Looking at Depression From an IFS Parts Work Therapy Perspective

As I have discussed in prior articles, IFS (Internal Family Systems) Parts Work Therapy is a form of Experiential Therapy (see links at the end of this article for more articles about IFS).

Looking at Depression From an IFS Perspective

From an IFS perspective, depression is viewed as a "part" or a collection of "parts" rather than a permanent identity or a sign of a problem in the brain.

Depression From an IFS Therapy Perspective

In IFS, the mind is naturally subdivided into parts (or subpersonalities). 

As I discussed in my prior article, What is the Connection Between IFS Parts Work Therapy and Neural Networks?, the word "parts" is a metaphor for these naturally occurring subdivisions that everyone has. This makes the language of IFS understandable and accessible to clients.

In IFS, depression is typically viewed as either a proactive part, a reactive part or a wounded part depending upon the function of the part:

• Depression as a Proactive Part ("The Shield"): Depression can act as a protective proactive part where the objective is for the part to act as a preemptive "shutdown" mechanism.  The goal is to keep you safe from taking risks that could lead to failure, rejection or overwhelming disappointment. In IFS language, this part is called a "Manager" due to its proactive role.

Depression From an IFS Therapy Perspective

• Depression as a Reactive Part ("The Circuit Breaker): When emotional pain from the outside world is sudden or overwhelming, this reactive part can step in as a way to numb you emotionally. The goal is to instantly extinguish anxiety, shame or grief. This part is called a "Firefighter" due to its sudden reactive function.

• Depression as a Wounded Part ("The Wound"): This is often a young wounded part of you that is stuck in unresolved trauma. This part isn't trying to protect you. Instead, it carries the burden of the early emotional wounds ("I'm unlovable" or "I'm no good" or "I'm powerless"). This part is called an "Exile". The Exile is frozen in the past at whatever age the trauma occurred. The feelings it carries are raw and unprocessed. When someone is triggered, it is the Exile that experiences the trigger. However, the Exile, as the name implies, usually remains below the surface (unless triggered) and what is usually more apparent is either a the proactive Manager or reactive Firefighter.

How is IFS Therapy Different From Traditional Therapy For Depression?

Traditional therapy usually treats depression as a single entity. This can leave clients feeling consumed by it. 

Depression From an IFS Therapy Perspective

IFS therapy teaches clients how to "unblend" from the part of them that is depressed so instead of a client saying "I'm depressed", an IFS client would say, "A part of me is depressed."

This shift allows an IFS client to access their Core Self with the guidance from the IFS therapist so they can approach their depression from a curious and compassionate stance rather than be consumed by it.  

How Does the IFS Therapist Verify the Role of the Depressed Part?

An IFS therapist tracks the depressed part by facilitating communication between the client's Core Self and the depressed part. This is a skill the therapist helps the client to develop.

The depressed part might respond that they are protecting the client from failing, which would indicate a proactive protector part (a Manager).  Alternatively, they might say they are tryng to numb the client, which would indicate a reactive part (a Firefighter).  The other possibility is that the part is a young wounded part that is feeling alone and stuck in unresolved early trauma (an Exile).

How is Depression Healed in IFS?

An IFS therapist will lead the client through a process of helping them to lift the depression which would include recognizing depression as a part, helping the client to access their Core Self and from the Core Self's perspective the client observes the depressed part, befriends the part, and encourages the part to release their psychological burden.

Depression From an IFS Therapy Perspective

This allows the parts to take on a new and healthier role .

Although this might sound simple, it's often not so simple for a variety of possible reasons. Most of the time the proactive and reactive pars will step aside when asked, so that the client and therapist can work with the wounded part that holds the trauma. 

But there are times when these parts haven't developed trust yet with the client and the therapist, so it can take longer for them to agree to step aside.  

In the long run, IFS, which is a gentle, evidence-based trauma therapy, tends to be more effective at helping clients with depression. This is due to IFS's non-pathologizing stance and its step-by-step process of working with depression and unresolved trauma.

Get Help in IFS Therapy

If you have been struggling on your own or you haven't had success in traditional talk therapy, you could benefit from working with a licensed mental health professional who is an IFS therapist.

Get Help in IFS Therapy

When you free yourself from the burden of depression and trauma, you can lead a more fulfilling life.

About Me

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

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

To find out more about it, 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

IFS is a Gentle, Evidence-Based Therapy 

IFS Therapy Can Help With Anxiety 

How Are Emotions Processed in IFS Therapy? 

