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
Sign up for the Gold Package
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?
Appreciated the focus on distinctions between diagnostic categories and differences in how those patients may interact, respond and conceptualize their histories and influence their outcomes.
Any tips on helping clients differentiate between the different types of neglect, particularly the systemic neglect beyond the caregiver’s control, so they can begin to heal some resentments that come up when they become more cognizent of the neglect they had?
Thank you so much for this opportunity to learn about the impact of neglect on children and adults. This is a great primer or review for some. I work with children in a clinical setting that have an I/DD diagnosis. Children with I/DD are especially vulnerable to neglect and people with I/DD are more likely to experience childhood neglect. Children mildly impacted by I/DD have a higher chance of experiencing neglect than children who are more profoundly impacted. I believe the treatment approaches covered in today’s lesson can be adapted or used just as they were presented for clients in this population. That being said, I would love to hear from people in the audience with an I/DD diagnosis and how they feel about the treatment approaches discussed today. It would also be great to hear from clinicians who would like to offer considerations for serving clients with an I/DD diagnosis who have experienced neglect.
One consideration I would like to offer to the group is that trauma can present differently for people with I/DD, just as depression and anxiety can. A piece of advice that I have held onto in my work, is that clinicians should spend time digging into feeling labels the client uses to see if they mean the same thing to the client as it does to the clinician. This can uncover a lot of clinically significant information and can lead to better outcomes for clients who may have a different way of understanding or labeling their internal states.
Knowing the differences between Emotional Trauma and PTSD types, is worth the continued studying, especially for the scientifically based “art” of applications in therapy. The knowledge in these presentations, would be beneficial to use in professionally led parenting programs, besides individual or couples counselling, etc.
I learned that it is about presence, attunement, carefully exploring what might support the client in feeling truly seen and cared about.
So far what I’m hearing from you guys is the interpretation of the ancient energetic spiritual (Buddhism & Yoga) practices to modern science. Of course, unless you do the work and connect to your body, no logical understanding and all the knowledge of the world don’t do any good. Hopefully, every one of you lecturing here does the practice yourselves which doesn’t sound like hearing what you’re saying.
How from this session did you pick up that this is an interpretation of the ancient energetic spiritual (Buddhism & Yoga) practices to modern science? What points specifically? And what work are you referring to that these practitioners are supposed to be doing that they are not in your opinion? It would be helpful if you elaborate a little and are specific.
Thank you very much! As a therapist working with neglected children and adolescents, I recognised a lot of information. I do a lot of noticing and pacing. Something I didn’t think about enough, is where I sit in the room with my 16 year old patient who hardly makes any eye contact. I will try proposing other set ups and talk about how no eye contact is okay.
Hi Hannah, one thing I noticed with my own adolescent son was that we could have great talks in the car. I think some combination of active movement and being side-by-side, rather than looking eye-to-eye, helped him feel more able/willing to open up. I think he didn’t feel so vulnerable or “on the spot”. I like your idea of positioning seating differently (maybe side by side?) and not “expecting” eye contact. Maybe movement would also help? As a mother I sometimes need to step back and realize that while *I* don’t feel like I’m being judgmental or “threatening” in any way, the fact that I’m the main parent gives my input a very different weight from my son’s point of view, whether I consciously intend that or not. Good luck trying different strategies!
I very much appreciate the notion of subtle neglect being addressed. Martin Teicher’s words rang true.
Small neglects at critical junctures can have significant impact life long. Another pointed out how if certain neural channels are not used, the body “prunes” them. This can have horrible impact, esp. in terms of intimate relationships.
I found all of the information interesting and helpful.
I hope that the presenter/NICABM will please consider not selling during the short hour. We’ve received already numerous emails, there’s a huge red button at the bottom about the gold membership and discount. Interrupting for sales pitch really intrudes, imho.
I love this information! It is very helpful and informative.
I am curious about something when you are providing the connection and working towards reconciliation of a client with a history of neglect – what happens or how can the therapist avoid being in a position where the client attaches in an unhealthy way? Meaning – is the therapist replacing that nurturing part for the client in a way that signals an unhealthy or inappropriate attachment?
