For years, I have worked with individuals who feel they are all alone in this nameless, unidentifiable space and who often feel that nobody understands what they are going through. Thus, they don’t talk about it or stop talking about it altogether, choosing to keep the feelings to themselves. It’s isolating and can lead to immobility in life, meaning it can cause us to feel stuck and unable to carry out our day-to-day responsibilities and tasks. In order to understand this phenomenon, you truly must go through it. And chances are, most adults have experienced this in some form or another during their lifetimes.
What I’m referring to is “ambiguous loss.” The name itself implies the unfamiliar, foggy, or unknown. So what exactly does the term ambiguous loss mean? Ambiguous loss is the kind of loss we experience when a loved one is either physically or psychologically gone/absent. For example, when a person experiences a traumatic brain injury/TBI, or has a diagnosis of Alzheimer’s or Dementia, we feel grief because the individual is still physically present but cognitively gone/absent. Alternatively, when a person goes missing, or in cases of unknown parentage (such as with adoptees) and familial estrangement, the loved one or parent is psychologically present as the survivor/adoptee keeps them alive in their mind, but the loved one/parent is physically gone. This is ambiguous loss.
Why is This Such a Traumatic and Isolating Type of Loss?
In comparison, when a loved one dies or passes away as the euphemism goes, there is a certain finality to it. There is a sort of closure as life comes to an end. However, when you experience ambiguous loss, it involves having to simultaneously hold two opposing beliefs: 1. The person is gone, and 2. The person is also present. There is a lack of closure when this occurs. This ambiguity can last for years with no real end in sight which makes this type of loss not only complex but also incredibly traumatic.
If you speak to caregivers of individuals with TBI, Alzheimer’s, or Dementia, adoptees and others with unknown parentage, families of missing individuals, or individuals estranged from loved ones, they will tell you that the experience is horribly painful and lonely. They often feel that no one understands. They are frequently told by well-intentioned people that they need to just move on or let them go. But how do you let go of someone who may still, someday, come back? Even worse, when your hope or need for that person to come back is so strong, is it even possible to “move on” or “just let them go?”
How Do We Help Those Experiencing Ambiguous Loss?
Pauline Boss, an expert on the subject, has developed guidelines for working with individuals experiencing ambiguous loss. One of the biggest factors in navigating this type of loss, according to Boss, is resiliency. If a person lacks resiliency, ambiguous loss is going to cause immobility, depression, and a feeling of being “stuck.” When we are able to build resiliency or find instances of everyday resilience, it empowers the person to be able to navigate life with the loss. We may never truly get over it or accept it, but we can learn to live with it and thrive despite it. Boss has developed 6 areas of importance for building resiliency in the face of ambiguous loss:
Finding Meaning: When working with individuals experiencing ambiguous loss, we work to help them find positive meaning in the day-to-day. This could include giving the problem a name, building the ability to hold the opposing beliefs of here/not here simultaneously, leaning into spirituality, and finding forgiveness.
Adjusting Mastery: Mastery in this context means having a sense of control over one’s life or destiny. We can help individuals work to readjust their sense of mastery by coming to terms with injustices in the world and recognizing that things are not always fair; building an understanding that one’s efforts don’t always result in the desired outcome; shifting blame from internal to external; and increasing human connection.
Reconstructing Identity: Identity is the knowledge of who one is and what roles one plays within their social circles and community. Identity becomes confusing in the context of a partially missing family member or loved one as it requires reconstruction within this context. We may find ourselves asking, “Who am I now? Who is my family now? What role do I now play? Where do I fit in or where do I belong?” So how do we reconstruct identity? We encourage individuals to share stories in the company of others who have experienced ambiguous loss; lean into spirituality to deepen personal identity; help to reconstruct new rituals and celebrations; and help to revise new roles.
Normalizing Ambivalence: Ambivalence is a state of having mixed feelings or contradictory ideas about something or someone. Normalizing ambivalence means acknowledging its existence. Again, the ability to hold two opposing beliefs (love and hate, here and not here). In order to normalize ambivalence, we may encourage individuals to see family and community as sources of support; encourage the telling of stories; emphasize the belief that normalizing negative feelings minimizes them; and recognize what is lost but also what is still here.
Revising Attachment: Attachment is, in essence, a reciprocal relationship between someone who is a constant presence in one’s life. In revising this sense of attachment, we help individuals come to terms with the conflicting concept of being here and not here; use social circles and community to build new connections; connect individuals with support groups to connect with others experiencing ambiguous loss; and develop memorials and farewell rituals in honor of the missing person.
Discovering Hope: Hope, by definition, is the feeling that what is wanted can be had or that events will turn out for the best. Boss adds to this definition with the Buddhist belief that suffering can stop and that comfort is possible in the future. In helping our clients to discover hope we encourage human connection; encourage connection with others experiencing the same type of loss; redefine justice and work against injustice.
By equipping our clients with the tools for coping with the duality of ambiguous loss, such as caring for loved ones with TBI, Alzheimer’s, or Dementia, or instances of missing loved ones, cases of unknown parentage, and instances of familial estrangement, we can minimize the trauma associated with the loss and help them to grow and thrive around the ambiguity.
How Can We Help?
If you are feeling stuck and are unsure how to manage ambiguous loss, our grief and trauma-trained therapists are here for you. Schedule a free consultation with our compassionate and experienced team, dedicated to guiding you on your path toward healing.
Boss, P. (2006). Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss (1st ed.). W. W. Norton and Company.