Recognizing Complicated Grief in our Clients

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Dave Shuey, MSW, RVT, CHPT.

We all tell ourselves that euthanasia has the effect of ending suffering, both for the terminally ill or injured pet, as well as the owner who may have been carrying burdens of care and concern throughout the course of events leading up to euthanasia. How often do we acknowledge the strong probability that in providing that gift we are simultaneously setting in motion a new disease process? Most of our clients will be touched by this illness, the shadow of euthanasia’s relief known as Complicated Grief (CG). There is an unavoidable kindred experience between those who have lost a human or non-human loved one (Lee, 2020, Testoni et al, 2019). Understanding the complexities of euthanasia includes the mental health implications it holds for those left behind.

Complicated Grief is an endemic, pervasive illness (Shear, 2015). It has been studied to the point that one can now identify signs and symptoms, as well as treatments, across multiple dimensions of human experience. The American Psychiatric Association gives it a longer, more cumbersome and lifeless name, “persistent complex bereavement disorder (APA, 2013),” with its own set of criteria and timeframes. CG manifests in difficulty with reconciling the death with one’s beliefs, avoidance of enjoyment, irritability, anger, and isolation. Coming to terms with the death feels impossible.

Mental health professionals assess for CG by examining a wide range of symptomatology; from the ability to accept the death, intrusive interference of thoughts and feelings surrounding the death, to basic beliefs about the death; feelings of regret, unfairness, “if only,” and the nature and frequency of “difficult times (such as anniversaries).”  Treatment elements include repeated storytelling, imaginary conversations with the departed, and involvement of other human contacts in the clients social network. 

The prevalence of CG and its inextricable connection to what we do as end-of-life practitioners, argues in the strongest possible way for the standard inclusion of mental health support resources in every veterinarian’s toolbox. If we can realize that there is no such thing as “normal,” that things don’t always happen “for a reason,” the more open we will become to embrace brokenness, uncertainty, meaninglessness, and to honestly face and tend to the needs of the human-animal bond, even as it is changed by the departure of a beloved pet.


American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association.

Lee., S.A. (2020). Does the DSM-5 grief disorder apply to owners of deceased pets? A psychometric study of impairment during pet loss, Psychiatry Research, 285.

Shear, K. (2015). Complicated Grief Treatments. Columbia Center for Complicated Grief.

Testoni, I., De Cataldo, L., Ronconi, L., Colombo, E.S., Stefanini, C., Zotto, B.D., & Zamperini,
A. (2019). Pet grief: Tools to assess owners’ bereavement and veterinary communication skills. Animals, 9(67).

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