Dr Jasmine B. MacDonald (00:00:08):
Hello and welcome to this episode of Psych Attack. I'm Dr. Jasmine B. MacDonald. Today I'm catching up with Dr. Abigail Alfrey about the role animals can play in mental health practice and cognitive assessment. I hope you're going well and have settled in with a warm cup of tea.

Dr Jasmine B. MacDonald (00:00:23):
Abby, welcome to Psych Attack.

Dr Abigail Alfrey (00:00:29):
Hello.

Dr Jasmine B. MacDonald (00:00:30):
It is so lovely to have you here. I appreciate you taking the time for a chat. And I'm also especially excited because you are the first international guest on the show.

Dr Abigail Alfrey (00:00:40):
I'm very excited to be the very first international guest on your show.

Dr Jasmine B. MacDonald (00:00:43):
. Today we're gonna catch up about your expertise area in really experiential and creative approaches to clinical practice in psychology. But what I like to do is to start a little more broad and so that I and the listeners can get a sense of you more holistically as a person. So I wondered if you wouldn't mind talking a little bit about yourself and covering things like where you grew up and how you got into psychology.

Dr Abigail Alfrey (00:01:11):
Sure. Yeah. The two are really linked and I think tie in really nicely with this topic today of talking about animals in psychology. So I was really fortunate. I grew up in a small holding in rural countryside of England, and so I've grew up with the luxury of like surrounded by animals. We had horses, I had a dog and chickens and geese and all of that kind of stuff. So right from the word go, I was like surrounded by nature and animals and got to really experience the advantages that that had on my developmental process, my growing up, the ups and downs I suppose that come with that and how you manage your emotions. So that led me really directly into psychology and mental health. And I actually kind of got into psychology through trying to understand the animals and animal behavior more than the human side, that kind of came later. So I started off working with animals that had, well, particularly horses that had phobias or traumas.

Dr Jasmine B. MacDonald (00:02:00):
Whoa, interesting.

Dr Abigail Alfrey (00:02:01):
Yeah, because, well, we didn't have tons of money, so I didn't buy flashy horses, but I would help sort of rehabilitate horses that had had traumatized background, help them live more sort of fulfilled lives, I suppose. And, and I learned a huge amount about, I suppose the more behavioural aspects of psychology there and non-verbal communication, development of trust, which was all very nice foregrounding for working with people .

Dr Jasmine B. MacDonald (00:02:27):
Absolutely.

Dr Abigail Alfrey (00:02:27):
But a slightly, slightly different route in than a lot of people take.

Dr Jasmine B. MacDonald (00:02:31):
Yeah. Nice. So how did you come about thinking that therapy was something that would really motivate you and interest you?

Dr Abigail Alfrey (00:02:38):
Well, I guess I saw the effect that it had on the, on the horses when I was working with them. So say I got a horse that had a really bad experience going into a horse box for traveling for like shows and moving around and stuff, or I had a horse that wouldn't go over certain jumps or wouldn't go near certain stuff that freaked them out. I had that experience of working one-to-one with them, building the trust, seeing the gains week on week and, and really having that experience of doing something useful and that was beneficial for me and for them. So that really gave me a bit of a, a hit I suppose, that I wanted to keep chasing and working with people was just such a natural extension of that like...

Dr Jasmine B. MacDonald (00:03:15):
Mm-hmm.

Dr Abigail Alfrey (00:03:15):
...once I got into working with people, actually the benefits were, were even broader because you see the suffering around in the world and you see the difficulties and challenges that people go through everyday.

Dr Jasmine B. MacDonald (00:03:25):
Right.

Dr Abigail Alfrey (00:03:26):
Myself, not excluded and I'm sure we, we can all connect to that. So...

Dr Jasmine B. MacDonald (00:03:30):
Yeah.

Dr Abigail Alfrey (00:03:31):
...doing something that really felt like it was making a difference and that you're there, connecting with something real was really, really important to me. I couldn't have done like a desk job where I was doing something kind of abstracted and....

Dr Jasmine B. MacDonald (00:03:43):
.

Dr Abigail Alfrey (00:03:43):
I'm sure... no, no disrespect to people that do at all, but I think I would've gotten really, really switched off with that kind of work.

Dr Jasmine B. MacDonald (00:03:50):
Yeah. I'm wondering about then your pathway in terms of your formal training, but I guess double-barreled questions aren't good. Try not to do that. But here's one , how much did you feel aspects around the human animal interaction was included in your training?

Dr Abigail Alfrey (00:04:07):
Yeah, not so much, which was interesting for me. So, so I'll answer the first part of your question first. So the route into clinical psychology training in the UK, and I don't know if it's the same or different in Australia, it's pretty long-winded. You're generally expected to, you have to have an undergraduate degree in psychology. For me that was a joint degree with philosophy and psychology, then you're kind of encouraged to have a Masters, you don't have to, but if not, then you know, heaps of professional experience. So I worked first off as a support worker and then as an assistant psychologist. I then did go on to do a Masters in mental health studies. And from there I went on to do a doctorate in clinical psychology. So that's then a three year training funded by the NHS, that's our national health service. And really learning the theory-practice link. So getting out into the field and developing your skills as a clinician, but also as a researcher. So always having those two hats, a sort of scientist-practitioner, in inverted commas.

Dr Jasmine B. MacDonald (00:05:04):
Sure. Yeah.

Dr Abigail Alfrey (00:05:05):
And the second part of your question was about how much were animals integrated into that and yeah, it was really surprising for me that they're not really included at all. In fact, I don't think I've heard them mentioned once.

Dr Jasmine B. MacDonald (00:05:17):
mm-hmm.

Dr Abigail Alfrey (00:05:17):
Which coming from my background growing up on the farm where it was just such an intuitive aspect of how I manage my emotions and just being a human being where you talk to people and nearly everyone you know, has an animal or has an interest in animals, that's not quite right. But there are lots of people out there that don't like animals, but it is a statistical norm in Western countries. So in the US I think it's about 70% of people own a pet.

Dr Jasmine B. MacDonald (00:05:44):
Right.

Dr Abigail Alfrey (00:05:44):
In the UK it's about 50, 45, 50, I don't know what it is in Australia.

Dr Jasmine B. MacDonald (00:05:49):
Yeah. I'm not sure actually.

Dr Abigail Alfrey (00:05:51):
It would be interesting to know. I mean I'm sure the data's out there, but generally you find that, kind of the more rural the place, the more animals that there are in people's lives.

Dr Jasmine B. MacDonald (00:06:00):
Yeah.

Dr Abigail Alfrey (00:06:00):
Makes sense. Right. And I'm sure that lockdown and the COVID context has changed that too. It'd be interesting to see what trends emerge in the coming times. So really baffling to me that animals just weren't included in any of our training experiences. You go into clinics and hospitals and health teams and there are no animals to be seen. You know, you hear of it happening every now and again, but it's rare.

Dr Jasmine B. MacDonald (00:06:23):
Mm-hmm

Dr Abigail Alfrey (00:06:23):
And it seems such a strange sort of counterintuitive way of managing people's health is to take away the things that they enjoy and, and that keep them well and the connections that are meaningful to them. So I wanted to change that.

Dr Jasmine B. MacDonald (00:06:35):
I won't get emotional, but I did recently lose our dogo we were guardians of a fur baby for 16 years and you really realise how many dogs and pets there are around when you don't have your own anymore . And so as a little kind of point ahead to one of your papers, we're gonna talk about when those service users were talking about bereavement and how that might impact their symptomology or their experience. I was reading the paper and reading it in a whole other way and it was just, the work is so relatable. In a broader sense, the work that you do is that experiential creative stuff. So we're not gonna focus on it today, but I wondered if you might just like sprinkle in there for listeners a little bit of the other things that you're interested in, because I suspect they'll wanna look at your other work or look out for future things that you might have happening.

Dr Abigail Alfrey (00:07:23):
Yeah, sure. I mean, generally anything that connects people with their human side is what interests me. So anything to do with the creative arts, um, movement, the natural environment, that's all the kind of stuff that interests me that I do in my clinical work and that I, that I research as well. So I've had a couple of papers out recently about poetry therapy.

Dr Jasmine B. MacDonald (00:07:44):
Nice.

Dr Abigail Alfrey (00:07:45):
And that's a real, real interest to me because it's so accessible. So, you know, all you need for poetry therapy is a pen and paper. You maybe don't even need that. Arguably. And it's accessible for all ages. Most backgrounds, as long as you have some degree of literacy, then you can engage in poetry therapy. And again, people light up when you talk to them about this stuff. If they're into it, then I'm into it and I wanna kind of integrate that into the healthcare that I provide. So that's the piece of work that's come out quite recently. And we've got another paper that's just going through from final checks before it's published this week, hopefully next week.

