Dolphin-assisted therapy

1. Introduction

Version followed: programmes as described by David Nathanson's Dolphin Human Therapy (as Marino and Lilienfeld 1998, the Seattle Times 1999 and the 2007 report of the Whale and Dolphin Conservation Society (WDCS), an advocacy organisation, describe it) and the range of formats the WDCS 2007 report catalogues; animal-assisted intervention terms from the IAHAIO White Paper (2018 update); evidence status from Marino and Lilienfeld (2007) and their 2021 update as the Association for Science in Autism Treatment (ASAT) summarises it.

Dolphin-assisted therapy (DAT) means swimming or interacting with dolphins, usually captive dolphins in tanks, pools or sea pens, offered as a treatment for illness, disability and psychopathology, most often to children with developmental disabilities and their families [source: Marino and Lilienfeld 2007; ASAT synopsis]. It is not a psychotherapy and has no recognised standards body: the WDCS report states there is no industry standard defining DAT and no professional body regulating it, and ASAT notes that sessions take place at dolphinariums or dolphin parks not regulated by any official body [source: Brakes and Williamson 2007; ASAT synopsis].

Its stated idea of change, as its best-known developer published it: David Nathanson, a psychologist who ran Dolphin Human Therapy in Key Largo, Florida, used basic behaviour-modification methods with dolphin contact as a powerful reward, proposing that children with disabilities have an attention deficit that dolphin interaction overcomes, so that gains in motivation, attention, motor skills and speech come faster than with conventional therapy [source: Marino and Lilienfeld 1998; Seattle Times 1999]. Other providers have claimed effects from dolphin sonar or ultrasound, or relaxed brain states; the WDCS report notes these explanations contradict one another, and Brensing and colleagues (as WDCS reports them) found contact too brief for an ultrasound mechanism and the mechanism unlikely [source: Brakes and Williamson 2007].

Evidence status, in one line: Marino and Lilienfeld found all five peer-reviewed studies from the preceding eight years methodologically flawed and concluded there is "no compelling evidence that DAT is a legitimate therapy", with no more than brief mood improvements; their 2021 update reached the same conclusion for autism and other developmental disorders [source: Marino and Lilienfeld 2007; ASAT synopsis of Marino and Lilienfeld 2021]. The IAHAIO White Paper states that wild and exotic species, even tame ones, cannot be involved in interactions, and cites WDCS on DAT's failure to meet the welfare needs of people or dolphins [source: IAHAIO 2018, p. 9].

What the psychotherapist actually does, therefore, is not deliver DAT. The work is: assessing what a family or client hopes for; giving them accurate information so they can decide; pointing them to evidence-based services for the same goals; screening and preparing a client who decides to go anyway; debriefing afterwards; supporting families who were injured, made ill or financially harmed; and working with the hope, desperation and grief that make the offer attractive [synthesis]. This guide describes programmes as operators and reviewers describe them, without endorsement. See the Harm account at the end.

2. Framework

DAT programmes have no common protocol [source: Brakes and Williamson 2007]. As reviewers and the WDCS report describe them:

Formats. Poolside interactions with a swim as a reward; swimming in tanks or sea pens; dorsal-fin rides; structured in-water sessions; and "looking after" the dolphin through feeding. "Wild DAT" is usually less structured swimming with free-ranging dolphins [source: Brakes and Williamson 2007, p. 3].
Nathanson's model. A child works on a set task (Marino and Lilienfeld give the example of placing a ring on a peg) and, when the child does what the therapist asks, a trainer directs the dolphin to interact with the child as a reward; programmes ran as one- or two-week blocks, and the 1997 study reported 17 sessions over two weeks compared against six months of conventional physical and speech therapy [source: Marino and Lilienfeld 1998; Seattle Times 1999]. Nathanson stated the aim as to "jump-start these kids so they can benefit from traditional therapies" [source: Seattle Times 1999].
Where. Programmes began in the US in the 1970s and have spread to Europe, the Middle East, Asia, Latin America and the Caribbean [source: Brakes and Williamson 2007, p. 3]. Outside the US, dolphins are often taken from the wild [source: ScienceDaily 2007].
Staff. WDCS reports no prerequisite for trained staff [source: Brakes and Williamson 2007, p. 14]. Under IAHAIO definitions, animal-assisted therapy proper requires a formally trained, licensed health, education or human-service professional, planned goals and documented progress [source: IAHAIO 2018, p. 6]; most DAT offers do not meet that description as reviewers describe them [synthesis].

