This is Part 6 of our Support Protocols for 14 Common Situations series. The cases described in this series are drawn from everyday scenarios found in general veterinary practice or emergency and specialty practices. Below you’ll find an example of a type of case you’re likely to encounter in practice. This blog’s subject is a case involving a client’s emotional response to pet loss.
Situation: Emotional Response to Pet Loss
One of your clients, Mary, sits in your exam room crying softly as you talk to her. You’ve just given her the news that her Basset hound, Freddie, has cancer. Now you’re providing her with the information she needs to take the next steps. You say, “Should I give you a minute, Mary?” She replies, “No, I’m okay. I’m listening…I’m sorry I’m crying. Freddie is still alive, so I shouldn’t be crying.”
Assessment: What’s Going On Here?
As human beings, we are meant to grieve before, during, and after the death of a loved one. It is a normal, natural, spontaneous, and necessary emotional response process. Mary in the example above is experiencing the very common phenomenon called anticipatory grief. She is also experiencing the common phenomenon of being embarrassed about expressing her emotions. In this section we will deal primarily with the issue of the emotional response to grief such as crying.
People express their grief in many ways, but typical grieving often includes crying. People cry when they are grieving because it is a natural reaction to pain. Crying is an effective way to release emotion and an essential part of the grieving process. Still, like Mary in the opening dialogue, many people feel embarrassed or ashamed of their crying. They may view it as an emotional outburst or a sign of weakness. Dr. William Frey, a biochemist and leading authority on human tears, has noted that “people have the right to be human, to feel, to cry. They need to know there is no need to deprive themselves of the natural, healthy, release of emotional tears.”
Fear of Crying
One of the biggest obstacles to helping others when they cry is the fear that you will cry, too. For this reason, you might find yourself wanting to avoid clients who are upset or even discouraging clients from being present at their pet’s euthanasia. The fear is that, if you have an emotional response, you won’t know what to say or what to do to help your grieving clients. Yet, clients rarely report that they disliked it when a veterinarian or staff member cried. In fact, it often touches clients deeply when you cry with them.
People generally feel better after crying. In general, studies have found that people with supportive friends and family who encourage them to cry are healthier than those who experience less encouragement from others to cry and to discuss their feelings of grief. It follows, then, that the best way you can support your crying clients is to encourage them to “get it out.” Support them while they sniffle, sob, or wail. Some clients may exhibit extreme displays of emotional responses, such as uncontrollable sobbing or a panic attack. If they do, help them work through their waves of emotion. Never leave the room because you assume your clients want to be alone. The act of leaving the room may signal your own embarrassment or disapproval of their grief. All forms of crying are healthy and acceptable. Your job when providing client support is to become comfortable with tears.
Before providing support, prepare yourself to deal with a wide range of expressions of grief. These may include tears, anger, guilt, depression, and even stoicism, flippancy, and relief.
Plan: Support Protocol for What to Say and Do
Lay the Foundation (Step 1)
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Structure the Environment
- Whether you are talking with a client whose pet has died or one whose pet is fatally ill or severely injured, structure the environment in a way that invites and supports the expression of emotion. For example, take the client to a private, comfortable room with soft lighting that provides privacy.
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Give Permission to Cry
- Give the client permission to cry. Offer them a tissue and a place to sit down, saying, “Take your time and let it out, Mary. I’m right here if you need me.” It’s essential always to have a box of tissues in the room. This is one of the most powerful types of nonverbal communication in supporting grief. The presence of tissues tells the client loud and clear that it’s okay to cry and to grieve without feeling that they have to keep up a conversation with you.
Implement Support Techniques (Step 2)
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Acknowledging
Acknowledge your client’s emotional response and expression of grief. You might say, for example, “I can see how sad [or angry, etc.] you are about Freddie’s diagnosis.”
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Normalizing
Normalize your client’s tears and emotions. You might say, “I would expect you to cry and be upset in a situation like this.”
