tag:blogger.com,1999:blog-8437901534161780164.post173156010086004321..comments2024-03-26T03:06:15.580-04:00Comments on Dog Law Reporter: Blanket Bans on Service Animals Disallowed for Psych Wards, Dialysis UnitsJohn Ensmingerhttp://www.blogger.com/profile/02840129911400528572noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-8437901534161780164.post-87649607696137116022013-11-25T12:14:26.791-05:002013-11-25T12:14:26.791-05:00I disagree with the comment that banning a dog can...I disagree with the comment that banning a dog cannot be a therapeutic response. It might not be in many cases, but could be in others. Recall that my example did not concern a mobility impairment animal but rather of a psychiatric service animal. Consider instead the scenario:<br /><br />A psychotherapist has a patient who brings a service animal to sessions. The dog calms the patient, and circles her or sits at her back when she is in public places and begins to panic. The animal is trained specifically for the patient and thus meets the ADA definition of a service animal. After some months of having the service animal in sessions, the psychotherapist concludes that whenever the patient begins to deal with certain subjects, the patient stops talking and begins petting and talking to the dog. The psychotherapist concludes that the therapy is not progressing and believes that the only way that it will progress is if the patient stops bringing the dog to sessions. <br /><br />I would argue that the following would be an analogy with regard to a mobility impairment dog. A patient has suffered a serious injury in a car accident. Some degree of recovery is possible. The patient brings the dog to a session with a physical therapist and insists that the physical therapist allow her to use the dog for stability during the sessions. Most of the equipment cannot be used with the dog beside the patient. The physical therapist suggests that the patient bring someone to take care of the dog while such equipment is being used. The patient declines. The physical therapist suggests that the patient will not make significant progress unless her use of the dog in the sessions is restricted and suggests she find a different physical therapist. <br /><br />I do not think that a therapist should be required to accept the patient’s terms for a therapeutic session after the therapist has formed the opinion that the presence of the dog is impeding the patient’s progress. Even if the patient could make some progress, but not as much as the therapist believes is likely to occur without the dog, I do not believe that the therapeutic setting should be required to accept a slower pace to therapy than the therapist believes is appropriate. The Department of Justice has stated that there is to be a “proper balance between ensuring access for individuals with disabilities and addressing fundamental alteration and safety concerns….” 75 Fed. Reg. 56260 (September 15, 2010). A service animal can be removed for certain behaviors “or if the presence of the animal constitutes a fundamental alteration to the nature of the goods, services, facilities, and activities of the place of public accommodation.” 75 Fed. Reg. 56267. I believe the examples I have given describe fundamental alterations. <br /><br />Of course, I believe that the therapist should assess each case based on the circumstances involved. A therapist would be remiss in automatically assuming that all patients with psychiatric service dogs are making less progress than they could without them. As I have discussed in several places, particularly in the article I wrote with Dr. Thomas for the Journal of Forensic Psychology Practice, there is little indication that animals have any curative effects on psychiatric conditions. There is even some evidence that patients who become overly attached to dogs actually deteriorate. A cure is not required, of course. Guide dogs do not cure blindness. Cases and regulations use such terms as benefit and amelioration, often with reference to symptoms or effects. This also touches on the fundamental-alteration argument. I believe that the determination of a fundamental alteration—here, the fact that a therapeutic process is being delayed or reversed from the presence of a dog—is not a strictly legal question. I believe that this is a question on which the psychotherapist can have input and that the therapist is entitled to insist that the therapy be conducted in an effective way. JEJohn Ensmingerhttps://www.blogger.com/profile/02840129911400528572noreply@blogger.comtag:blogger.com,1999:blog-8437901534161780164.post-13999591962498983532013-11-25T11:56:58.470-05:002013-11-25T11:56:58.470-05:00I forwarded the preceding comment to Dr. J.L. Thom...I forwarded the preceding comment to Dr. J.L. Thomas (my co-author on the article that appeared in the Journal of Forensic Psychology Practice. He replied as follows: <br /><br />I recall mentioning to John Ensminger, my co-author in an article about service dogs (which he referenced), a situation in which one of my brain injured patients wanted very much to bring in his dog to the sessions. In this case, the dog was not a service animal per se, but was of substantial comfort to this patient. I said this was OK, but with caution since I am in a setting with many other therapists and I did not know how this would be received. For example, How would I know if the dog would bark, and ruin colleague sessions in progress? Or could someone be allergic? <br /> <br />After a few sessions, it became apparent that the patient was often distracted with petting the dog, and therein limitations arose in our work. I do cognitive remediation exercises with my brain injured patients which require deliberate focus and concentration. It appeared to me that this patient simply wanted the dog with him because he loved the dog. But if we assume that this was a service dog within some definition of this term, it is easy to understand how the presence of the animal might help or hinder the work of the therapy. Ultimately, the therapist would have to make a decision as to whether it is best to have the animal present. I do not have a single answer as to the presence of a service dog in therapy sessions. <br /> <br />I might make another 2 comments. I would assume that patients are attending therapy to improve their lives, and this would demand a certain focus on the therapeutic enterprise. If service dogs were properly trained, they would allow the human patient to do the work required. But I do not think this is unusual for service dogs, since in my limited experience, service dogs are remarkably well-behaved when humans do their human work. The animals are trained to respond to certain situations to protect the master, and otherwise stay out of the way. <br /> <br />The second comment is that therapists should have the right to conduct the sessions the way they want. I do not have to treat anyone if the conditions are not acceptable. <br /> <br />J. Lawrence Thomas, PhD<br />Neuropsychologist<br />Faculty NYU Medical Center <br />Past-President of Neuropsychology Division, NYSPA<br />19 W 34th Street, Penthouse<br />New York, NY 10001<br />212-268-8900<br />nurosvcs@aol.com<br />www.thebrainclinic.com<br />John Ensmingerhttps://www.blogger.com/profile/02840129911400528572noreply@blogger.comtag:blogger.com,1999:blog-8437901534161780164.post-13481723434880792422013-11-23T00:02:38.221-05:002013-11-23T00:02:38.221-05:00I am the attorney who argued for the preliminary i...I am the attorney who argued for the preliminary injunction. Thank you for your discussion of these issues. Though I agree with most of what you say I must take issue with one point: Whether a psychiatrist should ever exclude a service animal from a psychotherapy session. You write, "It is therefore arguable that some individuals with service dogs should be able to bring their dogs into psychotherapy sessions, just as they could bring a walker or a wheelchair, but other individuals should not be allowed to do so." I strongly disagree. <br /><br />As you point out, a service animal is analogous to a prosthetic device. The user should never be deprived of his/her prosthetic. Can you imagine a therapist saying to a patient, "You move around too much during therapy. All that pacing is interfering with your progress. Therefore you must take off your leg when you enter the room." It would be considered ludicrous. Instead the psychotherapist must deal with the underlying issue: Why is the patient pacing? <br /><br />Similarly, if a patient is "hiding" psychologically behind his or her service dog, then it is the psychotherapist's job to address that problem directly. Banning the dog is not a therapeutic response.<br /><br />I mention this only because it is my firm opinion that the law categorically permits a service animal user to have full and equal access to facilities with his or her dog. The only exception is when the dog, under specific circumstances, poses a direct threat to health and safety or fundamentally changes the nature of the public accommodation and there is no way to ameliorate the impact by modifying other policies or practices. In other words, the dog is permitted and the burden is on the public accommodation to prove a very narrow exception to the rule. <br /><br />Thanks for the opportunity to exchange ideas with you.Celia McGuinnesshttp://reinlawoffice.comnoreply@blogger.com