The psychotherapist's pathway (no source gives one; all [synthesis]):

Enquiry and assessment. A family or adult client raises DAT, or has booked it. Goal: understand what is proposed, why now, and what they hope for. Move on when the specific programme, goals and decision stage are clear.
Informed-decision conversation. Goal: the family knows the evidence, the costs, the injury and infection risks and the welfare concerns, as Marino and Lilienfeld recommend telling parents [source: Marino and Lilienfeld 2007]. Move on when they can state the main points back in their own words.
Alternatives and collaboration. Goal: the underlying goals are mapped to qualified professionals and evidence-based services. Move on when referrals are made or the family declines them.
If they proceed: preparation. Goal: medical clearance, water-safety and infection screening, the child's assent and a stop plan, a baseline record. Move on once the trip is made.
Debrief and aftercare. Goal: separate the experience from lasting change, address disappointment, injury, illness or financial strain, and return to the ongoing treatment plan.

Format: ordinary individual or family sessions; the number depends on the family [synthesis]. No source gives a session count for this therapist-side work.

3. Guiding principles

Accurate information is the core intervention. Marino and Lilienfeld state that parents and participants should be told evidence for lasting benefit is lacking so they can decide [source: Marino and Lilienfeld 2007]. Practical meaning: say it plainly, early, and in writing if the family wants it.
The family's goals are legitimate even when the method is not. Practical meaning: take communication, motor, attention or mood goals seriously and route them to services that can address them [synthesis].
Respect autonomy; do not endorse. Practical meaning: the decision belongs to the family or adult client; you neither book, recommend nor promote DAT, and you have no financial or referral tie to any provider; ASAT urges professionals to take special care before recommending or promoting it [source: ASAT synopsis; synthesis].
A mood lift is not a treatment effect. Practical meaning: reviewers attribute the documented brief gains to novelty, water, attention and excitement, not dolphins [source: Marino and Lilienfeld 2007; Salon 2021]; help families judge outcomes against baseline over time.
Physical safety first. Practical meaning: dolphins are large wild animals and injuries are documented [source: ScienceDaily 2007; Brakes and Williamson 2007]; water carries drowning, cold-water shock and hypothermia risks; insist on medical screening and route water-safety questions to national lifesaving bodies (e.g. RNLI, Swim England) [uncertain: not verified]; cross-refer Domain X 196 (cold-water immersion).
Infection runs both ways. Practical meaning: screen for immune suppression and open wounds and involve the physician; the WDCS report notes brucellosis risk to humans and human respiratory infections in dolphins [source: Brakes and Williamson 2007; Salon 2021].
Animal welfare counts. Practical meaning: IAHAIO bars wild and exotic species from interactions and requires handlers able to read stress and discomfort [source: IAHAIO 2018, pp. 8-10]; captive dolphins cannot escape contact and food is used to secure participation, which Marino calls "a coercive practice" [source: Brakes and Williamson 2007, p. 6; Salon 2021]. Raise this as information, not as a moral test of the family [synthesis].
The child's assent and right to stop. Practical meaning: a child who shows fear or distress stops, whatever has been paid [synthesis].
Cost is a harm, not a side issue. Practical meaning: explore money, travel, debt and fundraising openly; providers have disclaimed outcomes in contracts [source: Brakes and Williamson 2007, p. 15].
Compassion for desperation. Practical meaning: reviewers describe providers targeting desperate parents of children with disabilities [source: ScienceDaily 2007]; meet the hope with warmth, not ridicule [synthesis].
Multiple relationships and competence. Practical meaning: avoid any role with a provider that could impair your objectivity (APA Ethics Code Standard 3.05, Multiple Relationships) [source: APA Ethics Code]; work inside your competence and refer medical, developmental and water-safety questions [synthesis].

4. Intervention inventory

The sources describe what DAT providers do, not therapist procedures, so the procedures below are therapist-side work built on what the sources document; each is marked [synthesis] unless a source is named for a step. None involves delivering DAT.

