Transcript Helping Military and Veteran Families Cope with the Stress

Ambiguous Loss:
Concepts and Clinical
Practice
Rose Collins, PhD
Minneapolis VA Health Care System
Ambiguous Loss
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A loss that is unclear and thus has no
closure
A situation or problem that has no answer
and thus no resolution
Thus, ambiguous loss can traumatize and
immobilize grief and coping processes
Due to ambiguity, individuals & families
can’t move forward with their lives.
Two Types of Ambiguous
Loss
Type I: Physical absence with
psychological presence (e.g.,
missing, disappeared, kidnapped,
military deployment)
 Type II: Psychological absence with
physical presence (e.g., TBI, coma,
dementia, addiction, autism,
depression etc)
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Types of Ambiguous Loss
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Type I and Type II often overlap in
the same person or family
Effects of Ambiguous Loss
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Confusion
Immobilization
No validation
No closure
Exhaustion
Effects of Ambiguous Loss
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Confusion
Immobilization
No validation
No closure
Exhaustion
Guidelines for Helping Families
Live with Ambiguous Loss
Guidelines for Helping Families
Live with Ambiguous Loss
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Finding Meaning
Tempering Mastery
Reconstructing Identity
Normalizing Ambivalence
Revising Attachment
Discovering Hope
Boss, P. (2006). Loss, Trauma, and
Resilience. NY: Norton
Finding Meaning
Tempering Mastery
Reconstructing Identity
Normalizing Ambivalence
Revising Attachment
Discovering Hope
Boss, P. (2006). Loss, Trauma, and Resilience. NY: Norton
Guidelines for Helping Families
Live with Ambiguous Loss
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Finding Meaning
Tempering Mastery
Reconstructing Identity
Normalizing Ambivalence
Revising Attachment
Discovering Hope
Finding Meaning:
What Helps
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Naming the problem
Dialectical thinking
Religion and spirituality
Forgiveness
Small good works
Rituals
Positive attribution
Sacrifice for a greater good or love
Perceiving suffering as inevitable
Hope
Finding Meaning:
What Helps
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Naming the problem
Dialectical thinking
Religion and spirituality
Forgiveness
Small good works
Rituals
Positive attribution
Sacrifice for a greater good or love
Perceiving suffering as inevitable
Hope
Finding Meaning:
What Hinders
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Hate and revenge
Secrets
Violent and sudden loss
Disillusionment
Tempering Mastery:
What Helps
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Recognizing the world is not always just and
fair
Recognizing where views of mastery
originate
Externalizing the blame
Decreasing self-blame
Managing and making decisions
Tempering Mastery:
What Hinders
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Too much mastery
Too little mastery
Ill-timed use of mastery
Belief that one’s efforts will always result in
desired outcome
Belief that bad things can’t happen to good
people
Blaming oneself or others for not being able
to solve the problem.
Reconstructing Identity:
What Helps
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Define family boundaries
Select major developmental themes
Develop shared values and views
Reconstructing Identity:
What Hinders
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Discrimination and stigma
Forced uprooting
Isolation and disconnection
Hanging on to one absolute identity
Resisting change
Normalizing Ambivalence:
What Helps
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Normalizing guilt & negative feelings, but
not harmful actions
Using the arts to increase understanding of
ambivalence
Regaining personal agency
Reassessing & reconstructing the
psychological family
Seeing the community as family
Reassigning everyday roles and tasks
Asking questions about context & situation
Bringing ambivalent feelings into the open
Normalizing Ambivalence:
What Helps
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Uncovering latent or unconscious
ambivalence
Managing the ambivalence, once aware of it
Seeing conflict as positive
Valuing diverse ways of managing
ambivalence
Knowing that closure does not lower
ambivalence
Developing tolerance to tension
Using cognitive coping strategies
Normalizing Ambivalence:
What Hinders
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Using only a symptom focus
Expecting typical coping and adaptations
Revising Attachment:
What Helps
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Thinking dialectically
Moving from despair to protest
Thinking systemically, but not seeing
maladaptations as bilateral pathology
Developing memorial ceremonies and
farewell rituals
Knowing that fantasies of a missing person
are common
Watching out for no-talk rules
Paying attention to developmental stages
that exacerbate anxiety
Revising Attachment:
What Helps
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Including children & adolescents in therapy
when parents or siblings disappear
Using multiple-family and couple groups to
build new connections
Encouraging the use of the arts
Revising Attachment:
What Hinders
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An overemphasis on individuation
Expecting closure
Discovering Hope:
What Helps
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Finding spirituality
Imagining options
Laughing at absurdity
Developing more patience
Redefining justice
Finding forgiveness
Creating rituals for ambiguous loss
Rethinking termination
Revising the psychological family
When Hope Hinders
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Persistent hope for closure
Continued longing for life as it used to
be