Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More
By: Allan N. Schwartz, LCSW, Ph.D.
One year ago, a desperate, young twenty-two-year-old woman was brought to my office by her grandmother. She was tearful and depressed but her major complaint had to do with acute anxiety. Her grandmother was present because Juli was at the point where she was fearful of leaving the house unless accompanied by another person. In fact, her grandmother drove her to the appointment because Juli was now fearful of driving. Although she never experienced an auto accident, never had a traumatic experience outside of her home, and had no logical reason to feel so extremely fearful, Juli was paralyzed with fears and phobias about the outside world. In Juli’s own words, “I was suffering from severe agoraphobia and social anxiety. At the same time, I experienced severe depression.” In sum, her life was at a standstill.
Anxiety disorders are like infectious diseases. If left untreated, they spread like germs, causing an ever increasing amount of sickness and disability. Juli had tried therapy before but without success. Now, she could no longer sit in a restaurant and enjoy a meal with family or friends. She couldn’t attend basketball games, go to the gym to workout, go to work, make purchases at the grocery store, or take a stroll down the block. Because she could not work, Juli lost the ability to support her self and was too paralyzed with fear to go to the welfare office or to social security to apply for financial benefits. Without the active financial support of her family, Juli would have been in even more dire circumstances.
Whenever Juli tried to summon up her courage and do the normal things that others take for granted, this is what she experienced: “I became overwhelmed with nausea, dizziness, and panic. I had numbness and a tingling sensation in my hands and feet and my vision became blurred. I even felt like would pass out and that was terrifying. I was especially afraid I would faint while driving or walking in the street. I would have the petrifying thought that I would lose control and die.”
The fact that she could no longer earn her own living filled Juli with guilt because she was relying on her family for financial support. Juli’s father, a warm and loving man, paid all of her bills since she stopped working. However, this was a drain on his finances as he needed to apportion money for her younger sister and brother who were of college age. Besides all of this, the inability to earn a living added to Juli’s fears about her ability to function as a normal and independent woman in the future. In short, her anxiety disorder caused her pride and dignity to take a severe beating. As she describes it, “It was a viscous cycle. I panicked about not being able to work and I couldn’t work because I panicked.”
Two major approaches were taken to help Juli recover from her debilitating anxiety and panic disorder. First, she was referred for psychiatric evaluation and medication treatment. The psychiatrist to whom she was referred prescribed a combination of anti anxiety and anti depressant medications to help alleviate her major symptoms.
Second, Juli and I began a course of Cognitive-Behavioral Therapy (CBT). In this treatment, Juli kept a record of her thoughts prior to, during, and after her panic and anxiety attacks. She was then taught to examine the extent to which these thoughts were unfounded and helped to cause her bouts of anxiety and panic. She learned to replace her fearful and unrealistic thinking with assessments based in reality and fact. In addition to this, Juli and I practiced deep breathing and muscle relaxation in the office in order that she could learn how to reduce the damaging effects of fear and anxiety on her body. She practiced at home and elsewhere, particularly if she felt her anxiety increasing. Lastly, Juli and I practiced meditation, which she learned to use on a daily basis so that she could develop a calm and relaxed mindset.
Gradually, Juli made minor improvements and she could do more things with her life. She began attending therapy sessions on her own without her grandmother. She was able to drive herself to the sessions and gained a hard earned sense of improved self esteem.
However, the work was painfully slow and fraught with setbacks and relapses. When Juli was too fearful, she was unable to drive to the sessions. “There were times I would call Dr. Schwartz from my cell phone frenzied, pulled over on the freeway and he would have to talk me down just to get me back home safely.” Her social life remained limited because she could not go to restaurants and concerts with her friends. She was afraid of crowds at concerts and sports events, and avoided restaurants because her anxiety led to the nausea that robbed her of her appetite. Finally, the mere thought of work led to spasms of fear and the wish to avoid.
Juli was becoming increasingly desperate. Her parents were complaining that she was not improving. Juli was living and had been working in Colorado, while her family with the exception of her maternal grandmother, lived in California. Each parent was pressuring Juli to return to California. Juli was resistant to this idea. It was important to her to assert her independence and to prove that she could care for herself. Yet, her financial situation was reaching crisis proportions and the family was complaining about the cost of maintaining her in Colorado while she could not work. Juli’s father was becoming increasingly frantic about finances and was pressuring his daughter to either return to California or get a job. He was losing patience. It seemed as though her therapy and progress were at an impasse and might end in failure.
Mingo, the Co-Therapist:
For several years now my wife has been involved in training service dogs. This was of particular interest to me because I had read about the value of using dogs and other pets as co-therapists in the consulting room. Clearly seeing how distressed Juli was from the moment she entered my office, I asked her if she would like to have one of my wife’s service dogs present during the session. I explained that she could hold and pet the dog, which might help her to feel calmer. An animal lover, who once had a dog that her mother gave away, Juli, was excited by the idea of a dog being in the office. I excused myself and invited the most special dog I have ever met, Mingo, into the room.