4.1 Find out exactly what is being proposed

Purpose: know which programme, format, setting and staff the family is considering. Use at the first mention of DAT.
Steps: (1) Ask for the provider's name, country and materials. (2) Identify the format against the range WDCS describes: poolside reward sessions, tank or sea-pen swims, fin rides, feeding, or wild swims [source: Brakes and Williamson 2007, p. 3]. (3) Ask who runs sessions and what their qualifications are. (4) Ask what the provider claims it will achieve and how it explains the mechanism. (5) Note how far along the family is: curious, saving, booked, or returned. [synthesis]
Example language (illustrative): "Before we talk about whether it fits, can you show me what they've sent you? I'd like to understand exactly what would happen there."
Watch for: claims of "healing", sonar or ultrasound effects, or that a short block equals months of conventional therapy, which the sources record as unsupported [source: Brakes and Williamson 2007, pp. 8-10]. Working if: you can describe the programme back accurately.

4.2 Elicit the goals behind the request

Purpose: move the conversation from the method to what the family wants for the child or what the adult wants for themselves.
Steps: (1) Ask what they hope will be different afterwards. (2) Translate hopes into concrete goals (e.g. more words, longer attention to a task, steadier mood, joy for a seriously ill child). (3) Ask what has and has not helped so far. (4) Note which goals are therapeutic and which are about an experience or a family memory. [synthesis]
Example language (illustrative): "If this trip went as well as you could imagine, what would you notice in her the next week? And in six months?"
Watch for: goals that belong with a speech-language, occupational, physical or medical professional; a wish for a special experience that is being framed as therapy. Working if: goals are specific enough to take elsewhere.

4.3 The informed-decision conversation

Purpose: give the evidence plainly so the family can decide, as Marino and Lilienfeld recommend [source: Marino and Lilienfeld 2007].
Steps: (1) Ask permission to share what reviews say. (2) Give the one-line status: reviews of the studies found them flawed and no lasting benefit beyond brief mood improvements, for autism or any other condition [source: Marino and Lilienfeld 2007; ASAT synopsis]. (3) Explain why short-term gains appear: novelty, water, attention, excitement [source: Marino and Lilienfeld 2007; Salon 2021]. (4) Note that IAHAIO, the international body for animal-assisted interventions, excludes wild and exotic animals from interactions, and that ASAT strongly discourages DAT [source: IAHAIO 2018, p. 9; ASAT synopsis]. (5) Ask what they make of it. (6) Offer written sources. [synthesis for structure]
Example language (illustrative): "I'll tell you honestly what the research shows, and then it's your decision. The studies that exist are weak, and none shows lasting change. What they do show is that children often enjoy it and feel good for a while."
Watch for: the family hearing criticism of themselves; testimonials or a single dramatic story outweighing the evidence; effort justification after a long wait or great expense, which Marino and Lilienfeld flag as a bias in study participants [source: Marino and Lilienfeld 2007]. Working if: the family can state the evidence in their own words, whatever they decide.

4.4 Distinguish therapy from a wish or leisure experience

Purpose: let a family choose a dolphin swim, if they still want one, for what it is.
Steps: (1) Note that some charities arrange swims for seriously ill children and describe them as not specifically therapeutic [source: Scotsman 2007]. (2) Ask whether the family wants an experience or a treatment. (3) If an experience, the same safety, infection and welfare questions still apply (4.7-4.10). (4) If a treatment, return to 4.3 and 4.12. [synthesis]
Example language (illustrative): "There's a difference between a day he'll love and a treatment that changes his development. Which of those are you looking for?"
Watch for: guilt at wanting joy rather than progress; pressure from relatives or fundraising supporters. Working if: the family names its aim without shame.

4.5 Cost and financial-harm review

Purpose: make costs visible before money is committed.
Steps: (1) Ask about total costs: programme fees, travel, accommodation, lost earnings, other children's care. Reported examples run to thousands of US dollars for a two-week programme, before travel [source: Seattle Times 1999; Brakes and Williamson 2007, p. 14]. (2) Ask what the contract promises; WDCS quotes a provider stating success is not part of the contract [source: Brakes and Williamson 2007, p. 15]. (3) Ask about debt, loans, crowdfunding and what else the money could fund. (4) Ask about refund terms if the child cannot take part. [synthesis]
Example language (illustrative): "Let's add up the whole trip, not just the sessions. What would the same money buy in therapy closer to home?"
Watch for: debt, sale of assets, or a sense that the money has already been spent and so the trip must go ahead. Working if: the family weighs cost explicitly.

