Facility and therapy dogs

1. Introduction

Version followed: IAHAIO White Paper (2014, updated 2018) definitions and animal-wellness guidelines; Assistance Dogs International (ADI) terms and definitions; SHEA expert guidance "Animals in Healthcare Facilities" (Murthy et al., 2015); Courthouse Dogs Foundation best practices for facility dogs at child advocacy centres and courts (2015); ACA Animal-Assisted Therapy in Counseling Competencies (Stewart et al., 2016); Pet Partners team evaluation as it publishes it. Where these differ (e.g. animal session limits), each is named.

Facility and therapy dogs are not a psychotherapy. They are dogs, with their handlers, brought into health, education, justice and human-service settings. IAHAIO groups this work under animal-assisted intervention (AAI): a goal-oriented, structured intervention that intentionally incorporates animals for therapeutic gain, ideally designed by an interdisciplinary team. Within AAI, IAHAIO separates animal-assisted therapy (AAT: planned, goal-oriented, delivered or directed by a licensed or equivalently qualified professional, with progress measured and documented), animal-assisted education (AAE: delivered by qualified teachers toward academic, pro-social or cognitive goals), animal-assisted coaching (AAC) and animal-assisted activities (AAA: informal, goal-oriented visiting for motivational, educational or recreational purposes, by teams with at least introductory training and assessment) [source: IAHAIO White Paper 2018].

The dog types differ by training, handler and legal status [source: ADI terms and definitions]:

Therapy dog: a pet dog trained to offer affection and comfort, usually on volunteer visits to facilities that invite it; no public-access rights. Teams are registered by bodies such as Pet Partners, which runs a handler course and a team evaluation [source: Pet Partners evaluation page].
Facility dog: works with a volunteer or professional in a residential or clinical setting, performs skilled tasks with many clients, "must be more than just a presence", and is trained to assistance-dog standards. A courthouse facility dog is trained by an ADI-accredited member and works in courthouses or child advocacy centres (CACs) to calm vulnerable people; access is by institutional permission or law [source: ADI].
Assistance (guide, hearing, service, psychiatric service) dog: trained to perform tasks for one person with a disability; public access belongs to the person, not the dog. Emotional support animal: supports a person with a mental health condition by its presence, without assistance-dog training or the same public access [source: ADI]. These are outside this guide; IAHAIO's guidelines exclude assistance dogs, and the ACA competencies exclude prescribing service animals [source: IAHAIO; ACA competencies].

The core idea of change, as these bodies state it: the human-animal bond can lower stress, build trust and a sense of safety, and engage clients, so that the work of therapy, an interview, a medical procedure or testimony becomes more bearable; the animal is a partner within a skilled intervention, not the intervention itself [source: Courthouse Dogs Foundation; ACA competencies]. The ACA competencies add that the bond can draw out unexpected disclosure, which the clinician must be ready for [source: ACA competencies]. Physiological mechanisms are named in the ACA document as training content; their evidence status is [uncertain: not verified].

The psychotherapist's possible roles: (a) clinician-handler delivering AAT with their own evaluated dog; (b) professional handler of a facility dog placed by an ADI-accredited school with an employer such as a CAC or hospital; (c) clinician who collaborates with a visiting therapy-dog team or a facility-dog handler; (d) clinician who prepares and debriefs a client (often a child) for an interview, examination or court appearance where a facility dog is present; and (e) clinician who works with what dogs mean in a client's life [synthesis].

2. Framework

This is a programme and setting framework, not a phased therapy. The sources give no session count for AAT with dogs; the dog is woven into the clinician's existing model and treatment plan [source: ACA competencies]. The stages below follow the order the sources imply [synthesis for the ordering].

Stage A. Readiness of the clinician. Goal: competence before the dog enters a session. The ACA competencies require general counselling competence first (effectiveness without the animal), formal evaluated AAT coursework, supervised practice with feedback, species-specific knowledge, and a working relationship with the individual animal [source: ACA competencies]. Move on when training, supervision and the team evaluation are complete.

