Someone to Run with: Towards a Relational Neuroscientific Approach to Dog-Assisted Child Psychotherapy

Dor Roitman

Grossman’s beautiful novel ‘Someone to run with’ (2004) begins with these words:

A dog runs through the streets; a boy runs after it. A long rope connects the two and gets tangled in the legs of the passersby, who grumble and gripe, and the boy mutters “Sorry, sorry” again and again. In between mumbled sorries he yells “Stop! Halt!” - and to his shame a “Whoa-ha!” escapes from his lips. And the dog keeps running (p. 3).

And somewhat later:

Dinka walked beside him, her head bowed, her tail drooping; walking like that on the side of the road, they looked like two mourners. The rope dragged on the ground between them. Assaf opened his hand and let it fall to the ground, but Dinka stopped, as if she were amazed and scared by his action, from the hinted intention of it. Assaf immediately bent down and picked it up (p. 101).

In these two quotes, Grossman vividly encapsulates the deep emotional bond that a person and a dog can share, the multiple levels of implicit communication that flow both ways and the way they can regulate each other’s emotional states. It is also a beautiful example of emotional contagion and of projective identification between human and non-human animals.

Animal Assisted Psychotherapy (AAP) is concerned with the effects of the presence of animals in a setting, which is used for the psychotherapy of humans. It builds on the way people and animals perceive, respond and interact with each other, to enhance the therapeutic process. People, especially children, are often strongly attracted to, cognitively intrigued by and emotionally responsive to animals. They are inclined to attribute a personality, intentionality and an inner emotional life to living beings from all species. For reasons that will become clearer further down, we humans easily connect with domesticated mammals such as dogs, relating to them as attachment figures, social partners, friends, siblings, offspring and so on.

Dogs are social relational beings, able to connect with other social animals and to build relationships with them. As I will show later, they share with us humans quite a similar neuro-physiological operating system that codes the interpersonal world in homologous tools and signals and operates in like mental and behavioural patterns. They, too, tend to see us, under the right conditions, as partners in creating and maintaining relational bonds. Hence, the participation of dogs in the analytic space brings with it an expansion of the possibilities for interactions and relationships for both the patient and therapist, within a more elaborate interpersonal matrix. Relational processes involving a third subject in the form of a dog in the analytic field occur as spontaneously as those involving the therapist and the patient.

A child therapist introducing a dog to the analytic space faces the challenge of dynamically administrating the therapeutic sessions accordingly while remaining engaged in the three-way interactions as they unfold, and at the same time being aware of and processing the multiple levels of communication and interaction that transpire, to the benefit of the therapeutic process. One question that constantly arises is about the ethical stance of the therapist and his/her responsibilities towards the dog. These (and other) issues and challenges require that we have a theoretical standpoint, to guide our clinical thinking and technique. Unfortunately, current theories on animal relationality and on dynamic psychotherapy in the presence of animals are scarce and insufficient. The first goal of this chapter is to propose some guidelines for such a theory. The second goal is to demonstrate how this theory can be applied in a therapeutic setting to guide the clinical assessment of and technical approach to the inclusion of a dog in the psychotherapy of children.

In the first part of this chapter, I will speak about what I think functions as a connecting tissue between all sentient beings, especially mammals. I refer here to specific mental and neurological mechanisms that I think belong to some aspects of the relational self. I will suggest that this level of functioning and communication is in the heart of dogs’ and people’s habits of seeing each other as similar and significant subjective others and to treat each other as legitimate partners for relational and interpersonal processes, as attachment figures and as transferential and transitional objects. This part will be dedicated to the establishment of the neuroscientific foundations for a clearer concept of the relational self in dogs. Based on this, in the second part of the chapter, using clinical material, I will demonstrate how the concept of relationality in dogs contributes to how we think about and work with what happens between a child patient and a dog in psychotherapy. Using the theoretical model that will be presented in the first part, some of the processes commonly explored in the relational literature and which are taking place in the human-animal matrix of the therapeutic session in which a dog is present will be discussed.

Discussing animal relationality and relational processes between humans and dogs necessitate, I think, a multi-disciplinary approach. A deep asymmetry

Dog-assisted child psychotherapy 57 is embedded in the dominating (some will say domineering) position that humans assume towards non-human animals. An exploration of the intrapsychic and subjective realm of dogs, in their relations with humans, might come across as projective and anthropomorphising and in any case be suspected to be over speculative. This is due to a disruption in the way we humans perceive the evolutionary continuity of which we are all a part, people and animals. Since I see this as a major problem that has impeded our theoretical advancement and creativity for many years, I decided to begin this chapter by reflecting on the human-animal split and the reasons for the lack of theory about animal relationality and intersubjective processes between humans and animals. In the present state of affairs, I think that in order to establish a sound and applicable relational approach to the effects of the presence of a dog in therapy, which takes into account such concepts as Self, Consciousness, Object Relations and Relationality, it is important that we base our premises on findings from various fields of knowledge. I found reinforcement in Schore’s words, relating to what he sees as Bowlby’s profoundly significant proposition, equally favoring an interdisciplinary approach to the study of developmental phenomena. Schore (2000) states that

in such an approach the collaborative knowledge-bases of a spectrum of sciences would yield the most powerful models of both the nature of the fundamental ontogenetic processes that mediate the infant’s first attachment to another [human] being, and the essential psychological mechanisms by which these processes indelibly influence the development of the organism at later points of the life-cycle (p. 24. My square brackets).

The reader may therefore find that this chapter speaks in more than one language. I hope that by connecting the dots I will be able, eventually, to draw a clear line around what I think could be a useful unified theoretical approach to Dog-Assisted Child Psychotherapy, and to offer therapists something to run with.

