U.S. clinical mental health counselors’ responses to requests for emotional support animal letters.

This article focused on how clinical mental health counselors (CMHCs) in the U.S.-handled emotional support animals (ESA) letter requests and whether the assessments used by CMHCs for clinical decision making were related to whether they would decline or agree to write the ESA letter. Following a three-stage approach, we first used polling responses from continuing education participants on issues related to ESAs to identify the needs for research on clinical decision making related to ESA letter requests; second, we used survey responses from 134 CMHCs to test factors that affected whether they would be open to write the support letter or would refuse to write the support letter. Finally, we conducted focus group discussions with seven CMHCs to illuminate our regression results. Our main finding is that the decisions to approve or decline ESA letter requests were significantly influenced by assessments of clients' disability status, inquiry into how ESA alleviated symptoms, and discussions on alternative treatments. Thematic analysis of focus group discussions revealed ambivalence toward ESA letter requests, uncertainty regarding legal and ethical ramifications, and concerns about clients' motivations and animal welfare. Overall, we found that most CMHCs lacked formal training in ESA assessment, and many relied on personal discretion rather than established guidelines in making clinical decisions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).