4.6 Questions to ask a provider

Purpose: equip a family that is still considering a programme to evaluate it.
Steps: help the family put these questions to the provider in writing [synthesis]: (1) Who leads sessions, and are they licensed health or education professionals, as IAHAIO's definition of animal-assisted therapy requires [source: IAHAIO 2018, p. 6]? (2) Are goals set and progress documented? (3) What medical screening is required, and what are the exclusion criteria? (4) Where do the dolphins come from: captive-bred or wild-caught? (5) Who is the attending veterinarian, and how are the animals' stress and discomfort monitored [source: IAHAIO 2018, pp. 9-10]? (6) How are injuries recorded and reported, and what insurance covers participants? (7) Which authority, if any, regulates the facility? (8) What does the contract say about outcomes and refunds?
Example language (illustrative): "A reputable provider should be glad to answer these. If they can't or won't, that's information too."
Watch for: no licensed professional, no written goals, wild-caught animals, no injury reporting, no regulator. Working if: the family returns with answers or decides not to proceed.

4.7 Medical and water-safety screening referral

Purpose: ensure a physician has assessed fitness for water and animal contact. Use whenever a client is going.
Steps: (1) Ask the family to see the child's physician before booking. (2) Name the qualitative concerns for the physician: heart conditions, epilepsy, pregnancy, medicines, swallowing or airway problems, mobility and the risk of cold-water shock, hypothermia and drowning. (3) Route water-safety questions to national lifesaving bodies (e.g. RNLI, Swim England) [uncertain: not verified]; cross-refer Domain X 196. (4) Do not give advice on medicines; the physician decides. [synthesis]
Example language (illustrative): "Before anything is booked, I'd like his doctor to look at this, especially with his seizures. They'll know what's safe for him in water."
Watch for: providers that do not ask for medical information. Working if: written medical clearance or a decision not to go.

4.8 Infection-risk discussion

Purpose: raise zoonotic and reverse-zoonotic risk.
Steps: (1) Explain that disease can pass both ways between dolphins and people [source: Salon 2021; Brakes and Williamson 2007, p. 5-6]. (2) Name brucellosis as a disease WDCS reports dolphins can carry, and note the survey it cites of marine-mammal workers reporting rashes and injuries [source: Brakes and Williamson 2007, p. 5]. (3) Ask about immune suppression, open wounds, skin conditions and recent illness; IAHAIO notes screening may be needed where immunosuppressed people are involved [source: IAHAIO 2018, p. 8]. (4) Refer to the physician. (5) Note that hospital AAI infection-control practices vary widely even with domestic animals [source: Dalton et al. 2020]. [synthesis for structure]
Example language (illustrative): "Animals and people can pass infections to each other. Because of her treatment, it's worth asking her medical team before she goes in the water with any animal."
Watch for: fever, rash, wound infection or flu-like illness after a trip; route to medical care and mention the animal contact. Working if: the physician has been consulted.

4.9 Fear, phobia, sensory and trauma history

Purpose: identify clients for whom a large animal or deep water is frightening or overwhelming.
Steps: (1) Ask about fear of water, of animals, of being touched or held. (2) For autistic children, ask about sensory responses to noise, cold, wet, crowds and new places. (3) Ask about past frightening experiences in water or with animals. (4) Ask how the child shows distress and how the family knows the child wants to stop. [synthesis]
Example language (illustrative): "How does he let you know he's scared or has had enough, especially if he can't say it in words?"
Watch for: pressure to push through distress because the session is paid for. Working if: the family has a clear picture of the child's distress signals.

4.10 Consent, assent and a stop plan

Purpose: protect the child's right to refuse or stop.
Steps: (1) Help the family explain the experience to the child in a form the child can understand (pictures, simple words). (2) Seek the child's assent and agree how the child can say no. (3) Agree in advance that the family will stop if the child shows fear or distress, regardless of cost. (4) For adults, confirm they know the evidence, risks and costs (4.3, 4.5, 4.8). [synthesis]
Example language (illustrative): "Let's decide now, while it's calm, what would make you take her out of the water. Then you won't have to decide in the moment."
Watch for: staff overriding a child's refusal; parents feeling they cannot stop. Working if: a written or rehearsed stop plan exists.

