Quantify or Classify? Recommendations for Ambiguous Loss Versus Boundary Ambiguity

STEPS TO H.O.P.E.: BUILDING HEALTH, OPTIMISM, PURPOSE, AND ENDURANCE IN PALLIATIVE CARE FOR FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA

Remand remains a particularly punitive and painful form of incarceration for prisoners, as well as their loved ones on the outside attempting to provide support. Drawing on in-depth qualitative data collected from 61 loved ones’ supporting remanded prisoners in England and Wales, this article examines how the ambiguity and unknowns associated with this form of incarceration is particularly painful. Through the unique application of Boss’s theory of Ambiguous Loss, this article contributes new knowledge about the nature, scope and resilience shown by loved ones supporting remanded prisoners, indicating where future research and policy should be focused.

Purpose. The article provides a theoretical overview of the theory of ambiguous loss in the focus of physical absence with the psychological presence of a loved one. Methods. To achieve the purpose of the study, the methods of scientific theoretical study were used: analysis, synthesis, structuring, and generalization. Results. Based on the analysis of research on the forced separation of children from their families and its psychological consequences, we can state that the theory of ambiguous loss is important in the situation of forced adoption of illegally displaced children. The theory of ambiguous loss clearly explains the mechanism of experiencing separation from a loved one, when this separation is not fully understood - there is no clear knowledge of the person's status: alive or dead, or the person is physically present but mentally absent, as in the case of dementia. The theory of ambiguous loss clearly explains three types of consequences: immobilization (affects the ability to communicate), consequences at the level of relationships (conflicts due to different views of the situation) and on the personality (manifestations of such conditions as depression, anxiety, guilt, etc.). Conclusions. The model of finding resilience in the face of uncertain loss includes such interrelated structural blocks as finding meaning, tempering mastery, reconstructing identity, normalizing ambivalence, revising attachment and discovering hope. The experience of working with displaced children in El Salvador is also important, because of studying the «disappearance» and "reunification" stages. They formed the basis for adapting the model of resilience in ambiguous loss to study the psychological consequences of forced adoption. The prospects for further research are in the empirical study of the psychological consequences of the forced adoption traumatic situation for children and their families.

An estimated 69.5 million Americans are reported to be grandparents. Among them, about 10% are raising grandchildren and the number of grandparents who are raising grandchildren (GRG) is increasing. Previous research on GRG suggests that the unexpected caregiving duties may lead to negative physical and mental health including more depressive symptoms when compared to non-caregiving grandparents (NGRG). Additionally, grandparent-grandchild relationships determined by emotional availability (EA) of the grandparent may be impacted. These factors might further be complicated, especially as it relates to the health and well-being of GRG, as a result of the COVID-19 pandemic. Thus, the overarching goal of this presentation is to use the biopsychosocial model to present a conceptual framework to test the mental well-being of GRG during the COVID-19 pandemic. In this presentation, we will 1) summarize appropriate literature on GRG; 2) share a COVID-19 health and well-being assessment survey designated for GRG in order to assess their health before and since the COVID pandemic; and 3) propose a conceptual model to investigate and test the protective role of physical activity and GRG’s EA in the grandparent-grandchild relationship for the mental health of GRG. In our model, we argue that GRG experience more COVID-19 pandemic-related stress and more depressive symptoms when compared to NGRG. This proposed conceptual model offers one way to test the predictors of depressive symptoms on GRG. Future testing has the potential to shed new light on the development of appropriate intervention programs tailored to maintain the mental health of GRG.

It is unclear how ambiguous loss in dementia caregiving is impacted by conditions of the Covid-19 pandemic. Ambiguous loss describes situations in which closure is impossible and ambiguities within a family system ensue. Two situations of ambiguous loss exist. In the first type, one is psychologically absent, yet physically present, e.g. when one has dementia. In the second type, one is physically absent but psychologically present, e.g. moving to a nursing home. Ambiguous loss theory was applied to longitudinal interviews with an adult-child caregiver (age=52) of a mother with dementia, who resided in memory care during the Covid-19 pandemic. Theoretical analysis revealed both types of ambiguous loss were experienced in the dementia caregiving relationship. This was embedded within ambiguous loss type 2 due to the Covid-19 pandemic, e.g. social distancing and quarantine practices led to physical estrangement from others and ambiguity ensued about when, or if, estrangement would end before resulting in death. Further, the coping mechanisms defined in the ambiguous loss framework: restructuring identity, finding meaning, gaining mastery, increasing ambivalence capacity, reframing attachments, and gaining hope, were compromised due to overarching ambiguous loss attributed to the pandemic. Continued panic and frustration regarding lack of communication with and access to the memory care center instilled a sense of being “locked out of caregiving.” Findings suggest dementia caregivers may experience both types of ambiguous loss compounded during the Covid-19 pandemic, suspending grief and coping processes, and inciting poorly understood needs and challenges that must be better understood to support dementia caregivers.