Really valuable snippet on working therapeutically and ethically with traumatised individuals. In addition to the robust clinical thinking and presented vignettes, I found the in-session behavioural suggestions really helpful. Thank you.
Working with adolescents and their brain plasticity, it feels like my work may impact their future relationships and cognitive function.
Thank you very much for the inspiration today. I saw a new patient and regocgnized in her attitude possibly signs of neglect. I Think about it. So I’m ooking forward to tomorrow’s session.
It has helped me to understand Milena. Her mother left her in her country and migrated to the USA. She was neglected, because her primary caregiver wasn’t present for her. I can see why she reacts in some ways. I really want to help her to thrive and have a goal in her life.
More awareness of clients that “expect nothing” and are almost phobic of “feeling”.
I love the suggestions Pat Ogden gave about eye contact, practicing the gesture of receiving, holding the ends of client’s long shawl to help her feel a sense of contentment. My takeaways are: go very slow, noticing and attunement are vital interventions for some clts who are survivors of emotional neglect.
My take-aways are the small things in focus like how to deal with eye-contact and the connection between body, mind and emotions. As a dramatherapist there are a lot of possibilities to work gradualy with these connetions. Sometimes we might go to fast so it is good to slow the pace en use different routes. And the connection with executive functions often leads to missdiagnoses. Good that there is attention for the connection with neglect, severe trauma and the effect on the development of executive functions of the brain. It could realy mislead the focus.
as a child of profound neglect I can identify deeply with both models of neglect & symptomology. And can, via Jungian Psychoanalysis & Trauma-informed Therapy attest to these methods of treatment. Especially attunement & acknowledging…& being conscious of titration towards the model of being cared for. Personally, my experience is this is fundamental stage…though have found latterly the Grounding, Stabilisation techniques are of meaningful use, effect…in certain contexts…e.g. Mindfulness, meditation practice environments. I sense an adjacent approach, if approached with the different contexts…can, do have an impact. Thank you so much for the opportunity to listen.
Such an inspiring webinar! I am very junior in my practice but my biggest takeaway was learning the difference between clients who suffered neglect and those who suffered abuse (notwithstanding the fact that these aren’t always mutually exclusive) and how this might present in the therapy room itself. Thanks also for dedicating a significant section to practical suggestions for treatment – most webinars that I’ve engaged with do not allow much time for this, even if they say they are going to. Looking forward to tomorrow’s session.
Thank you SO much for allowing non- therapists to attend 🙏. I am finding so much self-healing in listening and identifying my own childhood experiences through the voices of this amazing group. My parents were wonderful but neglectful only in the way of inexperience, trying too hard, listening to the wrong advice and so on. I am so grateful for this opportunity.
What I learned is not to take a ‘deep dive’ into analyzing the clients, but to be truly present for them to the extent they can tolerate; as Pat Odgen showed us to observe and tend to them.
It was very helpful to learn about different types of neglect and how to recognize them. How to also be mindful of working with clients uncomfortable with eye contact and being mindful to pace with clients who have been conditioned not to feel. And strategies to help clients experience being seen and heard. Thank you Ruth and NICABM and the speakers for a very insightful & helpful session.
What a beautiful series of presentations. I will be taking away a few things. One is the way in which eye contact can be such a trigger for shame in persons with neglect histories. It makes me rethink differential diagnosis with persons appearing to have neuroatypical patterns of development. I also very much appreciate the description of ways to slow down the treatment process to focus on noticing in the person in subtle ways, and how validating that can be. Thank you for valuable work. Jay Voss, Ph.D.
Thank you for including the somatic work and ideas. They were really helpful as I believe all this re-learning needs to be centred into the body. Deep gratitude for this training and gathering of bright minds and heartful practitioners x
That thank you to us at the end was very touching and appreciated. I will put into practice more mindfully looking out for neglect and also practicing more overt attunement to the clients subtle shifts in affect and body language as part of the healing process through the therapeutic relationship… as well as being mindful to create an atmosphere of attunement before diving into deeper processing of traumas.
I want to use the idea of really letting my clients know I see them by closing and then opening my eyes when appropriate of course. I have and still sometimes experience the feeling that I’m invisible to others so I can imagine how important that will be and know I have more to work on as well.