4.11 Animal-welfare information and the animal's signals

Purpose: give families who care about animals the welfare facts, and explain why animal-assisted interventions depend on the animal's willingness.
Steps: (1) Explain that IAHAIO requires animals in interventions to be healthy, to enjoy the activity, and to be handled by people trained to read stress and discomfort, and excludes wild and exotic species from interactions [source: IAHAIO 2018, pp. 8-10]. (2) Share, attributed, the welfare concerns reported: captive dolphins cannot escape human contact; stress can cause ulcers, disease and death; pools cannot meet the needs of social, wide-ranging animals; food is used to secure participation [source: Brakes and Williamson 2007, pp. 6, 15; Salon 2021]. (3) Note that capture from the wild, common outside the US, carries high mortality [source: ScienceDaily 2007; Brakes and Williamson 2007, p. 7]. (4) Let the family weigh this with their own values. [synthesis for structure]
Example language (illustrative): "Good animal-assisted therapy depends on an animal that wants to be there and can walk away. That's very hard to arrange for a dolphin in a pool. Does that matter to you?"
Watch for: shame or defensiveness; a child or teenager who is upset by the welfare issue. Working if: the family's decision reflects their values, whichever way.

4.12 Map the goals to evidence-based services

Purpose: direct the family's hope and money toward services that can address their goals.
Steps: (1) Take each goal from 4.2. (2) For communication goals, speech-language therapy; for motor goals, physical and occupational therapy; for developmental or behavioural goals, the child's developmental team and evidence-based autism services; for adult mood, evidence-based psychological treatment. (3) If the family values water, aquatic or hydrotherapy delivered by qualified professionals; WDCS notes water, the main distinctive element, can be replicated in hydrotherapy [source: Brakes and Williamson 2007, p. 12]. (4) If the family values animals, animal-assisted interventions with domestic animals that meet IAHAIO definitions and the standards of bodies such as Pet Partners, PATH Intl. or Eagala [uncertain: not verified]; hippotherapy is delivered by licensed physical, occupational or speech-language therapists [uncertain: not verified]. ASAT notes no evidence DAT outperforms cheaper animal-assisted options [source: ASAT synopsis]. (5) Make referrals. [synthesis]
Example language (illustrative): "He lit up around animals and loved the water. Those are real clues. Let's find a qualified therapist near home who can use both, every week, not just for two weeks."
Watch for: substituting one unproven therapy for another; waiting lists that make DAT feel faster. Working if: referrals are made and attended.

4.13 Collaborate with the child's team

Purpose: keep decisions inside the child's ongoing care.
Steps: (1) With consent, inform the paediatrician, speech-language, occupational and physical therapists and school. (2) Ask them for current goals and baselines. (3) Share the family's interest so the team can respond consistently. (4) Plan continuity if the family travels. [synthesis]
Example language (illustrative): "Would it help if I talked to her speech therapist? She'll have the clearest picture of where her language is now."
Watch for: the family hiding plans from the team; mixed messages. Working if: the team and family share one plan.

4.14 Preparation if the family proceeds (harm reduction)

Purpose: reduce harm when an informed family decides to go.
Steps: (1) Confirm medical clearance (4.7) and infection screening (4.8). (2) Record a baseline of the child's skills with the child's existing therapists. (3) Agree realistic expectations: enjoyment and perhaps a brief mood lift. (4) Confirm the stop plan (4.10). (5) Ask the family to note any injury, bite or illness and seek care. (6) Keep ongoing therapy in place and plan to resume immediately. (7) Schedule a debrief. [synthesis]
Example language (illustrative): "You've decided to go, and I respect that. Let's make it as safe as we can and keep everything else going so he doesn't lose ground."
Watch for: stopping existing therapy to fund the trip. Working if: the plan is written and existing therapy continues.

4.15 Debrief after participation

Purpose: process the experience and judge change honestly.
Steps: (1) Ask what happened, what the child enjoyed, and anything frightening. (2) Ask about injuries, bites, rashes or illness and route to medical care. (3) Compare the child's skills with the baseline over the following weeks, with the child's therapists. (4) Name that brief mood gains are common and do not mean lasting change [source: Marino and Lilienfeld 2007]. (5) Process disappointment and cost. (6) Resume the treatment plan. [synthesis]
Example language (illustrative): "It sounds like she had moments of real joy. Let's keep watching over the next weeks, with her therapists, to see what stays."
Watch for: pressure to return or buy more sessions; distress at lack of change; guilt. Working if: the family returns to the ongoing plan with a realistic picture.

