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  • How to Obtain an Emotional Support Animal

    As a licensed professional counselor in private practice, I get many calls from hopeful clients asking if I can write them a recommendation letter for an emotional support animal (ESA). The answer is always a tentative, “maybe.” You see, it’s not as simple as filling out a form and paying a fee. There is a careful screening, evaluation, psychoeducation, and follow-up process that must be followed before a therapist can provide that coveted letter. Many of my peers shy away from providing this service because of the misinformation and negative media attention given to emotional support alligators (or goldfish or whatever the headline of the day spouts). In this article, we’ll talk about ESA’s and the appropriate measures that need to be taken in order to receive an ESA recommendation letter. 

    Service Animals vs. Emotional Support Animals

    When starting the process of obtaining an ESA, it is important to do the research and to have a thorough understanding of the difference between a Service Animal and an Emotional Support Animal. Service animals help people with disabilities who need assistance in their daily lives. Some can be “seeing eye dogs” that help people who are visually impaired. Other service dogs keep their humans safe by detecting oncoming seizures, panic attacks, and more. These working dogs are so important that there is a law protecting them in public places. It’s called the American Disability Act (ADA) and it allows people that require service animals to take them where animals are typically not allowed to go such as grocery stores, restaurants, movie theaters, and other public settings.

    Other working dogs get jobs as emotional support animals (ESA). These hard-working dogs do exactly what their title says, they give support to those that are dealing with difficult situations or are struggling with mental afflictions. These pups are not protected by the ADA but are protected in houses with a “no pets” policy and while traveling.

    Laws on Service Dogs and Emotional Support Animals can vary by state. To find laws regarding ESA’s in your state, go to, and select your home state to read more information.

    Airline Travel with ESA’s and Service Animals

    In March 2021, the Department of Transportation rolled back protections that emotional support animals had for quite some time when traveling via airplane. This new ruling basically says that airlines can decide whether or not they allow emotional support animals on their flights. There are a few air services where dogs or cats can be certified as an ESA and still fly. Most of these airlines fly between the U.S. and Canada or between the U.S. and Mexico. They include Latam Airlines, Volaris, and Westjet. Most domestic airlines including United Airlines, American Airline, JetBlue, Frontier, Alaska and Southwest Airlines have stopped accepting ESA’s in their airline cabins. Service Animals are protected at the federal level and any airline will still allow service dogs and animals to fly in the cabin. The reason being is service animals are a federally protected class of pets and have been individually trained to a higher standard.

    Selecting and Training an ESA

    Some people on the internet will try to convince you that you need to buy special certificates to have an ESA, but all it really takes is a letter from a therapist or medical professional. An emotional support animal does not need specialized training and instead provides passive comfort, support, and companionship by its presence. The counselor or therapist will assess how beneficial an animal would be for your clinical diagnosis and will assess your ability to care for an animal. If they conclude that you would benefit from an animal and are able to take good care of them, they will most likely provide you with an ESA recommendation letter.

    Rules of Recommending and Obtaining an ESA

    When recommending an ESA, counselors should review the American Counseling Association (ACA) Code of Ethics to familiarize themselves with the specific ethics codes that could apply to Emotional Support Animal (ESA) assessments.When making a determination about whether or not to recommend an ESA to a specific client, we must weigh the risks to the client, to the animal, and the public. We should share those risks with our clients, so they, too, can weigh the risks against the benefits. There are also possible risks to us—the clinician—which must factor into our decision about whether or not to offer this service.

    The ACA’s human-animal interventions committee (HAIC) explores these risks in detail (2019). They suggest that clients might be risking inadequate treatment for a mental health disorder by relying solely on an ESA—in other words, an emotional support animal is not sufficient treatment for a mental health disorder and we must never give the client the impression that an ESA can take the place of mental health care. Clients may also face physical or emotional injury if the animal is not trained properly and there could be a financial burden to accessing the training. There may also be financial burdens in the ongoing care for the animal, such as vet bills, food, and toys. Clients or members of their household may develop allergies and zoonotic infections. And clients face the risk of potential legal repercussions if they misrepresent an ESA as a service animal. It is also considered a risk to the public when ESAs are misrepresented as service animals. Improperly trained and/or unvaccinated animals pose a public health risk in our communities.

    Counselors, too, face some risk in taking on this practice, including liability if working outside their scope of training; potential fraud if the evaluation is not completed ethically and professionally; and the possibility of being called to testify if the ESA is challenged or if an incident occurs. Finally, it is also our ethical responsibility to consider possible risks to the animal’s physical and mental health if a client is unable to fulfill their responsibilities as an ESA handler.

    As previously mentioned, in order for counselors to safely and ethically provide an ESA recommendation letter, it is required for the client/handler to be actively participating in therapy. Part of the assessment process is consulting with your counselor one year from now to assess your progress and renew the letter when it is due to expire.

    With all that being said, the process usually takes about 90 minutes and will normally cover assessment, diagnosis, and psychoeducation on working with an ESA. Ideally, the assessment should be done in-person, with an animal-assisted therapist if possible, so you have the chance to interact with a therapy animal. Be sure to ask the counselor to provide a superbill for you and be prepared to pay the cost directly out of pocket, as most insurance companies will not pay for the assessment.

    Unfortunately, these strict laws have been put in place regarding ESA’s because many people were abusing ESA’s as a service and were bringing peacocks and miniature horses on airplanes. ESA’s are working animals with a job to do, and therefore, their purpose and certification should be respected and taken seriously.

    Emotional Support Animals: Clinician’s Guide to ESA Assessments and Recommendation Letters by Annalisa Smithson is available on Amazon (FREE with Kindle Unlimited).