Part I: A relational neuroscientific theory of dog relationality

A disruption in the human-aninial communal bond

Once upon a time, our ancestors, the Homo-Sapiens, emerged as a distinct species of the Hominid family, the great apes. This process involved the gradual development of capabilities such as bipedalism and language. At that time no scholars and philosophers were about to ponder upon the differences and similarities between this new evolving species and other kinds of animals. Many centuries later came the Hunter-Gatherer era, with its tribal culture. By that time, around 40,000 years ago, the extinction of the Neanderthals, the other subspecies of archaic humans in the genus Homo,

was almost complete and Homo-Sapiens had largely established itself as the only human around. These early humans made marvellous discoveries, such as the taming of fire and wheat, developed elaborate ways of communicating abstract ideas through spoken and written language and achieved monumental feats through collaboration in big numbers. They realized that getting many people to cooperate was possible by convincing large populations to share in the belief in imagined stories about a world order, stories which functioned as social adhesives and motivational regulators (Harari, 2014). One question that these stories had to answer was - What makes us humans special, and what is the purpose of our being here? Many different answers were given to this question. A thread which was woven through all of them was the idea that there was something about humans that was essentially different from other non-human beings. Along the ages, this difference has expanded conceptually into a gulf, sustained by theological and later biological and psychological arguments. Freud, deeply influenced by the findings of Charles Darwin and the evolutionists, was puzzled by this change in man’s attitude towards animals throughout life, as well as throughout our phylogenetic development. In 1917 he wrote:

In the course of the development of civilization man acquired a dominating position over his fellow-creatures in the animal kingdom. Not content with this supremacy, however, he began to place a gulf between his nature and theirs. He denied the possession of reason to them, and to himself he attributed an immortal soul, and made claims to a divine descent which permitted him to break the bond of community between him and the animal kingdom... A child can see no difference between his own nature and that of animals... Not until he is grown up, does he become so far estranged from animals as to use their names in vilification of human beings.

...Man is not a being different from animals or superior to them; he himself is of animal descent, being more closely related to some species and more distantly to others. The acquisitions he has subsequently made have not succeeded in effacing the evidences, both in his physical structure and in his mental dispositions, of his parity with them (pp. 140-141).

Note his use of the expression ‘the bond of community’ (as translated by James Strachey), and the claim for parity in physical structure and mental dispositions. This passage can be read as suggesting the existence of a common matrix, incorporating both humans and non-humans, all connected through homologous physical and mental mechanisms. By now, a century after Freud’s hypothesis, this idea has been robustly validated by research. I will refer later to some aspects of these findings.

Freud is also pointing here to what may be the main reason for still very persistent misconceptions about animals, which account for the fact that

Dog-assisted child psychotherapy 59 many of us are still reluctant to attribute feelings, personality and a subjective experience to animals. This is seen in the general avoidance in, among other places, the academic and clinical literature to address the animal’s experience and point of view in its relationship with humans, or to analyse the human-animal interactions using psychoanalytic concepts and paradigms.

Animals are marginalized in the eyes and lives of humans (Berger, 1980). Berger says that pets have become mirrors for their owners, reflecting parts that need completion or recognition, taking the place of family members, representing trivial human traits and are raised to be ‘creatures of their owner’s way of life’ (p. 14). In zoos, they are reduced to a spectacle, usually a disappointing one because in the zoo the animal is sedated, restricted, confined and stripped from its natural vigor and self-dependency. It rarely looks back at the visitors. Berger sensitively observes

Therein lies the ultimate consequence of their marginalisation. That look between animal and man, which may have played a crucial role in the development of human society, and with which, in any case, all men had always lived until less than a century ago, has been extinguished (p. 28).

Myers (1998) also argues for the importance of re-centralizing the animals as they are in the actual lives of children, as a whole and compelling presence. In his criticism of psychoanalysis, Myers acknowledges that ‘psychoanalytic theory assumes a biologically based commonality with animals, but this is normally expected to be transcended with development’ (p. 38). And although there is an abundant reference to animals, he postulates, it is usually symbolic or projective representations belonging to immature parts of the human self, oedipal conflicts, antisocial urges, psychic stress or ill health. Tn therapy’, he adds, ‘they are but a means towards a mature social - that is to say, human - ego in a mono-species adult world’ (p. 39). Myers believes, like I do, that in exploring the role of animals in human development, ‘the key variable of interest, the child-animal relationship itself, needs to be the object of understanding’ (p. 39).

So, as Myers puts it, ‘Western culture may be exceptional in positing categorical human/nonhuman contrasts. Being human means not being an animal!’ (Myers, 1998, p. 46. Italics in origin). It seems that under the cautious tendency not to anthropomorphise animals lies a deeply ingrained conviction that we humans are exclusive in possessing a subjective emotional life, next to an archaic fear of losing our long-cherished sense of superiority and uniqueness. Freud (1917) thought that after the cosmological blow, brought by the realization that the earth was not the stationary center of the universe, the evolutionary claim for a communal bond with our fellow creatures inhabiting this planet was the second severe blow to humanity’s narcissistic self-love. Jaak Panksepp, a renowned researcher in (and founder of) Affective Neuroscience, reiterates, Tn my estimation, the argument against animal feelings comes ultimately from an unforgiving, anthropocentric formof solipsism combined with a pernicious form of neo-dualism’ (Panksepp, 2001, p. 143).

Nowadays, though, mounting evidence from brain research and modern psychoanalytic theories is casting new light on human-animal relations. Following is a review of some selected findings and perspectives, which to my mind have consequential implications in this field. In presenting them in brief, I am proposing an evolutionistic approach which accepts that in evolution the new lies on top of the old, as epitomized in Darwin’s notion of evolutional continuity, or in his dictum that the difference in the mental lives of animals are ‘one of degree and not of kind’ (Darwin, 1871, p. 105).1 This also means that since the brain has retained evolutionary layering, ‘lower’ or more basic mental structures and functions will be found in a larger variety of species, or in other words, that ‘from an evolutionary perspective... many of our fundamental abilities are remarkably similar to those of our brethren animals’ (Panskepp, 2001, p. 144).

