Nancy Rappaport M.D.

We Are Only Human

The Burden of Knowing

How to disclose ambiguous loss to children

Posted May 23, 2013

Recently I received a phone call from a woman, who I'll call Lisa, whose ex-husband had disappeared. Mysteriously vanished. How should she tell her children? Lisa wondered. The task seemed almost more difficult because there was no closure — what could she tell her children when no one knows exactly what happened except that he's missing? This 'ambiguous loss' is a useful term described in an article by Madeleine Abrams for the American Journal of Psychotherapy. Ambiguous loss encompasses everything from a parent moving back to his or her country, going to war, or being psychologically absent, which Abrams defines as "substance abuse, infidelity, or preoccupation with work."

She also writes that "in order to cope with ambiguous loss, individuals and families must first confront the change in their situation; they must he able to hold something meaningful of the past while letting go of that which is not in the present."

I encouraged Lisa to tell her kids and thought about how to give this difficult information and to be open about not having all the answers. "You could say something like, 'We don't know where daddy is, but when I know more I'll tell you,'" I suggested to Lisa. A parent risks losing the trust of their children if they say nothing, but sharing in the not-knowing is better than saying nothing at all in an effort to protect them from the anxiety.

After an ambiguous loss, as after a parent's death, it is helpful for the remaining parent to tell the truth, in a timely way, in a manner tailored to the child's developmental capacity, and in limited detail. While it's understandable that adults naturally wish to protect children from pain or bad news, lying threatens trust and may create a legacy of secrecy, shame and stigma that can persist for generations. Parents can protect children best by offering comfort, reassurance, and honest answers to their children's questions.

I helped Lisa to come up with five or six suggestions to help her young children cope with the disappearance of their father. First was protective language, giving her kids ready-made answers to use when confronted with curious peers. Something like "it's hard for me to talk about that right now" makes a good line of defense and doesn't disclose any facts. If a peer persists, the child may want to be more forceful and assert that "I don't want to talk about this right now." This may appear as if they are withholding information, but it is also a way to protect privacy when other kids may not understand how painful it is.

Teachers play a crucial part in this tough time. A child and teacher can agree on a nonverbal signal for the child to use if he feels uncomfortable or emotional and needs to leave the room. The child should also have an assigned go-to person, another teacher or counselor, who they can sit quietly with and do a comforting activity, or talk to if they prefer.

Rituals help to heal and reassure by the continuity of routines. Creating a memory book of the lost person to which family and friends can contribute, participating in activities that recall good memories (such as a trip to the missing parent's favorite park), lighting a candle at dinner, or saying a prayer all can help to keep the presence of someone even though they are not physically with the family. Children may need encouragement to play and be happy and know that this does not mean they are being disloyal to their parent.

The remaining parent will want to pay special attention to self-care at time when there can be an overwhelming amount of details to attend to. Allowing thoughtful adults to arrange for someone to clean your house or prepare meals is not self-indulgent but rather prevents the parent from becoming even more depleted, allowing for greater stability for the children.

Psychiatrist Albert Cain wrote that "The telling must be a process, not an event." As new information arrives, and as the child ages, questions will emerge, and the story may expand, or, in the case of an unsolved mystery, may remain the same. It's an ongoing dialogue, and every child will grieve differently. The remaining parent should invite their questions, which may arise at unpredictable times. Having a network of caring people, and a plan, is essential for the surviving parent and children.