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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We want you to get better outcomes from having invested your time and continuing education dollars into watching this program. What are you going to do differently after watching this module?
I LOVE the advice to notice before jumping to challenging thoughts of being unworthy. “The noticing is the change agent.” That was so helpful to me, and I will put that into practice.
This was an extremely painful session. Excruciating. It triggered my own psycho-emotional experience with neglect. I practiced staying present to the feelings that arise by practicing awareness and self-care as best I could.
I see your sharing and I am grateful for it. It echoed a little of my experience and I am grateful to share that here with you. I’m off to make a cuppa and snuggle in a warm wrap. I hope you can find care for you. Sending loving energy towards you x
I can imagine myself using the posturing work with a teenage male patient who sits hunched forward and closed off (likely experienced emotional neglect as a child). I hope to gently work toward how it may feel for him to open upward. I wonder how others might plan to react if a patient spontaneously opens upward. Maybe gentle noticing and sharing that noticing with them?
Lovely people, great ideas. Thanks
I plan to be more intentional about sharing what I am noticing about their experience. Although I do this, I do not do it intentionally and so realize I have missed many opportunities for this.
I also like the idea of an action to show I am taking something in. I look forward to trying this out will a few of my clients.
I will be careful to not focus on ‘emotions felt’ in the first few sessions with clients who have experienced neglect in their childhood.
I did not realize that neglect in the younger years can impact a person’s executive functioning in later years. Thank-you!
I will use it in my practice with children in Lima, Peru.
Thank you for my first introduction into the nicabm world. That was excellent. It has taught me to really slow things down and comment more about noticing the minutia of my clients.
It was, overall, a really helpful session. As a graduate student just getting started with clinical work, I would like more info on what cognitive restructuring and cognitive regulation would look like.
Thanks this was a great presentation.
I did some easy to read research into the unacknowledged trauma of “Competent Non-Disordered Adults Of Parents with a Serious Mental Illness” (CaN-ACOPMI). People just need to Google my name, Suzette Misrachi, to obtain it for free. Neglect is a huge part of people who grew up with a parent with a mental illness. Neglect is also a huge part of the parentification process. I write for psychiatrists and once they publish each short article I then put it on medium for the general public for free. The article on parentification relates to neglect and trauma.
Neglect indeed is a silent “killer” as it is so insidious with many not realising its impact, sometimes for decades!
I found today’s session very easy to follow and I already used some of what I learned today with a client. My client…a 57 year old woman, suffered considerable neglect….not outright abuse, but various kinds of neglect, when she was a child. She, in turn, had four children by three different men and ended up leaving her first three children with their inadequate father when she ‘fell in love’ with another man more than 3000 miles away and moved to live with him and had a fourth child with him. Her two oldest daughters are completely estranged from her and she struggles with her young adult son and 18 year old daughter who is on the autism spectrum. Client wants two younger children to move out….client wants to have ‘her own life’. Although I recognized prior to today the generational trauma experienced by now 4 generations, what I heard today gave me further insight and also allowed me to see the client with less judgement.
Key takeaways:
– distinction between emotional and traumatic neglect;
– reminder regarding attunement and pacing;
– info about social engagement disorder: which may be worth exploring with a current situation I am involved with;
– the ‘reframe’ of procrastination was very powerful and resonant;
– the question: To whom did (do) you go when you were in distress?
– the somatic interventions especially Pam Ogden’s example using a shawl with her client to experience being held… very powerful strategy to support the client’s self regulation, self determination in experiencing safely being held / holding onto self
– contextualising the use of eye-contact
Thank you for this excellent resource.
Neurocognitive deficit , ages 2-5 and early teens, continues in adulthood
was quite revealing from Neurobiology and physiological point of view as after- effect of Neglect and abandonment. Maternal absence can literally mean
” I Am Dying ” for the Infant.
This session is being built upon the Previous Webinar on Mastering Wounds of Trauma that had bought.It is excellent and definitely worth
Owning.
Thank you so much as it is also extremely enjoyable Dr Ruth B.
I’m treasuring Pat Ogden’s tender, refined steps to deepen presence and her modeled gentleness of engagement, for the most dubious of neglected patients. Exquisitely shared. Pat’s slow steady, sincerely curious tone and rhythm models sophisticated learnable skills to cradle the most delicate of wounding.