The relational self in dogs - exploring homologous mechanisms in animals

Subjective emotional experiences

In his exploration of the neurobiological substratum of emotions, Panskepp found evidence of genetically ingrained emotional systems, situated in deep subcortical areas of the brain, the arousal of which generates specific classes of emotional behavior and affective body-states (Panskepp, 2001, 2011, 2012). We can witness the operation of these mechanisms very easily in animals, on the behavioural level. Like when my dog Shula hears thunders on a stormy night and starts wailing and scratching the door in a desperate attempt to let herself in, or when my cat Itzik catches a glimpse of something moving in the grass and instantaneously crouches down flat with eyes and ears pointed forward. Affective neuroscience tells us that these behaviors are based on instinctual actions, or rather ‘intentions in action’, while at the same time the animal is experiencing a specific subjective feeling, an affective state or emotion, and a sense of valence (good or bad) which classifies the experience as potentially positive or negative in its effect on the survival of the organism (Panskepp, 2012).

Panskepp identified seven such primary-process emotional networks, correlated to specific neural circuits, which are: FEAR, RAGE, LUST, CARE, GRIEF, SEEKING and PLAY. The names of these distinct systems are capitalised for the purpose of differentiating them from the language of emotions that we regularly use (Panskepp, 2012). It helps to clear the distinction if we connect each emotion-action system to its prominent emotions, as in: RAGE - Anger, Hostility; FEAR - Anxiety, Fear, Dread; SEEKING -Enthusiasm, Expectancy; etc. We can now postulate that what was activated in Shula was the FEAR system, while in Itzik it was SEEKING.

Evidence also supports the claim that these mechanisms for affect are shared by all mammals and probably most vertebrates (Panskepp, 2001, 2012). What this means is that the capacity to feel affective emotions, accompanied by a clear sense of valence (good or bad), is an evolutionary forged ability shared by all mammals, including dogs. It can be easily explained how these mechanisms are necessary for survival.

Theories on the primary-self and core-consciousness

It seems then that this primordial level of functioning, these affective emotion-action mechanisms, are fundamental aspects of subjective experience. It follows that all mammals have subjective emotional experiences. What also seems to be implied from this is that we can speak about a neuro-biological self, a Primary SELF (Panskepp, 2012. Capitalised in origin.), or Proto-Self (Damasio, 1999), which is what binds, collects and weighs all these subjective affective-emotional experiences into an organismic coherence, or a continuous sense of an ‘I’, based on bodily sensations and representations. The biological self comes prior to the emergence of the narrative-self, or autobiographical-self in humans (and to some degree in other animals), which is the sense of ‘who we are’ based on memories, self-perceptions and projections into an anticipated future (Asma and Greif, 2012). The primordial biological self is centered in the coherent pre-verbal proprioceptive sense of the body and its survival needs and regulatory imperatives, which are the functions that Freud attributed to the Id and that Solms sees as the “fount of consciousness” (Solms, 2013, p. 5). What is this consciousness? As I see it, it is a continuous and automatic here-and-now evaluative assessment of sensory inputs from within and from without, regarding their relation to the individual organism and its survival. This is not a reflective-cognitive consciousness requiring more advanced cognitive capacities. It is closer to wakefulness than to awareness. Damasio (1999) equates ‘core-consciousness’ with ‘feeling a feeling’, in the sense that the organism has detected a change in its representation of its body state (the proto-self), and is able to produce ‘representations of the proto-self as it is affected by interactions with a given environment’ (p. 284).2

Stephen Asma and Thomas Greif (2012, pp. 30-31) tie it all together nicely:

the self first emerges in the pre-cognitive ability of most organisms to operate from an egocentric point of view. Way below the level of propositional beliefs, animals must solve basic motor challenges (e.g. where am I in relation to that advancing sharp claw thing? Am I moving now, or is the environment moving? Am I eating my own arm?). For mammals this low-level ability is accompanied by the archetypical survival systems, shaped by natural selection over geological time. These are homological affective systems that Panskepp isolated in the brains and behaviors of his subjects: approach when SEEKING, escape from FEAR, attack in

RAGE mode, pursue nurturance in PANIC, seek mate in LUST mode, and so on. These affects and emotions are survival skills and comprise and pervade primary and secondary consciousness - they have to be ‘owned’ by the organism for them to work properly. This is why Pan-skepp and Damasio, both fans of Spinoza’s monism, are in agreement about the reality of primary or core consciousness. Subjectivity resides first in the biological realm of action. It is not the disembodied Cartesian spectator.

We can therefore acknowledge the existence of a self in dogs, incorporating subjectively felt affective experiences and a core-consciousness able to detect changes in the embodied self, vis-à-vis external events, objects and stimuli.

Implicit communication and object-relating

Representations of changes in body state and of connections between affective experiences and environmental stimuli are the building blocks of procedural implicit knowledge. Implicit memory is where procedural knowledge is allegedly stored, and it is revealed when previous experiences facilitate performance on a task that does not require conscious or intentional recollection of those experiences (Graf and Schacter, 1985; Schacter, 1987). Implicit learning is fundamental in the learning processes of habituation and conditioning. In implicit learning, unconscious processes occur in which stored past experiences are reactivated and inform the way we interpret and respond to new experiences, creating over time (and repetition) new patterns of behavior. Conditioned emotions serve as an example of implicit memories. It has been found that the limbic system in the brain, and specifically the amygdala, plays a critical role in this type of learning/memory (Graf and Schacter, 1985). Fear conditioning in animals offers a reliable model of implicit learning, one where we already have a good understanding of the underlying neural circuitry.

Schore describes how implicit intersubjective affective transactions embedded in the attachment relationship with the mother influence the hard wiring of the emotion-processing areas in the infant’s brain (Schore, 1994, 2005). Thus, implicit processing underlies the quick and automatic handling of nonverbal affective cues in infancy, by which attachment communication transpires. According to Schore and Schore, ‘attachment experiences are thus imprinted in an internal working model that encodes strategies of affect regulation that act at implicit nonconscious levels’ (2008, p. 12). Bowlby’s original theory of attachment was based on ethological principles and observations (Bowlby, 1969). Attachment theory is widely accepted as referring to the infant-mother (and other attachment figures) relations in many animal species. A partial review of relevant literature can be found in Rajecki, Lamb and Obmascher (1978). Researches on dogs’ attachment

Dog-assisted child psychotherapy 63 patterns towards humans found striking similarities with human attachment dynamics (Topal, Miklosi, Csanyi and Doka, 1998; Horn, Huber and Range, 2013).

