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Absence and healing

Extending the reach of training for ambiguous loss

Pauline Boss was a graduate student in Wisconsin when she coined the term ambiguous loss in the mid-1970s. A little more than 40 years later, she is a professor emeritus of family social science at the University of Minnesota, and ambiguous loss is recognized by professionals and clinicians around the world. Her work has provided relief to people everywhere suffering from physical or psychological losses due to disappearance, separation, dementia, and many other common situations. Boss is a renowned and beloved therapist and scholar.

Photo of Pauline Boss
Pauline Boss

With success, invitations arrive to work with people far and wide. But Boss is now in her 80s and in a caregiver role, unable to keep up with the considerable demands or to travel far. 

Over the past year, Boss has worked with Educational Technology Innovations (ETI) to fill the gap and bring training in ambiguous loss to a wider audience. An online noncredit certificate program went live in November and will officially launch April 23.

“It was an honor to do it,” says Boss. “I want the theory of ambiguous loss to be used. I’m happy it will stay alive and continue teaching people.” 

Origins and evolution of a theory

Boss traces her recognition of ambiguous loss to her childhood, observing and sensing the deep sorrow of her father and maternal grandmother, separated from loved ones in their native Switzerland. Though physically so far away, they were still very present psychologically.

In college Boss became interested in psychological absence and physical presence, in particular of corporate executive fathers in intact families—as one child described it, “My dad’s head is still in his briefcase when he comes home.” That was the topic of her first academic paper, delivered at a conference in Afterwards, she was approached by representatives from the Center for Prisoner of War Studies, part of the Naval Health Research Center in San Diego.

“They said, ‘If you would reverse that and write about the physical absence of fathers, we would support your research,’” Boss remembers. “So I went back to my dissertation committee and they said, ‘Go for it!’”

Boss spent a year traveling the West Coast interviewing wives of pilots declared missing in action in the Vietnam war, an experience that moved her deeply and shaped her research and practice.

When Boss joined the University of Minnesota faculty in 1981, her research focused on ambiguous loss caused by dementia and memory loss of Alzheimer’s disease. Through the 1980s and ’90s she continued to refine and clarify the theory. She wrote and published her book Ambiguous Loss in 1999 and it was translated widely.

Two types of ambiguous loss

• Physical absence with psychological presence, as in cases of disappearance or separation

• Psychological absence with physical presence, as in cases of dementia, addictions, or other chronic illnesses

It was not until 2001 that Boss says she realized how useful her theory could be to guide interventions quickly and in different places. After the World Trade Center Towers in New York were destroyed on 9/11, a Minnesota–New York team was formed and developed an intervention in just three weeks to help families of missing union workers. The goal was “to protect and support the natural resilience of each individual and family.” And because the families they worked with came from 60 countries and spoke 24 languages, the theory had to be multicultural.

Since then, Boss has worked with countless international colleagues and groups, including health professionals in Japan after the tsunami and Fukushima nuclear disaster, counselors of families of those on board the unrecovered Malaysia Airlines Flight 370, and the International Committee of the Red Cross, who found her theory and started using it.

She’s learned that terrorists believe kidnapping hurts longer than outright killing because the pain of ambiguity lasts longer—consistent with the basic premise of her theory that ambiguous loss is the most stressful type of loss because it defies resolution. At the same time, practitioners are learning that it’s possible to live well despite “not knowing.” International Committee of the Red Cross commissions are finding ways to help villages and groups live with not knowing in a way that brings them together.

Boss is concerned about the tendency to pathologize grief, especially ongoing grief. She also proposes that there is far too much emphasis on closure, and that closure is a myth.   

Breaking new ground

Boss was already working with an agent in New York on a book about the myth of closure when she got a call about working with ETI to create an online course. She set the book aside to make it happen, attending meetings and recording the lectures: five modules, three CEUs per module, 15 CEUs for a certificate.

“I could see that the tech people were as excited about it as I was, and I loved that,” says Boss. “It was breaking new ground for them, and they have technical expertise to make it look its best for professionals and the public.”

Now, with the course set to take her place delivering the training, she’s back to the book. 

Learn more on the Ambiguous Loss website and explore ETI.


“The Context and Process of Theory Development: The Story of Ambiguous Loss,” by Pauline Boss. Journal of Family Theory and Review 8 (September 2016): 269–286. DOI: 10.111/jftr.12152

“The Trauma and Complicated Grief of Ambiguous Loss,” by Pauline Boss. Pastoral Psychology (2010) 59:137–145. DOI 10.1007/s11089-009-0264-0

Story by Gayla Marty | Photos courtesy of Educational Technologies Innovation | Spring/summer 2019