How to Identify and Treat the Invisible Wounds of Neglect
with Bessel van der Kolk, MD; Janina Fisher, PhD; Karlen Lyons-Ruth, PhD; Pat Ogden, PhD; Ruth Lanius, MD, PhD; Margaret Sheridan, PhD; Eboni Webb, PsyD; Usha Tummala-Narra, PhD; Martin Teicher, MD, PhD; Megan Schmidt, PsyD; Ruth Buczynski, PhD
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This session was quite interesting in terms of clearly distinguishing between various forms of neglect and resulting presentations in patients. As a Social Worker, I agree that Systemic Neglect and Societal Neglect are important to assess for and note in our work with trauma patients and their families.
One bit of feedback on the video, if I may: I have already purchased the enhanced package and unfortunately the pop-up link to buy it again blocked half of my view of the entire video presentation. Could that be placed elsewhere, rather than right in the middle of the video?
Debbie Carroll, PhD, MTA (certified music therapist), Montreal, Canada
As a retired music therapy professor and music therapy clinician, I found this module very interesting. It might be helpful to consider the potential of music therapy as a nonverbal expressive medium, as well as the other creative arts therapists, in working with patients who have experienced the various forms of neglect.
P.S. I would suggest that you add Music Therapy to the list of professions.
Great course thank you. I am not from the field I am an abdominalsurgeon and proctologist and found out that my patients are not fully helped with an operation. Also I got into conflict with some patients. A real take away is the pacing of nearness and distance. I seek eyecontact with my patients to really find out what is going on. I got some successes with that but also failure. I now know why. I will really work on my pacing and pendulation in this area. Also the advice to work with bodyposture and verbalising observations is a great advice. I was already doing that, but of course not fully integrated as it should be, so I got some practicing to do.
First of all, I wanna say thank you so much for this broadcast and all the effort you guys put into it. It’s so important and appreciated. What I take from this module is the authenticity of each therapist in their own practice. I currently struggle with imposter syndrome and lifting my practice off the ground but have such a huge desire to help others. So this broadcast is super important to me in my path of owning my value and life experience in order to be there for my future patients. I will definitely tune in to the other modules. Thank you kindly!
I think recognizing that adults who have suffered neglect can present with that feeling of being numb, or like a robot, is important to pay attention to. I also really loved the discussion around systemic and societal neglect. I think these concerns should be taught to all practitioners, doctors, lawyers, police officers etc because there is this survival that is happening within the persons they encounter, but if it is not noticed, all that is seen is disrespect, or defiance, or unwillingness to cooperate, or whatever, when it truly is just a desire to get a human biological need met. Finally, I also found the part about how executive functioning skills may need to be taught/practiced, and that it may not look like teaching those calming techniques, but specifically teaching how to DO things that are causing the stress/anxiety. Thank you!
– Identify between the 4 profiles : emotional, traumatic, societal, systemic neglect
– Be extra attentive about hypoarousal patients
– Brain damages such as disconnection with inside / ouside reality, with the cortex, executive functions
– Eye contact avoidance
– How to help the person
Thank you so very much. I am a French speaker and will have to revise it as I don’t understand all when speaking rapidly, I’m sure there is much more to say and look forward to reading the transcription which really is a genious tool! Thank you so very much for your excellent community work and approach. I am so thrilled to learn so much in such a short time.
Thank you for that excellent presentation with expert inputs and commentary. I now have a better understanding of the deep traumatic impact of neglect on clients who may present with seemingly unrelated issues and will hopefully be able to help them understand the implications.
Asking for permission to engage eg with eye contact and closed eyes very good approach
Being able to use a shawl or blanket to contain was something I haven’t used for a while
Very helpful
I have a patient I could imagine offering the shawl experiment to…
Thank you!
I love how cognitive regulation was talked about along with the somatic piece with assessing and treating trauma. I am looking into how we can use this information to teach skills to general population to help decrease impact of trauma before trauma happens, saving time in treating a traumatized brain.