Dr Jasmine B. MacDonald (00:08:18):
Nice.

Dr Abigail Alfrey (00:08:18):
So that's exciting. And then we've got a few irons in the fire. So I'm looking at a piece of work around psychodrama psychotherapy at the moment.

Dr Jasmine B. MacDonald (00:08:26):
Ah, cool.

Dr Abigail Alfrey (00:08:27):
So kind of dipping my toe in that. I've also got a manuscript that's just been submitted around mindful sewing, so mindful textile exercises with with mums.

Dr Jasmine B. MacDonald (00:08:38):
Nice!

Dr Abigail Alfrey (00:08:38):
So that was a really nice piece of work that I did, uh, a little while back. So yeah, anything really that gets people kind of integrating things that they're interested in and trying to find sustainable ways of managing emotions, managing the ups and downs of life and, and the things that make life tricky, like relationships and, and communication and boundaries and all of that I think makes so much more sense if you can integrate it into what you are already doing.

Dr Jasmine B. MacDonald (00:09:04):
Mm-hmm.

Dr Abigail Alfrey (00:09:04):
Then, you know, once our meetings have ended, so I might see people for say 24 weeks, six months, that's quite long in terms of the NHS, in terms of what we provide. But in terms of your life, it's not that long.

Dr Jasmine B. MacDonald (00:09:16):
Mm-hmm. .

Dr Abigail Alfrey (00:09:16):
Like 24 meetings, that's like 24 hours. That's a day.

Dr Jasmine B. MacDonald (00:09:20):
Yeah.

Dr Abigail Alfrey (00:09:20):
So, you know, how can I give you the skills that you can then take forward and and maintain throughout your life? And I think working with animals is great because if you do have a pet, then that animal is with you all the time.

Dr Jasmine B. MacDonald (00:09:32):
Mm-hmm. .

Dr Abigail Alfrey (00:09:32):
...or at least you know, most days. Right?

Dr Jasmine B. MacDonald (00:09:34):
Yeah.

Dr Abigail Alfrey (00:09:35):
So if you've got the skills to kind of ground yourself just by interacting with your pet, then you don't need me after a while. That gives me a lot of confidence that I can say goodbye and have a good ending with a client and know that they're gonna carry on doing good work for themselves.

Dr Jasmine B. MacDonald (00:09:49):
Yeah. I really like that. Almost like touching on that context dependent memory and bringing in these other cues to keep people thinking about what keeps them calm, what keeps them balanced, perspective of what's important as well, and keeping you in the moment.

Dr Abigail Alfrey (00:10:04):
Yeah, absolutely.

Dr Jasmine B. MacDonald (00:10:06):
Having these things that draw people into a therapy context or a self-development context that they're already connected with. So it doesn't seem like it's this scary thing that I'm, you know, not familiar with. And incorporating sewing and incorporating poetry stuff that already is meaningful for them.

Dr Abigail Alfrey (00:10:22):
Right. It's massive. So in one of the poetry papers, which is out there at the moment, we developed a model of poetry therapy and it's a kind of looks a bit like a triangle, and the very top of that triangle is engagement. And there's something about poetry that brings people, if you're into poetry, it brings people into the therapy room to start with. Now without that, we've got no therapy. You know, if we haven't got bums on seats, then we're not doing any good. Right.

Dr Jasmine B. MacDonald (00:10:46):
. Exactly. Yeah.

Dr Abigail Alfrey (00:10:47):
It's pretty basic, but not many models really integrate what draws people in.

Dr Jasmine B. MacDonald (00:10:52):
Mm-hmm.

Dr Abigail Alfrey (00:10:52):
Which is the foundation of any kind of psychotherapy. And I have a really strong memory of interviewing a participant for that project. And, and she said to me she was a CBT psychotherapist just by chance. I hadn't recruited some therapist, but she happened to be one. And she said to me, you know, it's funny because I'm a CBT therapist, I believe that CBT helps, but when I'm distressed or anxious or sad or lonely, I don't pick up my CBT self-help book and page through that , I pick up poetry.

Dr Jasmine B. MacDonald (00:11:20):

Dr Abigail Alfrey (00:11:21):
And it was such a, such an obvious thing. I thought, yeah, that's what we all do. We go to the things that naturally sooth us and contain us and connect us.

Dr Jasmine B. MacDonald (00:11:31):
Yeah. And you kind of need to do that before you might get to, uh, more of a like front brain purposeful, working through something in a rational sense or reframing. You need that soothing and calming. And I guess, I dunno, I wanna use the word intuitive.

Dr Abigail Alfrey (00:11:45):
Part of it comes down to motivation. It's intrinsically motivating to do that kind of stuff, whereas you need a bit more extrinsic motivation to do your CBT homework. Right. , like

Dr Jasmine B. MacDonald (00:11:55):
This is true

Dr Abigail Alfrey (00:11:58):
They're not mutually exclusive. So well there is a saying within poetry therapy that it's a tool, not a school.

Dr Jasmine B. MacDonald (00:12:04):
Right.

Dr Abigail Alfrey (00:12:05):
And it's kind of like a cloak that you can put over your CBT or over your psychodynamic therapy or whatever modality you work in. Right. And there's so much that you can kind of frame in terms of CBT language that, that you don't even notice you're doing it when you come to do your poetry. So if you think about behavioral activation, if you decide to go and write a poem, that's behavioral activation,

Dr Jasmine B. MacDonald (00:12:25):
Right.

Dr Abigail Alfrey (00:12:26):
You've done something and then you get all of the feel good stuff. If I've achieved something that I'm proud of that I wanna share with people,

Dr Jasmine B. MacDonald (00:12:33):
Yeah, nice.

Dr Abigail Alfrey (00:12:35):
You're doing CBT, but you don't necessarily know it and it, it doesn't feel as separate from the self.

Dr Jasmine B. MacDonald (00:12:41):
Mmm.

Dr Abigail Alfrey (00:12:41):
As I think we might have a tendency to frame it sometimes.

Dr Jasmine B. MacDonald (00:12:45):
I was thinking today it would be great if we could focus on in particular two pieces of work of yours and use that to talk about, um, what animal assisted work or, you know, human animal interaction looks like in therapy. So we have the review paper where you looked at the presence of doggos, um, and that's just how I'm gonna refer to them throughout the episode. the presence of doggos when doing cognitive testing with children. And then the other was pet ownership amongst service users of a community mental health service. And I guess I wanna put it to you about where do you think would be the better place to start?

Dr Abigail Alfrey (00:13:23):
I'll do them in chronological order. So I actually, although they were published separately, um, as you know, these things, can get a bit confused in the land of publications. So yeah, I actually did the piece of work in the community mental health team first.

Dr Jasmine B. MacDonald (00:13:37):
Okay.

Dr Abigail Alfrey (00:13:37):
That was the first piece of research that I did, like formal research that I did looking at animals in a mental health team. And this was a piece of work that I did in Central London, so like the urbanist of all the urban environments. And I was looking and it was a psychosis recovery service. So people who came into the service had had psychosis for at least three years.

Dr Jasmine B. MacDonald (00:14:00):
Mmm.

Dr Abigail Alfrey (00:14:00):
Of a level that really wasn't being managed at the primary care GP kind of level.

Dr Jasmine B. MacDonald (00:14:04):
Yeah.

Dr Abigail Alfrey (00:14:05):
So a lot of them were on depo medications and needing regular injections. A lot of people were coming in for mainly medication based treatment actually. And some people were engaging with psychotherapy and occupational therapy, but for the most part it was quite a medically oriented service.

Dr Jasmine B. MacDonald (00:14:22):
Mmm.

Dr Abigail Alfrey (00:14:22):
And there were issues with that in terms of client engagement. So generally if the only thing you offer people is something that's a bit scary and might restrict your freedom and isn't generally very nice, then people don't want to come. That makes sense, right?

Dr Jasmine B. MacDonald (00:14:35):
Mm-hmm. .

Dr Abigail Alfrey (00:14:36):
And it was really tricky. So, you know, as a clinician, and hopefully an ethical clinician, you wanna give people a good experience of your services.

Dr Jasmine B. MacDonald (00:14:44):
Right.

Dr Abigail Alfrey (00:14:45):
And we are really thinking about what can we do to improve this for people? How can we, how can we change, change the narrative so that we are not just a service that kind of gives people injections and sends them home again, but actually engage with people on a one-to-one human level and really build good meaningful relationships. And of course there was already lots of good work going on there, but noticeably absent with any kind of animal connection.

Dr Jasmine B. MacDonald (00:15:10):
Yeah.

