Journal Article Review: Ambiguous Loss

WCF Clinical Team

Ambiguous loss is defined as an incomplete or unverified loss. Such loss can either be:

• Physical: a person is physically absent, but psychologically present due to a lack of evidence to indicate a permanent loss (e.g. a missing family member)

• Psychological: a person is physically present, but psychologically absent (e.g. cognitive impairment, memory loss).

Ambiguous loss is posited to be the most stressful type of loss as it “defies resolution… there is no official verification of loss and thus no finality with rituals of support”.

• Without closure, a person may continue to experience loss and grief indefinitely.

Ambiguous loss can lead to ‘boundary ambiguity’, which is defined as not knowing who is in/out of one’s family system, resulting in uncertain perceptions about family membership and roles

• “A high degree of boundary ambiguity is a risk factor for individual and family well-being”.

(Boss, 2016)

Ambiguous Loss in Out-of-Home-Care (OOHC)

Mitchell, 2016

Children may experience psychological loss prior to entering care (e.g. neglect), and physical loss when in care (i.e. not residing with family; psychologically present due to child thinking about them)

Removal is not a concrete loss; the child may believe that returning to their parents is a viable option

Removal of children from unsafe environments may alleviate their further exposure to stress and trauma; however, it can be a traumatic experience in and of itself

Ambiguous loss can go unnoticed and manifest in ways that are easily attributed to other factors (e.g. behavioural concerns)

Meaning-making is important after a loss - this is harder for CYP in care who may not have all the information to understand their removal, and often do not have trusted adults to help them alleviate their distress and self-blame.

Boundary/role ambiguity is also prevalent – a young person has to find their place within new relationship dynamics (birth family, carer family, professionals), and come to terms with changes in their established roles/expectations.

• “As a result, these children not only are faced with the loss of their original family; they also are presented with the undertaking of appraising, and potentially reappraising, their assumptions, beliefs, and expectations about the meaning of family”.

• Incongruence between the roles of parents (i.e. those acting in the role, and those who should be in the role) must be resolved in a CYP’s mind to minimise distress.

Following a CYP’s lead on what they need for this resolution (e.g. calling foster carers ‘mum and dad’) is key

When CYP have experienced ambiguous loss, it is important to acknowledge this and provide them ongoing opportunities to discuss their grief experiences honestly and safely.

• As ambiguous loss is a relational loss, healing must take place through relationship-based practice.

References

Boss, P. (2016). The context and process of theory development: The story of ambiguous loss. Journal of Family Theory & Review, 8 (3), 269-286. DOI: 10.1111/jftr.12152

Mitchell, M. B. (2016). The family dance: Ambiguous loss, meaning making, and the psychological family in foster care. Journal of Family Theory and Review. 8(3), 360-372. DOI: 10.1111/jftr.12151