The Usefulness of Grief: Ambiguous Loss & How to be Present with Those Grieving

Ambiguous Loss

The end of a life triggers a whole set of customs and rituals that usher in the grieving process. We know the Kübler-Ross diagram of the five stages of grief. We have bereavement time off and gather family and friends to bury the dead. But what happens when a life ends before death? For many families a trauma, like a diagnoses with Alzheimer’s disease, or an accident causing a traumatic brain injury, can leave their loved one in a state where they are physically present but psychologically absent. They occupy a liminal space within the family, both there and not there. The life they once had, their behavior and personality, their memories and abilities may have passed away, presenting a kind of loss more ambiguous and harder to name than death. Dr. Pauline Boss, PhD, developed the theory of “ambiguous loss” to speak about the many scenarios where families experience a very real loss that isn’t triggered by the definitude of death. As she says, “Absence and presence are not absolutes.” It can be difficult to know how to grieve and when it begins.  

The Permission to Grieve

As humans, no life journey is without heartache. We all experience deaths both large and small. Loss is loss. The aging process itself can present a series of losses for families. On the day you realize your loved one doesn’t remember your anniversary; on the day you know your aging parent won’t be able to go to the family cabin one last time; on the day you know that grandmother won’t be able to travel to the wedding, there is a deep sense of loss. We can forget that trauma and loss can trigger grief as well as death. We can forget to give ourselves permission to grieve all our losses along the way.

Whether it is a trauma or a literal death that has caused the loss of life, we can portray our grief as reaching only into the past to what once was. However, grief reaches into the future as well. We carry within us the hopes and dreams for the future of ourselves and our loved ones. For the parent of an injured child, the future dreams, the spouse, the education, the job, the success they had envisioned for them must enter into the grieving process as well. For the widow, the dream house, the trip you planned to take, the growing old together must have a place at the table of grief.  We lose not just the life that was, but the life that could have been and until we grieve both of these it is difficult to reimagine and build a new life.  

It is important that we give not just these permissions to ourselves, but permission to those around us to grieve and grieve differently than we do. One of the family dynamics that often occurs after a death or a loss is something called “asynchronous grief”, where different members are in different stages and on separate routes in the process causing potential strain in family dynamics. Some may be angry and frustrated while others are detached, and some members may be moving into acceptance while others are still in denial. The key here is to be gracious to one another and honor the varied topography of grief and the many ways to travel.   

Grief & Friends: Being a Healing Presence

Even for those friends who are closest to a grieving family it can be difficult to know how to help and what to say. Accompanying someone in their grief is not so much about right actions and right words, as it is about right presence and the ability to just be with someone. Rarely does anyone in despair feel better because of something that was said to them. It is someone’s ability to emotionally stay put and their courage to not run in fear from others’ suffering that is the most impactful and compassionate. Those who choose to be a healing presence in the life of a family who is grieving have a double task. They must find a way to hold together in tension BOTH a hope and a vision of the person’s healing and future well-being AND the reality of what is going on now in the moment without trying to change it or fix the person. In the words of grief counselor and author, James E. Miller, “Healing presence is the condition of being consciously and compassionately in the present moment with another or with others, believing in and affirming their potential for wholeness, wherever they are in life.”

Everyone experiences loss and we take our grief wherever we go. When we encounter grief in another person it reminds us of our own grief we have experienced in our life. It is so natural to want to respond by talking about our own experiences when our friends or family lose a loved one. We want to let them know that we understand. These instincts, while good natured can give rise to behaviors and support techniques that actually make matters worse instead of better. Here are a few DOs and DON’Ts to remember when being present with a loved one during a loss or death.


  • Try and make someone grieving feel better so you can feel better.
  • Make judgments on their decisions or give advice unless they specifically ask for it.
  • Develop expectations about how someone should grieve or how long it should take; everyone’s grieving process looks different.
  • Offer an explanation or a silver lining to the loss.
  • Offer solutions for moving on or repress their grief.
  • Worry about what you aren’t doing or saying right. The presence of an imperfect friendship is all we can offer.  


  • Notice where your stories intersect with the grieving person and sense your shared experience, but recognize that your story doesn’t need to take center stage right now. (James E. Miller)  
  • Ask about the deceased and share memories and stories about them. You won’t be “reminding them of the loss” because the living loved one hasn’t forgotten the person and is well aware of the loss. 
  • Remember important anniversaries or family traditions and honor and recognize those.
  • Allow bursts of emotions, tears, anger, etc. Be a safe place and an environment of kindness for their grief process to unfold.
  • Get comfortable with ambiguity and lack of control. You will not know how life or even a simple conversation is going to turn out.
  • Bear witness to their loss with your listening presence instead of filling the void with well-intended words.

Good Grief

Grief gets a bad rap. We often forget that it is good and can actually be a transformative rite of passage. Hospice chaplain, Jenny-Rake Marona reminds us of the marvel that, "depending on how we travel through grief, it can help take us from our old life to a different and new life. As human beings, we have the capacity to grow through what causes us suffering.” This perspective however, is really only one that can be seen retrospectively and from higher ground. When someone is in the valley of grief, reminding them of the transformative and growing power of their grief can be that tempting silver lining on their sorrow that we must avoid at all costs.

Final Thoughts

Grief works much like fire in our lives. It is a good tool in the wilderness that nurtures our survival in the dark and helps light the way until morning. But left unattended, it can threaten our safety and well-being when we refuse to give it due attention. Whether we are professionals in the healthcare field, family experiencing a loss, or friends of the bereaved, we must recognize the importance of grief in the healing process as well as the destructive danger of unattended loss in each of our lives. When we don’t prepare ourselves or allow ourselves to feel our feelings, grief can flare up in us in unexpected moments and rob our ability to be present. We cannot take good care of others and be present to their losses until we have engaged in our own self-care and attended to our losses first.    

References & Further Resources:

  • The Art of Being a Healing Presence by James E. Miller and Susan Cutshall
  • Ambiguous Loss: Learning to Live with Unresolved Grief by Dr. Pauline Boss, PhD
  • Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss by Dr. Pauline Boss, PhD
  • Loving Someone Who Has Dementia: How to Find Hope while Coping with Stress and Grief by Dr. Pauline Boss, PhD. 

Published on March 4, 2015.