WOW! I’m a patient and in my 30 years of in and out therapy, none of this was ever addressed. It’s been a self healing, self learning journey to uncondition all the negative things in my CPTSD, GAD, depression, BPD. Wish I could afford real therapy! Thanks so much for the ability to gain more awareness through your free sessions.
I appreciate hearing about the idea of offering the client a scarf to wrap around them and then you can gently tug at the ends of it to mimic them being held, but in a safe way. I’ve also heard of the therapist and the client each holding one end of a scarf (you could even have a basket of scarves and maybe a shawl in your office) to have safe contact without any physical touch.
Thank you for this broadcast and for making it complimentary. I am looking forward to the other broadcasts.
I am so grateful for the learning from this session. Thank you!
As a Coach I am aware of the crucial point at which I must refer my clients to a trained therapist. This has helped me in being more aware and recognising when neglect issues arise and to refer.
It was helpful to learn about the different types of neglect and how they play out differently in their impacts in later life. (My practice is among adults.). Also, I will use the exercise about eye contact.
Thank you for todays session. Always learn from these bright minds.
Taking away a deeper understanding of my own neglect issues and how that affects my life.
Taking notes helped me to develop the wire frame of a series of yoga, meditation, mindfulness practices classes to teach the concepts of …..
Self-regulation, self-care and learning what it means for feel safe enough
Overcoming Deficit in executive function – working harder to hone skills around self-regulation – repetition, building strength and self-reliance
Mindfulness – the goldilocks formula with the felt senses – overcoming numbness and the inability to feel – intero/exteroception, afferent and efferent messaging
Titrated approach to eye-contact – checking and building the muscle of making eye-contact in an accessible and permissive approach, through dristi and eye work in asana, pranayama, mudra and bandha
Emotional intelligence – social connection, learning to be part of a supportive community through practice
There has been so much information and trainings on trauma, with little attention to neglet as a form of it. Thank you for this training.
My biggest takeaway was for the therapist to show attending behaviors. It reminds me of providing unconditional positive regard that is lacking in clients. To have them feel what that is like. Many state they do not have an identity as a child, they do not have a feeling of being cared for.
I will bear in mind that eye contact has a different meaning and impact for different people and what I feel is about connecting and “seeing,” a client may actually be distressful for them. I will give them the lead in managing eye contact and observing more carefully when people seem uncomfortable with eye contact and validating their experience.
Ask for permission
Offer to close my eyes so they are comfortable
Extend physical gestures as if reaching out
Make them feel seen and heard
Offer a shawl for comfort and kindness to feel warm and swaddled
Unfortunately I missed the first 30 but I’ll catch tomorrow. Thank you
I love the “wrapping in a shawl” strategy.
Thank you!
Thank you so much
I will use tracking the eye contact slowly, and other tips
I’m a student and don’t have a client to apply the learning to but I am also an adoptive parent and it is making me think about my child. I look forward to hearing about the abandonment next time, thank you
emotional regulation vs cognitive regulation
I actually used my shawl this am with a client who experienced emotional neglect and rejection. I covered her with the shawl during breathing exercises to draw a metaphor for being gentle and protective. This was during a relaxation exercise. I noticed a difference in her posture and breathing after placing the shawl on her and provided that immediate feedback.
I found the advice regarding eye movement, touch, etc. The gentle resonance techniques make a lot of sense for someone who has trouble identifying their emotions.
ThIs was a good lens to look at clients who are shut down and disconnected, and remember that childhood neglect is as much a trauma as other childhood experiences. i liked the breakdown of different types of neglect and the reminder of the importance of going slow and pacing, and practicing attunement. Thanks for the application discussion. I am grateful to be able to watch these sessions at my own pace.
The first education session to me was a very good reminder that nobody knows what anyone is or has went through… it was really heart breaking hearing about how mothers or fathers just didn’t come home for days. But the scary part is that the children were use to this and the children were “ok” with other children not wanting to be friends with them because of how they dress or how their family is living…. That’s is so heart breaking but I can imagine it happens so much more then I think it does. But it also opens up my eyes towards the mother or father with their struggle with addictions or trying to survive and understand their addictions or challenges that theybare facing too… all around sounds heart breaking but that in reality is what folks are struggling with day to day…
I loved the module on neglect. But there is a masterful new-ish book on the subject by Kathrin A Stauffer, “Emotional Neglect and the Adult in Therapy: Lifelong Consequences of the Lack of Early Attunement.” One thing she reiterates is that with neglect clients it’s important not to use challenge. They are already swimming in shame, and therapeutic challenges usually generate more shame.