Thank you ever so much. I’m grateful for the reminder that we need to not go to deep too quickly with clients who’ve experienced neglect, and how to build that sense of safety gradually. If possible, I’d like the names some of the various questionnaires that Dr.Sheridan mentioned.
I learned about survivors of neglect and their possible inability to feel and that numbness is real for many. They can be disconnected from
emotions and what is happening inside. Eye contact and posture will guide them to safety.
Thank you for this valuable webinar. I learned a lot about recognizing childhood neglect and the impact of it. Interestingly, I was able to recognize those symptoms in many clients and family members as well. I wish I could use the interventions on family members and help them heal from the traumatic effects of their childhood neglect and its impact on their executive functions and decision-making. But, I can certainly use the interventions on quite a few clients, though I work virtually. Hence, there are no opportunities for personal contact in virtual work. But I can improvise and make a few suggestions to embrace themselves and find ways to love themselves though wounded and neglected by others.
The differentiation between trauma and neglect is very helpful. It expands my ability to be more mindful of the childhood deficits the adult is struggling with and possible interventions
Dr. B your moderation is superior and exquisitely cohesive—thank you.
This is so informative. Thank you. Thank you for giving me a chance to be a part of it for free. “When you help someone heal from trauma, you change civilization.” Powerful statement right there. Thank you to all the researchers and practitioners helping change civilization! I really appreciated the “pacing” information and the part where my view of how the whole life can be lived with deep emotional connection, expression, outlet may be WAY TOO FAR to go with a patient initially. Just start where they are and go from there and maybe someday, deep emotional connection, expression, and outlet can be there’s. In the mean time, just noting that “my chest feels tight” is a BIG WIN for growth for them. Also, the different definitions of neglect were useful. And lastly, the building goals and working to stay on task, and tips to control behavior as ways to manage stress rather than “trying to relax” is brilliant. I know executive functioning skills that are so important and unless we expressly teach them the stress won’t go away, but sometimes I forget in the teaching of how to relieve stress to include that. I like to teach stress relief vs stress prevention. Relief is in the moment, prevention is those executive function skills, planning skills, organizational skills, boundary skills, etc. that must be implemented as life moves along. Both are so important. Thanks again to everyone who put this together!
when I heard about “seeing myself in my mother’s eyes was reading I don’t want you to exist” and then disappearing it happened to me and I have seen it in my patients that sad, careless hunched posture because no one has cared about me, right now I work on tables activities so they can take care of themselves and take breaths about the safe space
I have many patients that have been traumatic neglect. I am work with adults with co-occurring mental illness and substance use disorders
and my approach is to move slowly with my patients. This is very helpful to me in my practice. Thanks so much.
I really affiliate with using the physical gestures of taking in, receiving in a loving way and the use of the shawl to give containment and feeling of being held and thought of some clients that this would be useful for. At the same time I thought about clients that may not be able to do this yet and am thinking about how I can begin this process using art, movements of taking in, giving containment.
Yes! The physical gesture of taking in is so powerful! I have done it myself when I am in a real low. The containment piece is also so valuable. It says, I can handle you, you can handle you. You are here, be here. Wow, such good stuff.
Can’t wait to use these ideas in the preparation and latter phases of EMDR- as needed! Thank you so much !
I enjoyed the exercises that had to do with attending to really closed clients and slowly allowing
them to open their own closed door at their own pace.
Wonderful and insightful approach to training.
Thank you
I liked that as well Joanne.
I’m going to be more mindful of pacing, newly working with a younger child. Not diving into processing deeper emotions, but first noticing their responses, naming what I observe in body language, or avoidance etc, and just accepting these behaviours. Show them that I can be with these, without judgment or need to change them. – MW
I think I’ll experiment with providing a more caring relationship in the session, as an example to them about what it looks like to be cared for.
The aspect of seeking permission for eye contact resonated with me. Even the closing eyes to ensure the space provided is safe by the client’s definition is something that i can see myself using in practice. I also found the different types of neglect interesting. I can’t recall hearing the distinctions made in that way previously.
