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

Unresolved Trauma: Coping With Resentment For a Passive Parent Who Didn't Protect You From Abuse

Coping with resentment towards a passive parent for their role in childhood abuse or neglect is usually a difficult process (see my article: Letting Go of Resentment).

Coping With Resentment For a Passive Parent

When you were younger, you might have seen this parent as the "safer parent" or the "nice parent" as compared to the parent who was mistreating you.  However, as an adult, you might come to the realization that the parent you thought was safer or nicer didn't protect you from the parent who mistreated you.

Coping With Resentment For the Parent Who Didn't Protect You

Resentment is often a signal that your boundaries were violated and your need for safety was ignored.

Shifting from a child's view to an adult view often includes:

• Allowing the Pedestal to Fall: Shifting from idealizing the passive parent to a realistic understanding of their complex role is a first step in recognizing and coping with your anger and resentment. While it's understandable that, as a child, you might have seen the passive parent as the "good one" compared to the abusive parent, now that you're an adult, you can develop a more mature understanding of why they prioritized the abusive parent's comfort over your well-being. There can be many complex reasons for their passivity, but being aware of this parent's role in your mistreatment is essential to your healing.

• Understanding Responsibility vs Blame: There is a difference between blaming versus responsibility. The passive parent had a responsibility for your safety and well-being when you were a child. This is often a trap that many traumatized individuals get stuck in because they want to be empathetic towards the passive parent and yet they feel resentment towards them.

• Considering the Passive Parent's Humanity: At some point, as an adult, when you have worked through some of your resentment, as part of your healing, you can consider that your passive parent wasn't infallible. Acknowledging your passive parent's flaws, including their own fear, conditioning and their possible unresolved trauma, can help you to see them as a flawed peer.

What Steps Can You Take As An Adult to Deal With Your Resentment?

• Validate Your Reality: Your feelings of resentment and betrayal are real and valid. In many instances, the passive parent tends to minimize your experience in order to keep the peace with the mistreating parent. This might involve the passive parent telling you as an adult, "This happened a long time ago. Why don't you let it go?" or "You turned out alright so why are you still resentful about this?" Rather than allowing the passive parent to minimize your experience, you don't have to participate in the gaslighting as you reclaim your power (see my article: Self Validation).

• Set Firm Boundaries: Boundaries are for your own well-being. They are not meant to hurt your parents. Start by affirming your right to be treated with respect and prioritize your healing and personal growth (see my article: How to Set Boundaries Without Guilt).

• Learn to Stop Self Abandoning: In situations like these, many adult children learn to abandon their own needs to placate the passive parent, so it's important not to self abandon (see my article: What is Self Abandonment?).

• Expect the Possibility of Resistance: If you have changed your role with the passive parent, you might encounter resistance in terms of being described as someone who has been "brainwashed" or, from their point of view, they might say you are unnecessarily resentful. Try to remain calm and firm in your stance.

• Consider Their Limitations: You cannot force the passive parent to change or leave their situation. Each of you must make your own decisions. You also need to prioritize your well-being.

• Get Help in Trauma Therapy: Untangling these complex situations can be difficult to do on your own. You could benefit from working with a trauma therapist who can help you to heal and grow (see my article: How Trauma Therapy Can Help You to Overcome Unresolved Trauma).

Clinical Vignette

The following clinical vignette illustrates the complexities involved in terms of coping with resentment towards a passive parent and how trauma therapy can help with unresolved trauma:

Ann

As an adult, Ann revealed to her mother that had her father touched her inappropriately multiple times when Ann was 10 years old. In response, her mother remained silent for a long time. Then she said, "You're 25 years old. These things happened a long time ago. Why can't you just let it go?" 

Coping With Resentment For a Passive Parent

Ann was stunned. When she could find her voice, she told her mother that the of sexual abuse by her father was traumatic and, as an adult, it impacted her sexual relationship with her boyfriend as well as her prior relationships with other men.

