A veterinarian on behaviour therapy

Interview with Veterinarian Richard Baeke.
By Laure-Anne Viselé, October 2010

About Richard Baeke

Richard Baeke is a veterinary doctor in the Netherlands. He has been practising veterinary medicine for 3 years, and likes to keep himself up-to-date on companion animal behaviour issues. We met at the Angela Stockdale workshop, and hit it off discussing the overlap between behaviour therapy and veterinary medicine. We took our discussion to the next level and organised an interview.  The article below is the transcript of our chat.

Richard treating an iguana

Canine behaviour therapy and veterinary medicine: overlapping disciplines

Canine behaviour therapy is, in many ways, still in its infancy. In my view, in order to truly add value in society, it still needs a stronger regulatory body to govern:

• consistent standards of conduct and
• standard professional qualifications.

Until the field professionalises itself, it may be difficult to define and, to a certain extent, trust, its representatives. In most countries, anyone and everyone can declare him/herself a canine behaviour therapist, leading to a number of well-meaning, but not necessarily fact-based, up-to-date, or effective professionals.

Given the difficulty in finding qualified behaviour professionals, many veterinarians have had to fill the therapeutic knowledge gap and give behaviour advice themselves. Given that not many veterinary colleges teach companion animal behaviour, a vet’s behaviour advice is often, well, not necessarily fact-based, up-to-date, or effective…

This status quo is reminiscent of the tensions between medical doctors and budding psychologists back when psychology was fighting for recognition as a legitimate discipline.  I would like to see history repeat itself from the GP-psychologist relationship to the vet-therapist relationship, whereby:

• The generalist veterinarian initially establishes the existence of a behaviour problem, and refers his/her clients to a vetted (‘scuse pun) network of behaviour specialists; and
• The behaviour issue is then followed up by the vet and behaviour specialist as a multi-disciplinary team.

And this is where Richard Baeke comes in: he is one of the proponents of a greater collaboration between behaviour specialists and veterinarians. He is investing a lot of time and energy in exploring the skills and knowledge in the market  in order to strike effective partnerships from an informed position.

His vision, thirst for knowledge, enthusiasm, open mind and scientific mindset are essential ingredients in encouraging this partnership. Here’s what he had to say about the whole thing.

About veterinarians and behaviour knowledge

LAURE-ANNE: Would you agree that there is a serious deficit in behaviour specialists among veterinarians?

RICHARD: Yes, as far as I know, Dr Rudy de Meester is the only veterinarian in Europe who has earned the title of behaviour specialist.

LAURE-ANNE: Him and Ian Dunbar, of course. And of course Dr. Nicholas Dodman (at Tufts University, Cummings School of Veterinary Medicine, Grafton, MA), and Dr. Sophia Yin are major players in this field.

Canine behaviour qualifications

LAURE-ANNE: About animal behaviour qualifications courses, I understand that Rudy de Meester has founded a post-graduate course on applied animal behaviour in association with the University of Leuven (Belgium). And the University of Utrecht offers a Masters degree in companion animal behaviour.

But as far as the standard veterinary curriculum is concerned, (at least as of August 2010, when I contacted the veterinary college of Utrecht), there were no in-depth behaviour-related modules. The closest thing was a short (optional) module on neurology.

Were there adequate modules on behaviour when you were studying?

RICHARD: Actually, I studied at the Utrecht University.

They have have just started a behaviour clinic there [but this is related to the Masters in Companion Animal Behaviour, and not veterinary studies].

It’s true that there weren’t any in-depth behaviour modules as part of my veterinary degree. These were our choices:

• a short (optional) module on behaviour focusing on recognising signs of stress and anxiety, and not on specific therapeutic methods to deal with problem behaviours; and/or
• a short practical placement at a behaviour clinic for a couple of weeks as part of our practical rotation.

But it has all changed a lot recently since the University went over to to the Bachelors/Masters system, so I can’t speak of the latest course offerings.

LAURE-ANNE: So if you graduate from vet school now, you are no longer a doctor, but a master in veterinary medicine!? What a shame. It’s the end of an era!

RICHARD: This system is good for people with a veterinarian background who do not want to be a practitioner. Most universities had already switched to the Bachelor/Master system, actually. Utrecht was one of the last ones to follow suit.

LAURE-ANNE: I had a bit of an academic U-turn myself: I did my Bachelors in Zoology and my Masters in … IT.

Veterinarians advising on behaviour problems

LAURE-ANNE: But back on topic.

A lot of my friends and acquaintances ask me for dog behaviour advice and, when I talk to them, they invariably tell me: “That’s not what my vet has told us”. There seems to be a common practice, at least in Belgium, of veterinarians giving specific behaviour advice. Is is the norm where you work?

