Stephanie W. Johnson, LCSW
Veterinary Health Care Teams are confronted daily with complex issues of attachment, loss and grief. Your patience, compassion, and acceptance are an important part of your response and a client's reactions to the grief process. We will look at each stage and how you can help clients navigate the stages of the grief process.
Clients in denial can prove frustrating and try your patience. Remember that denial is a "normal" part of the grief process. Arrange to communicate with the client in person if possible so that you can minimize interruption and/or distraction. Communicate clearly and reiterate patiently. Avoid medical jargon and lapsing into complicated medical explanations. Listen actively. If the client cannot take in any more information, you will notice if actively listening(?), give the client time to think about and grasp the reality of the information given. Then restate the information. Remain nonjudgmental and unhurried toward the client. And don't attempt to "break through" a client's denial. The client will comprehend and accept the reality of the situation at their own pace, when they are ready.
Understand that bargaining is an attempt to control a dire situation. The client feels irrationally compelled to bargain during the grief process. Asking for a second opinion is not personal. Do not become defensive. Provide information/education. Be gentle while reminding the client that the "miracle cure" they've read about on the Internet is futile.
Angry clients are often difficult to get along with. Acknowledge and normalize the anger. Try to communicate in person, sitting at eye level and using attentive body language. Allow the client to ventilate his/her feelings. Acknowledge those feelings. Do not become defensive nor respond in a like manner to the client. Assuage guilt by reassuring the client, if possible, that they did everything possible for their pet and that they made the right decisions for their pet. Remove yourself from the situation to breathe and remember that this client is experiencing anger as part of the grief process and don't take their expressions/behavior personally.
Encourage depressed clients to talk about their feelings regarding their pet. Follow up with clients within a few days of death. Listen actively. Offer the client a private place to sit, offer tissues and/or a drink of water. Normalize crying(?). Offer to call someone within their support system. Encourage means by which the client can memorialize their pet through writing, scrapbooking, planting, making donations etc. Perhaps your clinic has a memorial wall or book that the client can add their pet to. Acknowledge your own feelings regarding each loss. Some of us are uncomfortable with other's emotions; we need to find a comfort level with our own feelings first. Empathizing with clients can be uncomfortable and painful. We must find ways to effectively express our own feelings. It is natural to share a moment/cry with clients; however, we must make sure the moment doesn't become about us.
When a client reaches resolution there may not be much more they need from us. Often, it is during resolution that clients might entertain acquiring another pet. Most clients are able to accept and attach to a new pet, but only when the possibility of replacing the deceased pet is not seen as an option. As clients begin considering the idea of another, I recommend that they visit friends and/or neighbors with pets or even dog parks just to give themselves a chance to assess their reaction. If the reaction is that of the client missing the companionship, or perhaps desiring new friendship this might be an appropriate time to acquire another pet. If the feelings are of loss, despair and frustration, maybe even anger, this is not an appropriate time. The client is still significantly grieving and not ready to attach to another. It is tempting to tell clients of animals in your clinic up for adoption. Proceed cautiously. Although well intended, if the client is not ready to reinvest in a new relationship, the outcome will be further grief and perhaps guilt for the client and unhappiness for the pet.2
There are many helpful resources available to assist clients in their grief and also to assist the veterinary health care team in understanding and educating themselves about grief and loss. A bibliography of written resources is included.
Complications and Referral
There are many factors which can complicate the grief process. These complicating factors may lengthen the time it takes to reach resolution, or in severe cases may arrest progress through the grief process. Early recognition of these factors can be helpful in facilitating a client's grief and may also be important for timely referral in situations where further assistance is required.
Just as keys to attachment can affect grief responses, there are also factors that can complicate grief: 1
Deaths that have no known cause
An unexplained disappearance
Not being present when death occurred
Not viewing the body after death
Witnessing a painful or traumatic death
Deaths that occur in conjunction with other significant life events such as birthdays or holidays
An inability to afford expensive care that was offered
Stories in the media that misrepresent or cast doubt on medical treatment procedures
Advice based on other's negative experiences with death or on inaccurate information about normal grief
Multiple losses occurring within a related time frame
Loss of a pet because of factors that may have been preventable
No experience with previous grief
Not being able to say goodbye
Insensitive comments from others who may not understand the bond between owner and pet
Just because you've identified complicating factors in a client, it does not mean their grief process will be lengthened or arrested. Knowing what factors can complicate grief may help you to help the client.
Knowing what to look for, what a struggling client might look like can help you decide if indeed the complicating factor(s) are impeding the grief process. Here is what complicated grief can look like:
Months following the death, the client is still coming to you to rehash the events surrounding the loss
The client has difficulty speaking of the deceased without experiencing, renewed and intense grief
The client reports ongoing sleep problems
They have symptoms of depression, especially extreme and persistent feelings of guilt, hopelessness, and lowered self-esteem
Their ability to manage everyday responsibilities at work, school, or home is significantly impaired
When grief is complicated and remains unresolved it can lead to other problems, such as depression, anxiety and even physical illnesses. Most members of the veterinary health care team are not taught, educationally equipped or comfortable with responding to clients experiencing complicated and/or unresolved grief. Just as you are taught in your medical training, it is imperative that you know when to refer.
