Puppies, Kittens and Hamsters–Oh My! Important Information for Therapists Regarding Writing Emotional Support Animal Letters (ESA)
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Photo Credit Unsplash
You may have noticed a rise in requests from clients for Emotional Support Animal Letters, sometimes referred to as an “ESA” letter. If you haven’t yet, it is likely that you will receive a request like this at some point in your clinical career.
Emotional Support Animal letters in the therapeutic world are most often requested from clients who are dealing with anxiety, depression or other mental health issues.
As such, the client may request an ESA letter from their therapist so that the client can provide the letter to, for example, an airline in order to take their pet on a plane. Edit update: Since this blog was written in October 2018, as of this edit in November 2021, many airlines have tightened up their policies on animals flying in the cabins with the pet owners.
A client may also request that their therapist write an Emotional Support Animal letter for a client’s landlord who normally does not allow tenants to have a pet. Such a letter would verify that there is a mental health reason for the client to have a pet in the client’s rental home or apartment.
Important Reminders Regarding ESA Letters
We therapists want to help our clients live their best lives. Most therapists, like myself, love animals and understand the benefit that a special pet provides. I am a lifelong animal advocate and have rescued, adopted and fostered many sweet pets and animals over several decades.
However, there are also individuals and organizations who attempt to take advantage of therapists in order to obtain an ESA letter, even though there is not an existing mental health issue that supports an ethical reason for a therapist to write an ESA letter for a client.
In these unfortunate cases, the therapist, out of compassion or concern for the client, may unwittingly put their license at risk with their state board by providing such a letter.
Before writing an ESA letter for a client, please be sure to consider the following:
1. What state does the client live in?
Example: You are licensed in the state of California only and provided 3-therapy sessions to “Jane Jones” who was a resident in California during the time you provided the clinical support. Jane sought therapy with you in order to heal from a breakup of a long-term boyfriend, and to reduce symptoms of grief and sadness.
After 3 therapy sessions, Jane then terminates therapy citing that she is moving to Oregon to be closer to her family and to start her life over again. You share with Jane that you are no longer able to continue therapy with her as you are not licensed in the state of Oregon. You provide Jane with 2-3 referrals to therapists in her area, and the therapy ends on good terms.
Three months later you receive a friendly email update and a request from your former client Jane asking that you please write an ESA letter so that she and her pet dog can obtain housing in a building that normally does not allow for animals. Jane shares that she did not resume therapy in Oregon and you are her last therapist.
Additionally, she shares that only with an ESA letter will the landlord consider allowing Jane to lease in the building with her dog. Jane goes on to share that her new dog has helped her heal from the break up, and she can’t bear to be separated from her beloved pet.
Perhaps you tell yourself that this seems like a reasonable request. You enjoyed working with Jane, she is doing better, and she has cited that her dog is an important emotional support for her. You (like me) may be an animal lover, and personally understand the importance of pets in one’s life
Photo Credit Jonas Vincent
You don’t see the harm in providing such a letter, so you have Jane sign a Release of Information, and then write a letter to Jane’s potential Oregonian landlord citing mental health challenges and the need for Jane to live with her dog. You send the letter to Jane, wish her well, make a copy for your files, and note the exchange in your former client’s file. And that’s that.
Or is it?
During a recent live video presentation in October 2018, former CAMFT attorney Dave Jensen discussed two current legal cases pending against California therapists for writing ESA letters to clients over state lines.
In one case a California therapist’s client had moved to Pennsylvania and requested that their California therapist provide an ESA letter to their Pennsylvania landlord. The therapist complied with the client’s request.
When the Pennsylvania landlord reviewed the letter and noticed that the therapist was located in a different state than their potential renter, the landlord filed a complaint with the California Board of Behavioral Science who then took legal action against the therapist.
The second case that Dave Jensen cited had to do with an investigative reporter who was writing a story on how easy it was for people (in this case the undercover reporter) to obtain an ESA letter from a therapist. The reporter shared that they had booked one session, and by the end of the session with the therapist had the requested ESL letter - complete with a DSM V diagnosis.
Because of the reporter’s story, the therapist who provided the ESA letter to the undercover reporter is now dealing with legal concerns.
Another risk factor that therapists may not be aware are the existence of national companies who are now attempting to recruit therapists to write ESA letters for individuals with the promise of paying the therapist to do so.
Emotional Support Animal (ESA) Letter Checklist for Therapists
As a therapist, it is crucial to follow best practices and legal guidelines when considering writing an Emotional Support Animal (ESA) letter for a client. The following checklist provides essential steps and considerations to protect yourself professionally and ethically. This document is for informational purposes only and does not constitute legal advice.** Always consult with your state licensing board, professional organization, or an attorney if you have any questions or concerns.
1. Determine the Client’s Location
Current Client: Is this a current client or a former client? If current, confirm that the client is physically located in the state of California at the time of your assessment and letter preparation.
Former Client: Has it been several months or years since you’ve worked with the client? Do you feel it is ethical to provide a letter of any kind to a client who you no longer work with? Additionally, if the client has moved out of state, be careful about writing an ESA letter unless you are licensed in the new state. Writing an ESA letter for a client outside your jurisdiction could be considered the provision of clinical care and may violate licensing regulations.
Note: I do not provide letters for current clients as I do not operate in a dual role as a court advocate, or an animal expert. I am neither and I outline this clearly in my counseling forms. I do not provide letters for clients I am no longer working with.
