What Are the Signs of Low Emotional Connection in a Relationship?

What is Emotional Intimacy?

Emotional intimacy is a deep, secure bond between two people built on vulnerability, trust and mutual understanding.

Low Emotional Connection in a Relationship

Emotional intimacy allows partners to share their true feelings, thoughts and vulnerabilities without fear of judgment. This allows both people to feel "seen", validated and safe with one another.  

What Are the Key Aspects of a Healthy Emotional Connection?

The key aspects include:

• Deep Connection and Vulnerability: It involves opening up about desires, fears, hopes for the future and more. This allows each partner to get to know the other on a profound level.

• Feeling "Seen": Emotional vulnerability is characterized by feeling truly seen, understood and accepted. This involves getting to know the partner's inner world.

• Shared Vulnerability: This involves holding space for each other through life's challenges--rather than just talking about superficialities or the past.

• Key Pillars: Emotional intimacy thrives on trust, mutual responsiveness, empathy and active listening.

What Are the Signs of Low Emotional Connection in a Relationship?

Communication and Interaction Patterns

• Conversations Based Mostly on Logistics: Superficial conversations that are based on tasks, schedules or facts rather than sharing feelings, deep thoughts and dreams for the future.

• Avoidance of Emotional Topics: When a conversation becomes serious or personal, a partner might change the subject, make jokes or shut down.

Low Emotional Vulnerability in a Relationship

• Difficulty Expressing Vulnerability: An inability and/or unwillingness to say "I feel hurt", "I'm scared" or "I'm sad". Rather than these vulnerable emotions, partners might default to anger or superficial happiness.

• Defensive Responses: When asked to open up emotionally, a partner might become defensive or they might offer logical or intellectual responses to their partner's emotional vulnerability rather than joining their partner in their emotional vulnerability and offering emotional validation.

Emotional and Intimacy Gaps

• Loneliness Together: Feeling lonely or disconnected despite being in a committed relationship and being in the same room together (see my article: Are You Lonely in Your Relationship?)

Low Emotional Vulnerability in a Relationship

• "Mechanical" Physical Intimacy: If the partners are still sexual together, physical intimacy loses its emotional charge and can feel robotic or mechanical.

• Emotional Numbing: A feeling of being disconnected or numb during emotional moments as a defense mechanism to avoid being emotionally vulnerable.

• Unresolved Resentment and Grievances: A tendency to "sweep under the rug" rather than having uncomfortable, high-stakes conversations to resolve conflict, resentment or grievances.

Behavioral Defenses

• Hyper-independence: Also known as "pseudo-independence". A defensive attitude of "I don't need anyone" where everything is handled alone to avoid relying on a partner--even in difficult times (see my article: Masking Emotional Vulnerability By Acting Like You Don't Need Anyone).

• Inconsistent Behavior: Being warm one day and distant the next, creating "emotional whiplash" to prevent the relationship from becoming too close.

Low Emotional Vulnerability in a Relationship

• The Silent Treatment: Not speaking or walking away during conflicts instead of working through them

• Maintaining a Persona: Faking happiness or appearing to be in control rather than showing true, messy and "imperfect" emotions

Relational Dynamics

• Neglectful Responses to Bids For Connection: Ignoring or responding with irritation to a partner's attempts to connect, share a thought or ask for attention

• Fear of Commitment: A persistent reluctance to define the relationship or make long term plans

• Lack of Trust in Vulnerability: Believing that expressing true emotions is a sign of "weakness" or that it will lead to rejection

While these behaviors are often meant to be self protective, they can lead to emotional neglect and a "dead inside" feeling in the relationship, which feels like coming up against an unavailable "brick wall".

Getting Help in Couples Therapy

If you and your partner are struggling with emotional intimacy, you could benefit from working with a licensed mental health professional who is a couples therapist.

Getting Help in Couples Therapy

A skilled couples therapist can help you to overcome the obstacles that keep you from having an emotionally intimate relationship.

