Ambiguous Loss Coping Strategies for Therapists child

Ambiguous Loss Coping Strategies for Therapists

This article looks at how you can help children coping with an ambiguous loss such as is the case for the children where a parent is physically unavailable (i.e. due to work, divorce…) but emotionally available or, physically available but emotionally unavailable (i.e. depression, addictions…).

COPING WITH LOSS IN GENERAL

From a psychological point of view, grief is the experience of intense sorrow following a loss. There is a wide range of things whose loss can induce grief. What all these losses have in common is that without them, one’s life experience is changed to a stressful degree. The purpose of coping with loss is to reduce this stress and enable the person to gradually re-establish their equilibrium and go on with their life.

THE COPING PROCESS: DEFINED LOSS VS. AMBIGUOUS LOSS

In order to help children coping with loss, it is essential to recognize that there are two very different categories of loss: 1. Defined loss and 2. ambiguous loss.

1. Defined Loss. An example of defined loss is death of a loved. In this example, the loss is well defined, familiar, and explained with most cultures having developed rituals e.g. the funeral and customs, to help a person grieve and move on in their life.  There is also psychological help because much research has been carried out on defined loss. For example there is the 5 stages theory of grieving (Denial, Anger, Bargaining, Depression & Acceptance) which is well known and useful in helping children encountering difficulty in grieving a defined loss (Kubler-Ross, 1970).

2. Ambiguous Loss. This type of loss is not clearly defined. The term “ambiguous loss” was introduced by Pauline Boss nearly 45 years ago (Boss, 1972) and has proven extremely useful. It arose out of her observation that some families had fathers who were physically present but psychologically and emotionally absent. Boss found that how the family coped with such an ambiguous loss was very different from how it coped with a defined loss such as the death of the father. Boss (2006) wrote “… ambiguous loss is the most stressful kind of loss. It defies resolution and creates the long term confusion … ” It is the ambiguity of their loss that makes coping so difficult for children whose parent is unavailable, either emotionally or physically. Fortunately strategies for helping those coping with ambiguous loss have been developed (Boss, 1972; 2006; 2013).

NON-PROFESSIONALS: AMBIGUOUS LOSS COPING STRATEGIES FOR CHILDREN

  • In both normal grieving of a well defined loss and, in coping with ambiguous loss, social support can be very helpful if done in a sensitive and informed manner. Educating yourself about ambiguous loss is especially important because it is more complex and requires more nuanced types of helping behavior.
  • One particular difficulty in the case of an ambiguous loss is that family and friends are confused about what to say to the children during times when his or her parent is unavailable. With ambiguous loss, thinking out supportive statements is more difficult although it can be done if one becomes familiar with ambiguous loss concepts. For example you can say, “Just take it one day at a time.”
  • It also is important not to avoid children coping with ambiguous loss because you don’t know what to say and do. It is enough just to be physically and emotionally present and available to listen.
  • Allow the child coping with ambiguous loss to work through their process in their own way. In the case of defined loss, some benefit by talking, or even writing about their loss while others do not (Stroebe et al, 2002; Stroebe et al, 2006).
  • If you feel that a child or an entire family is experiencing an unusual difficulty, then gently and calmly suggest that they get assistance from a mental health professional. If they refuse initially, as they probably will, gently bring it up later perhaps giving them the name and telephone of a therapist experienced in grieving for them to call.
  • Whether it is defined loss or ambiguous loss, it is important for those providing emotional support to be vigilant about their own level of emotional distress.

MENTAL HEALTH PROFESSIONALS: AMBIGUOUS LOSS COPING STRATEGIES FOR CHILDREN

  • All of the suggestions given above for family and friends hopefully will be useful to professionals as well.
  • Educate yourself about ambiguous loss theory by reading the literature of Pauline Boss, in particular her 2006 book “Loss, Trauma and Resilience: Therapeutic Work with Ambiguous Loss.”  One of the main therapeutic goals in ambiguous loss therapy is to increase the tolerance for ambiguity.  This contrasts to the goal of defined loss therapy where closure and acceptance are the goals.
  • Because of their different goals, therapists should not attempt to use the stage theory of Kubler-Ross developed for defined loss in the case of ambiguous loss. Therapists should be constantly aware that children are in a state of flux concerning the parent’s presence and absence. Application of the stage theory to them would likely confuse them even more than they are. That anger is not to be confused with the anger stage of grieving a defined loss. Rather their anger may be directed at the therapist for pressuring on them to accept the parental relationship as is.
  • Recent research indicates that attachment style (the habitual way a person orients to intimate others) influences the kinds of support that are useful for ambiguous loss (Boss, 2006).  It seems likely that attachment style, specifically insecure attachment might influence the person’s ability to cope with uncertainty.  Hence, attachment style is an individual characteristic that should be taken into consideration when designing the treatment plan for an individual.
  • Boss suggests a variety of specific topics to be discussed in cases of ambiguous loss such as the meaning of the loss, modifying the need for certainty, normalizing ambiguity, and discovering hope.
  • The coping process for ambiguous loss can be especially stressful and prolonged and mental health professionals must take care of their own stress by having a good social support system and by daily practice of their own stress management program.

CONCLUDING REMARKS

Loss is inevitable in life whether it be defined or ambiguous. As Queen Elizabeth II said “Grief is the price we pay for love.”  If we attempted to avoid loss by never forming loving or intimate relationships whether it be  love of people, love of pets, love of our careers, and even self-love, what kind of life would we have? It is our deep sense of being connected that makes us human. Ambiguous loss theory and therapy helps us all develop a deeper tolerance for the inherent ambiguities in such valuable connections and cope better with their disruption.

REFERENCES

Boss, P. (1972). Father absence in intact families. Presentation at the annual meeting of the National Council on Family Relations, Research and Theory Session. Toronto, Canada.

Boss, P. (2006). Loss, Trauma and Resilience. New York: W. W. Norton.

Boss, P. (2013). Resilience as tolerance for ambiguity. In D. S. Becvar (Ed.), Handbook of family resilience (pp. 285-297).

Kübler-Ross, E. (1970). On death and dying. New York: Collier Books/Macmillan.

Stroebe, M., Stroebe, W., Schut, H., Zech, E., & van den Bout, J. (2002). Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies. Journal of Consulting and Clinical Psychology, 70(1), 169-178.

Stroebe, M., Schut, H., & Stroebe, W. (2006). Who benefits from disclosure? Exploration of attachment style differences in the effects of expressing emotions. Clinical Psychology Review, 26(1), 66-85.