Ann's mother looked uncomfortable, "You know your father was drinking at the time. He probably didn't even know what he was doing. Now that he's dead, let him rest in peace."

Suddenly it dawned on Ann that her mother might have known about the sexual abuse when Ann was a child and her mother didn't stop it, "Did you know what he was doing to me?"

Her mother left the room quickly and Ann realized that her mother did know and she didn't protect her.  Ann felt enraged and followed her mother into the living room, "You knew, didn't you?"

Her mother looked upset, "You don't understand what it was like. When your father got drunk, he would threaten me. I was terrified that if I confronted him, he would hit me. And I wasn't working so I had no money. What was I supposed to do? Where was I supposed to go?"

"So you didn't do anything!" Ann shouted at her, "You just let him do it!"

"You were so young. I thought you wouldn't remember what happened when you got older" her mother responded.

Ann was speechless and she froze in the moment. But when she reconnected with her body, she left her mother's home and drove back to her apartment (see my article: Understanding the Freeze Response Related to Trauma).

On the way home, Ann was in tears. She recalled, as a child, hearing her parents arguing when he was drunk. At the time, she thought of her mother as an angel and her father as a devil.

Now she realized that, as a child, she had idealized her mother. But, as an adult, she now realized that her mother didn't protect her or try to get help to make the abuse stop--even though she knew about the abuse.

After several months of trauma therapy, Ann became aware that of just how angry she was that  her mother didn't take responsibility to protect her from her father.

She told her therapist that, when she was 15, a few months prior to her father's death, she confronted her father about the abuse. Her father told her he couldn't remember what he did when he got drunk and said, "Let's just put this behind us."

Her therapist used a combination of EMDR Therapy and Parts Work Therapy (IFS) to help Ann work through the unresolved trauma including Ann's feelings of resentment and betrayal towards each of her parents.

She and her boyfriend, Mike, also attended sex therapy to work on their relationship. Initially, when they first met, their sex life was good, but as their relationship became more emotionally intimate and Ann felt more emotionally vulnerable, Ann would freeze whenever Mike touched her.

During her treatment, Ann's trauma therapist and her sex therapist collaborated for the benefit of Ann and Mike's therapy.

Eventually, Ann's mother began her own individual therapy to deal with her role as the passive parent.

After a year in her own therapy, Ann's mother told her that she was ashamed that she didn't try to protect Ann and she apologized. She realized she needed to take responsibility for not doing her part to stop the abuse. She had profound regret and shame and she wanted to work towards reconciling her relationship with Ann (see my article: Understanding the Barriers to Reconciliation in Families).

Her mother also revealed to Ann that she had also been sexually abused as a child by her father and, in hindsight, she realized that her own experience complicated her feelings about her husband abusing Ann. She said she didn't want to make excuses. She just wanted Ann to understand.

Ann had a lot of mixed feelings towards her mother, but she wanted to forgive her. She also had mixed feelings about father because there were times when he was sober when Ann was a child that he was mostly a kind and loving father. 

She continued to work in trauma therapy to reconcile her feelings towards each of her parents. Since her father died, Ann had no way to reconcile with him directly, but she realized that adult children continue to have an internal relationship with their parents even after they are gone.

In the meantime, Ann and Mike continued to work on their relationship in sex therapy so that Ann could separate her traumatic experiences with her father from her sexual experiences with Mike.

Conclusion

The first step in these situations is to look at your childhood history with adult eyes.

Get Help in Trauma Therapy

Each person has to decide whether they are willing to reconcile with their parents or not. 

Some people decide that what happened when they were a child was unforgivable and others try to reconcile with one or both parents. 

Others decide to maintain a superficial relationship as opposed to being completely estranged (see my article: Family Estrangements: Understanding the Barriers to Reconcilation).

There is no right or wrong decision. There is only the decision that is right for you as an individual.

Trauma therapy can help you to free yourself from your traumatic history so you can live 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.

As a trauma 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.

 

Do You Feel Entitled to Set Boundaries With the People in Your Life?