Stage B. Readiness of the dog and team. Goal: a healthy, socialised, humanely trained dog evaluated by a qualified evaluator. IAHAIO requires domesticated, well-socialised animals trained by humane methods such as positive reinforcement, registered with a recognised organisation, behaviour- and temperament-evaluated by an expert, re-evaluated regularly and checked by a veterinarian [source: IAHAIO]. SHEA adds, for hospital visiting: adult dogs only (ideally at least two years old), at least six months in a permanent home, a temperament evaluation simulating hospital conditions, re-evaluation every three years and after a long absence or any behaviour change [source: SHEA 2015]. Pet Partners rates teams and the rating governs which environments they may visit [source: Pet Partners]. Facility dogs come from an ADI-accredited non-profit school after roughly two years of training [source: Courthouse Dogs Foundation]. A newer route is the Pet Partners / AAAIP Professional Team Evaluation, held in the professional's own workplace, which follows AAIS certification and is repeated every two years [source: APA HAI Section slides 2025]. Move on when the team holds a current evaluation suited to the setting.

Stage C. Readiness of the setting. Goal: written policy, infection-prevention sign-off, insurance and trained staff. SHEA calls for a written policy and a named liaison who consults infection prevention and control [source: SHEA 2015]; Courthouse Dogs Foundation lists written protocols on handling, the dog's daily location, client notification, cleanliness, insurance, requests for the dog, priorities and retirement, plus training for staff, prosecutors and judges before the dog arrives [source: Courthouse Dogs Foundation]. Move on when policy, insurance and staff briefings are in place.

Stage D. Per-client screening and consent. Goal: decide whether, how and with what limits the dog is involved for this client. Screen allergies, phobias, histories of animal abuse or animal-related trauma, infection risk and beliefs that conflict with AAI; obtain consent (and a child's agreement) [source: IAHAIO; ACA competencies; Courthouse Dogs Foundation]. Move on only with informed agreement and a plan for alternatives.

Stage E. Sessions or visits. Goal: goal-directed use of the dog within the treatment plan, with infection control and continuous welfare monitoring. Time limits are animal-welfare limits, not therapy doses: IAHAIO states 30 to 45 minutes per session for the animal; SHEA states visits of no more than one hour, ended early on signs of fatigue, thirst or need to eliminate [source: IAHAIO; SHEA 2015].

Stage F. Review, documentation and endings. Goal: measure progress in professional notes (IAHAIO's AAT definition), log contacts (SHEA), record the child's responses where the work is forensic (Courthouse Dogs Foundation), and plan for the dog's absence, retirement or death [source: IAHAIO; SHEA 2015; Courthouse Dogs Foundation; retirement planning per Courthouse Dogs protocol list].

3. Guiding principles

Animals are living beings, not tools [source: IAHAIO]. Practical meaning: you cancel or cut short a session when the dog is unwell or stressed, even if the client is disappointed.
The dog's welfare and choice are part of client safety [source: ACA competencies]. Practical meaning: a stressed dog is a bite risk; welfare monitoring runs throughout every session.
The animal may choose its level of participation [source: ACA competencies; ISU consent form]. Practical meaning: give the dog a rest area it can retreat to and never pull it back into contact.
You are your animal's best advocate (YAYABA) [source: Pet Partners]. Practical meaning: you guide interactions, speak to clients about the dog's needs and step in when it shows nervousness.
Intentionality: AAT is a skilled intervention, not a dog in the room [source: ACA competencies]. Practical meaning: each use of the dog links to a written treatment goal and is evaluated.
Competence and scope first [source: ACA competencies; IAHAIO]. Practical meaning: you integrate the dog into a model you already practise competently, inside your licence; training, supervision and evaluation precede use.
Client safety and exclusion criteria [source: IAHAIO]. Practical meaning: screen allergies, infection risk (e.g. immunosuppression) and fear before any contact.
Respect for beliefs and culture [source: IAHAIO; ACA competencies; Courthouse Dogs Foundation]. Practical meaning: if a client's or family's religious or cultural views conflict with dog contact, discuss alternatives and offer therapy without the dog.
Infection prevention is routine, not optional [source: SHEA 2015; Dalton et al. review]. Practical meaning: hand hygiene before and after contact, no licking, no raw-fed dogs, a barrier on beds and laps.
No surprises, child's choice [source: Courthouse Dogs Foundation]. Practical meaning: families hear about the dog in advance, see photos and the child decides whether to meet or touch it.
The dog never shapes a child's account [source: Courthouse Dogs Foundation]. Practical meaning: the dog is never a reward for disclosure and is never described as wanting to hear the story.
Monitor several parties at once [source: ACA competencies]. Practical meaning: track the client, the dog and any assistant simultaneously; if you cannot, the dog leaves.
Know your own bias toward your dog [source: ACA competencies]. Practical meaning: get an outside evaluation of your dog's suitability and watch your countertransference when a client rejects or mistreats it.
Professional handlers for confidential work [source: Courthouse Dogs Foundation]. Practical meaning: in forensic or therapy settings, the handler should be staff bound by confidentiality, not a volunteer.
Local law and policy govern [source: IAHAIO; SHEA 2015]. Practical meaning: check facility policy, licensing-board guidance and insurance before the first session.
Multiple relationships [source: APA Ethics Code, Standard 3.05; application [synthesis]]. Practical meaning: a client who offers to walk or board your dog, or meets your dog on volunteer visits elsewhere, creates a second relationship to weigh and usually decline [synthesis].

