The role of clinic staff in helping clients cope with their pet losses (Proceedings)

Veterinarians have the unique position of experiencing their patients' deaths at a rate seven times that of human physicians, frequently leading them into unique shared emotional experiences with clients whom they have known for many years (Hart, Hart, and Bain, 2006). Relationships of veterinarians with families focus on the animal and tie into rich and rewarding emotional connections, stretching over a period of years as the animal proceeds through the life cycle. Each family's relationship with an animal combines a person and an animal who are unique, making for a relationship that is one-of-a-kind. Yet, the emotions associated with that close relationship are similar across families. When the animal dies, the feelings of loss may be very similar for different people, so that friends and family members often can empathize with the deep feelings of loss that arise at such times.

Animals central in many relationships

Many people have circumstances that impose particular requirements for their veterinary care, due to their own emotional or medical situation, or the special working role of the animal (AVMA Committee on the Human-Animal Bond, 1995). Particular thought is worthwhile for dealing with grieving clients, those clients or patients who have physical disabilities, assistance animals, hospitalized clients, allergic or immunocompromised clients, or those who are extremely emotional or possibly violent. Consciously preparing for such potentially challenging occasions can facilitate them going more smoothly. Veterinarians today see companion animals filling a wide range of roles in families, sometimes also performing specific tasks as service animals. Often clinics establish methods of providing reminders in the record to indicate persons who are extremely involved with their animals, or vulnerable in particular ways, as an assist in making it easier to provide personalized care to such individuals.

Stress for the veterinary team

As veterinarians approach clients whose animals are dying, it can difficult to realize that the clients may be as affected in the loss as the veterinarians would be in a similar situation. Although the study was reported almost twenty years ago, it may still be true that veterinarians easily can underestimate the attachment that their clients feel for the animal, and the emotional consequences of losing the animal (Catanzaro, 1988). Understanding what the client is going through perhaps can ameliorate the stress for the veterinary team and position the experience as a loss shared by the client and veterinarian.

Though widely acknowledged, the stress of performing euthanasia is not well-studied. Animal shelter workers who were surveyed concerning euthanasia-related strain provided evidence of increased general job stress, work-to-family conflict, somatic complaints, and substance use, and lower levels of job satisfaction (Reeve, Rogelberg, Sptizmuller, and DiGiacomo, 2005). For veterinarians, at least some degree of emotional separation is essential to their ongoing psychological well-being, perhaps especially because the emotional experience of the veterinarian and the owner is closely entwined (Sanders, 1995). Healthful strategies of self care for the veterinary team are essential, so that the accumulated losses do not build up as a burden. Recreation and shared supportive sessions among team members are among strategies mentioned by veterinarians as being useful for coping (Hart, Hart, and Mader, 1990).

Stress for the pet's family

The pain and grief associated with losing a companion animal is well-publicized. At such times, the sensitivity of the client to every aspect of treatment becomes hypervigilant. The client's primary wish first of all to be treated with respect is probably emphasized at such times (Case, 1988). The widespread availability of support for grieving due to pet loss via hotlines (Mader and Hart, 1992) and support groups (Hart, Rivero, Mader, and Hart, 1987) has demonstrated and educated the public to know that people may be seeking relief, support, and solace when grieving or upset concerning a companion animal. Perhaps less understood is the variability in patterns of grieving.

For some individuals, the loss of an animal can be overwhelming. Among those who are seriously affected, grieving over a year can be expected, as was found among people who had called the University of California, Davis, Pet Loss Support Hotline. Indeed, some people never get over it. For an elderly person coming near the end of life, it can be symbolic that the good times are only in the past.

Losses can get strung together. Grieving is not a linear process that follows a prescribed pattern. Rather, a particular tragic episode with an animal may just get added upon another major loss, unleashing the grieving that did not occur earlier for multiple losses. After losing other family member(s) and then a pet, a person may experience this loss as the last link, as can particularly happen for an elderly person.

Challenging decisions

With the increased range of high-tech treatments available, the availability of hospice care, and the option for euthanasia of animals, people and their veterinary advisors are faced more than ever with weighing the animal's quality of life and discomfort, the economic factors, and the animal's prognosis overall when deciding on a course of action. These emotional issues especially affect the technical support veterinary staff who spend time with the clients as they are searching for answers.