Healing Trauma With IFS Therapy

How Does Experiential Therapy Achieve Psychological Breakthroughs?

In my prior article, How is Experiential Therapy Different Than Traditional Talk Therapy?, I began a discussion about why Experiential Therapy is more effective than traditional talk therapy.

Experiential Therapy Achieves Breakthroughs

In the current article, I'm focusing on how Experiential Therapy achieves psychological breakthroughs.

First, it's important to understand what types of therapies come under the umbrella of Experiential Therapy.

Experiential Therapies includes many mind-body oriented therapies such as:

• EMDR - Eye Movement Desensitization and Reprocessing

• Somatic Experiencing - also known as SE

• AEDP - Accelerated Experiential Dynamic Psychotherapy

• IFS - Internal Family Systems Parts Work Therapy

• EFT - Emotionally Focused Therapy For Couples

How Does Experiential Therapy Achieve Psychological Breakthroughs?

Experiential Therapy achieves psychological breakthroughs by:

• Bypassing the Analytic Mind: Many clients are very good at "talking about" their problems without being in touch with how they feel. This is especially true for clients who have had prior therapy. Experiential therapy uses the mind-body connection so that therapy isn't just an intellectualized experience. Instead, clients can get to the root of their problems in a more effective way by getting to unconscious issues rather than remaining on an intellectual level.

Experiential Therapy Achieves Breakthroughs

• Engaging Somatic Memories: Trauma and chronic stress are stored in the nervous system rather than just in the logical mind. Rather than focusing only on what the client thinks, an Experiential therapist emphasizes body awareness. Instead of only asking, "What do you think?", the Experiential therapist will ask, "What do you feel and where do you feel it in your body?" This helps the client to have a felt sense of their problems. This felt sense can release trapped physical tension and stress. 

• Memory Consolidation: A breakthrough requires updating old neural scripts. In Experiential therapy the brain updates the old memory with new adaptive information with the help of the therapist.

• Emotional Catharsis: Psychological shifts often require an emotional release. Examples of this include: Expressing long suppressed anger, grief and shame. 

Psychological Breakthroughs With Experiential Therapy

Rather than just gaining only an intellectual insight into their problems, clients experience a felt shift.  They can rewrite their emotional scripts through action (see my article: Healing From the Inside Out: Why Insight Isn't Enough to Heal).

Experiential Therapy Achieves Breakthroughs

For example, instead of just understanding their childhood trauma, they experience a felt sense of what has held them back and what has shifted for them in Experiential Therapy in an embodied way. This somatic and emotional alignment changes their internal representation of their world which leads to psychological and behavioral change.

Get Help in Experiential Therapy

If you have been struggling with unresolved problems and traditional therapy has been unhelpful, consider working with a licensed mental health professional who is an Experiential therapist.

The psychological breakthroughs can lead to a more fulfilling 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 Article:

Why is Experiential Therapy More Effective Than Traditional Talk Therapy? 

Cinema Therapy: How Can Watching Movies Improve Your Mental Health?

Watching movies with complex characters can be beneficial to your mental health. The practice known as cinema therapy (also known as movie therapy) is a growing therapeutic technique which uses the narrative arc and depth of films to foster psychological growth.

Cinematherapy Can Improve Your Mental Health

When you engage in multi-layered, three-dimensional characters, rather than flat, predictable archetypes, it stimulates specific cognitive and emotional processes that can directly support well being.

Watching complex characters can benefit your mental health through several key mechanisms:

Safe Emotional Distance and Projection

Discussing or processing your own personal pain can sometimes make you feel vulnerable  under certain circumstances. In cinema therapy complex characters in a movie provide an emotional buffer that includes:

• Safe Exploration: You can project your own fears, unvoiced struggles or internal conflicts onto a character.

Cinematherapy Can Improve Your Mental Health

• Objective Detachment: This allows you to process intense themes, including grief, trauma or confusion, with enough distance to evaluate them objectively without flooding your nervous system.

Catharsis and Emotional Regulation
Bottled up feelings can lead to anxiety and pent up stress.  Complex stories act as an emotional pressure valve:

• Controlled Release: Watching a character face existential dilemmas or deep emotional pain provides a structured container that invites you to laugh, cry or feel anger in a safe way.

• Neurochemical Reset: This cathartic release can trigger a drop in cortisol and an increase in dopamine which can lower physical and emotional tension.