The point I want to make here is that attachment behaviors and internal working models in dogs operate in similar ways as in humans. They are created through repeated implicit affective communication with the primary caretakers and are reactivated implicitly throughout life in social contexts. Earlier experiences thus influence the way dogs respond to humans, thereby reflecting their inner object-relating patterns. To reiterate, object-relating in dogs simply means that, like us, they are relating to significant others, including human others, according to their internalised representations of self and other and to their encoded strategies of affect regulation (working models) imprinted by early attachment experiences.

Regulation theory and the implicit-self-system

In considering neuroscientific findings with updated internal object relations theories, self-psychology, and contemporary relational theory, Schore and Schore (2008) offer a modern version of attachment theory which they call ‘regulation theory’. They are suggesting that an implicit self-system, located in the right hemisphere of the brain and evolving in the preverbal stages of development, serves as the biological substrate of the dynamic unconscious and is centrally involved in ‘maintaining a coherent, continuous and unified sense of self’ (Devinsky, 2000, cited in Schore and Schore, 2008, p. 12). In the framework of attachment theory, applicable to both humans and dogs, the parent-child relationship influences subsequent development, becoming a key determinant in the offspring’s socio-emotional regulation and adaptation. The regulation theory hypothesises that the implicit selfsystem is in constant interactive regulation, from the early phases of development, through unconscious/implicit emotional transactions with the primary caregiver.

It is yet unclear to what extent can dogs unconsciously represent complex social and interpersonal patterns. But their fundamental homogeneity with humans in this area is clear. Dogs attach to their caretakers and later to other important (sometimes human) figures in their life. They can take part in mutual emotional regulation, and probably have a corresponding implicit self-system, which is always on the look-out for emotional cues in others. Their patterns of relating are reflections of past relationships and they are susceptible to the reactivation of past traumatic experiences via environmental and interpersonal priming. In short, dogs have an inner world of object-relations which inter-permeates their ongoing relations with other organisms, within a context of constant emotional regulation. These findings open the road for us to explore their intrapsychic world using the same language and concepts we use to understand the human psyche.

Mirror neurons and the regulation theory

The neural networks we call mirror systems are situated in certain areas in the pre-motor cortex and take part in coordinating affective states, intents and actions. One of their tasks is to respond to external events, which are related to the actions and intents of other organisms. When someone does something in our field of vision these networks create internal models of the said gesture, via neuronal patterns. Then, other areas in the brain are activated inducing a matching internal state, including a mental intent, a physical affective state and an inclination for action, that mimic the intent, affect and action of the other. It is a kind of a ‘mirror game’ where you copy the other’s movements and emotional cues, only subliminally. Mostly, especially in humans, these mental-physical states are then monitored and constrained through inhibitory circuits and the activation of higher-level processing and decision-making parts of the brain, for the purpose of eliciting a more adaptable behavioral response (Wolf, Gales, Shane and Shane, 2001).

Science always struggled to explain the neuro-biological stratum that enables the movement from the representation of the world of objects to that of the world of subjects, and which forms the platform for our social behavior. The discovery of mirror neurons finally exposed the cerebral particle that functions as the link between subjects. That link whose function makes possible the kind of phenomena that psychoanalysis refers to as unconscious processes, such as Empathy, Mirroring and Projective Identification. Scher-mer (2010) claims that

in the world of mirror neurons and mirror systems, individuals attune to one another and represent themselves in and through each other, challenging the premise that minds function in relative isolation. Contrary to the traditional Cartesian dualism separating mind from the body and the material world, mirror systems are distinctly relational, forming a possible linkage among embodied selves, suggesting that, by extension, the mind/brain may be inherently social and intimately linked to its environment and group context (p. 489).

So then, the mirror systems in the brain are an organ specialized in sensing and communicating in the social world, channeling a transpersonal net of interconnected individuals that some refer to as a group mind, or a social matrix (Foulkes, 1973).

A wide research points to mirror neurons as the prime suspect in underlying imitation behaviors in animals, which have a crucial part in the offspring’s socialisation and maturation. Mirror neurons were found in monkeys and in some species of songbirds. There is good reason to assume that wherever social behaviors such as imitation and parent-offspring relations exist, mirror neurons will be, especially within social domesticated mammals, such as dogs.

Here is a short example of how mirror systems may work in dogs. I often observe Shula and other dogs in the park approaching each other, each in their own unique ways, sniffing, staring and circling around to assess whether it is safe to get together and play. Shula is a black coated medium size shepherd. She is usually good hearted, but her life has taught her that other dogs can present dangers sometimes. So, she is always a little edgy with new dogs. Sometimes, when the other dog is smaller and/or aggressive and insecure, an instant fight might erupt. In the first fractions of a second, when it starts, it’s like a quick chain reaction, where both animals respond to and imitate the other’s affective arousal and body language, switching instantly from a calm disposition into a violent one. Supposedly, each party’s mirror systems encode and mirror the other’s mental and affective state, activating in both the RAGE affective system and inducing a fight mode of behavior.

The relationallsocial BrainMind

I think that in considering the role and function of mirror systems, we get an idea of the social nature of the BrainMind in mammals, such as dogs. The combined term ‘BrainMind’ (Panskepp, 2011) reflects the view that mental processes and internal experiences are linked to neural functioning without prioritising either of the two aspects. According to Panskepp (2012), ‘the BrainMind is an evolved organ, the only one in the body where evolutionary progressions remain engraved at neuroanatomical, neurochemical, and functional levels’ (p. 7). And I would add that it is equally an organ of the self, carrying in it the traces of the evolutionary progressions of relational capacities. In importing the notion of BrainMind, I am underscoring the proposition that relationality is inherent in the genetically determined basic structure and function of both the mental and the neuro-biological realms in all mammals. Mirror neurons may be unique in embodying the elusive connection of mind and body and of self and other.