4. Intervention inventory

The published sources describe programme standards, safety procedures and roles rather than a catalogue of named in-session techniques. The ACA competencies name the skills (intentional selection of interventions, interpreting animal responses, modelling care, handling spontaneous events) without naming specific exercises. Items below are therefore mostly therapist-side procedures; where steps go beyond the sources they are marked [synthesis].

4.1 Choosing the right model for your setting

Purpose: decide whether you need a visiting therapy-dog team (AAA), your own AAT team, or a facility dog, before buying, training or inviting any dog.
Steps: (1) Write down the goal (e.g. engagement of withdrawn adolescents, comfort during forensic interviews). (2) Match it to IAHAIO's categories: informal visiting is AAA; goal-directed treatment within your licence is AAT [source: IAHAIO]. (3) If the dog must work every day with many clients alongside staff, consider a facility dog from an ADI-accredited school, handled by staff [source: ADI; Courthouse Dogs Foundation]. (4) If you want occasional comfort visits, partner with a registered therapy-dog organisation through the facility's liaison [source: SHEA 2015]. (5) Cost and commitment: Courthouse Dogs Foundation cites start-up costs and a handler commitment of about five years, with the dog living at the handler's home [source: Courthouse Dogs Foundation].
Example language (illustrative): "What we want is comfort during hard interviews, not a pet for the office, so a trained facility dog with a staff handler fits better than volunteer visits."
Watch for: choosing a dog because you love dogs rather than because of a client goal; the ACA competencies warn that AAT is not simply loving animals [source: ACA competencies].

4.2 Building your competence and credentials

Purpose: meet the competence threshold before using a dog in treatment.
Steps: (1) Confirm you practise competently without an animal [source: ACA competencies]. (2) Complete formal, evaluative AAT coursework covering teamwork with the animal, history and evidence, techniques, contraindications, and the human-animal bond [source: ACA competencies]. (3) Arrange supervised practice with feedback from a qualified AAT supervisor [source: ACA competencies]. (4) Complete the registering body's handler course and team evaluation (e.g. Pet Partners Handler Course and evaluation; or AAIS certification followed by the Pet Partners/AAAIP Professional Team Evaluation in your workplace) [source: Pet Partners; APA HAI slides 2025]. (5) Learn species-specific behaviour and stress signals [source: IAHAIO; ACA competencies]. (6) Keep up continuing education and consultation with AAT providers and animal specialists [source: ACA competencies].
Example language (illustrative), to a supervisor: "Before I bring my dog in, I'd like you to watch three sessions and tell me where I lost track of either the client or the dog."
Watch for: a failed or "Not Ready" rating is common at first; Pet Partners lets teams retest [source: Pet Partners]. Treat it as information, not a verdict on you.

4.3 Selecting and evaluating the dog

Purpose: ensure the dog is healthy, temperamentally suited and enjoys the work.
Steps: (1) Use only a domesticated, well-socialised dog trained by humane, positive-reinforcement methods [source: IAHAIO]. (2) For hospital visiting, SHEA specifies an adult dog, ideally at least two years old, in a permanent home for at least six months, not taken straight from a shelter [source: SHEA 2015]. (3) Have behaviour and temperament assessed by an expert and health checked by a veterinarian; repeat regularly [source: IAHAIO]. (4) SHEA: re-evaluate every three years and after a long absence or any behaviour change [source: SHEA 2015]. (5) Keep vaccinations (rabies per law) and parasite prevention current; IAHAIO and SHEA both exclude raw-fed animals (SHEA within the previous 90 days unless the product was treated) [source: IAHAIO; SHEA 2015]. (6) Ask someone other than yourself to judge suitability [source: ACA competencies on bias].
Example language (illustrative), to yourself or a colleague: "She's wonderful at home, but she freezes at loud noises. Would she enjoy this, or just put up with it?"
Watch for: signs the dog tolerates rather than enjoys contact; IAHAIO states animals should enjoy the work [source: IAHAIO].

