ESA Primer: A Therapist Explains Emotional Support Animals
As a therapist, I will often prescribe an emotional support animal (ESA) for a client. I also strongly advocate for my clients who wish to obtain an ESA. Many individuals struggle with anxiety, depression, trauma, and relationship problems. Obtaining an emotional support animal (ESA) can be an effective way to experience significant relief from these issues.
Emotional support animals provide comfort during times of distress. They also provide companionship, which is foundational to mental well-being. They help people achieve a sense of safety and security after experiencing trauma or adversity. And they help anxious individuals feel more calm and grounded.
Emotional support animals help the lonely and isolated feel less alone. A recent study shows how emotional support animals help to reduce anxiety, depression, and loneliness in individuals with mental health diagnoses.
In therapy, an ESA can serve an important role in your treatment plan.
Let’s review what Emotional Support Animals are for, how they help, and how to obtain your very own ESA.
What is an emotional support animal (ESA)?
The role of an ESA is to help alleviate symptoms associated with a mental health diagnosis.
An emotional support animal provides comfort, companionship, and a sense of safety/security.
What type of animal can be used as an ESA?
Most of the ESA letters I write are for dogs, cats, or rabbits. Some clients have requested their snakes or spiders be used as their ESA.
Since therapists typically only assess the individual and not the animal, your therapist typically cannot prescribe a specific animal.
What’s the difference between an ESA and a service animal?
An ESA should not be confused with a service animal.
The Americans with Disabilities Act (ADA) specifies that service animals have been trained to help perform tasks that assist individuals with physical or mental disabilities.
An emotional support animal does not have special training to perform tasks that assist people with physical disabilities.
An emotional support animal serves to provide companionship. The very presence of an ESA helps to relieve symptoms associated with a person’s mental health diagnoses such as generalized anxiety disorder, major depression disorder, or post-traumatic stress disorder (PTSD).
How can an emotional support animal help someone?
An emotional support animal can provide a great deal of support for individuals who struggle with a mental health disorder.
The act of petting a dog or cat can help someone regulate their nervous system, which is a necessary component to managing anxiety and PTSD.
An ESA can help alleviate the symptoms of someone with anxiety or PTSD by providing a sense of safety and security.
An ESA’s presence could also help the person regulate their nervous system when they experience flashbacks or panic.
People who struggle with depression or suicidal ideation can benefit from the companionship and responsibility that an ESA provides.
Clients with depression sometimes report that the only reason they get out of bed some days is to feed and walk their dog.
And when assessing for suicide risk, clients often report their animal’s dependence on them as a supportive factor. Emotional support animals can sometimes feel like the primary source of support in someone’s life.
A recent study shows that emotional support animals are especially beneficial for people throughout times of crisis by providing a distraction from upsetting situations. As a therapist, I’ve witnessed the benefits my clients have experienced with their pets and emotional support animals through the recent collective crisis or trauma from the pandemic.
Where can I bring my emotional support animal?
The main reason people seek ESA letters is to provide documentation to their landlord confirming their pet is a medical necessity. Unless it’s completely unreasonable, landlords cannot deny a person with an official mental health diagnosis the right to an ESA, assuming that person’s mental health care provider has prescribed the person an ESA.
You should not assume you can take your ESA places that you wouldn’t normally be able to bring a pet.
Unfortunately, many people experience anxiety and panic attacks in crowded, public spaces and wish to bring their ESA to stores or restaurants with them. I always suggest checking with the establishment first.
As of 2020, airlines stopped recognizing ESAs. If you have an ESA and wish to fly with it, you may still be able to bring it in the cabin with you but it will be treated as any other household pet.
Service animals, however, are still protected and given greater latitude.
Will I qualify for an emotional support animal?
In order to qualify for an ESA, you must be diagnosed by a mental health professional, such as a licensed counselor or therapist, with an official mental health disorder from The Diagnostic and Statistical Manual of Mental Disorders (DSM–5).
If you do not meet the full criteria for mental health disorder, a clinician cannot ethically prescribe an ESA for you. For example, an emotional support animal can help anyone with anxiety, but to qualify for an ESA letter from a therapist, you would need to meet the criteria for Generalized Anxiety Disorder.
Again, any other mental health diagnosis (such as depression, PTSD, or OCD) should qualify you for an ESA letter if your animal helps relieve associated symptoms and improves daily functioning.
There are different requirements for obtaining a service animal. Conditions that qualify you for a service animal generally include physical, mental, sensory, and intellectual impairment such as impaired vision, hearing, or a physical disability.
What is the process involved in getting an emotional support animal (ESA)?
To properly get an ESA, it is important to follow the following steps:
- If you’re currently under the care of a mental health professional, you can ask them if they are willing to write you an ESA letter or provide you with a referral to someone who can.
