Ambiguous Loss: Grieving Someone Who’s Still Alive
I sat in the recliner next to my dad, gently massaging lotion into his swollen feet. He was still here. Still breathing. Still occasionally making a joke when he had the energy. But in so many ways, I'd already lost him.
My first son, just over a year old, played on the floor nearby. I watched my dad watch him—the grandson he adored, the grandson he'd never see grow up. My heart clenched. Again.
You'd think I would have been prepared for this. My dad was a gerontology expert, a PhD who dedicated his career to understanding aging. My mom had spent my entire childhood working in hospice care, eventually earning her own PhD researching how to improve the dying experience in America. I had a master's degree in social work. My sister was a nurse.
None of it helped.
We all grieved. And we all grieved differently. Because no amount of professional expertise prepares you for the million small deaths that happen before someone you love actually dies.
What Is Ambiguous Loss?
Ambiguous loss is grief without closure—mourning someone who is physically present but psychologically absent, or psychologically present but physically gone.
The term was coined by Dr. Pauline Boss, and it captures something we don't talk about enough: you can grieve someone who's still alive.
This happens in many situations. When a loved one has dementia and no longer recognizes you. When addiction changes someone so completely that the person you knew seems gone. When mental illness, traumatic brain injury, or chronic illness steals parts of someone while leaving their body intact. When someone is missing and you don't know if they're dead or alive.
In my case, it was watching my dad lose his independence, his mobility, his energy, his future—piece by piece, loss by loss, while he was still here.
And here's what makes ambiguous loss so hard: there's no funeral, no ritual, no clear moment when everyone acknowledges the loss. People might even tell you to "be grateful they're still here." As if you can't hold both grief and gratitude at the same time.
Why Does Ambiguous Loss Hurt So Much?
Ambiguous loss is uniquely painful because it offers no resolution. Grief usually moves through stages toward some kind of acceptance. But with ambiguous loss, you can't fully grieve and you can't fully move forward.
You're stuck in this liminal space. The person is here, so you feel guilty for grieving. But they're not really here, so you can't pretend everything's fine.
The uncertainty is exhausting. You don't know if today will be a "good day" or a "bad day." You don't know how much time is left. You don't know which loss will come next—and there's always another loss coming.
For me, it was watching my dad handle bathing with dignity while my sister and husband helped him. It was the wheelchair replacing his beloved walks. It was knowing he'd walked me down the aisle and seen both of my brothers married, but would never see my sister's wedding. It was the phone call telling me he'd appeared on national television again to talk about dying with dignity—proud that he was removing stigma, heartbroken that this was happening at all.
Each loss required its own grief. And they kept coming.
What Kinds of Situations Create Ambiguous Loss?
Ambiguous loss shows up in more situations than people realize:
Progressive illnesses: Dementia, Alzheimer's, Parkinson's, ALS, multiple sclerosis. The person's body or mind slowly changes, and you grieve each new limitation.
Chronic mental illness: When severe depression, bipolar disorder, or schizophrenia changes someone's personality or ability to connect, you might grieve the relationship you once had.
Addiction: Watching someone become consumed by substance use can feel like losing them while they're still physically present.
Traumatic brain injury or stroke: When an injury fundamentally changes someone's personality, memory, or abilities.
Terminal illness: Like my dad's situation—still alive but dying, each day bringing new losses.
Deployment or incarceration: Physical absence with psychological presence—they're alive but inaccessible.
Estrangement: When family members are alive but the relationship is severed.
In all these situations, you're grieving someone who hasn't died. And that can feel confusing, isolating, and impossible to explain to people who haven't experienced it.
My Journey: What Helped Me Through Ambiguous Loss
I'm going to be honest with you. My professional background didn't make this easier. Neither did my mom's expertise or my sister's nursing training.
We still cried. We still struggled. We still didn't know what to do with the weight of watching someone we loved slowly slip away.
What helped me most was mindfulness.