Neglect has been an area that I found did not fit with a lot of the traumatic presentations I have encountered. You made neglect so clear and helped me to make sense of why so many clients are experiencing something so different to what most present with when talking about complex trauma. Thank you
As a client who had complex trauma and neglect, I’ve had bad experiences in finding an attuned and understanding therapist. Thanks for highlighting this. It’s good to hear that there are people who understand and validate my experience and that more are becoming aware of my reality.
I appreciate this so much. The therapeutic understanding is great. I’m a patient. Not unaware, in need of more support than I’ve got, and also overwhelmed, Not least, because insurance for getting treatment is almost impossible to come by, especially on a limited income, and needing to use Medicare. Talk about a sense of hopelessness and bitterness at systemic neglect. But thank you. This much that you provided is something.
I think I will not so readily check on emotional release mechanisms or validate emotional release so much as just being willing to meet the client where they are and perhaps use my own emotional sense of the person and name what I am sensing. Or check in with how they are experiencing internal body states welcoming whatever comes up.
The application of what I have heard and noted is right in the foreground. I still work on Zoom, for many reasons, yet manage to make vital contact and connection with most of clients who attend. I love Pat Ogden’s gesture of bringing towards the self what we are creating. I now have more awareness about why I would introduce some vigorous somatic practice for some people, those who are feeling numb or stuck in a funk, a ditch, a trough. I will introduce some other ways to elicit pleasant sensations, e.g handhugs, wiggling toes, stretching out toes, flexing ankles, pulling earlobes and such.
I will use the experiment of offering the client look up into my face or eyes. asking her if she prefers me to have my eyes closed or open.
this reminds me of here urge to touch eyes on pictures in an early stage of therapy…
I am curious.. what might come out of this suggestion..
Thank you
I will try the titrated exercise addressing issues with eye-contact. Also Pat’s approach to make a client feel more comfortable with the idea of being cared for. Thank you vey much!
As a psychologist and also dance-movement therapist, I appreciate Pat Ogden’s use of the body in noticing the client and using reflection of posture, eye contact and other body expressions in her interventions. I also appreciate the differentiation of different types of neglect, although I am not sure I truly understand the difference between systemic and societal neglect.
Thank you for making this available!
See you next time.
I will continue to be aware that one of the “3 legs of stress management” that I use will be more useful to some clients than others. Thank you.
For example, rather than a relaxation technique that is the “recuperative leg” I might focus on how they can use a calendar for the “time management/scheduling leg”. I might keep to myself the importance of the “self worth leg” knowing that they are not yet ready and do not have the brain areas develop to assess self worth.
Thank you so much.
this was very thought provoking, especially around patients who are unable to make eye contact, what may have seemed like extreme anxiety i can now see could be from childhood neglect and lack of development in this area of cognitive abilities plus i can recognise the emotional fear of being expected by other people to just be able to carry out, what to us are simple actions. The fear of having to try and engage when not knowing what threat is present and expecting a threat no matter how many times a person has forced themselves to behave in the expected way when pressed to.
very interesting. thank you
This single session was phenomenal! I’m retired from professional practice but I interact with other humans — and animals — frequently.
I plan to listen better to the tiny things they reveal about themselves in slips of conversation.
The eye contact thing was major! I definitely will pursue others’ behaviors and feelings about that.
Thank you so much.
yes, the eye contact awareness and process is an interesting exercise.
Thank you very much for this broadcast!
I liked the idea of containement… and physical touch, to be noticed, ask for attention, and straighten up body posture! It seems what
and how we feel shows on the ‘body’ posture…
I’m going to use the shawl technique as well as gesture for reaching and taking in. Really simple, warm and effective!
