1. Discussing Ambiguity & Ambivalence when there is Dementia Ambiguity Construct The person’s absence or presence clouds couple and family roles and boundaries. Ambiguity Qualities Location – in the family structure Source – from external context Effect – blocks cognition Assessment – individual and familial

2. Discussing Ambiguity & Ambivalence when there is Dementia Ambivalence Construct Family member experiences mixed feelings and emotions Ambivalence Qualities Location – inside the person Source – from one’s internal conflict about an external situation (ambiguous loss) Effect – Immobilizes and blocks coping, especially if ambivalence remains unconscious Assessment – individual

3. III.Cycle of Distress – Ambiguous Loss from Dementia 1. Situation - Ambiguous Loss 2. Boundary Ambiguity in the system 3. Ambivalent – Roles Rules Rituals Relationships

4. III.Cycle of Distress – Ambiguous Loss from Dementia 4. Caregiver & Family Immobilization 5. Caregiver Depression – Family conflict 6. Patient Behavior Problems

5. III.Cycle of Distress – Ambiguous Loss from Dementia 1. Ambiguous Loss 2. Ambiguity 3. Ambivalent 4. Immobilization 5. Depression 6. Behavior Problems

6. III.Things to Remember Ambiguity is a cognitive variable Facts do not appear to be available Lack of information Ambivalence is a affective variable Individual may have mixed emotions or conflicted feelings Love/hate – joy/sadness for the person

7. III.Things to Remember Not all Ambiguous Loss leads to ambivalence Factors Personality type Learned experiences Religious and cultural beliefs Socialization

8. III.Things to Remember Ambiguity and ambivalence can be normal Families can become immobilized When there are high levels of ambiguity and ambivalence

9. III.Things to Remember What is the goal? Increase tolerance for ambiguity Therefore minimize ambiguity and immobilization from guilt and shame