Dr. Molly: Hello everyone. Happy to be here.
Dr. Sharp: I’m excited to have Molly for two reasons; one is that Molly is probably my most familiar guest because we have worked together for the past many years, five maybe six years.
Dr. Molly: Has it been that long?
Dr. Sharp: It’s been a long time.
Dr. Molly: Wow.
Dr. Sharp: Molly started working with me back when she was a graduate student, she was a psychometrician here in the practice and [00:01:00] then went on to do her postdoc here in our practice, and now she is a staff psychologist in our practice so we have a long relationship. Molly’s a pretty amazing person in lots of ways.
Let me introduce you real quick, Molly, and then we can jump right into it. We’re going to be talking all about evaluations for emotional support animals today. This is something that has popped up in the Facebook group quite a bit and maybe a lesser-known area of evaluation but one that we get a lot of requests for, and I know, a lot of listeners get a lot of requests for. We’re going to talk with Molly all about emotional support animal evaluations.
In the meantime, though, Molly is currently a licensed psychologist. She is practicing, like I said, here in Fort Collins, Colorado with us. She graduated and got her doctorate from Colorado State University. She has many years of clinical experience in university counseling centers, college career centers, and community [00:02:00] mental health settings.
She was also a psychometrician, not just for me, but for a clinical neuropsychologist in the community during graduate school as well. Molly has done all of her dissertation research on, how would you phrase it, career assessment, and vocational services.
Dr. Molly: I think that’s fair, about career matching based on fit and online assessment.
Dr. Sharp: Cool. Molly brings a wealth of experience to our practice and we’re super lucky to have her here.
One of the things that we’ve gotten into and started to dig into over the last several months is evaluations for emotional support animals. Do you remember what those initial referrals look like or where those came from? I’m trying to think.
Dr. Molly: I think the first ones I received were from therapy clients who were struggling and end up in a [00:03:00] situation where they’re hoping to get emotional support animal living with them in an apartment.
Occasionally, it was after other types of evaluations like ADHD. I had one after a PTSD evaluation and she came back and asked for an emotional support letter.
Dr. Sharp: Got you. Some of those flow from other evaluations or therapy clients. I know that we’ve gotten some calls from out in the community as well. I think for me, that was the impetus to start looking into this and figure out what’s the deal here.
We’ll talk about all sorts of things related to emotional support animal evaluations, but maybe we could just start with defining what an emotional support animal even is because I feel like I see emotional support animals everywhere, like those vests in airports or in schools or the grocery store. [00:04:00] What is an emotional support animal?
Dr. Molly: That’s the tricky thing because people can just buy a vest and designate their dog emotional support animal in some ways, walking around and pretending that that’s an official thing because people don’t know what the definition is or how it goes about getting official. And so I think you touch on a controversial aspect of emotional support animals.
Technically, how they are meant to be defined is an animal that provides emotional support to someone who has a mental health disability, meaning a diagnosis of some sort, like major depression, anxiety, some phobia issues, or things along that line. The thing about emotional support animals that’s often confused is that they’re different from service animals.
Dr. Sharp: Okay. I didn’t even know that.
Dr. Molly: In a lot of ways, [00:05:00] the best way to define them is what they’re not.
Dr. Sharp: Okay.
Dr. Molly: So a service animal specifically, is an animal that’s trained in several ways to help someone with a disability. That’s usually some sort of physical disability such as maybe blindness or some sort of mobility issue. A dog might be trained to be, can be a guide dog or fetch things, be able to get things for an owner who has mobility issues whereas an emotional support animal is not necessarily trained in any way whatsoever.
Dr. Sharp: Oh, okay.
Dr. Molly: It’s just a pet that a person with a mental health diagnosis has found to be supportive for them and helped them feel better, maybe eases their anxiety or brings joy in their life if they’re depressed, that sort of thing, or in the example of maybe flying on a plane, if you have a phobia of flying, having your animal with you maybe helps you stay calm. [00:06:00] But that animal to be designated an emotional support animal doesn’t necessarily have to have any kind of training whatsoever, which is tricky.