The last piece of the puzzle is the fact, commonly known and now supported by research, that interpersonal processes that are intermediated by mirror neurons take place between species as well as within them. This has been known since the discovery of mirror neurons, when researchers realised to their surprise that the neuron they were monitoring in a Macaque monkey fired in response to it seeing a human making a specific gesture (Schermer, 2010). Parrots and monkeys have earned a reputation as imitators, although they are certainly not the only species who would willingly participate in such a back and forth interaction with humans. Everyone who owns a cat or a dog has probably many stories to tell about how they play the ‘mirror game’ with their pet, not unlike parents who play with their toddlers by imitating each other’s sounds and movements. I believe mirror neurons facilitate implicit affective transactions beginning with the first proto conversations with neonates.

Dogs in therapy - a summary

What we have here then is a model of a dog with a primary biological self, collected from a constant shifting through affective emotional states, a sense of subjectivity, a consciousness and a social Brain/Mind, constantly connected with and mutually affecting others, including human subjects. A creature who can take part in interpersonal relations has the cerebral equipment to be conscious and empathic, and who can participate in relational processes such as mirroring and projective identification (Roitman, 2019). It may even be that projective identification (or parts of it) is a basic element in the ongoing affective communication between all mammals, as it is said to be in humans (Ogden, 1979).

Dogs are very common as pets and are probably the most prevalent therapeutic animal. These facts are surely related, as many therapists have, or have had dogs as companions at some point in their lives. The changes that Canine Familiaris have gone through during their long domestication process and the socialisation of the individual dog in its human surrounding mould the personality of most dogs into something very human-like. Some say that millennia of artificial selection resulted in genetic changes in dogs, favouring socialisation with humans as if they were conspecifics (Topal, Miklosi, Csanyi and Doka, 1998). Most dogs are, in a way, adopted children. They are separated from their mother and siblings at a very early age, in incomprehensible circumstances as far as they are concerned, and are placed in adoptive families and foster homes. This early separation experience is surely encoded within their working-models, later to influence their relationship with their human caretakers and families. Dogs who live with humans learn to read human gestures and affective signals and adapt their regulatory functions to the human implicit affective communication vocabulary. In dogs’ working models, human representations and interactive patterns with humans must occupy a considerable part.

In the second part of the chapter, I will present some clinical moments from the psychotherapy of a child, in which my dog, Shula, was a central participant. In discussing these vignettes, I will demonstrate how the theoretical considerations that I have elaborated so far enable us to incorporate a deeper understanding of the dog’s side of the relational processes that transpire. With this understanding, new possibilities will emerge to clinically assess what is going on in the therapeutic process, thereby enriching our options as therapists to think and respond in ways that enhance the therapeutic value of our work.

Part II: Clinical and technical applications: the case of Kori and Shula playing ball

Kori is an eleven-year-old oppositional and avoidant child, who is overly concerned with his physical health and seems to underestimate his resilience.

He avoids taking risks and applying effort, shies away from social activities, and therefore is left socially isolated and academically regressed. His general demeanor is gloomy and withdrawn. In the first months of therapy, we spent most of our time in the backyard outside the therapy room. Kori would hesitantly try various physical challenges, like trimming grass with hedge shears and climbing trees, and gradually became more confident with his physicality.

Shula was always around, watching us, keeping close to me and usually ready to join in whenever one of us called her. At first, Kori would acknowledge her without making contact, or would comment on what he thinks her mood was. After some time, he began touching her fleetingly, with my close presence as intermediator, and was very wary of the area around her mouth and specifically her teeth. Then he started to play with her. A few months into therapy he invented a game: he would hold her favourite ball in his hand, waving it back and forth as if he is about to throw it for her to fetch. Shula would get excited and jump up and down, in response to which Kori would sometimes laugh with pleasure. Then he would make a strong throwing motion while saying ‘Shula, go fetch’, but wouldn’t release the ball. Shula would jolt in the direction of the anticipated flight of the ball, but instantly realizing that the ball is nowhere in that vicinity she would stop short, turn back and look at us confused, to Kori’s clear pleasure. Kori would then call her and show her the ball in his hand. At first, Shula would hesitate, as if weighing whether to withdraw, but most of the time she would comply and re-engage back in the game. But, in seeing her approaching, Kori would recoil in instant fear or hide behind my back, asking me to hold her. Only after restoring his courage, he would start over and repeat the whole procedure from the top.

In this game that Kori played with Shula, both have undergone several shifts in self-states (Bromberg, 1996). I think that for Kori it was these shifts in Shula’s affective-emotional states that were the interesting aspect of the game. In the language of affective neuroscience, we can speculatively track the changes in the affective arousal in both participants of this interaction. To my mind, Kori’s gestures with the ball were a trigger for the activation of the PLAY system in Shula, eliciting corresponding affective-emotional reactions in her mind and body, that could be related to the human emotions of joy, excitement and playfulness. Her behavior expressed these emotions and her willingness to be part of the game. For the hesitant and restrained boy, seeing her jumping excitedly in the air in such an overt manner seemed to elicit a quite similar, albeit uncommon, affective-emotional state and behaviour. In the realm of mirror neurons, this mutual affective regulation can be explained by the activation of each participant’s mirror systems, which generated an inner affective-intentional-behavioral state, mirroring that of its counterpart. Thus, a bi-directional communication was taking place, cocreating an interpersonal field, an ‘analytic third’ (Ogden, 1994), exuberant and lively with the anticipation for mutual play. In the analytic relationship between Kori and myself it was only many months later until we achieved such a place together.

But the fun was not to last long. The sudden change in the anticipated course of the game, when Shula’s flow was arrested and she found herself chasing nothing, also changed abruptly her emotional experience. Shula’s reaction seemed to express surprise and confusion. At the level of affective systems, we could speak of the disappointment resulting from the activation of a state of SEEKING without supplying the ensuing reward. Kori’s response to that was, most surprisingly, a show of glee and satisfaction. More complex emotions that I saw as manifestations of the inner conflicts and dramas that were reenacted for him through this interaction. It was clear that making Shula feel this way was eliciting ambivalent feelings in Kori. I thought I saw in him a sense of power and mastery that made him feel mighty and happy, along with a hostile-aggressive part, which accounted for his glee and satisfaction facing Shula’s distress. But I could also detect feelings of shame and probably remorse and self-condemnation, which were responsible for the fear (of retaliation) that arose later when Shula began making her way back towards us.

