Peace of Mind for Pet Parents Episode 057: Grieving Before and After Pet Loss: Anticipatory Grief, Trauma, and When to Seek Help (Part 2)

Episode Transcript: 

Karen Wylie: Welcome back to Peace of Mind for Pet Parents. I'm Karen Wylie and this is the second of four conversations with our guest: Judith Eve Rosen, a licensed clinical social worker, veterinary social worker, and author of "Life After Pet Loss". If you're listening to this, there's a good chance you're already in it. Caring for a pet who is aging or ill or moving toward the end of their life and there's a good chance that grief has already arrived even though your pet is still here.

That experience has a name, Anticipatory Grief. It is real. It is valid. And as Judith explains, it can actually hold something quietly, precious inside it if we know how to look. In this episode, we also talk about what happens when loss is sudden and traumatic, what it looks like when grief gets stuck, and how to know when it might be time to reach out for professional support. These are conversations I wish someone had offered me years ago. I'm glad we can offer them to you now.

Many of the pet parents that Gail and I work with are actually living with grief for weeks or months before their pets die— they're caring for an aging or seriously ill animal at home. So I guess I'd like to begin looking at the grief process by starting with anticipatory grief and ask you, I'm curious, how do you see anticipatory grief showing up differently than grief that comes when a loss is sudden?

Judith Rosen: Okay, I'm organizing my head… my response to that, because there's some layers to it. So the way I look at grief in general is grief is a natural human response to any kind of loss. When you are caring for an elderly, senior pet or a pet with some kind of medical terminal condition there's already several losses that are present at that moment, right? 

As you probably know, loss of mobility is a huge one and loss of independence— like you have to do a lot of things for them that maybe you didn't have to do before in terms of feeding, toileting, things like that. There's loss of the activities that you did together, and then there is, what I treat, anxiety a lot of times— and this is a separate thing. This isn't so loss oriented but one of the emotional difficulties during that time for people is "When's it going to happen?" By the way, this happens with humans as well. It's like they don't know when that day is going to be— "Is today going to be the day?" "I don't know."

A lot of people are dreading having to make the decision around euthanasia— How am I going to know when it's right?" "How am I going to know when it's time?" "How do I know if I've let them live too long and they've suffered?" Or "How do I know that I didn't let them go too early?" There's anxiety, there's already depression and loss.

But on the flip side of that, what I have seen with some of the clients that I've worked with, especially the clients that feel comfortable with whatever their medical decisions were and they feel like they've done as much as they could, is that they use that time to really begin to process the loss and talk about it. Talk about what emotions that they're going through which is so important in grief treatment. How sad they're feeling, maybe how angry they're feeling, what they're worried about, talking about what life will be like after the pet passes away. For some people that gives them a chance to treat them with a certain kind of love and care that we don't always do if we don't know that they're not going to be with us next week.

So often you'll hear this with any kind of loss, human or animal. That's "Oh my God, I had wanted to take them to this very specific park and I had wanted to give them this special meal." Or something like that and "I didn't have time to do it", or "I was busy at work, I should have been home with them all week."

Those are some of the regrets. So in some way, anticipatory grief and hospice, I guess you would say, gives you a chance to say goodbye, to bring them all their favorite foods, have them play with their toys, take the week off and just pet them and talk to them and be with them. I think there's multiple aspects of it with sudden loss, then you have the extra layer of trauma on top of that. 

This is a point I really wanted to make tonight. We may have talked about this, I think preliminary to tonight's interview, that I am a licensed clinical social worker. I am a licensed mental health professional, meaning that I can diagnose and treat any kind of behavioral disorder that's in the DSM-5, right? That gives me something extra that I can do for clients than somebody who's a grief counselor doesn't have that training.

And because grief is a natural human process that doesn't have to be or shouldn't be pathologized, that's why it's wonderful to go to a grief counselor or to a grief support group or to a spiritual counselor, priest or a rabbi. 

But for us, I'm looking, when I do my initial evaluation, I want to understand the circumstances of the loss and if there was trauma, because then over the next 30 days, that's acute trauma in the first 30 days. If it's continuing and there are other symptoms to go along with it, then that acute trauma can become PTSD which is something that I am trained to treat. I have a specific type of therapy that I do called Cognitive Processing Therapy and have had a lot of success with it.

Karen Wylie: Can you describe that for us a little bit?

Judith Rosen: Oh, sure, some of the types of traumas that people will have is they'll have a dog that was hit by a car or a cat that was somewhere too high and fell— things like that. There was some kind of accident there. So a Cognitive Processing Therapy comes out of Cognitive Behavior Therapy and it's all about how we think affects our emotions and behavior. Sometimes if we question our thinking a little or process our thinking, we can come up with more information that allows us to see things more clearly and can relieve some of the emotional distress that our thoughts can cause us.