Dr. Sharp: Oh, got you. Yeah, I would imagine. I have a lot of questions with that; can service animals be considered emotional support animals?
Dr. Molly: That’s a good question. It’s like a hierarchy; a service animal could provide emotional support but in order to be defined as a service animal, it would have to be trained beyond what an emotional support animal is.
Dr. Sharp: Okay. Got you.
Dr. Molly: Does that make sense?
Dr. Sharp: Yeah, certainly. It sounds like service animals actually go through specific training. Now that I’m talking about, I feel like I’ve heard of them being specifically trained to provide support for a seizure or something like that. They’re pretty specialized in what they can do, but an emotional support animal could be any animal.
Dr. Molly: A lot less than that. Yeah, it could be any animal. I think a lot of people think of [00:07:00] dogs initially. Dogs are probably the most common, but it can be any animal. That’s not even defined.
Dr. Sharp: Oh, wow. I’m getting a little bit ludicrous, but you could have an emotional support fish or frog, okay
Dr. Molly: Yeah.
Dr. Sharp: Good to know
Dr. Molly: As far as I know, that’s my understanding.
Dr. Sharp: Okay. That sounds good. The majority though, I would imagine are dogs or cats maybe.
Dr. Molly: Mm-hmm.
Dr. Sharp: Okay. Anyway, that opens up a lot in terms of how we handle the evaluation, what we’re recommending but I wonder, just in general, before we dive too deep, when would someone perhaps seek an evaluation for an emotional support animal?
Dr. Molly: The main benefits or permissions you get with an animal that is designated emotional support [00:08:00] animal is that they can be allowed under the Fair Housing Act to live with you in a residence that does not typically allow pets, for instance, sometimes that’s apartment complexes.
Sometimes, they will waive the fee as well. So sometimes it’s an apartment that you can have an animal, but you have to pay a pet deposit, rent and you can get that waived if it’s an emotional support animal or if they’re not allowed, you can then have them.
College dormitories is becoming a more common thing that students are requesting to bring their pets with them to college dormitories and they’re having to figure out how to handle that. Additionally, I mentioned earlier, flying on a plane. Those are the only two places that emotional support animals are actually allowed.
There’s a big misconception that they, like you had said, are allowed grocery stores, out and about while you’re shopping. I think the public thinks that and a lot of people think that so people bring their animals and then [00:09:00] there’s no repercussions for that because people assume it’s allowed. They have the vest on. They don’t want to pry or ask and so people get away with having their animal in public places. Even if they were designated emotional support, they aren’t allowed.
Dr. Sharp: Oh, that’s interesting. So all those signs that you see are specifically only for service animals.
Dr. Molly: Just service animals, yes.
Dr. Sharp: Okay. That’s really important. I don’t know if there’s any way for you to know this, but do people try to bring their emotional support animals into those situations?
Dr. Molly: My understanding, I believe that does frequently happen.
Dr. Sharp: Yeah, I would imagine so.
Dr. Molly: It’s controversial for that reason.
Dr. Sharp: Yeah, sure. That word, controversy, has come up two times already, so I think it’s probably worth diving into that. A lot of the testing and assessment that we do is [00:10:00] presumably empirically supported and we’re making recommendations that we think are going to help with whatever the person’s concerned with or their problem might be or their diagnosis might be.
We’re pretty big on empirically supported interventions. How does an emotional support animal fit into that paradigm? Do we have research to say that an emotional support animal is an empirically supported treatment for anything?
Dr. Molly: I would say the short answer is probably no. There’s research that definitely suggests animals can provide a soothing impact for people. There’s research suggesting that petting a dog, for instance, lowers blood pressure or increases oxytocin, serotonin, other feel-good chemicals in the body. [00:11:00] There was a study about older adults in nursing homes that their depression and loneliness somewhat alleviated by having companion animal or even a plant to take care of.