Most couples who have problems with emotional intimacy also have either a no-sex relationship or an unsatisfying sex life. 

If that's your relationship, you could benefit from working with a couples therapist who is also a sex therapist (not all couples therapists are trained to help clients to deal sexual problems).

Rather than struggling in a relationship where you each feel disconnected from one another, seek help from an experienced couples therapist so you can have a fulfilling relationship.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

 

What is Self Awareness and Why Is It Important For You and Your Relationships?

What is Self Awareness?

Self awareness is the conscious ability to recognize and understand your own emotions, thoughts, behaviors, strengths and weaknesses (see my article: What is Self Reflecting Awareness and Why Is It Important to You?).

Developing Self Awareness

Self awareness involves objectively evaluating your character and recognizing how your actions and personality affect yourself and others.  Self awareness acts as the basis for Emotional Intelligence (EQ).

What Are the Core Components of Self Awareness?

• Internal Self Awareness: Understanding your own inner emotional wants and needs, values, passions, aspirations and emotional reactions

• External Awareness: Recognizing how you are perceived by others and understanding the impact of your actions on them 

• Objective Focus: The ability to monitor yourself as if you were another person by focusing on the reality of your behavior rather than on a self created story

Why Does Self Awareness Matter?

• Enhanced Emotional Control: Recognizing your emotions helps you to manage them effectively

Developing Self Awareness

• Better Relationships: Understanding your impact on others helps improves interpersonal connections

• Personal Growth: Identifying strengths and weaknesses fosters a growth mindset and increased self esteem

What Are the Signs of Low Self Awareness?

Some of the signs of low self awareness include:

• Lack of Reflection: Rarely thinking about your own thoughts, feelings, behavior or motivations 

• Limited Emotional Vocabulary: Describing feelings as only "good" or "bad" or in some other vague way that make it difficult to understand, process or communicate your feelings

• Poor Emotional Regulation: Experiencing intense, sudden emotional outbursts or being unable to identify and manage your own triggers

• Defensiveness and Accountability Deficits: Responding to feedback with anger or excuses rather than reflection and taking responsibility for mistakes

• "Blind Spots" and Poor Perspective: An inability to "read the room" or to recognize how your behavior affects others (see my article: Overcoming Your Emotional Blind Spots)

• Arrogance and Over-Reliance on External Validation: Holding a distorted or overly positive view of yourself while needing to be the center of attention (i.e. a need for a lot of external validation) and always needing to be "right"

• Boundary Crossing: Consistently crossing or pushing other people's boundaries (see my article: How to Set Boundaries Without Guilt)

What Are the Consequences of Low Self Awareness?

While you might struggle to understand why your actions aren't getting you the results you want, low self awareness often leads to:

• Fractured relationships
• Poor decision-making
• High levels of anxiety and frustration 

How to Develop Better Self Awareness

• Get Curious: Get curious about your own thoughts, feelings and behavior and what motivates you (see my article: How to Develop a Curious Mindset)

• Practice Mindfulness: Be fully present and aware of your thoughts and feelings in the moment

• Seek Feedback: Ask trusted friends and family members for their perspective on your behavior

Developing Self Awareness

• Journaling: Reflect on your thoughts, feelings and behavior in a journal

• Asking Yourself "Why": Analyze the underlying reasons behind your behavior and your decisions and ask why you feel and think the way you do

How Can Therapy Help You to Develop Increased Self Awareness?

Psychotherapy, especially Experiential Therapy, provides a safe space for you to boost your self awareness:

• A Safe Reflection Space: The therapist can offer a "mirror", providing objective feedback that helps you to see blind spots and helps you to see how your behavior affects you and others.

• Identifying Unconscious Patterns: Therapy can help you to identify recurring unconscious thoughts, feelings and behavior that influence your life which helps you to move from automatic reactions to conscious choices.