👉 *Action Step:* If in doubt, consult with your licensing board or professional organization before proceeding.
2. Meet the Standard of Care
An ESA letter should meet the highest standard of care and demonstrate a thorough clinical assessment. This includes:
Clinical Assessment: Conduct a comprehensive evaluation that includes a detailed understanding of the client’s mental health and emotional needs.
Mental Status Exam: Ensure you have documented the client’s mental health condition and its impact on their well-being.
Established Relationship: You should have worked with the client for a sufficient length of time (minimally 30 days). This allows for a full evaluation and ensures that you have an informed understanding of the client’s needs.
🚩 NOTE: Do not provide an ESA letter after only one or two sessions. Licensing boards, including California’s Board of Behavioral Sciences (BBS), discourage therapists from issuing ESA letters without adequate time for evaluation.
3. Confidentiality and Information Disclosure
Be mindful of how much personal information you include in the ESA letter. Include only what is necessary to substantiate the request.
Obtain a signed and dated Release of Information (ROI) from the client to protect confidentiality and document the client’s consent. Keep a copy of the ROI in your clinical records.
4. Fee Policies and Documentation
If you charge a fee for preparing an ESA letter, this must be clearly outlined in your informed consent forms or clinical intake paperwork at the start of the therapeutic relationship. Clients should understand any fees associated with letter preparation before the request is made.
5. Assess Your Scope of Practice & Expertise
Ensure that evaluating the appropriateness of an ESA is within your scope of practice. Are you trained to assess animal behavior with your client? Have you witnessed in person your client with their pet? Confirm that you have sufficient expertise to assess whether the animal provides emotional support for the client’s mental health needs.
6. Understand the Difference Between ESA and Service Animals
ESA Animals: Do not require specialized training or certification. They provide emotional support but are not granted the same public access rights as service animals.
Service Animals: Are specially trained to perform tasks for individuals with disabilities and are protected under the Americans with Disabilities Act (ADA).
🚩 *Important Note:* Clients should not misrepresent an ESA as a service animal. It is illegal to do so and could result in legal consequences.
Final Considerations
When writing an ESA letter, consider whether you can confidently defend your clinical decisions if challenged. Protect yourself by following these steps:
- Document your rationale for providing the ESA letter in the client’s clinical record.
- Clearly state that the letter is based on your professional judgment made within the scope of your license and expertise.
When in doubt, seek guidance from your licensing board, an attorney, or your professional organization. By being thorough and cautious, you can help your clients while safeguarding your practice.
Additional Tip on the ESA Letter Assessment Process
Charlotte Hiler Easley, LCSW provides equine assisted therapies, intensives, and workshops, as well as EMDR and Equine assisted EMDR for women in Lexington KY. Working with animal assisted therapies, Charlotte offers this tip for assessment before writing an ESA letter:
“At my practice, part of the assessment process includes meeting with the client and their animal to assess whether the animal /client partnership is healthy so that the ESA is not further isolating or producing more anxiety for client because the animal is not socialized, housebroken, or has behaviors that are not appropriate, ( i.e. a dog that the client isn’t able to ask to sit/stay or one that growls if you come close to client). Also, it is equally important to consider if the reasons the client is asking for the letter also supports a healthy environment for the Emotional Support animal.”
You can learn more about Charlotte’s work and women’s healing equine workshops at: www.charlotteeasley.com
The Law and ESA Letters
ESA laws are evolving and changing, and may vary from state to state. For example, as of January 1, 2022, California has a new law that governs therapists who are writing ESA letters for clients. As of 1/1/2022, a therapist licensed in the state of California who decides to write an ESA letter for a client is required to:
Be licensed where the client resides. The therapist may NOT provide an ESA letter to a client outside of California unless they are also licensed where the client resides.
The letter must include the therapist’s license number and issue date.
The therapist must have a clinical relationship with the client requesting the ESA for a minimum of 30 days BEFORE writing the ESA letter.
The therapist must provide a full clinical evaluation (see above) of the client’s need for an ESA prior to writing the letter.
The therapist must provide notice to the client that misrepresenting the animal as a service animal is a crime.
Though not stipulated, it would be in the therapist’s best interest to provide this notice in writing with a client signature/date, and this be with a current client, and they therapist is operating within their scope of expertise.
As you are learning, no matter how much we may love animals, it is in the clinician’s best interest to fall back on best practices, to understand the legal requirements and ramifications in your state, and carefully and clinically consider if fulfilling an ESA letter request is within your scope of practice and expertise when considering a client’s request for an ESA letter. We work hard for our licenses, and as much as we care about our client’s emotional well being, and love animals, we are required to follow the law.
In these particular situations, saying no to a client (or former client) is not easy. As shared, I love animals and want my clients to have the support and love of their precious pets. However, as mental health practitioners, we must follow and adhere to our licensing guidelines and legal and ethical requirements.
I hope this information has helped round out your thinking regarding ESA letters. Feel free to comment or introduce yourself in the section below.
Are you looking for business coaching or consulting support? If so, take a look at what other clinicians have to say about my work here. Or do you feel like your client forms are all over the place and you want to tighten that up? You can find a complete forms packet here, and a complete group therapy forms packet here.
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Kindly and in support,
Mari A. Lee, LMFT, CSAT-S