4.4 Setting up policy, insurance and staff training

Purpose: make the programme safe and defensible before the first client.
Steps: (1) Draft or adopt a written policy; name a liaison; get infection prevention and control (IPC) to approve locations [source: SHEA 2015]. (2) Cover handling, where the dog spends the day, client notification, cleanliness, insurance, how staff request the dog, priorities and retirement [source: Courthouse Dogs Foundation]. (3) Confirm professional and personal liability cover; Courthouse Dogs Foundation lists assistance-dog organisations, a county rider or a homeowner's policy as routes; Pet Partners teams can obtain liability cover on passing [source: Courthouse Dogs Foundation; APA HAI slides 2025; ACA competencies]. (4) Brief staff that the dog is not an office pet and should not be fed or given commands by others [source: Courthouse Dogs Foundation]. (5) Plan for allergic or dog-fearful staff [source: Courthouse Dogs Foundation].
Example language (illustrative), staff briefing: "Please don't feed him or call him over. If you want him for a client, ask me, and I'll check whether he's had his break."
Watch for: many centres run without written protocols [source: Courthouse Dogs Foundation]; Dalton et al. found many facilities lacked standardised therapy-animal policies [source: Dalton et al. 2020 review].

4.5 Screening the client

Purpose: decide whether the dog helps, harms or is irrelevant for this client.
Steps: (1) Ask about allergies to dogs or particular breeds [source: IAHAIO]. (2) Ask about fear of dogs, bites, and animal-related trauma; ask about any history of harming animals [source: ACA competencies]. (3) Ask about immunosuppression, open wounds, invasive devices or isolation precautions; check with the medical team where relevant [source: IAHAIO; SHEA 2015]. (4) Ask about religious, cultural or family views on dogs [source: IAHAIO; Courthouse Dogs Foundation]. (5) Consider whether the client could tease, restrain or hurt the dog, or whether behaviour could frighten it [synthesis, from IAHAIO's supervision requirement]. (6) Decide: dog present, dog available but out of reach, or no dog; record the reasoning.
Example language (illustrative): "I sometimes work with my dog in the room. Before we decide anything, have you had any bad experiences with dogs, allergies, or reasons your family might not want one near you?"
Watch for: clients who say yes to please you; reluctant tone or body language is a reason to offer the no-dog option again [synthesis].

4.6 Informed consent and a child's agreement

Purpose: voluntary, informed participation, with the right to decline.
Steps: (1) Explain the dog's role, training and evaluation, and who handles it [source: ISU consent form; ACA competencies]. (2) Name risks: allergies, infection, scratches or bruises, damage to clothing, and less commonly intimidation or bites [source: ISU consent form]. (3) Explain rules: wait to be invited, touch only approved areas, do not pick up, restrain, provoke or feed the dog, bring no food or toys [source: ISU consent form]. (4) State that the client may ask at any time for the dog not to be present, and that the dog may also disengage and rest [source: ISU consent form]. (5) For children, tell the family in advance, show photos, and get both caregiver consent and the child's own agreement; the child decides whether to meet and touch the dog [source: Courthouse Dogs Foundation]. (6) Add guardian signatures and the child's assent, which the ISU form lacks [synthesis]. (7) Repeat the check-in at the start of each session [synthesis].
Example language (illustrative), to a child: "This is a photo of the dog who works here. You get to choose: you can say hello, have her lie nearby, or not see her at all. Any choice is fine."
Watch for: a caregiver deciding for the child; a child who agrees in the waiting room and then shrinks back; respect the later signal [synthesis].

