Animal-assisted therapy

animal-assisted therapy, AAT

Animal-assisted therapy is an intervention that uses animals to improve therapeutic outcomes. Animals may include horses, dogs, cats, birds, or others.

What is animal-assisted therapy?

The client, therapist, and animal work together in various activities outlined in a treatment plan, with specific goals for change, measurable objectives, and the expectation of identifiable progress toward the treatment goals. The therapy can take many forms, based on the patient, the animal, and the treatment plans.

Animal-assisted therapy is typically used to enhance and complement the benefits of traditional therapy.

The American Humane Association defines animal-assisted therapy as:

“A goal-directed intervention in which an animal is incorporated as an integral part of the clinical healthcare treatment process. Animal-assisted therapy is delivered or directed by a professional health or human service [professional] who demonstrates skill and expertise regarding the clinical applications of human-animal interactions.”


Humans have been connected with animals since before recorded history, as is evidenced by cave paintings from around the world. Ancient Greeks were the first individuals to notice that horses helped seriously ill individuals. The first documented use of animals therapeutically was in ninth-century Belgium, when people with disabilities were asked to care for farm animals. Animals were used in the 1700s at the York Retreat, a progressive “lunatic asylum” for its times. In the 1800s, Florence Nightingale recommended animals as companions for the infirm.

However, active research into animal-assisted therapy began in the 1900s with Dr. Sigmund Freud noting that individuals did better in therapy sessions when his pet chow was present.

During the 1960s, research involving animal therapy began to become more serious. Dr. Boris Levinson was first. He noted noticeable changes in his patients when his dog was present in therapy sessions too.

Unfortunately, nobody took Levinson seriously until Freud’s death and his early animal findings were published.

Levinson started the animal-assisted therapy movement. This approach advocated using pets to provide a safe environment for patients of all ages.

In 1969, the North American Riding for the Handicapped Association came to light. This institution provides therapeutic riding lessons for disabled children and adults.

Elaine Smith founded Therapy Dogs International (TDI) in 1976. This organization focuses on increasing the availability of therapy dogs for depression.

The Delta Foundation came about in 1977. It aimed to study the human-animal connection in more detail.

By the 1990s, animal-assisted therapy started gaining acceptance worldwide, leading to the establishment of the International Association for Human-Animal Interaction Organization.

Today, the medical world accepts animal-assisted therapy as a valid field. It’s widely used as an effective treatment for many mental and emotional issues.

Animal-assisted therapy techniques

Animal-assisted therapy can be a valuable intervention for some individuals or groups. It can help with various experiences and conditions, including stress, anxiety, depression, autism, ADHD, Addiction, schizophrenia, emotional and behavioral problems in children, Alzheimer's disease, and some medical conditions.

Techniques often vary depending on the condition being treated. There is no written manual spelling out the treatment procedures. The lack of standardization means that it is vital for individuals to ensure they have proper training in methods for animal-assisted Therapy. For the therapist, this means that your standard practices may need to be set up and monitored to ensure that treatment is progressing.

Animal-assisted therapy effectiveness

Research studies about animal-assisted therapy have shown its efficacy in:
  • Promoting positive emotions and improved mood
  • Helping individuals learn and express empathy
  • Improving social interaction and communication skills
  • Boosting confidence
  • Reducing feelings associated with low moods, such as loneliness, insecurity, sadness, social isolation, and anger
  • Helping participants improve motivation
  • Enjoying the therapy sessions more
  • Noting that the session atmosphere was less stressful during animal-assisted therapy
  • Easing anxiety

A study from 2018 shows that seeing and touching animals can trigger positive physiological changes, including higher levels of serotonin, endorphins, and oxytocin. Additionally, lower baseline levels of the stress hormone cortisol have been observed in these cases.

Research from 2016 has also linked animal-assisted therapy to improved blood flow in people experiencing heart failure. It may even reduce blood pressure for some people.


