Ambiguous Loss (Dr. Pauline Boss) training for BFOSCR Support Facilitators regarding supporting Families with Missing Loved Ones (Missing Persons) by Maureen Trask on Mar. 6, 2021.
1. Ambiguous Loss:
Supporting Families with Missing Loved Ones
(Missing Persons)
For: Grief Support Facilitator Workshop Training,
BFO South Central Region
Presented by: Maureen Trask
On: March 6, 2021
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2. Topics
Explore “Missing”
Ambiguous Loss and Family Needs
Support Frameworks and Your Role
Recap and Q & A
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4. Explore “Missing”
4
I will facilitate conversation to explore “Missing” and
identify the existing gaps and issues.
What is a Missing Person?
(Definition)
Who goes Missing?
Where are the Missing?
When are they Found?
Why do they go Missing?
How many go Missing?
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5. Stats - Patterns in the Data*
* Source data as reported on Canada’s Missing (Public Website), under Publications www.canadasmissing.ca
5
A-Adult C-Children
Year
Age
Grp
Ontario
#
Ontario
Total
Canada
#
Canada
Total
Ontario
%
Canada
%
2015 A 6,513 19,413 26,080 71,368 34% 37%
C 12,900 45,288 66% 63%
2016 A 6,717 18,465 27,789 73,398 36% 38%
C 11,748 45,609 64% 62%
2017 A 7,035 18,060 30,632 77,800 39% 39%
C 11,025 47,168 61% 61%
2018 A 7,497 17,686 31,387 73,620 42% 43%
C 10,189 42,233 58% 57%
2019 A 8,082 17,849 32,752 73,177 45% 45%
C 9,767 40,425 55% 55%
5 Yr Avg A 7,169 18,294 29,728 73,873 39% 40%
C 11,126 44,145 61% 60%
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6. A Poem by Tom M. Brown
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When Someone You Love Goes Missing
https://wenswritings.wordpress.com/when-someone-you-loves-goes-missing-by-tom-m-brown/
8. Ambiguous Loss Explained
Dr. Pauline Boss, principal theorist of the concept of Ambiguous Loss
and Dr. Gloria Horsley, founder and president of Open to Hope
Foundation, discuss Ambiguous Loss at the annual Association of Death
Education and Counseling (ADEC) Conference, 2011.
http://www.youtube.com/watch?v=C2vYyefAgZ0
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9. Ambiguous Loss Recap
Unclear Loss
Senseless Loss
Traumatic Loss
Externally Caused
Lacks Closure / Understanding
Frozen Grief / Being Stuck in Limbo
A Unique Individual Journey
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10. Types of Ambiguous Loss
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1. Physically Absent-
Psychologically Present
2. Psychologically Absent-
Physically Present
Adoption
Migration
Miscarriage and stillborn loss
Missing people
Natural disaster and
catastrophic tragedy
Addictions
Dementia and Alzheimer’s
Mental health issues
Separation/Divorce
Traumatic brain injury or coma
There is no verification of death.
There is no certainty that the person will come back
11. Ambiguous Loss differs
from Traditional Loss
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Traditional Loss Ambiguous Loss
Some knowledge and understanding
from society and western culture
Lack of knowledge about what
ambiguous loss is and its effects
Some services/supports available-
grief counsellors/professionals
Tremendous lack of services and
supports – lack of professionals that
specialize or educated on this
Seen as “normal” because everyone at
some point in their life has a loved one
that dies
Seen as “not normal”, “complicated
grief”, and not affecting the mass
majority
Spiritual/belief teachings exist that
speak to death and mourning
No spiritual/belief teachings discuss
ambiguous loss
12. Ambiguous Loss differs from
Traditional Loss continued
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Traditional Loss Ambiguous Loss
Mourn the loss after the death Cannot mourn because no defined
death to mourn
Customary rituals that allow for
closure
Symbolic rituals that ordinarily support
a loss do not exist. (Boss, 1999)
Some tolerance to the loss that results
from a death.
Co-workers, peers, and society are less
likely to tolerate ambiguity.
