AAP AND ATTACHMENT MODEL, FAMILIES2
Animal-Assisted Psychotherapy with Canine Co-Therapist:
Attachment Model for Families with Young Children
Pamela Pitlanish
Oakland University
Abstract
Animal-assisted therapy (AAT) literature cites many references to human infancy. Terms such as bonding have been borrowed from human infancy research regarding the formation and purpose of close parent-infant dyadic relationships. Children and animals have natural affective relationships, and numerous studies have shown that both children and adults develop attachments to companion animals. There is a body of evidence pointing to positive results of animal-assisted therapy (AAT) with children, however these are primarily for autism, health care, or in educational settings rather than in psychotherapy. Professional therapists employing AAT with the early childhood population are scarce. This paper proposes the development of an attachment model for animal-assisted psychotherapy with a canine co-therapist for families of young children, with the assumption that animals can serve as attachment figures for children and families in psychotherapy. Several key features and cautions for parent-infant work which includes the addition of a therapy dog are suggested. A quasi-experimental outcome evaluation could be feasible by comparing 2 groups of families, 1 which chooses to enroll in animal-assisted psychotherapy, and a control group of families which receive standard family therapy, but without a therapy animal. Results on attachment on attachment scores, parent-child relationships, use of therapy animal by parents for increased ability to read their child’s cues, and emotions, and to respond appropriately can be measured through standardized measures on attachment with parent-completed Devereux Early Childhood Assessment (DECA) scores, and by 20-question parent-completed questionnaire.
Keywords: animal, canine, animal-assisted therapy, attachment, psychotherapy, young children, families, infant mental health
Animal-Assisted Psychotherapy with Canine Co-Therapist:
Attachment Model for Families with Young Children
Born into a family which lived in the country on 40 acres, with a barn and many outbuildings, fields of corn everywhere, and pets of all species, writer considers herself very fortunate. Born into a family suffering the chaos of one alcoholic parent, one codependent parent, a mentally ill sibling, and persistent chaos and violence--not so fortunate. But this combination would prove to direct her life and career choices. Throughout childhood, the numerous family pets, including dogs, cats, fish, geese, and even raccoons, provided supportive relationships for this writer. Although she later developed a myriad of self-destructive methods for drowning out the pain of loneliness, trauma, fear, self-loathing and chronic anxiety, she realized her parents’ high expectations for her education. She finally succeeded—somehow—to earn a Bachelor of Fine Arts degree, then continue on many years later to pursue a Master of Social Work (MSW) degree. Social Work was likely embedded in her psyche and genes from birth, considering the family life she experienced. But it wasn’t just the field of Social Work that hooked her. During orientation, someone handed out brochures on the different certification programs one could specialize in while earning their MSW. She read on the cover of one, “Graduate Certificate in Infant Mental Health (IMH),” at the then Merrill-Palmer Institute. Having absolutely no idea what those words meant, she simultaneously had no ability to turn back from that point on. She began her graduate education with a 9-month-old and a 3 ½-year-old at home. Their success in childhood and in life, juxtaposed with her painful early experiences, has maintained a prominent position in her mind since prior to their births.
Daniel Stern, in Diary of a Baby (2008), beautifully describes the purely sensory experience of an infant within the confines of a crib. He portrays the purity of human life, prior to the point at which unadulterated sensory experiences of the world and the essence of emotions become confined by words, definitions, and judgements:
Joey is six weeks old…Joey is looking at the sunlight falling on his wall (“A Patch of Sunshine”). Then he looks at the bars of his crib and, through them, at the wall beyond (“Space Songs”). He becomes hungry and cries (“A Hunger Storm”) and, finally, is fed (“The Hunger Storm Passes”). Like shots in a movie, one moment may be continuous with the next, or fade into it, or cut abruptly against it, or be separated from it by a blank pause. It is not clear to Joey how he gets from one moment to the next or what, if anything, happens between them. (Is it so clear for us?) But all his senses are focused on each one, and he lives each intensely. Many are the prototypes of moments that will recur over and over throughout life. (p. 15).
Writer’s earliest memory, being alone in a crib, crying--seemingly forever--with alternating light and dark vertical lines was triggered by reading about Joey during her beginning studies in IMH at Merrill-Palmer. Early childhood mental health, critical for later development, was a personal issue while becoming a professional mission.