Developing Self Awareness

• Exploring Emotions and Triggers: You can learn to identify, label and understand the root causes of your emotional responses, including stress and anger, using tools like the Wheel of Emotions or other similar methods.

• Mindfulness Techniques: Mindfulness in therapy encourages you to be present and notice your thoughts and behavior in the here-and-now without judgment, which helps you to understand your inner world and manage your responses.

• Uncovering Core Beliefs: By exploring past experiences and current perceptions, you can uncover deep-seated beliefs and values that drive your behavior.

• Visualizing Your Inner World: Experiential Therapy, like Internal Family Systems (IFS), can help you to explore your desires, fears, needs and goals (see my article: How Does Imagery and Imagination Enchance Psychotherapy?).

Getting Help in Therapy

A lack of self awareness often occurs because adults weren't taught about emotional intelligence when they were children. 

Their parents didn't help them to name, validate and manage emotions in their daily life. 

Getting Help in Therapy

This often occurs because these parents weren't taught these skills as children, so they grew up to be adults lacking in self awareness.

A skilled psychotherapist can help you to develop emotional intelligence which will increase your self awareness and your awareness of others. 

By developing better self awareness, you can lead a more meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the year.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me

What is the Difference Between Psychotherapy and Psychiatry?

Psychotherapy and psychiatry sound alike, so it can be confusing to know what the differences are and when to see a psychotherapist versus when to see a psychiatrist.

The Difference Between Psychotherapy and Psychiatry

What is the Difference Between a Psychotherapy and Psychiatry?

While the two terms might sound interchangeable, there are important key differences:

Psychotherapy

Psychotherapists tend to focus on thoughts, including unconscious thoughts, emotions and behavior.

The Difference Between Psychotherapy and Psychiatry

Psychotherapists have at least a two year Masters degree and many of them also have an additional four years postgraduate training from postgraduate institute (like the Institute for Contemporary Psychotherapy, National Institute of Psychotherapies and other institutes).

Aside from traditional talk therapy, psychotherapists who go on for advanced training also provide specialized therapy including (but not limited to):

• Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR)

• Internal Family Systems Parts Work (IFS)

• Accelerated Experiential Dynamic Psychotherapy (AEDP)

• Somatic Experiencing

• Hypnotherapy

• Emotionally Focused Couples Therapy

• Sex Therapy (for individuals and couples)

Depending upon their skills and training, many psychotherapists can help clients to:

• Manage Stress and Anxiety

• Overcome Depression

• Develop Resilience and Better Coping Skills

Couples Therapy

• Improve Relationships

• Process Unresolved Issues, including Unresolved Trauma

• Improve Communication Skills

• Cope with Workplace Issues

• Process Unresolved Grief

• Improve Self Esteem

And many other behavioral and interpersonal issues.

Most psychotherapy sessions occur at least once a week for 45-60 minutes.

Psychiatry

Psychiatry focuses on the medical side of mental health.

Psychiatrists are mental health professions who are medical doctors (MDs or DOs). They provide differential diagnoses, prescribe psychotropic medication such as antidepressants, anti-anxiety medication, antipsychotic medication and other similar medications.

In the past, psychiatrists provided traditional psychotherapy, like Cognitive Behavioral Therapy (CBT), psychoanalysis and psychodynamic psychotherapy. However, these days most psychiatrists provide medication management. 

Some specialized psychiatrists also provide Electroconvulsive therapy (ECT) for severe mental health conditions such as treatment-resistant major depression, ADHD, schizophrenia and  catatonia (a state where someone is awake but unresponsive to other people or the environment).

After the initial evaluation session, psychiatry sessions tend to be shorter in duration (15-20 minutes) to assess how a client is responding to medication management. After a client has been stabilized on medication, sessions might occur every 3-4 months unless the client needs help with medication.

