[JOE SANOK] Providing great therapy day after day can be challenging even for the best of us. At Blueprint, they believe that nothing should get in the way of you doing your best work, which is why they created a platform that provides therapists with an array of clinical tools, things like therapy, worksheets, intervention ideas, and digital assessments that are designed to help you and your clients stay connected and confident throughout the care journey. Even better, Blueprint helps streamline your documentation so you can spend less time on your notes and more time on the things that matter. To learn more and request a 30-day free trial, visit blueprint-health.com. Again, that’s www.blueprint-health.com. This is the Practice of the Practice Podcast with Joe Sanok, session number 872. I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast. I remember in 2003 that summer my grandfather, grandpa Sanok passed away and also that summer our family dog, Bisket passed away and I went to, there was, a hospice offered a certain number of counseling sessions and so I was in grad school at the time and hospice offered him because my grandpa had been in hospice. I was talking with this therapist and I was, as I was talking to her she talked about how the loss of a grandparent and also the loss of a pet were two areas of grief that are often overlooked and how often people don’t really think through what it means to have that kind of loss. If you lose a child or if you lose a parent or if you lose all these other areas in your life it’s, people often pour out the emotions, but the grief around a pet loss and the grief around a grandparent loss just were ones that she pointed out. A lot of people just expect you to just move on from. I’m really excited that today we have Beth Gustin who’s joining us. Beth, being born blind never stopped Beth from accomplishing her goals. It did give her a unique perspective on a different grief and loss. Combined with this and her personal experience of human, pet and service dog deaths throughout her life and professional training and certification in grief and loss and transitioning through change PLLC, it just made sense for her. Beth uses humor, empathy, and wisdom to guide clients on their grief journey. Much like a guide dog teamwork therapy is similar. Beth, I’m so excited to have you here on the Practice of the Practice Podcast. [BETH GUSTIN] Thank you. Really glad to be here. [JOE] Well, let’s talk about pet grief. How did you get into this work? [BETH] It’s one of those things where I think the universe sort of told me this is where I was supposed to be, just through the way life worked out and experiences in life. It’s something I’ve always had an interest in just because of my personal experience with pet loss. There are not a lot, at least to my knowledge of resources out there for pet loss grief and so when I ran across the training through the Association of Pet Loss Bereavement, it’s actually Association of, yeah, APLB, yes of Pet Loss Bereavement, I took it and it was extremely beneficial. It’s not designed for mental health professionals and I honestly think it should be, not only because I thought I was back in grad school again because it was intense, but because it’s something that I think a lot of therapists experience with their clients and don’t have a lot of training in. And for me it’s just felt like a natural place to be. It’s something I can relate to personally. It’s something that I think there’s a huge need for professionally. [JOE] Yeah, no, so what were some of the things that you learned in that training? [BETH] We talked a lot about the differences, like how pet loss can be different than human loss and why it’s so much harder and we talked a lot about end-of-life care for the pets and helping someone navigate the anticipatory grief and the euthanasia process, or if they want hospice at home for their pet. There’s a difference in those two things. It was an eight-week course and it really gave me a broader understanding of just like I said, the differences between pet loss and human loss and why it’s so hard. [JOE] What are some of those differences that you learned there, that you’ve seen in your clinical work? [BETH] Both there and in clinical work, one of the biggest differences is our pets, I’m going to separate that from service dog because that’s a whole different type of grief and loss process in my opinion, but with pet loss, we tend to see it’s much harder because oftentimes if we don’t have a large circle of support, our pets are our only source of support. Our whole life revolves around their care and their routine so not only do you lose that pet, which will lose that routine and those, the secondary losses associated with that. Pets are often someone that we can talk to that’s nonjudgmental, that’s unconditional love. We don’t get that from humans. So it can hurt a lot more in some cases than a human death might. Now you had said that to separate out a service dog from the average family pet and part of that being how reliant someone is with their service dog. What are other differences that people should note? Because, I mean, as you say this, as I’ve interviewed people over this last month on their clinical work, a lot of it’s things that I’ve heard around EMDR or grief or just different training areas, it’s just obviously a position of privilege where I don’t have a service dog and it’s never occurred to me just