Dr Abigail Alfrey (00:15:11):
And for a lot of our service users with psychosis, they were really isolated in terms of people.

Dr Jasmine B. MacDonald (00:15:17):
Mm-hmm.

Dr Abigail Alfrey (00:15:17):
A lot of them were estranged from their families. They didn't have big social networks. But we found out that they did, a lot of them had some pets.

Dr Jasmine B. MacDonald (00:15:26):
Mm-hmm.

Dr Abigail Alfrey (00:15:26):
And the pets were so important to them. And we were hearing these stories just when people would come in and, and talk to us, they'd mention that one of them had a snake and the snake had gotten out this week. And the...

Dr Jasmine B. MacDonald (00:15:40):
That sounds terrifying .

Dr Abigail Alfrey (00:15:40):
rying.... To me it does, to me it sounds absolutely terrifying. But they were just distraught that they'd lost this snake and then they were joyous they'd found the snake again. And, and we started to just tune into these stories that we were hearing and we thought we're gonna audit this and find out how many of our service users have pets.

Dr Jasmine B. MacDonald (00:15:59):
Right.

Dr Abigail Alfrey (00:16:00):
And how can we take that into account when we are sort of designing and delivering their care? And it was kind of a two-fold process. So on the one hand we found out some information that they told us. So people filled in just a really, really brief audit questionnaire of do you own a pet? Yes or no? And have you ever owned a pet. Yes or no, because the course of the illness, we wondered if that might have impacted pet ownership as well.

New Speaker (00:16:22):
Yeah. Absolutely.

Dr Abigail Alfrey (00:16:23):
And people's migration stories too. I mean, London's a really transient place, so we were interested in that, but also interested in hearing from them about the pets and the connections that they did or didn't have. And many of our clients were sort of in and out of hospital, so what impact did that have on their pet connections?

Dr Jasmine B. MacDonald (00:16:42):
Mmm.

Dr Abigail Alfrey (00:16:43):
And really getting into it, there's a lot of literature out there about the advantages of having a dog if you have sort of depression and anxiety, and that's really helpful research. But there really wasn't much out there about people that have severe and enduring mental illness.

Dr Jasmine B. MacDonald (00:16:57):
Mm-hmm.

Dr Abigail Alfrey (00:16:57):
And we just didn't know if the research that was out there applied to our service users or not. So yeah, we got chatting to them, found out about how important animals were, but also the process of talking to them was so striking. Like suddenly people were like queuing up to come in and talk to us.

Dr Jasmine B. MacDonald (00:17:16):

Dr Abigail Alfrey (00:17:16):
And they were, they'd come in and they were ringing, they were ringing the psychiatrist who's one of the authors on the paper and saying like, can I come in and, and talk about Steve, my dog or whatever? And he was like, well, this is new like.

Dr Jasmine B. MacDonald (00:17:29):

Dr Abigail Alfrey (00:17:29):
This is, this is, this is totally not what we're used to having. And, and actually it got a little bit competitive as to who, who might wanna be involved. And we couldn't get people out the door. We thought we'd interview them for like 20, 30 minutes, wanted to keep it really manageable for people and we couldn't get them out the door. They just, some people brought in photographs, someone brought in some drawings they'd done of their cat.

Dr Jasmine B. MacDonald (00:17:52):
Oh my gosh.

Dr Abigail Alfrey (00:17:53):
But they wanted to share their lives with us. And I thought, this is the magic of it. This is the work.

Dr Jasmine B. MacDonald (00:17:59):
Definitely. And and in hindsight, when you think about it, of course that's the reaction. You know, of course they're gonna be so excited to, to share these experiences, but it's just so far from what we might instantly think of when you think of a service like this. Yeah.

Dr Abigail Alfrey (00:18:14):
Yeah. Totally. And you know, as soon as we started doing this, people were sort of rolling their eyes and saying, well what's, what's the point of that? Like, what are you gonna suggest that they bring their cat into appointments? Don't be so silly. And no, we haven't suggested that, although, you know, who knows?

Dr Jasmine B. MacDonald (00:18:30):
Is it so silly? Yeah. .

Dr Abigail Alfrey (00:18:30):
Yeah. I think you can probably guess what my position on that might be, but in the, uh, interest of diplomacy. I'll, I'll keep a nuance here, but yeah, I mean, there are so many things that we can do. And actually the experience of talking to people about their pets, they really lit up and we realized this is the way into those difficult conversations that we cannot get people to have, the risk management conversations. What happens if you go into hospital?

Dr Jasmine B. MacDonald (00:18:56):
Mm-hmm.

Dr Abigail Alfrey (00:18:56):
What keeps you alive in the moments when you just really, really don't see any point?

Dr Jasmine B. MacDonald (00:19:01):
Yeah.

Dr Abigail Alfrey (00:19:02):
You know, what keeps you grounded when you forget what's real, when you, when you feel disconnected from yourself, from the world, from other people, what brings you back? And animals was the answer for a proportion of our service users, is animals. You know, so many people said, I wouldn't be here if it wasn't for Bruce, my dog. You know, they've got me through really, really tough times. They're a reason to get up in the morning when I just would rather stay under the covers.

Dr Jasmine B. MacDonald (00:19:29):
Hmm.

Dr Abigail Alfrey (00:19:29):
You know, it's, it given people pride, it's given them companionship. There was a lovely sound bite. It's actually in one of the papers from a lady who'd been experiencing bullying and she said, no, we stand up to these bullies together. We do not like bullies. And it's just that sense of camaraderie that people get from their pets and.

Dr Jasmine B. MacDonald (00:19:49):
Definitely.

Dr Abigail Alfrey (00:19:49):
Togetherness and family. So important.

Dr Jasmine B. MacDonald (00:19:52):
Yeah. Yeah. One of the things that really resonated with me was the role in terms of being a caregiver, but also pride, like you said, I think one of the participants said they nursed their cat through a time of being really ill and that was really hard, but how proud they were that they got through it together and they could take care of, you know, their their fur baby through that time .

Dr Abigail Alfrey (00:20:14):
Yeah.

Dr Jasmine B. MacDonald (00:20:14):
And the other part was the role it played in their sense of self and identity. And having a 16 year old staffy that I watched get older and older, I had anticipated we wouldn't have him much longer. But what I hadn't anticipated was after the initial grief of, you know, losing him was, well what now I'm, that's part of my identity gone. I don't care for this little furry thing that otherwise used to follow me everywhere all the time. Especially working from home.

Dr Abigail Alfrey (00:20:43):
And you have to remember that, you know, for these clients, a lot of them are in the patient role. You know, it's a very medicalized healthcare system here in the UK and they come in and they're, a lot of them are called patients. They have an illness and we might contest , but the reality is that is a lot of the time the language that's used and the kind of positioning that clients might find themselves in, and suddenly they're the nurse, they're the caregiver.

Dr Jasmine B. MacDonald (00:21:08):
Mm-hmm.

Dr Abigail Alfrey (00:21:09):
They are able to help someone else. And I think that is so important that we can hold both roles. We're all a patient at times, we all get ill at times.

Dr Jasmine B. MacDonald (00:21:17):
Hm-hmm.

Dr Abigail Alfrey (00:21:17):
But we all also have the power to help others.

Dr Jasmine B. MacDonald (00:21:20):
Yeah.

Dr Abigail Alfrey (00:21:20):
And both are really, really important to be able to receive and to give care. In terms of people's identities. And, and like you're saying, you know, that role of, of caregiving and companionship is, is massive. And I really remember someone, well, lots of people talked about grief in the paper. There just wasn't the space to, to talk about everyone's experiences unfortunately. But, but the emotion that would come over people was, as with our conversation now of, you know, it is grief. It is proper grief. And often I think a much less complicated grief than we have when we lose people.

Dr Jasmine B. MacDonald (00:21:56):
Mm-hmm.

Dr Abigail Alfrey (00:21:57):
Because our relationships with animals are in the here and now they're straightforward. They're quite pure often.

Dr Jasmine B. MacDonald (00:22:02):
Yeah.

Dr Abigail Alfrey (00:22:03):
And you know, I'm sat here drinking out of a mug with my staffy

Dr Jasmine B. MacDonald (00:22:07):
Oh, you, you have a staffy? Oh my. What's the chance of that ?

Dr Abigail Alfrey (00:22:15):
I don't, I don't have him in my life anymore, but I have this mug as a reminder. It's, it's him looking at a tennis ball and he never ever took his eye off the ball.

Dr Jasmine B. MacDonald (00:22:23):
Of course.

Dr Abigail Alfrey (00:22:24):
And he taught me so much.

Dr Jasmine B. MacDonald (00:22:26):
Exactly. They do. They do. Yeah.

