Key Terminology for Therapy Dog Handlers

As a therapy dog handler, you are already well aware that you, other handlers, and your canine ‘compawtriots’ (compatriots) visit a range of places, including prisons, children’s hospitals, university campuses, and older adult retirement communities. The people you meet in these spaces can have varying mental health needs. This can range from university students experiencing stress when writing their final exams, through to individuals and even communities dealing with the aftermath of a tragedy. A therapy dog handler can best offer comfort and support to the people they are visiting with by being aware of the signs and symptoms associated with human mental health needs.

Everyday conversations surrounding the situations you find yourself in with your dog often include terms we use broadly in everyday conversations, but these terms have very specific meanings among health care professionals and therapeutic service providers. It is useful, therefore, to consider how common terms – like mental health, stress, anxiety, crisis, and trauma – are defined by professionals.

Mental Health

The Canadian Mental Health Association defines mental health as “a state of well-being [based in] our emotions, feelings of connections to others [and ability] to manage life’s highs and lows” as influenced by environmental factors, including “safe and affordable housing, meaningful education and employment, leisure activities, the support of a community, access to land and nature, freedom from violence, and good access to health care and mental health services” (2021). Our mental health is strongest when we have reassurances about our safety and security, can keep a positive attitude, and the connections we have with those we care about continue, including our companion animals.

It follows that our mental health is negatively influenced when these factors are absent or threatened. This could include, for example, if our employment and standard of living suddenly become unstable, or we lost a person or animal who is important to us. We also need to recognize that many individuals do not have a lot of positive experiences and social supports that help them maintain a positive attitude, feel safe, or connected with others. Consequent feelings of insecurity and isolation can contribute to the development of a set of problematic behaviors to cope, such as using substances in an unhealthy way and can have a further negative influence on their mental health.

Stress and Anxiety

We have all experienced stress and anxiety; two closely related and what seem to be increasingly common feelings that can have a negative impact on our mental health. From a mental health perspective, stress can be defined as “the body’s response to a real or perceived threat [meant] to get people ready for some kind of action to get them out of danger” (CMHA, 2016). To distinguish between stress and anxiety, think about the differences between our patterns of thinking and the physical sensations we experience as a result. Whereas stress is related to our thinking, anxiety is more closely related to the physical responses we experience in our body because of stress. It is stress that keeps us up at night thinking about the challenges of the day ahead, and it is anxiety that causes us to have dizzy spells or shortness of breath as we encounter stress in the moment.

Crisis and Trauma

As with stress and anxiety, the concepts of crisis and trauma are closely related but also distinct. The term crisis is commonly used to refer to the onset of difficult situations that can negatively influence our mental health. A crisis is a situation that is happening at the moment, and is impacting an individual emotionally, physically, mentally, and/or spiritually. A crisis can emerge in a variety of forms, such as with the onset of an event or situation that threatens our personal safety and security or that endangers significant people and relationships in our lives.The duration of a crisis can range from short-term (such as an accident) to long-term (such as being subject to longstanding patterns of abuse in a home environment).

Trauma refers to the lasting influence that experiencing a crisis – or significant stress for a prolonged period – can have on an individual’s physical, mental, emotional, and/or spirtual health as they continue on with their daily lives. Defined by the Canadian Centre for Addiction and Mental Health, “trauma is the lasting emotional response that often results from living through a distressing event. Experiencing a traumatic event can harm a person’s sense of safety, sense of self, and ability to regulate emotions and navigate relationships. Long after the traumatic event occurs, people with trauma can often feel shame, helplessness, powerlessness and intense fear” (CAMH, 2022).

Later in this module we will elaborate on the types of trauma that people you visit with may be experiencing and the ways it may be informing their thoughts and actions. For now, let’s begin by reviewing some examples of how you and your therapy dog ‘pawtner’ (partner) will be able to assist and support therapy dog program participants, should they be in crisis, experiencing trauma, or encountering stress and feelings of anxiety.

Trauma-Informed Strategies for Therapy Dog Handlers

The following two examples – one at a federal correctional facility and the other at a vaccination clinic – demonstrate the therapeutic benefits and positive outcomes associated with therapy dogs involved in an animal assisted activity, These examples also highlight the important role that handlers play in providing environments that help participants feel safe, empowered, and accepted.

Example 1: Six Strategies

As a therapy dog handler, you no doubt frequently meet individuals that can benefit profoundly from an opportunity to make meaningful connections with you and your canine partner. Let’s take the time to review one example. St. John Ambulance therapy dog Kisbey and her handler visited a federal correctional institution in Saskatchewan to spend time with clients with a wide range of unique needs. They interacted with participants described as having “complex mental health needs including self-harm, childhood trauma, mental illness, substance abuse, and posttraumatic stress disorder (PTSD)” (Dell and Poole, 2015, p. 2). The team sought to recognize and respect the unique conditions and needs of the participants by engaging with six trauma-informed strategies in their interactions: establishing relationships built around safety, promoting trustworthiness, providing peer support, allowing for collaboration and mutuality, providing safe spaces for empowerment, voice and choice, and respectfully recognizing cultural, historical, and gender issues. In a subsequent study of their visits, participants expressed how making connections with Kisbey – in the respectful, non-judgmental environment – had a positive influence on their mental health. They also acknowledged how Kisbey as a therapy dog uniquely contributed to that supportive environment in ways that only a dog can.

Review the following trauma-informed strategies for interaction, as adapted from the Substance Abuse and Mental Health Services Administration (2014) Trauma Informed Care in Behavioral Health Services: A Treatment Improvement Protocol.

1. Safety: Ensure that clients and all participants involved in the interaction feel safe and secure.

2. Trustworthiness: Clients and all participants should build trust by being honest and open about the organization and intent of all aspects of the interaction.

