This document summarizes a presentation about ambiguous loss given by Tania Sousa and Maureen Trask. The key points are: 1) Ambiguous loss refers to situations where a loved one is physically absent but psychologically present, or psychologically absent but physically present, resulting in a lack of closure. 2) Ambiguous loss is different from traditional loss in that there are no rituals or societal acceptance to help with closure. The ambiguity is not legitimized. 3) Counseling for ambiguous loss focuses on finding meaning, accepting uncertainty, reconstructing identity, and learning to live with ambivalence rather than completing grief tasks. 4) There is a need for more research

1. Ambiguous Loss
The Experience of Loss
Without Closure
Presenters:
Tania Sousa, BSW
Maureen Trask
Ambiguous Loss
BON Conference
Oct. 17, 2013
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2. Introductions
Our real life experience of
Ambiguous Loss (journey)
 Tania, facilitator perspective
 Maureen, griever perspective
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3. Daniel Trask
Missing since Nov. 3, 2011
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4. Learning Objectives
 Educate you about what ambiguous loss is
 Create awareness for the need of research,
education and services
 Add to your perception of what loss
encompasses
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5. Who here knows what ambiguous loss is?
Who here has a client or knows someone
that is dealing with ambiguous loss?
Who here has experienced ambiguous loss
themselves?
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6. So what is ambiguous
loss exactly?
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7. What is ambiguous loss?
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Traumatic Loss
Externally Caused
Unclear Loss
Senseless Loss
Lacks Closure
Frozen Grief/ Being Stuck in Limbo
An Individual Journey
(Boss, 2009)
(Boss, 2009)
(Boss, 1999)
(Boss, 2009)
(Boss, 1999)
Boss, P. (2009). The trauma and complicated grief of ambiguous loss. Pastoral Psychol, 59(2), 137-145.
doi: 10.1007/s11089-009-0264-0
Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Cambridge, MA. Harvard
University Press
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8. There is no Closure…
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9. Two types of ambiguous
loss…
Physically AbsentPsychologically Present
Psychologically AbsentPhysically Present
Boss, P. (2002). Ambiguous loss in families of the missing. The Lancet Supplement, 360, Retrieved from
www.thelancet.com
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10. Examples of Ambiguous
Loss
Physically AbsentPsychologically Present
Adoption
Migration
Missing people
Miscarriage & stillborn loss
Natural disaster and
catastrophic tragedy
Psychologically AbsentPhysically Present
Divorce/Separation
Dementia
Traumatic brain injury or coma
Addictions or other mental
health disorders
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11. How is ambiguous loss different
from traditional loss?
Traditional Loss
Some knowledge and
understanding from society and
western culture
Ambiguous Loss
Lack of knowledge about what
ambiguous loss is and its effects
Some services/supports available- Tremendous lack of services and
grief counsellors/professionals
supports – lack of professionals
that specialize or educated on this
Seen as “normal” because
Seen as “not normal”,
everyone at some point in their life “complicated grief”, and not
has a loved one that dies
affecting the mass majority
Spiritual/belief teachings exist that No spiritual/belief teachings
speak to death and mourning
discuss ambiguous loss
Mourn the loss after the death
Cannot mourn because no defined
death to mourn
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12. How is ambiguous loss different
from traditional loss?
Traditional Loss
Customary rituals that allow for
closure
Ambiguous Loss
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.
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13. How is ambiguous loss
similar to traditional loss?
 Both create a loss within one‟s life affecting identity,
family relationships, meaning/purpose and perspective.
 Both include a grieving journey that is a never ending
rollercoaster of emotions and challenges.
 Both do not have a timeline for healing.
 Both have expected timelines from the western culture
 Both types of losses are individualized.
 Both affect belief systems, perspective, routines, and
communication patterns.
 Both will affect their worldly
 Both have similar physical grief reactions
 No closure
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14. Let’s Hear from
Pauline Boss
http://www.youtube.com/watch?v=C2vYyefAgZ0
Dr. Pauline Boss and Dr. Gloria Horsley
discuss Ambiguous Loss at the annual
ADEC (association of Death Education
and Counseling) conference, 2011.
Dr. Pauline Boss, principal theorist of the concept of Ambiguous Loss
Dr. Gloria Horsley, Open to Hope Foundation, founder and president
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15. 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 closure?
* Living in Limbo: Five Years On, Missing People UK, 2013
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16. Effects of ambiguous
loss…
 Emotional rollercoaster
 Changes families, relationships, roles
and identity
 Can change spiritual beliefs
 Withdraw/isolate self
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17. Emotional ride…
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18. Ambiguous Loss Counselling
vs. Grief Counselling
Grief Tasks- William Worden (1982)
Tasks of Ambiguous Loss- Pauline Boss
(?)
1) Accept the reality of the loss
1) Find meaning
2) Experience the pain of the grief
2) Accept uncertainty
3) Adjust to an environment where the
deceased is missing
3) Reconstruct identity
4) Withdraw emotional energy and reinvest in
another relationship-
4) Learn to live with ambivalence as a new
norm
5) Revisit attachment
6) Discover hope
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19. Find meaning
 Look at values, beliefs, and traditions