For example, with PTSD people have flashbacks, they feel like it's happening all over again. They have terrible nightmares. They can get triggered by anything and they start avoiding walking in a certain neighborhood where it happened, for example. Or if they hear a tire screeching or a fast car go by, it startles them. So it has that kind of response and a lot of times that's coming from their beliefs about what happened. 

What their beliefs about themselves are: "It was my fault. I shouldn't have opened that door." Or other people, "Why was that driver there at that time?" This shattering of this belief that the world is a safe place as long as we're good people. Bad things happen to bad people. Good things happen to good. "So what did I do wrong? What was the mistake I made that made this thing happen? Why did this happen to me?"

So when they stay focused on that then the PTSD symptoms remain and it can be difficult to go into actual grief and process the grief. CPT is a 12 step program— it's not a 12 step program, it's a 12 session program. I don't want to be confusing.

Karen Wylie: I was going to say, "Wait a minute." 🙂

Judith Rosen: It's got nothing to do with AA. Kathleen Chard, wherever you are, I'm sorry. She's one of the developers of it and I trained with her. It's a very interesting program and I've used it in the clinic with adult survivors of childhood sexual abuse and people that have been mugged on a train, for example. So it's really useful.

What you're doing is, you're not reliving the event because that's another type of therapy— that's like an Exposure Therapy that can be done. But what you're doing is, you're asking them to look at that event and just tell us why you think it happened and how it's changed how you see the world now. From that we can elicit the type of thinking that they're going through— maybe their thoughts that are in their head over and over again. We call them stuck points. Particularly around guilt, as you I'm sure know from.

Karen Wylie: Yes, that's what I was just going to say to you. This is sounding very much like aspects of the grief that we hear discussed because they're not really getting to the grief part. It's the guilt. They're so focused on the guilt. They're second guessing everything that they did. With the benefit of 20/20 hindsight, six months later they are looking back and saying, "I should have done this and I should have done that." It just keeps going round and it's so hard to help them let go of the blame they place on themselves for the decisions they made or didn't make.

Judith Rosen: Exactly! And they leave out the element of chance and people forget, doctors don't know. Medical professionals? They're guessing, maybe they know if, "okay, you take penicillin, it gets rid of your strep throat." But in general, they really don't know what the outcome of a surgery is going to be. There can be so many complications.

So what the Cognitive Processing Therapy does step by step through the first half of it, we teach them how to question those thoughts using some worksheets and some techniques using something called Socratic Questioning. Asking yourself, "Okay, what's your evidence that this thought is true?" What is your evidence that this thought is not true? Or might not be true?" "What information are you maybe leaving out of the story?"

When they walk through the steps of that and you have to do it sometimes several times - they're usually able to see a bigger picture of it and they'll remember more things, "Yes, I had actually forgotten that there were two other vets that came in and gave their opinions that night. I forgot that I had talked to somebody at the hospital before I called my own vet." It all comes back because the trauma's keeping them from really remembering that stuff. So I have had to use that with several cases. Then once we go through that work then we're able to really grieve at that point.

Karen Wylie: So, how would a pet parent who has experienced the loss of a pet and they feel they're having a very difficult time, how would they know where they are in the process? In terms of when they're going through more usual or typical processes of grief over a period of time. And when they need to reach out for some additional help?

Judith Rosen: This is a tough one right now because of how prolonged grief disorder has been prescribed in the DSM-5. DSM is our Bible, if you will, and because we can't do a blood test for depression essentially, right? We have to look at a criteria, does this person meet the criteria for depression or for prolonged grief disorder?

There's certain metrics for that. Prolonged Grief Disorder is that you still are exhibiting severe sadness and yearning and you're unable to function in certain areas of your life 12 months after your person has died. They use the word “person" in there, which means no pets and those of us who are pet loss therapists are like, upset.

Okay, I'm upset. I don't know how the other ones feel, but I'm upset by that.  I've seen that kind of situation with people. So I did the prolonged grief training anyway and what I think is, again it's not official yet, but from my observation of people that are still having a difficult time, not able to go certain places that they used to go, not able to do activities that they used to do, withdrawing, really isolating themselves from the world, and it looks a lot like depression for example. 

Very often it can happen because during those 12 months, they have not processed their grief. In the case studies that we did in the training, it was very much like that. I think if somebody has gone a year and they're really not able to function, they really want to stay home in bed under the covers all day, they used to love going running and they haven't, they don't even go outside to walk, like their life has been severely affected by this loss. I think it's worth seeing a professional and being evaluated.

I don't want it to sound like I'm saying, "You should be over it after a year" because I am so not saying that at all. I'm the last person that's going to say it. 

