Ambiguous Loss: Navigating Grief in Uncertainty

In times of uncertainty and change, grief often arrives in ways that are unclear and difficult to name. A loved one may be physically present but emotionally unavailable, affected by illness, the effects of trauma, or mental health challenges. Other times, they may be absent—through separation, disappearance, or estrangement—but continue to shape our daily lives, remaining viscerally present in heart and memory. Such losses, in their ambiguity, are often marked by limited closure and uncertainty, intimately impacting the many ways we process and tend to our grief.

Coined by Dr. Pauline Boss, renowned author and family therapist, ambiguous loss refers to those endings which resist resolution. Unlike death, where rituals and social support often provide acknowledgment of what has happened, ambiguous losses can leave us suspended in the vast space that exists between presence and absence, knowing and not knowing.

Dr. Boss identified two main forms:

• Physical Absence, Psychological Presence – when a person is physically gone, but psychologically present and alive in memory. Such losses can include the pains of incarceration, separation by forced displacement, deportation, or military deployment, as well as traumatic accidents, such as plane crashes and natural disasters, whereby the griever may receive no confirmation that their loved one is either dead or alive.

• Physical Presence, Psychological Absence – when a loved one is physically present, but emotionally unavailable or cognitively impaired. Dementia, Alzheimer’s, traumatic brain injury, severe mental illness, and addiction can, too, create an atmosphere of absence and disconnection, even when both parties are physically present and close in proximity.

Why Ambiguity Can Complicate Grief

Grief often involves adapting to life without a loved one, but ambiguity can make this process more difficult. Without clarity or closure, the mind and heart may circle repeatedly: Are they really gone? Should I keep hoping? How do I live with not knowing?

At times, such added ambiguity may complicate the natural grieving process. As outlined in the latest edition of the Diagnostic Statistical Manual of Mental Disorders, DSM-5-TR, Prolonged Grief Disorder (PGD) is a relatively recent diagnostic category that describes grief which persists intensely and disruptively beyond culturally expected timeframes—lasting for more than a year, and characterized by significant impairment in daily functioning and routine.

While this diagnosis is still debated in some professional circles for its medicalization of mourning, potential stigmatization, and arbitrary timeline, it reflects a growing effort in the field to attend to the myriad needs of grievers and distinguish those presentations which might prove uniquely difficult to cope with and could benefit from professional support. Those who experience ambiguous loss may not meet the diagnostic threshold for PGD, but its uncertainty can often intensify yearning, disbelief, and emotional numbness, leaving mourners particularly vulnerable, isolated, and unsure of how to move forward.

Other factors that can impact the grieving process include:

• Relational Complexity – Dynamics such as enmeshment, estrangement, heightened tension, or unresolved conflict can bring about complex feelings of anger, guilt, shame, and relief alongside deep sorrow.

• Trauma – Trauma, which occurs when a deeply distressing event overwhelms a person’s coping abilities, leaving the nervous system in a heightened state of alert, often intersect with experiences of ambiguous loss. Sleeplessness, anxiety, dissociation, and bodily tension can accompany trauma, further impacting the grieving process.

• Disenfranchisement – Losses minimized or stigmatized within one’s culture or society -- such as loss by suicide, overdose, and incarceration – may leave mourners without social recognition and vital community support.

• Cumulative Loss – When multiple or ongoing losses occur simultaneously—as experienced for many throughout the COVID-19 pandemic, wherein for many the death of a loved one coincided with a loss of stability, unemployment, and social isolation.

Healing Pathways through Grief

Grief rarely follows a straight path. Elisabeth Kübler-Ross’s widely known stages—denial, anger, bargaining, depression, acceptance—provides a useful framework which continues to resonate with grievers across the world, but it is important to acknowledge that experiences of grief tend to ebb and flow more fluidly, rather than occurring in a linear fashion.