Thank you so much for sharing your expertise. I was motivated to take this course as I am a practicing meditation teacher and am always on the lookout, for any further information that can help me to support my students. I loved the somatic suggestion of using the movement of the arms and hands toward the body to signal receiving of whatever the student might need, in the moment. I found that to be a simple and helpful suggestion that I could integrate into my teaching. Look forward to the remaining modules. Thanks, again.
Is it emotional neglect or trauma if a mother is overwhelmed by her own needs and stress, and is frequently unavailable as a result of stress related physical symptoms, such as fatigue and headaches?
Thank you for your generous presentation.
I found distinguishing the different types of neglect useful.
The lack of self care in adulthood as an indicator of emotional neglect, given through the example of ‘procrastinating’ when needing to make a phone call to sort employment health care was informative. Also the reference to forming social connections.
I am interested to hear more about the impact, effect and presentation of emotional neglect.
This reminds me, with two very “intellectualizing” patients, to stay with/notice their emotions –
not to be sidetracked into their tendency toward interesting but “non-emotional” topics
I have a situation in life that is like that too, the person is such a professional in dodging the feeling and going back into thought, observation, etc. I liked the statement, “Survivors of neglect often cannot feel.” That was a powerful statement for me to remember in these situations.
Thank you so much! I appreciated the breakdown of various forms of neglect and how to recognize them. The sheer wealth of the brain trust gathered in these modules is stunning, and I thank each of you for contributing your experience, insights, knowledge and wisdom.
I have learnt from this module that when dealing with a client who has experienced neglect, it’s important to NOT reassure them everything is ok straight off the back, it may come across as in-genuine and reinstate their feelings of feeling unseen, it’s important to validate their emotions and and identify with what they are feeling to begin with so we are not rushing them into what we think they should be at right now
I have just discovered the theories and methods of neurobiology, epigenetics, neuroplasticity and such. I am a trauma survivor, having had subtle maternal parental neglect from young childhood to a more progressive sort of combination between high expectations of my self reliability and responsibility in manage house and sibling, verbal volatility in high quality and quantity of expectations, to high level of angry physical discipline.
I’ve heard so much that I relate to and I can understand to my level of revelation. I’m seeing that there is a path to healing in this method of healing trauma and I am feeling encouraged to tell all of you practitioners that this is so reassuring for me, even though I am 57 and I have lived a long time before I found this information and having participated in self-appointed psychotherapy for more than 30 years. I was not able to pin down what my persistent problem because I present very well. can be highly functional or very very dysfunctional, due to recurrent episodes of depressive anxious and PTSD symptoms repeated themselves regularly. for decades I felt like there’s no path out but now I see that there is a very reasonable logical solution and how to address symptoms, feelings.
I’m sorry I don’t seem to have a clear picture how I’m going to apply what I have gotten from this session today, actually I do, I am going to this time, diligently practice putting into actual practice, action is critical. I recognize now I have been passively resisting healing, and perhaps I now know why. For me it’s in the knowing, The Knowing of the science, knowing of the path, the direction in which to go that helps me to feel more comfort in this very moment. so another application that I’ve learned from this session would be educating myself and reading more about the science of the brain neuroplasticity and other suggestions heard today. and I will also apply information I have learned today, towards my college-aged daughter, who has also been affected by my intergenerational circumstances. I must comment because of 30 years of therapy I feel fairly confident I was able to be a more caring mother. so perhaps I have found inspiration in knowing that even though I have difficulties still, I have broken up a bit of the cyclical intergenerational effects. I hope to nurture, encourage and see myself, parent myself and to explore my emotions further because now I have some more of the questions I could ask myself. I will explore the science of neurobiology, epigenetics and neuroplasticity and apply it to myself and further educate my daughter in a loving compassionate more educated way to address her and her feelings. The science and these practitioners in this session have enlightened me and given me a better understanding of how to approach my further healing. the subject of neurobiology has led me to this group of wonderful people. I can now and in future have more understanding of who I am and why I may have remained in dysfunction, and now I can help myself better.