RICHARD: No, not at all. Our consultations are ten to fifteen minutes long so, to start with, there is no time to address the dog’s behaviour at depth. Our role as far as behaviour problems are concerned is to detect potential problems needing serious attention, and then to refer the owners to a suitable professional.

I do sometimes see dogs for a totally different reason, and end up referring  them to a therapist when I suspect there is a potentially serious behaviour issue.

There was this young dog (6 – 8 months), for example, with extreme anxiety. He snapped at me when I tried to handle him. Most dogs are nervous while at the vet’s, but the owners confirmed this was his normal demeanour. So I gave them a contact form for a behaviour therapist.

LAURE-ANNE: What was the outcome?

RICHARD: I got a report from the therapist a few weeks later. It showed real improvement. The process mainly involved educating the owners in how to best handle situations that were stressful for the dog.

It is unlikely that this  dog will ever be the boldest, but he is now a lot more confident and finally comes to his owners spontaneously, tail wagging. It’s not yet one year old, so he may even grow out of it completely.

Number of vet visits dedicated to behaviour problems

LAURE-ANNE: Do some clients visit the surgery for the sole purpose of addressing a behaviour problem?

RICHARD: Hardly ever. We work from 8am til 6pm, five days a week, with 10 to 15-minute consultations. That makes about 700 consultations a month. Out of all of these, less than 2 visits per month relate exclusively to the animal’s behaviour.

These numbers do not accurately represent the incidence of significant canine behaviour problems, of course, as people either do not see anybody about them, or they contact behaviour therapists or trainers. In the absence of a central log, one can only guess at the number of canine behaviour problems requiring therapy.

Most commonly reported behaviour problems at the vet’s

LAURE-ANNE: What about people who ask about a behaviour-related issue as a by-the-way in a physical consultation? What are the common issues?

RICHARD: We get a lot of questions about fireworks phobia, which I see it as part of a generalised anxiety problem which happens to come to light during fireworks week (late December in Holland). There are often subtle precursor signs, like the dog cowering every time it hears a truck. But the owners fail to notice until the problem is expressedin a more extreme form.

So I would say that the most commonly reported behaviour problems we see are anxiety, and related aggression issues. In 80% of the aggression cases we see, there is a link to anxiety. Signs of anxiety are often missed by the owners, who only become aware of the problem once it translates into aggression.

Behaviour problems: where the vet can help

LAURE-ANNE: Are there behaviour problems you feel qualified to advise on yourself?

RICHARD: There are some things which I recognize in the consultation room, like tips around raising puppies. One such tips is to advise them to go to a puppy course.

Euthanasia and behaviour problems

LAURE-ANNE: What happens when you are presented with a dog with such severe behaviour problems that the owners demand it being put down?

RICHARD:  When I graduated, I swore to myself that I would not euthanise an animal unless there truly was no better option and I’ve held myself to that promise. There are some very difficult cases, though, and I am realistic enough to know when all practical options have been exhausted.

Once there was this aggressive Bernese Mountain Dog (about four years old), for example. The owners brought a report from a behaviour therapist attesting to the extreme nature of the aggression.

I did put that dog down because:

• The owners had genuinely tried the therapy option,
• It was a large, unreliable dog, and therefore a potential danger, and
• The owners were no longer capable of managing the dog safely.

LAURE-ANNE: What a difficult decision. But yes, re-homing to the average household is completely inappropriate when it comes to a large dogs with an aggression problem. That leaves the option of overburdening the shelter system, which is obviously also less than ideal.

RICHARD: Yes, you do not want to have an incident on your conscience, in case the dog attacks its new adoptive owners.

About euthanasia

LAURE-ANNE: What about cases where clients come to you with a dog with extreme behaviour problems, but have not explored all the options on time? If the client pressures you to euthanise the dog, what can you do?

RICHARD: When I get the feeling that the problem could have managed if they’d come earlier, I really don’t want to be part of the euthanasia process. I am realistic enough to know that they’ll go to another veterinarian, though. So sometimes, I have to put it down because there are no more realistic options for that dog. The owners left it too late.

Owner commitment and prognosis

LAURE-ANNE: There was an interesting study that showed a statistically significant correlation between the owner’s commitment to the dog at the time of starting the therapy, and the likelihood of a successful outcome. If the owner was already contemplating re-homing or euthanasia, then the prognosis was much poorer. Your gut instinct about the “point of no return” closely reflects exactly that.