The loss as a result of a death is
legitimized by society.
Ambiguous loss is not legitimized by
society.
Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief.
Cambridge, MA: Harvard University Press.
13. Why does it matter?
Freezes the grief process
Paralyzes couple and family functioning
Prevents “closure”
Families can name it,
“Ambiguous Loss”
Families need help
Families need support
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14. How does one learn to
ease the effects?
Guidelines for resiliency while having to live with
ambiguous loss: (Boss, 1999)
1. Find Meaning (look at values, beliefs, traditions)
2. Accept Uncertainty (make 2 opposing ideas into 1)
3. Reconstruct Identity (forced to change roles)
4. Normalize Ambivalence (as the new norm)
5. Revisit Attachment (celebrate the missing and mourn the changes)
6. Discover Hope (look at strengths, making it with the pain)
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15. Manage the Contradictions
Take two opposing ideas, make into one (both/and)
•I am both sad - and still happy
•I am both alone - and still connected
•I am both powerless - and still empowered
•I am both frozen - and still transforming
•I am both doubtful - and still hopeful
•I am both burdened - and still grateful
•My loved one is both gone - and still here
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16. Needs of Families
•Be heard, believed, and supported
•Be safe and connected, with trust
•Understand the systems and resources
•Know what to expect of self and others
•Minimize the emotional roller coaster
•Take care of self first, find balance
•Cope in healthy ways, reduce stress
•Strive to maintain Hope, build Resiliency
•Access to timely information and resources
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17. What Families need to Do
•File a Missing Person Report
•Contact family, friends, last know locations
•Handle jurisdiction changes
•Deal with property (Home, Bills, MTO, Medical)
•Manage triggers (Sightings, Remains, Psychics)
•Maintain relationship with Police and searchers
•Live with the ambiguity and uncertainty
•Hopefully, find meaning and hope
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19. 1. Re-animation
Move past “frozen”
Help families with their
sense of being frozen
to the time of their loved
one's disappearance.
Assist families to move
from their sense of
feeling ‘stuck‘.
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20. 2. A celebration so far
Respond to loss
Acknowledge and honour the family's relationship
with the missing person.
Facilitate families to find
an opportunity to respond
to the current loss of
their loved one.
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21. 3. The trauma timeline
Explore the impact
of the disappearance,
as well as the
accumulated traumas,
families may have
faced prior to their
loved one going
missing.
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22. Triggers and Trauma
“Having a missing loved one is the most painful
loss of all.” (Dr. Pauline Boss, 1999)
Triggers can affect the emotional ups and downs:
• News, tips, or new leads
• Items found, but no physical evidence
• Possible sightings or remains found
• Significant dates, events, songs, smells, places, things
• Other Missing Person stories and cases
• Officer or Jurisdiction changes
The *Trauma Timeline is an important aspect
when assessing the implications of the loss.
* Supporting those who are left behind, Australian Federal Police (Sarah Wayland), 2007
22
24. 4. A protected place
A safe place of pain
Co-construct with families a space where they can
acknowledge the
pain of not knowing
while still finding
ways to live life.
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25. 5. Opportunities for growth
Living with loss
Explore ways in which families can live
with their loss,
rather than being
consumed by it.
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26. *AFP Updated Support
Framework
Assist people to tolerate the unknown
* Dr.Sarah Wayland and Univ. of New England Research Team , Mar. 4, 2019
26
The Australian Federal Police (AFP)
National Missing Persons Coordination
Centre (NMPCC)
27. First Nations Experiential
Knowledge Circle / Learning Cycle
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Experiencing - Engagement in
"Real life" learning experience
Reflecting - Internalization of the
Experience
Making Meaning - Analysis of the
Experience
Acting - Application of Experience
to other Real Life Situations
28. What to Avoid
Guidance for Facilitators
•Supporting the person from a grief
approach (like a death)
•Focusing on advice or assumed cause
•Assuming every situation is the same
•Asking “How does that make you feel?”
