Volume 56, Number 3 - Summer 2010

 

By Uma Lerner, MD

Pacino Lerner is a four-year-old fawn pug dog. He was adopted by his parents, George and Uma Lerner, at the tender age of eight weeks. Pacino was able to participate in much of his parents’ psychiatric residency training and managed to learn a fair amount about diagnosis, case formulation, interpretation, and treatment. He has been assisting in his mother’s private psychiatry office for the past year, and it seems he has quite a knack for therapy. 

Pacino greets the patients in the waiting room and walks them back to the office. Like a seasoned psychotherapist, he can, within the first five minutes, identify the patients struggling with depression. He offers the supportive psychotherapy technique of flopping down right beside the person on the couch, offering his belly to be rubbed, and falling asleep. After weeks of this empathic gesture, a strong therapeutic alliance is built, and Pacino moves on to his next intervention—acceptance and nurturance. This is carried out by Pacino standing on the person’s lap, licking his or her face, and then flopping over on the couch to fall asleep. 

But he doesn’t only do supportive psychotherapy. He also does powerful work in transference and dream interpretation. Therapists have long known that patients can project information and feelings onto the treater, feelings that actually originate from another relationship or somewhere in the patient’s psyche. Pacino has experienced his fair share of patient projections. Patient A began the session by talking about a stressor he experienced the past week. Pacino employed his falling-asleep technique. Mr. A was offended and hurt. He turned to the human therapist and said angrily, “I guess I’m too boring for Pacino.” This created an opportunity for the patient to talk about his feelings of insecurity and ideas about other people’s perceptions of him.

Patient B brought a dream to session. The dream was marked by significant anxiety and featured her son, with whom she had been in conflict. The human therapist asked Ms. B what she thought the dream was about. She said she didn’t know and began recounting the dream again. Pacino had been asleep next to her, and at one point in the retelling, he got up and moved to the other side of the couch. “I afraid that my son will leave me, and that I will lose him!” Ms. B exclaimed. 

Pacino is experienced in couples therapy as well. Patient C, who usually sits in the chair away from Pacino, brought his girlfriend into session one week. This time Mr. C sat on the couch. When his girlfriend attempted to sit next to him, he said, “No, that’s where Pacino sits,” thus forcing her to sit alone on the chair. After some discussion, the girlfriend asked Mr. C if she could move to the couch, and he agreed. She sat on the opposite end of the couch far away from Mr. C. Pacino then moved from lying next to Mr. C to having his paws touching both Mr. C and his girlfriend. The two people began petting Pacino, and their hands met in the middle.

Now, Pacino does not only work with the “worried well.” He also has a few patients with schizophrenia, and with these patients reality testing is an important technique. Patient D has significant paranoia about being spied on. She believes that her apartment, her parents’ home, and the therapist’s office are all bugged. The first day Ms. D met Pacino, he kept an appropriate distance by sitting on the chair away from her. This is important with paranoid patients, as they can easily feel intruded upon. After about half the session had passed, Pacino jumped off the chair to join Ms. D. They eyed each other carefully from opposite sides of the couch. Finally, the patient asked, “Is this a dog?” The human therapist responded in the affirmative, and the patient asked, “How can you be sure?” The human therapist gave all the reasons she had for knowing. For the first time in therapy, Ms. D relaxed. Pacino moved closer and offered Ms. D his belly for petting.

As you can see, Pacino, the canine therapist, is very well versed in the art of psychotherapeutics. Of course, we have to give credit to his parents, George and Uma Lerner, and the family’s psychiatry residency program at UCSF. While Pacino offers a variety of techniques in working with the diverse group of patients whom he has in his practice, his most important skill is that he offers a safe and respectful environment and an empathic relationship.

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Reprinted with permission from San Francisco Medicine. Patients’ names and other details have been changed to protect confidentiality.