3. Peer Support: Clients should be granted support in the manner they identify.

4. Collaboration and Mutuality: Clients should feel free to contribute to the organization of the interaction as equal partners.

5. Empowerment, Voice, and Choice: Clients should be granted opportunities for self-empowerment and a celebration of their strengths and resiliency.

6. Recognizing Cultural, Historical, and Gender Issues: Clients should be treated to interactions that are sensitive to their beliefs and identities.

Example 2: The CARD System

On other occasions, as a second example, you and your therapy dog may have an opportunity to assist people by alleviating anxieties associated with stressful situations. In 2021, St. John Ambulance dispatched a number of therapy dog teams to COVID-19 immunization clinics throughout Saskatoon and Regina to help alleviate fears for vaccine resistant patients and the stress of clinic healthcare providers. These dogs and handlers endorsed best-practices associated with the CARD system: therapy dogs provide comfort, relaxation and distraction while handlers ask vaccine recipients if they wish for canine companionship and respond to questions about the dogs.

Figure 3-1: The CARD System. Permission: Courtesy of Colleen Dell, Department of Sociology, University of Saskatchewan, based on About Sick Kids (2022) – The Card System Learning Hub at https://www.aboutkidshealth.ca/card/

In many cases, your therapy dog partner provides comfort, relaxation and serves as a distraction, but it likely depends on you to consider and respond to any questions the vaccination clients may ask about being a therapy dog team! You can review the article How therapy dogs are helping to reduce needle fear at a COVID-19 vaccination clinic (Canadian Nurse) for some more specific examples from members of our team.

Handler Story (Womble and Wendi Stoeber)

Before we move on to discuss trauma-informed practice in more detail, consider this first-person account of the impact therapy dogs and their handlers can have for people experiencing a crisis. Pay particular attention to what therapy dog handler Wendi Stoeber learned from her experiences visiting with Womble during a Saskatchewan crisis.

Please watch the following video.

Written content and video by Wendi Stoeber

Program Participant Perspectives (Speaker – Erin Beckwell)

Next, Erin Beckwell’s presentation provides a thorough overview of different forms of stress and trauma and how they can influence behavior in people, including people you meet as a therapy dog handler. She also looks at how different forms of stress and trauma might be shaping your own behavior, revisits the importance of using destigmatizing language, and highlights strategies to help you and your therapy dog provide trauma-informed comfort and support to the people you visit with.

Introduction, Definitions, and Overview of Trauma

Please watch the following video.

Erin has made some important points about the different ways stress and trauma can be experienced. Here is a summary of terms and definitions she presented to refer to as you continue through the activities in this module:

• Eustress Response: A reaction to stress that (usually) has a positive influence on people. A eustress response produces excitement and provides motivation.
• Distress Response: A reaction to stress that (usually) has a negative influence on people. A distress response produces anxiety and provides apprehension.
• Trauma Response: A reaction to overwhelmingly distressing experiences that negatively influence a person’s ability to cope. A trauma response produces feelings of insecurity and threatens mental, emotional, physical, and spiritual well-being.
• Immediate Trauma Response: Trauma responses inspired by a disturbing event or set of circumstances that a person has recently experienced.
• Delayed Trauma Response: Trauma responses inspired by a disturbing event or set of circumstances that a person has experienced in the past.
• Persistent Trauma Response: Trauma responses inspired by a disturbing event, series of events, or circumstances that effect a person repeatedly throughout the remainder of their lives.

Erin also addresses Intergenerational Trauma and Historical Trauma in her video. The 2015 reports from the Truth and Reconciliation Commission’s investigation into Canada’s residential school system has informed a wider understanding of how the horrific legacy of colonialism directly influences forms of trauma that impact First Nations, Inuit, and Métis populations today. As we noted in the last module, therapy dog handlers in Saskatchewan and other parts of Canada interact with therapy dog program participants who are experiencing ongoing trauma related to colonialism.

Intergenerational trauma occurs when the effects of trauma by those who have experienced it passes down generationally. This can occur by witnessing patterns of conduct that align with trauma-exposed behavior, being subject to abusive behavior by individuals who have been trauma-exposed, and/or through changes at the cellular levels with trauma-exposed family members (DNA – deoxyribonucleic acid).

Historical trauma is the process through which a history of inequitable, and oftentimes dehumanizing, relations between a powerful group of people and a disempowered group of people has a cumulative, multigenerational traumatic impact on the less powerful group.

To learn more about these forms of cultural trauma and their connection to Canada’s commitment to reconciliation with Indigenous peoples, a variety of reports and resources can be accessed through the National Centre for Truth and Reconciliation.

How Trauma Can Impact Thoughts, Perceptions, and Actions

Now that we have a clearer understanding of trauma and the different ways in which trauma can be experienced, let’s move on to Erin’s overview of the types of trauma-influenced responses people often have.

Please watch the following video.

Destigmatizing or Reframing Language

You likely noticed that Erin’s discussion of the four Fs touched on the topic of stigma. Earlier in module two, we discussed destigmatizing language related to personal attributes like sex, gender identity, sexual orientation, ethnicity, culture, religious perspective, ability, and age. In this next video, Erin touches on destigmatizing language related more specifically to mental health and substance use disorders.

Please watch the following video.

This table presents some alternatives to stigmatizing terms commonly used with mental health and substance use disorders.

Table: Destigmatizing Language 2: Destigmatize Harder

Source: Canadian Centre on Substance Use and Addiction, 2014; Mental Health Commission of Canada (2020).

Remaining Strategies for Trauma-Informed Practice

The final section of Erin’s video continues on to highlight the importance of providing feel safety, choice, and control.

Please watch the following video.