Self care, fostering mental health, for veterinary staff and pet owner

The capacities to work and love over time are extremely important indices of mental health (Vaillant, 2003). For many people, animals are pivotal figures in their working and loving. During periods of rapid change, challenges, or loss, keeping a balance that is supportive of mental health and appropriate coping responses can be facilitated by increasing social supports and interpersonal safety and facilitating nervous system health through rest and nutrition (Vaillant, 2003). Positive emotions are healthful, facilitating self-care, innovation and creativity, and ultimately supporting longevity (Danner, Snowden, and Friesen, 2001).

What is new over the past decade in veterinary medicine is a much clearer idea of strategies for self care for both veterinarians and clients. Veterinarians can better help themselves, and also coach others in healthful steps that move toward mental health and feeling better. Mental health professionals working in the area of euthanasia counseling and pet loss have contributed their skills to this field, and provided concrete methods that are helpful. Working with real veterinary cases at the Animal Medical Center, the Colorado State University, the University of California, Davis, the University of Pennsylvania, social workers, counselors, and psychologists have brought their expertise to the context of pet loss and put forward improved methods for fostering mental health during these difficult circumstances. For example, the Colorado group developed a practical guide for communicating with clients who are facing grief with loss of a companion animal (Lagoni, Butler, and Hetts, 1994). Carolyn Butler (2001a) has provided specific suggestions for establishing family friendly policies for the veterinary workplace in the areas of time management, family-related resources, on-site support, and financial plans; she also specifies some very concrete needs of clients (2001b).

Conclusions

Dealing with pet loss has been an area of rapid change and improvement in care for the client and the veterinary team. Some resources and search templates that can aid in locating research literature on this topic are available through the UC Davis Program for Companion Animal Behavior: http://www.vetmed.ucdavis.edu/CCAB/main.htm

References

AVMA Committee on the Human-Animal Bond. 1995. AVMA guidelines for responding to clients with special needs. Journal of the American Veterinary Medical Association 206, 961-976.

Butler, C. 2001a. Staff and self-care in a bond-centered practice. World Small Animal Veterinary Association World Congress, Vancouver, 2001.

www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00146.htm

Butler, C. 2001b. Pet owner care in a bond-centered practice: Providing effective emotional support. World Small Animal Veterinary Association World Congress, Vancouver, 2001. www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00145.htm

Case, D. B. 1988. Survey of expectations among clients of three small animal clinics. Journal of the American Veterinary Medical Association 192, 498-502.

Catanzaro, T. E. 1988. A survey on the question of how well veterinarians are prepared to predict their client's human-animal bond. Journal of the American Veterinary Medical Association 192, 1707-1711.

Danner, D. D., Snowden, D. A., and Friesen, W. V. 2001. Positive emotions in early life and longevity: Findings from the Nun Study. Journal of Personal and Social Psychology 80, 804-813.

Hart, B. L., Hart, L. A., and Bain, M. J. 2006. Canine and Feline Behavior Therapy, 2nd ed. Ames, Iowa: Blackwell Publishing.

Hart, L. A., Hart, B. L., and Mader, B. 1990. Humane euthanasia and companion animal death: Caring for the animal, the client, and the veterinarian. Journal of the American Veterinary Medical Association 197, 1292-1299.

Hart, L.A., Rivero, C. A., Mader, B., and Hart, B. L. 1987. A pet loss support group: Evaluation of the first year. California Veterinarian 41(2):1315, 26.

Lagoni, L., Butler, C., and Hetts, S. 1994. The Human-Animal Bond and Grief. Philadelphia: W. B. Saunders Co.

Mader, B., and Hart, L. A. 1992. Establishing a model pet loss support hotline. Journal of the American Veterinary Medical Association 200, 270-274.

Reeve, C. L., Rogelberg, S. G., Sptizmuller, C., and DiGiacomo, N. 2005. The caring-killing paradox: Euthanasia-related strain among animal-shelter workers. Journal of Applied Social Psychology 35, 119-143.

Sanders, C. R. 1995. Killing with kindness: Veterinary euthanasia and the social construction of personhood. Sociological Forum 10, 195-214.

Vaillant, G. E. 2003. Mental health. American Journal of Psychiatry 160, 1373-1384.