Dr Abigail Alfrey (00:22:30):
It's, um, it's wildly underestimated by healthcare professionals. The impact that a relationship with an animal has. I think they get played down and really done a disservice to like, oh it's, it's just a cat.

Dr Jasmine B. MacDonald (00:22:42):
Mm-hmm.

Dr Abigail Alfrey (00:22:42):
It's not just a cat. For some people it's their whole world. It might be the only person, and I'm gonna use the word person.

New Speaker (00:22:50):
Mm-hmm.

New Speaker (00:22:50):
It might be the only person that they actually trust.

Dr Jasmine B. MacDonald (00:22:53):
Yeah.

Dr Abigail Alfrey (00:22:53):
That's actually been with them through the ups and downs.

Dr Jasmine B. MacDonald (00:22:56):
Yeah.

Dr Abigail Alfrey (00:22:57):
Hugely, hugely important. And I really don't think we give credit to that. I don't think we ask the question enough, do you have an animal in your life? What's your relationship like with that animal? Both in terms of meeting the person and taking an interest in them.

Dr Jasmine B. MacDonald (00:23:11):
Mm-hmm. .

Dr Abigail Alfrey (00:23:12):
But also being aware that if that animal gets sick or gets lost or it's coming towards the end of its life. You talked about your 16 year old dog and having that realisation that this can't go on forever. And the same is true for our patients. And if we are thinking about relapse or or illness, um, we need to be aware of those risk indicators as well and add some extra support in around those times.

Dr Jasmine B. MacDonald (00:23:35):
Yeah. Yeah. Absolutely. And you touched on hospitalization. So I guess maybe a really practical aspect in working with people might be having a care plan, you know, when I'm unwell, what do I want this to look like? Is that something that kind of was coming out in the discussions you were having?

Dr Abigail Alfrey (00:23:53):
Yeah, absolutely. And one of the service improvements that we implemented in that particular team was that now anyone has it on their record if they have an animal in their life and it's standard practice to integrate that into their care plan if they do.

Dr Jasmine B. MacDonald (00:24:06):
That's awesome.

Dr Abigail Alfrey (00:24:07):
So yeah. And such a simple change, but a really relevant one for I think any team, it doesn't matter where you're situated, we are in central London, people are saying, what's the importance of pets? Well, people still have pets in central London.

Dr Jasmine B. MacDonald (00:24:19):
Mm-hmm.

Dr Abigail Alfrey (00:24:19):
And yeah, the importance is that we can ask about them. We don't have to bring them in, but we can ask about them and we can find out about how they might open up a conversation, which can be really difficult. Care planning can be really triggering for people.

Dr Jasmine B. MacDonald (00:24:32):
Mm-hmm. .

New Speaker (00:24:32):
Often when people are well and able to have that conversation, they don't wanna think about times when they're not well.

Dr Jasmine B. MacDonald (00:24:37):
Yeah.

Dr Abigail Alfrey (00:24:38):
But if they can think about, okay, well what happens to my dog when I go into hospital? Then that encourages that, okay, we're gonna plan for the worst, but hope for the best kind of mentality.

Dr Jasmine B. MacDonald (00:24:51):
Mm-hmm. .

Dr Abigail Alfrey (00:24:51):
So yeah. Simple changes, but hopefully quite important ones,

Dr Jasmine B. MacDonald (00:24:54):
The way that the paper's written, the things that you are drawing out from people's experiences really highlighted the social facilitation that pets play in terms of, you know, sparking up a conversation. But you've got me thinking with what you were just talking about, then potentially keeping others in the loop when you're not doing so well because well now you need to reach out to somebody to take care of your pet.

Dr Abigail Alfrey (00:25:19):
Yeah. Yeah. There was one lady in the paper that um, she really made friends with, she lived in a block of flats and um, one of her downstairs neighbours would look after the cat whenever she went into hospital. And they've stayed friends. This lady who looked after her cat, she's moved away now, but they still write to each other. They're in contact, really meaningful lasting friendships. It was built around some real vulnerability actually.

Dr Jasmine B. MacDonald (00:25:41):
Yeah.

Dr Abigail Alfrey (00:25:42):
And it's hugely important to people. I mean, we also ask people that didn't have pets, why not? And a lot of it was around, well, what happens if I go into hospital? And I think if we can help people think about who, who could you talk to about this? And also let them know what happens naturally within the service. So we do, if someone is unfortunately detained under our mental health act, then we do have a process of the pets. We have a relationship with kennels and catteries and things. And that is a whole part of the process that that's taken care of and that your pet's not just gonna be left alone and nothing terrible is gonna happen. But if you can have that conversation upfront, then you're in control of where they go. And you know that the animal is gonna have a good experience. You feel confident in their care. And the conversations you can have with neighbours or family members, they can be so, so important. And breaking the ice, getting people talking. If you walk your dog once, twice a day and you meet other dog walkers or people wanna come say hi and pet your dog, you've got some social contact in your life. And that's a springboard. Right?

Dr Jasmine B. MacDonald (00:26:47):
. It's true. Even in walking, Taz, our staffy, even people who didn't necessarily want to talk to us would talk to him, just stopping and having a conversation with somebody. Or I don't know how many times in the 16 years we had Taz, I'd have people come up to us and say, I had a staffy at one point. Or like, just love dogs in general and it, it connects you. That's really cool.

Dr Abigail Alfrey (00:27:10):
Yeah. I mean, I'm gonna own up to this and say I'd never spoken to my next door neighbour until my cat got stuck on her roof.

Dr Jasmine B. MacDonald (00:27:16):

Dr Abigail Alfrey (00:27:16):
Right. Like.

Dr Jasmine B. MacDonald (00:27:17):
It was a good strategy of the cat to form relationships for you.

Dr Abigail Alfrey (00:27:24):
Sometimes they do and, and you just have to kind of go with it. And actually, you know, we are now in touch and we have a, a much more healthy next door neighbourly relationship. But I think, uh, I I, that happened quite soon after I moved in. I will say that. But yeah, I think these things happen and they get people talking and they got people talking in the waiting room too, so.

Dr Jasmine B. MacDonald (00:27:46):
Mm-hmm.

Dr Abigail Alfrey (00:27:46):
Some people talk, and this was a really painful part of the study for me, was finding out just how scary people found the waiting area.

Dr Jasmine B. MacDonald (00:27:53):
Yeah.

Dr Abigail Alfrey (00:27:54):
And that title of the paper, "Why should the fish feel safe?" That was so striking to me. I just thought we were asking people to come into a space where they actually wouldn't bring an animal, even though it'd bring them comfort to and make them feel safer in this place, they actually would rather protect the animal and leave them at home and take it themselves.

Dr Jasmine B. MacDonald (00:28:13):
Mmm.

Dr Abigail Alfrey (00:28:13):
Which was super painful for me. And something that really absolutely needs to be addressed

Dr Jasmine B. MacDonald (00:28:18):
Shows how brave they are to show up despite how uncomfortable and scary the situation is.

Dr Abigail Alfrey (00:28:23):
Yeah, absolutely. People even though their animals weren't there, they still got talking about them.

Dr Jasmine B. MacDonald (00:28:27):
Mm-hmm. .

Dr Abigail Alfrey (00:28:28):
So one lady had made friends with another person who was sat in the, in the waiting room, cuz they found out they both had cats and they were like, oh yeah, sharing stories about what had happened and then the phones out and they're showing pictures and

Dr Jasmine B. MacDonald (00:28:41):

Dr Abigail Alfrey (00:28:41):
And we can all relate to that. I mean, how many social media, memes, videos, etc, are out there right now? I mean, I think this entire business is TikTok I'm pretty sure is founded on animals, like doing cute stuff,

Dr Jasmine B. MacDonald (00:28:55):
Uhhuh,

Dr Abigail Alfrey (00:28:55):
So we're interested in it, we bond over it, we share it, you know, we talk about it and it's a huge social lubricant.

Dr Jasmine B. MacDonald (00:29:02):
Oh, animals are the best. I guess in the conversation we've had so far, you've already highlighted a number of ways in which for the people you spoke to, having a pet was challenging, but also it was something that could be really protective in terms of isolation and symptom management and stuff like that. I'm wondering about tips or insights from this work and your broader experience that you might have for individuals around their own mental health and pet ownership and clinicians and the role of animals.

Dr Abigail Alfrey (00:29:35):
There's reams and reams of ways in which animals can be helpful. So I think one of the papers we'll move on to talking about is that review paper where it looks at how dogs might support children, young people that are going through stressful things such as clinical testing. So cognitive assessments. I'm gonna talk about why that's the case. And I think generally it's about attachment systems, right? So hopefully attachment is a word that's on people's radars much more often now.

