Neglect
March 26th, 2009 |
A GoodTherapy.org Featured Column written by Dennis Thoennes, Ph.D., ABPP
Click here to contact Dennis and/or see his GoodTherapy.org Profile
The song says, “Sorry seems to be the hardest word.” Well… that depends. There is a bounty of research that tells us about the impact of trauma such as mugging, rape, burglary, war, genocide etc. No doubt such activities inflict pain and leave scars. What is too often missed are the scars that are not there. That might well be because this scar is the imprint of neglect.
Alan Schore Ph.D. has done a masterful job of educating us about the neuropsychobiological effects of interpersonal relationships including the dyadic regulation of affect. Right there on the screen, evident for anyone looking is (or could be) an FMRI (functional magnetic resonance image) that shows us a person’s brain. We can see differences between the prefrontal orbital cortex of a person raised with a healthy degree and manner of attunement and one who had less than that. This is evident in many of the children found in Romanian orphanages or those here in the US. One such orphanage was depicted in the movie Cider House Rules.
There is a long and storied history of the tough, silent guy, the “John Wayne” type. The difference though, between that silent type and the adult we might see in our office, the adult who grew up neglected and unattuned to, is that the former is more likely to care about other people, society and relationships. The adult who was profoundly neglected as a child is more likely to display a generalized indifference, disconnection from others and a diffuse visceral reaction and feeling unrelated to others and thus feel, think and behave like a stranger in a strange land. This has many of the hallmarks of depression: anhedonia, isolation, poor self care, and lack of future plans and ambitions. We might see these symptoms.
To some therapists this person may appear to be in need of social skills training or direction and encouragement to get involved in life activities such as gardening, exercise or a drumming circle, or an antidepressant. The benefits of these treatments are most likely to be short lived or prove insufficient. The lyrics in Elton John’s song ask these questions “What have I got to do to make you love me? What have I got to do to make you care?”
In my experience it is essential to get a good and thorough history of this client, particularly of their first ten years. Did she have significant people in her life that she believed really cared about her, whom she could rely on? When questioning, be sure to get specific examples. Don’t let the truth languish in ambiguities. This client may protest, “Yeah, I was well fed, went to good schools.” This client may avoid self-reflection eschewing the “pity pot” and quickly point to others who “had it worse”. As much as this client rejects the therapist’s inroads to contact he also wants exactly that.
I have found that this client is not playing games but profoundly doesn’t know how to connect and very likely doesn’t know how to articulate that. I have found that asking her (or him) to make a collage that shows me that feeling or to bring in a poem or song lyrics or recordings helps bridge into that diffuse visceral reality.
This client can be tremendously challenging to a therapist because if the therapist has had a childhood of good enough attunement this client is speaking, at a gut level, a very different language than the therapist. Therapy with such a client can lead the therapist to think he/she is “following a rabbit down a rabbit hole” or indulging the client’s pathology. In this therapy the therapist may confront some of his/her own darkest, scariest, loneliest and unexplored areas of psyche.
In the Odyssey, Odysseus encountered a sign when he arrived at the river Styx, “Abandon hope all ye who enter here”. Though paradoxical, I believe this may be the most curative therapy for this client, this victim of neglect. It’s not about being drug down a rabbit hole or joining them in a pity party. It rather is a profound respect for the client in his greatest fear and deepest reality. It is as though the client asks the therapist, “What have I got to do to be heard?” “Can you see me? Tolerate me? Hear me? Attune to me? And, when you can hear me, tolerate, and attune, my reality takes on texture, dimension and we have connection.” This connection can be a means of developing new neuronal pathways, hope and engagement. Not just in the abstract but here and now with us.
As the client recognizes this deep loneliness he may come to a very deep sadness and grief. The therapist being present and attuned provides the client the experience of being real. Being real means I exist, you exist. This is mirroring. As the client unwraps these undeveloped or exiled parts of himself and sees that the therapist sees and cares, the neglect of the past begins to be transformed and the client gains the tangible experience of attuned engagement.
During this therapy process the therapist must be very sensitive to signs of a client’s self abuse, addiction behavior or suicidality. During this process the client is venturing into truly terrifying territory. It’s as though the client is using the therapist as a ladder into the deep, dark, terrifying cavern of his psyche. The therapist needs a good support system and to be familiar with his own demons and dragons in order to see and support the client and not join him in the decent. Signs of therapeutic gain may include the therapist’s recognition that the client comprehends he is being seen, heard, therapeutic rapport, as well as signs the client is taking care of themselves and connecting with others. These signs may include more socially appropriate dressing, friendships and meetings with peers, interest in activities, and improved appetite.
