Culture, spirituality, ethnicity, race, and religion can shape a family’s values and beliefs—forming the foundation of one’s worldview. From within this system, children observe family members participating in loss rituals. These early experiences can influence how we respond to loss in the future.

In this new blog series, I discuss types of complicated grief and how counseling can help a person struggling in their time of mourning. Last week, I wrote about disenfranchised grief. This week, we look at ambiguous loss.

COMPLICATED GRIEVING

Each loss is unique. Each response to loss is unique.

When a loss disrupts an individual’s sense of self and upends one’s worldview, complications in grieving can arise. A community’s response to violent death, such as a school shooting, can bring death close to home. One’s own mortality becomes fragile, even scary. Nora Gross, PhD, a visiting assistant professor of sociology at Boston College, explains:

“We internalize the threat, which leads to grief, anxiety, fear and so much more. Stress hormones flood our bodies, and we feel out of control. Without us realizing it, a fight, flight or fear response becomes what controls our reactions.” [@MakeIt]

The inability to make sense of a loss and difficulties in reconstructing one’s life in that absence can lead to unhealthy coping strategies and/or complicated grief.

Ambiguous Loss

In the 1970s, Dr. Pauline Boss identified a form of loss that results due to the physical or psychological absence of a loved one: Ambiguous loss. It is different from ordinary loss because “there is no verification of death or no certainty that the person will come back or return to the way they used to be.” [@ambiguousloss.com]

Two forms exist:

1. Physical ambiguous loss occurs when a loved on is “physically missing or bodily gone.” Spouses and children of servicemen and women can experience this type of loss when a loved one goes missing in action (MIA) or becomes a prisoner of war (POW). Spouses and children of imprisoned loved ones can experience this type of loss. Other examples include loss of loved ones due to natural disasters, terrorist attacks, genocide. Another type of physical ambiguous loss occurs within family units when there is separation, divorce, fostering, adoption, and immigration. Emotional connection remains in the absence of physical presence.

2. Psychological ambiguous loss occurs when a loved one is physically present but emotionally, cognitively, or psychologically absent. Individuals and families can experience this type of loss when a loved one suffers from dementia, traumatic brain injury, or mental illness (e.g., schizophrenia, depression, bipolar disorder, addiction). This type of loss can lead to anticipatory grief—a prolonged, emotional preparation, often unconsciously, for the death of a loved one due to illness or prognosis. Unexplainable deaths, such as suicide or infant deaths can also lead to psychological ambiguous loss. Physical connection remains in the absence of psychological presence.

Working through the Pain & Sorrow

A certified grief counselor can provide a safe holding space for loved ones to express themselves and explore their individual and collective losses. Couples and family counseling can be greatly beneficial because family roles can be disrupted due to ambiguous loss. Caregivers can suffer from psychological ambiguous loss because they may take care of their loved one but the strong emotional and intellectual bonds are gone.

Dr. Elizabeth Kübler-Ross illuminated her pioneering work with hospice patients in her 1969 book, On Death and Dying. She described five stages of grief that terminally ill patients experienced: Denial, anger, bargaining, depression, and acceptance. While grief counselors recognize her groundbreaking work, we also recognize that grief is non-linear and task-oriented.

Throughout this process—with no fixed staging or timeframe—a counselor supports a client as s/he/they work through the tasks of grief. Based on my training with Drs, Robert Niemeyer and Carolyn Ng of the Portland Institute, I work on the following tasks with my clients:

• accepting the reality of the loss

• experiencing grief’s myriad emotions

• returning to life’s demands

• adjusting one’s relationship with the person

• reconstructing one’s life story after the loss.

Through this process of reconstructing your life, you are able to find meaning and hope while receiving validation for your ambivalence.

If you have had an ambiguous loss and would like to see if you would like to work with me, please contact me for a free 15-minute consultation.

Check back next week, when I discuss how I help clients during the grieving process tend to loss-oriented and restoration-oriented tasks.

Lisa A. Rainwater, PhD, MA (couns) LCMHCA, NCC, CGP, CT is the owner of Rainwater Counseling in Winston-Salem, North Carolina. She earned a master’s in German studies from the University of Oregon; a master’s in counseling from Wake Forest University; and a doctoral degree in German and Scandinavian studies from the University of Wisconsin-Madison. She is a Certified Thanatologist through the Association of Death Education and Counseling and is seeking certification in Grief Therapy as Meaning Reconstruction at the Portland Institute for Loss and Transition.