•Thinking newfound Hope remains
•Using the word “Closure”
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29. Support:
Looks different to everyone
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“Someone to really
listen…”
“Being present…”
“Just being there …”
…were by far the most
popular ways to
support someone
30. What you can do as a Support
(Facilitator)
Create and hold a safe space
Educate that grief is “frozen” and is not a linear process
Encourage to share story, call loved one by name and
educate on importance of this
Help build strategies to cope with tidal waves of emotion
Help cope with the tough questions: the ‘why’, ‘what if’
and ‘should have’ from the family
Help to recognize and build resilience
Help externalize the loss to release blame and guilt
Help find meaning in their experience of loss
Help embrace the paradox and move forward with the
“good enough” (Boss & Carnes, 2012)
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31. What you can do as a Support
(Facilitator) continued
Listen more and do less
Empower to see loss in a new way
Hold multiple truths about the missing person
Normalize the experience, feelings, and thoughts
Work collaboratively with the families as equals
Help build “… a new narrative that is less burdened with
negative attributions, which invoke guilt, shame, remorse,
or desire for retribution” (Boss & Carnes, 2012)
Use tasks as guidelines
Focus on the impact of the loss
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32. Living and Learning on my
Ambiguous Loss Journey
• “Loss of a missing loved one is often a lonely and an untrodden path
for each of us who has to walk it.” *
•Can I learn to live with
this loss?
•How do I get answers?
•How do I get support?
•Can VS be that support?
32
* Living in Limbo: Five Years On, Missing People UK, 2013
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33. Recap and Q & A
Ambiguous Loss is an uncertain/unclear loss
Triggers can impact the journey
I’m not “crazy”, it’s the situation
Each situation is unique and individual
Families need support (someone to listen)
It’s about finding meaning and hope
“Closure” is a myth, families want answers
Any moments or thoughts? Questions?
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34. From me to each of you:
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Maureen Trask: trasker@rogers.com
Links to the Presentation and Resource Materials will be emailed.
“Thanks”
Editor's Notes
I’m here to share my journey of ambiguous loss, with having had a missing son for 3 ½ years.
Daniel had set me on this path, which was new to me, but I am learning lots about strength, resiliency, never giving up.
As a parent, no one prepares you for this type of loss..
Through this presentation, I will share what ambiguous loss is, what you can do to help support families and how to relate to their experience of uncertainty.
So, as a Mom left behind, living in limbo, frozen in grief, not knowing what I was grieving or how to deal with this loss. More questions than answers.
My journey was 3 ½ years. Many have endured this path on their own, for far to many years.
This poem “When Someone you love goes missing”, by Tom M. Brown, speaks to this journey.
(read poem)
What is a Missing Person? (Definition on * Wikipedia, updated Jan. 24, 2020)A missing person is a person who has disappeared and whose status as alive or dead cannot be confirmed as their location and fate are not known.
Who goes Missing? Potentially anyone
All ages: infant, child, adolescent, adult, seniors All races, sexes, locations, education, economicsAnswer Intentional or not? Crime or not? Alive or Dead? Unique situations and experiences
Where are the Missing? Potentially anywhere. All jurisdictions across Canada: Municipal, Regional, Provincial, Territorial, Federal, Ontario Provincial Police (OPP), Sûreté du Québec (SQ), RCMP, Indigenous Policing including Nishnawbe Aski Police Service (NAPS)
Other jurisdictions outside Canada: Cross border-USA, International (INTERPOL), Abroad (Consulates, Embassies, ICMP-International Commission on Missing Persons (ICMP), founded in 1996 at the G-7 Summit in Lyon, France. ICMP is the only international organization of its kind that addresses the issue of missing persons in all facets. https://www.icmp.int/
When are they “Found”? Most, within a week, older (with 6 months – 1 years), cold cases many years, decades, even after your lifetime. Adults: 62% of missing adult reports were removed within 24 hours, while 90% were removed within a week. Children: 63% of missing children/youth reports were removed within 24 hrs, while 93% were removed within a week. * Based on Occurrence Data, 2019 Fast Fact Sheet, National Centre for Missing Persons and Unidentified Remains (NCMPUR) of RCMP
Why do they go Missing? Many reasons, but little data or research.