A significant downside of this therapy is that individuals who have allergies or significant fear of animals cannot benefit. Therapists who utilize animal-assisted therapy may or may not have multiple animal options, however, the typical animal used is dog, cat, or horse. These are three that tend to cause allergic reactions.

Another downside of animal-assisted therapy is the space required to hold therapy. While traditional therapy only requires a small office, animal-assisted therapy requires a large enough space for humans and animals to be comfortable regularly. Suppose the animals used are cats or small dogs. In that case, this may not be a significant difference. Still, if larger dogs or larger animals like goats or horses are used, a much larger area is required, limiting the accessibility of this type of therapy.

Insurance coding for animal-assisted therapy

Animal-assisted therapy doesn’t currently have a specific code for use. However, because animals could be considered similar to other ‘tools’ that therapists use, like games, then some therapists bill under regular coding 90837/34/32 while others use code 90899 Other Psychiatric Services or Procedures, to report psychiatric services or procedures that do not have a specific code. In the notes, therapists should indicate information referring to the use of the animal and the client's response to the treatment.

Some specific insurance companies have their own billing codes to designate specific animal therapies, such as equine therapy. Always consult information received upon credentialing with specific insurance boards for best billing practices.

Special training for the therapist

The first qualification for using AAT is to be qualified to work as a therapist. This requires a minimum of a Master’s Degree and a license to practice as a mental health practitioner. Examples include licensed professional counselor, licensed marriage and family therapist, licensed psychologist, or any other license that allows the individual to provide therapy.

Additional training is needed post-licensure to be considered a specialist. You can obtain this training one of two ways.
  • You can earn an animal-assisted therapy certification online, which typically consists of a mix of instruction and experience. To pursue this option, you can apply to an online program and find an animal-assisted therapy program in your area where you can gain the necessary expertise to pursue this career.

  • You can also pursue the needed specialization through a graduate program. These programs may consist of online and in-person instruction and include a research component.

Most common types of AAT

While animals of any kind can be used, the two most commonly used animals in therapy are dogs and horses.

Therapy dogs undergo extensive training to be friendly and welcoming. They can comfort patients with body contact as a means to promote feelings of calm and well-being. Some therapy dogs interact with patients by engaging in activities to improve motor skills, while others encourage clients to relax and open up. This can help in the treatment of conditions like PTSD, autism, dementia, and ADHD.

There are three different forms of therapy involving equines.
  • Therapeutic horseback riding is an excellent low-impact exercise. It’s suitable for developing muscle tone, coordination, and confidence. It is helpful for individuals with mobility difficulties.

  • Hippotherapy uses horses as a type of occupational therapy. Here the focus is on addressing cognitive, social, psychological, behavioral, and physical problems.

  • Equine-assisted psychotherapy (EAP) involves using horses to help people with mental health issues. This may involve simply interacting with and working with the horse or taking part in riding exercises, depending on the needs of the individual.

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How animals are chosen to assist

Animals are ultimately chosen by the therapist who will be utilizing them in their practice. However, most therapists consult animal professionals' guidance to determine the most suitable characteristics and breeds.

Dogs must pass temperament and obedience tests to be certified with their handler, and they cannot begin the process until they are at least one year old and have lived with the handler for six months. Any breed can work as long as they can pass the training. Some therapists choose to have animals in their private practice that are not certified but have good temperaments and enjoy people. It is important to be cautious with this practice, though, as this can place more liability on the therapist in the case of misbehavior of the animal.

Smaller animals such as rodents, turtles, and birds may be utilized and may not be trained explicitly as they lack some of the behavior concerns that accompany larger animals in therapy. With any animal-assisted therapy, the therapist must be upfront in advertising and informed consent about the animals present and their level of training to mitigate risks and decrease the chances of adverse incidents.

Therapists using tools such as animals in their practices can utilize EMRs and practice management software to help with scheduling and billing for these services. TheraPlatform is an intuitive, all-in-one platform that offers a 30-day trial without entering a credit card. Cancel anytime.

Resources for animal-assisted therapy

Interested in working in animal-assisted therapy? See a few options below.

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