Supporting those faced with loss

Kanthi Perera, Senior Social Worker2005 Churchill Fellow

Losses affect people• Emotionally• Physiologically• Intellectually• Spiritually• Sociologically• Behaviorally

Ambiguous Loss

Losses that are incomplete, uncertain and lack resolution are termed “ambiguous losses”.

Ambiguous loss is experienced when a person is physically absent but psychologically present e.g. 9/11.

“Leaving without goodbye”

Physically present but psychologically absent

e.g. chronic mental illness, dementia, head injury.

“Goodbye without leaving”

Research done overseas by Professor Boss and colleagues have found that this is the most stressful loss that a person can go through.

Ambiguous loss is not always a problem. Everyone goes through normative ambiguous losses in their life. e.g. children leaving home, elderly parents going to nursing homes.

It is a problem when

• Parenting roles are ignored• Decisions are put on hold• Daily tasks are not done• Family members are ignored are

cut off• Rituals and celebrations are

cancelled.

or when

• There are feelings of hopelessness that lead to depression and passivity.

• Feelings of ambivalence that lead to guilt, anxiety and immbobilization.

STRESS IS SIMPLY CAUSED BY CHANGE

Understand that it is the situation and not the family that is sick. People may be adapting to unhelpful ways to an unusual situation. This is a sociological perspective.

FAMILY BOUNDARY AMBIGUITY

A state when family members are uncertain in their perception about who is in or out of the family and who is performing what roles and tasks within the family.

The higher the degree of ambiguity, the more negative the outcomes.

Immigration/MigrationDivorce, remarriageWork relocationMilitary deploymentadoption

COMMON SITUATIONS OF AMBIGUOUS LOSS

Young adults leaving homeElderly moving to nursing home.Preoccupation with workObsession with computer games, internet , TV

COPING WITH FAMILY BOUNDARY AMBIGUITY

Depending on the family members’ perceptual and behavioural responses to the loss, they will clarify their boundaries and reorganize their system accordingly.

ABC-X Model of Stress

Event or Situation

A

PerceptionFamily

Individual Community

C

ResourcesFamily

IndividualCommunity

B

Degree of StressLow/High/Crisis

X

Family Stress Perspective

When faced with change, individuals and families hunger for certainty about their:•Identities•Roles•Relationships•Family rules•rituals

PERSISTENT STRESS IS NOT GOOD FOR ANYONE

Learning to manage stress.•Name the situation as one of ambiguous loss. •Has this loss created ‘boundary ambiguity’?

• Obtain information about the situation

• Share your views and feelings about the situation with others in the family.

Information need to be shared even if it is “I don’t know what the outcome will be”.

Recognize that ambivalence is common in such situation. Important not to act on negative feelings.

Discuss with other family members how

Roles rules and rituals could be adapted to accommodate

the situation.

Support hope and optimism in each other.

e.g. with illness, we may hope for cure and later hope for living life well despite disability.

Imagine options.

E

Externalize blame.

In ambiguous loss, it is the situation that is “sick” not people.

Explore spirituality.

Practice dialectical thinking. (Holding two opposing ideas at the same time).

Involving the Psychological family

The “psychological” family is intrinsic in our lives and compensates for loss.

Therapeutic Goals

• Finding meaning• Tempering mastery• Reconstructing identity• Normalizing ambivalence• Revising attachment• Discovering hope

Therapeutic Goals

Finding Meaning Tempering

Mastery

Reconstructing Identity

NormalizingAmbivalence

Revising Attachment

DiscoveringHope

Therapeutic work to center on human connections such as family & community as these are ongoing and needed for resiliency. Professional connections are temporary.

Normalizes the responses and not interpret them as a medical condition or dysfunctional behavior.

Encourages those affected to resist social pressure to “get over” the loss, instead learn skills to live with the ambiguity by developing resilience based on personal strengths and family and community connections.