4.7 Infection-control routine for each session or visit

Purpose: reduce transmission of zoonoses and healthcare-associated organisms.
Steps (SHEA, for healthcare settings): (1) Handler self-screens for illness; one animal per visit; dog groomed, nails trimmed, bathed if soiled, checked for parasites; short non-retractable lead; no choke or prong collars; toileted before entry [source: SHEA 2015]. (2) Everyone performs hand hygiene before and after contact [source: SHEA 2015]. (3) Use a sheet or towel between dog and bed, chair or lap; a disposable impermeable barrier if the dog goes on a bed [source: SHEA 2015]. (4) Prevent licking; staff do not give treats; if treats are therapeutic, the patient offers them from a flat palm, avoiding rawhides, pig ears and bones [source: SHEA 2015]. (5) Keep the dog away from wounds, devices and equipment; no eating or drinking during contact; dog stays out of patient bathrooms [source: SHEA 2015]. (6) Exclude intensive care, isolation rooms and neonatal nurseries [source: SHEA 2015]. (7) Clean surfaces with a hospital disinfectant afterwards and keep a contact log [source: SHEA 2015]. Outside hospitals, adapt the same logic to your office [synthesis].
Example language (illustrative): "Let's both use the hand gel before and after. And she's not allowed to lick, so I'll ask her to settle if she tries."
Watch for: Dalton et al. report therapy dogs carrying organisms such as MRSA and C. difficile, with raw diets, patient-fed treats and licking as risk factors; transmission to patients was not shown and evidence is limited [source: Dalton et al. 2020 review].

4.8 Introducing the dog and opening the session

Purpose: a calm, predictable first contact that keeps the client in charge.
Steps: (1) Settle the dog in its spot before the client enters; let it toilet beforehand [source: SHEA 2015; Courthouse Dogs Foundation on settling]. (2) Ask the client to wait until invited and show where touch is welcome [source: ISU consent form]. (3) Invite the client to offer a hand and let the dog choose whether to approach [synthesis]. (4) Show the dog's rest area and explain that the dog may go there when it has had enough [source: ISU consent form]. (5) Name the plan for the session and how the dog fits it [source: ACA competencies on intentionality].
Example language (illustrative): "If you'd like, hold your hand out low and let him decide whether to come over. If he goes to his mat later, that just means he's resting."
Watch for: a client who reaches over the dog or hugs it tightly; IAHAIO says animals must not be bent over or jumped on, so redirect gently [source: IAHAIO].

4.9 The dog as quiet presence during hard material

Purpose: support regulation and a sense of safety while the client speaks about difficult things.
Steps: (1) Place the dog lying quietly within the client's reach, as in the forensic-interview model [source: Courthouse Dogs Foundation]. (2) Keep the dog settled; it should not invite play or distract [source: Courthouse Dogs Foundation]. (3) Let the client choose touch (resting a hand, stroking) or none [source: Courthouse Dogs Foundation on child choice]. (4) Notice when the client turns to the dog during distress and, if useful, reflect it gently [synthesis]. (5) Keep the clinical work your own model's work; the dog supports it but does not replace it [source: ACA competencies].
Example language (illustrative): "I noticed your hand went to her when you started talking about that night. Take your time; she's right there."
Watch for: the ACA competencies note the bond can draw out unexpected disclosure [source: ACA competencies]. Pace the session, check consent to continue, and plan containment before the end [synthesis].

4.10 Engagement and rapport building

Purpose: build trust with clients who are guarded, young, or wary of therapy.
Steps: (1) Courthouse Dogs Foundation notes that in therapy the dog can be more playful and help build trust and safety [source: Courthouse Dogs Foundation]. (2) Use structured, low-pressure activities the handler has trained, such as basic cues (sit, down, wait, leave it) [source: Pet Partners; APA HAI slides 2025 cue list] [synthesis on their use with clients]. (3) Move from dog-focused talk toward the client's goals once rapport is there [synthesis]. (4) Never let play replace agreed therapeutic work [source: ACA competencies on intentionality].
Example language (illustrative): "Would you like to ask her to sit? Say it once, calmly. There you go. What was it like when she listened to you?"
Watch for: sessions that stay about the dog week after week; review the goal (see 5.1) [synthesis].

4.11 Interpreting client-dog interaction

Purpose: use what happens between client and dog as therapeutic material.
Steps: (1) Allow natural interactions to occur [source: ACA competencies]. (2) Observe the client's approach, touch, voice and response to the dog's choices [synthesis]. (3) Link what you see to the client's goals and concerns, as the ACA competencies require [source: ACA competencies]. (4) Offer the observation tentatively and ask the client's view, rather than declaring what the dog "feels" [synthesis]. (5) Note the observation in the record [source: IAHAIO on documented progress].
Example language (illustrative): "When he went to lie down, you said 'he doesn't like me.' I wonder whether that's a thought that shows up with people too?"
Watch for: over-reading the dog's behaviour; dogs move away for rest, heat or noise. Stay curious and do not attribute human motives to the dog [synthesis; compare Courthouse Dogs Foundation on not giving the dog human characteristics].

