Ambiguous Loss in Schools: Guidelines for Practitioners.

Author:Pataky, Meghan Gabriel

There are many forms of loss that may cause a student to grieve; death is only one of them (Boss, 2006). Although grief is primarily associated with the death of a loved one, other forms of loss such as parental divorce or incarceration can disrupt a student's life (Malone, 2016). Although schools are now supporting students who may need additional support after experiencing a loss through death (Quinn-Lee, 2012), large numbers of grieving students who have experienced a non-death loss are not getting the support they need because their losses are not readily expressed or considered distressing factors. These losses, referred to as ambiguous losses by Pauline Boss (1999), refer to physical or psychological experiences that are not as identifiable as traditional losses such as death and that are unclear to both the people who are connected to them and society as a whole. This kind of loss leaves a person searching for answers, which complicates and delays the process of grieving, and often results in unresolved grief (Boss, 2006). Many resilient children and adolescents develop into well-adjusted individuals despite experiencing loss, but many others struggle with the residual negative effects of grief and loss well into their adulthood (Malone, 2016). The way grief is experienced can be influenced by many different factors: who or what was lost; how a loss occurred; how it was experienced; and personal characteristics such as the griever's age, culture, gender, and temperament. Additionally, whether or not the loss is acknowledged by others influences the way grief is experienced and determines if it becomes disenfranchised.

This article will explore current childhood grief theory, which focuses on loss through death, and expand the lens to include ambiguous loss within a school social work context. There is almost no research that looks at the effects of ambiguous loss in a school setting, and there is very limited research that looks at the effects of ambiguous loss on children and adolescents. The importance of school social workers identifying students experiencing ambiguous loss as a specific problem that may warrant intervention will be discussed, and a peer support group model will be outlined as a promising best practice intervention for students experiencing ambiguous loss. Wediko Children's Services' Living with Loss peer support group will be used as a case study to showcase a ten-week group cycle that supports young people of all ages from urban schools in Boston and New York City.

Wediko Children's Services is a nonprofit organization committed to improving children's mental health since 1934, with residential programs in New Hampshire and school- and community-based programs in Massachusetts and New York. Wediko currently works in forty-eight schools in the Boston and New York City metro areas, using a trauma-informed approach to provide social and emotional learning programming and direct clinical supports to help students reach their academic and social emotional goals. Sixteen of these schools are currently participating in Wediko's Living with Loss grief support program.

Literature Review

Children experience a wide range of emotional and behavioral responses to grief following parental death. Responses may include anxiety, depressive symptoms, fear, anger outbursts, regression regarding developmental milestones (Dowdney, 2000), lower self-esteem (Haine, Ayers, Sandler, & Wolchik, 2008), and somatization (Goldberg, 1998; Servaty & Hayslip, 2001). Many children may also experience guilt, thinking they may have caused the death (Christ et al., 1993). Goldberg (1998) studied the impact of the death of a loved one on 750 children. The children in his study demonstrated behavioral problems, social withdrawal, and increased daydreaming. He also found that bereaved children display higher levels of fear and worries about death and the well-being of other loved ones.

Studies have also focused on the impact of childhood bereavement in the school setting. Research shows that grieving children are more likely to display a drop in academic performance and increased rates of school dropout, as well as difficulties with memory and concentration (Dyregrov, 2004). Christ and colleagues (1993) found that bereaved children experience a disruption in school functioning and anxiety that they will never return to their previous levels of functioning. Often a student's physical, cognitive, emotional, interpersonal, behavioral, and spiritual changes are greater than anticipated by the family or school (Balk, 2009). Berg, Rostila, Saarela, and Hjern (2014) found that parental death in childhood is even associated with reduced educational attainment as an adult.

Although many school social workers are cognizant of the need to provide more support to students grieving a loss through death (Quinn-Lee, 2012), many may not be aware of the needs of students who are experiencing an ambiguous loss. School social workers surveyed in a 2012 study reported that, although grief support following a loss through death is important, it is essential for school staff and administration to keep an open mind related to grief and loss. Many of the students in their schools were grieving a loss experienced as a result of parental divorce, absent parents, developmental transitions, moving, and shifting peer groups and were not receiving support (Quinn-Lee, 2012).

Expanding the Lens: Ambiguous Loss

A student aged sixteen said, "I never knew that the anger that I'm feeling was caused by my situation at home. My mom can't be a mom because her mental illness takes her away from us." Boss (1999), who coined the term ambiguous loss and is the lead expert on the topic, defined ambiguous loss as an unclear loss, focusing on two specific types. The first involves a loved one who is physically absent yet psychologically present. This can be an absent parent, a loved one who is incarcerated or deported, or a civilian or soldier who is missing in war, for example. The second type of ambiguous loss involves a loved one who is physically present but psychologically absent. This can result from dementia, substance abuse, depression, and other forms of mental illness. It can also result from a move or migration to a new country where a person is physically present but emotionally or cognitively elsewhere. In these instances, the family may look intact but family members may experience a huge loss (Boss, 1999). Boss (2006) further explained that one of the challenges of ambiguous loss is that it is not a single event but rather an ongoing situation that has no closure. The pain can potentially last forever.

Unlike loss through death, an ambiguous loss often has no rituals whereby family and friends come together to mourn. Systemically, if a family does not address ambiguous losses, then family secrets, no-talk rules, relationship cutoffs, and repressed emotional expression can occur. Symptoms of depression, anxiety, ambivalence, guilt, and unresolved grief may result in an inability to move forward in one's life (Boss, 1999). Unresolved grief occurs when a person's grief process is obstructed or delayed. Experiencing unresolved grief can put children and adolescents at greater risk for depression, physical and/or mental illness, and increased drug and/or alcohol use (Lenhardt & McCourt, 2000).

For individuals experiencing ambiguous loss, there is often a feeling of uncertainty or lack of information regarding a loved one. This confusion--is the loved one dead or alive, absent or present?--can be traumatizing for most individuals, couples, and families (Boss, 1999). Family members often create their own truth about the status of the person who is absent in mind or body, and this ambiguity freezes the grief process, ensuring that closure is impossible (Boss, 2006). Betz and Thorngren (2006) suggested that ambiguous loss refers to the "physical or psychological experiences of families that are not as concrete or identifiable as traditional losses such as death" (p. 359). Although many significant losses have little to do with the experience of loss through death (Corr, 2010), our society still equates the term loss with death. Many children experience different types of loss on a daily basis, and many of these losses are not as clearly definable as death nor are they recognized by society as a loss. Loss can involve a person, object, experience, or event. Malone (2016) suggested that non-death losses may include parental separation or divorce; incarceration of a parent; parental military deployment; family relocation; friendship loss; and loss of physical safety, innocence, or childhood. Additionally, students could be grieving due to changes in appearance (e.g., weight gain or loss, acne, or physical changes associated with puberty), the loss of a relationship (in-person or virtual relationship), or comparisons made between themselves and others on social media.

Some studies have shown the impact of a specific type of ambiguous loss on children and adolescents. Morgan (2013) reported that English language learners (ELLs) experience a sense of cultural bereavement and ambiguous loss as they are adapting to a new culture, and that ELL students often struggle both academically and socially in new school environments. Boss (2003) explained that ambiguous loss occurs in confusing situations when the clarity needed for boundary maintenance or closure appears unattainable. In families who immigrated, members may be separated and experience a loss of both cultural...

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