I threw myself into learning it better. At work (I was seeing teenagers at the time), I started leading mindfulness groups three times a day. Sure, it helped them focus at school and regulate their emotions better. But mostly? It helped me.
Mindfulness gave me something my professional training couldn't: a way to be present with the loss without being consumed by it. A way to hold my dad's hand without spending the entire time thinking about the day when I wouldn't be able to anymore.
Here's what that looked like practically:
Present-moment awareness: Instead of spending our conversations thinking about how this might be one of our last talks, I practiced actually being there. Listening. Noticing the sound of his voice. The warmth of his hand. The way his eyes lit up when my son toddled over.
Non-judgmental observation: Grief brings a lot of thoughts. "I should be stronger." "I should have visited more." "Why can't I just be grateful he's still here?" Mindfulness taught me to notice those thoughts without getting tangled in them.
Breathing through discomfort: When the waves of grief hit—and they hit hard sometimes—I learned to breathe through them instead of pushing them away or drowning in them.
Finding moments of peace: Even on the hardest days, there were moments. The sun coming through the window while we sat together. My dad laughing at something my son did. These moments mattered, and mindfulness helped me actually experience them instead of missing them while worrying about the future.
My dad became interested in Buddhist philosophy during his final years, despite being Christian most of his life. We'd talk about meditation and mindfulness together. He was curious about everything, even at the end.
In his last couple of days, he wasn't conscious anymore. But when he'd moan in his sleep, I'd quietly walk him through a mindfulness meditation—almost as if he was a client, even though he couldn't respond. And we were amazed. He seemed to hear me. His body would calm. His breathing would slow and steady.
I don't know if that brought him peace. But it brought me peace. And in those final days, peace was everything.
Other Tools That Help With Ambiguous Loss
Mindfulness was my anchor, but it wasn't the only thing that helped. Here are other tools that made a difference:
Naming it: Just having the term "ambiguous loss" helped. It gave me language for what I was experiencing. It helped me explain to others why I was grieving someone who was still alive.
Giving myself permission to grieve: I had to let go of the guilt. Yes, my dad was still here. Yes, I could still hug him. And yes, I was allowed to grieve what was already lost.
Talking about it: Not everyone understood. But the people who did—my mom, my sister, close friends—those conversations were lifelines. We'd cry together. Share memories. Acknowledge the losses.
Rituals and meaning-making: My dad created YouTube videos about his journey. He appeared on TV to talk about dying with dignity. He was determined to remove the stigma from death. That gave his losses meaning, which helped all of us.
Taking breaks from grief: This might sound contradictory, but sometimes I needed to just watch Netflix or go for a walk or play with my son. Grief doesn't require constant attention. It's okay to step away sometimes.
Professional support: I had my own therapist during this time. Even as a therapist myself, I needed someone to help me process what I was experiencing. That support made a real difference.
When Should You Seek Professional Help?
Not everyone needs therapy to process ambiguous loss. But here are signs that professional support might help:
You feel stuck in grief and can't see a way forward
The grief is interfering with your daily functioning—work, relationships, self-care
You're experiencing physical symptoms (chronic headaches, stomach issues, exhaustion)
You're using alcohol, substances, or other behaviors to cope
You feel intense guilt, anger, or resentment that won't ease
You're having thoughts of self-harm or suicide
You feel isolated and alone in your grief
You want tools and support to navigate this experience more effectively
Therapy for grief doesn't mean you're weak or broken. It means you're wise enough to ask for support during one of life's hardest experiences.
How We Support Grief at Aspire Counseling
At Aspire Counseling, our licensed therapists understand that grief doesn't follow a timeline or a neat set of stages. We know that ambiguous loss is its own unique kind of pain—and that it requires a different approach than traditional grief counseling.
