Ambiguous Loss for Kincare Families April 4, 2012 Brookdale RAPP Webchat Deborah Langosch, PhD, LCSW JBFCS Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Ambiguous Loss Lack of clarity on the loss incomplete or not definite Ensuing confusion Emotional contradictions Unclear if loss is permanent or temporary Symbolic rituals are denied Coping with ambiguous loss Individuals and families will need to confront the meaning of the change Importance of holding onto something meaningful of the past while letting go of that which is not in the present Boss, Pauline. (1999) Ambiguous Loss, Harvard University Press Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Ambiguous Loss Ambiguous losses are real losses that can cause significant pain Physically absent / Psychologically present – eg: Absence of parent; foster care; MIA; abduction of a child; hostage; loss of relationship or friendship Physically present / Psychologically absent – eg: chronic illness or disabilities; Alzheimer’s; substance abuse; infidelity; preoccupation with work; coma Giving a name to this type of loss gives recognition Boss, Pauline. (1999) Ambiguous Loss, Harvard University Press Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Ambiguous Loss Support network does not know how to respond – Unable to validate the experience of the person – Avoidance – Uncomfortable with uncertainty – Uncomfortable with intense emotions resulting from an “insignificant” loss – Results in doing nothing Can contributes to complicated or unresolved grief Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Factors that Increase Vulnerability Poor or ambivalent relationship with absent person Poor relationship with a step-parent, surviving parent or caregiver Dependence on child by surviving caregiver Limited capacity of caregiver to respond to child Absence of a support network Nature and number of changes in child’s life as a result of the loss Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

More Factors Feelings and or fantasies of responsibility for the loss Subjective perception of physical harm History of previous exposure to trauma No shared experience with peers Pre-existing anxiety or behavior disorder Continuing threat, disruption and chaos Absent or distant caregivers Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Culture and Ambiguous Loss Understand the family’s response by asking: 1.What are the beliefs about what happens after loss within the cultural context? 2.What are the beliefs about appropriate emotional expression and integration of a loss experience? 3.What are the expectations in terms of gender differences? 4.Are certain types of losses particularly stigmatized or traumatic for a cultural group? Walsh F., McGoldrick M., Et Al. Living Beyond Loss (1991). W.W. Norton, New York. pp Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Resiliency: Protective Factors Caregiver and social support are key mediating factors – Believing and validating a child’s experience – Tolerating child’s affect – Managing own emotional response Cognitive and self regulation abilities Positive belief about oneself Motivation to act effectively in environment Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Cognitive Behavioral Therapy Recognition that thoughts, feelings, and behavior all influence each other Change can be brought about by intervening in any of the following domains: – Emotions - regulation skills – Cognitions - identification and correction of maladaptive beliefs – Behavior – Interpersonal - relationship skill building Cohen, Mannarino, Deblinger Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Cognitive-Behavioral Therapy Recognition that thoughts, feelings, and behavior all influence each other. Judith Cohen, 2002 Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012 F T B

Coping Techniques – Relaxation Deep Breathing Progressive Muscle Relaxation – Thought Stopping – Feeling Identification – Cognitive Processing, unhelpful thoughts Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Expressive Arts Painting and Drawing Bibliotherapy Clay work Puppetry Collage Music DVDs Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

Providers’ Self-Care Both at work and personally: Psychological and Emotional Physical Professional Spiritual Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012

JBFCS Center for Trauma Program Innovation Deborah Langosch, PhD, LCSW Project Director, Kinship Care Program Clinical Coordinator Loss & Bereavement Program for Children and Adolescents NY, NY Not for further training use or dissemination without permission from JBFCS MKS Training Institute 2012