things with your friend pan out. Is a frustrating feeling to feel like you have to prove your circumstances are severe enough to a therapist.

Kristen, I may... Let me do some digging and get back to you. Right now most of my professors do not do research, but the ones I have that I am still friendly with, do. I'll see what I can find! This would be awesome!

Offline servicedoginwaiting

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Re: Therapist and SD
« Reply #9 on: August 23, 2017, 11:11:15 AM »
I didn't look through all the results but a quick search on pubmed shows 87 results for service dog articles. Maybe as a student you have access through your school Poedog? I don't know if any of those articles contain prescribing guidelines but if I had a doctor who I didn't think was adequately educated on the topic, that's something I would share with them. If they seemed unwilling to educate themselves, I would personally look for a new doctor. Not for a rubber-stamp of my own personal opinion as to whether or not I needed any particular thing, but for an educated opinion (that's what they're supposed to be providing, not off the cuff personal thoughts).

https://www.ncbi.nlm.nih.gov/m/pubmed/?term=%22service+dogs%22

Offline Moonsong

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Re: Therapist and SD
« Reply #10 on: August 23, 2017, 12:05:22 PM »
If they seemed unwilling to educate themselves, I would personally look for a new doctor. Not for a rubber-stamp of my own personal opinion as to whether or not I needed any particular thing, but for an educated opinion

I agree with this. Not only because I want an educated opinion, but also because I feel like a doctor unwilling to be educated is someone who will stubbornly hold on to what they believe, regardless if it's actually true, and I wouldn't them treating or diagnosing me. Stubbornness is a red flag for me with doctors.
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Offline servicedoginwaiting

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Re: Therapist and SD
« Reply #11 on: August 23, 2017, 12:57:27 PM »
Exactly Moonsong - if I need a stubborn person's off-the-cuff opinion on something, I only need to look in the mirror, I don't need a doctor for that haha!

I think the idea of more info on this site etc is great, more info is always better, but when it comes to things like prescribing guidelines, I would also be suspicious of a doctor who took that sort of advice from a non peer-reviewed website. The reality of peer-reviewed publishing (have done it a few times) is that it takes a painfully long time for something of any substance to be researched, written, reviewed, edited and then finally published (it's bloody agonizing to do! I know there are more lax pseudo-peer-review journals online now, but that's the process for anything reputable). So while of course it would be great to get a project like that going, for Poedog's present purposes I don't think it would be that helpful. Thus the encouragement to look to the sources that already exist. :smile:
« Last Edit: August 23, 2017, 01:00:20 PM by servicedoginwaiting »

Offline TherapyPals

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Re: Therapist and SD
« Reply #12 on: August 30, 2017, 12:53:24 PM »
Chiming in on the issue of administrators saying "no ESA/SD letters."  I used to represent a lot of doctors, so I still hear the stories. I got a call recently from a cardiologist who is terribly upset.  He saw a regular patient and she told him she was going into elderly housing and could not keep her pet dog unless it was a service dog, so could he write her a letter saying that Rover was a service dog? This man knew nothing at all about service dogs. He thought he was just saying that she should be allowed to keep her pet.  But he wrote what she asked: "To whom it may concern, Mrs. Smith has a service dog named Rover and should be allowed to have him in her new apartment."

Well, the housing authority did not know any better, so they just allowed the dog.  Rover bit a kid in the face. Permanent disfiguring scars. The housing authority and the doctor have been sued. The housing authority cross-claimed against the doctor (which means they are saying, "we might have done something wrong, but if we did it was your fault and you have to pay for any award against us." The doctor's malpractice insurer has disclaimed because -- duh-- saying "Rover is a service dog" has nothing to do with the practice of medicine.  So here's this guy personally on the hook for the entire award, which is substantial!  So word is spreading, and administrators are doing what they do best, which is limiting liability by blunt decision.  It would be much better if they learned their role and executed it properly.

I would love to see the case on this.  I do think it is because the doctor mentioned a specific dog vs. a typical letter that just says 'xzy' is a candidate for an ESA/service dog and the patient choose it themselves. 

Offline sahi

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Re: Therapist and SD
« Reply #13 on: November 08, 2017, 04:34:53 PM »
Here are some articles I found available on the internet. Many suggest referring the patient to a forensic psychologist to deal with ESA requests.

Examining emotional support animals and role conflicts in professional psychology.
Younggren, Jeffrey N.,Boisvert, Jennifer A., Boness, Cassandra L.
Professional Psychology: Research and Practice, Vol 47(4), Aug 2016, 255-260

Writing letters to help patients with service and support animals.
John J. Ensminger LLM  & J. Lawrence Thomas PhD
Journal of Forensic Psychology Practice , Vol 13(2), Feb 2013, 92-115

Is that a pet or therapeutic aid? What should you do if your patients ask you to write letters certifying that their pets are emotional support animals?
Rebecca A. Clay
APA Monitor on Psychology, September 2016, Vol 47 (:cool:; Print version: page 38
http://www.apa.org/monitor/2016/09/pet-aid.aspx

Recommendations for certifying emotional support animals.
University of Missouri-Columbia. (2017, May 18). ScienceDaily. Retrieved September 2, 2017 from www.sciencedaily.com/releases/2017/05/170518140223.htm

Unexpected Requests: Ethical Considerations Related to Support Animals
Alann Dingle
California Psychologist, Summer 2016
http://c.ymcdn.com/sites/www.cpapsych.org/resource/resmgr/Governance/Ethics_Committee/Summer_2016.pdf