Our therapists in Lee's Summit and Columbia work with clients navigating all kinds of grief: the loss of a loved one, the loss of a relationship, the loss of health or ability, the loss of a future you'd imagined. We use evidence-based approaches including EMDR, Internal Family Systems (IFS), and mindfulness-based interventions to help you process grief while building resilience.
We also track outcomes carefully using the Blueprint system. For clients working through grief, we've seen significant improvements. Grief scores on the GIS assessment dropped from an average of 26 at the start of treatment to 11 at discharge—an effect size of 1.52, which is considered very large in research terms. What that means in practical terms: people feel noticeably better. The grief doesn't disappear, but it becomes more manageable. Life becomes livable again.
We offer both in-person therapy in our Lee's Summit and Columbia locations, and online therapy throughout Missouri. Many clients find online therapy particularly helpful when they're caring for a loved one and can't easily leave home.
What Therapy for Ambiguous Loss Actually Looks Like
If you're considering therapy for ambiguous loss, you might wonder what to expect. Here's how we typically approach it:
Creating space for all your feelings: You might feel sad, angry, guilty, relieved, grateful, and resentful all in the same day. All of those feelings are valid. We help you hold space for the complexity.
Processing the ongoing losses: Each loss requires its own grief. We help you acknowledge and process them as they come.
Building coping skills: Like mindfulness, breathing techniques, grounding exercises—tools you can use when grief feels overwhelming.
Working through complicated emotions: Guilt, resentment, and anger are common with ambiguous loss. We help you process these without judgment.
Maintaining connection: How do you stay connected to someone who's changing or declining? How do you be present without losing yourself? These are important questions we explore together.
Finding meaning: This isn't about putting a positive spin on loss. It's about discovering what matters to you during this experience and how you want to show up.
Supporting your other relationships: Grief affects your whole life. We help you maintain your relationships and take care of yourself while caring for someone else.
Moving Forward While Still Holding On
Here's what I want you to know: grieving someone who's still alive doesn't mean you're giving up on them. It doesn't mean you're being negative or pessimistic or ungrateful.
It means you're being honest about what's happening. And that honesty is the first step toward finding any kind of peace.
The losses will keep coming. That's the reality of ambiguous loss. But you don't have to face each one alone, and you don't have to face them without support.
My dad died several years ago now. The acute grief has softened. But I still think about those months and years of ambiguous loss—the time when he was here but slipping away. The time when every goodbye might be the last one. The time when I learned that love and loss aren't opposites; they're companions.
Mindfulness helped me be present for the time we had left. Therapy helped me process the grief without drowning in it. And giving myself permission to grieve someone who was still alive—that might have been the most important gift I could give myself.
If you're in that space right now, I see you. The grief is real. The losses are real. And you deserve support as you navigate them.
Take the Next Step: Counseling in Missouri
If you're experiencing ambiguous loss and need support, we're here to help.
Call our office at (573) 328-2288 to schedule a free consultation. We'll talk about what you're experiencing, answer your questions about therapy, and help you determine if Aspire Counseling is the right fit.
We offer both in-person therapy in Lee's Summit and Columbia, and online therapy throughout Missouri. Whether you're caring for a loved one with dementia in Blue Springs, navigating a family member's addiction in the Kansas City area, or processing any other form of ambiguous loss, our expert therapists are trained to help.
You don't have to carry this alone.
Contact Aspire Counseling by calling 573-328-2288.
About the Author
Jessica (Tappana) Oliver, LCSW, is the founder and Clinical Director of Aspire Counseling. She specializes in trauma and anxiety treatment using evidence-based approaches including EMDR, Cognitive Processing Therapy, and mindfulness-based interventions. Jessica's personal experience with ambiguous loss while caring for her dying father—combined with her professional training and her family's background in gerontology and hospice care—gives her unique insight into the complexity of grief. She believes that grief deserves space, attention, and skilled support, and that healing doesn't mean forgetting. Outside of her clinical work, Jessica loves spending time with her family, practicing mindfulness, and cheering for the Chiefs.