Mingo is a Golden Retriever and a fully trained and certified psychiatric service dog. She is warm and loving and has an instinct about when people are in need. From the moment I brought Mingo into the office to meet Juli, a tight bond was formed between the two of them. Mingo went right up to Juli, put her snout into Juli’s stomach and pressed as tight as she could. Juli wrapped her arms around the dog and another important step was taken toward Juli’s recovery. Every session thereafter, Mingo was present and available to Juli, who derived great pleasure and relief from her stress by stroking the dog’s thick, soft fur. As Juli describes it, “There is something so reassuring about having a dog in your lap when you panic. It’s like all your anxiety melts right off and onto them.” There was no question in my mind that Mingo was my co-therapist during these sessions.
But, how could this help Juli in the outside world? When she left the office to go home her fears returned. She did all of her therapeutic homework, including cognitive work, deep breathing, meditation, and muscle relaxation exercises. She was fully compliant with her medications, which had been modified by her psychiatrist in the hope that the right combination of medicines would resolve her symptoms. While there was slight improvement, it was not enough to improve the quality of her life. Something more had to be done to break the deadlock and help Juli get on with her life.
I began to entertain the idea of Juli purchasing a psychiatric service dog of her own that could accompany her and be a comfort when she needed to leave the house for any reason. However, to my dismay, I soon discovered that purchasing a trained emotional support service dog is prohibitively expensive. I was beginning to feel as desperate as Juli and her family.
Then an idea occurred to me that just might be able to work in Juli’s favor. What if Juli adopted a puppy from the humane society that could be trained to be an emotional support dog? When I proposed this idea to Juli she became very excited.
As Juli expressed it:
“The idea of having a dog appealed to me because of my experience with Mingo and because I thought I might feel safer, like someone would be able to look out for me all the time. Maybe this potential dog could alert someone if I did run into trouble and that thought seemed to put my mind at ease.”
Juli always missed the dog her mother gave away, loved dogs in general, and welcomed the idea. I suggested that she give careful thought to this idea since caring for a dog is a major responsibility and expense and she might not have the necessary inner and outer resources to adopt and raise a puppy at this time. However, there was no restraining Juli. She was so excited about the idea that she recruited a friend to go with her to pet stores and the humane society.
I began receiving excited phone calls from this young woman on the weekends when she would be out with her friend looking at puppies. Juli would ask me about one type of breed or another and its suitability for her purposes. Usually, her choices were of very cute puppies that were destined to grow up and become large and ferocious canines that would be difficult to train. Besides that issue, there was the simple fact that pure bred dogs were extremely expensive.
One fine and quiet Sunday afternoon while I was out shopping at the mall, my cell phone rang. I answered the call to the irate voice of Juli’s father who wanted to know if I was aware that his daughter had just adopted a puppy from the pound. He was convinced that his daughter had completely lost her mind and should be sent home immediately. I assured him that, while I could not discuss his daughter with him due to issues of confidentiality, I was certain that she was not crazy and that I would look into the situation. He was skeptical but somewhat re-assured that I was willing to check it out. That phone call left me feeling very much like I had made a serious blunder in suggesting what now seemed like a hair-brained idea. Ten minutes after this conversation the phone rang again. This time it was Juli who reported to me, with great excitement, that she had just adopted a puppy from the humane society. She also complained about her father, whom she had told so he could send her some extra money to adopt the dog. I then understood why her father was outraged. He feared the puppy would be an additional drain on his fragile budget.
Juli and I met Monday morning as we were scheduled to do. Accompanying her was the cutest puppy I could ever imagine. Juli named her Lily and often referred to her as “Miss” Lily. Lily was brown with big floppy ears and very large paws. Clearly a mix between a Labrador retriever and some other large breed, Lily was going to be a big dog. More than anything, Miss Lily was as friendly and cuddly as could be desired. She seemed to have the perfect temperament to be an emotional support dog.
Needing to solve the next problem of how to get Miss Lily and Juli trained, I gingerly approached my wife, the executive director and founder of Golden Kimba Service Dogs. Why did I approach my wife gingerly? Well, I knew that Juli could not pay for training sessions and that there was no way anyone could approach her father about adding more financial aid. Like the trooper she is, my wife took Juli and Miss Lily on for free and began training both of them.
Although the going was not easy, adopting, training, and being with Lily utterly changed Juli, her life and her ability to cope. As her constant friend and ally, Juli felt reassured with Lily’s presence. She began leaving her apartment to go on walks with Lily. On the streets or in the park, Juli met many people who came up to her wanting to pet the cute little puppy. Juli began taking training lessons with my wife. Eventually, Lily earned herself an official service dog in-training vest and Juli, an official I.D., which allowed them to enter stores and restaurants without being hassled by management wanting them to leave.
As Juli grew in confidence, she started to work, socialize, and feel terrific about herself.
Juli and Lily are now a spokesperson team for the use of emotional support dogs for people who are disabled by emotions they cannot seem to control. Even that is a major break through for Juli who, previously was so fearful she never would have spoken to strangers.
Lily is still in training and she and Juli and Lily continue to learn a lot about how to work together in public. But the main idea is that Juli is able to live her life again with the help of her friend and companion, Lily. As Juli sums it up:
“Lily is my best friend. I feel safe with her. She has been a blessing in my life. Having a service dog is crucial for someone with my kind of illness. I have to take her on walks, I have to go to the store to buy her food, and it forces me to get out. It’s a win-win relationship. I do for her and she does for me, without even knowing it. My life would never have been the same without her.”
The story of Lily and Juli continues, but now there is hope.