How Many go Missing? Next, statistics, patterns in the data 70,000 to 80,000
Probable Cause Classification: (comes from CPIC)
Abduction by Stranger, Abducted by Relative,
Parental Abduction with Custody Order. Parental Abduction without Custody Order,
Accident, Wandered Off, Runaway, Presumed Dead, Human Trafficking, Unknown, Other
What about Homeless?
2019 Fast Facts
57% of missing adult reports in 2019 involved males.
66% of adults who wandered off in 2019 were males.
In 2019, British Columbia had the highest number of missing adult reports per capita, with 257 reports per 100,000 people, followed by the Yukon with 195 reports per 100,000 people. Nunavut had the lowest, with 8 reports per 100,000 people.
2019 Children
57% of all missing children/youth reports in 2019 involved females.
74% of missing children/youth reports (male and female) in 2019 were runaways.
55% of all missing persons reports (male and female, adults and children) involve children.
In 2019, Manitoba had the highest number of missing children reports per capita, with 594 reports per 100,000 people, followed by Saskatchewan with 427 reports per 100,000 people. Prince Edward Island had the lowest, with 4 reports per 100,000 people.
This poem “When Someone you love goes missing”, by Tom M. Brown, speaks to this journey by families, a raw and real experience.
(read poem)
Dr. Pauline Boss presented the theory of ambiguous loss in 1999 (book).
This comment explains ambiguous loss as an uncertain, unexplained loss, lacking answers, unsolvable.
Dr. Pauline Boss presented the theory of ambiguous loss in 1999 (book). She has also applied her theory by facilitating support for families in numerous disasters including 9/11, Thailand tsunami, and Malaysian air crash. When I learned of her work, I read her books and immediately connected with what I was experiencing, it made sense. It wasn’t me, it was the situation. I contacted her to learn more and determine if support material or services were available for families such as mine, very little in Canada. This short clip is an excellent introduction to ambiguous loss.
Pauline has written subsequent books on Loss, Trauma and Resilience (2006) and Dementia (2011), building on research and clinical experience of ambiguous loss.
In Loss, Trauma, and Resilience, Boss provides the therapeutic insight and wisdom that aids mental health professionals in not "going for closure," but rather building strength and acceptance of ambiguity. What readers will find is a concrete therapeutic approach that is at once directive and open to the complex contexts in which people find meaning and discover hope in the face of ambiguous losses.
In Loving Someone Who Has Dementia, Boss builds on research and clinical experience, yet the material is presented as a conversation. She shows you a way to embrace rather than resist the ambiguity in your relationship with someone who has dementia.
I would like to note that I will be using the term “traditional loss” to refer to loss from a death that is followed by a funeral.
Unclear Loss- the loss is unclear because the relationship is not completely gone. Rather a part of the loved one is still very present yet the other part of them is gone which I will further discuss in a moment.
Senseless Loss- the loss is confusing and incomprehensible due to the many uncertainties and unanswered questions.
Traumatic Loss - typically with ambiguous loss the loss comes from a traumatic experience.
Externally Caused- external circumstances and situations cause the loss rather than individual pathology This situation has caused sadness in my life. But, I’m not crazy, or depressed – I’m heart broken.
Tell story of Denise Allen, who’s son Charles is missing. (Police tried to commit her to hospital. Was forced to see a psychiatrist who then allowed her to see a general physician – no support services for her).
Lacks closure- I researched what closure was because I wondered is closure ever possible with any loss. Some of the definitions I got where: an often comforting or satisfying sense of finality, bringing to an end, and a conclusion. From this, I decided that full closure was never possible with any loss because you can never shut the doors on the memories, relationship, love and the bond, which can never be erased. In other words, while death does bring finality to one’s life. Complete closure is not possible with any loss because loss is never satisfying. However, with ambiguous loss there is absolutely no closure because there is no verification of death, no real goodbye rituals such as and burial. With ambiguous loss, there is no finality, but rather ongoing uncertainties, which deny any small sense of closure that, allow people to try to go on, not move on but go on with the sadness. This leads me to the next point…
Frozen grief / Stuck in limbo- ambiguous loss freezes the grief process because not all is fully lost, there is no finality, and it does not feel right to fully mourn. It is an on-ongoing grief. It is essentially as though being stuck in limbo.