Dr Jasmine B. MacDonald (00:30:01):
Mm-hmm.

Dr Abigail Alfrey (00:30:01):
And anything that connects you with that attachment system is it's neurobiological. So if you are around an animal, then it activates your attachment system and it gives you all of those feel good chemicals, the oxytocin, that bonding chemical and it makes you feel better, less stressed, like more relaxed. And I think anyone can take that into their lives. If you've, if you've got a pet, then you've already got really good access to something that's gonna help you feel soothed, that's gonna help you feel supported. And I think anything you can do to kind of, I suppose notice what the gaps are, what the challenges are in your life. If you are wanting to have more exercise in your life and you've got a dog, then that's a natural motivator to kind of get up and do some exercise with the dog. Right?

Dr Jasmine B. MacDonald (00:30:46):
Mm-hmm. ,

Dr Abigail Alfrey (00:30:46):
Back to behavioural observation, I suppose.

Dr Jasmine B. MacDonald (00:30:48):
.

Dr Abigail Alfrey (00:30:48):
But I work quite a lot with the model of compassion-focused therapy and that talks about kind of three core systems that we have. We have the threat system, the soothe system, and the drive system. And I think most of us tend to spend our lives somewhere between threat and drive.

Dr Jasmine B. MacDonald (00:31:03):
Mm-hmm.

Dr Abigail Alfrey (00:31:03):
Either we're sort of alert to the kind of the dangers, whether they're social or whatever they might be, or we're kind of trying to achieve something. Certainly myself, I find myself in drive system a lot, but that soothe system, we just don't do much with that soothe system. And that can really cause problems when the drive system goes offline for whatever reason, if we're like super tired or if we get depressed or whatever happens to stop us getting engaged with that drive system and we have no soothe system, then we are really high and dry.

Dr Jasmine B. MacDonald (00:31:36):
Mm-hmm.

Dr Abigail Alfrey (00:31:36):
Animals are wonderful for activating our soothe system. Just hanging out with them, like stroking them, you know, being together really, really important. And like anyone can do that, even if you don't have a pet, just go find some animals somewhere and go say hi to them. So yeah, I think that's pretty accessible hopefully for people.

Dr Jasmine B. MacDonald (00:31:58):
Mm-hmm.

Dr Abigail Alfrey (00:31:59):
For clinicians, I mean these days actually pets are way more part of clinical experience than they ever were because we're doing so much work remotely.

Dr Jasmine B. MacDonald (00:32:07):
Yeah.

Dr Abigail Alfrey (00:32:07):
So if I'm seeing a client via Zoom, and maybe this might speak to my boundaries as a clinician, but the dogs walking in and out having a bark, like what can you do? So, you know, animals have been a part of my work even within the NHS where strictly speaking, well no, very strictly speaking, we don't allow animals into our clinic, but when I'm seeing someone on Zoom, the animals come in and I integrate that into the work that I do with them. So if the dog is really, really barking, rather than thinking this is disruptive to the therapy, I'm like, wow, Bruce is really having his opinions known right now. Like

Dr Jasmine B. MacDonald (00:32:41):
,

Dr Abigail Alfrey (00:32:42):
What, what's the impact of that? Oh well he wants this. Right. Okay. So he's really found a way to let you know that he wants that. How, how do you let people know when you want that? Oh, I don't really say, you know, it invokes his kind of conversations about communication, getting your needs met or I remember having, um, a session with a client who was talking about a really traumatic event in their childhood and their dog just came and sat on their lap. And actually that was enough to ground her and keep her feeling tethered to the present moment and feeling soothed that she was able to kind of reach back into that really difficult memory, connect with it, work through it, and then still stay anchored to the here and now. And I think that can be really difficult sometimes when you're working with clients in the therapy room, like trying to keep people anchored and we're talking about trauma can be, can be hard and quite dangerous if we don't have that anchor.

Dr Jasmine B. MacDonald (00:33:36):
Hmm.

Dr Abigail Alfrey (00:33:37):
And so if animals are in people's lives, I use them definitely.

Dr Jasmine B. MacDonald (00:33:40):
Super powerful. I can't remember who I was talking to. I was having a catch up with someone and talking about like mindfulness meditation and there's a couple of different apps that I use because I usually am also in drive mode and in one of the apps that I use, there was pet, like co meditation and it was like, you know, sit near or you know, next to your pet and listen to them breathe, or put your hand on them and just feel them breathe in and out. And that kind of integration is really nice. And that sense of sharing a moment.

Dr Abigail Alfrey (00:34:11):
Oh goodness me. Yes. Absolutely. This is more or less my entire business model where I work privately, I do some work on a farm. So much of it is about mindfulness and involving the animals in that because one of my favorite sort of factoids about human animal interaction, particularly with prey animals, so horses are really good at this, they are very alert to threat signals. They exist within the herd. So their heart rates synchronize with each other. So if one of them picks up a threat signal and the heart rate elevates, then all of their heart rates will elevate. And it's the same with people so they can hear a human heartbeat from two meters away.

Dr Jasmine B. MacDonald (00:34:49):
Whoa.

Dr Abigail Alfrey (00:34:49):
So if I am feeling anxious and I go hang out with a horse, there's this sort of old wive's tale, uh, sort of folk tale that as a horse rider I was always told, um, you need to be calm because the horse will sense your, your fear and they'll pick up on that and they need to take their confidence from you.

Dr Jasmine B. MacDonald (00:35:08):
Mm-hmm.

Dr Abigail Alfrey (00:35:08):
And it was so exciting to me when I found these research studies that are actually telling you, yeah, that's true. And this is why they synchronize with your heart rate. They literally show you your emotions, they act them out for you. And that's so important as sort of biofeedback really for people to regulate their own emotions and see, oh, that's what effect my emotions having on myself, on the people around me.

Dr Jasmine B. MacDonald (00:35:31):
Right.

Dr Abigail Alfrey (00:35:32):
And I can right here, right now, take a few deep breaths and look what happens. The horse has actually slowed their breathing down too to match mine. It's an amazingly powerful but very simple intervention. And we don't just do it with horses, we do it Guinea pigs. I've got a client that I'm working with at the moment working with a family and we quite often do like a Guinea pig meditation just to end the session. And it's such a comfort just to be stroking and attending to the, the softness and the warmth and the regulation of their breath and just seeing the impact that your emotions have on theirs and their emotions have on you. And finding some, some balance in that dance between the two. I even did that in a, in a call with an NHS client. I had someone call through that was really, really distressed. Someone who has a very, very traumatized background and can experience episodes of dissociation where they really don't know what's real, if they even exist.

Dr Abigail Alfrey (00:36:30):
And uh, as I'm talking to her, I was asking, you know, what are the grounding techniques you've been working, working through with your, she works with an OT occupational therapist and she said, well, I've been been stroking the dog. I said, okay, great. Where, where's your dog right now? Her dog was called Fluffy . And so she's like, oh yeah, no, she's, she's over there. So the dog comes over and, and uh, okay. Right. So let's spend some time, would your dog be all right if you gave her a little stroke? So she's stroking the dog. And I'm like, okay, which bits are softest? And she's saying, well, the ears are the softest and okay, which bits are the warmest? Okay, well she's, she's warmest under her tummy and you know, we were really grounding into that moment just over the telephone. It's really accessible if people do have animals.

Dr Jasmine B. MacDonald (00:37:16):
Mm. And this gets me thinking around the decisions you might make on the farm of what situations might it work best to work with a horse or a Guinea pig? Keeping in mind the stress and comfort of the animals that you work with as well, because you're trying to balance both in the whole process, be effective as a clinician and make sure that it's useful for the person that you are working with.

Dr Abigail Alfrey (00:37:40):
Yeah, there's a lot of, a lot of balancing to be done. A lot of it comes from take a very person-centered stance and it, it comes from the client's preferences, their goals, what they wanna work on at that moment in time. And you know, some people like got a client in the moment who said like, I'm just terrified of horses. Now that's not to say we wouldn't ever work with a horse cuz maybe at some point they'll wanna kind of manage that anxiety and think what it's like to bring that anxiety into the space. But at the moment I'm not gonna...

Dr Jasmine B. MacDonald (00:38:08):
That's a different goal.

Dr Abigail Alfrey (00:38:11):
Yes. We we're not going to do that until a time comes where they might want to do that, see the utility of it. But at the moment we stay on this side of the fence, we might go say hi to some of the animals, but they're in control of where they go. I mean, for so many of our clients, control has been taken away from them.

Dr Jasmine B. MacDonald (00:38:29):
Yeah.

