More Than Words

Alternative And Nonverbal Therapies Transcend The Limits Of Language To Get To The Heart Of The Matter



Richard Waxman’s therapy dogs, Scruffy and Maddie, give patients an emotional lift when they need it most.

Courtesy Richard Waxman

Scruffy takes his job seriously. As a therapy dog with Palm Desert-based Paws and Hearts, Scruffy, a 25-pound Cairn terrier mix with “Toto’s head and the body of a Buick,” as his handler, Richard Waxman describes him, visits patients three times a week at Eisenhower Medical Center in Rancho Mirage. Waxman says Scruffy knows intuitively what to do when someone hurts. A few years ago, the duo visited an older woman who lay alone in her hospital bed. When Waxman placed Scruffy alongside her, she said: “I lost my dog six months ago, and I miss her very much,” and Scruffy moved closer to her. She put her arms around the dog, looked at him and said, “I lost my husband a year ago,” and began to cry — until Scruffy began gently kissing her tears away.

“Words can’t describe what Scruffy did for this woman,” Waxman says of his 11-year-old partner. “Dogs are great healers by nature, and if you give them a chance to do this type of work, they really understand that they’re making people feel better. The woman didn’t want to let him go, and he just rose to the occasion. He knew that she really needed the attention.”

Paws and Hearts volunteers collectively make about 120,000 bedside visits a year at hospitals and long-term care facilities across the Greater Palm Springs area, taking dogs as large as Great Danes to visit patients for between three and seven minutes. “Animal therapy is very tactile,” Waxman says. “It’s all about hugging the dog, it’s all about petting the dog, and it’s all about getting a kiss from the dog if you want.”

Waxman, who founded the group 13 years ago and still visits Eisenhower with Scruffy and his other dog, Maddie, a 14-pound mixed-breed terrier, sees the joy pet therapy brings first-hand: “Patients say, ‘Can you just leave one of the dogs here and come back in an hour? I’m feeling so much better because you’re here,’ or ‘I’m going into surgery in a couple of hours and you brought down my stress level. You’ve made my day.’”

The benefits are both physical and emotional, according to research compiled by Bellevue, Wash.-based Pet Partners (formerly Delta Society), a group with 11,000 therapy animal teams across the country (see below.) Pet Partners serves hospitals, treatment centers, retirement communities, schools and universities, and offers animal-assisted interaction and animal-assisted therapy using dogs, cats, horses, llamas, rabbits, and “pocket pets.”

President and CEO R. Stephen Browning, formerly vice president of the American Cancer Society for the region that includes the Greater Palm Springs area, joined Pet Partners last year. “Having come from the world of science based, human health as an executive for the American Cancer Society, I have been deeply impressed with the tangible and measurable effects our therapy animal teams have on those who need us most,” he says. “The human/animal bond contributes immeasurably to the quality of life for people of all ages facing physical and emotional challenges.”

Equine Therapy
J. Everette Perry

Animal therapy is all about hugging and petting the dog. Touch is important, says therapist Gail Hromadko, because some people communicate nonverbally.

Equine Therapy Goes for Emotional Healing

Gail Hromadko, a licensed marriage and family therapist for more than 20 years, became a certified equine therapist after her own “amazingly profound” experience witnessing horse healing.

“Just the presence of another mammal can be therapeutic,” says Hromadko, therapist at Five Hearts Healing Arts in Morongo Valley. “We tend to synchronize our breathing to other beings in our presence, so if that animal is relaxed — for instance, a therapy dog — it helps people reduce their blood pressure, and they feel comforted by the touch and the tactile aspect of it. There is also a relational aspect, and all of those things are also true of equine therapy.”

Hromadko started wondering about the real nature of healing while working with traditional talk therapy, which she maintains is effective and helpful for some people. For others, she has found equine-facilitated psychotherapy effective in tapping into emotions and trauma that talking may not easily address. “The great thing about having some alternative therapies at your fingertips is that broader services can access those places more effectively,” she says. “Not everybody is verbal; some people really live in their bodies, and some people are really visual. To be able to speak in their language is going to help them tell their story.”