There’s some research that it can be a positive thing, but surprisingly the research isn’t very convincing that they mitigate mental health disorders. There’ve been meta-analyses on the research that is out there and it’s borderline and more research is needed for sure to fully determine that.
Dr. Sharp: Certainly. It seems like one of those things that, on the surface, it would make intuitive sense that an animal would certainly help you feel better, certainly if you’re an animal person and you choose to be [00:12:00] around an animal, it would help you feel better. I wonder if it’s one of those areas where the research maybe hasn’t caught up or there’s not enough yet or something along those lines, I don’t know.
Dr. Molly: That’s certainly plausible. It’s also plausible that there’s a specific subset of people and disorders that might be benefited by emotional support animals. And then it’s possible that some could be harmed and we don’t know that.
Dr. Sharp: Sure.
Dr. Molly: So it’s definitely tricky.
Dr. Sharp: Do you have thoughts just off the cuff about when an emotional support animal would not be helpful or people who might not benefit from that?
Dr. Molly: I could conjecture.
Dr. Sharp: Sure.
Dr. Molly: I don’t have any evidence other than my own opinion based on working with clients but I could see potentially someone with maybe severe [00:13:00] social avoidant tendencies, social anxiety feeling better having an animal companion, but then maybe feeling less motivated to go out and make human friends because it’s easier to have a canine friend and as such, their life getting limited or potentially their mental illness getting worse because they can rely on that animal rather than getting out.
Dr. Sharp: Sure. That makes sense.
Dr. Molly: Not that I’ve necessarily seen that happen, but could see it being a possibility.
Dr. Sharp: That makes sense. I can absolutely see that. On the flip side, though, are there things that you have worked with or maybe common concerns that people come in with that you think an animal is more beneficial for has more propensity for helping?
Dr. Molly: I do think that animals make people feel better in their home if they’re [00:14:00] anxious or feeling low, or if they, again, the same example, the flip side of social anxiety, if you’re struggling to make human connection and you can make animal connection, that can probably make you feel better but you have to be able to balance it by continuing to work at what’s going on for you.
Same thing with depression, having an animal in your home could potentially boost your mood, make you feel a little happier as long as you’re continuing to combat the depression in other ways. People who are not in favor of emotional support animals argue that other strategies could do that, too and so do we really need to have emotional support animals?
Dr. Sharp: That’s always the question when we’re talking about treatment efficacy; is it better than whatever the standard is, CBT or medication, whatever [00:15:00] intervention might otherwise be used.
Dr. Molly: And in this case, that’s maybe even particularly important because we’re talking about giving special permission to people to have these animals in places that they wouldn’t ordinarily be because it needs to be far and away better than any other options they have to get that access.
Dr. Sharp: Yeah, that’s a good point. This came up in the Facebook group maybe, if anybody’s not a member of the Facebook group, it’s The Testing Psychologist Community on Facebook. We have a lot of cool discussions in there about testing-related stuff.
When we were talking about emotional support animal evaluations, someone brought up the point that there’s a certain amount of the population who is actually allergic to animals, and that’s something that we have to consider when we’re granting treatment, so to [00:16:00] speak, that happens in public that puts other people at risk
Dr. Molly: For sure, especially on an airplane.
Dr. Sharp: On an airplane, yeah, exactly. I wonder, this is totally spinning off, do they ask the other passengers if someone can bring in a service animal or emotional support animal? I’ve never been asked.
Dr. Molly: I don’t think so. You can bring your pet on a plane if you pay.
Dr. Sharp: That’s true.
Dr. Molly: In the cabin, if they’re small enough. This just waives the fee.
Dr. Sharp: Oh, got you.
Dr. Molly: And let them sit in your lap rather than under your seat.
Dr. Sharp: Yes, right. It seems fair to say the jury is maybe out on the efficacy of emotional support animals. Anecdotally, it seems to make sense. I’ve certainly heard stories of folks on the autism spectrum who have a good connection with animals and that can sometimes facilitate connecting with people as well.
