A Review of Loss, Trauma and Resilience: Therapeutic Work With Ambiguous Loss
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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: 09704491. L oss is a word that is used frequently to describe numerous life events. In its most apparent state, loss is experienced through the physical death of someone who was once spiritually, psychologically, and physically near. Far more often, however, there is a certain randomness or unpredict- ability about loss because it occurs across the life span on multiple levels. Individually, clients describe personal losses of dreams, hopes, skills, and abilities, which frequently emerge as fundamental concerns. Systemically, losses may happen between people and institutions when relationships shift and change. Pauline Boss, professor emeritus and clinical supervisor in Marriage and Family Therapy at the University of Minnesota, has dedicated a tremendous amount of time and attention to the study of ambiguous loss of relationships. In her most recent work, Boss draws from an expansive base of research and practice that is conveyed through personal narratives, clinical descriptions, and a salient review of relevant literature. Organized in two distinct yet overlap- ping sections, the book provides a conceptual framework for understanding Boss’s theory and proffers guidelines for therapeutic intervention. Outlining her major assumptions, Boss begins by articulating the importance of contextual understanding when working with families and individuals. From this multicultural perspective, Boss argues against the view that traditional, dualistic classifications of “presence” and “absence” are absolute. According to Boss, relationships are typically more ambiguous with regard to physical and psychological attachment than is frequently acknowledged. Furthermore, Western ideology, which values finality and closure, is disputed. 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: [email protected]).
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Transcript of A Review of Loss, Trauma and Resilience: Therapeutic Work With Ambiguous Loss
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: [email protected]).
8� Counseling and Values ■ October 2007 ■ Volume 52
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).
Counseling and Values ■ October 2007 ■ Volume 52 87
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.
