Referring Your Grieving Clients to Mental Health Professionals

The first step to referring your clients to a counselor is to decide under what medical and/or emotional circumstances, you will refer. These guidelines can vary widely. For instance, some veterinary teams inform every one of their clients who experience pet loss about local support groups, pet loss counselors, pet loss support hotlines, books, videos, and other materials available through the hospital’s lending library. This is usually done by providing clients with a packet of written materials at the time of their pets' deaths. With referral names or website addresses in hand, clients are made aware of the resources available to them and can choose for themselves which, if any, they want to use.

Other veterinary teams make referrals on a case-by-case basis. They assess which of their clients may be in need of extended support-based services by examining several factors. These factors include the strength of the human-companion animal bond, the circumstances surrounding their patient's death, their client's personal social support system, and their client's ability to cope.

Even if information is provided though packets of written material, there may still be clients who will need your gentle verbal guidance in order to pursue additional support. To be effective, you must be comfortable making referrals in a compassionate and supportive manner. If you do not do this well, the referral may alienate or even anger clients. However, if the referral is articulated delicately and gently, clients are made aware of the resources available, while at the same time feeling empowered to make decisions on their own.

Basic training in making a mental health referral helps ensure that your referral will be seen as supportive rather than as a suggestion to “see a shrink.” There are several techniques that can be used so clients understand the sincerity of your intentions, your understanding of the emotional situation they are experiencing, and your dedication to helping them find the support they need to help them through a very difficult time.

These techniques include: Self-Disclosure, The Illusion of Choice, The One Down Approach, The Medical Analogy, and The Back Door Approach. You may find there is a particular technique that you feel the most comfortable with or your choice of techniques may vary with the situation. The following are examples of each:

Self-Disclosure: This technique normalizes, or gives credibility to your clients’ thoughts, feelings, behaviors, and experiences.

"Thomas, I can see how difficult Bo's death is for you. Here at the clinic, we work closely with someone who specializes in helping people with the grief they feel after their pet has died. Many of our clients talk with her once or twice, and they have said that it has really helped them. From time to time, the staff here also finds it valuable to meet with her and discuss some of our most difficult cases, too. Would you like me to give you her name and number?"
The Illusion of Choice: This technique allows your clients to feel empowered by the information as well as remain in control. While you are steering them toward the choice you’d like them to make, your clients can still feel respected and appreciate the information you have provided even if they decide not to work with a counselor.

"Thomas, we covered the diagnosis, prognosis, and treatment options for Bear last week, but I sense you are still feeling overwhelmed by the information and confused as to what decision to make. I'd like to have you talk with someone that many of our clients look to for additional support and guidance when faced with decisions regarding their pets' care. Would you like to call her and arrange a time to talk, or would you prefer that I ask her to call you?"
The One-Down Approach: Using the words counseling, therapy, or even mental-health professional when making a referral may cause some clients to think you are implying they are “crazy.” The “One-Down” technique allows you to offer another avenue of support as their peer, rather than as an authority figure.

"Thomas, I appreciate that you trust my judgment, but aside from the difficulty you are experiencing about the decision of whether or not to treat Bo, it is clear to me that you are not receiving the support you may need from your family. While I wish there was some way that I could be of greater help, I feel that what you are experiencing is beyond my expertise. I would like to recommend someone who has extensive experience in helping people who are struggling with decisions about their companion animal. Would you like me to give you his name and number?"
The Medical Analogy: Many clients are familiar with the “continuum of care” model within the human health care system and understand the nature of this referral system for providing extended treatment. This technique facilitates referrals for clients who may be “stuck” in their grief.

"Thomas, if you had a broken arm, you wouldn't walk around for three weeks without having it assessed by an expert. The same is true with a broken heart. I know someone who can assess your emotional pain and guide you through the process of healing. Would you like me to call him and see if he can set up an appointment to see you today or tomorrow?”
The Back-Door Approach: If a client feels that a referral is not aimed directly at them, it can be less threatening. For instance, clients may be more receptive to accepting your referral if they believe it’s on behalf of their spouse or children. This technique can be quite successful towards helping clients adjust to the idea that they, as well as their family, may benefit from additional support.

"Thomas, I know that you have two children. Have you thought about how you might tell them of Bo's illness or involve them in his treatment? I would like to recommend a professional who specializes in assisting both children and adults during emotional times. Before you leave, I’ll give you her name and number.”

You may have to refer clients for additional support several times before they are ready to actually talk with a mental-health professional. Clients who are reluctant to seek professional help are often the ones who continue to ask you to help them with their grief, but it's important for you to continue to abide by the limits and boundaries of your role as a veterinary team member. This means you need to sensitively, but consistently, continue to provide them with the appropriate referral to the counselor with whom you work, regardless of whether or not they actually follow through with seeking help. It’s important to realize that, for many people, talking with a counselor makes their pet’s death seem more real. Thus, many people avoid the encounter for as long as possible.

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