that that pet loss would be so different from a different pet loss. Like, so just from a personal standpoint, I’d love to hear some of those additional differences of just the meaning that that pet brings as a service dog or a service animal and how that’s a different type of loss. [BETH] Sure. I think with service, so service dog is my way of addressing all service animals because I have a service dog. So with service dogs, you not only, not only they’re a pet when they’re not working, but they’re with you in a lot of areas of life where your pet may not be allowed to go and they’re serving as your eyes, in my case, since I’m blind. So my service dogs are my eyes, they make sure I get places safely. So you not only grieve the loss when they retire, because when they retire, we have the option to keep them as a retired service dog as a pet. So you have that loss, but then when they actually die, you also have that loss and so you’re grieving, I think, on more levels because of the role they have in your life. [JOE] So when you look at the grieving process, like take us through that and what that looks like for pets, for service dogs and maybe things that are unique in there that maybe wouldn’t be top of mind for a lot of clinicians. [BETH] I think the biggest thing that I have seen in professional work with clients and the trainings is the guilt. I know we experience guilt with human death as well, but I think it is much more intense with pet loss and service dog loss or retirement largely due in part because we are having to make decisions for our pets and service dogs that we can’t talk through with them. So I’m on my fourth service dog right now and I just had to euthanize my third service dog about two months ago. In thinking through the retirement processes of my past three guides who are now deceased as well as the euthanasia process, there is a lot of guilt that comes up because we don’t know what the dog wants, we don’t know what’s really going on inside, how bad are things. We have a lot of guilt around when is the right time to euthanize? Should it be at home? Should it be at the vet’s office? Do I want in-home hospice? And there’s a lot of guilt that tends to come after the death of the pet or service dog because we never know, was it too soon, was it too late? There’s a lot of guilt and a lot of work around self-forgiveness that I do. [JOE] Now when you’re talking about self-forgiveness, talking about guilt, what are common things that an individual would feel guilty about in that situation, [BETH] A lot of my clients will call me before they choose to euthanize a pet because they want to work through when is the right time and how do I know and how do I make sure that I’m providing the best quality of care for whatever life they have left. But then I get an equal number of calls for clients after the fact who say, “I’m really guilty, I’m feeling horrible, but I didn’t do more. I should have done more.” I do think we experienced that with human death loss, but oftentimes, depending on the way someone dies, you often have a chance to have some conversations around that unless it was a sudden death. Whereas with pet loss we’re depending on your religious beliefs, we’re sort of playing God, we’re playing the role of God because we are choosing when to end a pet’s life and that’s very heavy and involves a, brings up a lot of emotions for a lot of people. [JOE] Now if you were in charge of the average general therapist and you were like, okay, here are the three to five bullet points, the masterclass on pet loss that you would say every single clinician should know, should have as part of their tool bag, what are some of those things that you would deem as essential for any clinician to know about pet loss? [BETH] I think the biggest thing is holding space. If you’re working with anticipatory grief, then helping them make sure they’ve got a good connection with their veterinarian because you want to make sure that they’re in close connection with the veterinarian because that veterinarian will help guide them on a better, better knowing when to make those hard decisions. I think being aware of something called the Quality of Life Scale, which, there’s a number of them out there online, but it can help you help your client assess on multiple dimensions when it might be time to say goodbye to your pet. I think if it is after the death, really making sure that you process with them what that pet or service dog meant to them, giving them space to tell their story, helping them find ways to honor and memorialize their pet. And like I said, the guilt, there are a lot of different emotions that we go through in our grief process and with pet loss, I tend to see a lot of guilt. I’ve also seen a lot of anger at the veterinarian, at themselves, at the situation. So just knowing what might come up most commonly for your clients in pet loss and having the tools to support them through that. [JOE] Now when you think through case studies, without obviously giving any confidential information are there cases that come to mind where you feel like this work really it like puts a spotlight on what this work can be? For you as someone that’s helping people through pet loss? [BETH] I think pet loss is such a disenfranchised grief that one of the biggest things I’ve seen is just knowing that there are some clinicians out there who do specialize in this and they truly get it. I’ve heard a lot of clients say