4.12 Modelling respectful care and consent with the dog

Purpose: show respectful, empathic care and make consent and boundaries visible.
Steps: (1) Model respectful, empathic animal care [source: ACA competencies]. (2) Honour the dog's choice not to interact and say so aloud [source: ACA competencies; ISU consent form]. (3) Invite the client to notice the dog's signals before touch, e.g. whether it leans in or turns away [synthesis]. (4) Link this, where relevant, to the client's own right to say no [synthesis].
Example language (illustrative): "She's turned her head away, which is her way of saying 'not now'. Let's give her space. You get to say 'not now' in here too."
Watch for: clients with trauma histories may find this powerful or painful; follow the client's pace [synthesis].

4.13 Real-time welfare monitoring and advocacy

Purpose: protect the dog and, through it, the client.
Steps: (1) Know this dog's cues for excitement, stress and needing a break [source: Pet Partners]. (2) Watch for the categories Townsend and Gee use: avoidance, fear, gaze, freezing, aggression, and the animal's assent or dissent [source: Townsend & Gee 2021]; detailed signal lists [uncertain: not verified]. (3) Support the dog with presence, eye contact, touch and speech (Pet Partners' PETS) and a soft voice, gentle touch and relaxed body language when it is unsure [source: Pet Partners]. (4) Step in and communicate with the client when the dog seems nervous (YAYABA) [source: Pet Partners]. (5) Provide water, rest, a safe floor and no costumes or tricks [source: IAHAIO]. (6) Respect time limits: IAHAIO 30 to 45 minutes; SHEA no more than one hour; end early on fatigue, thirst or need to eliminate [source: IAHAIO; SHEA 2015]. (7) Supervise clients at all times to prevent teasing or mistreatment [source: IAHAIO].
Example language (illustrative): "I'm going to let him go to his bed for a bit. He's worked hard. We can keep going, just the two of us."
Watch for: your own wish to keep the session going; the ACA competencies require you to honour the dog's wish not to interact [source: ACA competencies].

4.14 Preparing and accompanying a child for a forensic interview, medical examination or court

Purpose: reduce a child's stress when a facility dog is used at a CAC or court, without affecting the child's account.
Steps: (1) Coordinate with the facility-dog handler (often a victim advocate, forensic interviewer, detective or therapist) [source: Courthouse Dogs Foundation]. (2) Tell the family in advance; get caregiver consent and the child's agreement [source: Courthouse Dogs Foundation]. (3) In interviews, the dog lies quietly within reach [source: Courthouse Dogs Foundation]. (4) In examinations, a long leash can let the child hold on, at each centre's discretion [source: Courthouse Dogs Foundation]. (5) For court, the dog practises in courtrooms; it can lie in the witness box or in view; the dog is settled before the jury enters, tags are silenced and the jury is told a dog is present; the court needs a motion with evidence of benefit and the dog's credentials [source: Courthouse Dogs Foundation]. (6) Never offer the dog as a reward for disclosure and never imply the dog wants to hear the story [source: Courthouse Dogs Foundation]. (7) Debrief the child afterwards in therapy, separate from the forensic process [synthesis]. (8) Follow mandatory-reporting and safeguarding duties throughout; never name the child in records shared outside the team beyond what is required [synthesis].
Example language (illustrative): "On the day, she'll be lying by your feet. She's there to keep you company. She doesn't need to hear anything; you just talk to the person asking questions."
Watch for: Courthouse Dogs Foundation notes that defence lawyers can challenge the dog's use; document every interaction and the child's response [source: Courthouse Dogs Foundation].

4.15 Collaborating with visiting therapy-dog teams and facility-dog handlers

Purpose: bring dog visits into a client's care in a hospital, school or residential setting without running the programme yourself.
Steps: (1) Route requests through the programme liaison and policy [source: SHEA 2015]. (2) Confirm the team is registered and currently evaluated [source: Dalton et al. review; SHEA 2015]. (3) Share only what the handler needs (e.g. fear, allergy, where to sit); a volunteer handler is not part of the clinical team [source: Courthouse Dogs Foundation on confidentiality] [synthesis on information sharing]. (4) Get the client's consent and the room-mates' permission [source: SHEA 2015]. (5) Agree the purpose (comfort, motivation) and how you will follow up in session [synthesis].
Example language (illustrative), to a handler: "He's keen to meet your dog but startles easily at sudden movement, so a slow approach from the side would help."
Watch for: staff feeding treats or calling the dog over; ask them to stop, as policy requires [source: SHEA 2015; Courthouse Dogs Foundation].