Integrating Psychotherapy and Psychiatry

Clients, who need medication management, benefit from integrating both psychotherapy and psychiatric treatment and many psychotherapists and psychiatrists collaborate to integrate both treatments (see my article: Medication Alone Isn't As Effective As Including Psychotherapy).

For instance, a psychotherapist who is helping a client with anxiety will often be in touch with the client's psychiatrist to provide feedback on what she has observed in therapy sessions and to get information about medications prescribed. This is only done with a written consent from the client.

While some clients choose to only take medication, research has shown that combining psychotherapy and psychiatric treatments is most effective (when psychiatric treatment is needed) rather than just relying on medication because clients learn coping skills and strategies to deal with their mental health issues. 

Psychotherapy can get to the underlying issues that cause the mental health issues and if worked through in therapy, it's possible that medication won't be necessary for certain clients. 

In addition, when clients stop taking medication for certain mental health issues, they often go back to having the same problems they had before they took medication. For instance, if they never learned to manage anxiety symptoms or get to the root cause of their anxiety in therapy, once they stop taking the medication, they are back to where they were before they stopped taking the medication.

At the same time, there are certain mental health conditions that require medication such as schizophrenia, some forms of ADHD or bipolar disorder to mention just a few.

How to Choose Between Psychotherapy and Psychiatric Treatment

Making a decision about mental health treatment can be a big step, especially if you are new to it.

Consider what you need:

Are you looking for help with understanding yourself, improving your relationships, dealing with situational anxiety or working on unresolved trauma or are you dealing with more complex long-standing psychiatric problems?

If you are dealing with a mental health issue that requires medication (e.g., ADHD, bipolar disorder), starting with a psychiatrist is a good first step. Then, once you are stabilized on medication, you can see a psychotherapist to help you to make the behavioral changes that medication alone won't do.

How to Discover What is Right For You

It's easy to get confused about the differences between psychotherapy and psychiatry.

The Difference Between Psychotherapy and Psychiatry

You're not a broken machine that needs to be "fixed". You're a human being which means that, like everyone else, you have messy, complicated and wonderful parts of yourself. We all do.

Rather than focusing on being "perfect", the goal is developing a better understanding of yourself, practicing self compassion, finding the right tools and strategies to deal with life's inevitable ups and downs and living a meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles:

Why is Experiential Therapy Better Than Traditional Talk Therapy to Deal With Trauma? 

With Experiential Therapy, There Are No Blank-Slate Therapists 

The Mind-Body Connection: Experiential Therapy Offers a Window Into the Unconscious Mind 

How Can Your Dreams Help You to Develop a Deeper Understanding of Yourself?

Dreams are an internal bridge to your unconscious mind.

Develop a Deeper Understanding of Yourself Through Dreams

Dreams help you to process your emotions, problems-solve and confront unresolved fears and desires. This is why they are such a rich source of information about your internal world.

How Can Dreams Help You to Develop a Deeper Understanding of Yourself?

Since dreams bypass the logical part of your waking mind, you can gain a deeper understanding of your unconscious mind in the following ways:

• Emotional Processing and Regulation: Dreams can help you to identify emotions and work through unprocessed emotions which helps with emotional regulation.

• Identifying Blindspots: Since dreams bypass your logical conscious mind, they can reveal aspects of yourself that you're not aware of during your waking state including blindspots (see my article: Overcoming Emotional Blindspots).

Develop a Deeper Understanding of Yourself Through Dreams

• Creative Problem Solving: Dreams can provide you with a fresh perspective on challenges you are trying to resolve. They can provide ways to practice responses to these challenges that you might not think of when you're awake.

• Highlighting Unresolved Problems: Recurring dreams are often signals about ongoing stressors or unresolved conflicts. 

How Can You Remember and Use Your Dreams For Self Discovery?

Here are some practical tips that can be helpful:

• Set a Pre-sleep Intention: Before going to sleep, tell yourself that you will remember your dreams.

