One of the most frequently overlooked and misunderstood phenomena is the concept of Ambiguous Loss. This theory, developed by Dr. Pauline Boss, compels us to better examine experiences of unresolved losses due to stigma, disenfranchisement by larger society, discrimination and oppression or other factors.
This type of loss is not typically associated with a death, although it can be. Ambiguous losses are losses that are generally unrecognized or unacknowledged because they are viewed as less important than losses associated with death. There are two categories of Ambiguous Loss: physical loss with psychological presence, or psychological loss with physical presence.
More articles in this series...
Anticipatory Grief: Just Think of me as a Guy whose Husband is Dying
Living life disabled with a TBI: And oh, by the way, I’m Gay
How Ambiguous Loss Works
For lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, the first type could be experienced as the physical loss of an unaccepting family that doesn’t want contact, but remains psychologically attached, perhaps through a sense of loyalty or a hope that things will change.
The second type may be a situation where someone is allowed to be part of the family, but is not unconditionally accepted, inclusive of sexual orientation.
Ambivalent feelings, ambiguous messages and behavior and lack of clarity about the nature of relationships create confusion and ongoing stress. This combination can lead to a state wherein a person must learn how to balance the dilemma of dialectical thoughts and feeling: I love my (family, friends, faith) and I’m angry with them. I get to have both of these thoughts and feelings—referred to as “both/and.”
Ambiguous losses are always associated with relationships. If unrecognized and unresolved, they can contribute to poor functioning across multiple domains. For LGBTQ people, there may be multiple instances of this type of loss throughout a lifespan. Ambivalent feelings and loss of friendships or family contact, loss of job or reputation due to sexual minority status, confusion about roles and sense of belonging in social and family groups or even hopes and dreams. Such hopes could include wanting to be a parent, or the ability to identify and be accepted, supported and affirmed as a same sex couple.
Many older LGBTQ people may have never been asked critical questions about the depth and nature of their relationships, or potential losses because they were in the sexual minority. Providers may assume that LGBT people do not have children, or are surprised to hear someone express sadness about not being a parent. Older LGBTQ adults may have lost parental custody based upon their sexual orientation and do not discuss this because of the associated stigma or having been judged by others.
Benefits of Resilience
Resilience is a trait that helps people exhibit personal strength and self-efficacy in the face of adverse events or circumstances. It allows us to engage in situations despite negative factors or barriers to attaining goals, and it can help when we choose to remain in less-than-satisfying relationships. Resilience is the ability to experience continued personal growth and healthy functioning despite multiple stressors. Resilient behaviors or attitudes are expressed in being able to recognize and display responsibility for one’s actions, and distinguish from others’ behaviors; having a sense of optimism; ability to recognize limits to personal power and control over others; and ability to reframe problems without destructive or self-critical blame.
Fostering resilience includes access to such protective factors as having basic physical needs met (food, housing, health); ability to problem solve; emotional supports and sense of community, culture or family; cognitive skills and knowledge; a sense of belonging (including a faith or spiritual community); mental health and personality traits; healthy or positive life experiences; and other supports such as recreation, hobbies or social outlets, according to Boss’ 2006 book, Loss, Trauma, Resilience: Therapeutic Work with Ambiguous Loss.
Thus, when working with older LGBTQ adults, it’s important to determine how they have displayed resilience or accessed supports throughout their lives. Many have created intricate webs of social networks, and early advocates established specific LGBTQ community resources, recognizing that affirming and supportive structures did not exist for most people, yet are an integral component of resilience.
Resilience in older LGBTQ adults may be more common than we recognize, simply because they have lived with adversity because of their sexual minority status and learned how to adapt. This does not mean that they have not experienced ambiguous losses, some of which may remain unresolved.
A significant loss complicated by ambivalent feelings, stigma or lack of recognition for the loss can result in confusion, stress and ambiguity in relationships, and ultimately to an ambiguous loss. One example of this could be ending a significant couple relationship and getting no support from others, particularly if the relationship was not previously disclosed to others, or the relationship was considered less valid than an opposite sex relationship.
In her book, Boss identifies a process for facilitating resilience through finding meaning, tempering the need to control (mastery), reconstructing identity, normalizing ambivalence, revising attachments to others and discovering hope. Focused questions can be used to better assess and understand the degree to which unresolved losses may be hindering the ability to function well.
We can also explore the sense of optimism about life and reduce a sense of self-blame that sometimes accompanies ambiguous losses. Simple first steps can be to identify and name the problem for what it is, uncovering secrets, focusing on competencies, and exploring ambivalent feelings.
The construction of a psychological family is not uncommon for LGBTQ individuals, and it is important to recognize that the definition of family may be very different, and sometimes more important, than a biological family. Yet, older adults may feel a sense of obligation or loyalty to family, struggle with ambivalence and consciously chose to remain in relationships that are less than affirming, especially if they fear loss of social or physical supports as they age, and need more assistance.
Helping others with ambiguous losses may not mean promoting significant changes in behavior or relationships. Rather, the focus can be on cognitive coping. Sometimes telling stories assists in emotional management. Allowing people to become comfortable with feelings of ambivalence, and consciously tolerating distress without judgment or blame is essential. Exploring what constitutes family, and designing new rituals or other ways to express identity may be very helpful for some.
Learning how to “temper mastery” by engaging in dialectical thinking can also be useful. Recognizing that “bad things happen to good people” without fault or blame, and being open or able to adapt to change can help with cognitive restructuring of perceived problems. Part of the difficulty with ambiguous losses is that there may be no closure to the loss. Thus, the focus is not necessarily on fixing the problem, but on learning how to live with it.
Ambiguous losses are always relational, so we must be willing to engage in a relational method to foster resilience and hope. Above all, as service providers, family members and friends, we must always engage in these kinds of conversations with authenticity, genuineness and compassion, and become comfortable with questions about faith or spirituality, conflict and how to manage distress and sadness. We may be the only person to hear the whole story: and entrance into another’s heart in this way is always a treasure to embrace.
Lake Dziengel, Ph.D., MSW, LICSW, is an assistant professor at the University of Minnesota: Duluth. Lake researches LGBTQ aging and same sex couples. Lake created and published models on Resilience and “Be/Coming Out” and is researching losses and resilience in couple relationships across the life span. Lake can be reached at email@example.com or 218-726-8569.
This article was brought to you by ASA's LGBT Aging Issues Network.
The Spring 2017 issue of Generations is dedicated to ensuring all Americans with advanced illness receive comprehensive, high-quality, and person-... Read More