Dr Abigail Alfrey (00:38:29):
And I think it's really important that they're able to, to let me know what takes their interest, what happens to them, them when they even think about picking up a Guinea pig.

Dr Jasmine B. MacDonald (00:38:38):
Mm.

Dr Abigail Alfrey (00:38:38):
And how they might approach that. So it really is about meeting people where they're at. And for me, I have the luxury of having lots of choice. We have lots of animals on the farm. I had one client that was really, you know, we'd take a walk around the farm and for a few sessions we'd go hang out with a few of the animals. But after a while we just went to hang out with the goats. She just loved the goats and they were wonderful. They were absolutely brilliant. Like a lot of our conversations were around boundaries and bullying and uh, the goats. I mean, I dunno if you've ever had the pleasure of working or hanging out with goats, but...

Dr Jasmine B. MacDonald (00:39:10):
I had a friend who had a goat . Yeah.

Dr Abigail Alfrey (00:39:12):
They're very playful, very curious . And they were coming over and one day they were just being super annoying, like just butting their heads up against both of us. just constantly like knocking behind my knees. And I was like, let's talk about boundaries. Like is this okay?

Dr Jasmine B. MacDonald (00:39:28):
.

Dr Abigail Alfrey (00:39:28):
Are we gonna just stand here and let them push us over? This is, this doesn't feel quite right to me. How often do you get to do that and have that here and now? Like we're gonna put a boundary up right now, , how might we approach that? But in terms of the other side of the coin, you've all sort think about the animal's welfare and there's an international organization called IAHAIO [International Association of Human-Animal Interaction Organizations]. I'm not even gonna attempt to remember what what actually stands for. The International Association of Human-Animal Interaction Organizations.

Dr Jasmine B. MacDonald (00:39:57):
Okay. You've done well!

Dr Abigail Alfrey (00:39:58):
But anyway, they I might have missed something out there, but yeah, IAHAIO they've got some really useful stuff around animal welfare animals as co-therapists, they get burnout too because they're so attuned to our emotions.

Dr Jasmine B. MacDonald (00:40:11):
Yeah.

New Speaker (00:40:11):
And they've got like a Prague Declaration, which is worth checking out, which talks about animal welfare standards. And if you're working with a therapy dog, they need regular breaks, they need playtime, they need fresh water. So I try and rotate around the animals on the farm so that you're not constantly, you know, the animals aren't getting burnt out or tired or bored or that they enjoy their work as much as I do.

Dr Jasmine B. MacDonald (00:40:34):
Yeah. Nice. And do you have a certain animal on the farm that people do tend to gravitate towards?

Dr Abigail Alfrey (00:40:41):
Everyone is so different.

Dr Jasmine B. MacDonald (00:40:42):
It's like a projective test.

Dr Abigail Alfrey (00:40:44):
It's, no, it's, it's like a modern day Rorschach.

Dr Jasmine B. MacDonald (00:40:48):
.

Dr Abigail Alfrey (00:40:49):
It's really interesting. I'm working with a family at the moment and we are walking around the farm and one of them, this cow, we've got a lovely dairy cow that came galloping over to us and half of the family were like, amazing. She's come to say hi, that's so cool. And the other half were like, that's a big cow . Um, I'm gonna go stand over here. . So that was really interesting because it really mixes up the sort of the family roles and you get to see people experiencing different stuff over a relatively neutral kind of stimulus I suppose. And then a bit later on we're walking around the farm and we had the joy of seeing a wild rat just run across the paddock into the pigsty and it completely switched. So the people that hadn't wanted to hang out with the cow cow we're like, that's a really cute rat. And the other half were like, cute rat, sorry?

Dr Jasmine B. MacDonald (00:41:38):
.

Dr Abigail Alfrey (00:41:39):
And it's brilliant. People are drawn to really different stuff and it gets people thinking about that.

Dr Jasmine B. MacDonald (00:41:44):
Mm-hmm .

Dr Abigail Alfrey (00:41:44):
There isn't a particular animal that has a special status, but we all have different connections and identifications with different animals and part of the joy of a lot of the work is the metaphors that come out of it and seeing how people identify with different aspects and what that shows them about themselves as a mirror to their internal world, their landscapes and their relationships and what they expect of other people too.

Dr Jasmine B. MacDonald (00:42:07):
Absolutely. Whether it's individual or in a group. And I imagine that when you are walking around, say with a family, it's also gonna give you insights to their dynamics and...

Dr Abigail Alfrey (00:42:18):
Oh yeah.

Dr Jasmine B. MacDonald (00:42:18):
...someone is scared or whatever their reaction is. Like who kind of jumps onto that, who's really attuned to it. That sounds really powerful Abby.

Dr Abigail Alfrey (00:42:26):
Really powerful and really diverse. You know, there might be some days where we just take yoga mats out into the field and we just hang out and look at the animals and notice their herd dynamics and their social relationships and what that might tell us about our social dynamics.

Dr Jasmine B. MacDonald (00:42:40):
Mm.

Dr Abigail Alfrey (00:42:40):
Other times we might be doing a team building exercise and other times we might be trying to do something more interpretive or more here and now grounding and there's is such diverse work. I really think that, you know, your creativity and your imagination is the limit of this kind of work.

Dr Jasmine B. MacDonald (00:42:55):
It sounds like that. And it's making me question my career decisions , I'm gonna be working with animals. It's amazing. Alright, so we did segue a little bit into, or you gave a little bit, um, of like a intro to the other study we're gonna talk about today, which is around cognitive testing with young people and having dogs involved in that process. And I think what might be useful to kind of set up this discussion of why it could be useful to have doggos around is for you to talk a little bit for listeners who might never have gone through cognitive testing or who maybe trained in psychology, but that's not what their career or workplace looks like in setting up okay, why might cognitive testing be impacted by the level of anxiety that the person you're working with is experiencing?

Dr Abigail Alfrey (00:43:45):
Yeah, sure. So I mean, cognitive testing is hopefully something that a lot of people don't have to go through. It's generally something you only do if this real sort of clinical need. But I think most of us can relate to the experience of being tested, of going through exams or you know, some kind of presentation or an assessment of some kind. And hopefully you can bring to mind some of, I mean we all have different relationships to, to being tested, but it, it usually brings up some kind of feeling, um, some kind of nerves or, or anxiety. And for some people, particularly young people that come into mental health services, they've maybe not had such a great experience of adult being in a position of, again, power being taken away from them, of loss of control. And there can be something for some people, some love it, some really thrive on it, but for a lot of people it's a really terrifying prospect to come and sit in a room with an unfamiliar adult and do a series of tests, a lot of which are conducted with a stopwatch.

Dr Abigail Alfrey (00:44:42):
And I might have a clipboard and a and a pen and I'm literally have to keep to a script. So because these tests are standardized and they're tests of things like memory, they might be tests of frontal lobe functioning. So here's, we get into some more sort of neuroanatomy and neuroscience, but you know, the frontal lobes are part of your executive control system. So the planning, organization that, that kind of conductor of the brain, or we might be looking at the temporal lobes, that kind of memory system and the difference between your sort of visuospatial memory and your linguistic memory. And to do that, we've got these wonderful standardized tests which, you know, scientifically brilliant, but as an experience to actually do them, particularly when we're doing them for a reason. So for young people it might be to get them a special educational provisions, some extra funding, extra support, so well-intentioned.

Dr Abigail Alfrey (00:45:34):
But it doesn't take away from the fact that, you know, you've got maybe two hours of sitting in a room with someone being asked to say numbers backwards in fives or to build blocks that look like a picture within a timeframe and to remember a list of words. And it's quite stressful for a lot of people. Now because it's standardized, you know, there's a script that you have to read off. You can't really be a human in these tests. It's quite hard. , it's, it's something that I've done a lot of cognitive testing in my time. I used to work within an epilepsy service where we did this as part of surgical workup. So really high stakes. The outcomes of these tests would really influence whether or not someone actually had a part of their brain removed. So really, really serious stuff. And you have to try and find a way to reassure people so that you get the best out of them.

Dr Abigail Alfrey (00:46:23):
And so they have a good experience, but the results are actually valid and a true reflection of their ability. But without ever deviating from this script that you have to say these specific words at this specific order and I have to use a stopwatch and I have to, and you can't bring in a carer or a family member and you can't really do much that might reassure you. And as a young person, uh, in particular who might not have developed those kind of self-soothing strategies and who might have had really challenging experiences of being tested at school, they might not have done so well in those experiences. It can be really challenging as as a healthcare provider to offer those tests. And I was working in a child and adolescent service and really finding this dilemma quite upsetting and wanted to find out is there something we can do that would change the environment that these these young people are in. So, okay, I'm not gonna argue with you that they can't bring in mom or dad or whoever it is to sit with them.