RICHARD: But it’s not all about owner commitment. We had a couple of very committed owners a few months ago, but it still was not enough. They tried therapy for their aggressive Springer Spaniel for two or three months, and we still had to put him down.

LAURE-ANNE: It wasn’t the “Springer rage syndrome”, was it? A while back, a significant number of Springer Spaniels in the UK were diagnosed with a condition whereby the dog would, without warning, provocation, trigger or gradation, enter into a sudden and brief state of extreme aggression. Most owners characterise the attacks as completely out of character.

But despite the wide publicity that this diagnosis got, it is a very rare condition, and it turns out that the aggression bouts are most often were related to the usual suspects:

• resource- and territory-guarding,
• dominance aggression and/or
• fear biting.

RICHARD: In this case, the problem started when the family cat died. The dog had become very insecure and started to fiercely guard certain spots. The dog would go in hind-brain (i.e. in the red zone) in these episodes. As soon as the owners clipped the leash on, he would snap out of it.

LAURE-ANNE: It sounds like both these cases had a strong environmental component (the cat’s death, territorial/resource guarding, the leash). I do not think that’s compatible with the ‘Springer rage’ syndrome.

Behaviour problems: do owners wait too long?

LAURE-ANNE: So a lot of people leave behaviour problems unchecked too long? Why do you think that is?

RICHARD: Yes, many owners definitely leave it so long that the problem is no longer easily manageable. It’s always best to address the problem early. I have noticed  that dogs that show behaviour problems at a young age often come back when they are two to three years old, after several behaviour incidents.

I wish people knew to come to us for behaviour problems too, not just medical problems. I am not saying that we would treat the problem, but we could confirm to them whether they need a referral.

As to why many clients leave it so late, I could speculate about three reasons:

• People either do not recognise the problem for a long time (some signs can be quite subtle), or
• They think they can handle it themselves with books and using the internet, or
• They have contacted a behaviour therapist but the treatment was unsuccessful. In my mind, this is in great parts related to:
  • The owners’s expectations of a quick outcome;
  • The owners finding themselves incapable of applying the protocol consistently; and
  • The owners becoming aggravated at the problem too readily.

Vetting behaviour therapists

LAURE-ANNE: The third point you make (unsuccessful treatments) begs the question of the quality of the work of that behaviour therapist. I realise that there are no guarantees when it comes to behaviour and animals, but the market is currently severely lacking in uniformity in quality standards.

So it can be very tricky to find a good all-round behaviour therapist. I know of many in the region, but I find it difficult to assess the quality of their work in terms of the recency and scientific quality of their techniques, their success rate, customer satisfaction and their philosophical position.

I would say that the market is slightly more mature in the US/UK, where the dog training and behaviour therapy professions are slightly more established and therefore subject to more scrutiny. This makes it easier to shop for a good dog trainer or behaviour therapist.

LAURE-ANNE: So, what do you see as an essential skill in a behaviour therapist?

RICHARD:  I would say refraining from making the owners feel guilty. Most owners already feel so bad about the situation. Adding the pressure of guilt can only lead to defensiveness and bad feelings. There is a wide array of dog owners and canine behaviour problems and all of them should be managed differently. Angela Stockdale showed the kind of empathy and people skills I am talking about.

You see major trends in the dog training and therapy world. Ten years ago, it was extremely important to correct bad behaviour. But nowadays, that is no longer in favour. You can tell how modern a therapist is in light of their position in that regard.

Referring behaviour therapists

LAURE-ANNE: Increasingly (at least in the UK and US), you see a relationship establishing itself between veterinarians and the behaviour therapists. They (excuse the pun) ‘vet’ each other’s work practices and philosophical positions, and enter into a relationship of mutual referrals with compatible partners. This allows for behaviour problems to be approached by a multidisciplinary team with mixed medical and behaviour backgrounds.

Does your practice have such a relationship with local behaviour therapists?

RICHARD: We often refer clients to a reputed therapist, Peter Beekman. He is the author of “de Black-box methode”, a very respected book about dog behaviour.

Behaviour therapy referral: follow-ups

LAURE-ANNE: In this relationship, have you established follow-up and feedback processes both from the therapist and from the owners?

RICHARD: We manage the follow-up through our medical records. We make a note of the reported problem, and ask about progress at the next visit. I also follow up directly with the therapist on a periodic basis.

But I would like this to be formalised into a more targeted information system. So I am working on a set of forms and reports to support the follow-up process and to build some statistics.

Puppy socialisation

LAURE-ANNE: The American Veterinary Society on Animal Behavior issued a position statement on puppy socialisation (2008) supporting early attendance to (positive) group training classes despite incomplete vaccinations at that age. What is your position on puppy classes?

