Ambiguous Loss Theory Research Articles

Addressing Ambiguous Loss Through Group Therapy

When children are placed out of the home, state child protective service departments continue to voice their desire to place these children with relatives rather than in traditional foster care. Research has shown the positive impact kinship placement can have for the child; however, there is no consistent way kinship caregivers are supported once the child is placed in their care. This article will show mental health and child welfare workers how the theory of ambiguous loss can be applied in a group format to provide support for kin guardians to address the feelings of loss they face within themselves and the children they care for.

School counselor conceptualizations of the needs of children of incarcerated parents

More than 5 million children in the United States will experience parental incarceration. These children may have academic, behavioral, or social difficulties in school. School counselors are positioned to support the mental health needs of children of incarcerated parents, but little was known about how school counselors understand their needs. This study used an instrumental case study design to consider how school counselors recognize and understand the needs of children of incarcerated parents in a single school district in a southeastern state. Participants described the observable impacts of parental incarceration at school. They conceptualized loss experiences for children of incarcerated parents, including losses of family connections, family stability, and social acceptance. Findings support ambiguous loss theory as a conceptual framework for the experiences of children of incarcerated parents. Recommendations for counselors, educational leaders, and future research are discussed.

Promoting the Resiliency of African American Teens Experiencing Ambiguous Loss

ABSTRACTA disproportionate number of African American youth experience childhood adversity and situations of loss, including parental incarceration and divorce, while navigating racial discrimination. Ambiguous loss theory offers a conceptual framework to understand these experiences as losses of relationships, stability, and social validation due to parental behaviors. Theoretically and culturally informed interventions are needed to help adolescents cope with ambiguous loss. This article describes a psychoeducational group intervention for female African American adolescents experiencing ambiguous loss that aims to promote resilience and coping rather than promote closure following loss.

Forced separations: A qualitative examination of how Latino/a adolescents cope with parental deportation

Shifts in U.S. immigration policy over the past two decades have resulted in increased deportations of unauthorized persons residing in the United States. As a result, a disproportionate number of Latinx families have been subjected to forced family separations. While previous studies have focused on the effects of parental deportation on young children, this study uniquely contributes to the literature by exploring how adolescents experience and cope with a forced family separation. Drawing upon ambiguous loss theory, in-depth, semi-structured interviews were conducted with Latinx youth (n = 8) and their mothers (n = 8) who experienced a forced family separation, and school-based staff (n = 11). The analysis revealed four main findings: 1) Following the deportation of a parent, youth experienced symptoms of trauma; 2) fear of additional family separation; 3) behavioral changes; and 4) academic disruptions. Implications include developing culturally-based, trauma-informed, and contextually situated assessments and interventions for youth and families affected by deportation.

Applying ambiguous loss theory to children of parents with an opioid use disorder.

Opioid use disorder (OUD) has reached epidemic proportions in the United States. Children of parents with OUD are an unrepresented population, who often suffer consequences from their parent's substance abuse disorder. Such children may incur numerous psychosocial and physical losses. Without intervention, they are more likely to be diagnosed with a mental illness and/or substance use disorder (SUD). This paper examines the experiences of children of parents with OUD using Boss's theory of ambiguous loss (AL) as a lens. Children growing up with a parent who has an OUD experience AL through that parent's physical absence and psychological presence (e.g., the parent is out opioid-seeking or in rehab or jail) and psychological absence but physical presence (e.g., the parent is high or in withdrawal, or is preoccupied with obtaining opioids). Evidence supports the fact that OUDs affect parenting, produce changes in the parent-child relationship, and often impact child development. Interventions that are child-focused are lacking. The application of AL theory to this problem can enhance health professionals' understanding and need for developmentally specific interventions to care for this population. Interventions should focus on diminishing stigma and promoting psychosocial wellness and resiliency for children of parents with an OUD.

Ambiguous Loss: A Phenomenological Exploration of Women Seeking Support Following Miscarriage

This study aims to explore miscarriage through the theory of ambiguous loss. The sample consisted of 10 females currently seeking support services related to their miscarriage experience. From the data, six primary themes emerged from the miscarriage experience, including: Emotional Toll; Stolen Dreams; No One Understands; He Loves Me in a Different Way; Why? I Don’t Understand; and In the End, I Have My Faith. The findings in the current study suggest ambiguous loss theory may not fully capture the experience of miscarriage. Clinical implications and future research directions for this population are discussed.

The Ambiguous Loss of Singlehood: Conceptualizing and Treating Singlehood Ambiguous Loss Among Never-Married Adults

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.