4.16 Working with hope, desperation and grief

Purpose: address the emotional drivers that make families vulnerable to unproven treatments, which reviewers say providers target [source: ScienceDaily 2007].
Steps: (1) Acknowledge the family's love and effort. (2) Explore what it means to them to try everything. (3) Explore grief for the child or future they expected. (4) Explore exhaustion and isolation. (5) Help them find hope in things that can be done. (6) Offer parent support or a family therapist if needed. [synthesis]
Example language (illustrative): "Wanting to try everything is what loving parents do. I wonder what it would mean to you if this didn't work."
Watch for: depression or burnout in a parent; marital conflict over the decision. Working if: the family can talk about grief and hope together.

4.17 Supporting a family after harm

Purpose: help a family or client injured, made ill or financially harmed.
Steps: (1) Ensure medical care for any injury or infection, telling clinicians about the animal contact. (2) Help them document what happened and report to the facility and to local authorities (see Harm account). (3) Address guilt, anger and self-blame. (4) Address financial strain and practical help. (5) Screen the child and parent for trauma reactions after a frightening incident and treat or refer. [synthesis]
Example language (illustrative): "You made the best decision you could with what you were told. What happened isn't your fault."
Watch for: post-traumatic stress symptoms; fear of water or animals spreading to everyday life. Working if: symptoms ease and the family is back with ongoing care.

4.18 Adult clients seeking DAT for depression or wellbeing

Purpose: respond to adults drawn to dolphin swims for mood.
Steps: (1) Note that the strongest study (adults with mild to moderate depression) compared dolphin swims with snorkelling without dolphins and still had serious flaws [source: Marino and Lilienfeld 2007]. (2) Explore what the client hopes for: awe, nature, connection, a break. (3) Offer evidence-based depression treatment and behavioural-activation framing (cross-refer Domain II 040) for valued activities, including nature contact. (4) If they still go, cover 4.7, 4.8 and 4.11. [synthesis]
Example language (illustrative): "What's pulling you toward the dolphins? If it's awe and being in nature, let's look at how to build more of that into your weeks."
Watch for: spending as escape; a wish for a single cure. Working if: valued activities increase and mood improves.

4.19 Your role, boundaries and documentation

Purpose: protect the client and you.
Steps: (1) Do not recommend, book or promote DAT; ASAT urges care before recommending it [source: ASAT synopsis]. (2) Avoid any financial or referral relationship with providers (APA Ethics Code Standard 3.05) [source: APA Ethics Code]. (3) Document the information you gave and the family's decision. (4) Do not write letters supporting DAT for funding or insurance. (5) Stay within your competence and refer. [synthesis]
Example language (illustrative): "I can't recommend this programme, but I'll support you whatever you decide, and I'll help you get the best care for him."
Watch for: requests for supportive letters; pressure to endorse. Working if: your notes record the conversation and the decision.

4.20 Safeguarding check

Purpose: act if a child is placed at risk.
Steps: (1) Distinguish an informed family decision from coercion or neglect of necessary medical care. (2) If a child is being harmed, forced to continue against distress, or denied needed treatment, follow local safeguarding procedures and consult. [synthesis]
Example language (illustrative): "I'm concerned that stopping his medical treatment to pay for this could put him at risk. I need to talk with you about that."
Watch for: abandonment of essential medical care. Working if: the child's essential care continues.

5. Handling problems

No source addresses therapist-side difficulties with DAT; all responses are [synthesis] except where a source is named.