If survivors of Neglect often can’t feel … could they possibly obey any demand as adults… even become potential candidate for becoming a psychopath… or torture physically others (even if those ones often wont come to therapists)
Many thanks for your brilliant broadcast
Excellent summary of this very large field. Information paced at an easily absorbable pace for me. Thank you.
Thank you for this webinar. It truly is an amazing opportunity to hear directly from such an esteemed group of experts in the trauma field. I had several of my clients in mind and I hope to use some of the assessment tools and interventions mentioned.
Thank you for being so informative and caring at the same time. The well-being of the participants is so important, as many of us are patients. I am one of them, and I am on my path to healing the wounds of the past.
It was shocking to realise that my mum’s look activates my brain’s fear centre. Now I know why I am shrinking and feeling so uncomfortable in front of her. Sitting at the table with her is so challenging.
The above is an example, but this knowledge applies to many situations. The look is a trigger, especially with women who remind me of my mother. However, awareness is a great tool to help me work on mother-related issues.
Kind regards from Poland, where somatic psychology isn’t mainstream yet.
Thanks all. I will use ideas to inform how to translate lived experience of trauma for patients, practitioners and community. NICABM series will help in reviewing, applying, and naming various trauma experiences and therapy approaches and as nascent programs are being developed in my community to approach healing in new ways, from personal to local, regional and one day internationally. More aware than ever what Ruth said in closing, that helping one person heal from trauma will change the course of civilization. This course offers hope we can plant seeds to bring benefit from lived experience to our community, society and beyond.
This first session has pointed out how there is a pattern throughout the history of my relationships caused by childhood neglect. To assess my future clients I will ask more questions about their relationships with friends, relatives, and lovers to see what kind of pattern they have.
With Loving Kindness & Compassion, Wayne Hough
..Also, I see that there are clinicians who seek trauma-informed training to be used in a virtual setting (“tele-sessions”). Is that a good idea? Does something significant not get lost when treating a traumatized person happens over a screen? I am committed to in-person sessions (unless some dire circumstance warrants a video session). I would like to hear if there are professional arguments for and against screen-based intervention. Thank you.
I absolutely agree & wonder what is being lost when having sessions online. I understand the benefits of online when situations like Covid prevented getting together in-office. It was better to have something rather than no connection to the therapist, especially when already working together. Since being able to gather again, I really feel something is often lost when doing online sessions. It’s interesting however to have the proximity of the other person onscreen verses the physical distance in the office. How should this be addressed? What does it change when dealing with neglect?
As a client, I’ve really suffered for the past few years not having in-person sessions. The screen removes so much of what a person can offer and contributes to a sense of detachment. I don’t think I would have recovered to such a degree if I hadn’t had in-person sessions in the past. It’s kind of the inverse of removing someone from a perpetrator. Senses and awareness are diminished and so are hopes for acceptance and closeness. It’s harder to be present when you aren’t really there. There’s an easy escape to my own surroundings when I really want a path to a relationship. Virtual sessions work against my goals. (I’m struggling to write something sensible and it may have to do with my language development being thwarted because of neglect.)
i too wonder about this with screen based technology. the beautiful moment with pat and her client and the shawl could not happen in an online setting. I imagine that for those with hx of emotional neglect the screen is likely not ideal… would love to know more about how to mitigate this as a mostly online practitioner.
How important: the principle of meeting a client where they are, with how they are feeling, and what they believe about themselves, without challenging their beliefs or trying to help them think more effectively. First and foremost, meet them, be with their experience, see them, be there for them. Not trying to change their way of thinking until they have felt seen and understood, and then only with their permission and willingness to change.
the important of attunement with client, pacing and focusing on skills rather than relaxation and verbal reassurance
eye contact could be the red flag of neglect and can used as the starting point for the engagement
This was useful. Thank you. I look forward to next session, next week. ~Jane
i loved Pat Ogdens approache with her patient that démonstrated her “tending” to her patient and respecting the paitients physical boundries of touch. the example of the shawl is very powerful. Would love to hear more practical exemples. i will be integrating these ideas into my inner child art therapy workshops.
Thanks for this!