Experiences of childhood neglect result in many difficulties for an adult – most profoundly when it comes to relationships. The main struggle is the inability to be vulnerable and trust that another person will meet ones emotional needs. This plays out in intimate relationships when someone wants to get close to a person who has been neglected but due to fear of abandonment (either emotional or physical), that person may reject gestures of care and support. In many cases, neglectful behavior by a parent is inconsistent which makes it even harder for a person to trust a friend or partner. They don’t know what to expect and even though someone seems trustworthy, there is fear that they could disappear or reject them at any time. Being vulnerable can feel almost impossible for someone who was neglected in childhood. The risk of getting hurt is just too great.

It can be hard for adults who were neglected in childhood to connect with others and build healthy relationships due to deep seated fears that they aren’t worthy of love. Because they were not properly cared for in the formative years, they believe there is something inherently wrong with them. This leads to feelings of shame (“I am bad”) and such problems as substance abuse, risky sexual behaviors, etc may arise as the person tries to self-soothe.  The tendency to be involved in domestic violence relationships is also common since the person believes they deserve to be punished and cannot imagine how to handle receiving love from another.

Treatment for neglect first involves building a solid, trusting relationship with the therapist in which boundaries are put in place and the therapist models what a nurturing, dependable relationship looks like. Coping strategies are developed such as distress tolerance skills so the person is able to regulate their emotions when anxiety around abandonment arises. Cognitive behavioral therapy is useful in changing a person’s schema around worth and lovability.

People with childhood neglect histories are actually not more likely than others to neglect their own children. In fact, I have seen the opposite – they can oftentimes be very protective and involved parents because they remember how it felt to be abandoned and are concerned with meeting their own children’s needs. In many cases though, people who are neglected may be afraid to have their own children as they feel they lack the skills necessary to properly care for them.

Neglect is similar to abuse in that is has damaging effects on the emotional and physical well-being of the child into adulthood. It can sometimes have even more harmful consequences such as failure to thrive or cognitive impairments if the neglect is extreme. Most therapists consider neglect to be a form of abuse but because it can go unnoticed due to the lack of obvious physical signs, many children suffer in silence and do not receive the help they need.  Through awareness of what could be causing one’s relationship difficulties and the effective treatment options available, people with neglect histories will hopefully be able to receive the support they deserve in order to thrive.  

 

 

Earlier this month, I was getting a facial (something I have never done before but now cannot wait to do again – hello smooth skin!) and as we were starting, the esthetician mentioned that my long hair needed to be swept away from my face and neck and so she went looking for something to tie it back with.  I immediately said, “I’m so sorry, I obviously should have brought a hair tie, I didn’t even think of it!” and then, reassuringly, she responded with, “It’s okay, it’s not your fault.”  These four words – it’s not your fault – had an instant calming effect and took away all shame that I was feeling for not being prepared to have the facial done.  I recognize that this is such a small, pretty insignificant example but grace is grace and letting me off the hook that I immediately placed myself on made me feel normal.  All the automatic thoughts I had of, “What am I even doing here – I can’t even prepare the right way for this service”, “I’m so embarrassed – she must think I’m an idiot”, and “I’m totally inconveniencing her” just melted away.  As a therapist who specializes in trauma, I spent much of the facial thinking about how those four words are so rarely used, especially when needed the most.  We live in a culture of victim-blaming and shaming which results in people, mostly women, walking around always feeling like they’re doing something wrong or causing their own pain.  I hope more of us can bestow grace on others by speaking the words, “It’s not your fault”, whenever we see someone in distress over a perceived wrongdoing.  It’s exactly how we’d like to be treated, right?

As a therapist, I often refer to the six stages of change originally developed by Prochaska and DiClemente in 1983 when helping clients through a transition.  For most people, it can feel overwhelming to try and make changes in one’s life.  There is usually a lack of understanding of why it takes so long to create lasting change and why it’s so easy to fall back into old habits.  Additionally, as a domestic violence specialist, I often get asked, “Why doesn’t she just leave?”.  I have worked with many clients who find leaving an abusive relationship to be extremely difficult.  I realized that using the stages of change as a framework to explain why this is could be helpful in building understanding. 

The first stage of change is precontemplation.  This occurs when a person is simply not acknowledging (or is in denial) that there is a problem that needs to be addressed.  They tend to defend their behavior and are unwilling to try something new.  A victim of domestic violence would deny that she is being hurt or that her partner is, in fact, an abuser.  She will likely make excuses for him, blame herself, or refuse to talk honestly about the relationship.  In this phase though, seeds can be planted and conversations can be started that present new ideas and information.  Victims in the precontemplation stage will oftentimes be introduced to a counselor, but it usually takes several more points of contact for them to connect in a meaningful or consistent way.