J. William Worden’s Four Tasks of Mourning offer a more flexible approach:

1. Accepting the reality of the loss, learning to live with uncertainty.

2. Processing the pain of grief, holding space for complex emotions as they arise.

3. Adjusting to a world without the “deceased,” finding ways to live with, and find meaning, in the face of absence.

4. Finding an enduring connection while embarking upon a new life, carrying the memory of who or what has been lost forward, cultivating an ongoing emotional connection whilst making room for new experiences, connection, and joy.

While there may be no healing from grief, there is an abundance of healing which can occur through grief—an experience which inevitably brings us into deepened relationship with our shared humanity. 

Coping with Ambiguous Loss

Even when closure is not possible, there are ways to live meaningfully alongside loss:

• Rituals and Ceremonies – Lighting a candle, planting a tree, creating a small altar, or marking anniversaries may help symbolize remembrance and support grievers in cultivating an enduring connection amidst absence and disconnection.

• Creative Expression – Engaging in creative activities, such as music and art, journaling, and letter writing – whether sent and received, or kept close to the chest – can give form to emotions that feel too large or complex to express verbally.

• Memoirs and Storytelling – Reading or writing about grief can often reduce isolation and validate emotional experience.

• Community Support – Support groups, collective rituals, or peer networks can help mourners feel seen and supported, less isolated and alone.

• Professional Guidance – Therapy can provide a safe space to explore complex emotions, hold contradictions, and create meaning in the face of uncertainty when external closure is indeterminable.

These practices often focus on meaning-making: acknowledging the loss, feeling and validating our emotions, adjusting to life without the missing, separated, emotionally distant, unavailable, or deceased, and carrying connections forward in ways that allow for life to blossom and continue.

Finding Meaning Amidst Uncertainty

Ambiguous loss shows us that quite often grief cannot be neatly defined, contained, or resolved. Such losses exist in tension, uncertainty, and contradiction. Living with grief often means learning to navigate the unknown while discovering ways to create meaning. Rituals, storytelling, community, and personal reflection can often transform ambiguity into a space for insight, remembrance, and deepened connection. While hardly linear, meaning may emerge in small moments, guiding life forward even in the absence of certainty and closure.

If you, or someone you love, is navigating the complex terrain of ambiguous loss, or generally struggling with change and uncertainty, know that support is available. At Big Life Change Therapy, we provide compassionate and individualized grief counseling support, meeting you wherever you are in your grief and healing journey. Contact us to learn more about our grief counseling and psychotherapy services today.

Recommended Reading

• Ambiguous Loss: Learning to Live with Unresolved Grief – Pauline Boss A foundational book that explains the two types of ambiguous loss and offers guidance for coping with uncertainty.

• The Myth of Closure: Ambiguous Loss in a Time of Pandemic and Change – Pauline Boss An exploration of why “closure” is not always possible, with reflections on how ambiguous loss shapes both personal and collective experiences.

• Soulbroken: A Guidebook for Your Journey Through Ambiguous Grief – Stephanie Sarazin Blends personal stories with practical guidance for navigating grief when there are no clear answers or endings.

• Finding Meaning: The Sixth Stage of Grief – David Kessler Introduces meaning-making as a way to carry grief forward without forcing resolution.

• The Year of Magical Thinking – Joan Didion A memoir capturing the disorientation, uncertainty, and altered reality that can accompany sudden loss.

• Notes on Grief – Chimamanda Ngozi Adichie A moving reflection on the death of a parent during the pandemic, highlighting cultural silence and the ambiguous nature of grief.

  
  

References

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.

• Boss, P. (1999). Ambiguous Loss: Learning to Live with Unresolved Grief. Harvard University Press.

• Kübler-Ross, E. (1969). On Death and Dying. Macmillan.

• Prigerson, H. G., & Maciejewski, P. K. (2017). Prolonged grief disorder: Diagnostic, functional, and clinical correlates. World Psychiatry, 16(2), 142–149.

• Worden, J. W. (2009). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (4th ed.). Springer Publishing.

Erin McQueen, AMFT is a dedicated therapist and grief specialist. You can read more about her here and reach her at Erin@biglifechangetherapy.com.