• Stay Still When You Wake Up: When you wake up, don't move or open your eyes immediately.  Physical movement and sensory input (light) can make it more difficult to remember dreams.

• Dream Delving: Dream delving is also called reverse recall. If you only remember a fragment of your dream, focus on that fragment, image or emotion and work backwards. Ask yourself, "Where was I?" and "What was I doing in the dream?". It's also helpful to be aware of the emotions you're experience upon waking up to see if these emotions are related to your dreams.

• Keeping a Dream Journal: Recording dreams in a dream journal on a consistent basis can help improve dream recall and help you to see growth patterns over time.

• Dream Analysis: Instead of taking dreams literally, look for the emotional tone of the dreams, symbols as well as personal meaning (see my article: Dream Analysis: Are You Fascinated By Your Dreams?).

• Active Dream Participation: Techniques like rewriting nightmares after you wake up allow you to consciously interact with the dream material to face fears directly and allow you to work through unresolved issues (see my article: Transforming Nightmares Through Creative Dreamwork).

How Can Psychodynamic Psychotherapy Help You to Understand Your Dreams?

Psychodynamic psychotherapy can help you to understand your dreams by providing a collaborative framework with your therapist to identify symbolic imagery, emotional patterns and unconscious conflicts and desires.

Psychodynamic psychotherapy can help:

• Identify Themes: Psychodynamic therapists can help you to spot recurring symbols and emotional patterns that might signal unresolved issues.

Develop a Deeper Understanding of Yourself Through Dreams

• Help With Emotional Regulation: Psychodynamic therapists can help to unpack dreams, including nightmares or scary dreams which can help you to manage your emotions.

• Provide a Safe Place For Exploration: Therapy provides a safe space to explore difficult feelings that can surface in dreams. 

• Help With Behavioral Change: When you gain a better understanding of your dreams, this understanding can provide a catalyst to make changes in your life.

There are many different ways of doing dreamwork (see the links below other articles).

About Me

I am a licensed New York psychodynamic psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles:

Dreams and Embodied Imagination 

Jungian Dreamwork 

Using Dreams to Tap Into Your Creative and Intuitive Power

Working With Dreams to Develop Your Creative Imagination 

How Does Imagery and Imagination Enhance Psychotherapy?

How to Develop a Curious Mindset

Being curious has emotional, psychological, social and health benefits.

Developing a Curious Mindset

Being curious also strengthens relationships by promoting active listening and empathy.

Curiosity can also lower anxiety because seeking new information is a "feel good" stimulator that can keep the brain from focusing on worst case scenarios.

What Are the Key Benefits of a Curious Mindset?

The following are some of the benefits of being curious:

• Enhanced Learning and Memory: Curious people tend to learn faster and retain information better because curiosity activates the brain's reward center and hippocampus

Developing a Curious Mindset

• Stronger Relationships: Curious people are usually viewed as being warmer and more approachable. They tend to build deeper connections by genuinely engaging in others' ideas and perspectives.

• Increased Mental Health and Resilience: A curious mindset, which is similar to a growth mindset, helps individuals to adapt to challenges and reduce stress, resulting in greater life satisfaction.  

• Professional Growth and Creativity: Curiosity drives innovation, boosts career performance, and helps to find solutions to problems.

• Improved Cognitive Health: Curiosity keeps the mind active and engaged, which strengthens mental capacity.

How to Become a More Curious Person

Becoming a more curious person is a skill that can be developed by shifting from a "know it all" to a "learn it all" mindset.

Curiosity is like a muscle. It requires regular exercise and a willingness to embrace uncertainty.

    Habits to Develop a Curious Mindset

• Ask "Why" and "How": Move beyond simple facts. Instead of just learning what something is, ask why it originated and how it works so you can gain a deeper understanding.

Developing a Curious Mindset

• Adopt a "Beginners Mindset": Approach topics that you already know with fresh eyes. Get comfortable with saying "I don't know" or "I don't understand" to keep your mind open to new information. Then, get curious (see my article: Beginners Mind).

