The Ambiguous Loss Syndrome
Have you ever lost something you know still exists? Perhaps it was an old picture, a sentimental letter or your favorite pair of shoes. Initially, you search and search for the item but you cannot recover it. It eats away at you, day after day, until you are lucky enough to be reunited with it. When this happens, you give a big sigh of relief, the panic eventually subsides and you move forward with your life.
This same scenario can apply to children in the foster care system. They have been separated from what is most precious to them, their families. They know that their family members still exist, but they cannot live with them. Clearly, those children who are reunited with their families feel a great sense of relief. The children who remain in care hold onto the hope of reunifying with their families as long as they are in foster care. Their losses are unresolved.
Ambiguous loss is also known as an unresolved loss. Boss, 1999, defined ambiguous loss as the grief or distress associated with a loss (usually a person or relationship) in which there is confusion or uncertainty about the finality of the loss. There are two types of ambiguous loss:
1. When the person is physically present but psychologically unavailable. An example of this might be when a child’s parent has a mental health diagnosis or a substance use issue that makes him/her emotionally unavailable to meet the needs of the child, even if that parent is physically present.
2. When the person is physically absent but psychologically present. Examples of this would be when a child does not live with a parent due to divorce, incarceration, foster care or adoption (Boss, 1999).
For children in foster care, ambiguous loss occurs over and over again and is very difficult to process. Children who enter foster care often lose contact with their birth parents, their siblings, other family members, friends and their physical surroundings. They enter uncertain situations and are left wondering if the separation from their biological families will be permanent or temporary. Frequently, the biological family stays psychologically present in the child’s mind, even though the biological family members are not physically present. While in care, many foster children fluctuate between hope and hopelessness with regard to reunification. This is due to the ambiguous loss, which causes them to block themselves from forming healthy attachments to their new foster families. To gain a better understanding of a foster child experiencing an ambiguous loss, consider the example of this 11-year-old boy who was in foster care:
I knew that my mom kept thinking about getting us back and that helped me hang on. She told me she wanted us back. I just could never give up on my mom even though she did so much stuff. I know no matter what she put me through she still loved me. There was no way I was going to call my foster mother Mom. I got a mother. At times my mom said she couldn’t stop thinking about us and wanted to kill herself because she wasn’t with us. I thought one day she will come back and get me, wake up and realize what she did wrong. After all the pain you go through you hope there is happiness waiting for you in the end (Manuel, age 11).
Nationally, there are 463,000 children in foster care, 49% of whom are slated for reunification with their biological parents. With this in mind, it is essential that professionals working with foster children and foster parents understand the concept of ambiguous loss and work with their clients to create more stable relationships between foster parents and their foster children (www.childwelfare.gov).
How Foster Parents Can Cope Ambiguous loss can be difficult for many foster parents to comprehend if they do not have a clear understanding of its role in the foster child’s life. As outsiders, we expect the foster child to be as angry as we are at the biological parents who caused them pain. We cannot understand why the children want to have anything to do with their biological parents after being treated so badly. This may be our reality, but it is not the foster child’s reality. Extreme loyalty remains between the child and the biological family members, and hope of returning home is kept alive by phone contact or visits with biological parents who tell them that they are attempting to regain custody. These statements by parents underscore for the children that reunification is not a fantasy; it can be a reality. Since the loss is unresolved, the children find it very difficult to detach from their biological parents and attach to a new caregiver; their parents are still very much alive.
Foster parents can ease the transition for themselves and their foster children by recognizing the symptoms of ambiguous loss prior to the child entering the home. These symptoms often include: Difficulty with changes and transitions, even seemingly minor ones like sleeping in a new bed Trouble making decisions Feelings of being overwhelmed when asked to make a choice Problems coping with routine childhood or adolescent losses (last day of school, death of a pet, move to a new home, etc.) A sort of learned helplessness and hopelessness due to a sense that he has no control over his life Depression and anxiety Feelings of guilt Fear of attachment Lack of trust
(www.nacac.org). Foster parents can also help alleviate the ambiguous foster child’s anxieties and fears and create a healthy attachment by:
Acknowledging that the foster child’s biological family still exists; denial can be a real enemy. Not taking sides but spending time exploring the foster child’s feelings if he is open to this.
Giving a voice to the ambiguity – give a name to the feelings of ambiguous loss and acknowledge how difficult it is to live with this ambiguity.
Learning to redefine what it means to be a family, both foster and biological. Giving your foster children permission to have feelings about being separated from their family of origin without feeling guilty.
Helping the child identify what has been lost (the loss may not be limited to the actual parent – loss could also include the membership of that extended family, the loss of the home or town, the loss of having a family that looks like them or the loss of their family surname.
Create a “loss box.” In her work with adopted adolescents, therapist Debbie Riley guides youth as they decorate a box in which they place items that represent things they’ve lost. This gives them both a ritual for acknowledging the loss and a way for them to revisit the people or relationships in the future.
Creating a life book and writing in the birthdays and names of their biological family members. Understanding that sometimes certain events trigger feelings of loss, such as holidays, birthdays or the anniversary of an adoption.
Alter or add to family rituals to acknowledge the child’s feelings about these important people or relationships that have been lost. For example, adding an extra candle representing the child’s birth family on his or her cake may be a way of remembering their part in your child’s life on that day.
Don’t set an expectation that grief over ambiguous loss will be “cured,” “fixed” or “resolved” in any kind of predetermined timeframe.
Explain that feelings related to ambiguous loss will come and go at different times in a person’s life and provide a safe place for the child to express those feelings (www.nacac.org).|
In addition to unconditional love, the best gifts that anyone can give a foster child coping with an ambiguous loss are patience, honesty and acknowledgement.
References Boss, P. (1999), Ambiguous Loss. Learning to live with unresolved grief. Cambridge, MA. Harvard University Press. National American Council on Adoptable Children. (2011). Retrieved October 2, 2010, from www.nacac.org/links.html
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