Therapist Scrutinized for Writing ESA Letter

In what appears to be a first, the California Board of Behavioral Sciences has disciplined a licensed therapist for writing a client an Emotional Support Animal (ESA) letter without first conducting a “proper assessment.”

If you’re not familiar with ESAs, they are distinct from service animals for people with disabilities. A service animal is trained to assist its owner in completing everyday tasks. They can legally go almost anywhere its owner can go. An ESA, on the other hand, does not need to be trained or certified. Its presence is only legally protected in two places under US federal law: Housing (under the Fair Housing Act, which requires landlords to allow ESAs without charging pet rent) and flights (under the Air Carrier Access Act). 

Difficult decisions

ESAs have become more controversial in recent years as their presence has grown. Airlines, fed up with the problems that ESAs have created, received permission from the federal government to place restrictions on the ESAs allowed on board. The public has grown skeptical of ESAs, speculating that some pet owners simply use ESA letters to be able to travel with their pets, or to have their pet in a housing situation where it would not normally be allowed.

When a client asks for an ESA letter, therapists are often torn. There are no clear legal or ethical standards suggesting when such a letter should or should not be issued. One division of the American Counseling Association put forward a policy statement earlier this year aiming to clear up some of the confusion, but their guidance does not represent an enforceable standard.

The California case

In the California case, a licensed marriage and family therapist issued an ESA letter to an out-of-state client based on the client’s responses to an internet questionnaire. The letter reported that the client was under the therapist’s care. However, the client and therapist had never spoken, either in person or via technology. The client’s landlord, noticing that the therapist was from California, filed the initial compliant. 

The Board of Behavioral Sciences found two causes for discipline: The therapist was practicing out of state without a license, and the therapist had not done a “proper assessment” before issuing the ESA letter. Because the therapist and the board agreed on a “stipulated settlement” (similar to a plea bargain) before the case went to hearing, the board did not determine what the standard for a proper assessment would be.

Protecting your practice

Without a clear standard, therapists are likely to continue struggling with determinations of whether a client requesting an ESA letter should be granted one. Of course, it stands to reason that you should not be writing ESA letters for people you have not actually met and meaningfully assessed. And, you should not be writing ESA letters for people who are located in areas where you are not licensed or qualified to provide services. Beyond that, there is a great deal of room for debate. If you do choose to write such letters, we would recommend the following:

• Have specific training you can point to establishing your competence in assessing animals’ impact on their owners.
• Review the position statement put forward by the ACA Division on Human-Animal Interactions in Counseling.
• Carefully consider the benefit of an ESA for its owner against the potential problems it could cause.
• Include only minimal information in an ESA letter, avoiding anything that suggests you are endorsing or attesting to the animal’s behavior or safety.

There is a lot to consider in these cases. With licensing boards aware of potential abuses, it’s not just your client’s comfort that is on the line —it could be your good standing with your board as well.

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