People grieve after any type of loss—physical loss after a death, or an ambiguous loss after an accident—either can be devastating.  Dr. Pauline Boss (2010) writes about ambiguous loss and explains that it can be a, “…physical presence with psychological absence. A loved one is physically present, but missing psychologically” (Boss, 2010, p.138).  With a physical loss, the deceased is no longer present; people mourn the absence of the deceased.  An ambiguous loss is confusing especially during the beginning stages of the healing process.  Because the injured loved one is physically present, there is still hope that the injured loved one may return to who they were before the accident, physically, cognitively, and emotionally.  In these cases, “traditional therapies are insufficient because closure, the usual goal in grief therapy, is impossible” (Boss, 2010, p.137).  During the recovery process, the permanent changes become apparent and families begin to accept and grieve the reality of their devastating ambiguous loss.

William Worden’s Four Tasks of Mourning leaves space for the complexity and the ambiguity of the loss. The lens of William Worden’s theory of grief and mourning after the physical loss, or death of a loved one (Worden, 2009), is better used as a lens to guide the reader though ambiguous loss, like that of someone who has experienced the TBI of a loved one. Worden’s theory illustrates the phases of the mourning process that he calls the “Tasks of Mourning” (Worden, 2009, p. 39).  Worden’s Tasks of Mourning (2009) include the following:

Task I. Accept the reality of the ambiguous loss.

Task II. Process the pain of the grief.

Task III. Adjust to the world without the injured loved one as they were before the accident.

Task IV. Find an enduring connection with the injured loved one in the midst of embarking on a new life (p. 39-50).

Grief that families experience associated with ambiguous loss – the drastic change in everyday life, the potentially permanent change of a loved one’s independence in her activities of daily living, inability to communicate, and personality/cognition changes—are much like, and should be treated like, a physical loss. Every person has the ability to heal and should be provided emotional assistance during the continuum of care, especially acute rehabilitation where the family learns how different their lives will be upon their loved one’s discharge (Griese, 2015).


Boss, P. (2010). The trauma and complicated grief of ambiguous loss. Pastoral Psychology, 59, 137-145.

Griese, Brook. “Judi’s House: Grief And Loss”. Dec. 14, 2015. Presentation.

Worden, J.W.  (2009). Grief counseling and grief therapy (4th Ed.). New York, NY: Springer Publishing Company.