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Veterinary Wellness – Understanding loss: Going beyond “the obvious” to manage unmet needs

December 11, 2024

Inherent to the provision of healthcare services is loss. With the sine qua non to sustain professional health and well-being, and remain resilient, loss is a reality that needs to be acknowledged. In veterinary medicine, conversations about loss seem to be few and far between, yet loss colors our experiences on a daily basis. To be able to manage loss, the losses need to be recognized for what they are. If not seen, the emotions accompanying them likely won’t be processed, meaning moved through and released. Instead, they may “accumulate,” and the accumulation of such emotions, embodied as grief, can have negative effects. Grief is not one emotion, but “the container that holds all of the emotions felt as a result of loss”. Grief has been described as “the emotional response to any loss”.

There are different kinds of losses. Naturally, the ending of a pet’s life (i.e., euthanasia) and the unexpected passing of a previously healthy patient are losses. So too are a valued team member leaving the practice and the practice being sold. Each of these are “obvious” losses, with significant outward effects.

There are also less obvious, or what might be called “hidden” losses. These are not the ones we have sympathy cards or normative conventions for. They also can cause grief, but the grief too may be hidden — that is, not seen or recognized for what it is. As such, the grief will tend to accumulate, and this will inevitably exert a toll, affecting us, those we serve, and our workplaces.

It is important to understand that a range of human experiences, aside from the obvious, can give rise to grief, and that grief is a natural response to loss, no matter how seemingly small. For work to remain rewarding and fulfilling, it behooves us to take a closer look at loss — to go beyond the obvious — and what we can do to keep ourselves whole.

UNDERSTANDING LOSS
Loss can be understood in terms of basic human needs, which include the universal emotional needs that all human beings share. As with our physiological (i.e., physical) needs, when our emotional (i.e., psychological) needs are met, we will thrive. However, when these needs are not met, deep-seated as they are, we will grieve. Grief can show up for us when we experience the loss of needs, expectations, hopes, and dreams.

The practice of veterinary medicine is relationship-based, with crisscrossed interactions, connections, and affiliations between patients, clients, and teammates. To relate the universal emotional needs to your day-to-day experiences in practice, consider the following questions:

• Do you feel welcomed and cared about? Do you feel like you fit in, that you belong?
• Does it feel safe? Do you feel grounded?
• Do you feel valued and respected? Are your contributions appreciated? Do you feel integral to the operations of your practice?
• Do you feel you can be your authentic self? Are you living your values (or are there values conflicts)?
• Do you have a sense of hope for your future (or are you just putting in time)? Do you expect that things can get better and that you can help make them better?
• Do you feel that your work is meaningful, that it makes a difference? Is it worth getting up for?
• Do you have a say in your work? Do you feel your work is manageable? Do you have aspirations for the future?

Hopefully you are able to answer many of these questions affirmatively. Can you think of times when your needs haven’t been met? Sometimes even the smallest of incidents can give rise to a sense of loss when it comes to basic human needs. Consider the loss that might be incurred when a client declines a recommendation. How do you feel? Why do you feel that way? Might it be associated in part with your needs — for attachment, structure, identity, meaning, or control? There will always be times when our emotional needs aren’t met. The key is to notice the feelings that arise, recognize what they signify, and restore your emotional equilibrium.

Our emotional needs are just as important as our physical needs, and unfulfilled, can have a profound impact on our lives. Grief is not just associated with the obvious losses, but also with the less obvious ones when our basic needs are not met, especially additively over time. The problem is, if we aren’t aware of this grief, we won’t deal with it. It will accumulate. It is called “unresolved grief,” and its impact is considerable.

THE IMPACT OF UNMET NEEDS
As complex emotional beings, when our emotional needs are not met, the impact can be profound, affecting our health, relationships, and the ability to self-actualize, to reach our highest potential. Unmet emotional needs:

• Are a source of long-term stress which can impact physical and mental health.
• Can lead to emotional withdrawal, unavailability, and difficulty bonding with others.
• Affect motivation, the way we see the world, and what we will achieve.

The first two points are self-explanatory, but the third requires further mention. Call to mind Maslow’s hierarchy of needs theory. When our emotional (i.e., psychological) needs are not met, we tend to lose our sense of motivation, feel like our lives lack purpose and meaning, and begin to feel directionless. Our focus shifts away from positivity and possibilities to instead dwell on negativity and failures. Because of this, we will prefer to “play it safe” or “play not to lose” rather than “play to win,” which reduces the likelihood of ever self-actualizing (i.e., reaching one’s highest potential). The ways in which this might affect our lives and place in the world, including the difference we make, are nearly endless.

TAKING A MOMENT TO REFLECT
Hopefully your needs — for attachment, territory, structure, identity, future, meaning, and control — are, for the most part, fulfilled, and you are generally satisfied with your sense of “you and your place in the world.” Certainly, every day is different, and each has its unique challenges.

