Understanding and Help for Ambiguous Loss--Compiled by Tammy McLeod

Are you experiencing a feeling of loss? Or lost? Confused? We—and the people of the world—are feeling these losses and uncertainties in this global pandemic. How long? How do we live like this? Will I survive?

Tammy and Pat McLeod experienced similar—and deeply traumatic—feelings when their son received a serious brain injury in a football accident. Theirs lives changed completely. You can read about it in their book Hit Hard.

Here Tammy explains the origins of this concept of ambiguous loss, with her helpful highlights from the books of Pauline Boss.

Pauline Boss coined the term ambiguous loss in her book Ambiguous Loss: Learning to Live with Unresolved Grief, Harvard University Press, 1999.

Definitions of Ambiguous Loss: 

“Type One: Occurs when there is physical absence with psychological presence. This includes situations when a loved one is physically missing or bodily gone. Catastrophic examples of physical ambiguous loss include kidnapping and missing bodies due to war, terrorism, ethnic cleansing, genocide, or natural disasters such as earthquake, flood, and tsunami. More common examples of physical ambiguous loss are divorce, adoption, and loss of physical contact with family and friends because of immigration. 

“Type Two: Occurs when there is psychological absence with physical presence. In this second type of ambiguous loss, a loved one is psychologically absent—that is, emotionally or cognitively missing. Such ambiguous loss can occur from Alzheimer’s disease and other dementias; traumatic brain injury; addiction; depression, or other chronic mental or physical illnesses that take away a loved one's mind or memory.

“Psychological ambiguous losses can also result from obsessions or preoccupations with losses that never make sense, e.g., some suicides or infant deaths.” (http://www.ambiguousloss.com/four_questions.php)

Boss calls ambiguous loss the most stressful type of loss, and to be resilient she says we need to hold together both having and not having the person(s).

In her book Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss, Norton, 2006 she writes to counselors about six therapeutic goals for treating ambiguous loss. As a chaplain, I use some of Boss’ ideas to help students find resilience in ambiguous loss.

Six Areas of Importance for Resilience in Ambiguous Loss

Finding Meaning

What is this? Making sense of an event or situation. We need to help people find some positive meaning.

What can help with Finding Meaning? 1. Naming the problem. 2. Both/and thinking-the person is here and not here. 3. Perceiving suffering as inevitable. 4. Sacrificing for greater good or love. 5. Religion and spirituality. 6. Small good works. 7. Forgiveness. 8. Rituals.  9. Hope.

 Adjusting Mastery 

Mastery (sense of control over one’s life) is not the same as self-efficacy (control over the performance of specific tasks). 

What helps in Adjusting Mastery? 1. Recognizing that the world is not always just and fair. 2. Recognizing one’s efforts won’t always result in the desired outcome. 3. Externalizing the blame--external culprit is ambiguity. 4. Mastering ones’ internal self. 5. Telling stories in the company of trusted others. 6. Increasing human connection, not separation. 7. Managing and making decisions

Reconstructing Identity

Identity is defined here as knowing who one is and what roles one will play in relation to others in the family and community. 

Knowing who you are in relation to partially absent or present family members requires cognitive and emotional reconstructions of roles, status, boundaries, and rituals: 1. Who am I now? 2. What is really my family now? 3. What roles am I expected to perform now? 4. To what community do I now belong? 5. Where is home? 

This process is relational. People struggle together to renegotiate and reconstruct identities and roles to accommodate for the missing person.

People enter into a process of searching for new options about who to be and what to do now but still leave the door open for possibilities that may emerge down the line.  

What helps in Reconstructing Identity? 1. Telling stories in interaction with others who suffer the same ambiguous loss. 2. Developing some spiritual identity to deepen personal identity, 3. Continuing family life, rituals, and celebrations. 4. Helping people reconstruct rituals and celebrations. 5. Helping people revise their roles. 6. Helping people recognize dysfunctional interactional patterns.