In fact, Shula now would always come back to me, not to Kori. The boy at that stage was usually hiding behind me, and his stare and body language expressed fear and avoidance. I think that both at that point were in a distressed PANIC state, seeking comfort. I believe that in the first instants after the dramatic twist in the game, seconds after Shula hit the brakes, there was a moment when they exchanged looks and affective states, via the mirror systems in each, and this was the moment of change in the general atmosphere of the interaction. A mood-contagion was taking effect again, influencing them simultaneously.

So now here I was, a wailing wall3 to both, one behind my back and one at my front. At that point, for the game to recommence, my emotional participation was needed. Each time this happened, I found myself intervening as if being activated to resolve and dissolve the interpersonal block that has appeared between them. I would then caress Shula, talk calmly and reassuringly to her while explaining to Kori what I think he and Shula felt at that moment and that there was nothing for him to fear. I’m sure that my tone and affective state played a part in restoring, in both child and dog, confidence, curiosity and the motivation to play. Here again, I assume that it was with the mediation of the mirror neurons in all of us, that this group regulation was made possible, and the game resumed.

Intrapsychic, intersuhjective and relational perspectives alternate

Watching Kori’s way of playing the ball game with Shula made me think of the roles they both played as representing his experience with his father, a somber man with anxious and hypochondriac characteristics. Whenever Kori would show enthusiasm, his father would react in an over-protective

Dog-assisted child psychotherapy 69 manner, restraining him while pointing to possible hazards and physical dangers. On the current level, in his game with Shula, it was as if a bigger force from within was restraining Kori, preventing him again and again from following through with his intention to throw the ball. And every time, when that happened, Shula would react with surprise and confusion, possibly reflecting for Kori his self-state in reaction to his father’s protective grip. Kori’s show of glee and satisfaction was, in my mind, a sign of his identification with the father’s need for control and his disavowed hostility and envy at the child’s spontaneity, self-confidence and playfulness.

In his wish to repeat the pleasurable experience and maintain his control over the dog, Kori would tempt her then back into another session of his tantalizing game. But now, watching her depleted of her former energetic state, he felt he had to revive her into a playful mood again. Waving the ball at her and calling her were gestures that I could again connect in my mind to his parents, especially his mother, who relentlessly encouraged and sweet-talked him, trying desperately to make him get up, get dressed, go to school, join social activities and do his homework.

But what struck me as most curious was his emerging anxiety, as Shula was coming towards us. He clearly had felt in danger. As I mentioned earlier, 1 thought that for him, it was his projected sadistic urge that was now deposited in Shula and was coming after him. An overwhelming fear, arising from the activation of some early experience, had now overshadowed his ability to read Shula’s affective state correctly, using his regular sensors. What he saw at that moment was not a disappointed dog, looking for a comforting touch and eager to reengage in play. In his eyes, she was a predator with huge teeth coming at him with vengeful rage. A part of himself, a disavowed self-state, was too scary to express or even acknowledge.

Veering our attention now to Shula, let us see what more we can say about her intrapsychic experience. Here is her history in brief: Shula was first adopted as a pup, separated from her litter and her mother at the age of two months. She lived with a young woman in an urban flat but had to be given away after the landlord forbade the owner to keep animals in the apartment. 1 took her in when she was six months old. When she joined my family, we had a newborn girl, who is now 8 and has a brother aged 6. Shula spends most of her time in the yard, where she has her kennel and lots of space, but likes to lie around inside the house when we let her. While I am in my clinic, which is also a part of the house, she usually hangs outside my therapy-room door, in the waiting hall, until invited to join the session.

Thinking about her early days, Shula was taken from her mother at an age when pups are usually weaned and reach independence in all their bodily functions, and their main efforts are mobilized to playing and socializing. But Shula couldn’t stay longer with her siblings. I don’t know much about her time in the city and her relationship with her first owner, nor about how she reacted to her two separation experiences. Since I adopted her, she hasn’t had much playtime with other dogs. Most of the time she was alone inthe big yard, and sometimes with us who were busy with our own babies and our human affairs. In the house next door lives a family with a pack of three or four dogs. It’s their habit to bark violently at anyone coming close to their fence. They are especially fond of barking at other dogs. In her first years with us Shula would frequently get enraged and launch at them, from her side of the fence, barking and growling with bare teeth and bristled mane.

I think that these selected facts from her life story are important because they account for some personality traits in Shula that are relevant for the analysis of her interpersonal patterns. As I have mentioned in the first example with Shula, she tends to be quite edgy around other dogs and I have noticed that even if the first encounter goes well, she doesn’t really know how to play with them. Her playstyle is too rough for most dogs, and she quickly loses interest. With humans, she learned to allow kids to be around her and touch her (this is something that I took the time to teach her) but seems quite indifferent towards them and prefers to get the attention of adults. In a way, she is a bit like an only child who never learned how to get along with his peers and only strives to please and get attention and affection from grown-ups. Someone who other kids quickly grow tired of, and who grows to be a loner.

Knowing her character, I had anticipated that Shula would be happy to join Kori in a game of‘fetch the ball’, which she knew very well, and would enjoy the satisfaction of accomplishing what her human counterpart would ask of her. But when the game took an unexpected turn Shula didn’t know anymore what was expected of her and got confused. She didn’t immediately ‘play along’ with the new rules, as some dogs might have done, but lost her spirit and redirected herself to me, the authority and parental figure, for guidance.

While writing these lines, it comes to my mind that there is something in Shula that reminds me of Kori in those first months of therapy. Albeit for different reasons, both were children who couldn’t play and whose social adjustment was impaired. Both had been over-concerned with their relations with adults and authority figures to be bothered with their peers.

Where was I when all this was going on? I must admit that I felt very uncomfortable with Kori’s behaviour towards Shula. I decided to bite my tongue though because I trusted Shula to withdraw from the game if it would become too frustrating for her. I’ve seen her do that many times before. So, I didn’t discourage Kori from resuming the game a few times, and at some point, he would just let go and move on to something else, mostly not involving Shula. Or, she would just tire and not come back for another round.

