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Ambiguous Loss


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NAMI PA, Main Line Forum Discussion on Ambiguous Loss, the term used to describe loss that is unlike ordinary loss in that ambiguous loss lacks closure, social acknowledgement or ritual, or normal means of coping & grieving.

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Ambiguous Loss

  1. 1. Created November 2013 Ambiguous Loss Presented by NAMI PA, Main Line, an affiliate of the National Alliance on Mental Illness Please view the final slide for NAMI PA, Main Line contact information, and links to resource documents and the YouTube video of this presentation.
  2. 2. 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.
  3. 3. 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.
  4. 4. 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
  5. 5. T1: Physical Absence T2: Psychological Absence  Missing loved ones from abduction, military, college  Missing from war, terrorism or natural disaster  Abandonment  Adoption  Immigration  Dementia/Alzheimer’s  Mental Illness  Brain injury  Chronic Illness  Autism  Depression  Addiction  Workaholism Ambiguous Loss Types & Examples
  6. 6. 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
  7. 7. 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.
  8. 8. 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
  9. 9. 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”
  10. 10. 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
  11. 11. 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”
  12. 12. 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
  13. 13. Created November 2013 Presented by NAMI PA, Main Line an affiliate of the National Alliance on Mental Illness Contact presenter Craig DeLarge directly at: Listing of resources used to create this presentation: 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.