This is a big part of what makes the life of the psychologist so taxing, so difficult and so rewarding. Each of our clients, in some way, invites us to meet parts of ourselves as we meet. Hence, the dyadic discovery of the Real Self is at hand.
©Copyright 2009 Dennis Thoennes, Ph.D., ABPP All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Dennis and/or see his GoodTherapy.org Profile
15 comments so far
It’s nice to think that a client contributes to the therapist’s self discovery too. I have a distinct memory of being neglected. In all my childhood memories of family get togethers I used to be the only lonely one in a crowd and noone seemed to notice that I was always left out. After a while I thought that’s how it normally is.
Too many times I think that people dismiss just how much of an impact the way that you raise a child can impact their later years. This type of research shows once again how important those formative years are.
I think we take ourselves too seriously in adulthood and that mars our perception of the child’s feelings at that point. We get callous with our words, feelings and actions as we age. We get more self-centered and that is probably why we dont put a check on ourselves before we react. Neglecting a child is the cruelest thing anyone can do.
I am married to the “strong silent type” and I can’t tell you how crazy this makes me sometimes! He was not neglected as a child but I swear there are times when it feels like due to this personality characteristic of his that he is neglecting me and the kids. I do not want my own children to grow up with these issues, and since they are boys I do not want them thinking that this is the approach that they need to take with their own families one day. How do I break that cycle and turn it into something positive? Believe me the silent brooding probably did a lot to attract me to my husband in the beginning but now it really repels me.
Oh I am married to a “strong silent type” too. It’s funny how we cant stand what we were attracted to the most after we tie the knot. My husband is stubborn too and sometimes he can cut like a knife in an argument. I think every married couple disagrees but to be bitter and brutal in verbal conflict almost as if the partner is an enemy is something noone deserves. I found my son has started copying our yelling patterns when he is angry. Even the same words. I feel like I am stone walling and that makes me want to state my point a little more.
Why is it that people like this cant understand pure love? I am in a stable relationship but I always have this question about how deep my spouse’s love is? It is sad to break everything down practically. Sometimes it’s nice just to know how much the care quotient is.
I dont know if some people just like to stay private in order not to visit that dreadful past that they were well acquainted with.
I think my spouse is the strong silent type, never cries, and he thinks he is always right. He is very good to me, and would do anything for me,but sometimes I feel as if I am the child. He is 6 years older than me. I think he had a good childhood life as well. Me, I can barely remember mine. I do know that my younger sister got all the attention from friends and people at school and I felt like the ugly duckling, even tho now, I know I wasn’t. Back then, teenagers had their own ideas who was the pretties or whatever. This does take a toll on a child when you get older.
I think we neglect children without really meaning to or realizing it. My son stays in his room all the time playing on the computer or listening to music and comes out just to see what we are doing, or to watch a movie every now and then. He is content and happy doing what he is doing, but I have realized that both my husband and I need to get our son out of the house more often or just spend more quality time together whether playing games or something else.
I appreciate that you’ve read the posting on Neglect and have provided your comments. A couple of resources come to mind. 1) Alan Schore: The Psychobiology of Affect Regulation (it’s a classic), 2) Cassidy (ed): Attachment, 3) Terry Real: I Don’t Know How To Get Through To You, 4) –& Dawson: Growing Up Again. Also, you are welcome to contact me through my website email drdt@redmondtherapy.com
Thanks for that information, Dennis. The resources sounds like something I would love to check out. As like a lot of people, I see a lot of neglect and the parents don’t even notice it, and I am sure I have face the same thing when i was younger.
To Nadine.. I don’t think you are really neglecting your son. He is happy doing what he is doing it sounds like. I would want my child to be happy doing what he likes instead of forcing him to do something he doesn’t. You can always spend time together whether going out to eat, renting a movie he likes and you all watch it together, etc..
I do believe that the way you were treated or neglected as a child runs into your adult life when you get older. Consciously or unconsciously, it does impact on how we bring up our kids.
I hate to see anyone neglected, young or adult. It’s no wonder that children seek attention elsewhere, whether it be positive or negative, just to get what they had been deprived of. We really need to show our children (and our loved ones) the love they deserve.
I’m sure there are many reasons why there are silent types. Some may not want to be judged because they may think their stupid, hence neglect from their childhood, some may had some bad experiences in their past. I can see why many of these adults are “quiet types” and if we can just try to understand where this stems from, maybe they can open up to a select few of people they trust.