The family is already committed (booked, paid, fundraised). Do not reopen the decision repeatedly. Give the evidence once, clearly (4.3), then move to harm reduction (4.14) and a debrief (4.15). Keep the relationship; families who feel judged may stop telling you their plans.
"It worked for another child we know." Acknowledge the story; explain that single cases cannot separate dolphins from novelty, water, attention and natural development, the confounds reviewers name [source: Marino and Lilienfeld 1998, 2007]; return to the family's own baseline and goals.
"You're against anything that isn't mainstream." Treat as a rupture: acknowledge the frustration, name your aim (their child's progress and safety), and show the same evidence standard applies to all options you suggest.
Anger at you after a disappointing trip. Expect displacement of disappointment and loss; repair by validating, not saying "I told you so", and refocusing on next steps (4.15, 4.16).
Parents disagree. Use a joint session; let each state hopes and fears; separate the decision from the marriage; look for shared goals both can fund.
Overwhelm and burnout in a parent. Slow the pace; address caregiver strain directly; refer for respite, parent support or the parent's own therapy.
Non-adherence to referrals for evidence-based services. Explore barriers: waiting lists, cost, distance, past bad experiences, hope invested elsewhere; problem-solve each.
The child shows fear or distress at the facility. The stop plan applies (4.10); afterwards, check for lasting fear of water or animals and treat if it persists (4.17).
Injury, bite or illness after a session. Route to medical care at once, telling clinicians about the dolphin contact; WDCS and major news report bites, broken bones and infections risk [source: Brakes and Williamson 2007, pp. 4-5; Seattle Times 1999]; support documentation and reporting (Harm account).
Water-specific concerns (cold-water shock, hypothermia, drowning, seizures in water). Do not advise on water conditions or durations; route to the physician and national lifesaving bodies [uncertain: not verified]; cross-refer Domain X 196.
Request for a supporting letter for funding or insurance. Decline, explain why, and offer a letter supporting evidence-based services instead (4.19).
A colleague refers or promotes DAT. Discuss the evidence and IAHAIO's position collegially; if a colleague has a financial tie to a provider or misrepresents evidence to families, consult your professional body's ethics guidance.
An adult client returns wanting more trips. Explore the function (awe, escape, hope) and redirect to sustainable valued activities (4.18).
Virtual, animatronic or "dolphin-free" alternatives. Nathanson himself tested an animatronic dolphin and concluded that cost and other limits make dolphins impractical for therapy on a global scale [source: Brakes and Williamson 2007, p. 9]; such options avoid animal welfare and injury risks but remain without good evidence of lasting benefit, so the same informed-decision approach applies [synthesis].

Harm account

What was actually done

Dolphin Human Therapy (Key Largo, Florida). Run by the psychologist David Nathanson, it offered children with disabilities, many travelling from abroad, short intensive programmes in which the child worked on motor or speech tasks set by a therapist and, on success, a trainer directed a dolphin to interact with the child as a reward [source: Seattle Times 1999]. Children with autism, cerebral palsy, Cri-du-chat syndrome, tuberous sclerosis and other conditions took part; Nathanson's 1997 study reported 17 sessions over two weeks and claimed DAT "significantly increases motivation, attention span" and motor and speech skills faster and more cheaply than conventional therapy [source: Marino and Lilienfeld 1998]. In 1999 the Seattle Times reported a two-week programme cost $6,500, with one visiting family spending a further $45,000 on travel and other expenses; WDCS reported US$7,850 for two weeks or US$11,800 for three weeks in 2006, excluding flights and accommodation [source: Seattle Times 1999; Brakes and Williamson 2007, p. 14].
Other formats. Poolside interactions with a swim as reward, swimming in tanks or sea pens, dorsal-fin rides, feeding and caring for the dolphin, and swims with wild dolphins; programmes spread from the US to Europe, the Middle East, Asia, Latin America and the Caribbean [source: Brakes and Williamson 2007, p. 3]. In 2021 Salon pictured a dolphinarium at the Okean medical centre that had begun offering dolphin therapy that year [source: Salon 2021].
Supply of dolphins. Outside the US, dolphins are often captured from the wild; Marino described Japan's drive hunts, in which animals are killed or die of panic and young animals are selected for marine parks [source: ScienceDaily 2007]. WDCS describes capture by high-speed boat chase and rough handling, with mortality risk rising sharply during and just after capture [source: Brakes and Williamson 2007, p. 7]. Food is used to secure the dolphins' participation in touching and riding [source: Salon 2021].
Regulation. In the US, the National Marine Fisheries Service lost jurisdiction over captive-dolphin programmes after a 1994 court challenge by Mirage Resorts, and the Department of Agriculture's proposed guidelines stalled [source: Seattle Times 1999]. On 2 April 1999 APHIS suspended enforcement of its swim-with-the-dolphin regulations and asked for comment on, among other things, whether therapy sessions for people with disabilities should be covered [source: Federal Register 64(63), 1999]. ASAT reports that DAT facilities are not regulated by any official body [source: ASAT synopsis].