• Keep a Curiosity Journal: Collect ideas, quotes and random questions that pop into your mind throughout the day.

• Read Outside Your Field: Explore topics, books or articles that are entirely unrelated to your area of expertise.

• Change Your Daily Routine: Take a different route or try a new hobby to expose your mind to new stimuli.

• Travel or Explore Locally: Visit new places including museums and other areas where you live that you have not been to before.

• Connect Unrelated Ideas: Look for bridges between unrelated topics. This type of networked thinking can lead to creative insights and a more engaging way to view the world.

• Slow Down and Notice: Pay more attention to your immediate surroundings. Simple activities like walking without a set path or people-watching can stimulate a sense of wonder.

    Habits to Enhance a Curious Mindset

• Listen Without Judgment: Practice active listening where your goal is to understand the other person rather than just waiting for your turn to speak.

Developing a Curious Mindset

• Ask Open Ended Questions: Instead of asking questions with "yes" or "no" answers, ask questions like, "What is it about ______________ that is so fascinating to you?" 

• Surround Yourself With Curious People: Join book clubs, discussion groups, volunteer groups or online communities where learning is valued. Curiosity can become "contagious" in the right social setting.

How to Overcome Barriers to a Curious Mindset

• Face Your Fear of Being Wrong: Many people suppress their curiosity because they're afraid of being wrong or making mistakes. Reframe being wrong as a valuable step in the learning process (see my article: Overcoming Your Fear of Making Mistakes).

• Replace Judgment With Curiosity: When you feel annoyed or judgmental about someone else's behavior, challenge yourself to come up with alternative explanations for their actions.

• Experiment and Be Playful: Give yourself permission to try new things--even if you're not good at them--to break out of rigid routines and ways of thinking.

How Psychotherapy Can Help to Develop a Curious Mindset

Therapy helps individuals to become more curious by helping them to shift from an automatic state of judgment and "knowing" to one of open investigation. 

Therapists encourage clients to explore their inner world by modeling curiosity, using open ended questions, and fostering a safe environment:

• Modeling Compassionate Curiosity: Therapists demonstrate curiosity by asking open-ended questions ("What are you noticing within yourself right now?) instead of making assumptions.  The therapist's "not knowing" stance encourages clients to mirror this openness towards their own thoughts and feelings.

Developing a Curious Mindset

• Developing Interoceptive Awareness: Therapeutic practices that encourage somatic awareness help clients to pay attention to their bodily sensations--such as tension or a feeling of lightness in the body--which can open the door to curiosity about their emotional, psychological and physical state.

• Challenging Rigid Narratives: Therapy challenges rigid narratives. It also helps clients to explore discrepancies between goals and behavior. Instead of clients asking themselves, "Why did I do that?", they can learn to get curious and say to themselves, "What lead me to do that?"

Developing a Curious Mindset

• Reducing Defensiveness: Curiosity is incompatible with judgment. Shifting from a judgmental state to a curious state activates the logical part of the brain and calms the reactive part of the brain.

• Breaking Stagnation: In relationships, curiosity helps reignite intimacy by encouraging partners to keep asking questions rather than assuming they know everything about each other.

• Enhancing Resilience: Developing curiosity can help to cope with depression and anxiety. by fostering flexibility and life satisfaction (see my article: Developing Emotional Resilience).

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles 

Maintaining a Sense of Wonder As An Adult 

Seeing Small Wonders All Around Us If We Take the Time to Notice

Striving to Be a Lifelong Learner 

Coping With Ambiguous Loss

The term ambiguous loss was coined by Dr. Pauline Boss in the 1970s. She is an internationally-recognized American educator, researcher and family therapist.

She has written a few books on the topic of ambiguous loss:

• Ambiguous Loss: Learning to Live With Unresolved Grief

• Loving Someone Who Has Dementia: How to Find Hope While Coping With Stress and Grief

• The Myth of Closure

What is Ambiguous Loss?