You move in this direction of doing an evaluation [00:17:00] to see if this would be helpful. What does that process actually look like?
Dr. Molly: So again, that’s not very well delineated. To put it out there, my bias, initially going into this as we were talking, one of yeah, sure, of course, that’s helpful. I was all gung-ho about doing these ESA evaluations until I started looking into the research and I’m like, wow, this is a lot more complicated than I had realized.
So I had a protocol set up that would involve a clinical interview with the client, collateral interviews with people in their lives, whether other professionals that they’ve worked with around their mental health concerns or family, close friends, that sort of thing, who could corroborate their symptoms and concerns for a little bit of extra data there.
And then also personality assessment of some sort, so PAI, MMPI, MCMI, one of those [00:18:00] to get an assessment and some backup objective data of their symptoms to document that there’s truly a mental health concern present.
I think the biggest concern with the evaluation is making sure that people aren’t just trying to game the system in some way and save $1, not have an animal with them when they’re not supposed to, because they love their pet, which I sympathize with. I love my dog but there’s rules in existence for a reason with these institutions that aren’t allowing animals to make it important that we are being thorough in how we do this evaluation.
Dr. Sharp: Sure. But there’s no standard, you said, set forth by any agency or APA or anything like that. It’s not like we have standards of care for emotional support evaluations.
Dr. Molly: Unfortunately, no. It’s not empirically supported so there’s no [00:19:00] empirically validated way of measuring something that we don’t even know necessarily helps.
Dr. Sharp: Yeah, that’s true. Circular argument there.
Dr. Molly: You can certainly argue that there’s an empirically validated way of establishing diagnosis, that mental health disability exists. That’s about as far as the evaluation process goes. That they have social anxiety, that they have major depression but not to say necessarily, that the animal is going to lose help.
Dr. Sharp: Right. That makes sense. In that way, it’s similar to any number of other, I would say, personality evaluations for like egg donation or adoption or something; you’re just getting a good, and I don’t mean to minimize by any means those types of evaluations, but getting a good sense of someone’s personality, mood, [00:20:00] social-emotional functioning just to see what’s going on with them.
Dr. Molly: Yeah, definitely.
Dr. Sharp: Sure. I know that you have to document those results somehow, so what does the documentation look like? Do you write a report? Is it something different? What’s that look?
Dr. Molly: You certainly could write a report. I’m not big on report writing so my plan was to focus on the necessary documentation for their request. For instance, most of the time people are coming with something specific that they’re wanting.
They usually have some sort of form that they need filled out from their apartment complex or from their dormitory or you can write a very generic kind of letter acknowledging that you did the evaluation with them, that you’ve diagnosed them with a mental health disorder and you’re prescribing [00:21:00] an emotional support animal for that.
Dr. Sharp: Oh, that’s an interesting word, prescribing.
Dr. Molly: Yes, that’s the word they use.
Dr. Sharp: Huh?
Dr. Molly: It is interesting.
Dr. Sharp: Wow. That is interesting. That makes me think, can a physician write a letter for an emotional support animal?
Dr. Molly: I believe so, yes.
Dr. Sharp: Okay. That’s good to know. So the prescribing, so you are actually saying, yes, this animal …
Dr. Molly: Prescribing it for this issue.
Dr. Sharp: Absolutely.
Dr. Molly: And sometimes the forms also have some liability language as well, which is interesting.
Dr. Sharp: What do you mean?
Dr. Molly: That you would be willing to go to court if something were to come up and testify that everything was legit and that you do support this emotional support animal for this person.
Dr. Sharp: Got you. I think that’s maybe where we were getting stuck within the practice in whether we do these evaluations or not. I’ve talked before on the podcast about [00:22:00] scope of expertise and using that question, what if you had to defend this in court, would you feel comfortable?
And so when it comes down to it, when you’re actually signing a letter that says, I will testify that this person needs an emotional support animal, that’s hard when there’s not a ton of research to back it up, right?
