Family Enmeshment and Bullying:
CJ the Therapy Dog to the Rescue

One of the tragic consequences of ongoing post-traumatic stress disorder (PTSD) can be increased risk of suicidal behavior. Engelman (2019) showed how Animal-Assisted Interventions (AAI) help those who are traumatized to reduce their heightened physiological and emotional arousal and begin to feel safer in ways that traditional interactive treatment modalities alone may not accomplish. Sarlon, Staniloiu, Schöntges and Kordon (2018), and Altschuler (2018) point to how AAI may be used to alert professionals to and prevent suicidal behaviors.

What follows is a case example of using AAI with a therapy dog on a suicidal patient from Dr. Engelman’s psychotherapy practice. Identifying information has been changed to protect the patient’s confidentiality. This vignette is an example of bullying and abusive family dynamics that led to the daughter, Dr. Engelman’s patient, becoming suicidal as a girl and continued into adulthood.

Sitting atop of the refrigerator, 6-year-old Juliet finally felt safe. Her rapid breathing slowed, and the pit in her stomach finally lessened. Her latest asthma attack subsided. She gazed at her paranoid schizophrenic mother in the darkened kitchen below busy making P& J sandwiches, which Juliet hated. Her mother forced her to eat them because her mom liked them; whatever her mom liked; Juliet was coerced into accepting as her own. Juliet was the “replacement daughter” for her mother’s favorite child who had died 7 years earlier from sudden infant death syndrome. Enmeshed as they were, Juliet having her own likes and dislikes was not allowed.

She had climbed to safety, because to be on the ground level with her mom meant being handled and touched by her mother, who was adamant about Juliet understanding that her body and emotions were an extension of her mom’s. No individual feelings were allowed, and Juliet developed panic attacks when physically close to her mother, who was “trying to eat me, absorb me…like I was being sucked into quicksand.”

Juliet felt terrible guilt for wanting things to be different. The mother’s mistreatment and abuse resulted in her daughter developing intense anxiety, panic, depression and even catatonia. Juliet created an isolated relational “bubble” to save herself. In addition, after all the horrible things her mother had told her about what “outsiders” would do to her, social interactions had become too risky and frightening. The house was always darkened, shades drawn, so that “they” couldn’t peek in. And because her mother had made her wear boy’s clothes to school, the teasing she got from classmates verified her mom’s rants that other people are dangerous and should be avoided. Juliet’s anxiety turned into agoraphobia, and she became terrified of leaving home because of social anxiety, despite being desperate to get away from her mother.

There was no escape, except maybe through suicide. The suicide attempts began with an overdose on pills at age 11. Juliet’s mother had abandoned her, because Juliet wanted to go live with her grandmother. And then the cutting started. Another pill overdose at age 15, and more cutting. “Each cut was like a mouth screaming, and it made me feel better.”

By the time Juliet was referred to Dr. Engelman’s practice at age 20, she was covered with cuts and scars, hidden under her long sleeve shirts and on her torso. Although not actively suicidal, Juliet had suicidal ideation and was still cutting herself, and sometimes needed hospitalization for stitches to stop the bleeding. Her only social interactions were gaming online, where her identity could be disguised. She very much wanted to go to the local trade school but was terrified of being in contact with others. Dr. Engelman and Juliet established a no-suicide contract early on in their work, and reviewed resources to stay safe.

Juliet felt like a “wounded animal” and yet she also identified a “spark in me that doesn’t want to die.” Animals felt safer to her from within her interpersonal bubble. It was this dynamic that allowed her to bond with CJ, the therapy dog.

CJ greeted Juliet in the waiting room with a wagging tail and friskiness that instantly helped Juliet feel accepted. CJ dropped her ball at Juliet’s feet, begging for interaction, which helped Juliet feel “useful” and “needed.” In the consultation room, CJ slept on Juliet’s feet, and occasionally would jump up onto the couch to lick her face when the tears flowed.

From her online world, Juliet had discovered a game where different-colored, ferocious and scary monsters hid behind certain doors, and other doors opened into rooms that were restful and inviting. The rooms containing monsters were terrifying to go into, because they contained all the pain and trauma of Juliet’s childhood. Her mother in all of her evil often lurked behind the “wrong” doors and encountering her in these imaginal rooms could feel devastating to Juliet for weeks. It was critical to not pick those rooms to enter, as they would trigger unrelenting traumatic memories, feelings of unsafety, and intense stomach pain and migraine headaches.

To begin safely exploring these rooms, Juliet began petting CJ, which helped to calm her. This was combined with Dr. Engelman teaching her how to use slow-paced diaphragmatic breathing to calm anxiety and hyperarousal. Then, after signaling with her finger that she was ready, Dr. Engelman would utilize guided, relaxing imagery to arrive at the hallway of doors. Juliet would carefully have to pick which room to go into for a safe experience.

She did this by cracking open the door and seeing if CJ was inside. If she saw CJ in her imagination, she knew the room was safe and could enter. CJ would then serve as her guide for the remainder of the session. Time after time, CJ would be waiting for her in this room to accompany her in her visualization, exploring her imaginal environment, helping Juliet build confidence and curiosity. Seeing the environment outside of the room as inviting and often beautified with fields of tulips and daisies, it gave Juliet hope that there was the possibility of safety outside of her circumscribed life. Eventually, she could visualize going outside of this room with CJ leading her through the fields of flowers; other times CJ reunited her with other positive figures from her life.

Returning to conscious presence back in the therapy room, Juliet would be aglow with the discoveries that she made with CJ. She would feel grateful to CJ, who was asleep next to her, for inner guidance, unconditional love, and companionship. In this way, Juliet was able to experience safety in her unconscious, which then generalized to her feeling more capable in her life outside of the therapy room.

Her psychotherapy proceeded; when Juliet felt like cutting herself at home, she would remember CJ’s loving gaze, and her protection that she bestowed upon Juliet in her imaginal world. As her negative core beliefs about herself began to change with Dr. Engelman and CJ’s help, she also began to develop courage to explore her external world. This began by her being willing to go for short walks around the office building with CJ and Dr. Engelman. As she walked holding CJ’s leash, she would verbalize her fears to Dr. Engelman concerning what she thought others might be saying or thinking about her. The fact that CJ walked next to her and appeared unperturbed by others helped Juliet relax.

Gradually, the length of the walks in public increased, from 1 minute to 5 minutes. Juliet was able to soothe her own social anxiety more readily, and even begin to laugh at her own made-up worries about what others might be thinking about her.

At home, Juliet’s agoraphobia lessened enough that she felt comfortable opening her front door and gazing outside. After many months of therapy, this evolved into actually leaving the house to walk down her sidewalk to the street without feeling overwhelming physiological tension.

Gradually, over months and several years of weekly psychotherapy with the assistance of CJ, Juliet’s incapacitating migraines ceased, and she was able to enroll in one class at the local community college. Her asthma attacks were reduced in intensity, and she began to consider applying for a part-time job doing bookkeeping.