Ambiguous loss is defined as a loss that lacks closure or a clear understanding. 

Dr. Boss classified two types:

• Physically Absent But Psychologically Present: A loved one is gone physically but remains present in the minds and hearts of family and friends (e.g., a missing person, estrangement, giving up a baby for adoption, separation). The experience is: Gone but no certainty if they are alive or dead, which often leads to a search for answers.

Coping With Ambiguous Loss

• Physically Present But Psychologically Absent: In this type of loss a person is physically present but they are emotionally or cognitively absent (e.g., dementia/Alzheimers; traumatic brain injury; chronic depression; an intense preoccupation with work, technology, etc.) The experience: "Here but not here" which leads to grief for what is missing.

Ambiguous loss is considered the most stressful loss because it usually doesn't allow for typical grieving rituals and closure.

Coping With Ambiguous Loss

Coping with ambiguous loss involves accepting that complete closure may not be possible.

Strategies for coping include:

• Finding Meaning: Acknowledging the ambiguity and that the situation is not within your control but finding personal meaning for yourself

• Balancing Emotions: Managing the tension between hoping for a return/recovery and accepting the current reality

Coping With Ambiguous Loss

• Seeking Support: Utilizing therapy or a support group for emotional support and to validate your experience

Clinical Vignette

The following vignette, which is a composite of many different cases, illustrates how someone can cope with the ambiguous loss of a loved one being physically present but psychologically absent:

Gina

When Gina's mother, Ann, was diagnosed with Alzheimer's disease, Gina felt crushed. Her mother had always been an intelligent, active and loving person who held a responsible job as a hospital administrator for many years before she retired.

Coping With Ambiguous Loss

Several years after Ann retired, she complained to Gina that she was getting forgetful and confused. When Gina discussed this with her brother and sister, they decided to take their mother to a neurologist to get evaluated. That's when they were told that their mother was in the middle stage of Alzheimer's.

The neurologist provided them with resources for their mother and support groups for them, including the Alzheimer's Association. 

They talked about the diagnosis as a family and realized they had different views. Gina and her sister felt their mother should be told because they knew she would want to know what was happening to her and be part of the planning. However, their brother, who was the eldest, said their mother would only get upset if she knew so she shouldn't be told.

After going back and forth about this decision for several weeks, the brother relented and said he would go along with what Gina and her sister thought was best.

When they told Ann, they weren't surprised to hear that she already had a feeling that she might have Alzheimer's because her mother and maternal grandmother had it (although people don't always inherit Alzheimer's).

Knowing that she would decline over time, Ann was very sad, but she was also a practical person. She asked her children to arrange for visits with a geriatric social worker and an elder care attorney to advise them.

Gina and her siblings each had different reactions. Gina's brother tended to be stoic and he didn't want to discuss his feelings. Gina and her sister supported each other in their grief. They talked frequently. They also joined an online Alzheimer's support group and felt relieved to hear that other adult children were going through the same emotional ups and downs as they were experiencing.

Gina also sought help in individual therapy because she wanted the privacy to talk about things she didn't feel comfortable talking about in the support group.

She told her therapist that she had always relied on her mother for emotional support and advice whenever she had to make big decisions and the thought of not being able to do that made her feel tremendous grief.

As her mother declined, Gina's therapist recommended that she work on a family photo album with her mother. So, Gina gathered together the loose family photos her mother kept in a box, bought a photo album and went through the pictures with her mother as they placed the pictures in the album.

She and her mother laughed and reminisced about the events in the photos for hours. Her mother told her she hadn't thought about some of the people and events in the photos for a long time.

They also listened to some of her mother's favorite music which she enjoyed when she was younger. This also stimulated certain memories for her mother.

While her mother was still able to garden, Gina's sister and Ann spent time planting in the mother's garden, which they both found relaxing.

