Created November 2013; Revised September 2020
Ambiguous Loss
Presented by NAMI Main Line PA,
an affiliate of the National Alliance on Mental Illness
Please view the final slide for NAMI Main Line PA contact information,
and links to resource documents and the YouTube video of this presentation.

The Author: Pauline Boss
— Pauline Boss, Ph.D., is
emeritus professor at the
University of Minnesota and
was visiting professor at
Harvard Medical School,
1995-1996, and Hunter
School of Social Work, 2004-
2005.
— She is best known for
groundbreaking research as
the pioneer theorist and
clinical practitioner of stress
reduction for people whose
loved ones are ambiguously
lost.
A short Pauline Boss video launches after this slide.

What is Ambiguous Loss?
— Loss without closure, social acknowledgement or ritual, or
normal means of coping & grieving, unlike ordinary loss
— 2 Types:
¡ Type #1 - Physically absent but psychologically present
¡ Type #2 - Physically present but psychologically absent
— Stressful, tormenting, confusing, uncontrollable,
indeterminate, exhausting, guiltful, conflicting
Video to provide narration for Part I of this presentation is available by clicking on the
Ambiguous Loss, Part I link on the final slide.

What is Ambiguous Loss?
— Ambiguous loss is a relational disorder and not an
individual pathology.
— With ambiguous loss, the problem comes from the
outside context (situation) and not from your psyche.
— It follows, then, that family- and community-based
interventions—as opposed to individual therapy—will be
less resisted and thus more effective.
– Pauline Boss

T1: Physical
Absence
— Missing loved ones from
abduction, military,
college
— Missing from war,
terrorism or natural
disaster
— Abandonment
— Adoption
— Immigration
T2: Psychological
Absence
— Dementia/Alzheimer’s
— Mental Illness
— Brain injury
— Chronic Illness
— Autism
— Depression
— Addiction
— Workaholism
Ambiguous Loss Types & Examples

Ambiguous Loss sufferers are…
— denied rituals & acknowledgement of closure & stigmatized
— denied emotional & social support by society
— expected to carry on as normal amid uncertainty
— struggling with dark emotions: grief, doubt, guilt, anger, fear,
anxiety, depression, help/hopelessness, isolation, exhaustion,
ambivalence, denial & PTSD (without the post)
— faced with determining how their loved one fits in the family &
tempted with withdrawal
— struggling with responsibility boundaries
— often immobilized owing to ambiguity of situation

Coping Options
— Developing resilience &
comfort with ambiguity
— Taking refuge in
community
— Dialectic & narrative
therapy: mindfulness &
storytelling
— Validation of loss
— Self-care: rest, recreation,
accepting help; humor
— Acceptance & letting go;
“ease w/ imperfection”
— Mastery of the
controllable
— Meaning making;
celebrating what is
Video to provide narration for Part II of this presentation is available by clicking on the
Ambiguous Loss, Part II link on the final slide.

Meaning Making Factors
1. Family of origin & early social experiences
2. Spiritual world view: things happen for reason
3. Habits of thinking: optimism v. pessimism
4. View of cause/effect: neat equation v. random

Resilience Guidelines
— Finding Meaning
— Tempering mastery with acceptance
— Reconstructing identity (Psychological Family)
— Normalizing Ambivalence (Turning Point)
— Revising Attachment
— Discovering Hope: “AL doesn’t have to be devastating”

Ambiguous Loss Coping Actions can include:
— Labeling the loss
— Getting educated
— Identifying the loss
— Identifying remaining consistencies
— Encouraging acceptance/empathy for different views
— Facilitating problem solving in a safe holding space
— Sharing care

Good Coping Examples
— Sewell Family: mother with dementia and sons: able
to enjoy the new, shifting view, continuing joyous
parts of life
— Native American Women: mother with dementia:
“not failure but circle of life”
— Betty & Kenny Klein: lost boys: “holding 2 opposing
ideas”

Loving the Questions
— “be patient toward all that is unsolved in your
heart and try to love the questions themselves
like locked rooms and like books that are written in
a very foreign tongue... And the point is, to live
everything. Live the questions now. Perhaps
you will then gradually, without noticing it, live
along some day into the answer."
— Rainer Maria Rilke

Presented by NAMI Main Line PA
an affiliate of the National Alliance on Mental Illness
www.NAMIMainLinePA.org
info@NAMIMainLinePA.org
Contact presenter Craig DeLarge directly at:
craig@wiseworking.com
Listing of resources used to create this presentation:
www.diigo.com/user/cadelarge/ambiguous_loss
The YouTube presentation of this discussion can be found at:
Ambiguous Loss, Part I Ambiguous Loss, Part II
All information is current as of publication date; please let us know if you encounter broken hyperlinks.