In the next stage, contemplation, people will start to become aware of the negative consequences of their behavior but are afraid of what it would take to make changes.  Trying something new is a risk and requires a great deal of time, energy, and resources.  When looking through a domestic violence lens, there are other costs such as retribution by the abuser, potential homelessness for the victim (and any children), loss of money, etc.  Although freedom could potentially be gained, the victim is also losing companionship, what she has considered to be “love”, etc. In this stage though, the victim will start weighing the pros and cons of leaving and possibly be open to help.  A sense of curiosity will hopefully be created here so the victim can start imaging a way out.

The third stage is preparation.  At this point, a commitment has been made to change one’s behavior and determination increases.  Depending on how complicated the situation is, this phase can last for days, weeks, or months.  Information gathering is still taking place and factors such as safety and mental health are being attended to.  The client will be open to seeking shelter or moving away from the abuser, and she may start to acknowledge all the abuse she’s endured, have realizations about the relationship, and understand for possibly the first time how she got to this place.  The challenge with the preparation phase is that if a person is pushed too hard here, they may retreat because it all feels too overwhelming. 

After successfully moving through the first three stages of change, a person is now ready to act.  The action stage is the shortest one but requires the most willpower.  The victim is feeling vulnerable and fearful that she is not making the right choices, especially if she is still being influenced by the abuser.  Her self-esteem is likely destroyed which makes taking action very difficult since she questions her judgment, intelligence, etc.  Even after receiving a lot of support and education, she will likely still be unsure if she’s making the right decisions and will experience a whole host of difficult emotions during this stage.  Additionally, if the abuser is particularly difficult to separate from, she could be forced to not take the actions she desires until the situation becomes safer.

The next stage, maintenance, is the one in which someone hopes to stay in permanently.  This occurs after action has been successfully taken and the person has avoided the temptation to return to old habits (in this case, an abusive partner).  It can be difficult to keep the momentum going and a great deal of energy is required to resist the urge to find comfort in what one has known for so long.  We hope that after leaving her abuser, the survivor will be able to remain in this phase forever, but people are not perfect, and a normal part of any change process includes the tendency to go back to what is familiar.

Our last stage, relapse, is oftentimes referred to as a “fall from grace”.  The person has done such a good job of moving through the previous five stages and making changes in her life, but motivation can run out when one becomes weary.  Or, the outcome is disappointing/not what was expected and as is human nature, we forget how bad something (or someone) was for us and we slip back into old habits.  For a victim of domestic violence, this usually means contacting the ex-abuser.  It is in this stage of change that people on the outside will oftentimes roll their eyes, place judgments on the victim, and wonder why she returned to such an awful person after all that work to leave.  Nostalgia and comfort are powerful forces though – and when you mix in genuine fear, it’s no surprise that a person is going to seek out the one they have so heavily depended on for so many years.  What we need to understand is that even though she may falter here, it does not mean that all is lost.  At this point, she has most likely developed tons of positive coping strategies, gathered useful information, and has a support network to fall back on.  These are things she didn’t have in the beginning and these are the things that will ultimately lead her back to the action stage where she will once again choose herself and her well-being over the abuser. 

With some understanding of what a normal change process looks like, we can develop patience with ourselves and others who are going through difficult transitions.  Most likely, we will eventually make it out the other end stronger and happier than ever.

So often I hear people say, “I’d love to go to therapy but I wouldn’t even know where to start!” My advice, as a therapist, is simple: just begin.

There’s no perfect way to tell your story – it’s complicated because you’re a real person who has lived for 20, 30, 40, etc years and has had a lot happen to make you who you are today. Starting anywhere you feel comfortable is perfectly fine. I often ask clients, “Do you know what you’d like to talk about or would you like me to ask you some questions to get going?” It’s common for people to show up and know they need help, but just not know exactly how to express their needs. It’s my job to guide you and give you a little direction. Oftentimes, there will be a “final straw” that brings someone to therapy such as a breakup, loss of job, or major fight with their significant other. In these cases, starting with what happened today and working backwards can feel helpful. If there is no “urgent need” though, maybe starting with how you’ve been feeling about life recently would give you a place to begin. In fact, starting counseling when you’re not in crisis can be wonderful because you have the mental space to start developing good coping strategies for when you do face difficulties.

Remembering that therapy (like most things in life!) is a process and not a race is important. Everything doesn’t need to come out in the first session. As counselors, we are also really good at picking out what’s important and asking you clarifying questions to assist us in getting the information we need to best help you so don’t worry about feeling scattered – we can put it all together.

I remember wanting to try out minimalism last year and just standing there, staring at all my stuff, wondering where to even start because there was so. much. After several weeks of doing nothing, I realized that I was no closer to my goal of getting rid of things I don’t need because I was paralyzed by fear of not starting the “right” way. Finally, I looked at the chaotic mess of books on my shelf and started making piles of what to keep and what to give away. I felt so accomplished after clearing those books away that it gave me the momentum I needed to move on to my closet and then the kitchen, etc. The moral of this story is that to get un-stuck, I just needed to begin somewhere, anywhere.

I would love to hear from you! And if you live in Massachusetts or abroad and are interested in beginning therapy, feel free to visit my site to see if we may be a good fit.