But I think if you're at a stage where there's a difficulty with functioning and it's been more than a year, I think it's worth just seeing if you can be helped by a therapist. Why not? It's not betraying the memory of your beloved animal companion. Would you even think, if you bonded with your pet and you have this wonderful, loving mutual relationship, right? There's symbiotic in a lot of ways. Do you think, I am going anthropomorphic here, but would you think they would want you to be suffering?

So many of us when we are sad, our pets notice that, right? A dog will come up and lick your face. A cat will look over at you and go, "Get it together..." no, I'm kidding. I'm kidding. Maybe my cat? A cat will come over and maybe cuddle next to you or put their paw on you. So they seem to sense when we're not feeling well, and why would they want us to be suffering? 

If you look at things that way and some people do spiritually look at things that way.  And our suffering doesn't honor our pets when there's some other ways that we can honor them that do not involve suffering. I am, again, if you are sad, you will cry. You will have days that— the other day I was feeling very sad and really missing Joanie, who's the cat that passed away and that's eight years ago.

So there's days you're going to cry and you're going to miss them, and you would give anything for them to be with you at that moment. But I think being able to be of service in some way, being able to live your life in some way that for you has meaning— I think that's a better way to honor your pet. I don't want it to sound like I'm saying, "Just get over it," because I'm so not saying that.

Karen Wylie: No, and I'm not hearing you say that. I don't think or I hope people wouldn't hear that from what you're saying. I've certainly heard that kind of comment of "I can't get another pet. It hasn't been long enough."

It's like they feel that by bringing another pet into their life, they're dishonoring in some way— the pet who died. Again, it's kind of like the pet who has passed on would probably love for you to have another pet to love in your life.

Judith Rosen: And that decision I think in the first year it's definitely such an individual choice because I have seen clients get a successor animal too soon. It is, of course, and you may have this experience too, that's a question I get asked a lot. "When should I get another dog? Should I get another dog? Why are they people telling me I should get another dog? I don't want another dog." So you're all that, right?

Some of us can't last very long. I thought after Joanie died, I was like, "Okay, I am going to give these things to the shelter. I'm going to keep maybe these toys. I'm going to be cat free. See what that's like for the next, maybe six months. I'll see what that's like. Maybe I'll give money or volunteer at a shelter." I lasted six weeks and was running to the ASPCA to get a kitten because I couldn't… But some people need longer than that. When they asked me that question, I just suggest some questions to ask yourself.

One of the problems that I do see is when somebody has recently lost an older pet, for example, that they've been with for 9 years or 10 years. Let's say dog. That dog is very well-trained and very loving. There's no behavior issues and they're very sweet and they come to work with them. They sit at their feet while they're typing and they shuffle on home with them, and they're all loving. 

Then they get a puppy and all hell breaks loose. It's because they're forgetting what puppyhood is like and they're imagining, "Oh, I'm going to have another dog that's going to sit quietly on my feet and lovingly sit with me and be so well-behaved."

Nuh-uh, you've got a toddler with four feet and so sometimes that can be very disturbing. I did experience that with Riri because, as we've talked earlier, she's a Tortie. She's got the "Tortietude" and she was pretty feisty when she was young. Whereas, Joanie was just like a Velcro cat and loved everybody. I brought her to the vet and she was not a good girl at the vet. Oh, she got kicked out of camp. I forgot that she got kicked out of Camp Feline because she was too spicy, they said.

Karen Wylie: Torties are all going to be spicy.

Judith Rosen: But I've since worked with a wonderful animal behaviorist and I learned that actually I was the problem. I had to change behavior.

Karen Wylie: Oh, look at that.

Judith Rosen: We're so much better now but in the beginning I do remember it was like this feeling like, "Oh my gosh, she's not Joanie." Feeling that kind of angst about that, "What did I do? It's not the same." I would never rehome, that's why I worked on myself essentially. 

But my point is that I think getting a successor animal is something that you have to think through and there's no rush to do it. For a lot of folks fostering is a nice interim way— fostering or volunteering at a shelter.

I do have to mention one thing that I do have in the book. I talk about people that have a service animal of some kind. In that case, for example, if they are helping them, they help with their mobility or they're able to help them with certain things around the home or if they are sight impaired, they can help them be out in the world— they cannot wait. They have to get another pet. There is an agency that supports people with service animals and have their own, I think, loss group for that reason because it's different.

Karen Wylie: It'd be very different with an animal with them every moment of the day and helps them live their life.

Judith Rosen: So it's a completely different thing. I also address people that work with animals, people in law enforcement or the service— that's their partner. That loss can be devastating too. What I tried to do in the book was consider everybody, which is really hard, but I wanted it to be accessible to all different situations and different people.

Karen Wylie: So that everybody can find themselves at least on a few pages where they can identify with it.

Judith Rosen: I also talked about how there's other people that your animal encounters during the day, during the month, whatever, that they do also have a relationship with. If you have a dog walker, I have a cat sitter, neighbors in your building, the groomer, the vets. They all maybe love your pet too and feel the loss. I had a veterinarian that loved Joanie and there were tears in her eyes at the end.