Dr. Molly: Yeah, definitely. It definitely gave me pause and was part of why we were like huh, let’s think a little bit more about this and do some good research to make sure that it feels valid to prescribe an emotional support animal for someone.
Dr. Sharp: Absolutely. There are a lot of questions with these, in terms of moving forward with the process though, if it felt like that was reasonable, you can write that letter or sign that form. Before we started to pull back from these, did you ever have to tell someone that they did not [00:23:00] qualify for an emotional support animal or deliver that kind of feedback?
Dr. Molly: I did not. I think that brings up another interesting issue is that when we were planning to do this, it was something that we thought about ahead of time to make sure was in the disclosure that just because someone is coming in for an evaluation does not mean that they would necessarily get support. The people I did see for a support evaluation, I did end up supporting, I felt like it was valid.
Another piece of that that I was planning to do was to make it pretty comprehensive, thorough, that it would be a lot of work for someone to go through just to save a few bucks and that it costs money for them. So it’s not necessarily just about that, it’s about a need for them to try to weed out people that maybe are trying to gain the system, [00:24:00] so to speak.
At the outset, that would be a tricky conversation to have with someone. The good news would be that if they aren’t qualifying, it’s because you didn’t find them meeting criteria for a mental health disorder. And so I think one way to frame that would be like, hey, you’re actually functioning pretty well, I don’t think you meet criteria for a mental health disorder. In some ways, that’s very good news.
Dr. Sharp: Sure.
Dr. Molly: That could help soften the blow, but I do think it would be tricky, especially if you’re their therapist.
Dr. Sharp: Right. So then we get into that dual role issue. You said that you had some therapy clients that were requesting these letters, how did you handle that?
Dr. Molly: Fortunately, if memory serves, I’ve had two. I felt, at the time, comfortable recommending the emotional support animal for [00:25:00] them. I felt that it was valid and that they did have a documented mental health disorder that was mitigated at least in their eyes by their animal.
I think that it could really put a rift in rapport with a therapy client if that therapy client asked you and you said, no, I don’t think that is appropriate. If you say you’re not comfortable doing it, they probably roll with that, but it’s hard to know who then to refer them to.
Dr. Sharp: It’s a good point.
Dr. Molly: So that’s where we were thinking about coming in but it’s hard.
Dr. Sharp: It is hard. I think that’s the thing that’s come out of this conversation is that there’s still a lot of question marks with how to do an evaluation like this. We’re still waiting for the research to catch up and better guidelines for how to do it.
Dr. Molly: Yeah. [00:26:00] A lot of people are, and I think there’s frustration across the board for providers that don’t know how to handle it, don’t know what to do, don’t want to turn people away, especially with no good person to refer them to as an expert in this. So there’s a gap.
Dr. Sharp: Sure. That makes me think, I know that there are a lot of resources online to, if you google emotional support animal letter, there are all kinds of places that you can fill out an online survey. Maybe you meet with someone over Skype, I don’t know, but they’ll give you a letter just over the internet. Do you have thoughts on that process or the validity of that or what do you do with that? Because I would imagine clients would just walk away from the psychologists and go google it online.
Dr. Molly: Probably. In my opinion is [00:27:00] that it seems sketchy. It seems like a way to make money because they charge $150 or something for this letter, maybe. I don’t know, don’t quote me on that, but a little fee.
And then they say that it gets reviewed by a mental health professional and you just send in information saying, here’s what’s going on for me. They review your case, and maybe they look at some documentation. I don’t know how thorough, some may be more thorough than others but having not met the person and the fact that it’s just all over the internet seems a little sketchy.
Dr. Sharp: Sure. I’m with you on that. There’s a lot to sort through here. It’s an interesting situation in that there aren’t a whole lot of other evaluations that you can also just go to the internet [00:28:00] for, right?
Dr. Molly: Very true.
Dr. Sharp: It’s got me thinking about is this a service that psychologists need to think about providing or not.