Dr Jasmine B. MacDonald (00:47:22):
What's the risk there, Abby, that they might, they're gonna influence them and like maybe try to help them out or put pressure on on or?

Dr Abigail Alfrey (00:47:29):
Exactly so, yeah. I mean even the most well-intentioned parent might stiffen or you know, they're kind of like leaning in, I mean I've been in a number of cognitive assessments where people say, come on, you know this one or you were able to do this yesterday.

Dr Jasmine B. MacDonald (00:47:45):
Yeah.

Dr Abigail Alfrey (00:47:45):
Tell the lady.

Dr Jasmine B. MacDonald (00:47:46):
I mean I might be thinking more of like a, a trauma background, but there are kids, especially around attachment disorders where they're gonna be really attuned to body language and facial expressions. Yeah.

Dr Abigail Alfrey (00:47:58):
Yeah.

Dr Jasmine B. MacDonald (00:47:58):
Okay.

Dr Abigail Alfrey (00:47:58):
Absolutely. And you know, as much as you want to kind of put people at ease, there's a real limit to what you can do as the, uh, examiner I suppose. So we started thinking about what, what can we do to the test environment that might make it feel a bit more comfortable for these young people? And naturally my uh, instincts led me to thinking about about dogs and I was really aware that they're being used in criminal justice settings as supports for young people that are, are testifying or child witnesses or oh, victims of crime. There's quite a lot of work coming out of the university I was at at the time, Canterbury Christchurch looking at um, justice Dogs. And so it was a natural extension of that for me thinking, okay, well there's literature out there about that setting. I wonder if there's literature out there about cognitive assessments because if there is then we might have some kind of inroad to helping to just settle people a little bit into this process.

Dr Abigail Alfrey (00:48:56):
So I got reading around it and ended up doing a review article about what's out there. And actually there really wasn't a lot of literature out there and it certainly wasn't about clinical applications of, of testing it , it was very much about schools and there were a couple of articles around children with attachment traumas and, and how they respond to testing, but there's only really three labs out there across the world that seem to have looked into this stuff. So it was a pretty rudimentary study really, but interesting just to find that out I suppose that people aren't looking into this.

Dr Jasmine B. MacDonald (00:49:29):
Absolutely. Yeah.

Dr Abigail Alfrey (00:49:29):
When actually I think it has huge potential. So through the course of the work, we were looking at the impact that a dog might have, both on the emotional process but also on the outcome, the cognitive performance. And I suppose the sort of naive model I had in my head was that if we have someone who's feeling anxious, we all know that once anxiety gets to a certain point, thinking kind of goes offline.

Dr Jasmine B. MacDonald (00:49:53):
Right.

Dr Abigail Alfrey (00:49:53):
That executive function of the brain, that's no longer necessary. We're right in the limbic system thinking fight or flight. How do I protect myself? How do I get out of here?

Dr Jasmine B. MacDonald (00:50:02):
Yeah. That exact part of the brain that you're trying to assess through cognitive testing. Great.

Dr Abigail Alfrey (00:50:07):
Yeah, exactly. It's gone. Right? So that's, that's initially a huge problem, right? . So not ideal. We're trying to assess that part of the brain. That bit switched off. Oh dear. So yeah, the idea was that if we've got something that helps to kind of bring thinking back online by bringing that anxiety down somehow. Some kind of social support. And we know from the literature that animals can be experienced as a social support. Just look at the pet study.

Dr Jasmine B. MacDonald (00:50:34):
Yeah.

Dr Abigail Alfrey (00:50:35):
Then we've got something that could potentially bring thinking back online and then hopefully cognitive performance is, is more valid. Right. We want people to perform to the best of their ability to give a true sense of what their ability is cuz then we know what their needs are and we can support those needs.

Dr Jasmine B. MacDonald (00:50:52):
Yeah.

Dr Abigail Alfrey (00:50:52):
So that was kind of the working model in my head. And the papers I looked at kind of fell into three kind of categories, which in the end formed quite a nice sort of process model of how this actually might work in practice. So some of them looked at the relationship between animals and attention and some of them looked at the relationship between animals and attachment and some of them were looking at something else I can't remember, but . Um, but essentially we ended up in a place where they kind of tie up really nicely to show that being in the presence and and interacting with an animal seems to bring down cortisol. So one of our stress hormones by activating, it seemed like by activating the attachment system.

Dr Jasmine B. MacDonald (00:51:37):
Mm-hmm.

Dr Abigail Alfrey (00:51:37):
So when we are under that fight or flight response that gets triggered, we seek proximity to an attachment figure. The literature shows that animals can be attachment figures. So if a child is able to activate that attachment system and to release some oxytocin and those kind of feel good hormones, the cortisol decreases and the thinking system comes back online.

Dr Jasmine B. MacDonald (00:52:03):
Mm-hmm .

Dr Abigail Alfrey (00:52:03):
So quite a simple attachment based model of how animals can help us to kind of reach our true thinking potential. And I suppose, you know, in a clinical setting we might think about that in terms of grounding. Again, we're back using the whole brain, the emotion system can talk to the, the kind of thinking assessing system and there's that bidirectional feedback again, which is so helpful in therapy and uh, in cognitive assessments crucial for being able to count backwards in threes. So .

Dr Jasmine B. MacDonald (00:52:32):
Right. Yeah.

Dr Abigail Alfrey (00:52:34):
So that was kind of the pretty simple outcome of that study. Now what needs to happen is research actually looking at clinical testing. And it's complicated because like I say, these tests are standardized, they're not standardized with dogs. So actually we've then got the thing of what happens if a dog gives someone an advantage. So, you know, my argument would be that you know, the dog's not giving you the answers. It's actually helping you to access your potential and your ability and natural ability. But I suppose it's about equality of opportunity and making sure that people have that option if they think it's supportive to them. If that's the kind of thing we're gonna bring into to services. So maybe starting to look at this in sort of pilot or feasibility studies, seeing whether or not this is possible, what the outcomes might be in a clinical setting. Cuz the argument you always hear is well the dog could be distracting or it might put the examiner off or the child might have phobias or allergies. Like for sure don't put a dog in with someone that has a phobia of dogs, like that's not gonna help them or allergies. Like you're gonna have to do some kind of risk assessment around this beforehand. I'm not saying it's a panacea.

Dr Jasmine B. MacDonald (00:53:40):
,

Dr Abigail Alfrey (00:53:41):
But actually that that argument about the dogs being distracting is really interesting. So the studies I looked at actually found so that one of the studies was looking at preschoolers in America, sort of three to five year olds. And they would do these kind of experiments where they would have a task the child needed to complete like balancing uh, you know, an egg and spoon race or something like that. And they had three conditions where they would have one where the child would do it with just verbal instructions. Like they'd tell them what to do and then they had one where they were given a human supporter and one where they were given an animal supporter and actually the number of repetitions of instructions was the lowest in the animal supporter condition. People were able to listen and take in the information when they were with an animal much better than with a human or with nothing.

Dr Jasmine B. MacDonald (00:54:28):
Wow.

Dr Abigail Alfrey (00:54:30):
And people learn quicker from an animal model than they do from a human model. There's actually something less distracting about an animal than a person. Because I think probably, and I don't know this is pure speculation, but what you were saying about attunement to body language, what's that person thinking about me? Am I making appropriate eye contact right now?

Dr Jasmine B. MacDonald (00:54:49):
Mm-hmm.

Dr Abigail Alfrey (00:54:49):
All of that stuff goes through our head in a split second. We might find that we've been listening for five minutes and have no idea what that person said . But with an animal the attachment system is activated, we're feeling calm, we are attuned, we're listening, we're integrating information into our database of how we do stuff already and just get on with it.

Dr Jasmine B. MacDonald (00:55:12):
Mm-hmm , I was reading through the paper and noticed the part where you said anecdotally one of the studies said that these effects held true even when the child said they didn't like the dog . Even when it wasn't like I'm loving the dog or I'm so fascinated, it was like this still had a positive effect on the testing and ability to listen and perform tasks.

Dr Abigail Alfrey (00:55:34):
Yeah. And you know, I think it comes down to something again biological that happens. So a really, really interesting study that I came across at a conference was taking place over in Canada and they'd done this study where they'd taken photographs, again a randomized control study, I think from memory they'd taken photographs of therapists just headshots and they'd taken two photographs of each therapist, same headshot to all intents and purposes except out of sight in the picture, in one of the pictures they've got a dog with them at their feet and at the other one they don't. Okay. So they've randomized it completely and then they've asked people to rate how likable and trustworthy these therapists are and they found that if the dog not in the picture, you cannot see the dog. They didn't know anything about about dogs. The participants that were doing this study, they were just rating pictures of therapists. What they found was the therapists that had dogs at their feet were more likable and more trustworthy. They're just looking at their head. They don't even know a dog is there. They have no idea.

