1. Supporting those faced with loss Kanthi Perera, Senior Social Worker 2005 Churchill Fellow

2. Losses affect people Emotionally Physiologically Intellectually Spiritually Sociologically Behaviorally

3. Ambiguous Loss Losses that are incomplete, uncertain and lack resolution are termed “ambiguous losses”.

4. Ambiguous loss is experienced when a person is physically absent but psychologically present e.g. 9/11. “Leaving without goodbye”

5. Physically present but psychologically absent e.g. chronic mental illness, dementia, head injury. “Goodbye without leaving”

6. Research done overseas by Professor Boss and colleagues have found that this is the most stressful loss that a person can go through.

7. Ambiguous loss is not always a problem. Everyone goes through normative ambiguous losses in their life. e.g. children leaving home, elderly parents going to nursing homes.

8. It is a problem when Parenting roles are ignored Decisions are put on hold Daily tasks are not done Family members are ignored are cut off Rituals and celebrations are cancelled.

9. or when There are feelings of hopelessness that lead to depression and passivity. Feelings of ambivalence that lead to guilt, anxiety and immbobilization.

10. STRESS IS SIMPLY CAUSED BY CHANGE Understand that it is the situation and not the family that is sick. People may be adapting to unhelpful ways to an unusual situation. This is a sociological perspective.

11. FAMILY BOUNDARY AMBIGUITY A state when family members are uncertain in their perception about who is in or out of the family and who is performing what roles and tasks within the family.

12. The higher the degree of ambiguity, the more negative the outcomes.

13.  Immigration/Migration  Divorce, remarriage  Work relocation  Military deployment  adoption COMMON SITUATIONS OF AMBIGUOUS LOSS

14.  Young adults leaving home  Elderly moving to nursing home.  Preoccupation with work  Obsession with computer games, internet, TV

15. COPING WITH FAMILY BOUNDARY AMBIGUITY Depending on the family members’ perceptual and behavioural responses to the loss, they will clarify their boundaries and reorganize their system accordingly.

16. ABC-X Model of Stress Event or Situation A Perception Family Individual Community C Resources Family Individual Community B Degree of Stress Low/High/Crisis X

17. Family Stress Perspective When faced with change, individuals and families hunger for certainty about their: Identities Roles Relationships Family rules rituals

18. PERSISTENT STRESS IS NOT GOOD FOR ANYONE Learning to manage stress. Name the situation as one of ambiguous loss. Has this loss created ‘boundary ambiguity’?

19. Obtain information about the situation Share your views and feelings about the situation with others in the family.

20. Information need to be shared even if it is “I don’t know what the outcome will be”. Recognize that ambivalence is common in such situation. Important not to act on negative feelings.

21. Discuss with other family members how  Roles  rules and  rituals could be adapted to accommodate the situation.

22. Support hope and optimism in each other. e.g. with illness, we may hope for cure and later hope for living life well despite disability. Imagine options.

23. E Externalize blame. In ambiguous loss, it is the situation that is “sick” not people. Explore spirituality. Practice dialectical thinking. (Holding two opposing ideas at the same time).

24. Involving the Psychological family The “psychological” family is intrinsic in our lives and compensates for loss.

25. Therapeutic Goals Finding meaning Tempering mastery Reconstructing identity Normalizing ambivalence Revising attachment Discovering hope

26. Therapeutic Goals Finding Meaning Tempering Mastery Reconstructing Identity Normalizing Ambivalence Revising Attachment Discovering Hope

27. Therapeutic work to center on human connections such as family & community as these are ongoing and needed for resiliency. Professional connections are temporary.

28. Normalizes the responses and not interpret them as a medical condition or dysfunctional behavior. Encourages those affected to resist social pressure to “get over” the loss, instead learn skills to live with the ambiguity by developing resilience based on personal strengths and family and community connections.