1. Boundary Ambiguity - Who’s In & Who’s Out of the Family
Not knowing who is in & who is out of the family.
Refers to Family Perceptions in the ABC-X model.
2 Key Dimensions -
Incongruence between physical & psychological presence in the family

2. Boundary Ambiguity
Physical Presence is determined by actual bodily presence in the home.
Psychological presence is the presence of a physically absent family member in one’s mind, cognitively and emotionally.

3. Boundary Ambiguity in Families
Physical
Present
Absent
Low
(boundary clarity)
High
Psychological

4. Boundary Ambiguity: Students Generate Lists and categorize
Physically Absent, Psychologically Present:
Examples:
War, Natural disasters, terrorism, incarceration, desertion, missing bodies, immigration, divorce, work re-location, military deployment, children leaving home.
Psychologically Absent, Physically present: Examples:
Disease, mental illness, addiction, depression, affairs, work pre-occupation, obsessions with TV, computer games, texting
Figure 5.2, pg. 100

5. D. Key Points to Remember about Boundary Ambiguity
Physical presence/psychological absence
Physical absence/psychological presence
When family boundaries are clear and consistent, the family experiences lower stress.
Boundary Ambiguity causes stress over and above the stress of the event itself.
It’s triggered by the lack of certainty.

6. To determine Boundary Ambiguity in Families
Ask each family member: Who is in your family? Is anyone missing from the family right now?
Who performs what roles?
List what each family member does to help the family.
Who is included in the family rituals & celebrations? Who is not included?

7. Boundary Ambiguity
Clarify family boundaries after loss or acquisition.
The ability to clarify and maintain boundaries after loss may be more relevant to predicting whether a family will manage stress or go into crisis, than a continued focus on the stressor event.
Reorganization or restructuring is needed before stress will subside.
Family must sometimes make a decision or choice about whether the person is in or out of the family system.

8. What Can Be Done to Work Through the Situation?
1. Actively seek facts about the stressor event (as when a family member is missing, an alcoholic, or ill). Even the smallest bits of information will help, because knowledge helps you to manage stress.
2. Once that is done, realize that short-term ambiguity will not be dysfunctional. Not even when loss is clear, such as death, will the family accept the fact immediately. It takes time to clearly accept a loss.
3. Realize that families have boundaries: that it is important to know who is in and who is out. Talk about the loss and the ambiguity surrounding it even if it is a forbidden topic. Break the family rules and talk about it. Discuss with your family how they see their membership and boundaries.

9. Ambivalence
Occurs when there is no clear course of action in ambiguous situations.
Arises our of conflicting emotions
Often directed toward the ambiguous family member.
EXAMPLES:
Teri Schaivo case;
Runaway or kidnapped children;
Alzheimer’s disease;
Soldiers missing in action

10. Difference Between Ambiguity & Ambivalence
1. Cognitive- something we know or don’t know
2. Structure – ambiguity exists in family structure
3. Causes stress and confusion of roles & boundaries
Ambivalence
1. Emotional - something we feel
2. Mixed feelings & emotions
3. Arises from internal conflicts about an ambiguous situation.
4. Serves to block coping & decision-making.

11. Therapeutic Focus GOALS:
1. to increase tolerance for stress/ambiguity;
2. when possible, to minimize ambivalence, immobilization & denial;
3. to increase sense of mastery.

12. Perceptions of stressors
Internal Factors
Boundary Ambiguity
Boundary Clarity
Denial
Acceptance
Fatalism
Mastery
Ambivalence
Clarity
External Factors
Negative
Positive
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