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Small, black therapy dog comforting a woman sitting outside in the grass.

Therapy dog vs. service dog vs. emotional support animal (ESA)

Before we dive into the specifics of therapy pets, it’s important to learn the differences between these three types of working animals. 

Therapy dog: Therapy dogs go through specific therapy training to be able to provide relief to those in anxiety-provoking situations, bring comfort to those who are grieving or lonely, and offer affection to people who are in institutions such as hospitals, nursing homes, and schools.

Service dog: The main difference between a service dog and a therapy dog is that a service dog is trained to help disabled people, such as those with a seizure disorder, diabetes, or visual impairments. Thanks to the Americans with Disabilities Act, these pups can go anywhere their handler needs to go (unlike a therapy dog, which is limited in where they are allowed to go). These dogs have one handler who they serve and don’t travel to facilities to work with multiple people.

Emotional support animal (ESA): Emotional support dogs (or any type of animal) are prescribed to support individuals by a mental health professional. They provide comfort to their person just by their presence. Providing comfort is not a trained behavior and, therefore, the dog is not considered an assistance (service) dog under the ADA. Emotional support dogs don’t have the intensive and specialized training that a service dog receives.

💡 Pro tip
Interested in getting a visit from a certified therapy dog? Contact the Alliance of Therapy Dogs to get more information on scheduling a visit for your facility.

What benefits can a therapy pet provide?

Just the presence of a therapy dog will help take a person’s mind off of their worries, physical or emotional pain, and anxieties. The simple act of petting a dog has been proven to provide multiple mental and physical health benefits. For example, hormones such as serotonin, prolactin, and oxytocin, which play a role in elevating moods, are released in the brain while interacting with a pet. 

Physically, the presence of and interaction with therapy animals can help lower blood pressure, reduce the number of medications that people need, diminish overall physical discomfort or pain, motivate people to exercise, and help children with autism with language development and social interaction.

Types of therapy pets

Even though dogs are traditionally the most commonly used animal in the therapy world, other species can also perform this important work. These include:

Cats. Kitties might not have the same reputation as being energetic and lovable like dogs, yet some facilities have made cats a permanent part of their therapy regimen. For example, a resident feline at a nursing home can easily weave in and out of rooms and may even choose to stay for a snooze or a snuggle. A visit from a cat can brighten even the darkest of moods.

Equine. Horses are being used to help individuals that are dealing with things like drug abuse, learning disabilities, or rehabilitation. Teaching a person how to trust and interact with a creature such as a horse can have invaluable benefits. Because they can be so large (unless you’re working with a mini-horse), it may be difficult to bring them into facilities rather than allow people out to come to see them in their own homes. They will also need more care than smaller companion animals. 

Small Animals. Guinea pigs and rabbits are also being used for therapy work. These small animals offer the same comfort, companionship, and emotional/behavioral benefits as their canine co-workers. Both guinea pigs and rabbits tend to form strong bonds with their owners and enjoy strokes and cuddles, just like a dog or cat. Plus, they are pretty low maintenance when it comes to care.

Are dogs the most popular choice?

Dogs make such effective therapy animals because of their sensitivities to human emotion. There are over 50,000 therapy dogs in the US and that number is steadily climbing as their use becomes more popular. 

Golden retriever therapy dog getting petted by a crowd of people

Which breeds are best?

Even though any breed can become a therapy dog (with some training), the top 10 breeds found in this role are:

There are, however, some specific traits that your dog should exhibit should you want them to become a therapy dog, regardless of their breed.

Even-tempered. Therapy dogs must be well-tempered. This means they shouldn’t be quick to anger, overreact, or get stressed out easily. They should enjoy being petted and not worry if a person were to mishandle them (we know young kids love to grab ears or tails sometimes). And while some of these behaviors can be trained, dogs will need to be inherently calm to some degree to excel in this industry.

Friendly and social. Therapy dogs must be social and friendly. This may seem obvious, as they will be working to cheer people up when they need it the most, but it can often be overlooked if the dog checks all the other boxes. However, dogs that are too energetic may be rough with certain people (especially the elderly) or unable to focus on the job at hand, so therapy dogs must be social, but not too overly excited.