There are many available referral resources for your clients. Many social workers, psychologists, and licensed professional counselors have special training or interest in pet loss and bereavement counseling. There are also pet loss support hotlines, many staffed by the aforementioned and veterinary students in training, and support groups in existence all over the country. A list is included in this section of proceedings. You must set boundaries with clients and yourself as to what you can do, are qualified to do and comfortable with. Actually making a referral to a client might feel uncomfortable, but getting "in over your head" or being "out of you league" may be even more uncomfortable and have negative consequences for you and the client.
Follow up communication is very important for the client and the veterinary health care team. Cards, letters, or even flowers can be sent from everyone involved. Some clinics routinely do something in memoriam of a deceased pet; for example, making a donation to the SPCA in memory of or baking a paw print to send to the owners can be done. These methods of remembrance, not only let the clients know that you care but also allow the veterinary health care team to feel some closure. As a clinic you may also have a scrapbook or bulletin board with which to memorialize beloved pets.
Each client and member of the veterinary health care team will experience the grief process differently. Clients should be made aware of pet loss support groups, pet loss hotlines or local specialists who are knowledgeable about the grief process in regard to pet loss. These support services, even if not used, provide a sense of validation for the caregiver's sense of loss and grief and can be of lasting benefit to everyone involved. Your veterinary health care team needs to take care of itself also. Going through clinic losses during staffing is helpful but being aware of your own grief process is also very important.
Best Friend Gone Project: Suggested Reading List
LSU School of Veterinary Medicine, Baton Rouge, LA
1. Montgomery H, Montgomery M. (1994). A Final Act of Caring: Ending the Life of an Animal Friend. Montgomery Press. (A helpful handbook for those dealing with the difficult euthanasia decision);
2. Montgomery H, Montgomery M. (1991). Good-bye My Friend. Montgomery Press;
3. Morehead D. (1996). A Special Place for Charlie. Broomfield, CO: Partner's In Publishing, LLC. (Children);
4. Quackenbush J, Craveline D. (1985). When Your Pet Dies: How to Cope with Your Feelings. Simon & Schuster;
5. Viorst J. (1971). The Tenth Good Thing about Barney. New York: Macmillan Publishing Company. (Children)
The above five books are available directly from the American Animal Hospital Association. Order by calling 800-252-2242.
1. Anderson M. (1994). Coping with Sorrow on the Loss of Your Pet. Los Angeles, CA: Peregrine Press;
2. Church JA. (1987). Joy in a Woolly Coat: Living with, Loving, and Letting Go of Treasured Animal Friends. Tiburon, CA:
3. HJ Kramer Inc.; Euthanasia of the Companion Animal: The Impact on Pet Owners, Veterinarians, & Society. (1988). In W. J. Kay, et al. (Eds.). The Charles Press;
4. Kubler-Ross E. (1969). On death and dying. New York: Collier;
5. Lagoni L, Butler C, Hetts S (1994), The Human-Animal Bond and Grief. Philadelphia: W. B. Saunders;
6. McElroy SC. (1996). Animals as teachers and healers. Troutdale: New Sage Press;
7. Mooney S. (1983). A Snowflake in My Hand. Dell Publishing;
8. Neiburg HA & Fisher A. Pet Loss: A Thoughtful Guide for Adults and Children; Pet Loss and Human Bereavement. (1984). In W. J. Kay, H. A. Nieburg, A. H. Kutscher, R. M. Grey & C. E. Fudin. Ames, Iowa: Iowa State University Press;
9. Quackenbush J, Graveline D. (1985). When your pet dies: How to cope with your feelings. New York: Simon & Schuster; Rogers, F. (1988). When a Pet Dies. New York: G. P. Putnam's Sons. (Children);
10. Ross CB, Baron-Sorenson J. (1998). Pet loss and human emotion: guiding clients through grief. London: Taylor & Francis; Rylant, C. (1995). Dog Heaven. New York: The Blue Sky Press. (Children);
11. Rylant C. (1995). Cat Heaven. New York: The Blue Sky Press. (Children); When Your Pet Dies: Dealing with Grief and Helping Your Children Cope. (1996). New York: Berkeley Books;
12. Wilhelm H. (1985). I'll Always Love You. New York: Crown Publishers, Inc (Children).
1. Lagoni L, et al. The Human-Animal Bond and Grief 1994.
2. Johnson S, et al. "Client Bereavement and the Human Animal Bond" in The Clinical Textbook for Veterinary Technicians2006.