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A four-legged therapist

14 May 2019
Steffie van der Steen
Steffie van der Steen

Cuddling kittens to combat stress, keeping animals in nursing homes to alleviate loneliness, reading to dogs projects, care farms – the use of animals in healthcare is booming, and the practical results are positive. The theoretical underpinning of those results is lagging, however, says Steffie van der Steen, UG researcher in the department of Pedagogical and Educational Sciences. She is about to embark on a large three-year project that seeks to link theory and practice.

Text: Nynke Broersma / Photos: Merel Weijer

Let’s get rid of one prejudice right away: Van der Steen does not have a house full of animals herself. ‘Indeed, a lot of people ask me that question! Actually, it has been the other way around for me: my work has set me thinking about animal interests. A dog needs a lot of time and attention, which I can’t give at the moment’, is her down-to-earth response. It was her specialization in Orthopedagogy rather than a passion for animals that got her into animal therapy. ‘This field was an opportunity that presented itself, and I really enjoy just throwing myself into something and completely immersing myself in it’.

Contact with animals releases oxytocin, the 'cuddle hormone'.
Contact with animals releases oxytocin, the 'cuddle hormone'.

Dog in the therapy room

From cuddling puppies to reading to dogs projects : there are plenty of examples of using animals to improve the wellbeing of people. They can all be classified as ‘animal-assisted interventions’, a field of research that Van der Steen claims is changing and growing rapidly. The field is not completely new however: prior research has shown that contact with animals may have positive effects, such as the release of oxytocin, the ‘cuddle hormone’. Animals can also help to shift your attention, so that difficult issues become easier to discuss. ‘One of the first people to study animal assisted interventions was a psychiatrist. When he took his dog to work one day, he noticed that patients opened up to him more’, Van der Steen explains.


Animal therapy is an animal-assisted intervention with somewhat stricter criteria overall: for example, it is provided by professionals who are trained in social wellbeing, treatment goals are formulated and evaluations are held. It is a form of therapy that is increasingly being used in care, for example with children who have Down’s syndrome or autism. While practical research has shown positive effects, the academic substantiation of these effects sometimes lags behind. ‘There are great differences, for example, in the research designs and in the roles that animals play. In addition, the effect is generally only measured during or immediately after the sessions, and there is little attention for the lasting effects in daily life’, says Van der Steen.

That is why Van der Steen has decided to reverse the order and start with a theory, which she will subsequently test. Van der Steen believes that attunement could be the key. In developmental psychology, attunement is also called synchrony or interpersonal coordination. ‘Good attunement ensures smooth contact with others, for example in conversations where people take turns speaking or in the alternation between leading and following. Another good example is that uneasy moment when you approach another pedestrian on the sidewalk and you both need to pick a side to avoid bumping into each other. Attunement is thus a big part of daily life, which children with autism or Down’s syndrome sometimes find difficult to achieve’.

'Attunement is a big part of daily life, which children with autism or Down’s syndrome sometimes find difficult to achieve’.
'Attunement is a big part of daily life, which children with autism or Down’s syndrome sometimes find difficult to achieve’.

Dogs don’t judge

To find out whether attunement indeed plays a role in the effectiveness of animal therapy, the children who will participate in Van der Steen’s study will follow therapy sessions that include a dog. During the sessions, they will be asked to run a simple course together with the dog and give commands that the dog must follow. This will be a case of practice makes perfect: if children with autism or Down’s syndrome can practice attunement in such a safe environment, it may become easier for them to achieve in social situations involving other people. But why can’t they practice on people? ‘Dogs don’t judge, at least not visibly, and they have no ulterior motives. That reduces the tension for clients’, says Van der Steen. ‘At the same time, like people, dogs are not entirely predictable. This means that animals too require careful attunement to establish smooth contact. The pilot study contained a great example of this: a dog was distracted and left the course, so the research participant had to recapture his attention. He ultimately achieved this by using a lower voice, which turned the dog around’.

A pack of robot dogs

Some of the children in the study follow sessions with robot dogs instead of real dogs, so Van der Steen has an actual pack of them in her office. She personally named each one of them, not for sentimental reasons, but because otherwise they won’t respond to commands. ‘Max, sit down!’, she demonstrates, and one of the robot dogs obediently does. ‘This is a lot different from this afternoon: I was giving a presentation on the research, and there were technical problems, so I ended up switching it off to try again later. It doesn’t work that way in real life, though, when attunement is problematic. Just imagine saying to the approaching pedestrian: “Let’s go back to the beginning of the street and try again”. This makes the attunement to a robot dog much more unilateral than that to a real dog or a person. As a result, the robot dog is expected to have a less positive impact on the children's social skills in daily life’.

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Participants wanted

Where previous studies primarily measured the effect of animal therapy during the therapy sessions, Van der Steen’s research will also attach great importance to the follow-up. She will not only be monitoring the effect during and immediately after the sessions, but also after three months. After all, if children with autism or Down’s syndrome achieve better attunement with dogs, it remains to be seen whether this achievement will translate into real life and improve the attunement with their parents, carers or friends. We will have to wait a little longer for the answer: presently, Van der Steen’s is primarily engaged in finding therapists and children who are willing to participate . So, what happens if attunement turns out not to play any role? ‘That would be a surprising result, and I kind of like surprises!’

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Last modified:11 May 2020 4.19 p.m.
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