Cognitive Flexibility and Shattering Binary Thinking

Flat characters teach us to view the world in black-and-white terms (good vs evil). Complex, morally ambiguous characters force your brain to stretch:

• Brain Activation: Neuroimaging studies show that watching complex characters activates the parts of the brain that handle perspective-taking and the management of cognitive conflict.

• Nuanced Realism: Seeing a character who is deeply flawed yet capable of profound kindness helps you to reject harsh, binary judgments about yourself and others, which builds tolerance for life's natural ambiguities.

Building Inner Resources and Resilience
When characters navigate complicated psychological terrain, they model coping mechanisms and self discovery:

• Inner Resources: Watching a character struggle to find their authentic self amidst social pressure or personal crisis can awaken forgotten internal resources and coping skills as well as help to build resilience.

Cinematherapy Can Improve Your Mental Health

• Active Reflection: It inspires post-viewing reflection, which is the mental integration that happens after watching the movie. It can help you to apply the character's breakthroughs and gained wisdom to your own life.

Universal Experiences and Reduced Isolation

A core part of many mental health problems is that you feel alone with your experience and that no one else has ever experienced what is happening to you, so watching movies with complex characters helps you to realize you're not alone:

• Validating the "Hidden Self": Complex cinematic portrayals capture the messy realities of the human condition. An example of this is putting on a happy public persona while struggling on the inside (see my article: Looking Happy on the Outside But Feeling Broken on the Inside).

Cinematherapy Can Improve Your Mental Health

• The Power of Shared Humanity: Seeing those hidden, complicated parts of yourself reflected on the screen helps you to realize that many problems are universal. This can help you to realize that your struggles are a normal part of being a human being.

How Does a Psychotherapist Use Cinema Therapy in Therapy Sessions?

A psychotherapist uses cinema therapy (or movie therapy) as an emotional bridge to help clients to discuss personal issues. 

The therapist uses a structured framework where clients watch the movie, discuss the movie and process their own real-life experiences which are similar to what the characters dealt with in the film.

How Therapists Use Cinematherapy With Clients

Talking about fictional characters can feel less threatening than if clients talk directly about their problems. 

The therapist will often ask questions like, "Why do you think the main character made that choice?" or "What would you have done in this character's place if you had the same dilemma?"

The therapist can also explore with clients what it was like to watch the movie and to realize they aren't the only ones who have these types of problems. 

They also ask questions like "Would you have handled this problem in the same way or in a different way?"

After clients have processed their thoughts and feelings about the movie with the therapist, the therapist can also ask what it was like to discuss the movie with her. This is called metaprocessing.

This can help clients to open up to discuss their own problems and reflect on their therapeutic relationship with the therapist.

What Kind of Movies Can Help to Improve Your Mental Health

There are so many movies that can be beneficial.

Here is one example that can be beneficial for individuals and couples to watch:

The Before Trilogy: The Before Trilogy is a highly acclaimed series of three romantic dramas by Richard Linklater and starring Ethan Hawke and Julie Delpy. The three films in the trilogy are:

• Before Sunrise (1995)
• Before Sunset (2004)
• Before Midnight (2013)

The trilogy follows the evolving relationship between an American man named Jesse and a French woman named Celine. This series, which was filmed in real time over several years, is famous for its naturalistic conversation-driven format.

What Can You Learn From Watching the Before Trilogy? (No spoilers)

The Before Trilogy teaches that long term relationships require active continuous choices rather than relying only on romantic fate:

• Love changes over time
• Communication predicts survival of the relationship
• Love requires constant effort
• Time can alter your perspective

When I assign this trilogy to watch over a period of a few weeks, I use the films to help the client reflect on their personal struggles and how the characters in the movie dealt with similar struggles.

If I assign it to a couple, I ask them to watch the movies and discuss it afterward in terms of the characters and the dilemmas the characters faced in an effort to stimulate deeper communication between them and a deeper understanding of their relationship.

Conclusion

Cinema therapy is an expressive therapeutic modality where a mental health professional assigns a certain movies to help clients process emotions, gain new perspectives and heal. Therapists can also use TV programs or other types of videos.

Cinema therapy works by using carefully selected movies as a "third person" tool to mirror real-life struggles, encourage empathy and prompt breakthroughs.

It can be beneficial for individual adult clients or couples.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), IFS and Ego States Parts Work, 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 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 

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