While most people are familiar with the grief that follows a clear loss like death, there’s a less understood but equally painful form of grief that I often see in my practice: ambiguous grief.

What is Ambiguous Grief?

Ambiguous grief, a term coined by family therapist Pauline Boss in the 1970s, refers to a loss that’s unclear, incomplete, or intangible. It’s a grief that lacks closure or understanding, often because the loss is ongoing or because there’s uncertainty about whether a loss has occurred at all.

This type of grief can be just as intense and debilitating as grief following a death, but it’s often not recognized or validated by society in the same way. This lack of recognition can leave those experiencing ambiguous grief feeling isolated and confused about their emotions.

Types of Ambiguous Grief

Ambiguous grief can manifest in various situations:

1. Physically absent but mentally present: This occurs when a loved one is no longer near you, or a relationship has changed, but they are still living rent-free in your mind.

Examples include:

• Missing persons
• Divorced parents who are still emotionally involved in their children’s lives
• Military deployments

2. Physically present but mentally absent: This happens when a loved one is with you physically, but for some reason there is an emotional lack of awareness.

Examples include:

• Alzheimer’s disease or dementia
• Severe mental illness
• Addiction

3. Unclear loss: This involves situations where the loss itself is ambiguous. Here is the largest category of loss that is felt but often glossed over, as if not worth memorializing. Examples include:

• Infertility and pregnancy loss
• Chronic illness with unpredictable prognosis
• Loss of a dream or anticipated future
• Friendship breakups
• Empty-nesting or family members leaving home
• A loss of a faith community or belief system
• Natural disasters
• Loss of a childhood home or special place
• Unexpected employment termination
• Being ghosted

The Challenges of Ambiguous Grief

Ambiguous grief presents unique challenges that can complicate the grieving process:

1. Lack of closure: Without a clear ending or resolution, it’s difficult for individuals to move through the typical stages of grief, or even to recognize that they are grieving at all

2. Ongoing stress: The uncertainty of the situation can lead to chronic stress and anxiety.

3. Difficulty in meaning-making: It’s challenging to make sense of a loss that’s unclear or unresolved. Am I grieving or am I being too sensitive? Is this situation worth the emotional energy? Maybe it will change?

4. Social isolation: Others may not understand or recognize the grief, leading to feelings of loneliness and lack of support.

5. Guilt and self-blame: The ambiguity can lead to questioning one’s actions and decisions, fostering feelings of guilt.

6. Identity confusion: When a change occurs that maybe we didn’t want or expect, we sometimes need to update our talk-tracks about ourselves. What was once a given may no longer be true. Especially in cases of psychological absence with physical presence, individuals may struggle with their role and identity in relation to the person who is “there but not there.”

Coping with Ambiguous Grief

As a mental health professional, I’ve found several strategies helpful for individuals dealing with ambiguous grief:

1. Acknowledge the grief: Recognizing and naming the experience as grief is an important first step.

2. Embrace the ambiguity: Instead of fighting against the uncertainty, learning to tolerate and accept it can be liberating. Life is full of gray spaces.

3. Create rituals: Developing meaningful rituals can provide a sense of control and connection in ambiguous situations.

4. Redefine hope: Shift from hoping for a specific outcome to hoping for strength, resilience, and the ability to cope with uncertainty. Hope often requires creativity and flexibility

5. Connect with others: Joining support groups or connecting with others experiencing similar losses can provide validation and reduce isolation.

6. Practice self-care: Just like we would rest a sprained ankle, or allow time for bereavement after the death of a loved one, when we experience ambiguous loss, grace, gentleness and extra care are required

7. Seek professional help: A mental health professional can provide valuable support and guidance in navigating the complexities of ambiguous grief.

The Role of Therapy in Ambiguous Grief

As a therapist, my role in helping clients with ambiguous grief often involves:

1. Validation: Acknowledging the reality and difficulty of their grief experience.

2. Psychoeducation: Helping clients understand ambiguous grief and normalize their reactions.

3. Narrative therapy: Assisting clients in constructing meaningful narratives about their experience.

4. Cognitive reframing: Challenging unhelpful thought patterns and fostering more adaptive ways of thinking about the ambiguous loss.

5. Mindfulness techniques: Teaching skills to help clients stay present and manage the anxiety associated with uncertainty.

Reach Out

If you’re experiencing ambiguous grief, you’re not alone. Your feelings are valid, and there is support available. Our many therapists are available to provide support and guidance through this challenging experience. Consider reaching out today!