4.16 Responding to bites, scratches, falls and other incidents

Purpose: protect the client, the dog and the programme after something goes wrong.
Steps: (1) End the visit immediately after any bite or scratch; get the wound treated promptly [source: SHEA 2015]. (2) Report to the liaison and, where the law requires, to public health or animal control [source: SHEA 2015]. (3) SHEA: permanently withdraw a dog after a bite or intentional scratch; after an accidental scratch, investigate and withdraw if the risk cannot be reduced; suspend the handler if their behaviour contributed; after vomiting or diarrhoea, withdraw the dog for at least a week; after submissive urination, suspend, address the cause and re-evaluate [source: SHEA 2015]. (4) For trips or falls (e.g. over a lead) or an allergic reaction, give first aid and follow facility incident procedure [synthesis]. (5) Debrief the client: what happened, how they feel about the dog and about you, whether to continue with or without a dog [synthesis]. (6) Inform your insurer as the policy requires [synthesis].
Example language (illustrative): "I'm sorry that happened. Your safety comes first, so she's leaving the room now. Let's look after your hand, and then talk about how you're feeling."
Watch for: Dalton et al. found injury, allergy and phobia risks are mentioned in commentaries but not measured [source: Dalton et al. 2020 review]; absence of data is not absence of risk.

4.17 Documentation and progress review

Purpose: show the dog is part of a planned treatment and support contact tracing and legal scrutiny.
Steps: (1) Record the treatment goal the dog serves and measure progress in professional notes [source: IAHAIO AAT definition; ACA competencies]. (2) Keep a visit log of rooms and people seen, for contact tracing [source: SHEA 2015]. (3) In forensic work, record each interaction and the child's response [source: Courthouse Dogs Foundation]. (4) Record screening, consent, any incidents and the dog's welfare notes (breaks taken, sessions cut short) [synthesis]. (5) Review at set points whether the dog is still helping and whether the client wishes to continue with it [synthesis].
Example language (illustrative): "Looking back over the last few weeks, has having her here made it easier or harder to talk about what you came for?"
Watch for: notes that describe the dog but not the goal; per the ACA, outcomes should be evaluated [source: ACA competencies].

4.18 Working with a client's fear of dogs

Purpose: decide what to do when a client fears dogs, either as a barrier or as a treatment target.
Steps: (1) Default: keep the dog away or out of sight; Courthouse Dogs Foundation describes this for fearful staff and clients [source: Courthouse Dogs Foundation]. (2) If the client wants help with the fear itself, treat it with an established, consented exposure-based approach from your own training, not as an add-on to a visit programme [synthesis]. (3) Any graded contact with a real dog needs explicit consent at each step, a right to stop, a calm, evaluated dog whose welfare is monitored, and a handler who is not also running the therapy if you cannot monitor both [synthesis]. (4) Screen for contraindications to exposure (e.g. acute crisis) as your exposure protocol specifies [synthesis].
Example language (illustrative): "We'll go at your pace. You can say stop at any point, and the dog will stay on her mat unless you ask otherwise."
Watch for: the dog's stress when used as a fear stimulus; repeated approaches by a frightened person can stress a dog [synthesis].

4.19 Endings: absence, retirement and death of the dog

Purpose: handle the dog's absence or loss as part of the therapy.
Steps: (1) Tell clients at consent stage what happens if the dog is ill or unavailable [synthesis; the ISU form does not address this]. (2) Plan retirement in the written protocol [source: Courthouse Dogs Foundation]. (3) Give notice of a dog's retirement, as you would of any planned change [synthesis]. (4) If the dog dies, decide with supervision what to tell clients; make room for their grief and for associations with past losses [synthesis]. (5) Watch your own grief and how it affects sessions [synthesis].
Example language (illustrative): "I wanted to tell you before our next session that she's retiring. I know she's been part of our work, and I'd like to make space for how that lands for you."
Watch for: clients who drop out when the dog leaves; offer to continue and explore what the dog stood for [synthesis].