Adaptable. Therapy dogs will need to adapt to various environments. Sometimes they may need to provide support in highly stimulating and distracting environments, or they may need to help people in cramped living spaces. A dog that is uncomfortable in new places or doesn’t adapt easily may become shy, weary, or even aggressive if pushed too far, and isn’t ideal for the job.

Non-shedders. Therapy dogs shouldn’t shed excessively. Shedding can be a major problem for people with allergies, plus it creates a mess for hospital, clinic, or school staff to clean up. You can try to combat shedding with frequent brushing, but some dogs simply shed more than others. This is especially prevalent in retriever breeds with double coats.

Therapy dog getting petted on the head

Where are therapy pets allowed/not allowed?

There’s a lot of confusion over just where you can take your therapy pet. Because of the confusion on how therapy pets are viewed by the government, there are a lot of misunderstandings over where they are allowed to go with their owners. 

Therapy animals don’t fall under the same laws as assistance animals (service dogs and emotional support animals), so their access to certain locations is more limited than you might think. Understanding the laws makes it easier to determine where you can take your therapy pet. Read the below information for specifics on where you can and can’t take a therapy dog.

Colleges. While therapy dogs have proven to be very beneficial for stressed students, living in college dorms with your therapy dog is a decision that must be made by your college. No set laws state that colleges and universities must house your therapy dog, but you may find that many are open to discussing the possibility.

Airports and planes. There is a common misconception that therapy dogs are allowed on flights for free, needing no more than a discussion with your airline. This is partly due to the rise in numbers of people who are traveling with emotional support animals. However, once again, therapy dogs are not classed in the same category as assistance dogs ─ they will be treated as a pet when flying and you will need to pay for their seat. (You can learn more about flying with your dog here.)

Hotels. There are no laws in place that will protect you if you simply show up with your therapy dog without letting the owners or staff know in advance. However, if you can prove the credentials and good behavior of your dog, then many hotels and Airbnbs will allow them. Many hotels already have dog policies in place that allow pets in general, so it may be easier than you think to find one that is pet-friendly who can accommodate you and your therapy pet. You can usually find this info by searching on their websites. (Marriott is a great example.)

Work. Service dogs are legally covered when it comes to animals in the workplace. Unfortunately, both therapy pets and emotional support animals are not. Like hotels and Airbnbs, there are no strict laws in place that allow you to bring a therapy dog into the workplace. But if you have a conversation about it and ask your employer if it’s allowed, some may permit it. 

Always check with your destination before you arrive with your therapy dog. While you may not be legally protected or given guaranteed access to where you want to take your therapy dog, a lot of times a quick explanation of what work your therapy dog does will do the trick.

A simple step-by-step certification process

If you would like to own a therapy dog, the process is relatively simple. Although it’ll take some time and effort, there are only three steps to register a therapy dog: adopt, train, and register.

How to train a therapy dog

Once you have chosen a dog to bring home, you should begin the training process as soon as possible. Some dog owners prefer to do the training themselves, but getting advice from people who train animals for a living can save you time and help ensure that your dog has what they need to be ready to see people.

In general, you’ll want to make sure that your dog exhibits certain positive behaviors and avoids negative ones. Dogs that like to jump on people, bark excessively, or chew on things won’t qualify. Dogs that are overly shy and don’t like to approach people won’t make the cut, either.