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

Currently over 5 million Americans are living with Alzheimer's disease and related dementias. Family caregivers may experience loss and grief, leading to ambiguity in their caregiving role. Palliative care interventions are necessary to help family members cope with the progressive and unsurmountable grief experiences with these terminal conditions. It is hypothesized that caregivers who participate in the Steps to H.O.P.E. program will experience a reduction in ambiguous loss, stress, and burden, and identify self-care measures to improve overall health and well-being. Steps to H.O.P.E. is an education program and interventional research study at Banner Alzheimer's Institute, Phoenix, Arizona. Boundary Ambiguity and Ambiguous Loss theories guide the theoretical framework for this program. Ambiguous Loss Theory postulate that ambiguous loss, which happens when a person with dementia is physically present but sometimes psychologically absent, may contribute to caregiver stress, anxiety, compromised coping, and the inability to initiate self-care strategies necessary for successful caregiving. Four pilot groups of 8 to 10 caregivers of persons with dementia received weekly focused discussion and guidance regarding ambiguous loss and grief over a four-week period. Program evaluation and caregiver outcomes analysis in this convenience sample consisted of descriptive analyses, paired t-tests, and repeated measures ANOVA. Results from this 12 month program with 4 pilot groups (n=37) showed a reduction in both caregiver stress and strain (F=26.88, p<0.001) and ambiguity related to pilot group affiliation (F=44.82, p<0.001). Qualitative findings indicated numerous self-care strategies and program tools that were helpful to caregivers in managing the stress, burden and grief associated with ambiguous loss including physical exercise, self-talk, asking for help, and taking breaks throughout the day. Understanding this unique loss through education and problem-solving strategies may help family caregivers begin to effectively manage their loss and grief with the tools and resources necessary to reduce ambiguity, promote resilience and foster self-care.

Broken Promises and Lost Dreams: Navigating Asylum in the United States

Nearly 65 million people around the world have been displaced by war, conflict, and persecution since 2014 (UNHCR; United Nations High Commissioner for Refugees, 2015). This yields an average of 42,000 people refugees, asylum seekers, or internally displaced every day. Displacement has adverse and disruptive consequences, including mental health problems (e.g., anxiety, depression), impaired interpersonal relationships, and heightened conflict. These consequences are compounded by profound ambiguity associated with navigating asylum in the United States. In this article, we describe the treatment of a couple from Syria who is seeking asylum in the United States. Informed by personal and professional experience, this case illustrates how ambiguous loss theory and awareness of relevant legal processes enhance our understanding of working with asylum seekers.

The Context and Process of Theory Development: The Story of Ambiguous Loss

AbstractThis is the story of how the theory of ambiguous loss was born—the context of time and space in which it developed; the misunderstandings, clarifications, and corrections; and now, the theory's cultural updates. From an early interest in family stress theory, I coined the term ambiguous loss to name a previously unidentified stressor common to families everywhere. Discovering this phenomenon and developing the theory has been a lifelong process, but with a new generation of scholars, the theory continues to build and improve. This narrative is my tribute to a new generation of scholars, many of whom are testing the theory and broadening its application across cultures, disciplines, and types of ambiguous loss. May this account also stimulate the building of other useful theories of the middle range that include, without bias, the broad diversity of families today.

The Family Dance: Ambiguous Loss, Meaning Making, and the Psychological Family in Foster Care

AbstractThis article explores how a child's psychological family can be affected, challenged, and transformed in the foster care system. When placed into foster care, children are often disconnected from many significant relationships, especially familial relationships (e.g., parents, siblings). Similarly, as children navigate their way through the foster care system, placements can change and relationships are formed and dissolved; as a result, children engage in a dance of family formulation, dissolution, and meaning making. The theory of ambiguous loss is used as a guiding framework to explore the choreography of a child's “dance” with family and meaning making during the acculturation into foster care.

Lifelong Ambiguous Loss: The Case of Cuban American Exiles

AbstractUsing Cuban Americans who immigrated to the United States between 1959 and 1971 as an example, this article demonstrates the chronic nature of ambiguous loss in the context of loss of homeland. Ambiguous loss theory provides a framework for understanding the pain experienced by this cohort of Cuban Americans and their families who cope with a traumatic loss that defies closure. While keeping their homeland ever present psychologically, this cohort of Cuban Americans has experienced unique identity and relationship challenges rooted in the tensions between the United States and Cuba. They emigrated because of societal changes that followed the 1959 revolution launched by Fidel Castro against the regime of Fulgencio Batista. Contact with their homeland has been limited while they harbor hope that Cuba's government will change for the better. The utility of the ambiguous loss model is supported and suggestions for future research directions are suggested.

Resilience in the Context of Ambiguous Loss: A Commentary

AbstractThis 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.

Ambiguous Loss and Emotional Recovery After Traumatic Brain Injury

AbstractTraumatic brain injury (TBI) is highly prevalent, with many survivors experiencing long‐term disability as a consequence of cognitive impairments, adverse personality changes, and emotional and communication difficulties. Because family members most often assume the long‐term role of caregiver, their feelings, relationships, and life plans are often negatively affected. Boss has defined a type of ambiguous loss in which the person is physically present but psychologically absent, which is the case for many families after brain injury. Over the past 2 decades we have developed interventions incorporating ambiguous loss theory to enhance resilience and improve psychological outcomes in families after TBI. This article provides a brief overview of TBI, discusses ambiguous loss in families after TBI, and describes the therapeutic goals and framework of empirically supported family interventions using the lens of ambiguous loss theory.