Equine therapy differs from the perhaps better-known hippotherapy, which focuses on physical, occupational, and speech-language rehabilitation using horseback riding and movement. Pegasus Riding Academy for the Handicapped in Palm Desert, for example, offers equine therapeutic riding for certified disabled children and adults. While both offer the psychological benefits of bonding with an animal, equine therapy uses ground work and emotional interaction with horses rather than riding. Individual sessions typically last 75 minutes, with four- or five-hour workshops for small groups.

Horses are especially suited for this type of therapy, Hromadko says, and they have a completely different way of sensing their environment. They can see almost all the way around their bodies to be able to sense predators, and they can read energy because they need to be able to do that in order to sense incongruities in their environment.”

Equine specialists read the horses’ reactions in conjunction with what a patient is saying and doing to assist the therapist in identifying underlying issues, she explains.

“When a person enters the arena with one of these horses, the horses are sensing and reading everything,” Hromadko says. “Their sense of smell is more acute, they sense vibrations through the floor, they’re sensing energy through their body, they’re seeing this person, and they’re hearing this person. This gives us the ability to read incongruities and what’s really going on with the person. If someone comes into the arena for example, and says, ‘No, I’m not afraid,’ but their energy is fearful, a horse will read that and respond to it. Interpreting that reflection is one of the ways the therapy works.”

Another aspect involves left-brain and right-brain function, she says. Horses’ cerebral cortexes are highly developed for instinct, a right-brain attribute, and contact with them helps patients move from left-brain function — focusing on language and tasks, for instance — into right-brain thinking and assists in processing and healing trauma. “This is one of the harder things for people to do,” she says. “Horses are completely, 100 percent in the moment, so they bring us into the moment.”

Many of the horses at Five Hearts Healing Arts have experienced trauma or abuse themselves. Hromadko says, “It is remarkable how they recognize that in people. I have one horse, for example, who was abused and neglected. He is the most loving when somebody is in touch with their pain. He will move towards that person, wrapping his head around them, which definitely looks like a hug— that is how we would interpret it, as a way of comforting and sheltering. [The patient] can shake off the trauma, and they’re getting the social connection that says, ‘You are loved. You are valued. What you’re saying is OK.’ It’s affirming and comforting, and it’s deeply powerful work for people who have had trauma.”

Reading the Psyche Through the Sand

Sand play therapy also offers a means of accessing emotional issues nonverbally, Hromadko says. The practice originated in the 1950s with Jungian therapist Dora Kalff , who worked with children. She placed toys on the floor to help children express themselves and determined that a child’s worldview is about the size of sand tray — approximately 28.5 inches long by 19.5 inches wide.

With sand play, patients of any age create whatever design they wish in a sand tray, using miniature icons or representations; their choices will reflect their psyches, and can then be discussed and interpreted with a therapist.

Hromadko has a collection of more than 1,000 icons for patients to choose from to create their trays, which are filled with sterilized sand and/or water. The miniatures represent everything from people in professions and modes of transportation to homes, rocks, trees, and animals.

“The process is that the person does not have to speak,” she says. “They go to the shelf and they pick these miniatures based on whatever is calling to them. They can put them anywhere they want — they can bury them, they can build a mountain, they can make it flat, and they can light a candle. They can do whatever they want to build this picture. There’s a creative process and right-brain process, and at the end, they are invited to share and asked if there is anything in the tray that wants to be spoken about.”

The trays may be symbolic — using an icon as symbol for a person — or may be metaphorical, such as a vignette about an event, or archetypal, such as a tray that has a “wise old owl as an archetype on one end and the evil stepmother on the other end,” Hromadko says.

“We are reaching into the collective unconscious, and the story develops. This is a way of integrating those aspects of self and resolving complexes,” she says. “Every time you go in, you create a new [tray], because the psyche is different every time. The psyche is evolving.” The results of each tray are interpreted, discussed, photographed, and noted, she says, and revisited at the end of process to help people understand the gains they’ve made.