I thank you so much for the opportunity to allow me to feel comfortable not being a practitioner, I was concerned that I was not a practitioner, isn’t that funny! I felt welcomed I learned so much more than I knew an hour ago and I feel in my chest a feeling of comfort literally in my chest and also a little bit of a rapid heartbeat which represents to me maybe some excitement.I thank you again so much and I’m so grateful to have listened to the practitioners here and how they attempt to help and address these traumatic experiences for those of us who have wandered and been lost and and those that are young and have an opportunity to experience a full exciting life.
my one dream of purpose was that I really wanted to affect the world in a positive loving way. I challenge myself to go out into society and perform more of my volunteer work which always makes me feel better!
I thought I wasn’t going to be able to heal at 57. now I see there is a chance for me at this age. to you, have a lovely day bless you all thank you all for being such a kind caring nurturing people, this ball of Earth needs people in this world to help those of us who don’t quite have it all down yet.Sending sunshine and blessings to you with love and encouragement and go forth and heal!! I’m going to go sit down at the kitchen table and journal and make a plan of what and how I’m going to put this information into action! Be well 🧐😢🤔😏😀
Marti
Nice overview of several treatment modalities. Dr Lanius brought great engagement ideas that we often use in schools with kids, that she detailed for use in beginning sessions with clients. I note the absence of IFT based treatment and theory which de emphasizes the Disorder in favor of the Parts that emerge to defend and protect people experiencing trauma and trauma response.
It would be most valuable to add this to the panel; it provides a more humane description of the wounded parts, as well as explains the viability and healing capacity that IFS, and Parts theory of personality offers to us all! I would also add how many Therapists have trauma pasts that bear mentioning, as a shared journey with clients. This format can be a bit top down, ie., us Therapists, you clients with your disorders, eg.
Once again, IFS recognizes most adults have Parts that have trauma. To start by being Curious, like Dr Lanius suggests, is the first step in hearing and seeing these hidden parts. Thanks so much for this review!
Thank you Marti, for putting your newfound thoughts & feelings into words so clearly.. it actually helped me to clarify a number of points in so much of the content I can resonate with being the same age & similar narrative. I am not a certificated practitioner but equally the incredibly valuable insights from those very skilled training providers have in a short space of time enabled me to grow in a way I’d not imagined before.. that I’m very grateful for the feeling of a door opening that I can practically step through. Kind regards!
SO MUCH amazing, insightful information! As a movement worker, I especially appreciated the last insight shared about ‘taking in’ using the hands. I also found it very interesting that calming techniques may not be useful. I would love to learn more about why this is and how I can even begin to integrate somatic calming techniques for clients presenting with neglect. I wonder also about meditation or visualisation and if these are also things I should use caution with in this regard..?
Hi, thank you so much for your attention to this!! In the name of all those who will benefit from your insight! I’m a survivor of both neglect of different flavors and abuse. I struggled so much with the persistent message that I should be able to breathe and calm down. Over time I discovered that I can do specific things in specific circumstances to reach a state of greater presence, instead of breathing etc. such as focusing on the gentle touch of my lips together. Sometimes I need to do something productive to regulate, because any focus on my body dysregulates me more not less. And yes, I meditated a lot because it was supposed to help. I stopped when I finally realized it really wasn’t good for me. Actually there were some benefits, but those benefits could have come at a lesser cost using trauma sensitive approaches. So grateful for your caring and attention in this difficult world, whoever you are!
What turned my lights on today was the mention of neglect of self-care.
I have had much somatic psychotherapy, and have learned to self-regulate to manage my life. Therefore I am quite stable.
However, I have been puzzled by my lack of ability to make and keep commitments to myself – my body particularly to regularly stretch, walk, attend qigong classes etc. To take action to help my body be in a healthy state, especially as I age.
I am very focused on computer activities in setting and reaching goals. Yet cannot apply that focus to balance my life physically. I do appreciate comments about shut down responses, and disconnection from embodiment and engagement. You didn’t mention dissociation today, but that is part of this process too.
Today you have given me a more self-compassionate paradigm to slowly encourage myself to make my bodily health a priority. My history of mental existance as a survivor response to womb mate loss, did leave me disconnected from both body and emotion. I have learned the tools to transcend, but it is a continuous process.
I have the same issues as you! I really liked the part about learning specific skills to be more productive and functional. I will try that now! It feels so good to have heard this in this context, it just seems valid and trustworthy coming from these people in a caring environment. Definitely makes it easier to have compassion for myself. Both on the front end with my expectations of myself, and the back end when I fail despite my best efforts. Good luck to you!!!
