Counseling and Values ■ October 2007 ■ Volume 52 85

Book Reviews

© 2007 by the American Counseling Association. All rights reserved.

A Review of Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss

Reviewed by Holly Thompson

Pauline Boss (200�). Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss. New York: Norton, 251 pp., $27.50 (hardcover). ISBN: 0�9�704491.

Lossisawordthatisusedfrequentlytodescribenumerouslifeevents.Initsmostapparentstate,lossisexperiencedthroughthephysicaldeathofsomeonewhowasoncespiritually,psychologically,andphysically

near.Farmoreoften,however,thereisacertainrandomnessorunpredict-abilityaboutlossbecauseitoccursacrossthelifespanonmultiplelevels.Individually,clientsdescribepersonallossesofdreams,hopes,skills,andabilities,whichfrequentlyemergeasfundamentalconcerns.Systemically,losses may happen between people and institutions when relationshipsshiftandchange.

PaulineBoss,professoremeritusandclinicalsupervisorinMarriageandFamilyTherapyattheUniversityofMinnesota,hasdedicatedatremendousamountoftimeandattentiontothestudyofambiguouslossofrelationships.Inhermostrecentwork,Bossdrawsfromanexpansivebaseofresearchandpracticethatisconveyedthroughpersonalnarratives,clinicaldescriptions,andasalientreviewofrelevantliterature.Organizedintwodistinctyetoverlap-pingsections,thebookprovidesaconceptualframeworkforunderstandingBoss’stheoryandproffersguidelinesfortherapeuticintervention.

Outlininghermajorassumptions,Bossbeginsbyarticulatingtheimportanceofcontextualunderstandingwhenworkingwithfamiliesandindividuals.Fromthismulticulturalperspective,Bossarguesagainsttheviewthattraditional,dualisticclassificationsof“presence”and“absence”areabsolute.AccordingtoBoss,relationshipsaretypicallymoreambiguouswithregardtophysicalandpsychologicalattachmentthanisfrequentlyacknowledged.Furthermore,Westernideology,whichvaluesfinalityandclosure,isdisputed.

Holly Thompson, Human Development Counseling, University of Illinois–Springfield. Correspondence concerning this review should be addressed to Holly Thompson, Human Development Counseling, University of Illinois–Springfield, One University Plaza, MSBRK332, Springfield, IL 62703 (e-mail: hthom2@uis.edu).

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Boss describes two primary types of ambiguous loss: physical absencewithpsychologicalpresenceandphysicalpresencewithpsychologicalab-sence.Intheformer,lossexistsduetotheambiguityofholdingsomeonepsychologicallyclosewhilephysically,thesignificantpersonismissing(e.g.,duetoanaturaldisaster,war,incarceration,adoption,relocation)orabsent.Thesecondclassificationofambiguouslossoccurswhenacentralpersonispresentphysicallybuthasmentallyorpsychologicallydisappeared(e.g.,duetodementia,mentalillness,coma,preoccupationwithwork,addictions,divorce).AccordingtoBoss,suchlossesposeparticularchallengesbecauseoftheheightenedstateofconfusionpresentwhenconflictingthoughtsandfeelingsemerge.Bossdiscussestheimplicationsoflivingwithsomeonewhois“presentbutabsent,”notingthatsuchasituationproducesanxietyandoftenwarrantsintervention.

Key theoretical concepts (i.e., psychological family, trauma and stress,resilienceandhealth)aredescribed throughout thefirsthalfof thebook,emphasizingashiftfromapathology-basedperspectivewhenworkingwithclientswhoareexperiencingambiguousloss.Additionally,Bossadvocatesfortheimplementationofacommunity-basedapproachthatdrawsuponmultipleresources.Sheconcludesthefirstsectionofthebookbyoutliningprinciplesfortreatmentandprevention.

Part2ofthebookisfocusedontheapplicationofBoss’stheory,andshepresentsgoalsfortreatment.Achapterisdevotedtoeachofthefollowingmajorgoals:findingmeaning,temperingmastery,reconstructingidentity,normalizingambivalence,revisingattachment,anddiscoveringhope.Pri-marytheoreticalsuppositionsassociatedwitheachgoalaregiven,andsug-gestionsforachievinggoalsareprovided.Finally,Bossconcludesthebookbyaddressingessential“selfofthetherapist”issuesthatmayhinderworkwithclients if these issuesare leftunattended.Thisemphasis supportsatheoreticalpositionheldbycounseloreducatorsthatclientscanonlygoasdeeplyintoanissueastheircounselorhasgoneoriswillingtogo.Withinthissection,Bosschallengesprofessionals to identifypersonal losses thathavebeenshroudedwithambiguity;sheprovidesthought-provokingques-tionsthataremeanttoencouragetheprocessofself-discovery.