If you are wondering how satisfied you really are, go through the list of universal emotional needs and see how you feel about each of them. Have an honest dialogue with yourself about whether your needs are being met, or what might be missing or going wrong. If you sense a “needs frustration,” meaning a loss, name it. Many of us try to avoid or ignore our losses, as they can be painful, worrying, or spawn a myriad of unknowns, but without naming them, we cannot begin to tackle them.

Next, feel it. Feel the loss; lean into the emotions that come up for you. You may find the Center for Nonviolent Communication’s (CNVC’s) Feelings and Needs Inventory helpful for specifying your feelings. Once you name the loss and the associated feelings, which together form the truth of your experience, you’ll be poised to take action, to make things better.

TAKING ACTION
There are 2 approaches (or “ways”) to manage unmet needs. Outward ways refers to actions to change your outer world, such as your work or workplace, to better meet your needs, whereas inward ways refers to actions to change your inner world, so you can move through and let go of the grief so it doesn’t end up holding you back. Both approaches are vital in sustaining health, well-being, and resilience.

Once you recognize a need not met, it is up to you to decide whether and how to take action, weighing the merits and risks. What changes might you be able to make in your work or workplace that would enable your need(s) to be met? Who would you approach? Do you worry that your needs or feelings aren’t valid or that you’ll be rejected? Can you see them as valid? If not, why not? What might you be able to achieve if you could be, and offer, your best? Might this benefit others as well? It may be helpful to speak with someone you trust to help you reflect on and sort through these matters.

Although it goes without saying, our needs cannot be met all the time. That’s life. And life is not all about “you” or “me,” but about “us.” There is give and take and compromise. Moreover, and especially within healthcare, needs accord to grander schemes than the self. Think about the client who declined the recommendation. Our role is to serve client needs, not our own. So, there will be times — many times — when we experience a sense of loss, frustration, or unfulfillment wherein there is no outward fix. In such instances, how might you find restoration? Here are some inward ways to remain resilient, each of which require intention, commitment, and practice to serve you well.

Engage in restorative storytelling
We story the experiences of our lives, and naturally, these stories, which include others, are constructed with limited information (after all, we can’t expect to fully understand the experiences of others — sometimes we can’t even understand our own!). In fact, information is always limited. There are always unknowns. This means that the stories we tell ourselves (what we feel to be true) are really just one “take” on reality. There may be other explanations of what happened. What other version can you imagine, one that enables your needs to be met and not leave you at a loss? A restorative story will keep you whole.

Practice gratitude Instead of focusing on what you lack — the loss — focus on the opposite. Practicing gratitude is a way to be consciously appreciative of what you have. It also gentles the mind and fosters kindness, generosity, and compassion, helping us to be less critical and judgmental (which enables more charitable storytelling!). It also helps us to be happier, more optimistic, and experience more positive emotions get in the habit of finding things every day that you are grateful for. There are several simple ways to grow and practice gratitude.

Adjust your temporal focus
To varying degrees, we live in the moment, dwell on the past, or dream of the future. The extent to which we typically (i.e., on average) direct our attention — to the past, present, and/or future — is called our “temporal focus”. In theory, there are benefits from focusing on each time period. After all, we can learn from the past, savour the present, and plan for the future. Yet research shows that those with a past focus tend to have less life satisfaction and lower overall well-being. Although we wouldn’t want to downplay what the past and present might offer (including what could inform future plans), focusing on the future may offer the most benefits for life and work. The research on this is inconclusive, yet it may be worth trying. If, in your experience, you find yourself focusing on the past, catch yourself and purposefully switch to the present, and even better, the future. Every “catch and switch” may help you move past the loss. Make plans for the future, including what you can do today to build your tomorrow.

Grow your emotional intelligence
Emotional intelligence (EQ) enables us to be aware of our feelings and why we are feeling the way we are and manage our emotions better — including the emotions of loss. With higher EQ we are not only more emotionally versatile, but also more hopeful and positive, which, in the face of loss, is particularly beneficial. Just being able to name emotions can offer relief. There are many doable ways to grow your emotional intelligence, and ideally you have set this as part of your long-term personal growth.

IN CLOSING
In the emotionally complex, demanding field of clinical practice, wherein loss can take many forms, a broader, more comprehensive understanding of loss seems imperative. It is not just the obvious losses that can elicit grief, but those, too, that are less so, the “hidden” ones. Both can undermine emotional equilibrium, and each increases susceptibility to the other. Understanding loss through the lens of universal human needs offers not just a deeper conceptualization of it, but also a richer repertoire of ways to manage it. “Outward ways” requires outward action and dialogue with others. “Inward ways” requires inward action and dialogue with self. The balance of outward expression and inward adjustment may be the perfect blend to process the many losses that we experience, and in this, better sustain health and well-being and remain resilient.

What is it in practice that gives you grief?

–Debbie L. Stoewen