Dr Jasmine B. MacDonald (00:56:36):
Oh wait, what?

Dr Abigail Alfrey (00:56:37):
Yeah. Yeah, that's what I'm saying. So they're just looking at the headshots. The dog is out of sight.

Dr Jasmine B. MacDonald (00:56:42):
This is the effect of the presence of the dog while the photo's being taken and the observer only sees the face of the clinician.

Dr Abigail Alfrey (00:56:50):
Yes, yes.

Dr Jasmine B. MacDonald (00:56:51):
Mind blown.

Dr Abigail Alfrey (00:56:53):
Yes. Mind blown. And I would love to see, I don't know how rigorous the research was, I haven't properly like torn into it, but I would really love to see how this stands up and maybe see some replications of that. Because what a mind blowing, like finding that is.

Dr Jasmine B. MacDonald (00:57:07):
I'm just blown away by this. This is what like potentially the release of dopamine or oxytocin that then somehow impacts facial expression and we can see that in another human.

Dr Abigail Alfrey (00:57:17):
Yeah. .

Dr Jasmine B. MacDonald (00:57:19):
Oh that is cool.

Dr Abigail Alfrey (00:57:21):
Yeah. So subtle. It's amazing. Right? And I think if we think about the kind of work that we do as clinicians, we're trying to offer people a safe space in order to talk about really difficult stuff. Whether we're doing clinical testing or whether we are talking about traumas or difficulties in people's lives, whatever they may be, we're trying to offer a safe space, but in response we are hearing difficult stuff which might interact with our own experiences too.

Dr Jasmine B. MacDonald (00:57:46):
Yeah.

Dr Abigail Alfrey (00:57:47):
And for various reasons we might feel a little on edge at times. There might be sort of threat signals that we pick up...

Dr Jasmine B. MacDonald (00:57:55):
For sure.

Dr Abigail Alfrey (00:57:55):
If someone's really getting in touch with an experience of anger or aggression that they've either experienced or for whatever reason we might feel threatened. Now if we are feeling safe because we've just had an interaction with a dog or if we've got a dog in the therapy room with us. I think that has huge potential in terms of being able to really stay attuned to our clients' experiences and be able to contain their emotions because our emotions are contained.

Dr Jasmine B. MacDonald (00:58:21):
Yeah. And you have that grounding yourself but also, uh, whether or not the person you're working with can see that animal, apparently pick that up, that warmness or calmness. That's incredible.

Dr Abigail Alfrey (00:58:34):
Yeah. Really exciting stuff. So, um, yeah, huge, huge ramifications and actually we're just starting to see that come through now. So the service I'm working in at the moment, we are about to pilot an intervention for staff wellbeing. So I don't know how it's been in Australia, but I can imagine this is a worldwide phenomenon where healthcare workers are really struggling.

Dr Jasmine B. MacDonald (00:58:56):
Yeah.

Dr Abigail Alfrey (00:58:57):
I think particularly with the pandemic, but just in general in the UK we've had a real staff wellbeing problem for a long time. There's been various papers written about the experience of psychologists and psychotherapists and people that work in the mental health sphere in terms of their wellbeing for various reasons. Both the content of the work but also the pressures and the funding situation.

Dr Jasmine B. MacDonald (00:59:18):
Mm.

Dr Abigail Alfrey (00:59:19):
Workload and the hours and and that kind kind of stuff. So it's been an issue. We have generally quite a difficulty retaining staff within services. There's a really high sick rate.

Dr Jasmine B. MacDonald (00:59:30):
Yep.

Dr Abigail Alfrey (00:59:30):
And this isn't just my services, this is across the UK. This is what the data shows. And of course that has a negative experience for the clients because we've got inconsistent care.

Dr Jasmine B. MacDonald (00:59:38):
Yes.

Dr Abigail Alfrey (00:59:38):
We've got the unpredictability of if a therapist is off sick this week, that means I don't have a session. They might be off sick for six months, which means I have to go see a new therapist and start all over again.

Dr Jasmine B. MacDonald (00:59:48):
Mm-hmm.

Dr Abigail Alfrey (00:59:49):
Really, really challenging. And of course it's, you know, from an operational perspective it's expensive recruiting staff, training them, induction periods, all of that stuff.

Dr Jasmine B. MacDonald (00:59:57):
Yeah.

Dr Abigail Alfrey (00:59:57):
So everyone recognizes that this is something that needs to be thought about. Everyone wants happy, healthy staff and we're just starting a quality improvement project off the back of these two papers where we are gonna trial bringing in a therapy dog for staff wellbeing and just see where that takes us. I mean my hope and ambition would be that one day we can have a staff pet policy. So some corporates have this like Nestle of really leading the field with this, where they have like a pet passport and the dog gets registered with HR and they, there's, you know, they have to be vaccinated and they have to be well behaved and all of that stuff, but they're allowed to come in and hang out with staff at at the office. And I think when we started talking about this in my team about 12 months ago, again people just light up. They're like, yes, that is absolute... And people have been emailing photographs and emailing their enthusiasm to the clinician that's leading this project, one of my supervisees. And it's just such a heartwarming experience. There are people out there that are doing this kind of work and there are all sorts of risk assessments that we can borrow from other teams and develop and try and do this really safely.

Dr Abigail Alfrey (01:01:04):
And I think the beauty of a quality of improvement project is that we've got a really nice timeframe around this, where we're gonna do it for, I dunno how long we're gonna do it for actually, but probably like say we're gonna do it for six months and then it gonna, it's gonna end. And so, you know, we're not suggesting a permanent change to our service, but more we're gonna trial something, we're gonna evaluate it, we're gonna find out what people's experience was of this, take all of that into account and see if it's something that's worth doing again or expanding on or or widening in some way. If it doesn't work, we won't do it. And that's the beauty of the research practice links, right, .

Dr Jasmine B. MacDonald (01:01:38):
Exactly. Yeah. Um, well I look forward to catching up with you later and hearing how that went.

Dr Abigail Alfrey (01:01:44):
Yeah, definitely. And it's been so interesting during the pandemic and seeing how many people are working from home and I've seen so many sort of anecdotes about people that have been able to work with their pets in the office space and, and how that's really improved their quality of life.

Dr Jasmine B. MacDonald (01:02:00):
Yeah.

Dr Abigail Alfrey (01:02:00):
And what the research shows is that it probably improves the quality of their work as well.

Dr Jasmine B. MacDonald (01:02:05):
Interesting.

Dr Abigail Alfrey (01:02:06):
But really brings us back to the fact that, you know, you can sit and because of that attachment system, you can focus in on the work that you're doing and, and it really helps us to feel safe and regulated whilst we're working. But also that dog's gonna need regular breaks, they're gonna need to go outside, they're gonna need some fresh water. You also need fresh water, you also need to go outside.

Dr Jasmine B. MacDonald (01:02:28):
Yeah.

Dr Abigail Alfrey (01:02:29):
It really attunes us, I think to that sense that it's not that healthy actually for us to sit for 14 hours and not eat or drink or stand up and stretch and move around and...

Dr Jasmine B. MacDonald (01:02:38):
Mm-hmm.

Dr Abigail Alfrey (01:02:38):
I think for a lot of us that reminder is something that we could really do with.

Dr Jasmine B. MacDonald (01:02:44):
Like, oh yeah, I need to eat and pee now that that would make me feel more comfortable and productive. . Um, yeah, it's a really good point, Abby. All of this is really exciting and as an animal lover, it's really cool to hear about these changes and, you know, fascinating experiments that are being done that, uh, just reaffirm the bias that you have when you love dogs or when you love animals. That feels intuitively right to see science behind it and the way that it's incorporated into something as important as clinical psychological practice is amazing. So, incredible. I've really enjoyed our conversation.

Dr Abigail Alfrey (01:03:23):
Yeah, me too. It's really nice to have the chance to talk about it. It really excites me, this kind of work and this field, and it's really nice to see other people interested in it too. Hope we can spread the word.

Dr Jasmine B. MacDonald (01:03:33):
Yeah, absolutely.

Dr Jasmine B. MacDonald (01:03:33):
For those of you at home, that's all for today. Show notes for the episode can be found@www.psychattack.com. If you've enjoyed listening to Psych Attack, please rate it on your favorite podcast platform and share this episode to help other people find the show. If you have questions or feedback, you can reach out on Twitter at Psych Attack Cast. Thanks for listening and we'll catch up with you again next time.