A unique individual journey- much like a traditional loss, each person’s grief journey is unique and individual. While two people may experience ambiguous loss for the same reasons, their journey will always be different. Having said that it is very important for those experiencing ambiguous loss to have a community connection with others experiencing the same thing as it helps to normalize the emotions, and the feeling connected helps to find the needed meaning.
Closure is a Myth (even with Death). Closure is not part of the grieving process. Nor is it necessary for healing.
A connection formed in LOVE can’t be closed. (The Grief Toolbox) Is closure a myth?
Ambiguous loss defies closure even with healthy families as discussed by Pauline Boss and Donna Carnes, in Family Process article, 2012.
I agree with their summary that ambiguous loss with its lack of closure makes immense demands on the human capacity to cope and grieve.
So to me, there will be no closure for me. Even if Daniel is found deceased, I agree that my connection formed in LOVE can’t be closed. This too is being questioned in traditional loss. Closure is a word I really, really do not like, which is true of others with missing loved ones. Instead, I prefer to say it’s answers I need. If answers are not available, then I need to find comfort in the uncertainty, some sense of meaning from this, peace, but certainly not “Closure”.
Families will never have closure, the best we can get is answers.
Two types of ambiguous loss…
Psychologically absent- Physically present
The loved one is physically present however; they are cognitively and emotionally absent.
Physically absent- Psychologically present
The loved one is physically absent but remains psychologically present.
Missing People (for example disappeared, kidnapped, missing in action, or mass disasters such as 9/11)
It is also possible to be experiencing both at the same time as I am with a missing son and a mother with dementia. As you can see with all of these examples there is no real goodbye to the relationship and roles, no farewell ritual, and yet someone is lost and something remains creating ambiguity.
Symbolic rituals that ordinarily support a loss do not exist. The result is an unverified loss by the community, and no validation of experience and feelings. People need to see the body and participate in rituals to break down denial, and cognitively begin to cope and begin the mourning process. Having the body empowers to let go and fulfills a need to say ‘good-bye’. Therefore, the grief process becomes frozen and paralyzes family members, and couple/family functioning
Co-workers, peers, and society are less likely to tolerate ambiguity. We are accustomed to focus on the problem and fixing the issue but with ambiguous loss, this is not possible which causes people to have less tolerance.
Ambiguous loss is not legitimized by society. We lived in a society that highly values answers, and a can-do attitude, and not being able to get closure is criticized because it goes against societal values.
Find meaning- look at values, beliefs, and traditions to find a purpose and meaning for self in order to regain some control. This helps to remove blame and to feel like being pro-active.
2) Accept uncertainty- change the way one thinks about loved one by taking two opposing ideas and making them one: they are both here and not here. This balances the need for control with acceptance of ambiguity.
We have two polarizing realities that co-exist.
We need to change the way we think of our loved one by taking two opposing ideas and make them into one: they are both here and not here.
I tried this on, and it makes sense. I applied this to my experience as follows:
Need to Manage the contradictions Take two opposing ideas, and make into one
I am both sad – and still happy
I am both alone – and still connected
I am both powerless – and still empowered
I am both frozen – and still transforming
I am both doubtful – and still hopeful
I am both burdened – and still grateful
He/She (Daniel) is both gone – and still here
3. Reconstruct identity- inevitable for roles within relationship/ families to change. Therefore forced to change roles and identity. The missing has created a hole in the family dynamics.
4. Learn to live with ambivalence as a new norm- experience conflicting feelings/thoughts (I.e. wishing for answers even if death itself). Here accept the emotional rollercoaster and develop strategies to help with the waves of mixed and overwhelming emotions.
