Monday, August 25, 2025

Ambiguous Loss

 As a mental health therapist I’m familiar with Elisabeth Kubler Ross’s Stages of Grief.  I am also well aware that grieving is not a perfectly linear cycle of steps but that grief can manifest itself in many different ways and can jump all over the place. 

I have also learned, through personal and professional experiences, that some losses- like death- are somewhat easier to understand and process because they’re so final and so public.  When you lose someone to death, there is an immediate outpouring of sympathy.   Having lost both of my parents and both of my in-laws over the past three years- [four of them within three short months of each other]- my husband and I have been on the receiving end of that kind of support. People learn of the loss and express their condolences because they want to be of help.  But what happens when people are unaware of a loss or it’s not a typical “I’m sorry for your loss- here’s some flowers and a casserole” type of loss?

There is a different kind of loss- ambiguous loss (also known as disenfranchised grief) which is a little more complicated because it refers to not a physical loss of someone, but grieving someone who is still alive.  A couple of examples which relate specifically to adoption and foster care are: 

1) The tremendous loss and grief children in the foster care system can feel when being split up from their siblings or separated from their parents. 

2) An adopted person or birth parent (especially in closed adoptions) grieving the loss of their relationship and/or role in the life of their birth parent or child.  Even though the person is still alive, they may not be around or even acknowledged. 

3) Foster parents grieving the loss of their foster children after they leave the home and are either reunified with family or placed in a different placement.  In this case I have sometimes chided myself and felt like I don’t have the “right” to grieve because the child was never mine to begin with and I’m the one who signed up for it in the first place.  Nevertheless, thinking of those babies and children who have been a part of our home and who aren’t here anymore hurts deeply.

A few other examples of disenfranchised grief not related to fostering or adoption could be divorce, miscarriage, or grieving over someone with dementia or a traumatic brain injury.  I feel like I lost my mom more than once due to her Alzheimer’s the last couple of years of her life.  As hard as it was to lose her to death, I became so frustrated and angry and sad that I lost her even before her passing when she was living, on the occasions that I felt she was not the same person I had been raised by.  

One of the reasons I’m talking about ambiguous loss is because over the past couple of years I have felt some very real losses over how I expected my children to be contrasted with the reality of some of the challenges that they’ve had to face and will continue to face.  These challenges- like Jill’s autism- aren’t always known to others so it’s a type of loss of hidden sorrow that my husband and I keep to ourselves without others necessarily knowing.

I can tell you for certain one thing that makes these losses even more apparent- and that is when I compare my children to other people’s children who appear to have no struggles at all.  I think it was either Eleanor or Theodore Roosevelt who said” Comparison is the thief of joy.” And I 100% agree. 

For Jill’s 4th grade year I was sure to give her teacher a head’s up of any concerns I had and she did pretty well academically, but struggled a bit emotionally and socially. Her attendance was good until about April when she started getting burnt out again- which seems to be a pattern over the past couple of years.   I also vividly remember an email I got from her teacher one day which was sent to me telling me how well Jill was able to pay attention and finish her work one particular day.  I literally breathed a sigh of relief when I received that email because it stood in sharp contrast to a couple other emails I’d received (and at least one phone call home from her teacher on one occasion and the vice principal on another occasion) when Jill had gotten in trouble.

Last school year (5th grade) we decided to enroll Jill in a private charter school which had smaller class sizes and a teacher’s aide in every classroom.  We believed she would get some more individualized attention for her needs and she did really well (with the exception of a couple of incidents at the end of the year requiring emails home from the principal and vie principal!)  I was really proud of Jill for making the transition to a new school, new classroom, new teacher, new rules and new dress code0 but especially since she didn’t know anyone.  However, for this school year Jill decided she wanted to spend her last year of grade school at the local elementary where most of her friends are.  I can’t blame her. 

We were planning on Jill going back to her regular elementary school this fall, but we had some rough patches with her behavior during the summer (including, sadly, some incidents of self-harm) so in the past couple of weeks we had a change of plans.  We withdrew her from her local elementary school temporarily- where most of the other kids in our neighborhood would be going, and after researching some different options, we were able to get her into an Intensive Outpatient Day Treatment Program during the day which specializes in kids with autism.  We are extremely fortunate that our insurance will pick up the cost, the commute is less than twenty minutes and that they had an opening for Jill to  be admitted the exact same day that classes began in our school district. 

Jill has successfully completed her first week of her IOP program and is doing very well. We get a write up of her progress each day and all of he medication management is taken care of by the nurses and staff at the center while she is there rather than her psychiatrist.  This has advantages as she went through some medication changes during the summer (when her focus didn’t have to be as high due to school not being in session) from a stimulant ADHD medication to a non-stimulant medication because of some side effects.  Go figure, she ended up recently going back on her original stimulant medication because the benefits outweighed the side effects.

 Jill will be in her intensive outpatient program for 8-12 weeks depending on the progress she makes.  She only spends about a couple of hours a day on actual school work an the rest of the time doing various groups (The OT room is awesome!) for therapy.  She sees an individual therapist at least once a week and will have family therapy once a week- which is important.  I know as a therapist with my children and adolescent clients that you can’t just drop them off to a therapist with the attitude of “fix my kid” without having the support and education of involved parents and understanding how parenting styles and family dynamics affect child. 

Jill was a little worried about what she might tell other kids when she returns to her regular school about where she was during the first couple months of the schoolyear, but her therapist explained to her that she could just tell them “I was at a different school” which is not a lie as the school portion of the program is an actual accredited school who will provide her teachers and next school a transcript of the work she completed.  I do worry that she might not have all the cushy advantages of her current program at her regular school (plenty of breaks and snacks and not a batted eye when she plays with fidgets to regulate or chews on her chewelry), but I’ve also been told that a staff member or two of the IOP can meet with her regular school when she’s completed the program to give an update and suggest which accommodations or teaching methods work well for her, so her 504 can be fine-tuned.

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