RICHARD: I highly encourage attendance to puppy classes.

The risk that your dog will contract a lethal disease in puppy class is significantly smaller than the risk of an insufficiently socialised dog developing a behaviour problem. The boosters are on 6 , 9, and 12 weeks respectively, and most people start with the puppy course around 11 weeks. Actually, most puppy courses even start from 12 weeks.

But I do not see a big danger in starting the course around 11 weeks, because by then the dog has had a significant portion of its vaccinations, and is not exposed to close contact with other pups or their faeces (owners are instructed to let their dog out and briefly fast them before the class).

Fireworks phobia

LAURE-ANNE: About fireworks phobia, I was taught that the most successful approach is two-pronged: medication and behaviour therapy. Have you been involved in such cases?

English springer spaniel

RICHARD: Yes. I really encourage preventive measures for fireworks, like desensitisation through puppy classes and following up at home with an audio CD.

I think that in most cases, you can really get results even without medication provided the owners are motivated enough. I also think that even in extreme cases, the problem can be brought back to manageable proportions for every dog with enough time and effort. But most of the time, progress feels too slow to the owners, and because they are not relaxed themselves, the dog shows very little progress.

In more severe cases, a dual medication/therapy approach may be advisable to put the dog in a more relaxed state ahead of the therapy. I am not talking of sedatives, which are the equivalent of ‘cutting the dog’s legs off’ and having it face its worst fear, to re-use an analogy by Rudy de Meester, but of anti-depressants and optionally anxiolytics.

LAURE-ANNE: So what medications are frequently prescribed for severe anxiety and phobias?

RICHARD: One is called Alprazolam (Xanax for humans). It is the first-choice anxiolytic (drug reducing excitement) by the Dutch Veterinarian Society.  Owners are advised to start experimenting with dosages a few weeks before the real need arises, so it is necessary to plan ahead. This is an issue when many owners come to us with as little as 24 hours’ notice. You would administer Alprazolam a couple of days before the predictable cause of acute stress.

As far as anti-depressants are concerned, there is Clomicalm. Rudy de Meester actually has a two-pronged approach for the short-term, combining behaviour therapy and Clomicalm. This has the advantage of taking the worst of the stress off to better prepare the dog for desensitisation training (which should start as early as September). But Clomicalm can make the dog lethargic in high doses.

LAURE-ANNE: Mmmmh. The human penchant for quick-win approaches can make that anticipatory approach difficult. It is likely that the problem will seem too abstract to owners weeks before the actual crisis.

RICHARD: Yes, we do observe that people tend to come too late. But public awareness on the subject is improved from many initiatives such as:

• Puppy classes with a fireworks desensitisation component when starting in September.
• Veterinary presentations to training schools (I am doing one myself in a few weeks, actually)
• Behaviour therapists spreading the information to their clients
• Advertisements in pet stores
• Leaflets in veterinary waiting rooms

Essentially, the message is: Sedating your dog on the day of the fireworks without any prior desensitisation is bordering on animal abuse.

Fear of vets

LAURE-ANNE: Fear of vets is a very common problem in dogs for the same reason many humans fear the dentist: every time the dog goes in, something unpleasant, or even painful, happens.

Does your clinic have a preventive desensitisation programme? Essentially, allowing owners to visit the examination room for nothing other than  a quick treat several times a month.

RICHARD: We absolutely welcome that sort of initiatives on the part of the owners. In fact, have a puppy consultation programme broadly following that approach.

I can speak for the whole practice when I say this: Please do just bring your dog in regularly just for a treat. It takes the vet five seconds and will save them a lot of time when actually examining the dog.

I would advise you to find out from your local practice what the more convenient times would be to do this, and I would really keep doing this regularly.

About breed-specific behaviour problems: nature versus nurture

LAURE-ANNE: In your experience, are certain breeds associated with certain behaviour problems?

RICHARD: [Richard takes a long pause to think] No, not really.

LAURE-ANNE: That’s good to hear, because public opinion is rather set against Staffies and Pitbulls, for example. With the resulting hotly debated Breed-Specific Legislations.

RICHARD: Actually, we see a lot of Staffordshire bull terriers at our surgery. They are a very popular breed. Staffies tend to be among the most docile and cooperative in the examination room. I think problem Staffies would sooner show aggression to other dogs than to humans anyway.

LAURE-ANNE: Oh totally. They were especially bred for self-control and bite inhibition in situations of high arousal (mid-fight) to prevent redirected bites to the human handler breaking the fight.

Aggression and genetics

RICHARD: But about the genetic component of aggression: I have read studies of Golden Retriever and Bernese mountain dogs displaying an inherited kind of aggression.