4.20 Working with what dogs mean in the client's life

Purpose: address the client's own animals, losses and requests, including about assistance or support animals.
Steps: (1) Ask about the client's history with dogs: companions, losses, bites, cruelty seen or suffered [synthesis; ACA competencies on animal-related trauma]. (2) Note that meanings of human-animal interaction vary across cultures [source: ACA competencies]. (3) If a client asks about a service dog or an emotional support animal, explain the distinctions in ADI's definitions and refer to the appropriate assistance-dog organisation or specialist; the ACA competencies do not cover prescribing service animals [source: ADI; ACA competencies]. Letters for animals raise questions of scope and of the treating role versus an evaluative role; weigh these with your licensing guidance [synthesis]. (4) If the client discloses harm to animals, assess risk to others and follow any local reporting rules [synthesis].
Example language (illustrative): "You've mentioned your old dog a few times. What did he mean to you during that period?"
Watch for: pet loss treated as trivial by others in the client's life; it can be a real bereavement [synthesis].

5. Handling problems

5.1 Client focuses only on the dog (avoidance). Name it kindly, link back to the goal, and agree portions of the session without dog contact [synthesis]. The ACA intentionality competency supports reviewing whether the dog still serves the plan [source: ACA competencies]. Illustrative: "We've had lots of good time with him. Shall we give the next part to the thing you came in for?"
5.2 Client refuses to continue without the dog. Explore what the dog provides (safety, distraction, company) and how the client can find some of that in the relationship with you [synthesis]. Keep an agreed no-dog option open.
5.3 Overwhelm after unexpected disclosure. Slow down, check consent to continue, use grounding from your own model, and plan containment before the session ends [synthesis]; the ACA competencies flag unexpected disclosure as a known effect [source: ACA competencies].
5.4 The dog shows stress, refuses, or the session runs long. End the dog's participation, give it rest, and continue without it; honour its choice [source: ACA competencies; Pet Partners; IAHAIO time limits; SHEA 2015].
5.5 Client teases, restrains or hurts the dog. Intervene at once, remove the dog, state the boundary, and explore the behaviour clinically; IAHAIO requires supervision at all times to prevent mistreatment [source: IAHAIO] [synthesis for the clinical response]. Reassess suitability (4.5).
5.6 Rupture: client feels rejected by the dog or by you for preferring the dog. Acknowledge it openly; explain the dog's behaviour without blaming the client; repair the relationship with you first [synthesis].
5.7 Non-adherence to infection-control rules. Repeat the reason briefly and make compliance easy (gel at the door, barrier ready); if rules cannot be kept, the dog does not take part [source: SHEA 2015] [synthesis for the response].
5.8 Allergic reaction or unexpected fear. Remove the dog, give first aid or seek medical help, record, and revise the plan [synthesis]; IAHAIO requires allergy screening beforehand [source: IAHAIO].
5.9 Cultural or religious objection from a family member. Discuss alternatives with the client or family, as IAHAIO advises, and do not press [source: IAHAIO]. Where the conflict is within a family about the client's own beliefs, see the Cultural Formulation Interview and its spirituality, religion and moral traditions module [synthesis] [uncertain: DSM-5-TR content not verified].
5.10 Staff treating a facility dog as an office pet. Re-brief staff; Courthouse Dogs Foundation warns that dogs can lose training quickly when treated this way [source: Courthouse Dogs Foundation].
5.11 Confidentiality with a handler present. Use a staff handler bound by confidentiality for therapy or forensic work, or limit what a volunteer hears [source: Courthouse Dogs Foundation] [synthesis for limits].
5.12 Your own bias and countertransference. Get supervision and an outside view of the dog's suitability; watch for defending the dog against the client, or using the dog to avoid hard material [source: ACA competencies] [synthesis for examples].
5.13 Multiple-relationship invitations. A client offering to dog-sit, walk, or buy gifts for the dog creates another relationship; weigh it under APA Ethics Code Standard 3.05 and usually decline warmly [source: APA Ethics Code] [synthesis].
5.14 Legal challenge in forensic work. Courthouse Dogs Foundation advises documenting each interaction and the child's response, motions with evidence and credentials, and a court record of the decision [source: Courthouse Dogs Foundation].
5.15 Insurance or licensing gaps. Do not begin until cover is confirmed in writing; the ACA competencies require confirming personal and professional coverage [source: ACA competencies].
5.16 Dog ageing or illness. Re-evaluate after any behaviour change; withdraw the dog when health is in doubt and plan the ending (4.19) [source: SHEA 2015] [synthesis].
5.17 Child safeguarding concern arising in a dog session. The dog changes nothing about duties: follow mandatory-reporting rules, do not use the dog to elicit details, and refer to the CAC or forensic process where appropriate [source: Courthouse Dogs Foundation on rewards] [synthesis].

Sources

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