- You will need to be assessed by a mental health clinician (such as a licensed counselor) who will determine whether your symptoms meet the full criteria for an official mental health diagnosis.
- If the clinician determines that you do not meet the criteria for a mental health diagnosis, they will not be able to provide you with an ESA letter. If they determine that you do meet the criteria, they will then assess whether an ESA can help alleviate symptoms associated with your diagnosis.
- After assessment and diagnosis, the clinician will discuss whether an ESA helps to alleviate symptoms associated with your mental health disorder.
- The clinical will also assess whether an ESA may add to your distress, which could exacerbate your symptoms. If the clinician determines an ESA would not be helpful, they may not be willing to provide an ESA letter.
- If the clinician decides to provide you with an ESA letter, they will give you information on the rights and responsibilities of having an ESA.
- Your clinician may need to advocate for your right to an ESA to the landlord. After your assessment and diagnosis, the clinician will write a letter, which you will then provide to your landlord. Your landlord may challenge the letter, in which case, you would consult with your clinician who can assist you and advocate for you until your ESA is secure.
What does an emotional support animal cost?
Not all ESA letters are created equally. Landlords deny many cheap, online ESA letters as they do not meet the full legal criteria. Many people waste their time and money on ESA mills. These can range from around $50-$100 and may not hold up, requiring the individual to have another assessment for a legitimate letter.
Therapists generally charge a session and/or paperwork fee of $120-$250 for an ESA assessment. Whether you are prescribed an ESA or not, you would be responsible for the assessment fee.
Our ESA fee is $150 and includes assessment, diagnosis, letter, follow-up paperwork, and expert tips for utilizing your emotional support animal to reduce your symptoms and improve your mental health.
Since service animals require special training, the associated cost is significantly higher than for emotional support animals. Service animals can range upwards of $10,000.
When considering the total cost of obtaining an emotional support animal, don’t forget to factor in the long-term financial commitment toward the proper care and feeding of your pet.
Who can write an emotional support animal letter?
Anyone on the internet can write a letter for an ESA, but they’re not all reputable. To avoid wasting time and money, it is imperative to obtain an emotional support animal letter from a medical professional who can assess and diagnose you.
I suggest finding a licensed therapist who can and will advocate for your right to an ESA should you meet the criteria. This is important because landlords often challenge ESA letters, which will require you to consult with your clinician, and your clinician with your landlord several times before your ESA is secured.
What is the ESA letter assessment process like?
When providing an ESA assessment, your clinician will ask you questions regarding the status of your mental health, which can include
- Level of anxiety
- Depressive symptoms
- History of trauma
- Impairment in functioning
You will not need to show proof, but it is important to be honest with the clinician assessing you as therapists are trained to identify malingering, which is when individuals exaggerate their symptoms to achieve a goal.
Can I get an emotional support animal letter for my existing pet?
Many individuals use pets that they’ve already trained as their ESAs.
You may be able to train your pet yourself, or you can find training programs if doing it yourself proves too challenging.
It is recommended your pet is trained to provide the best ESA experience for you, but it is not required.
Training can cost several hundreds of dollars. If you have the financial means, I recommend the following:
Gentle warning about fake emotional support animal letters
It can be tempting for individuals to try to obtain a “fake” ESA letter from an unqualified person or by exaggerating their symptoms to a licensed professional in an attempt to meet the criteria.
I’ve found that this usually backfires and people end up wasting their time and money as fake letters are often challenged, and legit mental health professionals can typically suss out malingering (exaggerating symptoms).
Additionally, being shady doesn’t feel good. It creates guilt and shame.
And if too many people abuse the right to an ESA, we may lose these rights altogether. This would only hurt individuals who really need their ESAs.
A final note about your ESA or emotional support animal letter
It’s important to remember that although having an ESA letter for your pet affords you certain rights and protections under the law, you are ultimately responsible for your animal’s behavior.
Before obtaining an emotional support animal, it’s imperative to consider how the additional responsibility, time requirement, and financial cost may factor into caring for an ESA. Please do a cost/benefit analysis or pros/cons list before making the decision to get an emotional support animal.
If you’re unsure about the decision to get an emotional support animal, a therapist can help you determine this during the appointment for your ESA letter assessment.
Rebecca Phillips, MS, LPC
I’m a therapist in Texas, more specifically, a Licensed Professional Counselor in Frisco Tx. I’m very much a dog person, but I love watching the shenanigans of my clients’ feline friends throughout online therapy.
I regularly prescribe emotional support animals because I know that pets are incredibly beneficial for people who struggle with mental health issues. In fact, one of the best things about online therapy is having the ability to utilize your emotional support animal while you’re in session processing through some heavy stuff.
If you believe you may have mental health struggles such as depression, anxiety, trauma, or relationship problems and would like to obtain an emotional support animal letter, contact me to schedule your ESA assessment here.