Is There Anything A Service Dog Can’t Do?

The patient was no Paris Hilton, and the clinic where I saw her is not someplace Ms. Hilton would ever frequent.  But one thing the two women had in common was carrying a dog in a handbag.

I often see ladies carry in more than one bag – a standard handbag and perhaps a sack full of medical records.  I’d never had anyone bring a purse-dog in to an interview, though.

The minute she sat down, she put her large tote bag on the chair next to her and pulled out a little white dog.  She informed me it was a Maltese, and I know it was larger than the little canine specimen Ms. Hilton seems to carry around.

I told her I usually don’t let people bring animals in the room, because it might take her attention and I needed her full attention and focus.

By way of reply, she pulled a tiny cape from her bag which she secured around the dog’s neck.  Thinking at first she had a super-hero delusion, I noticed that the cape was decorated with several patches featuring pictures and logos.  One showed a person in a wheelchair — which this claimant clearly was not. Another patch had a motto which wasn’t legible at that moment.

She told me this was a service dog, given to her for a psychiatric illness. In the state of California – and probably elsewhere — anyone may bring a service dog into any public place.

She told me she had this one for many years and it had been helpful with her condition – Panic disorder.

I’d never heard of a dog for this purpose, and I was curious to know how it worked.  She called it “Cutie,” so apparently that was the dog’s proper name, and it had been trained to stay still whenever she started to pet it.  Petting Cutie had a very clear anti-anxiety effect, and she stroked it whenever she felt nervous or anxious, but more often when she felt a panic attack coming on.

She had made the decision somewhere along the line that she did not want to take any more Xanax for panic attacks – at least not any more than the minimum that she found it necessary to take to get through the day.  She was one of these people who divides up pills in little bits and takes pretty much the smallest bit she can cut the pill into.

Cutie was well trained and never made a sound in my presence – just peered at me with wide, friendly eyes.

In the past I had had some troubles with allergies to animals, but she said, “You’re going to love my little Cutie.”  There was no way she was allergenic.  People who have allergies to their animals get them from dander, not hair.

My real reason for not wanting the animal in the room was simply that when people have something else in a room, they tend to pay attention to it and not to me.  Psychiatric interviews are hard enough with two people, but with children or pets or something else in the room to take attention (like cell phones, which are also forbidden), they can become extremely difficult.

She maintained that her little Cutie was as necessary to her as a seeing-eye dog to a blind lady and there were laws to protect her right to have it. She begged me to please try and do the interview with Cutie present, so I relented.

When the interview got stressful she went for the dog,  whom she stroked sometimes almost feverishly and the dog would stare at me.  But the feverish stroking didn’t seem to stop her from answering my questions.

She said she knew what Cutie could and couldn’t do and she used it only as it was intended.  The dog had a fixed glassy-eyed stare at me as if it had been the one taking the Xanax.

We got through the questions and before leaving, she asked me if I was interested and wanted to know more about psychiatric service dogs.  I certainly was, and would research it online to find if this was something I might be able to use for patients.

On the back of Cutie’s cute pink cape was a patch embroidered with “workingservicedog.com” – which turned out to be a web site where owners can buy accessories and supplies for their dogs rather than anything about the actual dogs.

On my own, I found a directory of organizations and resources about mental health service dogs. I was surprised to find how widespread the usage of these animals has become, and how seriously they are taken in the support community.

But wait – there are also service horses! And cats! And I suppose other trainable animals. Amazing!

Several years ago I had heard of people who bring animals to nursing homes or hospitals and let the patients, pet and play and even feed the animals.  The one’s I heard about were usually medical illness patients rather than mental patients.

There has been enough research done that someone can say this is good for people.  Why?

The answer seems to be pretty simple to me. Pets, like cats or dogs and especially those that one can hold in one’s hands, form a complete transference relationship. “Transference”, is what happens when someone takes a whole set of previous experiences and projects their meaning elsewhere. That means that people may treat pets as substitutes for other people. They can be emotional substitutes for children, spouses, siblings or a parents who are no longer there.

A patient may bond to a therapist who reminds them of a father or mother, or a spouse.  Or that same feeling could be negative and keep the patient from being able to relate to the therapist.

There is also “counter-transference” when a doctor or therapist develops positive or negative feelings for a patient.

Yes – even professionals have family issues, or gender issues, or racial/ethnic issues.

When two people get together, each brings his or her background along.  This may be good or it may be trouble.

However, a dog or cat says nothing.  People can read anything they want into an animal’s facial expression or the simple sounds it makes.  I’m sure you’ve encountered someone who is convinced their cat is smiling, or that a purr means love and affection.  The human interprets the animal’s participation in the relationship.

Of course, the fact that the human cares for the animal affects how the animal acts.  Dogs love to be fed and are enthusiastic – licking and wagging the tail and maybe even giving a hearty bark.  The owner knows the dog is happy.

The two bond – animal and master.  Nobody can ask the animal directly, “Are you happy?  Do you love me?”

Over time is that the person constructs what they believe is going on in their relationship – and of course, it’s good.

Humans obviously love their animals, and animals can love their humans.  This may not be the same as parent-child love, but it is the strength of this pure transference, totally projected by owner, that is responsible for the one time that I actually used it to my benefit.

When I opened my first private practice in a Midwestern city and wanted to get known in the community, I did some public speaking.  And then, while visiting a nursing home, I found a periodical for pet owners. I wrote an article about the grief an owner suffers after losing a pet and it was published.  I was taken by surprise at how much response I got from that story.

This was long before the Internet and I doubt I could ever find a copy of it, but it was pretty much what I just said, phrased in a way that makes the pet owner feel good and important.

Yes, people grieve for pets. This can be as strong as the grief in losing a human relation. Since then, I’ve had many people come to me with very profound symptoms of depression when they lose a pet.  Other doctors may dismiss them as being silly and trivial. But if one only listens, invariably they tell about what they lived through with that pet, how much it “knew” about them, how much of a piece of life that was with them.

In addition to anti-depressants, and as the first and most significant cornerstone of therapy,  I usually tell people to memorialize the pet exactly the same way I would tell a human who happen to have a grieving reaction.  Some people do this by keeping a box with memorabilia – photos, collar, leash. Often they do it by having a burial service for the pet.

There is even a virtual pet cemetery, Rainbows Bridge, where you can set up a memorial to your pet that will always be accessible through your computer or smart phone.

It is comforting for the pet owners to know that there is a heaven somewhere where the pets regain their youthful vigor, the food is always plentiful and they can frolic and play in eternal happiness.

People often ask me about my pets and I don’t have any – except, of course, my pet husband.  When I was very young, I had a pet Mynah bird.  I didn’t take care of him properly.  It was supposed to be a talking bird and I had tried to teach him a few words – to no avail. If he had ever said anything, perhaps the relationship would have been closer. He died, but my mother had prepared me for that since he obviously had some kind of bird illness. I didn’t really grieve and I surely didn’t have a depression. I carried on.

It’s kind of hard to care for a bird and perhaps harder to get a personal relationship. You can’t be as close to it as you could with a kitten or a puppy.

There are support groups for pet grief both in person and online.  But the truth of the matter is very often simply understanding what the relationship is like when it is reaching transference, and this allows people to understand why they get so attached to their pets. They usually feel that if they buy a new pet too quickly, they are dishonoring the pet, so I tell them to do a burial and do a memorialization first.  Do whatever they have to do and if they want to buy another pet, just simply wait until they feel emotionally ready. Something about human nature creates a need to care for a being who seems helpless – whether a pet or even a baby.

That’s what keeps our species going.