The American Kennel Club (AKC) recommends that dogs pass the Canine Good Citizen (CGC) test before registration. This exam focuses on 10 key traits:

  1. Accepting a friendly stranger. The dog will allow a friendly stranger to approach and speak to their owner in a natural, everyday situation.
  2. Sit politely for petting. The dog will allow a friendly stranger to pet them while out with their owner.
  3. Appearance and grooming. The dog will permit someone to check their ears and feet, as a groomer or veterinarian would do.
  4. Out for a walk (walking on a loose lead). The dog will walk politely on a loose lead with their owner (no pulling, getting easily distracted, etc.)
  5. Walking through a crowd. The dog will walk through a small crowd of people, while closely passing at least three people.
  6. Sit and down on command and stay in place. The dog must demonstrate the ability to sit and lie down on command, then their owner must ask them to stay until released.
  7. Coming when called. The dog will come when called by their owner (from 10 feet away on a leash).
  8. React positively to another dog. The dog will behave politely around other dogs. During the test, two handlers and their dogs must approach each other from about 20 feet away, stop to shake hands, and exchange pleasantries while their dogs wait patiently.
  9. Relaxed reaction to distractions. The evaluator will select and present two distractions, such as dropping a chair, to which the dog must react properly (no overreaction or fear).
  10. Supervised separation. This test demonstrates that the dog can be left with a trusted person. The evaluator will hold the dog’s leash while the owner goes out of sight for three minutes.

If your dog can pass the CGC test, there’s a very good chance that they’ll be approved as a therapy dog. Once they pass, it’s recommended to take things slowly ─ test the waters with friends or family members before taking your dog to more formal therapy sessions at a healthcare facility. Throwing your dog into what could be an overwhelming situation before they’re ready may cause more harm than good. Allow your dog to be 100% prepared and get used to their new job before taking them into highly stimulating environments (such as a school full of young, loud kids).

How to get started with your therapy dog after training/certification

Once your dog achieves therapy dog certification, you can start putting your dog’s training and special skills to work in different settings. A great place to start is by joining a pet therapy group

These groups and organizations can pair you and your dog up with the right facilities and volunteer organizations. Volunteers are usually covered by the organization’s liability insurance, that way you don’t have to worry about the legal side of things and can focus on the therapy work.

👉 We don’t recommend working independently without this kind of liability coverage, so be sure to do your homework if you choose to work with your therapy dog solo.

Anecdotes from therapy pet owners on their experience getting certified

The Carrs and their therapy dog

“For the Carrs, training a service dog to serve as a therapy dog was less involved than might be expected. To become certified, Sherman first had to pass a “Good Citizen Test,” which involved being approached by a group made up of both children and adults. A tester hidden in the group put Sherman through a series of tests designed to gauge his temperament and how he would react in stressful situations. These included pulling Sherman’s tail, shouting, springing open an umbrella in front of him, and tossing a soda can filled with pebbles in front of him. ‘It sounds like a brutal test, but it’s necessary to know how the dogs will react [under stress] . . . Sherman did a great job,’ said Joy Carr.”

The Story of Rufus, the therapy dog

“The day that my Grandpa turned 90 was also the day that Rufus came into the world. The two of them got along like a house on fire. If soul mates exist, then I’m sure my Grandpa and Rufus were two of them. When my Grandpa became ill, the hospital generously agreed to let Rufus visit at the hospital offering the deep comfort and compassion that only animals seem to possess. I watched as Rufus, still a puppy in his own right, climbed onto my Grandpa’s bed and nuzzled in close beside him. He just stayed there, offering his comfort and support for his fellow man, his partner-in-crime, at a time when it was needed most. It was in that still moment that I knew what Rufus already was, and what he was officially to become: a therapy dog. Rufus graduated [his therapy program] with honors and was ready for his very first placement. The way Rufus is able to walk into a room and bring comfort to people he’s never met, often during their darkest hours, is something that keeps us going back. It’s not only therapy for the humans we visit, but also for me.”

Potential setbacks 

When it comes to pet therapy, some of the biggest risks involve safety and sanitation. People who are allergic to animal dander may have reactions during a pet therapy session. Animals in pet therapy programs are typically screened for behavior and health to help prevent these reactions, but there’s always a possibility. And, while uncommon, injury to a person or the animal can occur when unsuitable animals are used or when the animal isn’t handled properly. 

Pet therapy risks aren’t always physical. In some cases, people may become attached to or possessive of the animals helping them and be reluctant to give them up after a session. This can result in low self-esteem and depression, leaving them in a worse mental state than when they began the session. 