I have a great therapist, but they just don’t understand the pet loss piece. They just don’t seem to be able to relate to me. They don’t seem to be able to really grasp what I’m feeling and what I’m going through. So in my work, I’ve seen a lot of people needing to find someone that they truly can connect with around that piece and who really can relate to it. It’s unfortunate because I get more calls for support across state lines than I do in my own state, which is challenging because I’m only licensed in Colorado. So trying to figure out a way to meet those needs or spread the word that other therapists should become trained in pet loss grief. [JOE] Now, when would you say it’s worth referring out to a specialist like you compared to someone just managing it on their own within their practice? [BETH] I think when, so I’m going to back up in my training, they say if you’re just doing pet loss grief, then usually one to three sessions can resolve it. Now, with my therapist lens, I have seen some different, I don’t believe that because our pet loss grief brings up a lot of other stuff for us, as we know as therapists’ grief brings up a lot of things from our past. So I would say if you are noticing that your client is stuck in their grief, they’re not able to move forward, they’re still experiencing and exhibiting a lot of symptoms of grief refer out because sometimes it just takes a different perspective or it takes that relatedness piece for a client to be able to feel able to move forward [THERAPY NOTES] Is managing your practice stressing you out? Try Therapy Notes. It makes notes, billing, scheduling, and tele-health a whole lot easier. Check it out and you will quickly see why it’s the highest rated EHR on Trustpilot with over 1000 verified customer views and an average customer rating of 4.9 out of 5 stars. You’ll notice the difference from the first day you sign up for a trial. They offer live phone support seven days a week so when you have questions, you can quickly reach out to someone who can help. You are never wasting your time looking for answers. If you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your clients’ demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE], J-O-E to get the first three free months totally free to try it out, no strings attached. Remember telehealth is included with every subscription free. Make 2022, the best year yet with Therapy Notes. Again, use promo code [JOE] to get three months totally free. [JOE SANOK] Now I know lots of times the clinical work we do can then inform our personal lives or give us a different lens in the world or a different meaning in the world. For you personally, when you look at the work you’ve done around pet loss, around service, dog loss grief how has that impacted you to think or operate differently in the world? [BETH] It’s interesting. I’m laughing because I’ve also recently began doing a lot of social media marketing online and I’m trying to draw from my own personal experiences to be authentic in that marketing piece. It’s made me start to notice more how I handle my own grief process. It’s like I was saying before, I had to use my third service dog about two months ago. I remember waking up like a week later going, Shannon’s not dead, she’s on vacation, she’s going to come back. I’m like, what? Like, where would she go? She’s a dog. She can’t be on vacation. I’m laughing about it now, but it was just interesting to realize as I live and breathe grief and loss work more with clients and experience it in my own life, how my brain is shifting the way it works through my own grief process. So I definitely was in a very firm stage right there. I don’t like the stage theory personally, but I was definitely experiencing some denial in that moment, or disbelief, which there’s, those are two separate things, but it definitely informs how I, it’s given me more compassion for myself and for others, if that makes sense. [JOE] How does that practically play out for you? [BETH] With clients? It’s definitely allowed me to slow down. Those who know me know I am, I was born premature, so I do everything quickly. That’s my half joke, half serious. That’s just who I am. I talk fast, walk fast, everything is yesterday. So by fully niching into grief work and further into pet loss grief as a niche, it’s definitely helped me slow down and in slowing down, I do tend to find I have more compassion. [JOE] From like a macro, broader society standpoint, like from advocacy or things like that, what do you think should change in regards to just pets or the way people view pets? It can be around pet loss or it can even just be pets in general. What would you like to see from a macro societal change? [BETH] Yeah, there’s different types of bonds that we can have with our pets, and I feel like the biggest challenge that a lot of my clients face is because the grief is disenfranchised, there isn’t a lot of support. It’s like, oh, it’s a dog, we had another one. No, it doesn’t work that way. It’s just a cat, I mean, who cares about cats? Well, the person that just lost their cat does. So I think it’s, I don’t know how we do this, but I think it’s helping people understand the role that pets can play our lives and the benefits that we can reciproc, reciproc, I can’t say that word, big words are hard, but that we can both gain from [JOE] We all have those moments [BETH] We do. But there’s mutual benefits of owning pets and having pets and