Podcast Summary:

Private Practice Startup Podcast — Episode 132
Title: 3 Common Concerns Providers Have About Responding to Emotional Support Animal Requests
Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Becky Stone, LMHC
Release Date: April 20, 2019

Overview

In this engaging and educational episode, Kate and Katie welcome Becky Stone, a licensed mental health counselor and consultant, to address the most common concerns private practice providers face when responding to Emotional Support Animal (ESA) requests. The discussion covers legal requirements, ethical considerations, differences between ESA, service, and therapy animals, as well as best practices for assessments. Becky’s expertise clarifies common misconceptions and empowers clinicians to approach ESA requests with competence, confidence, and an ethical foundation.

Key Discussion Points & Insights

1. Becky Stone’s Entry Into ESA Consulting

• (03:03) Becky shares her experience at a university counseling center (Stetson University), where the rising request for ESAs among students prompted the formation of an interdisciplinary task force to design comprehensive and legally sound animal policies.
• She highlights that encountering confusion and caution among professionals inspired her to provide resources and training for fellow clinicians transitioning to private practice.

“I recognized when I shifted over to private practice that this was still a need. There was lots of confusion out there... So I wanted to be able to help clear up some misconceptions and really make sure mental health professionals are aware, knowledgeable, and prepared to respond to these requests.”
— Becky (04:43)

2. The Benefits of ESAs for Clients & Students

• (06:01) While current research on specific ESA outcomes is limited, Becky cites well-established findings on the benefits of pets, including stress reduction, increased activity, structure, and emotional support.
• She points out ESAs often aid with routine, socialization, accountability, and adjusting to independent living, especially for college students.

3. Defining Emotional Support Animals vs. Service Animals

• (10:10) Becky distinguishes between pets, ESAs, and service animals:
  • Pets: Any domesticated (or wild, in theory) animal someone keeps for companionship.
  • Emotional Support Animals: Any pet that helps alleviate at least one symptom of a person’s disability. They are “prescribed” by a qualified mental health or medical professional and require no specialized training.
    • ESAs are not limited to dogs or cats—can include birds, reptiles, rodents, etc.
    • The crux: the person must qualify for a “disability” (lasting 6+ months, impairs daily functioning, not a Z-code).
  • Service Animals: Only dogs or miniature horses, trained to perform specific tasks to assist with a disability. Have broader public access rights compared to ESAs.

“Emotional support animals are also pets. They're just 'prescribed' to a person with a disability in order to help alleviate one or more symptoms associated with their disability.”
— Becky (11:12)

“A service animal is trained to provide specific work or tasks for the individual with a disability.”
— Becky (13:46)

4. Eligibility and Legal Requirements for ESA Letters

• (13:35, 16:53)
  • The client must have a documented mental health diagnosis that significantly impacts their life.
  • The ESA must be shown to alleviate one or more symptoms of the diagnosis.
  • Letters must be issued by a licensed mental health professional or doctor after thorough assessment.

“It’s not a one time, here’s your letter… Let’s talk about it, let’s assess, let’s identify what this animal is doing for you so we can go about this the right way.”
— Becky (17:02)

5. Addressing “Fake” ESA Registries & Provider Caution

• (17:02, 18:53) Becky warns against the proliferation of online ESA certificate and registry websites. These are often illegitimate and are increasingly recognized and rejected by housing and airlines.
• She stresses that practitioners should rely on a structured assessment and ethical process.

“There are lots of websites and registries out there... these fake registry and certificate sites... housing and airlines are becoming very aware of [them], and it’s causing some pushback.”
— Becky (17:59)

6. Assessments, Scope, and Liability

• (19:00–20:16) Providers are encouraged to:
  • Check their liability insurance and ensure ESA assessments are within coverage.
  • Confirm state licensure allows for assessments.
  • Understand that due diligence (documented assessment and policy/procedure) protects against liability.