Tolerance for paradox is the goal for reconstructing individual, couple, and family identities after the trauma of ambiguous loss. 

Normalizing Ambivalence

What is this? Ambivalence is state of having mixed feelings or contradictory ideas about something or someone. Normalizing Ambivalence means acknowledging its existence. 

Ambiguity means lack of clarity—no validation or clarification of the loss.

Ambivalence in more detail refers to conflicted feelings and emotions either simultaneous or fluctuating (love and hate, attraction and repulsion). All these thoughts and feelings are normal. 

Ambiguity is what one knows and ambivalence what one feels.

What can help in normalizing ambivalence? 1. Helping people see family and community as major resources for support and healing. 2. Bringing conflicted feelings into awareness through telling and listening to narratives. 3. Normalizing negative feelings (minimizes them). 4. Working collaboratively: psychologists, psychiatrists, community leaders (clergy, first responders, and local educators).  5. Using the arts to bring mixed emotions to the surface (film, dance, creative writing, music, literature, painting, and theater). 6. Talking about what is lost and what is still there. What did you lose? What do you still have? How do you feel about the ambiguity now? What are your views about what to do, how to proceed? What does this loss mean to you now? f. How do you see the missing person now? 

What hinders Normalizing Ambivalence? Blaming, shaming, and guilt.

Revising Attachment

Boss defines attachment in a more general sense—a relational and reciprocal relationship with one who is constant, a deep connection between individuals in couples, families, or other close relationships. 

What helps in Revising Attachment? 1. Accepting the paradox of absence and presence—here and not here. 2. Using groups to build new connections. 3. Encouraging the use of the arts (story, song, film). 4. Providing empathy and understanding that the situation is a stressful one (not normal to have someone vanish). 5. Putting people in touch with support groups and others who have had similar experiences of loss. 6. Helping individuals and families identify with peers to regain relational strength. 7. Helping them discover what they have of the missing person and recognize what is lost. 8. Developing memorial ceremonies and farewell rituals.

“It may be impossible to shift perceptions about absence or presence until one can actively participate in the rituals of honor and farewell that begin the process of revising the attachment.” (Loss, Trauma, and Resilience, p. 165).

What hinders Revising Attachment? 1. Overemphasis on closure and focus on the past. 2. Boss says the goal is to “grieve and revise earlier hopes and dreams about the person and the relationship, and to do this without the extreme reactions of absolute enmeshment or absolute detachment.” (Loss, Trauma, and Resilience, p. 169)

Discovering Hope

According to Boss, hope is belief in a future good, a positive belief with the expectation of fulfillment, believing that suffering can stop and that comfort is possible in the future.

What can help in Discovering Hope? 1. Helping people rediscover hope in human connections in a community. 2. Having a communal opportunity for emotional expression through story-telling. 3. Using the arts. 4. Being with others who have experienced the same kind of loss. 5. Redefining justice. 6. Working against injustice. 7. Practicing religion/spirituality. 8. Reflecting.

“For the sake of health and resiliency, we need to find something new and positive to look forward to—some other human connection and a cause beyond ourselves that has meaning.” (Loss, Trauma, and Resilience, p. 184)

Tammy McLeod serves as a Harvard chaplain for Cru, an interdenominational Christian ministry. Tammy is also the director of college ministry at Park Street Church in Boston. She received her master's degree in spiritual formation from Gordon-Conwell Theological Seminary.
You may contact Tammy at www.patandtammymcleod.com. Follow Tammy on Facebook: @patandtammymcleod
Instagram: @patandtammymcleod 

You will be blessed by this book by Pat and Tammy McLeod:    Hit Hard: One Family's Journey of Letting Go of What Was--and Learning to Live Well with What Is

Books by Pauline Boss:

Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss 

Loving Someone Who Has Dementia: How to Find Hope while Coping with Stress and Grief

Ambiguous Loss: Learning to Live with Unresolved Grief 

Photo by Karim MANJRA on Unsplash