Writer’s twenty year long career in Community Mental Health (CMH) was spent primarily in the homes of at-risk families of infants and toddlers, using the model Selma Fraiberg developed in the 1970’s. This was a child-centered, psychodynamic, relationship-based model of parent-infant psychotherapy (Fraiberg, Adelson, & Shapiro, 1975). After the exceptional professional experiences received within the CMH system, she retired to part-time solo private practice where she now treats individuals and families from pregnancy through adult. She has trained her two dogs for certification with Therapy Dogs International (TDI) and uses them in her practice, particularly with children. The combination of writer’s early experiences in infancy, the supportive role of the many animals to which she developed attachments beginning in early childhood, and the professional Social Worker/Infant Mental Health Specialist she became in adulthood have fused into this plan for the development of a model for animal-assisted psychotherapy (AAP) using a canine co-therapist with an attachment-based treatment orientation for families and their young children.
AAT literature cites many references to human infancy. For example, use of the term bond, as in human-animal bond, is referenced as being borrowed from parent-infant relational terminology (Beck, 1999). This is one of the reasons why this writer finds using animals in psychotherapy with families of infants and toddlers to be fitting. Parish-Plass (2013) cites a prominent early parent-infant author in Animal-Assisted Psychotherapy: Theory, Issues, and Practice when discussing the similarity between D. Winnicott’s terminology and the use of an animal as a transitional object.
This paper will examine the potential for enlisting the assistance of a canine co-therapist
with families of young children, and will look at the following questions: Whereas animals are noted for alleviating children and adolescents’ reservations regarding attending therapy (Katcher & Wilkins, 1998), could the use of a therapy animal—dog, for instance—also be enticing to a family of infants and toddlers? Should a therapist insure that interventions with a therapy dog are pertinent to psychotherapy, and not simply employ animal-assisted interventions? But the more basic question might be, is there even a difference between AAP and AAT? Can AAP play an important role in family therapy which focuses on attachment relationships? How might one design specific interventions for a therapist and canine co-therapist in order to assist a family of young children with their therapeutic goals? Can a therapy dog assist parents in recognizing and responding to their child’s emotional needs? Might parents model the relationship between therapist and therapy dog for use with their child? Do attachment scores on a standardized test rise when AAP is provided to families with young children? Also, does the practice of tuning-in to a therapy dog’s body language and emotions assist parents in tuning-in to their child? This exploration has been diagrammed in a Logic Model (Figure 1) with some of these questions listed as outcomes. They will also be addressed in the section on evaluation, within a client survey for post-treatment.
Needs Assessment
Mental health challenges in early childhood are common, often overlooked, and underserved. According to the National Center for Children in Poverty, one in five children Nationwide from the ages of 0 to 18 has a diagnosable mental health condition (Stagman & Cooper, 2010). In Michigan alone, 20% of children suffer from at least one mental, behavioral, social, or emotional condition (The Annie E. Casey Foundation). Genesee County, Michigan has a population of slightly over 30,000 children ages zero-to-five, with 1,000 of these being confirmed cases of child abuse or neglect (The Annie E. Casey Foundation). And yet PsychologyToday.com—a primary referral source on the Internet--lists only 20 therapists serving Genesee County who advertise on their site, with just 10 treating the birth-to-five population, and only three of those using an attachment model.
For little ones, social-emotional health is mental health. Social-emotional development is critical at the early ages, because success in school and in life depends on a child’s ability to relate well with others, to get their needs met in socially-appropriate ways, and to self-regulate (National Scientific Council, Center on the Developing Child at Harvard University, 2007). Clinical treatment of young children is best conducted in as close to the child’s natural environment as possible, within the family unit that can be both the source and relief of negative experiences: “The emotional well-being of young children is directly tied to the functioning of their caregivers and the families in which they live…When children overcome these burdens [trauma, maltreatment, emotional abuse], they have typically been the beneficiaries of exceptional efforts on the part of supportive adults” (Center on the Developing Child, Harvard University). Addressing the issues within the child’s family is therefore essential, and is considered best practice in the field of child psychotherapy.
