Ambiguous Loss

One important concept in psychotherapy studies is the concept of href="http://www.indiana.edu/%7Efamlygrf/units/ambiguous.html">ambiguous
loss.  This is a loss that is, in some
way, less than definitive.  If you are at the hospital
visiting an ill beloved family member, and see the death, it is
perfectly clear that a specific loved one has in fact died.
 If you are mature enough to grasp the permanence of the loss,
is it unambiguous.



Many losses, however, are ambiguous.  Examples include
infertility, when the loss is a loss of opportunity, as opposed to the
loss of a specific person; a prolonged hostage crisis, in which you
don't know whether or not the person is coming back; and Alzheimer
Disease, in which the personality, but not the person, is lost.



In and around Galveston, an unknown number of persons sheltered in
place.  It was reported to be tens of thousands, but nobody
knows the actual number.  Today (the day after Hurricane Ike),
early reports said that here were no know deaths in the Galveston area.
 But looking at some of the photos, it is hard to believe that
nobody died.  



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From Coast Guard News

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Right now, many people are faced with ambiguous loss.  Some
who evacuated do not know if they still have a house.  Others,
regardless of where they live, do not know if they have lost a friend.
 Some may not know if they have lost a family member.
 

Ambiguous loss presents certain challenges to the person who has had
the loss, and to potential helpers.  It is hard to know how to
comfort someone who faces ambiguous loss.  



For those who personally face ambiguous loss, they often do not know
how they are supposed to feel.  That is a
problem.  Another is that they may not know if they are entitled
to feel as bad as they feel.  A third problem is that they may
know know what they feel.  A fourth
problem is that they may not realize that their emotional state has
even changed.



The challenge to the therapist is that none of these problems can be
approached directly.  



As for what the person is supposed to feel, the therapist cannot simply
tell the person what to feel.  There are many reasons for
this.  For one, the therapist's role is not to tell people
what to feel.  Second, the therapist does not know what the
person is supposed to feel.  Third, telling someone what they
are supposed to feel generally does not produce any therapeutic effect.
 Fourth, in order to know what one is supposed to feel, first
one has to know who it is, that is doing the supposing.  



Anytime a question arises, in the course of psychotherapy, and the
question is posed in the href="http://www.unc.edu/depts/wcweb/handouts/passivevoice.html">passive
voice, it requires thoughtful handling.  The
therapist runs the risk of sounding like a nitpicky English teacher,
reviewing a grammar lesson when the person is not in the mood for such
a lecture.  Plus, when people are in distress, their capacity
to grasp nuanced distinctions may be impaired.  



The question "what am I supposed to feel?"  is troublesome
because it does not specify a subject, that is, it does not say who is
performing the action (the action, in this case, is "to suppose").
 Perhaps it could be rephrased as "What does society expect me
to feel?" or "What do you think I should feel?" or any of a number of
possibilities.  But as I mentioned, it would not be helpful at
that point in the session, for the therapist to say, "Don't you know it
is counterproductive to pose questions that are phrased in the passive
voice?"



The other thing is that the person may harbor this question, but not
put the question into words.  That makes it more dificult for
the therapist to address.



See, it can be tricky.  There are a lot of pitfalls.



Sometimes, though, a little teaching can be helpful.  For
example, is a person is in distress after an ambiguous loss, it can be
helpful to do a little teaching about the topic of ambiguous loss.
 That provides the person with a label that they can use, to
start constructing an intellectual framework for working through the
loss.  Sometimes a person benefits from accepting the
ambiguity first, then to work on accepting the loss.



After large disasters, therapists might find it helpful to anticipate
what kinds of problems are likely to arise for their people.
 People who were not affected directly by the disaster, may be
affected indirectly, in unexpected ways.  These effects may be
important, but not expressed.  They may not be important, or
pertinent.  There are many possibilities; the important thing
is to be open-minded.