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Responding with Touch
Touch your client lightly on the arm or shoulder or give the client a hug, if you sense that providing nonverbal comfort is appropriate.
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Self-Disclosure
Self-disclose by crying yourself if you’re moved to do so. Crying demonstrates compassion and shows empathy for your client and their pet. If you cry easily, you might say, “I often cry during times like this. I can still do my job, though, and be here for you.”
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Respect Cues for Space
When possible, respect your client’s need to end the conversation or leave your clinic quickly. It can be extremely uncomfortable for some people to show emotions like anger or sadness in public. These clients may feel an urgent need for privacy, especially if they feel they need to cry. Other clients may feel flooded by strong emotions when they hear sad news and need time alone to clear their head before continuing the conversation with you. In situations like these, it’s not uncommon for clients to attempt to end the interaction that was taking place between you. They may do this by shutting down completely (showing no emotion at all and even being unable to speak. Or, they may suddenly start talking a lot and even using inappropriate humor to comment on the situation.
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Understanding Anger
If the client expresses their grief through anger, it is important to understand what is driving that anger and not to become too defensive. Most people who display anger with their grief do so in very short bursts and without any real desire to hurt anyone. If you spend time acknowledging their grief, the anger usually lessens, especially if you use immediacy and make them aware of it. For example, you might say, “Mary, I can hear in your voice how angry you feel about Freddie’s death and I would also imagine that you are feeling terribly sad. There’s nothing fair about this situation and I’m sorry that you have to go through it.”
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Setting Boundaries
If a client’s anger appears to be over the top and you feel threatened, it is necessary for you to set boundaries to protect yourself and your staff. If a client refuses to work with you or becomes inappropriate with their anger, you should tell the client to leave and not return and that you will contact the police, if necessary. Your responsibility to support your client does not supersede your responsibility to ensure a safe working environment.
Stay Connected through Follow-up Care (Step 3)
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Remember that two responses will tell you that your clients appreciate the grief support you provided. They will return to your practice when they are ready to treat their pet (or future pets), or they will call or write you to thank you for your kindness after a pet has died. In short, when you provide high-quality grief support, your professional relationship is likely to continue with an even deeper feeling of mutual care and loyalty.
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Check-in telephone calls should be made as soon after a pet’s diagnosis as possible. During the call, invite the client to contact you with any further questions or concerns and take advantage of the opportunity to educate them about normal anticipatory grief. If you speak with the client in person, provide printed materials about decision-making and preparing for pet loss, along with referrals to local pet-loss support groups, pet-loss counselors, or online resources.
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Some pet owners find it meaningful to have an object that links them to their pet. This object may be a dog’s collar, a cat’s toy mouse, a special blanket, or even a food dish. The object may also be part of the actual animal, such as a feather, the wool of a llama, part of a horse’s mane or tail, a clipping of fur or pawprint set in clay. Consider helping your clients make a paw print, or clip some fur as a forever keepsake of their pet. It’s helpful to reassure clients that, if these objects comfort them, they can be kept in a special place in their home, rather than stuck away in a box or a drawer.
Supporting an Emotional Response Role-Play Ideas
- For hospital managers and client care specialists: Use the opening scenario to practice supporting a client who is crying. You may need to dig a little to get connected with these strong emotions. Practice normalizing the client’s tears. Remember to pay attention to your tone of voice while using the verbal communication skills you will need in this situation.
- For veterinary technicians: Practice supporting a client who has just heard bad news about a beloved pet and begins to cry. Normalize their emotions and respond to the client’s apologies for being upset.
- For veterinarians: Practice supporting a client who is grieving the news of a pet’s terminal illness. Respond to the client’s tears, paying attention to your tone of voice, your word choice, and your demeanor. Also practice supporting a client who expresses other strong emotions, such a sanger or depression. Consider how you would provide nonjudgmental and non-defensive support. Practice making a referral for additional grief support.
Keep up the good work,
Laurel Lagoni
Co-Founder
World by the Tail, Inc.