But in practice, virtually all the aggression cases I see have a very clear environmental components. Mostly, it’s a case of the dog learning to use aggression as a means of coping with stressful stimulus.

I have only seen one case where “aggression” stemmed from a physical cause. In that case, it was related to epilepsy. Also, (partial) blindness can result in aggressive episodes. There are very easy management tips for that: just avoid startling the dog.

Almost all other aggression cases are triggered by hormones or environmental problems, and very often inadequate education methods.

Hormones and behaviour

LAURE-ANNE: You mentioned hormones. I consider them to be on the physical side.

RICHARD: Yes, I think hormones are in the middle in the nature/nurture continuum.

LAURE-ANNE: I see what you mean. They can be the barometer of the dog’s internal state rather than the cause of the dog’s behaviour.

RICHARD: I think that hormones can intrinsically trigger aggression, but I also think that even a dog with endocrine problems can be adequately managed through therapy alone.

About hormones, there is an interesting study showing that some bitches can show increased aggression during menstruation, actually.

LAURE-ANNE: A bit like human females, then?…

RICHARD: he he he [non committal, clever man].

There isn’t really a consensus on the influence of hormones on aggression, actually. I have read a study concluding that females should be neutered to limit the risk of aggression, while another suggested the exact opposite.

There is also that study where female pups in a mainly male litter showed abnormal aggression through testosterone ‘contamination’ in the womb. As oestrogen inhibits the aggression-triggering effects of testosterone, it would then be advised not to sterilise the female in that case.

So there is definitely not one answer when it comes to hormones and behaviour. I think every dog is different. But I really do not think you can speak of a behaviour problem purely caused by  endocrine causes. There is nearly always an environmental cause, and solution.

Purely genetic or physiological behaviour problem?

LAURE-ANNE: So in your practice, you have never come across a behaviour problem that was 100% physical (genetic or neurological) and not at all environmental?

RICHARD: There was perhaps this Bernese mountain dog,whose owners told me was getting unreliable. They explained that they didn’t trust the dog any more. They saw this strange look in the dog’s eyes at times and were becoming nervous of their own dog. We took some blood samples and ruled out secondary epilepsy (caused by organ failure). By elimination, we treated for primary epilepsy, and that has completely resolved the problem.

They came to me right on time and did not wait until an incident. If there had been an incident, the environmental role would have compounded the behaviour issue.

Standard physical tests for behaviour problems

LAURE-ANNE: You mention that you did some blood work. Is there a standard pannel of usual tests to run for behavioural complaints? Because in the US, it is becoming increasingly frequent to do a full check-up (including blood work, scan, etc.) upon reporting a behaviour complaint.

RICHARD: I think the culture in the Netherlands is quite different. People are less ready to spend so much money on their pet. Many American books are quick to recommend a total battery of medical tests including blood works, ultra sound, x-ray, etc.

We can do all of this if people really want it, and we may advise it if it can genuinely help our diagnosis, but we definitely don’t do this systematically.

This is where a sustained relationship with a behaviour therapist also helps. The behaviour therapist we contact, Peter Beekman, will systematically flag a physical problem for us to check if he thinks there is one.

Also, I always ask direct questions relating to:

• elimination,
• drinking,
• eating,
• activity level,
• etc,

And we do a complete physical exam at each consultation (hearing, feeling, eyes).

Contact details

Richard works for the Visdonk Animal Hospital in Roosendaal (the Netherlands).

This large, modern clinic has state-of-the-art diagnostic equipment for companion and farm animals. The clinic also offers 24/7 on-call emergency service.

The veterinary team consist of practitioners of the following specialities:

• veterinary surgeon;
• ophtalmology (eye);
• specialists for pigs, horses, and cows;
• specialists for exotic animals and ferrets;
• internal medicine specialist;
• endoscopy and arthroscopy;
• orthopaedics;
• dentistry; and
• echography.

Dierenkliniek Tolberg, Tolbergcentrum 53, 4708 GB Roosendaal.

Tel: 0165 533508.

Mail: dierenhospitaal@visdonk.nl

Any comments?

Do you have any comments? I am particularly interested to hear from you if you have a position with regards to the following:

• The advisory role of vets on behaviour problems
• The standards of service and qualifications of behaviour therapists
• The results of behaviour therapists: Have you contacted one and want to sing their praises? Or do you feel the process was a waste of time?
• The need for qualified behaviourists (i.e. MSc or PhD in Animal Behaviour) and veterinarian behaviour specialists

So don’t be shy, leave a comment.

You can also vote on the important dog issues to let your position be heard.