Setting boundaries with the people in your life is an act of self care (see my article: How to Set Boundaries Without Guilt).

Setting Boundaries

But if you're someone who doesn't feel entitled to set boundaries, you might feel that boundary setting is an act of aggression (see my article: What's the Difference Between Assertive and Aggressive Behavior?)

Self Abandonment and People Pleasing Tendencies

Not setting boundaries is often a survival strategy children learn in families where they weren't allowed to say "no". 

If you grew up in such a family, maybe you were even punished for expressing your feelings, especially if they were contrary to your parents' feelings. 

If you weren't allowed to say "no" as a child, you might have believed that you could only earn love if you were compliant with your parents' wishes. As a result, you learned self abandonment (see my article: What is Self Abandonment?).

Maybe you were also raised to believe you should feel guilty if you didn't comply with your parents' wishes. As a result, you might have developed people pleasing tendencies as a way to to avoid displeasing others. So, you might have learned to feel you're responsible for other people's comfort and happiness--even if it meant you neglected your own.

People who have an anxious attachment style are especially prone to fear that setting boundaries is an existential threat in terms of losing a relationship or a friendship.

Many women are socialized to believe they need to be nurturers who are "flexible" to the point where setting a boundary might be contrary to their role.

Confusion About What It Means to Set Boundaries

You might not feel entitled to set boundaries with others because you think setting boundaries means you're trying to control others. However, setting healthy boundaries is a fundamental part of self care.

Another possible problem is that you don't know what you feel so you only have a vague sense of what you're feeling at any given time so you don't know if you need to set a boundary or not.

Getting Help in Therapy

If you don't feel entitled to set boundaries with others, you could benefit from working with a licensed mental health professional who can help you to work through the underlying issues that are creating problems for you.

Getting Help in Therapy

Rather than struggling on your own, seek help from a skilled psychotherapist who helps clients to feel empowered enough to set boundaries (see my article: Taking Back Your Personal Power).

About Me

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

As a trauma therapist, I have over 25 years of experiencing helping individual adults and couples (see my article: What is a Trauma Therapist?).

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:

How to Set Boundaries in an Enmeshed Family

How to Set Boundaries Without Guilt  

How to Set Boundaries in Your Relationship

Coping With Separation Guilt as an Adult in a Traditional Family

Family loyalty is important in most families and it usually works best when there is flexibility for individuals to be loyal family members at the same time that there room for individual autonomy and personal growth (see my article: Being the Different One in Your Family).

Separation Guilt in a Traditional Family

Family loyalty usually includes:

• Being faithful and supportive of family members
• Being committed and trustworthy regarding family members
• Being emotionally present to offer support and encouragement during good times and bad
• Providing mutual support through life's challenges and successes
• Maintaining a shared identity

In addition to the above, a modern interpretation of family loyalty also includes:

• Challenging blind loyalty
• Setting healthy boundaries
• Prioritizing love over obligation (shifting from loyalty based on obligation to loyalty based on love, respect and mutual understanding)
• Encouraging personal growth (supporting each other's individual growth rather than demanding conformity)

Coping With Separation Guilt as an Adult in a Highly Traditional Family

Separation guilt is a psychological burden which occurs when individuals defy family expectations (see my article: Freeing Yourself From Family Expectations).

Separation Guilt in a Traditional Family

Defying family expectations is usually perceived by the family as being disloyal.

Key aspects of separation guilt for adult children can include:

• Breaching family expectations
• Perceived disloyalty to the family
• Emotional manipulation by family members (either consciously or unconsciously)
• Conflict with internalized beliefs 
• Fear and anxiety about being an individual in a family that expects conformity
• Fear of being ostracized from the family

This often leads to internalized conflict for individuals who prioritize their emotional and psychological well-being over family expectations.

In highly traditional families where family loyalty is prioritized over individual needs, family expectations can be spoken or unspoken and these expectations often include:

• Family obligations over individual independence, autonomy and personal growth
• A high degree of interdependence among family members where personal boundaries are blurred
• Conformity to established beliefs, traditions and values without question or deviation

How to Cope With Separation Guilt in a Highly Traditional Family

Coping with separation guilt can be very challenging.