Karen Wylie: It's so interesting that you're bringing that example up because I can go to May 24th— in this book.

Judith Rosen: Wait. I feel like, I'm like, are we going to sing too or?

Karen Wylie: You were suggesting that people rehearse a simple explanation of the loss of their animal because if they are in a situation, just as you're describing where people are aware of the pet and they're asking about the pet, that could be a very difficult time for you because they can ask when you're not expecting it. To just rehearse a simple explanation and to say, "I really don't want to talk about it right now, but thank you."

Anyway, as you were talking about that, I thought that was one of the best pieces of advice in the book, because that is something we can all relate to when we've had pets and lost them. There are other people around who knew them.

Judith Rosen: I think what happens is you have a stress response when you're asked and it brings all that flooding back. When we're in fight or flight mode, let's say, our executive functioning is a little bit compromised and it's hard to create a sentence to say. That's why if you have it stored ready to go.

Can I tell you where it came from? Where I got the idea to do this and help people with it. I used to work in substance use, right? I worked in a rehab and when we did groups, we would always have a practice in groups like in the middle of November. Can you guess why? What were we practicing related to this?

Karen Wylie: The holidays.

Judith Rosen: Exactly! So we would practice, "What are you going to say when somebody offers you a drink at Thanksgiving?" And everybody would come and they would practice it. I was like, "Wow, really it's actually the same situation where you are under stress and you need to have something rehearsed rather than try to think of it in the moment." This will make you feel more confident and more calm to do it. Especially if you can find something that really feels like it can cut the conversation short: "I don't really want to talk about it." More people usually respect that.

It's hard because here in New York, for example, there's I think 500 apartments in the building I live in, and a lot of your neighbors see you with your dog. They may not have seen you for the last 2-3 weeks and you come in, they're like, "Oh, where's Joanie?" And you're hearing that over and over— every doorman, every person in the elevator. This helps them do it. So I'm glad you liked it.

Karen Wylie: Yes, as I was going through it, that was just such an immediate, practical piece of advice that would help people.

Judith Rosen: That makes me feel good to hear because I was going for the practical.

Karen Wylie: Yes, that's the thing. When you're grieving, you're often not thinking in a practical way. Of course, you're so overwhelmed with the sadness and the emotion of it all. Reading something that kicks your logical brain into gear for a little bit is a really helpful thing. 

One thing I wanted to say just in finishing up what we were talking about with the traumatic losses or traumatic aspects to a loss, is that I think it was just a couple months ago was the first time I was aware of the Prolonged Grief Disorder as something that now had a name. It was estimated that 8-10% of people who lose a loved one would fall into this prolonged grief. 

So I just wanted to mention that because it's not just 1%. It's not just this occasional one person out of 100. 8 or 10%, that's a lot of people out there.

Judith Rosen: Absolutely!

Karen Wylie: Struggling to to integrate what happened.

Judith Rosen: The training and research that's being done is being done at Columbia University. They do tremendous work. They're the developers of prolonged grief disorder treatment and they have live trainings - and they didn't pay me. I feel like I'm doing a commercial!

Karen Wylie: I'm just going to say, with you right there in the city. It's another certification for you.

Judith Rosen: I took the course, I’ve got to stop but it does relate to what I do. They have training online or in person and it's good for people to understand it. But I also blame our society— although there are some cultures within our society, we are multicultural and there's some that do address it and do talk about death. But I think we don't talk about death and mourning enough that it becomes something that is not natural— when it is natural.

It becomes something that is taboo to speak about and I think people will get this message that "I have to put it out of my mind. I have to not think about it. I just got to pretend it didn't happen. I'm going to avoid it." Or "I'm not going to go down that block where I used to walk her because I'll start crying and I won't be able to stop."

It's a fear of falling apart and it's a fear of feeling emotions but if you don't do that's when a lot of the symptoms of prolonged grief disorder can linger.

Karen Wylie: That's a tough enough road to walk when we're grieving another human. There's at least often some level of support. It may be for two or three days after someone dies but there's so much less isolation than when it comes to pet loss.

Judith Rosen: That's disenfranchised grief, right? That's what makes it so hard for us to go through it.

Karen Wylie: Absolutely.

Grief is not a problem to be solved but it can become a weight that's too heavy to carry alone and there is no honor in suffering longer than you have to. If anything Judith shared today resonated with you, I want you to know what you're feeling is real. It is valid, and there is support available. Judith's contact information and her book are linked in the show notes.

In our next episode, we turn to something almost every pet parent I've ever worked with has struggled with: the guilt that follows the decisions we make at the end of our pet's lives. Judith draws a distinction in that conversation that I genuinely believe has the power to set people free.

I don't want you to miss it.