How it caused harm

Physical injury. Dolphins are large wild animals; Marino warned that injury is "a very real possibility" when a child is placed in a tank with one [source: ScienceDaily 2007]. A 1994 Fisheries Service study found dolphins in swim programmes often became sexual and aggressive without close trainer monitoring, biting, body-slamming or trying to mount swimmers, often targeting women and children; the Seattle Times reported an adult swimmer whose bones were broken when a dolphin struck him [source: Seattle Times 1999]. WDCS cites reports of injuries including unconsciousness, a ruptured spleen and broken ribs, bites requiring emergency care in Bermuda in 1999, a child bitten by a beluga in Canada in 2000, and an adult woman with a broken rib and punctured lung after being struck in a sea pen in Cuba in 2006 [source: Brakes and Williamson 2007, pp. 4-5]. Even non-aggressive contact can injure because of the animals' size and strength [source: Brakes and Williamson 2007, p. 5].
Infection. Marino and Lilienfeld note "a significant risk of infections and parasitism" for both species [source: Marino and Lilienfeld 2007]. WDCS cites brucellosis as a serious disease that dolphins can carry and a survey in which nearly a quarter of marine-mammal workers reported skin rashes or reactions; humans can also pass infections, such as respiratory infections, to dolphins [source: Brakes and Williamson 2007, pp. 5-6; Scotsman 2007].
Financial and opportunity harm. Families paid thousands of dollars plus travel and lost earnings [source: ScienceDaily 2007; Brakes and Williamson 2007, p. 14], under contracts that, in one quoted case, excluded success [source: Brakes and Williamson 2007, p. 15]. Marino describes DAT as charging "desperate parents a lot of money" [source: Salon 2021]. Money and time spent may displace evidence-based services [synthesis].
False hope and its aftermath. The only documented benefit is a short-lived "feel good" effect [source: Marino and Lilienfeld 2007]; families told otherwise may face disappointment, guilt and further spending [synthesis].
Harm to dolphins. High mortality during wild capture; captive stress linked to ulcers, disease and death; confinement and sensory deprivation; inability to escape human contact [source: Brakes and Williamson 2007, pp. 6-7, 15; Salon 2021].
Most at risk. Children with developmental disabilities and their families, especially those travelling far at great cost; immunocompromised participants; children and women, whom aggressive dolphins targeted in the 1994 study [source: Seattle Times 1999; ScienceDaily 2007; synthesis].

Recognising it today

Claims and phrases: dolphin "healing"; claims that dolphin sonar or ultrasound heals; claims that a short block equals months of conventional therapy; "jump-starting" development; brain-wave or relaxation-state explanations [source: Brakes and Williamson 2007, pp. 8-10; ScienceDaily 2007]. These are unsupported.
Rebrandings: "dolphin encounter", "swim with dolphins for special needs", "dolphin-assisted activity", medical-centre dolphinariums, and wish trips described as therapy [synthesis; Salon 2021].
Red flags in a provider or colleague: no licensed health professional leading; no documented goals or outcome measures; wild-caught animals; no injury reporting or veterinary oversight; contracts that disclaim outcomes; testimonials in place of evidence; waiting lists and urgency; requests for supportive letters [synthesis; Brakes and Williamson 2007, pp. 14-15].
How legitimate animal-assisted interventions differ: domestic animals only, not wild or exotic species; a formally trained, licensed professional; planned goals with documented progress; animal welfare and stress monitoring; veterinary care and hygiene; screening for allergies and immunosuppression [source: IAHAIO 2018, pp. 6-10].

What to do instead and how to help those harmed

Alternatives: speech-language, occupational and physical therapy and evidence-based developmental and autism services for the child's goals; aquatic or hydrotherapy with qualified professionals where water is valued [source: Brakes and Williamson 2007, p. 12]; domestic-animal interventions meeting IAHAIO definitions [source: IAHAIO 2018]; evidence-based psychological treatment for adults [synthesis]. ASAT strongly discourages DAT and notes no evidence that it outperforms cheaper animal-assisted options [source: ASAT synopsis].
Assessment of affected clients: medical review of injuries and of any fever, rash or illness after contact; trauma screening after a frightening incident; assessment of financial strain, guilt, grief and family conflict [synthesis].
Treatment: trauma-focused treatment where post-traumatic symptoms follow an injury; graded, consented work if a fear of water or animals has developed; family support for grief and decision regret (4.16, 4.17) [synthesis].
Ethical, reporting and legal duties: do not recommend or promote DAT and avoid any financial tie to providers (APA Ethics Code Standard 3.05) [source: APA Ethics Code; ASAT synopsis]; document the information given; help families report injuries to the facility and to local animal-welfare or public-health authorities and seek legal or consumer-protection advice for financial harm [uncertain: which authority applies varies by country]; follow safeguarding procedures if a child is coerced or denied essential care [synthesis].

Sources

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