Every situation will be different, but here are some tips that can be helpful:

• Identify and Acknowledge Your Feelings: Rather than suppressing your feelings, allow yourself to identify and acknowledge your feelings without judging them. This can include guilt, sadness, anxiety and shame.

• Explore the Root Cause of Your Guilt: Understand that feeling guilty doesn't mean you're wrong.  Assess the specific situation and the family traditions or beliefs that are causing the conflict within yourself.

• Recognize the Difference Between Guilt and Shame: Guilt is about a specific action and shame is about a more pervasive feeling about who you are as a person (see my article: What is the Difference Between Guilt and Shame?). Writing in a journal to clarify your thoughts and feelings can be helpful.

Separation Guilt in a Traditional Family

• Set Clear Boundaries: If you have decided to pursue a particular course of action that conflicts with your family's traditions and you know it is what is best for your own emotional and psychological well-being, recognize that this isn't a betrayal to your family--even though they might think it is. Clearly and respectfully communicate your needs to your family. Set clear boundaries with family members to protect your well-being (see my article: Setting Healthy Boundaries in an Enmeshed Family).

• Focus on Your Life: Focus on building a life that affirms your values and needs. Set new personal goals and spend time with people who are supportive.

• Find Emotional Support: Connect with supportive loved ones and/or join a support group for people in similar situations.

• Seek Professional Help: If you're having difficulty coping with separation guilt, consider working with a licensed mental health professional who can help you to navigate complex family dynamics.

Clinical Vignettes

The following examples of separation guilt are composites of many different cases:

• The Family Business: When Tom graduated college, he decided to pursue a career outside of the family business. Prior to making this decision, his highly traditional parents expected Tom to join the family business after graduation. When Tom told his parents about his decision, they were stunned. His father inherited the business from his father and grandfather. He was very disappointed because he expected Tom to take over one day and continue the family tradition. If Tom didn't join the family business, the business would have to be sold after the father retired. Although Tom felt anxious and sad about disappointing his parents, he knew he needed to follow his own path rather than conform to family expectations. Even though he felt separation guilt, Tom focused on his personal needs and goals with the support of friends and other family members. After a few rough years, Tom's parents conceded that he needed to follow his own dreams and they were able to reconcile.

• Religious Conversion: Ann was raised in a highly religious family. When she was a child, she adhered to her family's religious beliefs, but when she turned 21 and she was no longer living with her family, she questioned that religion. She also explored the possibility of other religions and discovered she liked Buddhism. When she spoke with her family about it, they were very upset. They couldn't believe she would abandon the family religion after all the sacrifices the family made to come to the United States for religious freedom. They were so upset that they refused to speak with her. Ann had never gone against her family and the estrangement caused her significant separation guilt. After she invited them to a few family therapy sessions, she was shocked that they forgave her. Although her family still wasn't happy that she wasn't practicing their religion, they agreed she was an adult, she could make her own decisions and they welcomed her back into the family.

• Racism: Jake was aware that his family was racist, but he hoped that once they met his girlfriend, Tania, they would grow to know and love her. He wasn't prepared for their anger and upset when they told him they didn't even want to meet her. Over time, they remained adamant and they refused to come to Jack and Tania's wedding. They told him that no one in their family had ever married anyone from a different race and they were appalled. On his wedding day, Jake had a heavy feeling in his heart because his family wasn't there, but he loved Tania and he wouldn't let his family stop him from marrying her. Two years later, his father had a massive heart attack. Although he survived, the heart attack took its toll. When Jake's sister called him, he and Tania went to the hospital to visit the father who was in a weakened state. When he saw Jake, he looked happy and he even extended his hand to Tania. He told Jake and Tania he was a foolish old man and it took a heart attack to make him realize he wanted them back in his life.