Secondary traumatization of partners of war veterans: The role of boundary ambiguity.

The existing literature has shown that war veterans' posttraumatic stress disorder (PTSD) symptoms are associated with a higher level of distress in their female partners. However, less agreement exists regarding the sources of this distress and the mechanism by which this process occurs. The current study examined the consequences of Israeli war veterans' PTSD on their female partners, as manifested by the females' PTSD symptoms, mental health status, and functioning, while taking into account females' earlier traumatic events. Using the theory of ambiguous loss, it also suggested boundary ambiguity as a mediating variable by which the PTSD of the male veteran is transmitted to his female partner. Participants were 300 men who had served in the 2006 Israel-Lebanon War and their female partners. Results revealed direct associations between males' PTSD and their female partners' PTSD, functioning, and mental health. In addition, boundary ambiguity mediated the association between males' PTSD and females' adjustment. Finally, females' own earlier traumatic events were directly associated with their own PTSD symptoms. Implications of this model for intervention and research are further discussed.

A cross-sectional survey of the effect on emerging adults living with a depressed parent.

A parent who is depressed is physically present, but may be psychologically absent, or different to their children. Changes in the parent-child relationship, feelings of loss, and increased stress can occur for the child. These factors can impair psychosocial well-being throughout the child's upbringing, and the effects might impact that child the most in their transition to adulthood. The aim of this exploratory study was to examine factors experienced while growing up with a depressed parent that might contribute to the current psychosocial well-being of emerging adults (individuals between the ages of 18 and 25) using ambiguous loss theory as a theoretical lens. A cross-sectional, correlational design with multiple regression analysis was used to examine relationships between emerging adults' (n = 120) perceptions of retrospective duration and understanding of parent's depression, caregiving, stress, social support, hope, and boundary ambiguity and current psychosocial well-being. Experiencing hope, stress, and then the length of parent's depression during their upbringing were the most predictive variables for emerging adult psychosocial well-being. Findings from this study will help mental health professionals better understand factors contributing to outcomes for this population. The knowledge to be gained is important for developing or refining age and developmentally appropriate interventions aimed at improving outcomes of adult children of depressed parents.

Down Syndrome and Fathering: An Exploration of Ambiguous Loss

Fathers of children with Down syndrome (DS) described their attitudes and coping behaviors, responses were evaluated in the context of Ambiguous Loss theory, using a person-oriented, mixed-methods approach. In general, the fathers expressed the ambiguity of loving the child they had while mourning a life they may have anticipated. Three clusters of fathers (Mastering, Connecting, and Thriving) were identified and described. Mastering cluster fathers used action-oriented coping strategies to manage their life. Connecting cluster fathers engaged in outreach activities related to DS. Thriving cluster fathers embraced their life and reframed their experiences as giving them a sense of purpose or higher meaning. Ambiguous loss theory provided a non-deficit lens to better understand this group of fathers of children with DS.

Losing the Child They Thought They Had: Therapeutic Suggestions for an Ambiguous Loss Perspective with Parents of a Transgender Child

In our culture, gender is a deeply felt, value-rich, organizing principle; it informs our understanding of who we are as an individual, as well as who we are supposed to be and how we are supposed to act within relationships. This is especially evident in family relationships, and perhaps most strongly in the relationships of mothers and fathers with their sons and daughters. Thus, when a person comes out as transgender or transsexual, parents often experience a profound sense of loss and confusion about their child's new identity and role in the family. In this article, I discuss parental experiences of grief in response to their transgender child's gender transition and propose that parents who struggle with a child's gender transition may be experiencing ambiguous loss. I discuss these experiences in terms of ambiguous loss theory and introduce the concept of dual ambiguous loss. I also provide clinical suggestions for using an ambiguous loss framework with these parents, and offer directions for future research.

Cuba No; Miami Sí: Cuban Americans Coping with Ambiguous Loss

This study explores the lifelong loss that Cuban émigrés experienced after leaving Cuba following the 1959 revolution. Many left thinking they would remain in exile for a brief period, but a return no longer seems possible. Nevertheless, their attachment to the lost homeland persists. The annual Cuba Nostalgia event at the Miami Expo Center attests to this enduring sense of attachment. Employing a phenomenological framework, we interviewed 10 older attendees who left Cuba between 1959 and 1979. Themes that emerged from the interviews are consistent with ambiguous loss theory and also reveal positive coping skills and resilience.

Paradise Lost: Older Cuban American Exiles’ Ambiguous Loss of Leaving the Homeland

To explore the experience of leaving Cuba, 2 Cuban American émigrés interviewed 20 Cuban exiles aged 65 or older, who left Cuba between 1959 and 1971. The interviews were conducted in New York and New Jersey using a phenomenological approach (Moutsakas, 1994). Themes included feeling betrayed by the Revolution, the inevitability of leaving, the expectation of a temporary refuge, and longing and idealizing the past. The psychological presence that participants expressed, along with an endless sense of loss, resonates with ambiguous loss theory (Boss, 2006)—themes that have yet to be explored in the literature and that have research and practice implications.