Ambiguous Loss: A new framework for understanding opposition in the relationship between the adolescent and caregiver

I have argued that the DSM is only one framework to understanding opposition and defiance in adolescents.  I see oppositionality in adolescence as a social and relational construct.  We need alternative frameworks to help us see, understand and treat oppositionality within a relational context, not solely located in a person but between people.

Harry Stack Sullivan believed relationships were primary.  He claimed that the personality could only be known through interpersonal interactions.  People are not these autonomous living beings.  Sullivan argued there were two sources of motivations for humans: the pursuit of satisfactions and the pursuit of security.  Sullivan claimed people have a strong desire to minimize insecurity and anxiety that rises from the pursuit of cultural and social needs.

“In reality, relationships are made of thousands of interchanges.”  Jean Baker Miller, M.D., Wellesley Center for Women

Have you ever heard the saying, “a cigar is just a cigar”? I say not all the time.  I have argued that opposition is a form of advocacy and power expression in adolescence, relationally experienced and expressed, but what if opposing in some relationships is not about power or rules, but reflects a deeper issue or need?

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Over the years as a clinical social worker working with adolescents and their parents,  I have heard parents say to me, “what happen to my little boy, where did my little girl go…who is this person in my house now?  I don’t even know who this person is”! Then they proceed to tell me stories filled with fond memories of their son or daughter when the adolescent was younger and hung to their parent’s hip.  After a few minutes of storytelling, the parent snaps out of his or her thought as if awaken from a trace. In that moment,  I see the same face I have seen a hundred times before, one with a warm smile that suddenly saddens, a face expressing loss and grief for a fleeting moment, then back to a frustrating frown and the parent starts again, “ all that kid does is argue with my rules, thinks I am a maid, demands his or her way, and only cares about him or her!

What is happening for this parent?  What is the parent struggling with in the relationship with their adolescent son or daughter?  Are they experiencing a loss and grief?  How are they handling the adjustments taking place in their relationship with their adolescent?

According to Pauline Boss (2006; 2016) Ambiguous loss is a relational phenomenon.  It is one of the most stressful losses due to ambiguity— no closure, unclear loss.  Boss describes “how ambiguity complicates loss, elongates trauma, and threatens resiliency”.

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Boss (1999; 2006) has identified two types of ambiguous losses:  physically present and psychologically absent, such as Alzheimer’s disease and psychologically present and physically absent, such as a child removed from their family and placed in foster care for an undetermined amount of time.

Some of these parents who say they are living with a stranger, I question if they are holding onto the little boy or girl who is apart of their psychological family—the family they hold in mind.  I wonder when a parent is opposing their adolescent, could they be opposing what is physically present and not in accord with their psychological family.

“The family that exists in people’s minds is more important…personal narratives illustrate the bittersweet legacy of ambiguity about psychological presence and absence for…families, especially when the psychological family is not in accord with the physically present family.  Unless people resolve the ambiguous loss—the incomplete or uncertain loss…the legacy of frozen unresolved grief may affect their offspring…” (Boss, 1999, p.3-4).

What is really going on?  What is the opposition between the adolescent and caregiver really about?

One family I worked with in the past, a mother and her 12 year old adolescent son. I will call the mother Ms. Y and her son Jermaine for confidentiality purposes.   The referral stated Jermaine had ADHD and ODD, he had demanding ways, does not accept no, easily frustrated and annoyed, and bullies his younger sisters.   He demonstrates these behaviors at home and school.  Ms. Y informed me in the initial session that she could not trust Jermaine.  She went on to describe her relationship with Jermaine as “one of being forced to be in a relationship with an enemy”.  I asked, how did their relationship become so fractured and dissatisfying? Ms. Y told the story…”one day Jermaine did not like the consequence he received for not coming home at curfew.  So he went to the school and told the guidance counselor that his mother hits him and a call was placed to the Division of Children Protection and Permanency.”  When the child protection investigator came to the home, Ms. Y described herself as being in “fight mode”.  She was verbally “combative and hostile” towards the investigator.  The mother did not deny the allegations,  she did not hit him, but due to her presentation in the moment with the investigator and refusal to work with the investigator to plan for safety, the investigator made the decision to remove her three children.  The three children were both placed in foster care, the twins in one home and her son in another.  Ms. Y cried midway through telling the story.  She ended stating, “how could I ever trust him again.”

Over the next few sessions, Ms. Y and I processed the hurt, pain and helplessness she felt. Her children where removed for about a year in total.  Her twin daughters were out-of-her care for six months and her son was returned to her care about 45 days before therapy started with me.  DCP&P was now looking to close her case, she was just linked to CMO for case management and services. Ms. Y discussed how nobody in her family has ever had DCP&P involvement or needed therapy.

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We discussed how it felt to feel embarrassed and ashamed. We explored what type of relationship would she like to have with her son.  I utilized a strength-based approach and the miracle question with Ms. Y.  I did the same with Jermaine.  They both struggled with imagining how their relationship could be safe, satisfying and trustworthy.  I took my time with Ms. Y and Jermaine, we explored over a couple of sessions this question. But there was an obstacle I encountered—an unknown obstacle. Ms. Y could not go there with me.  She did open up and discuss how she had been disappointed and let down by men in her life.  She shared stories about her relationship with her father who she had no contact with for the past 5 years, her older brother who was deceased, her younger brother was incarcerated, and the fathers of her children were both missing-in-action.  Ms. Y said “she could not trust men.”  As I explored further, what was this obstacle….it sounded like ambiguous loss.

John Russon writes, “our family members become people from who we are incapable of separating our own identities…our interpersonal identity always carry the traces of our family members as our founding points of human reference”. (2003, p 66-67)

Ms. Y’s relationships with the males in her life were unclear and tangled together.

Ms. Y discussed how she did not believe her own son would betray her, but she was wrong.  She went on and said her son was a stranger to her now and she didn’t think their relationship could recover.

Is Ms. Y correct?  What did Jermaine think?  He was not sure how he felt or thoughts upon asking.  He did share mid-way through therapy that he did not trust his mother.  He could not say how he came to think and feel this way about her.  After some time, Jermaine said, “well, she does not trust me, so why should I trust her”?

I witnessed  opposition on the part of Ms. Y and Jermaine, both of them fighting for the relationship and the other person to be what they wanted without dealing with the loss that took place between them or the loss Ms. Y carried from previous relationships with males in her life.

Could this mother and son’s relationship involve ambiguous loss?

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According to Pauline Boss (2006; 2016), ambiguous loss is a relational phenomenon.  It is one of the most stressful losses due to ambiguity— no closure, unclear loss.  Boss describes “how ambiguity complicates loss, elongates trauma, and threatens resiliency”.

Thinking about opposition as a social and relational construct, opposition as a symptom of something deeper going on between people, such as ambiguous loss.  How would using this framework help clinical social workers think differently about opposition in adolescences, in relationships and their work with adolescents and their parents?  What would the treatment look like? Would it be a non-blaming model? Would the interventions be focused on the relationship?  Focused on loss and trying to figure out how to move the persons in the relationship into spaces where they could acknowledge the losses and create new identities with one another and about their relationship?

What do you think? Please share your thoughts.

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