Gina's brother took Ann for walks around the neighborhood and pointed out places that Ann knew from years ago. 

Although the medication the neurologist prescribed helped to slow Ann's decline, eventually, Ann could no longer be maintained at home with a home health aide, and Gina and her siblings had to make tough decisions.

At that point, their mother had declined so much that she only remembered her children intermittently. She was also frequently agitated, which was so different from how Gina and her siblings had always known Ann to be prior to the onset of Alzheimer's.

Gina and her sister wanted to explore nursing homes, but their brother refused to even consider the idea. The thought of putting their mother in a facility was beyond what he could bear. So, he decided to take time off from work and, with the help of an aide, took care of Ann full time.

He soon discovered how exhausting this was--even with Gina and her sister relieving him for a few days out of the week and the help of a home health aide.

When Gina's brother needed to return to work, they spoke with the geriatric social worker who helped them to find facilities that were suitable for their mother. They visited several places, which were good but left each of them feeling very sad.  These facilities had memory units to help patients with dementia and Alzheimer's, patients were well taken care of, but the sight of many elderly impaired patients was upsetting.

At that point, Ann was no longer able to make decisions for herself. Gina and her siblings had already consulted with an elder care attorney to establish a durable power of attorney with Gina in charge. Then, they chose a facility close to where they all lived so they could visit Ann frequently.

At each stage of her mother's decline, Gina felt, at times, that her sadness and grief were unbearable. But she continued to discuss her feelings with her therapist and in the Alzheimer's support group because this was unlike any loss she had ever experienced before.

Over time, even though she felt tremendous sadness and grief, she accepted she couldn't control what was happening to her mother. 

There were some days when her mother seemed content to be participating in activities at the facility and other days when Ann glared at Gina and her other children and said, "Why did you put me here?"

Every time Gina felt she had come to accept her mother's condition, she had to contend with the next stage of her mother's decline. 

Gina's friends, who had older parents who were still functioning well, seemed to want to avoid talking to Gina about how she felt. Gina felt frustrated about this, but she understood that they had their own fears for what might eventually happen to their parents.

In addition to therapy and the Alzheimer's support group, Gina also felt some comfort in journaling. 

After her mother died, Gina felt a mixture of sadness, grief and relief that her mother was no longer suffering. 

She told her therapist she felt guilty that she felt relief and her therapist normalized what Gina was experiencing. She told Gina that it's common for adult children to experience a mixture of emotions including relief.

Gina learned to accept that her grief and sadness would come in waves so that she could feel better for a period of time but, seemingly out of nowhere, she felt tremendous sadness.

Over time, Gina learned to live with her grief. There were even days when she felt hopeful and grateful for what she had in her life. 

She also volunteered to be a peer group leader with the Alzheimer's support group so she could help others to deal with their loss and provide them with a sense of hope.

Conclusion

There are two types of ambiguous loss. I focused on the physically present but psychologically absent because this type of loss isn't addressed as often as the physically absent but psychologically present.

The vignette presented a daughter with a mother who had Alzheimer's. This type of loss could also involve someone coping with a sick or cognitively impaired spouse.

Coping With Ambiguous Loss

Both types of ambiguous loss are difficult, but with help there is hope.

Getting Help in Therapy

Loved ones can be well-meaning but often say and do things that are unsupportive.

A licensed mental health professional, who has an expertise with helping clients to cope with ambiguous loss, can help you to navigate the stages of loss.

Rather than struggling on your own, seek help from a qualified mental health professional so you can learn to cope with ambiguous loss.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years with grief, loss, trauma and many other issues.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles

The Challenges of the "Sandwich Generation": Raising Children and Taking Care of Elderly Parents

Coping With the Loss of Loved Ones - Common Reactions 

The Many Layers of Grief 

You Continue to Have an Internal Relationship With Your Parents After They Have Died

Coping With the Loss of a Pet