Written by Hillary Bowler Davis, Marriage and Family Therapist

What does loss feel like to you? Some might describe it as a painful gap, hole, or chasm. Through grief work and healing, the gap generally becomes more manageable as it closes little by little. Except when it doesn’t. 

Some losses are ongoing. They raise questions without answers, pain without resolution, and they lack a clearly defined path to closure. To put it simply: “Something is lost, but something is still there” (Boss, 2009, p. 31). Pauline Boss, a therapist and researcher specializing in family stress, named these ambiguous losses, extreme and persistent losses that result in a frozen grief (Boss, 2007). Her theory sparked an entire movement and a field of training for therapists.

Ambiguous loss is generally experienced in one of two ways: a physical absence and psychological presence (leaving without goodbye) or a psychological absence and physical presence (goodbye without leaving) (Boss & Yeats, 2014). A typical loss, while hard in its own way, has a finality to it because of the clear physical and psychological absence (leaving and goodbye). 

When there aren’t clear boundaries defining what’s been lost, there’s a lack of tradition to tell how you mourn it (Cacciatore et al., 2008; see Figure 1). Examples include miscarriage, infertility, estrangement, divorce, chronic illness, severe mental health disorders, suicide, dementia, missing persons (soldiers missing in action, accidents or disasters leading to missing bodies, kidnappings), desertion/abandonment, adoptions, immigration and incarceration (Boss, 2007; Boss, 2009; Boss & Yeats, 2014). 

As with most things, there is a spectrum of loss experiences. Many everyday losses can also carry enough ambiguity that it disrupts the grief process. For example, a young woman who successfully broke off an unhealthy relationship may struggle with how much she misses her former partner, despite it being for the best. A parent might grapple with their newly empty nest—excited for the opportunities ahead for their adult children but struggling to put a finger on why they feel suddenly unsure of themselves. We constantly navigate transitions and changes where we simultaneously gain and let go, and it leaves us with a mess of emotions.

Some ambiguous losses cause mild distress and avoidance—we don’t talk, think, or acknowledge our feelings about it. Time does heal some wounds, and people are remarkable for their ability to adjust. However, the greater the ambiguity, the worse the symptoms, and the more likely the loss becomes traumatic (Boss, 2007). Symptoms can include anxiety and depression, identity issues, substance abuse and self-harm, and feelings of guilt and helplessness, just to scratch the surface (Boss, 2006). 

Imagine experiencing a loss so confusing and so painful that you also seem to lose your relationship with yourself and others around you. Families, couples, and individuals can become completely immobilized, struggling to communicate and make decisions, reconcile differing grief experiences, and carry on with their lives (Boss & Yeats, 2014). The challenge at hand is not only attempting to move forward after a loss, but to move forward, period. 

How do you manage grief for a loss that by its very nature seems to have no resolution? How do you change something that won’t change? 

Boss proposes that the change happens not because the situation will ever change, but because we can learn to change ourselves, nurturing tolerance for ambiguity and the resilience to live our lives in spite of the ongoing gaps (Boss, 2009). She developed six ways to manage ambiguous loss (Boss, 2006), and the following suggestions are adapted from her work. 

To navigate the painful losses and ambiguities in your life, try the following:

Define the loss and find meaning

A critical component for managing ambiguity is making the experience as concrete as possible (Brier, 2008). For example, researchers have found that when parents who experienced a pregnancy loss used a name or label for their loss (even tender nicknames such as “Little One”), it increased their coping (Sawicka, 2017). Defining the loss strips away the first layer of ambiguity to not only make it more tolerable but also to open the door for the rest of your healing process.

Once it is acknowledged and defined, people naturally try to make sense of the loss. However, by its very nature, ambiguous loss defies logic and is therefore difficult to make meaningful. 

Your first attempts at making meaning out of the situation might even be negative, such as wondering whether this loss is some kind of a punishment (Boss & Yeats, 2014). Keep going. You can seek a healthier meaning by investigating what this loss really means to you personally. Be gentle with yourself as you move you through the following:  

1. You have experienced a loss.

2. You have lost _____.

3. This loss means____.

Meaning making is at the heart of all ambiguous loss work (Boss, 2009). It is just your first step toward healing— consider this your “rough draft” meaning. 

Let go of what you can’t control, master what you can

You might be familiar with the idea of choosing to focus on what you can control and letting go what you can’t. But an ambiguous loss pulls back the curtain on something that has always been true: There’s not much that is under your control. 

Since you can often do little to restore what is lost, ambiguous loss experts recommend finding a balance through self-mastery: prayer, meditation, creative endeavors, goal setting, exercise, etc. 

While these disciplined activities can help you take charge of yourself in moments when everything feels out of control, they are not meant to replace the truth. They must be tempered with acceptance and surrender, which can be cultivated with activities like mindfulness (Boss & Yeats, 2014).

Reclaim old identities, construct new identities

As mentioned before, it can be helpful to find things you can make more concrete to ease the ambiguity, and your identity in relation to what or who was lost is one of these points (Sawicka, 2017). Are you still a mother? A son? A spouse? How has your identity changed with this loss?  You can’t have resilience without flexibility and clinging to what was will keep your grief frozen. You have the opportunity to redefine you as someone who lives well, questions and all.