“It’s just going through and doing your due diligence... Generally speaking, we are not liable... the individual is responsible for their animal and the animal’s behavior.”
— Becky (19:00)

• Becky recommends a minimum of three sessions for assessments, to:
  • Complete a biopsychosocial evaluation,
  • Assess diagnostic criteria,
  • Provide education about ESAs and related responsibilities (especially regarding airlines, housing, and dealing with stigma).

7. Ongoing Documentation and Renewal

• (23:41) Best practice is for ESA letters to be valid for one year; clients should be reassessed annually to confirm ongoing need.
• Psychological ethics regarding dual roles (assessor and treating therapist) are discussed; practitioners are advised to determine their own approach based on guidelines and comfort.

“Within the law, it’s typically said that these letters are good or valid for a year… after that, they should come back and get another letter.”
— Becky (24:22)

8. Core Components of a Legitimate ESA Letter

• (25:33) The letter needs only to establish that:
  • The client has a disability,
  • The animal alleviates symptoms of the disability,
  • The clinician supports the ESA’s role.
• Avoid specifics about the animal itself (“Bella the dog”) to stay within scope and avoid accidental endorsement of the animal’s behavior or training.

“We are not actually assessing the animal themselves, just the individual... if you really were hard pressed by a housing authority... you can just say, well, they’ve identified their ESA as their dog, but not like Bella the dog.”
— Becky (26:45)

9. Personal Touches and Pet Advocacy

• (27:22) Fun segment where hosts and guest share about their own pets, fostering a sense of camaraderie and common ground.

Notable Quotes

• On the process and clinician responsibility:
  “As long as you are informed, you’re knowledgeable, you’re competent, and you’re confident about emotional support animal related information, you can certainly incorporate this into your practice.”
  — Becky (28:19)

• On resisting quick or unethical yes’s:
  “We want to be able to respond with a, 'Let’s talk about it. I do have a policy and procedure in place. Let’s see if you fit the criteria and then be able to evaluate and move forward with that.'”
  — Becky (29:48)

Timestamps for Key Segments

• 03:03 — Becky’s background, university ESA policy development
• 06:01 — The (limited) research and practical benefits of ESAs
• 10:10 — What counts as an ESA; difference between pets, ESAs, and service animals
• 12:19–13:46 — Disability definition and mental health diagnoses
• 16:53–17:59 — ESA assessment process and warning about fake registries
• 19:00 — Scope of practice, liability, and insurance considerations
• 20:16 — Three-session assessment model
• 23:41 — Documentation renewal and dual provider roles
• 25:33 — What an ESA letter should and shouldn’t include
• 28:19 — Main takeaway for providers
• 29:16 — Information about Becky’s ESA E-course and free sample

Memorable Moments

• Humor & Camaraderie: Hosts joke about the various animals that could be ESAs in South Florida (“a crocodile or an alligator?”), and swap stories about their dogs named Roxy/Rossi (27:22), highlighting the human-animal bond.
• Practical Advice: Becky’s insistence on due diligence, minimum necessary disclosure, and annual reassessment dovetail ethics and practicality throughout.

Resources Mentioned

• Becky’s E-course for Clinicians: "From Oh No to Yes, I Can: Responding to and Evaluating Emotional Support Animal Requests"
• Becky’s Giveaway: Free sample lesson summarizing differences between service, ESA, therapy animals, and pets (includes a downloadable comparison chart)
• Becky’s Facebook group: For mental health professionals seeking ESA-related support and education

Takeaway for Listeners

• Be Educated, Be Structured: Don't shy away from ESA requests—use solid assessment, ethical policies, and current information to guide your process.
• Advocate for Clients—Ethically: A thorough, legitimate approach protects clients from scams and gives practitioners confidence.
• Embrace Your Niche: If compelled, ESA assessments can be a valuable practice niche—consider further training and coursework, like Becky’s.

“A lot of the clients out there that genuinely benefit from an emotional support animal are unfortunately getting trapped in those registry or certificate sites that are not the legitimate ways to go about it. So we can really be better advocates for our clients by adding in ESA services…”
— Becky (28:19)

For more information, visit: privatepracticestartup.com