Thank you – I was reminded of the shawl and the eyes closed ways of engaging – cultivating a sense of steady respectful safety. I was encouraged by the significance of small signals and attention to how listener responses create a conducive environment within which to be two human beings in caring growth – let the person grow themselves by offering conditions conducive to them growing themselves – not fancy techniques and tools. Again, thank you
in my practice (and everyday life) i continue to more and more deeply acknowledge and recognize the profound value and indispensable gift of ever deepening gentleness and consideration – standing in the unknown of someone else’s experience and being able to hold a loving container with those tenants in the foundations of my heart and ability to witness both myself and others exactly we they are, holding a profound reverence for our uniqueness and resilience – both deeply relating to and yet acknowledging that I can never fully understand someone else’s experience, yet being present in this, willingly and with a great honoring of our soul’s work here.
I found it helpful to think about attunement of the patient’s experience (even if that is the experience of absence of emotion) as distinct from processing emotion. I will definitely use attention to the patient’s experience of my attunement to them as a technique in neglect cases instead of trying to press for the emotion.
So useful to receive guidance on how to approach clients that struggle with eye contact. To ask the client what it’s like to make eye contact, to seek permission, collaborate, and invite their shift in posture is great – I can definitely try this with some clients.
I Loved the Shall practice to let traumatized person realize containment and recognition.
Thank you so. much for this! It is going to transform how I work with 2 clients I now see. I realize I have quickly gone to skill building etc when all I need to do at this time is be still, and connect with them and “see” them! They are seen!!!
This course has actually opened my eyes to one client in particular, that I need to go back and gain more knowledge of her childhood and what she experienced. Also, that trauma work is so much slower than people expect and it’s hard to get clients to understand that because so often they come in when they’re at their wits ends and want a quick fix when that’s not the case. It’s hard to get swept up in trying to give them a quick fix because of how much they’re struggling.
I’m a trainee and this was absolutely fantastic and jammed full of incredibly useful information. I already know of a client that I’ll be able to use much of this with. Fantastic. Thank you.
some clients from other cultures are trained not to make direct eye contact.
Yes, children may appear disrespectful to adults who demand, “look at me when I’m speaking”. Children w ASD, as well as adults, are often most comfortable looking past the listener.
I am one of these. lol!
It appears this session was a brief overview for the Gold package offerings, but it had great impact on me and even triggered some insights.
Best to you!
I appreciated the suggestions around more improvment of exec. functioning rather than emphasis on relaxing.
The framework, the different types of neglect and what you might observe – very interesting. Moved by the ‘noticing’ ‘seeing’ ‘tending to’ the client with no expectation of another’s attention, heart breaking. Thank you – Claire, Edinburgh, UK
i found the links made between neurocognitive deficits ( such as organizing different stimuli, goal tending and keeping, etc) eye-opening. I often focus on the attachment trauma of neglect and do not necessarily consider the neurocognitive fallout …. i will consider the presentation of ADHD with a wider lens thanks to this webinair. So grateful.
I am not a practitioner
Purchased a few courses from NICABM over the years – interest in human behavior, and being a better me
Excellent information with a ton of take aways from Module 1
Neglect – most interesting course material along my learning
Thank-You NICABM
Looking forward to learning Neglect therapy applications/strategies of improvement
I don’t believe that I have a client suffering from neglect, but one of his daughters presented that way with me when she was in counseling. The most telling was the daughter’s avoiding eye contact and looking androgenous. It’s clarifying to know that neglected clients usually manifest their experience of neglect in their physical appearance. It is great to have common sense tips for what to say and do instead of going to the emotions chart. I’m beginning to wonder about my client at this point. Maybe he was neglected in his marriage and has picked up some of the ex’s behavior? He is definitely socially isolated and has prided himself on being focused on just work and kids. He admitted to coming to counseling to be heard and needing to process outwardly with someone because he has no group of people he turns to for support. Maybe he needs treatment for neglect so he doesn’t pass it on? He was quick to slide over the negative emotion that he owned. I noticed that he listed a lot of positive emotions. I am going to start noticing things like that with a short comment.