Outside of risks to people, there have been setbacks to pet therapy in general. For example, there has been an increase in media reports of people passing off their pets as service dogs so that they could take their animals with them when shopping or in other public places. This practice is potentially dangerous (and illegal!) for several reasons:

  • Lack of proper training. These pets are not trained to be in public places. They are unpredictable, may panic, bark, or even bite someone.
  • Potty accidents. There is a chance that a nervous or poorly trained dog will go to the bathroom on the floor and create a health hazard.
  • Possible attacks. Fake service dogs may attack real service animals, putting handlers and actual service dogs in danger.

These incidents are also making it increasingly difficult for legitimate therapy pets to do their jobs. If a facility has been lied to about a fake therapy pet in the past, they are less likely to allow a real one in due to dangerous outcomes caused by the fake therapy pet. Some states in the U.S. are working to fight this by putting laws or bills into place in their legislatures, banning people from passing pets off as therapy or service dogs without the proper training.

Two therapy dogs greeting people on a public sidewalk

Best practices for bringing a therapy pet into your facility

When a therapy pet comes to your facility, there are some tips and best practices that should be kept in mind during the visit.


Therapy pets in schools can perform wonders: The animals relieve students’ stress, help kids learn to read, and even boost test scores and attendance. It’s important, however, to have someone running the program who understands risk and stress levels for the animals. 

Therapy volunteers should first work with a small group of students and teachers as not to overwhelm their pet. Parental permission should be acquired for each child to interact with the therapy pet. Administrators should also take proactive steps if students are afraid of dogs or have allergies.  At the same time, educators should be planning what activities therapy pets will be involved in and where the work will take place. 

Will the therapy pet work one on one with certain students? Maybe sit in on reading time with a group of students? Or walk from classroom to classroom just to pop in? A lot of people bring in pets, but they don’t have goals for the program. Whatever activity it may be, communicating the plan before the visit can prevent extra stress for all involved. 


For a hospital patient, a visit from a furry companion can raise spirits, reduce anxiety and depression, improve cooperation with treatment, and even lessen pain. While 90% of US hospitals allow animal visits in their facilities, there aren’t many formal policies over how to handle these kinds of therapy visits. 

Dr. Rekha Murthy, a medical director in the epidemiology department at Cedars-Sinai Medical Center in Los Angeles, and her team came up with a set of recommendations for healthcare facilities in regards to the health risks associated with therapy animals.

  1. Develop a written policy for all animal-assisted activities, covering training, interactions, and safety protocols.
  2. Designate one person to oversee the program. Many hospitals rely on someone from their volunteer services department.
  3. Be cautious with cats as they can be unpredictable and hard to train.
  4. Require formal training for dogs and handlers.
  5. Document all animal visits to make it easier to track outcomes and determine the source of any potential infection outbreak.

Nursing homes

There are two main ways to introduce pets in a nursing home:

  • Having a live-in pet (or pets) to share among residents (cats are very popular choices).
  • Having outside certified therapy pets come in with their owners.

Planning to bring therapy pets into a nursing home is similar to when bringing them into a school. Having a game plan in place before the visit can solve a lot of stress and problems before they even occur. Learn which residents would or would not want a visit from the animal, what group activities the residents could do with them, and if there are any allergy or fear concerns among the residents.

 As we recommended above, it’s helpful to have one individual lead the therapy program at the nursing home who can communicate with the pet’s owner ahead of time for planning. 

How to handle rejection with your therapy pet

It is important to note that therapy pets are not considered service animals under the Americans with Disabilities Act (ADA). They have no rights to enter an animal-restricted area (grocery store, public transportation, etc), and are only allowed where they are invited to visit. 

If you attempt to take your therapy pet with you somewhere and are asked to leave, there isn’t much you can do except to oblige their request. To prevent this from happening to you, you can always call your destination ahead of time and see if they’ll allow your therapy pet to accompany you. Or, stick to public places where all pets are allowed, regardless of their training or titles.