Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss

Comprehensive, clear and well referenced, this guide to the theory and practice of dealing with ambiguous loss — loss without closure — provides a realistic hope, not that we will “get over it”, but that it is possible to live with the uncertainty and the unknown.

This comprehensive, clear, well-referenced guide, mainly aimed at helping professionals, covers the theory and therapeutic practice of dealing with ambiguous loss — the kind of loss in which there is no closure. Terrorist attacks, wars, and abductions all produce situations in which there is no body to bury. Conversely, when a loved one suffers from Alzheimer’s or a terminal disease, they may be physically present yet mentally absent. Both situations cause a great deal of distress which cannot be dealt with by familiar cultural rituals.

Boss lays claim to the concept of ambiguous loss. She is clearly a hugely experienced clinician who has worked in a variety of contexts — in New York after 9/11, in Kosovo and with communities devastated by the 2004 tsunami. Experience, theory and practice work together seamlessly to create a framework in which to understand and work with ambiguous losses in their many, varied, acutely painful forms.

Ambiguous loss challenges us deeply. It defies our need for meaning. It challenges our faith in a just world, a good world, a solid world — maybe our religious faith, too. It challenges our feeling that we have some kind of control over events, our sense of agency, of self. It also challenges our sense of identity as part of our web of relationships, our family systems. Who are we in relation to someone who is present and yet absent, or absent and yet present?

How to deal with it? Ambiguous loss is above all a relational problem, to which relational means must be applied. Communities and families have to work together to find resiliency. Boss advocates narrative therapy, in which people tell their stories in group settings, but are not pressured to do so. The stories can be reconstructed in ways which are empowering. The idea is always to work together to unearth resources and resiliency which may seem to be hidden in a desperate situation.

The individualistic approach of many therapies is inappropriate and may harmfully isolate individuals from their families and/or communities just when they need them. This leads on to a useful critique of cultures in which “mastery” is central, the feeling that we control our own destinies by our behaviour, and that by implication, we live in a just world. Western cultures in general value mastery and the individual, believing that even after catastrophic events, strong and healthy people “get over it”. By contrast, Boss argues, in order to deal with ambiguous loss, we need to develop tolerance for never ending states of ambiguity, accept that our mastery is necessarily limited, and develop our resilience as part of groups, cultivating relationships rather than cutting ourselves off from them to generate “self reliance”. Therefore not only do therapists need to be culturally sensitive, but they should be alert to ways in which strongly held (yet rarely examined) cultural assumptions can really cause us pain, when life refuses to conform to them.

My only problem with the book was that it sometimes drilled the same theoretical points home somewhat repetitively, without providing any new insights or real depth along with the repetition. Some more case studies, or longer quotes from the voices of clients or therapists talking about concrete situations might have made the book more readable and given it more emotional depth and colour. Sometimes I found myself skimming over the same points, and felt that they were becoming slogans.

However, the book certainly presents valuable insight into the common feature in the situations so many people find themselves in, as they fall between the cracks. It normalises ambiguous loss, stressing that we almost never have states of complete presence or absence, and puts a name to the pain that this can cause, providing a realistic hope, not that we will “get over it”, but that it is possible to live with the uncertainty and the unknown.

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