Training a Pet as a Therapy Animal, with Leslie Horton

June 29, 2017
Download MP3 (18.26 MB/21:20)

A therapy animal has been trained to visit hospitals and other healthcare environments to provide comfort, help decrease a patient’s pain or discomfort, encourage movement, and even serve a role in a patient’s treatment program. In today’s podcast, Leslie Horton will discuss what is involved in training a dog or other pet to become a therapy animal.



ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer.

A therapy animal has been trained to visit hospitals and other healthcare environments to provide comfort, help decrease a patient’s pain or discomfort, encourage movement, and even serve a role in a patient’s treatment program. In today’s podcast, Leslie Horton will discuss what is involved in training a dog or other pet to become a therapy animal.

Ms. Horton is a registered nurse. She started the Animal Assisted Care Program at the Inova Fairfax Hospital Campus in 2001 and is the founder of Most Fine Canine, Inc.

ASCO would like to thank Ms. Horton for discussing this topic.

Leslie Horton: Hi. This is Leslie Horton and I am a registered nurse, and I am the coordinator for the animal-assisted care program on Inova Fairfax Medical Campus. I wanted to talk to you about therapy dogs and their use in oncology. Before we go any further, I'd like to talk to you first about all the definitions because it can get very confusing.

The first definition that I'd like to talk to you about is called working dogs. These are animals which perform actual duties to enable the completion of one's career's task. Technically speaking, animals used in sports therapy, obedience, and confirmation do not fall into the working animal definition. This term more applies to animals such as those used in armed forces, police, fire, park, security, and government type situations.

Service dogs are defined by federal law in the United States as a dog trained to complete tasks to mitigate some of the symptoms in a person with a disability. Therapy dogs are not service dogs. Service dogs in training are dogs being educated to provide tasks for people with disabilities or ailments. These animals do not have access into public areas under the federal regulations. However, most states allow them to come in. Again, these animals are not considered pets.

Then we've all heard about emotional support animals or assistance dogs or therapy animals. This is where the term can become very confusing because emotional support animals are animals who have the sole function to provide emotional support, comfort, therapy and companionship, and promote emotional well-being. They may or may not perform some trained tasks but federal law does not permit these animals to be on public access.

Therapy dogs are part of a team. They are pets. They are used with their handler to provide comfort to people in different situations. They are not covered under American's Disabilities Act so they do not have access everywhere. In order to have access into a place such as a library, a school, a hospital, a nursing home, one is required to get permission from that administration.

The characteristics of these animals are that they should be friendly, well behaved. And when I say well behaved, we're not talking about having to have excellent obedience. We are, however, talking about some of the basic skills such as a sit, a down, to walk nicely beside you, not to pull you, and not to jump up on other people. The dog should also be comfortable going around other dogs and love people. I cannot tell you how many people we have come to the campus that the person is interested in doing the therapy but the animal is not. If the animal's not interested in doing the therapy, then it is not the right job for him.

Whenever you are choosing your dog to be a therapy dog, or any animal, again, you want to make sure that they like interactions but you also want to make sure that they're healthy enough to do the job and that they're comfortable in the surroundings. So you want to make sure that they're comfortable with elevators, lots of people, slippery floors, etc.

When you're looking at an organization to become a registered therapy animal team, there are several out there. Three come to the top of my mind right off the bat. One is Therapy Dogs International, Therapy Dogs Inc., who has become Alliance of Therapy Dogs, and The Pet Partners Organization. However, when you're going into a hospital setting or acute healthcare environment, it is the responsibility of that healthcare environment to know that you have to meet what's called APIC SHEA guidelines. It's a lot of initials, so let me explain what they mean. APIC is the Association of Professionals for Infection Control. SHEA is the Society of Hospital Epidemiology of America. And what they're saying is for animals to come into the institution, there are certain guidelines that need to be met. These guidelines are available online under SHEA, S-H-E-A, Society for Hospital Epidemiologists of America. Part of these guidelines require that the dog be well behaved, that the person be educated on the transmission of diseases from human to dog or from dog to human, or from animal to human and human to animal. The name for that is called zoonosis.

Under the APIC SHEA guidelines, only dogs are permitted into acute healthcare environments, so I will be saying the word dog a lot but do understand that therapy animals can be domestic animals such as miniature horses, cats, rabbits, etc. So it's not only limited to the canine species.

The other requirement is that the person who's in charge of any such group is able to know dog behavior, is able to evaluate the teams, and is also able to adequately assess the patients or the clientele that the animals will be seeing so that they are safe all the way around. Not just the patient, but also any visitors, the dog, and the handler who is volunteering their time.

There is only one international registration that is meeting all of the SHEA APIC requirements at this time, and that it Pet Partners. Therefore, we require the Pet Partners registration on our campus at Inova. One of the other reasons I like Pet Partners is because it also teaches the handlers how to interact with the clients or the patients in various situations.