 Remove blame
Accept Uncertainty
 Change the way think of loved one by taking
two opposing ideas and make them into one:
they are both here and not here.
 Balance need for control with acceptance of
ambiguity
 Externalize blame
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20. Manage the contradictions
Take two opposing ideas, make into one
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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
 Daniel is both gone – and still here
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21. Why am I crying?
My heart hurts, not my head
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22. Reconstruct Identity
Roles and family dynamics change
Learn to Live with
Ambivalence as New Norm
• Conflicting feelings
• Accept emotional rollercoaster
• Develop coping strategies
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23. Revisit Attachment
Celebrate the missing and mourn the
changes.
Discover Hope
 Look at strengths and see how you have
made it to this point with pain.
 Discover hope in different ways
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24. HOPE (never giving up)
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25. What helps?
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26. Ambiguous Loss Counselling
vs. Grief Counselling Cont’d
Grief Tasks- William Worden (1982)
1) Accept the reality of the loss
2) Experience the pain of the grief
3) Adjust to an environment where the deceased
is missing
4) Withdraw emotional energy and reinvest in
another relationship
Tasks of Ambiguous Loss- Pauline Boss
(1999)
1) Find meaning
2) Accept uncertainty
3) Reconstruct identity
4) Learn to live with ambivalence as a new norm
5) Revisit attachment
6) Discover hope
* Use a Narrative Therapy approach
** Common to do family counselling
Goal: Learn to live with the emotional
tidal waves. Learn to live with
and adapt to the changes that
come with the loss.
Goal: Learn to live with the emotional
tidal waves. Learn to live with
and adapt to the changes that
come with the loss AND learn to
live with the ambiguity by
developing meaning. (Boss, 1999)
Boss, P. (1999). Ambiguous loss: learning to live with unresolved grief. Cambridge, MA: Harvard University Press
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27. As a facilitator…
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Educate that grief is not a linear process
Encourage to share story, call loved one by name and educate the
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 of
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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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 client(s) with a lowered hierarchyHelp 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
Boss, P., & Carnes, D. (2012). The myth of closure. Family Processes, x(x), doi: 10.1111/famp.12005
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28. What not to say …
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29. Understanding is key
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30. Also, Humour - Balance
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31. As a client, as a Mom…
Love -
Courage -
Hope
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32. What is needed (lacking)
in regards to Ambiguous Loss?
• Research
• Education
• Services (Support)
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33. Research – Pauline Boss +
Loss, Trauma, and Resilience
Therapeutic Work with Ambiguous Loss, 2006
 Focusing on bridging
individual models of trauma
and PTSD with those based on
relational and resilience
approaches.
 Learn to live with ambiguity
and thereby nurture resilience
in clients and their families.
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34. Strength –
Building my resilience
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35. Education – What’s out there?
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Anyone know?
Courses?
Counsellor training?
Experts?
Part of Grief and Loss programs?
Doctors, psychs, social workers, Police?
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36. Services
(Support)
Support looks different to everyone
* Someone to really listen
* Being present
* Just being there
were by far the most popular
ways to support someone.
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37. Support Services for Families
Missing People UK
www.missingpeople.org
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38. What I’ve learned …
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39. Uncertainty is my Reality
Living in
Limbo ?
Turn it into
a Dance !
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40. I can change, transform
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41. Future Implications
 Ambiguous loss becoming more
prevalent
CHANGE
 Need to change how we think about loss
TRANSITION
 Our services and our way of practising
need to change
TRANSFORMATION
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42. What Can You Do?
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Advocate
Educate
Be inclusive
Question
B

43. Who can help and how?
 We can all help - Ambiguous loss
touches all of us at some time.
 If its to be it‟s up to me! (I am not alone)
Educate, network, share, advocate
 Missing is a community issue and one
that we can all contribute to solving
B

44. Change
Transition
Transformation
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45. Who here knows what ambiguous loss is?
Who here has a client or knows someone
that is dealing with ambiguous loss?
Who here has experienced ambiguous loss
themselves?
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46. Thank You !
Tania Sousa:
taniasousasw@gmail.com
Maureen Trask: trasker@rogers.com
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47. Resources
 Pauline Boss www.ambiguousloss.com
 Presentations, such as this one
(reference list available)
 Social media blogs, chat rooms, groups
 Agencies willing to provide support
services (Cardinal Counselling)
 BON, BFO, others?
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