Ride the ups and downs 

Without a doubt, dealing with ambiguous losses can leave us feeling ambivalent, having mixed and conflicting emotions (Boss, 2007). It is perfectly normal in any context to have feelings that might contradict one another, but ambiguity tends to polarize these mixed feelings and cause even more confusion and distress (Boss & Kaplan, 2004). On top of this, you might also feel ashamed over specific emotions like anger, envy, and loneliness. When you anticipate ambivalence as part of the process, it can neutralize shame so that other feelings can flow. Remind yourself it is normal to feel strong emotions, refrain from requiring your emotions to make sense, and accept them as they are. They will pass.

Remember the certain

The societal push to “get over it” is likely even stronger when the loss doesn’t make sense— if you can’t make it fit into a predefined storyline, it’s tempting to cut it out entirely. In reality, the answer lies in finding a healthy balance between letting go and remembering. In therapy, traditional grief work often directs people toward some final stage of acceptance where the person says goodbye, which is usually not an option with ambiguous loss. 

An alternative approach might be especially helpful in cases of ambiguity. Rather than forgetting and moving on, you can deliberately remember and keep whatever or whomever as part of your life (Carr, 1998). Boss’s theory about “revising attachment” walks the line between keeping and letting go, and it requires some decision making on your part. In the case of some ambiguous losses such as divorce and abandonment, you won’t want to keep the person, but you may want to keep an idea or symbol. Perhaps you want to get married again, or you want to break unhealthy cycles in your family. Keep what serves your healing.

Another way to balance keeping and letting go is to turn your focus to what is still certain despite the uncertainty. Your love for the person might be certain. Your happy memories might be certain. Your other remaining relationships might be certain. Your dedication to finding a healthier opportunity or new relationship might be certain. In fact, clarifying roles, rules, and boundaries within our remaining relationships can help ease ambiguity and provide a sure context for the lost person, experience, or idea, to remain alive in our lives (Boss & Yeats, 2014).

Discover new hope

Waiting for closure hinders your ability to heal from an ambiguous loss (Boss & Yeats, 2014). Consider this: What if a sense of justice, peace, and resolution is something you can create? This is the step where you create options for yourself. What rituals, traditions, or other activities can you engage in? Can you join or start an organization? Make a donation? Celebrate a certain day? 

Hope is more an action than it is a feeling. Don’t wait for it to happen.

Find meaning…again and again

While each of these research-based tips can be considered steps to healing, they are often circular in nature rather than sequential, meaning that healing continues when the steps begin again (Boss & Yeats, 2014). Odds are that once you have worked through the previous steps, your definition and meaning of the loss will change. Apply these again and again until you are living well.

Lean into the ambiguity by engaging with, rather than avoiding, your complicated sense of loss. You can work through the first few steps above through journaling or by speaking up: talk to your spouse, a family member, or friend, to name the loss and begin the work of meaning making. Many of these losses are traumatic. There is no shame in seeking professional help as you work through these steps to develop hope and resilience in the face of all types of losses.

References

Boss, P. (2006). Loss, trauma, and resilience: Therapeutic work with ambiguous loss. New York: W. W. Norton & Company, Inc.

Boss, P., & Kaplan, L. (2004). Ambiguous loss and ambivalence when a parent has dementia. In K. Pillemer & K. Luescher (Eds.), Intergenerational ambivalences: New perspectives on parent-child relations in later life (pp. 207-224). Oxford, UK: Els

Boss, P. (2007). Ambiguous loss theory: Challenges for scholars and practitioners. Family Relations, 56(2), 105-111.

Boss, P. (2009). Ambiguous loss: Learning to live with unresolved grief. Harvard University Press.

Boss, P., & Yeats, J. R. (2014). Ambiguous loss: A complicated type of grief when loved ones disappear. Bereavement Care, 33(2), 63-69.

Brier, N. (2008). Grief following miscarriage: a comprehensive review of the literature. Journal of Women’s Health, 17(3), 451-464.

Cacciatore, J., DeFrain, J., & Jones, K. L. (2008). When a baby dies: Ambiguity and stillbirth. Marriage & Family Review, 44(4), 439-454.

Carr, A. (1998). Michael White’s narrative therapy. Contemporary Family Therapy, 20(4), 485-503.

Sawicka, M. (2017). Searching for a narrative of loss: interactional ordering of ambiguous grief. Symbolic Interaction, 40(2), 229-246.

https://www.ambiguousloss.com/

Hillary Bowler Davis was born and raised in Riverton, Utah. After starting her career in writing and marketing, she took a leap of faith to study to become a therapist. She graduated from Brigham Young University with a master’s degree in marriage and family therapy and works as an associate therapist in the Salt Lake Valley with individuals, couples, and families. Hillary is passionate about personal growth and healthy relationships and gets most excited about digging into life’s hard questions. Her next big adventure is building a family with her husband.