Coping with ambiguous loss

Ambiguous loss theory provides a framework for conceptualizing and treating singlehood ambiguous loss among adults who desire to be in a long-term committed romantic relationship, such as marriage, but have never been in such a relationship. Adults who have never married may experience an ambiguous loss due to the lack of clear information as to whether their anticipated spouse, who is psychologically present yet physically absent, will materialize at some point. This lack of clear information about an indefinitely missing anticipated spouse tends to create ambivalence about holding on to the prospect that the anticipated spouse will materialize versus moving on through accepting and grieving the loss of the non-materialized anticipated spouse. The absence of rituals for demarcating singlehood ambiguous loss may increase ambivalence. The degree of ambivalence experienced from adult singlehood ambiguous loss likely varies according to the developmental timing of singlehood, decisions between settling and indefinite singlehood, unviable potential spouses, and non-materialized children. Specific treatment recommendations (i.e., avoiding contraindicated treatment approaches, implementing an informed not-knowing stance, and fostering dialectical thinking) and specific interventions for adapting the established treatment for ambiguous loss (i.e., increasing resilience through normalizing ambivalence, tempering mastery, finding meaning, reconstructing identity, revising attachment, and discovering hope) for clients struggling with the ambiguous loss of singlehood are presented.

Longing to belong: The ambiguous loss of Indigenous fostered/adopted individuals

ObjectiveInformed by Boss's ambiguous loss theory and an ecological perspective, this study examined Latinx immigrant mothers' experiences of loss associated with their immigration status and the restrictive immigration policy climate.BackgroundUndocumented participants strive to maintain international familial ties and experience loss in their inability to see or share a space with loved ones in their country of origin due to restrictive immigration policy and enforcement that inhibits their international mobility.MethodsIn‐depth semistructured interviews were completed with 25 Latinx immigrant mothers who were mostly undocumented or members of mixed‐status families.ResultsFindings support a model of transnational loss. Loss is experienced at premigration, upon arrival, and long after settlement. Participants' quotes illustrate their experiences of ambiguous, anticipatory, and complicated loss. In addition, transnational loss was described as a shared experience, one that impacted many undocumented immigrants in the United States and participants' family members. A subtheme, intergenerational loss, emerged in which children vicariously experienced their parents' loss.ConclusionTransnational loss is disenfranchised because it is not socially recognized, leaving immigrants to mourn in silence.ImplicationsPractitioners serving immigrant communities should integrate grief and loss support through psychoeducation, assessments, and therapy. At a policy level, immigrants need to have the opportunity to adjust their status so that they can reclaim these lost social interactions.

This article contains an overview of three decades of research, theory development, and clinical application about ambiguous loss. Although the work includes both physical and psychological types of ambiguous loss, the focus is the aftermath of 9/11 (September 11, 2001), when the World Trade Center collapsed following terrorist attacks. On the basis of her previous work, the author was asked to design an intervention for families of the missing. She reflects on what she learned from this unexpected test and presents new propositions and hypotheses to stimulate further research and theory that is more inclusive of diversity. She suggests that scholars should focus more on universal family experience. Ambiguous loss is just one example. Encouraging researchers and practitioners to collaborate in theory development, she concludes that research‐based theory is essential to inform interventions in unexpected times of terror, and in everyday life.

This commentary compares the concept of resilience as conceptualized and studied in ambiguous loss and in the broader domain of developmental resilience science. The discussion highlights common roots, similarities and differences in the definitions of resilience and protective processes, and implications for interventions. Resilience concepts in ambiguous loss theory are congruent with contemporary developmental resilience theory in multiple ways. Future research and practice would benefit from further integration of these compatible perspectives on resilience.

Meeting the increasing demand for foster care homes is well recognised internationally and in Australia as a continual challenge. Understanding the needs of foster carers and supporting them to undertake this important work is a key element of meeting this demand. Lorraine Thomson and Morag McArthur report on the re-analysis of data from a small study of former foster carers who ceased fostering between 2004 and 2007 in the Australian Capital Territory. Interviews with former carers about their experiences as foster carers revealed themes of loss and uncertainty that alerted researchers to the possibility that the theory of family boundary ambiguity and ambiguous loss may be useful in understanding foster caring experiences. It is suggested that these concepts warrant further exploration and research in the area of foster care. With sensitive application, they may assist foster families, former foster carers, foster care workers and policy makers to understand more fully and respond to some of the challenging experiences of foster caring.

