This is Part 9 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 making referrals.
Situation: Making Referrals
Joan, a good client of many years, doesn’t seem to be handling the loss of her cat very well. When you ask her about it, she replies, “My daughter died three years ago and Betsy was her cat. That cat slept on the bed beside my daughter every day while she was sick. Losing Betsy is like losing Janie all over again…I don’t think I can bear to feel the grief again.”
Assessment: What’s Going On Here?
In the opening scenario, the cat’s death represents what is called a symbolic loss. A symbolic loss is one that is associated with a previous loss in life. A companion animal may represent a pet owner’s last living link to a special person, place, thing, or time in life. The pet’s death can destroy that living link.
Although pet loss is significant in its own right, the grief the client feels may be greater when the loss triggers memories of a previous loss than when no previous loss is associated with the pet. Symbolic losses are just one of many types of loss that can complicate the grieving process. A variety of factors may be present when a pet dies. These factors can intensify the grieving process, make the grieving last longer than usual, and/or cause it to be reactivated more easily later than when no complicating factors exist. Clients who experience pet loss that is symbolic, traumatic, unexpected, or complicated in some way by its association with other difficult circumstances are good candidates for referral to mental health professionals and grief support programs.
Plan: Support Protocol for What to Say and Do
Lay the Foundation (Step 1)
- Assess which of your clients may be in need of extended support by making referrals by examining factors present in the client’s history and current circumstances. These factors may include:
- The strength of the client’s bond with the pet
- The circumstances surrounding the pet’s death
- The client’s personal loss history and support system
- The client’s ability to cope
- When one or more of these factors seem to be suspect, the client is probably a good candidate for referral. For example, if you have had previous conversations with a client about her child who recently died and the solace she found in the company of her dog, your assessment of her need for further support would probably be high.
- Screen your referral resources prior to your need for them. Not all mental health professionals understand or are skilled in working with issues of grief. Likewise, not all grief counselors are sympathetic to issues of pet loss and pet owner grief. If you are interested in teaming up with a mental health professional, it is important to get to know something about your potential candidates and to choose wisely.
- There are many ways to make professional support available to clients. However, even if professional support exists, it won’t be of help if you are uncomfortable making referrals. Practice stock phrases you can use to let clients know about the human service resources that are available. Be sure to pair these words with nonverbal helping techniques such as touch, direct eye contact, and other attending behaviors.
Implement Support Techniques (Step 2)
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Written Materials
In cases like the one in the opening scenario, it is not your responsibility to meet your clients’ needs for ongoing grief education and support. These kinds of cases go beyond what you are qualified to do. This is a good time to refer clients to a professional grief therapist or grief support group. One of the most effective ways to do this is to give every client who experiences pet loss a packet of written materials describing local support groups, pet-loss counselors, and pet loss support hotlines. With referral names, addresses, and telephone numbers in hand, clients are made aware of the resources available to them and can choose for themselves which, if any, of these services would benefit them.
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Self-Disclosure on a Case-by-Case Basis
Another way you can make referrals is on a case-by-case basis. When speaking directly to a client who could benefit from further support, you can use self-disclosure and say something like, “I know how hard Betsy’s death is for you. I work with a person who specializes in helping pet owners deal with the grief they feel after their pet dies, especially in a situation like yours where there is a connection between Betsy and Janie. Many of my clients talk with her at least once, and it seems to help a great deal. I talk with her about cases that are tough for me, too. I’d like to give you her name and number.”
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Normalizing
Normalize your client’s grief by saying something like, “It sounds as though the connection between Janie’s death and Betsy’s death is complicating your grief. This is actually very common. I know your feelings can be sorted out, but I’m just not trained in this area. I do know someone who can help you, though. I know her well and recommend her highly. Shall we call her now to see if she has some time free, or would you like me to have her call you?”
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“Back-Door” Approach
Many adults seek help for their children or for another member of their family even if they are reluctant to ask for help for themselves. You might say something like, “Joan, I know you and Paul have other children. Have you thought about how you might help them cope with the connection between Janie’s and Betsy’s deaths? There are some really effective ways to help children deal with loss, and I work with a person who can provide you with this information. Here’s her name and number.” This is called the “back-door” approach and is usually less threatening for clients, since they do not perceive the referral as aimed directly at them.
Stay Connected through Follow-up Care (Step 3)
- You may need to refer a client to a mental health professional, social worker, or pet-loss support group several times before they are ready to actually talk with one. For many people, there is a stigma attached to talking to a counselor. Thus, they avoid the encounter for as long as possible. However, clients who are reluctant to seek professional help are often the ones who continue to ask you to help them with their grief. It’s important for you to continue to abide by the principles of your paraprofessional helping role. This means you need to sensitively, but consistently, decline to provide these clients with further help and continue to refer them to the counselor with whom you work, regardless of whether or not they actually seek help.
Making Referrals: Role-Play Ideas
- For hospital managers and client care specialists: Use the opening scenario to practice supporting a client by referring them to outside support. Be sure to normalize and acknowledge the client’s feelings.
- For veterinary technicians: Use the opening scenario to practice how you would tie Betsy’s and Janie’s deaths together and encourage the client to contact a counselor or grief support group. Be sure to ask the tough questions about the client’s intentions and make a referral or help the client find outside help. Alert your veterinarian to this conversation and bring them up-to-date regarding the client’s comments and your referrals.
- For veterinarians: Use the opening scenario to practice normalizing the client’s grief over Betsy and Janie. Provide good grief education and practice phrases or methods you can rely on for making referrals. For example, most clients are familiar with the process of being referred to an ancillary health care service in human medicine. You might say something like, “Joan, if you had a broken arm, you wouldn’t walk around for three weeks without having it looked at. The same is true with a broken heart. I know someone who can help you with the process of healing from both Janie’s death and Betsy’s death. Let’s call her now and see if she can set up an appointment to see you today or tomorrow.”
IMPORTANT: For situations where a client expresses suicidal ideation, you will need additional support and resources. Look for a future blog on this subject and also contact the Suicide and Crisis Lifeline by dialing 988. This helpline can be called by the person who is experiencing suicidal ideation or by someone who is concerned for another person.
Keep up the good work,
Laurel Lagoni
Co-Founder
World by the Tail, Inc.