I will pay more attention to the childhood history of the mothers and fathers I work with, especially the ones where I inwardly shake my head and ask myself “how can they (fill in the blank)?” or “how can they NOT (fill in the blank)?”
Very informative and helpful for adults unwinding their own childhood abuse/neglect and consequent broken relationships.
A big take away. Simply to start by being a good human to the patient. To notice them, to attend to them. To see them, and tell them that. Amazing. Assume nothing.
Consider rearranging the seating area for those who initially avoided eye contact.
thank so much to all of you for providing such useful and expansive insights and information about understanding the different types of neglect and how they might present themselves and different ways they can impact the clients life. I liked the questions that can be asked during history taking and many of the ways to help a client navigate through and heal by just beginning to have a therapist notice them and attend to them and be attuned before delving into the deep emotions and wounds. I loved that and think it’s so important. I learned a lot in this session and have been a therapist for a long time and still learning. So thanks again.
This was such a great session !Psychotherapy has come a long way.
Have always been very aware of the wounds of neglect, but never before really heard such a concentrated awareness about it.
Think many therapists tend to somewhat neglect neglect !
How important the reflection that there has to be a ”space” inside the client to receive certain feedback, experiences…
Thankyou, this webinar provides valuable insights on more subtle behaviours around how clients may behave, which I recognise in client I’ve worked with. My takeaway is around different techniques to talk to a client about self neglect. I also liked providing affirmative comments of recognition of the client feelings and supporting to raise their head and enable eye contact.
Beautiful insights. As a neglect and abandonment survivor, I resonate with the missing capacities and desires to cultivate more deep relationships, unless it is with God, an animal, or one of the precious souls I care for, who are more often to be bypassed by others because of their infirmities, their own social challenges, or loss of functions, cognitive and/or physical.
I work with couples and have them use engage in dialogue, facing each other with soft gaze, proximity, holding. And sometimes, some are not ready. Thank you, Ruth for your generosity of this program: my key takeaway today is to experiment with eyes closed. Suggest for one partner to close eyes to further cultivate the safety and connection in the space between, which is so often enhanced or disturbed by the intrapersonal skills of regulation, awareness, and relational health with self.
Fantastic breadth of evidence based practices. Thank you
We tend to rush into “how do you feel” and think a lot about actually making connections to feelings and reasons. While connecting to feelings is important, understanding how different it might look and time it might take, and pace needed to be taken with survivors of neglect is huge to recognize and inform the practice.
Grateful to also be able to tap into my own self-reflections based on this Module’s material… challenging to digest the new insights coming right away…
With gratitude and hope for healing of humanity and self,
PhD(c), MS, MINT-member, Global Drug Demand Reduction Trainer
Internalised neglect v procrastination…..difference and working to hone skills of executive functioning….cognitive tips, goals
Power of noticing……and staying with this…pacing
Very interested in eye contact “work” with respect to cultural diversity (differences in expectations and use of eye contact) – and also with neurodivergent clients/patients. Many ND people have experienced neglect on some level (eg. emotional neglect – caregivers not knowing how to attune to them; survival needs neglect – potentially from ND parents, or even older clients having been put in institutions as children). Is the discomfort many ND people have with eye contact intrinsic to their neurodivergence, or is it a result of related neglect/trauma? Is expecting an ND person to “work on” making eye contact helpful? Is it neuroaffirming or can it lead to shaming?
I am not a therapist of any kind, but I do work as an advocate and have experienced severe trauma and neglect myself. I am also “likely” to be autistic, but it is very difficult to disentangle autism from trauma. I have done a lot of research and might be able to offer a couple of observations.
I think societal neglect would fit well with a neurodivergent presentation because the autistic/neurodivergent person is constantly having to modify their way of existing in order to be acceptable from a very young age. Even clinically, the goal of treatment is often to make the autistic person less autistic and this can have profound impact on sense of self.
I would say that sensory overload is a common reason for lack of attunement with autistic children. Babies in particular are constantly being touched and stimulated with noise and novel experience. That can potentially cause misattunement.