Asacounseloreducator,Iespousevaluesthatemphasizeaconstructiv-ist, preventative, humanistic, holistic, and health- and wellness-orientedparadigm.Manyoftheideaspresentedinthebookstronglyresonatewithacounselingworldview.Anentirechapterisdedicatedtotheimportanceofassistingclientsintheprocessofcreatingmeaning.Bossaddressestypicalquestionsthatariseforpractitionerswhentheyaredealingwithexistentialissues of meaning construction. From a multicultural perspective, Bossalso acknowledges the importance of attending to issues of spiritualitythatfrequentlypresentthemselves.Hersuggestionsarewell-groundedincurrentliteratureandsupportemergingimperativeswithinthecounselingprofessiontointegratespiritualityintothecounselingprocess(Hall,Dixon,&Mauzey,2004).

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Contextually, Boss reinforces the need for counseling professionals tounderstandthesignificanceofculturalvalues,attitudes,beliefs,andmoreswhenworkingwithclients.Fromacommunityperspective,sheemphasizesthe need to attend to individual and group variables of diversity ratherthanprojectingmainstreamidealsontoclients.Additionally,Bossadvocatesstronglyfortheincorporationofsignificantfamilymembers,friends,others,andcommunitiesintraditionalandnontraditionalvenues.

In addition to encouraging the integration of the aforementioned prin-ciples,Bosschampionsadialecticalapproachasanalternativetoabsolut-istthought.Aboth/andperspective,asopposedtoaneither/orposition,allows counselors to challenge traditional dualistic thought, which mayinturnexacerbateclientconcerns.Bosscontendsthatinordertodevelopresilience,practitionersshouldassistclientsintheprocessofenhancingorcreatingatoleranceforambiguity.Myview,fromaprofessionalperspective,isthatmoreemphasismighthavebeengiventothevalueofthisconceptasamechanismforincreasingambiguitytolerance.

Boss’sworkallowedmetogainagreaterunderstandingofhertheoryandperspectiveonambiguousloss.Whetherambiguousornot,lossisdif-ficulttounderstand.Despiteitscomplexityandambiguity,however,Bosswasabletoclearlyarticulatehertheory.Theclientnarratives,humanisticemphases,andcontextualperspectiveswereespeciallyeffective.

AnotherstrengthofLoss, Trauma, and Resilienceisthecompellingemphasisonself-as-instrumentperspective.Bossencouragescounselors toengage inpersonalexplorationbeforeenteringintotherapeuticrelationshipswithclients.SuchanapproachsupportscounselingpedagogyandbestpracticesespousedbytheAmericanCounselingAssociation(2005).

Asaprofessionalcounselor,Ifoundmyselfstrugglingtoreconcilesomelanguagethatwasclearlysteepedinpositivism.Forexample,occasionally,Bosswouldrefertoaclientasa“patient.”Thiswording,suggestingpathology,wasfrequentlyusedwithlittlefocusonpreventativestrategies.Duringmyreadingofthework,Iwasremindedofthepsychology-basedperspectivesofBoss’straining,althoughitwasalsoclearthatshewaschallengingsometheoreticalunderpinningsofthetraditionalmedicalmodel.

Inadditiontopositivisticvernacular,Igrappledwiththeredundancyofthesecondsectionofthebook.AlthoughIbelievethatBoss’sintentionwastopresentacomplex,circularprocessofambiguouslossresolution,theorganiza-tionofthepresentationactuallyprovidesalinear,step-basedmodelinwhichtechniquesandbulletpointspredominate.Forinexperiencedprofessionals,thebookmayappeartooffersimplisticsolutionstocomplexconcerns.

Becauseissuesoflossareinextricablylinkedtohumanexistence,numer-ousimplicationsforcontinuedresearchandexplorationexist.Inherlatestwork,Bossprovidesafoundationforcontextualizingtwospecifictypesofloss. Her attention to pertinent literature and presentation of ambiguousloss theory in the first section has extraordinary heuristic value and hascontributedsignificantlytoexistingknowledge.

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References

AmericanCounselingAssociation.(2005).ACA code of ethics. Alexandria,VA:Author.Hall,C.R.,Dixon,W.A.,&Mauzey,E.D.(2004).Spiritualityandreligion:Implicationsforcoun-

selors.Journal of Counseling & Development, 82, 504–507.