My discomfort was partly due to my empathy with Shula. I think that a hostile angry self-state in me was resonating a denied part of Kori’s affective-emotional state. I saw Kori at that moment as a perpetrator and Shula as a victim. This created a conflict with my warm and caring feelings towards the boy. By allowing him to engage with Shula without my interruption I was modeling a way to contain the conflict and the tension, while resisting the urge to take control and ward off my anxiety by restraining him, thereby

Dog-assisted child psychotherapy 71 preventing him from exploring an important, albeit unacknowledged, selfstate. At the same time, 1 had to remain watchful and avoid another urge to look away. It was up to me to stay emotionally open to what was going on inside myself and inside Kori and Shula and be ready to intervene at the right time. In this way, I served both as a witness and as a parental guardian, waiting for my cue to step in and help process excess stress and anxiety in the matrix when needed to.

In Benjamin’s terms (2004), 1 was introducing the ‘third in the one’ to the matrix, an attitude that reflected my recognition of the other’s subjectivity and trust in the process of maturation and growth through interpersonal relations. 1 believe that my presence was helpful in moving the matrix towards becoming more intersubjective. In tuning my empathy towards the others in the field and making myself accessible to them emotionally, when they needed me to, 1 was making room for an exchange of feelings and self-states, thereby facilitating affective communication (Maroda, 2002). In addressing Shula’s emotional state, acknowledging it out loud and offering compassion I was assisting Kori, so I believe, to recognize her as a subject and gain a better understanding of the reality of his relationship with her. By reflecting on what 1 thought he was experiencing and by soothing his fears I was making him know that 1 recognize his subjectivity as well. I suggest that, to some degree, the same is true with Shula. That for her, looking at me looking at her empathically, hearing my words, seeing my facial expressions and feeling my hand gestures responding to her subjectivity, was a vitalising experience that reawakened and rewarded her capacity to see us humans as subjects. 1 became a witness to both their intrapsychic realities and helped pave the road for them to meet each other anew within an intersubjective matrix.

This short but rich interaction, involving the three of us, was made of many tiny relational moments, all channeled through the activation and mediation of our primary affective systems, our implicit memories and relational patterns, and our neuronal mirror systems. I believe one can show how relational processes, such as empathy, mirroring and projective identification, were also involved. In terms of self-states, it is an example of the way an animal in therapy can help the emergence of disavowed self-states and assist, with the aid of the therapist, in recognizing them and processing them. As Bromberg (1996) and others suggest, the renegotiation and integration of disassociated self-states are one of the desired outcomes of therapy. One can also see here how mutual regulation and affective contagion were involved and how they were helpful in the development and honing of interpersonal skills and in the creation and maintenance of transitional space in the analytic session.

Changing over time - Kori dubs Shula a superhero

About two and a half years later Kori came one day to therapy in a very good mood. It was summer by then, too hot to be outside. Before enteringthe room, he stopped next to Shula, sprawled on the waiting room floor, and gave her a long hug. Shula seemed happy to see him and licked his face, her tail thumping the floor rhythmically. He then came in and called her to join us. Shula got up heavily, stretched and followed him. They spent long moments playing together during that session. At some point Kori challenged her to guess in which of his closed fists he was hiding a tissue paper. Shula was clearly trying to figure out what was the game about, and sniffed his hands randomly, which was a sign for him to open his palms and declare her success or failure. Interestingly, and to Kori’s delight, it seemed that after a few trials, Shula’s success rate increased. Had she actually gotten better at finding where the paper was hidden? Or maybe it was Kori who had made it easier for her, unconsciously moving the hand with the prize closer to her nose? At another moment I noticed that while telling me about some events from his life Kori had his hand resting casually on Shula’s back. Later in the session he took another tissue paper and stuffed its edge around Shula’s neck-collar to make it into a cape and tried to blow some air to make it flutter, saying that Shula is a superhero. I was impressed by how permissive and playful Shula was. She is not the kind of dog that kids can climb on top of and pull her ear. But at that moment it was obvious that she enjoyed his touch and was rubbing herself against his body and licking him when he let her. I felt warm emotions watching this intimate moment between them.

I’ve included this second moment in Kori and Shula’s relationship to offer another perspective of the consequences of the integration of dogs in therapy. We are accustomed to speaking about the long-term effect of the therapeutic relationship between a patient and an analyst. Discussions addressing transference, enactment and other relational processes stress the importance of time in the resolution of therapeutic challenges and interpersonal entanglements. All relational analysts would agree that a successful treatment is one in which the therapist changes as well, in relation to the change in the patient. According to the regulation theory, we are in a constant state of change. Change, within a social context, is an inevitable part of being in a relationship. Dogs are relational beings, as we have seen, and are not excluded from this rule.

Both Shula and Kori have changed during these two and a half years, regardless of their relationship within the therapeutic setting. But it is my belief and clinical impression that their time together has made an impact on both their persons and on their working-models, in a way that contributed to them in other social circles and interpersonal encounters. The theoretical model that was presented in the first part of this chapter implies that there exists, at least potentially, a large measure of plasticity in the relational capacities of both the dog and the human self. The ongoing relationship of the patient with the dog, quite like the one he has with his analyst, has the potential to bring about deep changes to all. In Kori’s therapy, Shula has become an important figure for him. He has found in her a friend and

Dog-assisted child psychotherapy 73 partner for play, an attachment figure whose presence offers comfort and a secure base to go back to after distressing experiences, a transitional object to destroy and revive in fantasy at will and a reflection of some parts of himself that were made accessible and more tolerable as their connection grew stronger and more intimate. A similar change was observable in Shula, who became more relaxed and amiable in his presence, showing clear signs of affection and an increased ability to tolerate ambiguity and physical intimacy. 1 think Kori has become like a brother to her, thus facilitating the development of her capacity to play.

Much more can be said about this second vignette and about the symbolic meaning of the interactions therein, and the neuro-psychological and relational mechanisms that took part in their making. But I will let it speak for itself and move on to some concluding notes.

