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Ambiguous Loss: Concepts and Clinical Practice

Ambiguous Loss: Concepts and Clinical Practice. Rose Collins, PhD Minneapolis VA Health Care System. Ambiguous Loss. A loss that is unclear and thus has no closure A situation or problem that has no answer and thus no resolution

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Ambiguous Loss: Concepts and Clinical Practice

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  1. Ambiguous Loss:Concepts and Clinical Practice Rose Collins, PhD Minneapolis VA Health Care System

  2. Ambiguous Loss • A loss that is unclear and thus has no closure • A situation or problem that has no answer and thus no resolution • Thus, ambiguous loss can traumatize and immobilize grief and coping processes • Due to ambiguity, individuals & families can’t move forward with their lives.

  3. Two Types of Ambiguous Loss • Type I: Physical absence with psychological presence (e.g., missing, disappeared, kidnapped, military deployment) • Type II: Psychological absence with physical presence (e.g., TBI, coma, dementia, addiction, autism, depression etc)

  4. Types of Ambiguous Loss • Type I and Type II often overlap in the same person or family

  5. Effects of Ambiguous Loss • Confusion • Immobilization • No validation • No closure • Exhaustion

  6. Effects of Ambiguous Loss • Confusion • Immobilization • No validation • No closure • Exhaustion

  7. Guidelines for Helping Families Live with Ambiguous Loss

  8. Guidelines for Helping Families Live with Ambiguous Loss • Finding Meaning • Tempering Mastery • Reconstructing Identity • Normalizing Ambivalence • Revising Attachment • Discovering Hope Boss, P. (2006). Loss, Trauma, and Resilience. NY: Norton

  9. Finding Meaning Tempering Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope Boss, P. (2006). Loss, Trauma, and Resilience. NY: Norton

  10. Guidelines for Helping Families Live with Ambiguous Loss • Finding Meaning • Tempering Mastery • Reconstructing Identity • Normalizing Ambivalence • Revising Attachment • Discovering Hope

  11. Finding Meaning: What Helps • Naming the problem • Dialectical thinking • Religion and spirituality • Forgiveness • Small good works • Rituals • Positive attribution • Sacrifice for a greater good or love • Perceiving suffering as inevitable • Hope

  12. Finding Meaning: What Helps • Naming the problem • Dialectical thinking • Religion and spirituality • Forgiveness • Small good works • Rituals • Positive attribution • Sacrifice for a greater good or love • Perceiving suffering as inevitable • Hope

  13. Finding Meaning: What Hinders • Hate and revenge • Secrets • Violent and sudden loss • Disillusionment

  14. Tempering Mastery: What Helps • Recognizing the world is not always just and fair • Recognizing where views of mastery originate • Externalizing the blame • Decreasing self-blame • Managing and making decisions

  15. Tempering Mastery: What Hinders • Too much mastery • Too little mastery • Ill-timed use of mastery • Belief that one’s efforts will always result in desired outcome • Belief that bad things can’t happen to good people • Blaming oneself or others for not being able to solve the problem.

  16. Reconstructing Identity: What Helps • Define family boundaries • Select major developmental themes • Develop shared values and views

  17. Reconstructing Identity: What Hinders • Discrimination and stigma • Forced uprooting • Isolation and disconnection • Hanging on to one absolute identity • Resisting change

  18. Normalizing Ambivalence: What Helps • Normalizing guilt & negative feelings, but not harmful actions • Using the arts to increase understanding of ambivalence • Regaining personal agency • Reassessing & reconstructing the psychological family • Seeing the community as family • Reassigning everyday roles and tasks • Asking questions about context & situation • Bringing ambivalent feelings into the open

  19. Normalizing Ambivalence: What Helps • Uncovering latent or unconscious ambivalence • Managing the ambivalence, once aware of it • Seeing conflict as positive • Valuing diverse ways of managing ambivalence • Knowing that closure does not lower ambivalence • Developing tolerance to tension • Using cognitive coping strategies

  20. Normalizing Ambivalence: What Hinders • Using only a symptom focus • Expecting typical coping and adaptations

  21. Revising Attachment: What Helps • Thinking dialectically • Moving from despair to protest • Thinking systemically, but not seeing maladaptations as bilateral pathology • Developing memorial ceremonies and farewell rituals • Knowing that fantasies of a missing person are common • Watching out for no-talk rules • Paying attention to developmental stages that exacerbate anxiety

  22. Revising Attachment: What Helps • Including children & adolescents in therapy when parents or siblings disappear • Using multiple-family and couple groups to build new connections • Encouraging the use of the arts

  23. Revising Attachment: What Hinders • An overemphasis on individuation • Expecting closure

  24. Discovering Hope:What Helps • Finding spirituality • Imagining options • Laughing at absurdity • Developing more patience • Redefining justice • Finding forgiveness • Creating rituals for ambiguous loss • Rethinking termination • Revising the psychological family

  25. When Hope Hinders • Persistent hope for closure • Continued longing for life as it used to be

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