“The creations have a profound beauty, because they’re coming straight from the raw material of the psyche. People do not come to it easily. It is braver, in a way, because you have to trust that the unconscious process is going to be safe for you. It’s exquisitely precise. The psyche is going to put in that tray exactly what it needs, because the psyche knows what we need to heal.”

Truth Through Art and Play

Some children who visit Barbara Sinatra Children’s Center in Rancho Mirage for counseling have endured so much pain that they are simply unable to verbalize it, says clinical director Rosemary Marta.

“Words are not enough for children,” she says. “Many times, we work with traumatized children related to sexual abuse, neglect, or witnessing domestic violence. Sometimes a child is so traumatized that they’re not comfortable talking, but they might be comfortable painting.”

Art therapy, she explains, gives them a way to express their fear, anxiety, and depression.

“Perhaps while the child is painting,” Marta says, “the therapist can gently start a conversation about the trauma, and it helps the child be comfortable, because that’s our first and foremost job with children — to build trust and rapport.”

In addition to individual counseling, the center employs several other types of play therapy — such as games, doll houses, Legos, and sand play — to encourage communication. “You can’t sit a child down with a Q&A,” Marta says. “Children just aren’t comfortable doing that. You have to use tools.”

In addition, therapists have introduced a gardening program. “We have a fully functioning vegetable and flower garden, and the therapists bring the children out to the garden area to continue addressing and discussing challenging problems that arise,” Marta adds. “So while they’re working with the ground and planting, the therapist is gently discussing the concerns the child might have. All therapies are designed to help the child feel comfortable, number one, and number two, to open up in a safe, healing environment. After the children plant the seeds and watch the vegetables grow, they take home their designated vegetables and flowers, so it’s an ongoing healing process. The children also paint the planters and take pride in their artwork. It’s a way for the therapist to help the child discuss very, very difficult subjects, and oftentimes the big secrets that have been programmed into the child not to discuss.”

The center also recently introduced a new group tennis program for girls and boys to promote teamwork, leadership, listening skills, and conflict resolution.

“All these programs are playful,” Marta says, “but at the same time we’re working on therapeutic issues.”

Therapy Animals
J. Everette Perry

Therapy Animals Offer Health Benefits

The bond between people and their pets has dramatic effects on the quality of life for people of all ages. For people with physical and mental conditions, the tangible effects can surface with great immediacy. Pet Partners (formerly Delta Society), a Bellevue, Wash.- based group with 11,000 therapy animal teams working in healthcare facilities and schools nationwide, offers this list of potential benefits of interaction with trained therapy pets:

  • Long-term care residents have significantly improved moods, engagement, and care compliance when visited by therapy animal teams.
  • Children undergoing cancer treatment complemented with animal assisted therapy have less stress and anxiety, more physical relaxation, and better relationships with their physicians.
  • Animal-assisted therapy can reduce the loneliness and measurable anxiety in residents of long-term care facilities.
  • Patients with Alzheimer’s disease experience a decrease in sadness and anxiety and an increase in positive emotions and motor activity with animal-assisted activities.
  • Equine-assisted therapy has been shown to increase self-esteem, improve self-efficacy, and lower anxiety in female survivors of domestic violence.
  • Occupational therapists use animal-assisted therapy and activities to help soldiers cope with the stressors of living in a deployed environment.
  • Patients comforted by a dog prior to MRI scans are calmer and require fewer sedatives to complete necessary scans.
  • Children and adults improve emotional recognition by relating to dogs, thus improving interpersonal interactions and emotional competencies with other people.
  • Interactions with animals contribute to stress reduction, trauma recovery, and positive brain development in trauma-afflicted children.
  • Patients visited by therapy dogs require significantly less pain medication after joint replacement.
  • Autistic participants who completed 10 weeks of therapeutic horseback riding showed significant improvements on measures of irritability, lethargy, stereotypic behavior, hyperactivity, expressive language skills, motor skills, and verbal praxis/motor planning skills.
  • Schizophrenic patients experience less anxiety and feel safer during sessions with a friendly dog.

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