Lots to think about.
Dr. Molly: Indeed.
Dr. Sharp: Like I said, we’ve talked about this topic a lot in the Facebook group and it’s popped up here and there, other places as well. It was when we started talking about doing the evaluations and then the podcast and digging into it, I was surprised that the research was not present. I just assumed that it was out there.
Dr. Molly: Me too and as a dog lover, there was something I was reading brought up the point that media tends to support emotional support animals. Everything that they put on media is yay, emotional support animals and so people assume that it’s well documented.
There’s [00:29:00] also an important downside. I want to just mention that a lot of people don’t think about as well is that, the fact that emotional support animals are not well trained and if people are taking them in public places, even though they’re not meant to, and their animals misbehave or goodness, bites somebody, think about how badly that reflects then upon service animals, because people don’t know the difference.
Dr. Sharp: Sure.
Dr. Molly: Service animals are not going to misbehave like that. They’re so well trained, but people who have are dependent upon their service animal have to have the animal out with them in public, but then gives that service a bad reputation because people are bringing their untrained animals out and about with them. That’s a big concern.
Dr. Sharp: Sure. I would maybe even take it a step further and then say that some of the empaths falls on us to take some [00:30:00] responsibility for that and really be mindful certainly of the person’s presentation and the evaluation results, but also of the research in general to say yeah, this has got to be an ironclad kind of thing to recommend that folks are allowed to take, you never know, I hate to assume worst case scenario, but untrained animals in public where they maybe shouldn’t be.
Dr. Molly: Yeah, for sure.
Dr. Sharp: And then does that reflect poorly on us as well?
Dr. Molly: And one thing we can do is recommend to the client that they get basic training for their animal. As long as it’s not a gerbil, I don’t know if they have, but assuming it’s a dog of some kind, but there’s no way of following through with that or enforcing that. There’s not a framework in place for that yet.
Dr. Sharp: Sure. This is interesting. I appreciate your time and willingness. I know that you’ve spent a lot of time digging into [00:31:00] this and we’ve talked about, is this a worthwhile service and if not, why not? And if so, why so. I know you’ve spent a lot of time with it and appreciate you being willing to come on and chat and talk about it. Hopefully, it’s been somewhat informative for other folks out there who are considering taking on these evaluations.
Dr. Molly: Yeah, absolutely. Thanks for having me.
Dr. Sharp: Of course. I should ask, putting you on the spot, but any resources or things to look at if someone is considering doing these evaluations, anything?
Dr. Molly: I don’t know the website; web address is offhand. When I was doing some hunting, I was able to find some pretty good resources. Psychology Today had some but just discussing the pros and cons and the complications of it. So keyword searching for ethics in emotional support [00:32:00] animal evaluations or empirical support and emotional support evaluations, you can find a lot of good websites discussing the issue and both sides of it.
Dr. Sharp: Okay. That sounds good. I’ll dig around and try to find some of those links to put in the show notes in case people are curious and want to look more into it.
Dr. Molly: Great.
Dr. Sharp: It sounds good. Dr. Molly McLaren, it’s great to have you on the podcast and provide another dimension to our working relationship. So thank you so much for coming on and sharing all of your knowledge.
Dr. Molly: Absolutely. Thanks for having me.
Dr. Sharp: All right. Hope you all enjoyed that interview with Dr. Molly McLaren talking about emotional support animal evaluations. That’s something that we get a lot of questions about. Hopefully, that shed some light on that whole process.
As always, I would love to hear from y’all about your own experience with emotional support animal evaluations, or particularly in this case, letting me know if there’s any [00:33:00] research out there that I might not be aware of that could support doing these evaluations and feel a little better about recommending emotional support animals.
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Thank you again for tuning in. Great to be back with you doing some interviews and gaining some knowledge from other folks. There are a lot of great folks out there and we have some cool interviews coming up. Hope to catch you next time and take care in the meantime. Bye bye.