Understanding the Comprehensive Nature to Approving Emotional Support Animals (ESAs) in Order to Optimize Therapeutic Outcomes in Clinical Practice

By: Stephanie White, PsyD, PhD, LCSW. DCSW

Several hypotheses have been raised to understand the relationship between emotional support animals and conditions, such as anxiety, depression, autism, post-traumatic stress disorder, and bipolar disorder, in which changes in emotional activity and neurovegetative patterns may be mitigated as a result of daily interactions with an emotional support animal.

This article describes key experimental and clinical evidence that exemplifies how a licensed mental health professional, Dr. Stephanie White, Licensed Clinical Social Worker, uses certain clinical treatment algorithms in the prescription of an emotional support animal during the comprehensive assessment, follow up sessions, and in determining overall treatment needs of patients based on the etiopathology and symptomatology of anxiety, depressive states, and other mental health conditions based on the mitigating responses of emotional support animals to their owners reported disability-related needs.


Emotional support animals are not pets, and have been proven extremely effective at ameliorating the symptoms of depression, anxiety, and insomnia, as well as other disabilities, such as post-traumatic stress disorder, by providing therapeutic support. Emotional support animals are not the same as Service Animals. A licensed mental health professional can prescribe an emotional support animal under the Fair Housing Act Law. The Fair Housing Act includes ESAs in its definition of assistance animals. Under the act, people cannot be discriminated against due to a disability when obtaining housing. Rules such as pet exemptions or restrictions are waived for people who have a prescription for an ESA, and they cannot be charged a pet deposit for having their ESA live with them.

Emotional support animals are integral to the emotional balance of their owners. They serve an important role in helping to mobilize emotional homeostasis. It is important to understand that what qualifies as a licensed mental health professional is a Licensed Clinical Social Worker, Psychiatrist, Licensed Professional Counselor, Licensed Marriage and Family Therapist, and Licensed Clinical Psychologist. For a person to legally qualify for an Emotional Support Animal (ESA), they must be considered emotionally disabled by a licensed mental health professional. This means the person must meet the criteria for a diagnosis in the Diagnostic and Statistical Manual 5 (DSM 5) and the parameters set forth in the Fair Housing Guidelines. It is important to understand that it is not just about having a mental health diagnosis such as anxiety or depression.

According to the Fair Housing Act Guidelines, there must be a significant or substantial disability-related need that impairs the person’s level of functioning. The question is, how does the emotional support animal come into existence in that person’s life to ameliorate the disability-related need(s) during that human-animal interaction in order to help reduce the severity and intensity of the symptoms in order to improve quality of life and lessen symptom suffering? This is what the mental health professional must give careful assiduity to during the assessment. Moreover, we must ask what the disability-related needs are that are mitigated by the presence and interactions of the emotional support animal(s).

Assessing for Disability-Related Needs

As a mental health provider, there are several standardized measures that one may choose from in order to determine the level of emotional and psychological dysfunction, or if a disability does exist. It is important to understand that the term disability is a legal term. One may be asked is the disability short-term or permanent? First, some basic areas to cover are as follows: What is the reason the client is seeking an emotional support animal? What is the choice of animal and has therapy ever been considered prior to seeking an ESA? Is the client able to properly care for the ESA? Are there any medical issues that could impact the client’s ability to provide proper care for the ESA? Performing a mental status examination and comprehensive assessment is necessary in determining the level of significant impact on major life activities, such as sleep, concentration, focus, and social interaction, which by Fair Housing parameters are deemed disabilities. If an animal helps mitigate those symptoms (sleep better, etc.), then, the animal may be necessary for helping the client self soothe and promote adaptive coping to improve quality of life.

When assessing the client, it is important to determine if the impairment limits at least one of the client’s major life activities or major bodily functions. If so, it is a disability. In determining whether a particular impairment is a disability, it is important to elucidate how the ESA mitigates symptoms associated with the disability, for example, “Luna gets Jane out of bed every morning, and this increases her motivation, lessens her pessimistic attitude, decreases the frequency of her panic episodes, and helps her exercise daily. Luna also improves the quality of her sleep cycles.” It is important that you help the client recognize how the identified symptoms limit the patient on a daily basis and how that may or may not qualify for a disability.

Some of the measurements that I have used to qualify patients as meeting criteria for an ESA are as follows (please note that these are not the only behavioral health scales used, and these scales are also used in conjunction with a psychosocial assessment):

Beck Depression Scale
Hamilton Anxiety Scale- (HAM-A)
Adult ADHD Self-Report Scale (ASRS-v1.1)
Bipolar Disorder
Mood Disorder Questionnaire Scale
Shehan Disability Scale


Interview Guide for Evaluating DSM-5 Psychiatric Disorders and the Mental Status Examination

Now, in addition to the measurements described, I also perform what I call a psychosocial assessment, and depending on the symptoms reported by the client, such as depression, anxiety, sleep problems, mood swings, or if a patient provides medical records and information on past diagnoses, such as Bipolar disorder, ADHD, etc, I usually assess using the above scales and other clinically necessary scales. The goal of the screening and assessment process is to identify clients experiencing a functional limitation in their psychological, behavioral, and/or emotional states that qualifies that person for a mental or emotional disability, I also feel it important to encourage as part of the treatment process that clients seeking ESAs understand that this is a mental health service and it is important for clients to continue individual therapy beyond the ESA assessment as that is always beneficial to optimizing therapeutic gains.

I always get asked by the client if the animal needs to be brought to the assessment. Animals are not required to be part of the clinical assessment. In fact, while I do assess the extent of the human and animal interactions during the clinical interview, I do not assess the animal. Instead, I evaluate the client for the actual need for an ESA.

Do ESAs and Patients have Legal Rights?

The Fair Housing Amendments Act of 1988 is the law that protects an emotionally disabled person and their ESA. The legal protection an Emotional Support Animal (ESA) has is to qualify for no-pet housing (that also includes limited size, breed, or species housing) without being charged a pet fee. Remember, ESAs are not pets. They are assistance animals that alleviate symptoms associated with the disability-related needs. They are not just companion animals.

It is important to understand that working with a client who requests an emotional support animal as a reasonable accommodation does embark on the clinician taking on the ability to engage in critical thought in order to apply certain clinical treatment algorithms. Also, not everyone who requests an ESA will qualify.

Dr. Stephanie White, LLC Teletherapy Counseling Services

Licensed Clinical Social Worker/Psychotherapist

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