Background: A large proportion of maltreated children carry their experiences as secrets into adulthood, leading to the continuation of the maltreatment, developmental trauma, and prevention of treatment. Many undiscovered maltreated children are referred to therapy due to behavioral and emotional problems, yet they do not disclose their plight to their therapist. Many of these children are characterized by shame, avoidant attachment style, and lack of trust in professionals. They often attribute unjustified hostile intentions to others and are likely to transfer their past relationships and experiences with abusive attachment figures to the therapist. All these characteristics are likely to inhibit the establishment of the TA, resulting in poorer therapy outcomes, higher drop-out rate from therapy, and less self-disclosure. Therefore, the discovery of ways to create and strengthen the TA in psychotherapy with maltreated children, including increasing trust in the therapist and lowering feelings of shame during therapy, would provide a way to discover more previously undiscovered cases of child abuse. The presence of animals has been found to serve the functions of safe haven and secure base, possibly related to the findings that their presence lowers state anxiety, lowers cortisol, and may also stimulate the production of oxytocin in the child. In research not directly related to animals, it was found that oxytocin enhances effects of social support and sense of safety, reduces fear response, increases ability to cope with stress, increases social approach and affiliation, positive communications, promotes trust, and enhances attachment security. An animal has been found to act as a social facilitator and lead to more positive perceptions of another person. Therefore, it is reasonable to suggest that the psychological and physiological effects of the presence of animals in the therapy setting might facilitate the establishment of the TA for children, characterized by an avoidant style of attachment.
Objectives: In this pilot study of maltreated children living in residential treatment centers who are likely to resist psychotherapy, the establishment of the therapeutic alliance is compared in two psychotherapy approaches in play therapy settings: animal-assisted psychotherapy and psychotherapy that does not include animals. Hypotheses: The TA will be established earlier and stronger in AAP than in psychotherapy without animals, the gap (if any) being smaller at a later stage in therapy. Secondly, the TA for subjects lacking trust in adults will be higher in AAP than in psychotherapy without animals. Finally, The TA will be stronger for subjects with avoidant-style attachment in AAP than in psychotherapy without animals.
Methodology: 18 subjects from residential treatment homes, ages 7-11, participated in this study and were randomly divided into two treatment groups: 1) 9 subjects received AAP in a play therapy setting, and 2) 9 subjects received psychotherapy in a play therapy setting which did not include animals. All subjects filled out the Children’s Interpersonal Trust Scale, a 9-item questionnaire measuring the degree of their trust in adults, as well as the Revised Children’s Coping Strategies Questionnaire – Avoidant Scale, a 10-item questionnaire measuring their degree of avoidant-attachment style. After the third and eighth therapy session, each subject filled out the Therapeutic Alliance Scale for Children- Revised (TASC-R), a 12- item questionnaire measuring the strength of the TA that they felt with their therapist.
Results: As proposed in the research hypothesis, the TA after the third therapy session was found to be stronger in AAP treatment group than in the non-AAP treatment group. After the eighth session, although the mean was higher for the AAP treatment group, the difference was not significant. In addition, trust in adults was related to the TA after the third AAP session, and related to the TA in the non-AAP group after the eighth session, suggesting that the presence of animals in therapy, together with all the implications that this presence brings, may shorten the process of the establishment of the TA. Although no significant results were found relating avoidance scores with the establishment of the TA in the two treatments, a scatterplot of the TA measurements according to avoidance score points to the positive effect of AAP on the TA of avoidant subjects early in the therapy process.
Conclusions: These research results point to the significant contribution of the integration of animals into the psychotherapy process, specifically in terms of the establishment of the therapeutic alliance, with maltreated children characterized by avoidant attachment style, who otherwise may find it difficult to participate fully in the therapy process. This is especially critical due to the importance of therapy for these children. Although the small number of subjects participating in this study limits the strength of conclusions that may be drawn from results, they point to the justification for the continuation of this research.
IAAAP - The Israeli Association of Animal-Assisted Psychotherapy
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