really allowing us to see how much of a role those pets can play in our lives, no matter how old you are. I think about children and the bonds they form with pets. I think about the seniors and the bonds they form with pets and what that pet symbolizes to them and I wish all of society could just realize it’s not just a dog and it does, or a cat, or a bird or a horse. It really does hurt. We do grieve that loss very deeply. [JOE] Now as you look forward to your career, how do you think this will continue to inform it? Like, where are you headed? Where do you see changes based on what you’ve already learned in regards to pets, pet loss, service, animals, all of that? [BETH] I do see a slow shift towards pet loss, grief being more accepted and slowly being more understood. I do see more articles on pet loss, grief and more social media groups. For me personally, I’m trying to figure out what I can offer that isn’t just limited to Colorado, so thinking about like grief retreats around pet loss or how could pet loss coaching differ from pet loss, grief counseling thing. Because I do see, like I said, there’s a huge need, there’s a lot of gaps to be filled still and a lot of people don’t know that there are therapists who specialize in pet loss grief. So just finding ways to get that word out for those of us who do. [JOE] Well, my last question that I always ask is if every private practitioner in the world were listening right now, what would you want them to know? [BETH] I always love this question. I don’t always have a great answer for it. I think be yourself. When we’re in grad school, we don’t yet know where life will take us and the opportunities that might be open to us. I did not set out to be a specialist in grief. It took me a number of years to get here. So be open-minded, don’t be attached to the outcome and let life guide you where your heart wants you to go. [JOE] So awesome. And Beth, if people want to connect with you, if they want to look at your website, where should we send them? [BETH] The website is transitioningthroughchange.com and all my contact information is there. [JOE] So awesome. Well, thank you so much for being on the Practice of the Practice Podcast today. [BETH] Thank you for having me. Glad to be here. [JOE] If anyone says that they are wondering if they should niche in, I mean, like this is such a great example of that, to find an area that you enjoy, that you have a unique perspective in the world that is something you’ve been through or you care about. I mean, for Beth with all the different things that she’s overcome in her life and then to be able to incorporate her use of service animals and her relationship with service animals and the grief of losing service animals is so amazing to see that you can create a career out of that much of a niche. I think it really points to like, who would you want to see if you lost your service dog? Someone who doesn’t have pets, someone who maybe had pets here and there, or someone who has lost three service animals and now has her fourth service dog? So it really points to how we can niche and we can find ways to be in the world that we show up in a way that is fulfilling to us. Even just yesterday I was listening to someone lament about their job and I just had such appreciation that I get to do these types of interviews. I get to do consulting with people, I get to innovate and come up with things. It hasn’t always been easy. There’s been times I second-guessed it, there’s been all sorts of different things. But to be able to genuinely create the career that I want and to come up with new ideas with a team, it’s just so amazing to be able to do that. So go out there, go get them, think through parts of your career that you’re just like, oh, I hate this, and see if you can shed some of it. See if you can add some niches in that you really enjoy. We’re doing all sorts of innovation over here at Practice of the Practice. By the time this goes live, our website redesign should be completely done. John and the entire IT team has been doing this through the first and second quarter of the year and making it faster and doing a much more streamlined redesign. As well within our membership communities, we’re doing all sorts of trainings for our members around not just clinical issues and not just business issues, but using tools like AI and things like that to inform how we do things and how we can do things quicker and more efficiently within our practices. So a lot of really cool innovation happening. If you want to get connected to us, there’s lots of opt-ins and resources that can help you; practiceofthepractice.com is our main hub and if you want any of those free resources, we list them all out over at pillarsofpractice.com. But we couldn’t do this show without our sponsors. Today’s sponsor is Therapy Notes. Therapy Notes is the best electronic health records out there. It also comes with Teletherapy. They’ll help you switch from whatever platform you’re on. We have a direct relationship with them where we can give them feedback and give them ideas. So it’s a great service. Therapynotes.com, just use promo code [JOE] at checkout and you’ll get two months for free. Thank you so much for letting me into your brain and into your ears. I flipped that for the first time in what, 800 episodes, so thank you for letting me into your ears and into your brain. Have a great day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.