Category: Mental Health

Emotional Support Animals

The ESA Request

The following story is a culmination of the various requests I’ve had over the years, not one specific person, or animal, and the details are changed to protect the identity of the clients.

… He matches the soft breaths of the animal and slows down his …

He comes to me, obviously nervous.  A referral from his trauma-informed therapist. His voice is shaking, and he sweats.  He clutches a letter he’s prepared. I try to make him as comfortable as I can, but this poor young man looks terrified. I ask why he’s here, and he begins to tell me of the most horrific trauma he endured.  He sweats more, and he can barely look me in the eye, afraid to cry.  He can hardly get the words out, “I don’t want medications” he says almost apologetically, “I am doing so good with therapy, I can get through this, but the panic attacks happen almost every day.” He opens the letter, his hands trembling as he reads how having his cat has saved his life.  And it is no exaggeration.

He says that when he is reminded of the trauma, the re-living starts to happen, and then the subsequent panic comes on. His heart is racing, he cannot think, feels like he’s not in his body, and that he will faint. There are times he even thinks, “I can’t live like this anymore.” So, he lays down, he practices ‘grounding’- feeling the floor beneath him, and his sweet kitty comes and lays on his stomach. He matches the soft breaths of the animal and slows down his.  He feels the light weight of kitty on his stomach, which also stops it from spinning. He comes back to the room and spends a moment in cuddles and is then able to continue his day. His cat keeps him working, keeps him sleeping, and helps with grounding.

ESA Letters

When doing a letter for an emotional support animal (ESA), we make sure they are for people with a mental health diagnosis.  We ensure the owner understands they are responsible for picking a safe animal.  We make assess that the person knows and can clean, train, and care for their ESA, and most importantly, keep the animal safe around others.

Animals are an essential part of many people’s mental health recovery.

We include all paperwork you should need with your visit.  If your therapist is not comfortable filling out ESA paperwork, or you need additional supporting documentation, we can get that for you.  Paperwork is filled out and sent within 24 hours of your visit.

Care for the Highly Sensitive Person

Dr. Elaine Aron, PhD first described the highly sensitive person (HSP) as a personality trait in her book, The Highly Sensitive Person: How to Thrive When the World Overwhelms You. One part of this trait includes symptoms of being easily overwhelmed with strong sensory input, such as sounds, smells, and sensations. HSPs are more aware of subtleties around them; they pick up quickly on other people’s feelings and what is needed to soothe others who may be struggling. They also have a greater need to recuperate after upsetting and overwhelming tasks and must protect their energy levels.

Many of the traits of highly sensitive, empathic, and introversion overlap. HSPs may come in for help due to feeling anxious or overwhelmed when others do not seem so bothered by life, work, or family events. They judge themselves or feel judged for needing more alone time, more quiet time, and more self-soothing than others.

In the field of psychiatry, many clinicians look towards the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to label mental health conditions and illnesses. HSP, empath, and introversion traits are not in there due to not being pathological; it is just a way of being. HSPs have different wiring than others.

It is important for psychiatry clinicians to understand the HSP trait.

Things to know about HSP’s in Psychiatry:

  • Maybe prone to depression, anxiety
  • May look like social anxiety or avoidance when really it is recharging from overload
  • May exhibit more tearfulness without that being a symptom of a depressive episode
  • May react stronger to medications or have more side effects of drugs
  • Typically need sub-therapeutic (lower than standard) dosing of medications if they take them
  • More sensitive to the effects of stimulants
  • Benefit from mind-body modalities such as yoga, salt floats, meditation, time in nature, alone time

Having a highly sensitive personality is both a blessing and a challenge. HSPs feel a great depth of love and compassion for others. They also need to balance this with self-care and create good personal boundaries for protecting their energy.

Until We Can End Mental Health Stigma, We Work Around It

“I would never want to have a mental health diagnosis on my record”

A quote from Gold, Andrew, Goldman, & Schwenk (2016) retrieved from These researchers found the reason many female physicians will not obtain mental health care is due to their concerns for having a mental health diagnosis in a permanent, sharable, electronic medical record. This concern is valid. Physicians must often report their depression, anxiety, mood disorder, or substance abuse issues to the board of medicine. Physicians often must sit in front of their licensing boards and hope someone who they don’t know, doesn’t further stigmatize them. They worry they will lose their license due to the board findings.

Many factors play into the tragedy of the epidemic of physician suicide- moral injury, burnout, dehumanizing electronic medical records, bureaucracy, and also ACCESS & STIGMA! We need to do better for the mothers & fathers of medicine.

One day I was speaking with my colleagues about the privilege of treating those in the field. We all acknowledged we have a quiet system for psychiatric treatment on the “down-low” for physicians and clinicians, and those in the public eye. We bring the person in on off-hours, paper chart kept in a lockbox and other privacy measures. We all agreed it would be nice if there were no stigma, no need to do this, but we all do it. #endphysiciansuicide

Telepsychiatry provides a de-stigmatizing, accommodating, private way for physicians, clinicians, and those needing anonymity to get treatment for mental health or substance abuse support. At Your Service Psychiatry, PLLC offers the ability to seek treatment outside of an electronic medical record system, alternative consent sign-up, scheduling, and payment. Those who need additional privacy measures may call or text 833-AYS-PSYC (833-297-7792) for details on exclusive care.