• Homophobia: Ben knew from the time he was a young boy that he was gay, but while he lived at home he kept his homosexuality a secret, which was painful for him. When he went away to college, he met the young man who became his life partner, Nick. For the year, Ben kept his relationship a secret from the family. During the holidays, Ben and Nick went home to each of their families, but the secret they were keeping was taking a toll on them. Two years into their relationship, Ben and Nick decided that it was more painful to keep their relationship a secret than it was to come out to each of their families. Nick knew his family would be accepting so when he came out to them and introduced them to Ben, they were warm and welcoming. Ben's family was a different story. They were very traditional and very conservative. He came out to his older brother first because he knew it would be easier. Although his brother was surprised, he told Ben he would always love him. But when Ben told his parents, they were very upset. His father told him to leave the family home and never come back. Although this was hurtful for Ben, he knew he was being true to himself and to Nick. Several years went by before Ben's brother was able to act as a go-between to try to bring about a reconciliation. By then, his parents had missed Ben a lot and their stance had softened somewhat. To help them understand his homosexuality, Ben gave them information about PFLAG, an organization for families of gay adult children and they began attending meetings. With the support of PFLAG, they decided they didn't want to be estranged from their son, so they invited Ben and Nick to a family dinner. Ben's father struggled to understand Ben's homosexuality and to accept his gay relationship, but he realized he loved his son and he didn't want to shun him anymore (see my article: Famly Estrangements Due to Homophobia, Biphobia and Transphobia).

Conclusion

Separation guilt often occurs when a family member defies family traditions and the family considers this to be disloyal.

The individual who experiences separation guilt might know logically that they are making the right personal decision for their own growth and happiness, but they can still feel guilty and ashamed for going against a family tradition.

Getting Help in Therapy

If you're experiencing separation guilt, you could use the support of a licensed mental health professional to help you to get through a difficult time.

Getting Help in Therapy

A skilled psychotherapist can help you to develop the tools and strategies to get through this difficult time.

Rather than struggling on your own, seek help in psychotherapy so you can live a more meaningful and fulfilling life.

About Me

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

I work with individual adults and couples.

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.

 

Setting Boundaries: How to Stop Being Enmeshed With Your Family

I began a discussion about enmeshment in an earlier article, Overcoming Shame in an Enmeshed Family.

Overcoming Enmeshment in Your Family

Topics in the Current Article

In the current article, I'm covering:

• What is Enmeshment?
• What Causes Enmeshment in Families?
• How to Overcome Enmeshment
• Getting Help in Therapy to Overcome Enmeshment

What is Enmeshment?

If you grew up in an enmeshed family you probably had at least some of the following issues:

• There was a lack of physical and emotional boundaries.

• There was a tendency to focus on what's best for other family members and not what's best for you.

• You put other family members' happiness above your own.

Overcoming Enmeshment in Your Family

• You feel guilt and shame, as an adult, if you put your needs above other family members. For instance,  you might not want to call your mother every week, but you feel guilty and ashamed if you don't because you know she wants you to call weekly.

• Your family's self worth is dependent upon your success.

• Your family expects you to share everything about your life--even things you might want to keep private. They get offended if you say something in your life is private.

• Your family might have imposed their ideas on you when you were a young adult instead of encouraging you to follow your own hopes and dreams. If you wanted to follow your own aspirations, they felt offended and you felt guilty and ashamed.

• Parents in enmeshed families tend to treat their children like friends instead of children because there is a lack of boundaries.

• You tend to avoid conflicts, even now as an adult, because you have difficulty setting limits.

• You lack a strong sense of who you are.

• You absorb other people's emotions around you because you lack appropriate boundaries (this is different from being an empath).

What Causes Enmeshment in Families?

Enmeshment usually develops in dysfunctional families and repeats the pattern from one generation to the next (see my article: 

Overcoming Enmeshment in Your Family

It can be difficult to pinpoint when an enmeshed family dynamic started since it might go back generations and family members often have little to no awareness about the enmeshment.

Enmeshment often develops due to unresolved trauma, mental health problems, substance abuse, compulsive gambling or other related issues.

