ambiguous loss the experience of loss without closure oct 17 2013
TRANSCRIPT
Ambiguous LossThe Experience of Loss Without Closure
Presenters:
Tania Sousa, BSW Maureen Trask
1Ambiguous Loss BON Conference Oct. 17, 2013
Introductions
Our real life experience of Ambiguous Loss (journey)
Tania, facilitator perspective
Maureen, griever perspective
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3 Missing since Nov. 3, 2011
Daniel Trask
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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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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So what is ambiguous loss exactly?
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What is ambiguous loss? Traumatic Loss (Boss, 2009) Externally Caused (Boss, 2009)
Unclear Loss (Boss, 1999)
Senseless Loss (Boss, 2009)
Lacks Closure Frozen Grief/ Being Stuck in Limbo (Boss, 1999)
An Individual Journey Boss, P. (2009). The trauma and complicated grief of ambiguous loss. Pastoral Psychol, 59(2), 137-145.
doi: 10.1007/s11089-009-0264-0Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Cambridge, MA. Harvard University
Press†
There is no Closure…
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Two types of ambiguous loss…
Physically Absent- Psychologically Present
Psychologically Absent- Physically Present
Boss, P. (2002). Ambiguous loss in families of the missing. The Lancet Supplement, 360, Retrieved from www.thelancet.com
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Examples of Ambiguous LossPhysically Absent-
Psychologically PresentPsychologically Absent-
Physically Present
AdoptionMigration Missing people Miscarriage & stillborn lossNatural disaster and catastrophic tragedy
Divorce/Separation Dementia Traumatic brain injury or coma Addictions or other mental health disorders
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How is ambiguous loss different from traditional loss?
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
Mourn the loss after the death Cannot mourn because no defined death to mourn
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How is ambiguous loss different from traditional loss?
Traditional Loss Ambiguous Loss
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.
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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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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 Educationand Counseling) conference, 2011.
Dr. Pauline Boss, principal theorist of the concept of Ambiguous LossDr. Gloria Horsley, Open to Hope Foundation, founder and president
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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?
15* Living in Limbo: Five Years On, Missing People UK, 2013
Effects of ambiguous loss…
Emotional rollercoaster Changes families, relationships, roles
and identity Can change spiritual beliefs Withdraw/isolate self
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Emotional ride…
Ambiguous Loss Counselling vs. Grief Counselling
Grief Tasks- William Worden (1982) Tasks of Ambiguous Loss- Pauline Boss (?)
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-
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
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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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Manage the contradictions Take two opposing ideas, 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
Daniel is both gone – and still here
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Why am I crying?My heart hurts, not my head
Reconstruct IdentityRoles and family dynamics change
Learn to Live with Ambivalence as New Norm
• Conflicting feelings• Accept emotional rollercoaster • Develop coping strategies
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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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HOPE (never giving up)
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What helps?
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Ambiguous Loss Counselling vs. Grief Counselling Cont’d
Grief Tasks- William Worden (1982) Tasks of Ambiguous Loss- Pauline Boss (1999)
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
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†
As a facilitator… 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) 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 hierarchy- 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
Boss, P., & Carnes, D. (2012). The myth of closure. Family Processes, x(x), doi: 10.1111/famp.12005 †
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What not to say …
Understanding is key
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Also, Humour - Balance
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As a client, as a Mom…
31Love - Courage - Hope
What is needed (lacking) in regards to Ambiguous Loss?
• Research
• Education
• Services (Support)
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Research – Pauline Boss + Loss, Trauma, and
ResilienceTherapeutic 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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Strength – Building my resilience
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Education – What’s out there?
Anyone know? Courses? Counsellor training? Experts? Part of Grief and Loss programs? Doctors, psychs, social workers, Police?
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Services (Support)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.
Support Services for Families Missing People UK www.missingpeople.org
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What I’ve learned …
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Uncertainty is my Reality
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Living in Limbo ?
Turn it intoa Dance !
I can change, transform
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TRANSFORMATION
CHANGE
TRANSITION
Ambiguous loss becoming more prevalent
Need to change how we think about loss
Our services and our way of practising need to change
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Future Implications
What Can You Do?
Advocate Educate Be inclusive Question
B
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
Change Transition Transformation
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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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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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