Before I go any further about what we do in the hospital, I'd like to talk about some of the other alternatives that therapy animals can do. Therapy animals can do R.E.A.D. programs. These are programs where the animal just simply stays there and the child reads to it The animal is safe. He's non-judgmental. So if they make a mistake, they're less self-conscious and it also gives them more confidence.

The other thing I'd like to talk about is therapy animals going into prisons. Therapy animals will work with prisoners to help them to relax and to also help them learn to handle dogs and to provide positive interaction. Another place therapy animals can go is airports. Crowded airports, holidays, people are rushed, they're harried, stress levels are up. Therapy animals are used to help people calm down in those types of situations. You also see therapy animals doing disaster relief. The animals will come in and provide comfort to the victims and also to those who are rescuing those victims.

One other thing that therapy animals can do is they can go into nursing homes and they can comfort patients. This is what a lot of people think about with therapy animals. Therapy animals can also go into hospital settings, and again, this is something that a lot of people want to do with their dogs.

I do want to clarify some of the terminology regarding therapy dogs. When we say the word therapy dogs, we're actually implying that the dogs are either in therapy or the only therapy that the dogs do is that they're being petted. But in actuality, that term is an old term because the dogs do so much more.

The proper term rather than therapy dogs or therapy animals is actually called animal-assisted interactions. Animal-assisted interactions is just that. They're interactions that occur between the animal and the clientele to improve feelings of wellness in both the animal and the handler. Under the umbrella term animal-assisted interaction, there are two other accepted terms. It's called animal-assisted activities and animal-assisted therapy. Most places that have therapy dogs use animal-assisted activities. The people go in, they provide comfort, then they leave and then is not measured by a professional, a licensed professional. Under animal-assisted therapy, what happens is the interactions are actually measured by a professional. For example, if the R.E.A.D. program is done in a school and a teacher is measuring the progress of how many pages are read with the dog, then that is animal-assisted therapy. If the R.E.A.D. program is done in the school and there is no measurement by the teacher and the children are just getting practice reading, it is animal-assisted interaction. Neither is more important than the other. It's just important to know the definitions and to know the scope of what you are able to do as a volunteer.

Therapy Dogs International and Therapy Dogs Inc. do not support animal-assisted therapy. They provide animal-assisted activities, so visitation only.

In Inova Fairfax Hospital, on our campus, 85% of what we do is animal-assisted therapy. We also have a third term that we use called personal assistance therapy. And with our personal assistance therapy, we introduce people with disabilities to the tasks that a service animal can provide to help them gain more independence. We call that personal assistance therapy or PAT. We then provide them with the resources to be able to contact organizations and applying for their own service dogs.

Now, I'd like to talk to you about how a hospital visit goes. And in our organization, as in with any other healthcare organization, it's real important that the dogs are cleaned within 24 hours of coming to the visits, that their teeth are brushed, that their nails are not sharp so that they do not scratch anyone. It's also equally important for the handler to be clean, dressed professionally, and to wear closed-toed shoes. We recommend that our handlers carry hand sanitizer for visits in between because when you're walking in the halls, people do want to see your dogs. However when we're in the institution seeing patients, do we wash our hands with soap and water? The client washes his hands with soap and water before he even touches the dog and a barrier is used to place on the bed, such as a sheet folded in half. After the visit, the patient washes their hands and then the handler washes their hands again. So this way, we do our best to prevent infection and contamination from visit to visit. The barrier that was used, the sheet, is thrown into the laundry and not used throughout all of the visits.

We have had some amazing things happen with our oncology patients and the use of therapy dogs. One of our benefits is for patients who are going to have bone marrow transplant or have had bone marrow transplants. These patients are extremely at risk for getting infection. Therefore, it's very important that the dogs are well behaved and very clean. Same thing for the handler. So what we do, though, is the bone marrow transplant patients have to walk 10 laps or a mile each day to gain their strength. So what we have found is it's so boring to walk a circle in the hospital over and over again unless we add a dog. Once we add a dog, the interaction is more pleasant and patients are more motivated to complete their mile a day. It makes the time go much faster.

The important thing too about therapy dogs that people do not know is that 5 neurotransmitters—this is a study done by [inaudible]. 5 neurotransmitters are released in the dog and in the client that makes them feel better. So when a person who likes dogs interacts with a dog, they feel better, they lower their blood pressure, and they also release endorphins or our body's own pain medicine. They have found that patients who have had surgery, orthopedic surgery in particular, who receive therapy with dogs require less pain medicine than those who did not receive therapy with dogs. The important thing to remember is the dog benefits with this as well because the dog also has the neurotransmitters released in him as well.

So the dogs help the oncology patients walk. One of the other things that they do is they cheer people up who are sick and tired of being sick and tired. Cancer and chemo can be a long, drawn process, and it is easy to become discouraged. The dogs come in, they lift the spirits, they are a safe place for the client to vent. Sometimes the patients feel like they have to be so strong for their family members or they have to put on a brave face because people will be like, "You can beat it. Keep fighting. Keep fighting," and they're tired, so a moment with an animal actually allows them to know that it's okay to be sick and tired of being sick and tired, and it's a safe place for them to release some of their fears and insecurities about their illnesses. I think this is one of our best benefits with the dogs because it's safe. It's very safe for the client. We have seen people have conversations with the dogs that they would not have with their family members or the healthcare providers, but they have the conversation with the dogs and they are able to problem solve out loud and also unload some of that stress.