The infant mental health model was established in the early 1970’s by Selma Fraiberg at the Child Development Project in Ann Arbor, Michigan (Fraiberg, 1987). This model uses what is termed kitchen table therapy, coined from the flexibility of professional boundaries during home-based sessions, within an attachment model that focuses on the parent-infant dyadic relationship and on the internal working models of both child and parent (Shapiro, 2009). In Reflections on the Work of Professor Selma Fraiberg: A Pioneer in the Field of Social Work and Infant Mental Health, Shapiro (2009) notes Fraiberg’s inclusion of parents in the treatment team, “Her therapeutic work with parents was aimed at developing a working alliance with them, and helping them provide a holding environment for their child that was empathic, stable, and attentive to developmental needs” (p. 48).
In attachment theory, symbolic representations of the attachment object become internal working models—or templates—which the infant uses to understand themselves, others, and expectations for relationships. Ribaudo (2014) describes these as “patterns of interactions that, through repetition and over time, ‘tell’ the infant what to expect from caregivers and the environment.” One can see in Figure 2 how primary caregiver’s behavior influences the development of a child’s working model, and in turn, the attachment classification. Like other animals, humans are “biologically predisposed to seek out and sustain physical contact and emotional connection to selective figures with thom they become familiar and come to rely on for psychological and physical protection” (Sable, 2012). Can animals serve as attachment figures for children and families in psychotherapy? Many believe that this is not only possible, but have implemented animal-assisted psychotherapy programs around this premise. While a client’s positive change in psychotherapy can be attributed, in part, to new meanings of self and others which arise out of a healthy relationship with (human) therapist who is nurturing, responsive, and empathic (Lieberman, Silverman, & Pawl, 2005), it should not be surprising that a therapy dog, with their non-judgemental character, can assist a client—particularly a child—in developing new internal working models. Parish-Plass (2008) recognizes the uniqueness of AAT for inducing positive change with children suffering from insecure attachment, which includes the animal’s serving “as a safe haven, as a secure base and as an attachment figure” (p.14). Because of the similarities between young children and animals, particularly their innate ability for honesty and play, one of the newest modalities combining child therapy and AAT is animal assisted play therapy (AAPT), where “Play and playfulness are essential ingredients of the interactions and the relationship” (VanFleet R., 2008).
In 2004, Kruger, Trachtenberg, & Serpell stressed the importance of documenting mental health interventions when animals are an additional part of the treatment, stating, “Animal-assisted interventions (AAIs) are currently poorly defined. The lack of a unifying set of practice guidelines or a shared terminology is hampering efforts to evaluate and gain acceptance for the field” (p. 2). Whether a clinician chooses to develop treatment interventions prior to sessions may be a matter of personal preference, more so than a sign of how closely the clinician is following a specific model. Many mental health therapists conduct sessions as Parish-Plass (2013) describes animal-assisted psychotherapists in Israel practicing: “the therapist flows with the client (psychodynamic, client/child centered, non-directive), as opposed to a directive approach in which the therapist prepares activities ahead of time” (p. xxi). In the Animal-Assisted Therapy Certificate Program at Oakland University, Rochester, Michigan, one of the first assignments is to create lesson plans for AAT interventions: “Whether you are using your pet to counsel, visit a nursing home, help a child practice reading, assist in physical therapy, etc. there will need to be a specific task or goal to accomplish and the lesson plan will make that possible” (Johnson, 2013). Embarking upon this newer modality of psychotherapy called AAP, this writer has been challenged to figure out just how to engage clients with the canine co-therapist so that treatment goals are accomplished in as short a time as possible, maximum participation by co-therapist is facilitated, and that maximum benefits of AAP are realized. In traditional psychotherapy with no canine co-therapist, it is often useful when working with young children and families to have specific interventions outlined ahead of time that are designed to facilitate the family’s movement toward their particular treatment goals. Wilson and Barker (2003) noted the importance of matching proven human-animal interventions (HAI) with a specific client base: “Once HAI interventions have been standardized and evaluated with research supporting their effectiveness with specific popultations, practitioners will be able to select the most appropriate HAI intervention for their client popuation” (p. 23). It is for these reasons that the challenge of developing a model and eventual guide of specific AAP interventions for use with families of young children based on attachment theory is being undertaken.