The purpose of this synthesis of qualitative studies is to explore manifestations of ambiguous loss within the lived experiences of family caregivers (FCG) of loved ones with cancer. Grief and loss are familiar companions to the family caregivers of loved ones with cancer. Anticipatory loss, pre-loss grief, complicated grief, and bereavement loss have been studied in this caregiver population. It is unknown if family caregivers also experience ambiguous loss while caring for their loved ones along the uncertain landscape of the cancer illness and survivorship trajectory. We conducted a four-step qualitative meta-synthesis of primary qualitative literature published in three databases between 2008 and 2021. Fourteen manuscripts were analyzed using a qualitative appraisal tool and interpreted through thematic synthesis and reciprocal translation. Five themes were derived, revealing FCGs appreciate change in their primary relationship with their loved ones with cancer, uncertainty reconciling losses, an existence that is static in time, living with paradox, and disenfranchised grief. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous research. The results of this synthesis of qualitative studies complement the descriptors of ambiguous loss presented in previous theoretical and clinical research. By understanding ambiguous loss as a complex and normal human experience of cancer FCGs, oncology and palliative care healthcare providers can introduce interventions and therapeutics to facilitate caring-healing and resiliency. Untreated ambiguous loss can result in a decrease in wellbeing, loss of hope, and loss of meaning in life. It is imperative that cancer FCGs experiencing ambiguous loss are recognized and supported so that they may live well in the family disease of cancer.

In England, nearly three-quarters of looked after children are cared for in foster families. Despite this, relatively little is known about the experiences of foster carers’ children in families who foster. This study used narrative interviews to explore the experiences of twelve adults now aged eighteen to fifty-four years who had been brought up in such families. Their families had fostered for much or all of their childhood and growing up in a fostering family had had a considerable impact on them. Most participants viewed some of the fostered children as siblings and continued to do so into adulthood. The analysis used the theory of family boundary ambiguity and ambiguous loss to gain a deeper understanding of the participants’ experiences. The findings suggest that there is a need for much greater awareness of the issues that foster carers’ own children face. They also suggest that a change in how foster placements are supported needs to include a greater focus on the children of foster carers.

Introduction On the occasion of my retirement from the University of Minnesota, a symposium was held to encourage the continuation of research about loss and boundary ambiguity. This special issue continues that goal. The papers herein illustrate how a new generation of scientists and practitioners applies loss theory to understand previously unstudied situations and populations. Their work generates new questions and hypotheses and, hopefully, stimulates others to join the ongoing process of research, practice, and theorizing. Why Do We Need Theorizing? In these times of crises and terror, we need new theories to guide our work in safeguarding the natural resiliency of families. To assess both diversities and commonalities in how families stay strong, we need more inclusive theory to analyze data and guide interventions for easing the family stress and trauma. I began with a universal family experience-lossand studied it in the context of an additional stressor-ambiguity. Indeed, as Dilworth-Anderson (2005) writes, intuition begins this process. Observing family therapy in the early 1970s, I noticed physically present fathers were often psychologically absent (Boss, 1972). Soon, I realized that psychological absence was not only just about fathers but also about any loved one in the family who was there, but not there. Out of observation and intuition emerged a more inclusive term, ambiguous and a model of the two types: physical absence with psychological presence, psychological absence with physical presence (Boss, 1999, 2004, 2006). Family members have described the first type of loss as Leaving without good-bye, and the second type as Good-bye without leaving. Both are distressing and may traumatize. Today, the stress- and resiliency-focused theory of loss includes linkages to meaning, mastery, ambivalence, identity, attachment, and hope (Boss, 2006). Although many practitioners report anecdotally that the theory is useful, more research-based evidence is needed. This special issue serves as a beginning for more research to continue integrating theory, research, and application. What Is Ambiguous Loss? Ambiguous loss is a loss that remains unclear. The premise of the loss theory is that uncertainty or a lack of information about the whereabouts or status of a loved one as absent or present, as dead or alive, is traumatizing for most individuals, couples, and families. The ambiguity freezes the grief process (Boss, 1999) and prevents cognition, thus blocking coping and decision-making processes. Closure is impossible. Family members have no other option but to construct their own truth about the status of the person absent in mind or body. Without information to clarify their loss, family members have no choice but to live with the paradox of absence and presence (Boss, 2006). For example, when families are separated by military deployment, they of course hope to be reunited again but also know that they will never be the same as they were before the separation. I propose that both/and thinking strengthens adults' and children's resiliency despite the ambiguity of a family member's absence or presence. That is, it is useful for a family member to think dialectically about thesis, antithesis, and synthesis in a practical way: my loved one is gone, but s/he is also here; I can learn to tolerate the stress of the ambiguity (Boss, 1999, 2004, 2006). When relationships are unclear and closure is impossible, the human need for finality can distress or traumatize families. Whether it is caring for a mate in the grip of dementia from Alzheimer's, or waiting to learn the fate of a child gone missing, the ambiguity in such losses immobilizes and traumatizes. Bereft of rituals to support them (because the loss is unverified), families are left on their own. Because of the ambiguity, relationships dissipate as friends and neighbors do not know what to do or say to families with unclear losses. …