Regarding eye contact, many autistic people describe it as aversive. As in trauma, autism often means a person cannot connect socially/is not aware of the intentions or feelings of others. Whether the same pathways are involved would need specific research, but I would say that as not understanding others is identified as a core feature of autism, aversion to eye contact, which normally mediates social connection, is perhaps more likely to be a feature of autism than caused by any related neglect.
As the purpose of forcing an autistic person to make eye contact is primarily for the comfort of others, I suspect many autistic people would call it unnecessarily harmful because of the overwhelming aversion. The great purpose of the neurodiversity movement is to remove the need to make autistic people more neurotypical and simply to accept a different way of being that is as natural as neurotypicality. Some autistic people would not agree with that statement, believing instead in a need to be cured. Given the many obstacles to thriving, I understand and accept that viewpoint as also valid. What is ‘right’ for a particular autistic person depends on their situation and personal needs and perhaps on the people that surround them.
Yes, eye contact is very interesting. Having spent years seeing it as a feature of autism and unlikely to change in the individual, I have now evidence that it also reflects a history of trauma, and it can change. So I don’t think it is either or. Someone who has the sensory sensitivities and difficulties with social communication that comes with autism are likely to suffer trauma secondary to that, just to get through life. You could also argue that some of the features of autism are related to trauma in a predisposed brain. If you look at information from the polyvagal theory, eye contact and facial expression are related to social connection, which comes on board once there is an intrinsic feeling of safety. Eye contact then improves. Encouraging someone to use eye contact when it is discomforting to them was described in the research here in this video – it activates fear and stress. I don’t see that as either neuro affirming, or shaming, but see more likely to provoke anxiety. Like everything there is a gradation, but for it to come naturally, it is the underlying healing, attunement and sense of safety that will help.
Thank you
I will be using the notice, observe, name approach as the first step in supporting my client who has difficulty connecting with or putting language on any feelings.
To look or not in the eyes of the patient
Many types of neglect
People with neglect will not seek for help in the first place
I loved this very informative session and the infographics you emailed me. However, that last somatic ’embrace’ of being seen, accepting what another has to give, or life itself that Pat Ogden just demonstrated is something I will be using for the rest of my days. Just love it. So helpful and healing. Thanks.
Brilliant session! Thank you so much for making this available. Lots of food for thought. I work with a 7yr old girl who is in a situation of neglect and it feels very significant to have the opportunity to really notice and value her in the time I have with her.
Thank you for an excellent, and excellently presented session. Very helpful for me, in looking for markers in clients that might indicate that a referral on for therapy might be indicated, and ways to give people “space” in interactions.
Excellent session. One of my many take-aways was understanding how clients experiencing neglect are hypo-aroused and the categories of neglect. Thank You
Great course. Thank you for providing an opportunity to view it for free for those that financially cannot buy it!
My biggest takeaway was to understand that neglect is experienced as a threat rather than a deficit.
Yes I agree, this is a profound change in conceptualizing neglect. Thank you.
Thanks for a helpful and interesting session. I would really like to look more into loss of executive function stemming from neglect, especially related to self care, economics and other self sustaining skills. Is there anywhere to read up on research and possible treatment options?
I would also really like more information on this. I’d also like to know if any research has been done to differentiate between the long-term impairments caused by neglect (including/especially physical/traumatic neglect) vs. the symptoms of ADHD, especially inattentive type ADHD, as they sound quite similar to that.
Very helpful to learn how to as a clinician I can modulate client’s felt sense of self simply by my active presence in here and now.
thank so much to all of you for providing such useful and expansive insights and information about understanding the different types of neglect and how they might present themselves and different ways they can impact the clients life. I liked the questions that can be asked during history taking and many of the ways to help a client navigate through and heal by just beginning to have a therapist notice them and attend to them and be attuned before delving into the deep emotions and wounds. I loved that and think it’s so important. I learned a lot in this session and have been a therapist for a long time and still learning. So thanks again.
Thank you very much for good and useful knowledge.
I will use this further in my practice as a family therapist and as a teacher.
I look forward to more knowledge and am really passionate about a more trauma-informed society
Anita