Grief and Ambiguous Loss: Understanding an Unsettling Void
Grief is a universal human experience associated with death or other clearly defined endings. But not all losses end with closure. Some remain suspended in uncertainty, without resolution or social acknowledgment.
Coping, Resilience, and Therapeutic Implications
Despite these challenges, individuals and families can work through ambiguous loss. These strategies are not about eliminating grief but rather, living with it in healthier ways.
Resilience as a therapeutic goal
Since closure may not be possible, the focus shifts toward fostering resilience - helping people live with uncertainty, maintain hope, rebuild identity, and find meaning even when answers are not clear (Nathanson and Rogers, 2021).Narrative work and meaning making
Helping people tell their stories, constructing healthy narratives, and reframe the meaning of loss is part of the grief process. Research has shown that failure in meaning-making is strongly associated with negative affect (Zaksh et al., 2018). Therapeutic work can help people work towards acceptance and understanding.Addressing boundary ambiguity
Clarifying roles and expectations where possible; acknowledging what is lost (the person’s previous personality, capabilities, relationship) and what remains. A therapist can help redefine individual and family systems in ways that can help ambiguous grief (Zaksh et al., 2018).Acceptance of ambiguity, rather than forced closure
In some situations, resolution may not be possible. An important part of coping is tolerating uncertainty rather than resisting it. It is important to encourage insight into the ambivalence (hope + despair), acceptance of what is known and what is not, and letting hope and grief coexist (Comtesse et al., 2023).
What Helps People Navigate Ambiguous Loss
Here are some guiding suggestions for people experiencing ambiguous loss, and for those supporting them :
Recognize and name the loss.
Reduce isolation. Connecting with others can validate suffering and reduce isolation.
Allow for emotional complexity: ambivalence, anger, yearning, hope, despair all may coexist. It’s part of the ambiguous experience.
Practice self-care and boundary setting, especially for caregivers. The burden of caregiving and of ambiguous loss can lead to burnout (Nathanson and Rogers, 2021).
References
Zaksh, Y., Yehene, E., Elyashiv, M., & Altman, A. (2019). Partially dead, partially separated: Establishing the mechanism between ambiguous loss and grief reaction among caregivers of patients with prolonged disorders of consciousness. Clinical Rehabilitation, 33(2), 345–356. https://doi.org/10.1177/0269215518802339
Nathanson, A., & Rogers, M. (2021). When ambiguous loss becomes ambiguous grief: Clinical work with bereaved dementia caregivers. Health & Social Work, 45(4), 268–275. https://doi.org/10.1093/hsw/hlaa026
Comtesse, H., Killikelly, C., Hengst, S. M. C., Lenferink, L. I. M., de la Rie, S. M., Boelen, P. A., & Smid, G. E. (2023). The Ambiguous Loss Inventory Plus (ALI+): Introduction of a measure of psychological reactions to the disappearance of a loved one. International Journal of Environmental Research and Public Health, 20(6), 5117. https://doi.org/10.3390/ijerph20065117