Part III: Technical considerations and summary

The theory that I have presented on animal relationality and its implications on dog- assisted psychotherapy has, to my mind, some technical derivatives. As it may have struck the reader in my earlier discussions, it demands that the therapist adopt a multi-focal stance which holds in mind simultaneously three very different perspectives. The first would be the physical level, where phenomena such as emotional-affective activation and affective resonance via mirror systems occur. Bearing in mind these relational-neurological mechanisms helps to understand the moment-to-moment dynamics of the dog-patient interactions in the here-and-now. It can give us tools to decipher the mutual influence that the two exert on each other, which enables processes of mutual regulation and implicit, or unconscious, communication. The second level of awareness is the relational level, in which two subjectivities meet, each with its own inner world of feelings, working models, fears and expectations. This is a perspective focusing on the interpersonal encounter where both subjects reenact and renegotiate interpersonal patterns and mutually struggle to integrate disowned parts of their selves and to improve their capacity to play. The third and last level is the wider angle that takes into account group phenomena, relating to the multiple interactions between all participants, including the therapist. I will elaborate on this axis of the theoretical model in the next chapter.

At any given moment in the session, it is our job to assess what is going on in all three levels and be ready to intervene in a way that helps resolve interpersonal deadlocks and removes obstacles from a free-flowing interaction. We should strive to identify negative affective states and moments of reactivation / reenactment of traumatic implicit memories and working models, and act in ways that restore a positive interpersonal atmosphere, to allow the continuous working through of these toxic moments. In the vignette above, depicting the bailgame between Shula and Kori, I described such a moment and the way I found to bridge the hostility and alienationthat immerged between them, in hope of reengaging them to find better ways to play together.

It is of crucial importance that the therapist be comfortable with the dog and experienced in handling dogs in distress, just as he is necessarily trained in helping humans in hurt. The relational model here described advocates treating the animal as an essentially similar subject, whose affective state and regulation is equally important to address, as are those of the child patient.

It is also important to remember that the therapeutic setting is not just the place where the treatment is happening but also a dynamic and interactive living presence (Roitman and Kassirer-Izraeli, 2013). Adding a dog to a one-on-one classical setting increases the levels of responsivity and interactivity of the setting. In our function as dynamic administrators and (parental) managers of the setting, we must pay attention to the relationship of the patient with the setting. The dog in therapy is also a part of that setting and can be of positive or negative influence on the patient’s sense of security and to his capacity to surrender (Ghent, 1990) to the therapeutic process. In my practice, I can recall numerous occasions in which I decided to remove Shula’s presence from the session, and even from the road leading from the exterior gate to the waiting room. These were cases in which my impression was that her mere presence would result in excess anxiety in the patient I was about to see. At times, a dog in the therapeutic space can make the setting too menacing for the child.

Another technical aspect is concerned with the implication of treating the dog as a subject. The principle of ‘the animal as a subject’ is both the ethical and the theoretical backdrop of the theoretical model I am proposing. Using this model means to make room for the dog’s subjectivity in the therapeutic discourse. Taking this idea to the technical level, treating the dog as a subject means addressing it in similar ways that we address a human subject. It is my belief and experience that when we relate to dogs as subjects, in words, gestures and touch, it awakens their sense of subjectivity and motivates them to engage in intersubjective interactions. The attitude of the therapist here is of utmost importance, as a model to both child and dog in creating the right ‘rules of engagement’ for the therapeutic encounter.


The relational approach to dog-assisted child psychotherapy proposed here is very brief with general guidelines. Much more needs to be explored and elaborated. As I have pointed out, the psychoanalytical literature and the papers addressing the principles of the psychotherapeutic technique have so far done little to include the implications of a theory on the human-animal connection to the psychotherapy of children. This is part of a general trend that ignores the study of the human-animal relationships in the psychological sciences (Melson, 2002). For example, I think that we need to develop a better understanding of the unconscious processes between humans and

Dog-assisted child psychotherapy 75 animals. (Roitman, 2019). Exploring these processes, in the context of the neuroscientific-relational perspective, can clear up fundamental aspects of the effects of AAP and even illuminate some unvisited aspects of unconscious processes between humans.

On an ethical note, I believe that seeing and treating the dog as a subject is a first and important step in advancing a more equal approach to animals. This is part of a social duty that we all carry, as moral human beings and as therapists. The ethical point of view on the incorporation of animals in the treatment of humans also deserves more attention and elaboration.

What is suggested in the first part of this chapter and illustrated in the second is part of a three-axis theoretical model to animal-assisted-psychotherapy, with emphasis on the participation of a dog in a one-on-one therapy of a child patient. In this chapter, the focus was on the neuropsychological and the relational axes. The third axis will be formulated in the next chapter, presenting a group approach to AAP. It is this writer’s opinion that the three-axis model potentially encompasses all the fundamental aspects involved in AAP and is necessary for therapists who wish to muster the relational potential of animals to the benefit of the psychotherapeutic endeavor, be it incidentally or as a method of treatment.


  • 1 I am not ignoring the immense differences between humans and animals, pointed out by Darwin himself and many others (see for example Kolstad, 2013), which come from the fact that the human environment has become more cultural and social than natural. My point is only that these differences have not succeeded in effacing the evolutionary continuity and the basic functional homology between humans and animals.
  • 2 Very relevant here is the ‘Cambridge Declaration on Consciousness’, in which leading scientists declared in 2012 that ‘...the weight of evidence indicates that humans are not unique in possessing the neurological substrates that generate consciousness.’ The Cambridge Declaration on Consciousness was written by Philip Low and edited by Jaak Panksepp, Diana Reiss, David Edelman, Bruno Van Swinderen, Philip Low and Christof Koch. The Declaration was publicly proclaimed in Cambridge, UK, on July 7, 2012, at the Francis Crick Memorial Conference on Consciousness in Human and non-Human Animals, at Churchill College, University of Cambridge, by Low, Edelman and Koch.
  • 3 According to the Merriam-Webster dictionary: (1) Capitalised: A surviving section of the wall which in ancient times formed a part of the enclosure of Herod’s temple near the Holy of Holies in Jerusalem, and at which Jews traditionally gather for prayer and religious lament. (2) A source of comfort and consolation in misfortune.


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