The other things our dogs do for our oncology patients is if, unfortunately, the patient is losing their battle with cancer, the dogs provide what we call tactile comfort. In a hospital environment, some people see it's so sterile, they don't realize they can hold the patient's hand, they can sit with them, they can be with them, and the dogs actually get up in the bed and provide this tactile comfort. Whether the patient is terminal or not, that comfort is very soothing. However, for terminal patients, it's very soothing to them because they have the presence of something in the bed with them. And our dogs will stay with those patients until they stop breathing and their heart stops so it enables them to feel comfort as they're actively going through the dying process. It sounds like that would be something that's very difficult to do as a volunteer, but I will tell you that it is also one of the most impactful and rewarding things that one can do with their animal. It also relieves stress for the people and loved ones who are sitting with the person who is terminally ill.

The other thing that animals do for the oncology patients is they help them get moving. Again, the patients may be sick and tired of being sick and tired. They may not be able to have the strength to stand up but we want to encourage our patients to continue to move. So how do you do that? You can come in with physical therapy and they do a really wonderful job, and the person goes through and does the physical therapy but they're tired. Again, you bring the dog in, they have less pain because they're interacting with the dog, and they can have fun because they can be playing ball with the dog, or they can be hooking and unhooking a leash, hooking and unhooking the snaps on the vest. They can be brushing the dog. So even if they are not strong enough to walk at this point, they can still do exercise. One of the things that I am known for doing is just putting the dog on the lap just a little bit so that the patient has to reach for the dog a little bit more. This gives them the strength to lean forward and build their core so that they can then proceed with other activities such as throwing the ball and then eventually getting out of bed.

We also use our dogs to be with patients as they sit up and to maintain balance. We want the patients to sit in straight into their pelvis. So the dog can actually sit between their knees, and when the dog is sitting between their knees, they can pat the dog. In patting the dog, they maintain their balance because the dog is in the position where the person is sitting straight in their pelvis. The other thing that we can do is help them gain strength when it's time for them to start trying to move to the left and the right, and the way that we do that is by positioning the dog to the left or to the right of the patient and then having them pet them. Finally, the dog can be with them when they're using walkers and they can walk with them. When they take their first steps, they can do all of those things.

I am going to share a story with you about a patient that we have that had leukemia. She was a person who had a job working with animals. She was a kennel tech. And she was so depressed until we brought the animals in with her. In her process, we got to know her over 18 months because she would come in and out for chemo. Unfortunately, she lost her battle to cancer but there are so many things that she said that were so important to me that made me understand why what we do is important for our clients. She would say things like, "I feel so much better just because the dog is here," "I don't really want to walk today but I know the dog is expecting me to walk him so I'm going to walk him today," "All right. I'm going to try but I only make it halfway down the hall," and then "You know what? We're doing pretty good. We're going to continue to walk." So all of these things are motivation for her to continue to do her therapy and to push herself just a little harder. Unfortunately, her cancer spread. And when she passed, she had her favorite therapy dog on the bed with her. And the first thing she said when we got into the room was, "Oh, good. You're here. I've been waiting for you." And the dog laid with her and she was able to die peacefully a couple hours later.

Cancer can be beaten. I, myself, am a breast cancer survivor. And I cannot tell you how, when you're depressed and you get hit in the face with the diagnosis, seeing an animal means so much to you. It gives you a chance to take a break from all that's happening around you.

One of the other things that the therapy animals do is they also give a chance for control to the patient. Any one of us who's ever been in the hospital knows you're told when to eat, when you're going to get your medicines, when you're going to take your bath, when you're going to walk, if you're going to walk. It's very frustrating. And one of the things that happens when we come with the therapy animals is we can have a patient with cancer who's been seeing the dogs every day, and they will suddenly say, "No, I don't want to see a dog today." It's not about the dog. It's about ability to finally say no to something. And that in itself is empowering and is therapy. So we postpone that visit for that day and we come back the next day.

When I started this program, I was a critical care nurse. I knew that the animals would bring value but I never understood how much value and healing the animals would bring. Here I am, 17 years into the program, and I'm still amazed every day how an animal and a person will connect and how that animal will help someone heal. For those of you who are interested in doing therapy with your dogs, I strongly recommend that you do it. You will never find something more rewarding and you will never underestimate the power of your dog because you will see them do things that you never thought were possible. They will connect with a patient that no one else could connect with. They will bring meaning to a life for someone who's extremely depressed and sad. They have the ability to cross barriers that sometimes other humans just cannot.

ASCO: Thank you, Ms. Horton. For in-depth profiles of other members of the cancer care team, please visit the Cancer.Net Blog at

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net Podcast.