What is the Impact of Enmeshment in Adult Relationships?

The following characteristics are common for adults who grew up in enmeshed families?

• Low self esteem
  

• Anxiety
  

• Fear of abandonment
  

• Being out of touch with your feelings

• Feeling burdened by guilt and shame

Overcoming Enmeshment in Your Family

• An overdeveloped sense of responsibility

• Poor personal boundaries

• Difficulty setting boundaries with others

• Codependency
  

• Difficulty with assertiveness

• Difficulty with emotional regulation 

• Difficulty calming or soothing yourself emotionally

Clinical Vignette

The following clinical vignette, which is a composite of many cases, illustrates the negative impact of enmeshed family dynamics and how psychotherapy can help:

Maria

Maria grew up in crowded family home where she shared a bed with her two older sisters. She had no privacy. 

When Maria was 15 years old, her oldest sister found Maria's diary, she read it to their parents, grandparents and siblings and they laughed at what Maria wrote about feeling sad.

Her parents and grandparents invalidated her feelings and told her she had nothing to feel sad about since she had a roof over her head, food and clothing.  They told her that only someone who had something terrible to hide from the family would even want to write in a diary.  Then, her father tore up her diary and threw it in the garbage. He told her she should be ashamed of herself for what she wrote.

When she turned 16 years old, Maria's maternal uncle, who came to live with her family, began touching her inappropriately when no one was around. He told her that he would hurt her sisters if she told anyone about the sexual abuse (see my article: Overcoming the Trauma of Sexual Abuse).

One day her mother happened to come home early and she found her brother touching Maria's breasts. She threw her brother out of the house and she also blamed Maria for the sexual abuse.  

She told Maria it was her fault that the uncle touched her inappropriately. Then, she made Maria promise not to tell Maria's father because she feared what he might do to the uncle if he found out.

When it was time for Maria to choose a major in college, her parents insisted that she become a teacher--even though Maria wanted to become a medical doctor. Her parents told her that women shouldn't become doctors because they would have to see men's naked bodies and this was shameful for a woman.

Maria was upset that her parents were trying to force her to choose a career she didn't want so she sought help from a professor who referred her to the college counseling center.  

In counseling, Maria learned to set boundaries with her family--even though they didn't like it and they threatened to stop paying her tuition.

Overcoming Enmeshment in Your Family

Her counselor helped Maria to get a scholarship and a room in a dorm so she could live independently from her family.  She took pre-med courses and, eventually, she went to medical school.

While she was in medical school, she sought help from a trauma therapist so she could deal with the impact of her enmeshed family, including the sexual abuse.

Even though her family didn't like that Maria was making her own decisions and setting boundaries with them, they accepted it reluctantly.  

While she was in medical school, Maria met her husband-to-be and she learned to have a healthy relationship with him with the tools she learned in therapy.

How to Overcome Enmeshment

To become a mature adult, children need to learn to become their own person at stages that are appropriate for their development at the time.  This is part of the individuation process.

Individuation means being your own person and not just an extension of your parents and other family members.

When you are appropriately individuated from your family, you can maintain your relationships with them with appropriate boundaries. You also learn how to be your own person physically, emotionally and psychologically.

To overcome enmeshment, you need to learn to:

• Set appropriate boundaries with family members (see my article: How to Set Boundaries Without Guilt).

• Discover who you are as an individual apart from your family.

• Learn to stop feeling ashamed and guilty if what's right for you might make your family unhappy.

• Get help in therapy when trying to overcome enmeshment becomes too challenging.

Getting Help in Therapy

Overcoming enmeshment can be challenging.

Getting Help in Therapy

A licensed mental health professional with the right expertise can help you to develop the skills you need to overcome enmeshment and develop healthier relationships.

Rather than struggling on your own, seek help from a skilled psychotherapist so you can lead a more meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Sex Therapy.

As a trauma therapist, I have helped many individual adults and couples to overcome trauma, including enmeshed relationships.

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.