Ambiguous Loss: Concepts and Clinical Practice Rose Collins, PhD Minneapolis VA Health Care System Ambiguous Loss
A loss that is unclear and thus has no closure A situation or problem that has no answer and thus no resolution Thus, ambiguous loss can traumatize and immobilize grief and coping processes Due to ambiguity, individuals & families cant move forward with their lives. Two Types of Ambiguous Loss Type I: Physical absence with psychological presence (e.g., missing, disappeared,
kidnapped, military deployment) Type II: Psychological absence with physical presence (e.g., TBI, coma, dementia, addiction, autism, depression etc) Types of Ambiguous Loss Type I and Type II often overlap in the same person or family Effects of Ambiguous
Loss Confusion Immobilization No validation No closure Exhaustion Effects of Ambiguous Loss
Confusion Immobilization No validation No closure Exhaustion Guidelines for Helping Families Live with Ambiguous Loss
Guidelines for Helping Families Live with Ambiguous Loss Finding Meaning Tempering Mastery Reconstructing Identity Normalizing Ambivalence
Revising Attachment Discovering Hope Boss, P. (2006). Loss, Trauma, and Resilience. NY: Norton Finding Meaning Tempering Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope Boss, P. (2006). Loss, Trauma, and Resilience. NY: Norto Guidelines for Helping
Families Live with Ambiguous Loss Finding Meaning Tempering Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope
Finding Meaning: What Helps Naming the problem
Dialectical thinking Religion and spirituality Forgiveness Small good works Rituals Positive attribution Sacrifice for a greater good or love Perceiving suffering as inevitable Hope Finding Meaning: What Helps
Naming the problem Dialectical thinking Religion and spirituality Forgiveness Small good works Rituals Positive attribution
Sacrifice for a greater good or love Perceiving suffering as inevitable Hope Finding Meaning: What Hinders Hate and revenge Secrets Violent and sudden loss Disillusionment
Tempering Mastery: What Helps Recognizing the world is not always just and fair Recognizing where views of mastery originate Externalizing the blame Decreasing self-blame
Managing and making decisions Tempering Mastery: What Hinders Too much mastery Too little mastery Ill-timed use of mastery Belief that ones efforts will always
result in desired outcome Belief that bad things cant happen to good people Blaming oneself or others for not being able to solve the problem. Reconstructing Identity: What Helps Define family boundaries Select major developmental themes
Develop shared values and views Reconstructing Identity: What Hinders Discrimination and stigma Forced uprooting Isolation and disconnection Hanging on to one absolute identity
Resisting change Normalizing Ambivalence: What Helps Normalizing guilt & negative feelings, but
not harmful actions Using the arts to increase understanding of ambivalence Regaining personal agency Reassessing & reconstructing the psychological family Seeing the community as family Reassigning everyday roles and tasks Asking questions about context & situation Bringing ambivalent feelings into the open Normalizing Ambivalence: What Helps
Uncovering latent or unconscious ambivalence Managing the ambivalence, once aware of it Seeing conflict as positive Valuing diverse ways of managing ambivalence Knowing that closure does not lower
ambivalence Developing tolerance to tension Using cognitive coping strategies Normalizing Ambivalence: What Hinders Using only a symptom focus Expecting typical coping and adaptations Revising Attachment:
What Helps Thinking dialectically Moving from despair to protest Thinking systemically, but not seeing maladaptations as bilateral pathology Developing memorial ceremonies and farewell rituals
Knowing that fantasies of a missing person are common Watching out for no-talk rules Paying attention to developmental stages that exacerbate anxiety Revising Attachment: What Helps Including children & adolescents in therapy when parents or siblings
disappear Using multiple-family and couple groups to build new connections Encouraging the use of the arts Revising Attachment: What Hinders An overemphasis on individuation Expecting closure Discovering Hope: What Helps
Finding spirituality Imagining options Laughing at absurdity Developing more patience Redefining justice
Finding forgiveness Creating rituals for ambiguous loss Rethinking termination Revising the psychological family When Hope Hinders Persistent hope for closure Continued longing for life as it used to be