5. Revisit attachment-most difficult as you accept ambiguity and the uncertainty as part of life.
Part of this task is to celebrate the missing and mourn the changes.
6. Discover hope- look at strengths and see how you have made it to this point with pain. Discover hope in different ways (i.e. nature, volunteering, etc.). Understand hope changes over time.
*Use a Narrative Therapy approach- identify what has been lost, discuss the effects of the loss, normalizing the experience, assess coping resources, lay to rest guilt and blame, and develop rituals to allow to move on while still remembering. Overall, the goal is to take authorship of a new and more meaningful story of loss.
** Common to do family therapy, more beneficial than individual or group (particularly mass disasters)
“Loss of a missing loved one is often a lonely and an untrodden path for each of us who has to walk it.” *
* Living in Limbo: Five Years On, Missing People UK, 2013
“The weight of loss may never go away, but we learn how to carry it”.
My experience, read
‘The heartache of having a missing loved one is overwhelming as days turn into weeks, then months, then years. Each search or new lead sets us up for hopeful answers, but also painful disappointments. It’s an emotional rollercoaster that is difficult to describe let alone understand. There is so much uncertainty. Our family has experienced death of loved ones and the grieving process associated with this type of loss. But how do you grieve someone who is missing? How do you grieve when you don’t know if they are alive or dead? How do you carry on with the demands of life, and at the same time deal with the emotional turmoil? This is our reality. Naturally, one will seek out support services to help cope, seek out those who can help us deal with the uncertainty.’
(quoted in Living in Limbo from a mother’s perspective)
Yes, I believe I can learn to live with this loss.
But, know I will not get closure, need to carry on without answers.
A specific framework for supporting those left behind, families with missing loved ones.
Developed by Sarah Wayland, researcher, and adopted by the Australian Federal Police,
National Missing Persons Coordination Centre. Applies the Ambiguous Loss theory by Dr. Pauline Boss.
Therapeutic prompts
Can you tell me about your loved one? - referring to the person not just as a missing person
What would you say to (the missing person – name) if they were here now?
Therapeutic prompts:
Do you tend to get “stuck” on the circumstances around the missing person’s disappearance? What would happen if you focussed on other times in your relationship with them i.e. when they weren’t missing?
Do you find it challenging to celebrate the missing person in your life because you don’t know where they are and when they may be returning?
Therapeutic prompts:
Tell me about your life before your loved one went missing.
How have previous experiences of trauma impacted on the way you are coping with the loss of your loved one?
Therapeutic prompts:
7. Life continues even when your loved one is missing. How do you manage when life doesn’t allow you to focus only on your missing loved one’s disappearance?
8. Do you sometimes feel the need to take a break from concentrating on the sadness and frustration of having someone missing? What would it feel like to take some time for yourself?
Therapeutic prompts:
What are some of the ways that you can keep your loved one present in your life?
If the missing person could see the journey you have been on, what would they say this journey has said about you?
Acknowledging the Empty Space, The Australian Federal Police (AFP) National Missing Persons Coordination Centre (NMPCC)AFP launch updated framework to support those with a missing loved one | National Missing Persons Coordination Centre
Person-centered, empathetic listening, be where they are at, and what there needs are at this time.Wrap-around care. Unique experience, but common thread through lived experience.
Covers: Understanding Ambiguity, Experience of Missing, Providing Support and
Guideline sections for: Counsellors, Police, the Community, the Media
Also, The SOS Guide: Missing Persons A Guide for the Families and Friends of Missing Persons
Before we talk about specific services, first, let’s look at the ways to support someone with a missing loved one. Support looks different to everyone, but there are some that are most popular when it comes to supporting families with missing loved ones.
Ambiguous loss inherently creates complicated grief. But the pathology lies in the ambiguity, not in the person whose grief is frozen. Therapeutic challenge then is not closure, but a paradoxical search for meaning in meaninglessness.
Understanding is key – providers must understand ambiguous loss to understand my experience.
Let me live my experience, understanding that the type of loss I’m experiencing will influence the type of grief I experience. (the type of loss shapes the type of grief – and the support challenge)