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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Congrats for your wonderful work! I have listened and I love the excellent Lesson you have given to me! Thanks very much…..A lot of Sucess for NICAM!
Gabriela Acabado (Hidraulic engineer and Coach and Mentoring …)
Thank you so very much for offering this valuable information. I’m not a professional psychologist but very much thinking about a career reconversion after discovering my trauma and the generational trauma in my family thanks to my therapist and to contents like the ones you offer an nicabm. As a scientist, and biologist in particular, your contents explaining the research and the neurobiology behind the behavioral aspects is particularly appealing/satisfying. I do hope I’ll be able to spread this knowledge as a practitioner in the future and hopefully in my home country (Morocco)!
Thanks so much ❤️🙏🏼
Nabi
I have been tired of the neglect of neglect! So this is so refreshing and needed! Thank you so much for this information: it is so helpful and I am looking forward to learning more. It was particularly helpful to know that instead of hyperarousal there is hypoarousal and to not dive fast into emotional work. Thank you. As a survivor of neglect myself, I also felt understood and validated!
What I have learned: How important it is to make sure to attune first; let cl know that I see them – to state what feeling they appear to be expressing – you look sad. Be more aware of hypo-arousal and to ask clarifying questions about it. Not being able to feel – feeling numb is as important as feeling something and may be indicative of emotional neglect. How to deal with issues related to eye contact — be more respectful and understanding of the process it could take to help someone be comfortable with a change in eye contact and/or posture. Thank you!
I definitely enjoyed the techniques suggested for working with traumatized individuals to work on eye contact and how to step by step connect with them slowly in acknowledging and processing their emotions.
I am a Case Manager that works with youth between the ages 10 – 17 coming to a Youth Emergency Shelter and I am trying to educate myself and utilize trauma-informed care in working with these youth.
I am looking forward to the next upcoming broadcasts! 🙂
As a survivor, and support person for others, you have helped me touch areas in myself that have been liberating. As a Board member of a federally qualified health center in SC, and former administrator, I have witnessed the impact of poverty in all five levels of neglect.
Thank you all for the great content and valuable input!
I think I will try the following:
1. Giving recognition and care little by little. I`ve been noticing before (and it is fantastic to see your thoughts confirmed by top-level people in the industry) that people who suffered from neglect can`t digest care, attention, and confirmation the way other people can. In a way it is like cutting a pie into many pieces and feeding them one by one.
2. Eye contact levels will also be practiced.
3. A nice idea from Pat about a big shawl. I have a feeling I am going to keep something big and wrappable next to me and offer at a convenient time if I feel a person needs some additional coverage, protection, safety.
The content was insightful and useful for me as a college teacher. I have a student who consistently underperforms, but always comes to my class because, in her words, I’m the only one who sees her. I feel that instinctive way I’ve interacted with her conforms to the best practices outlined in this video. I took away additional strategies and I’m looking forward to learning more.
This session was not only fascinating but also very supportive of my practice in terms of practical strategies. For example, noticing, tracking, closing my eyes to support a client to look up. I particularly liked Pat Ogden’s use of a shawl for her patient. Thank you.
Very Insightful. Thank you for this work.
What was huge for me was realizing how important when working with trauma to first be attuned to the patient and have the patient feel seen and and recognize their emotional needs before doing deep processing work. This will reflect in my work by me taking more time before diving into processing. Moving slower with my clients. Waiting for them to hint that they feel safe enough to go deeper
An interesting comparison between traumatic neglect and emotional neglect. I agree that it is important for the client to first feel they have been seen, that they are noticed before moving into the process. Connection is key. I am looking forward to the second session regarding abandonment as I assume abandonment is a very big part of neglect. That both go hand in hand.
Show them they are “seen”” before diving into deeper emotions. Personally not being able to take the steps needed for self care:( loved this! Thank you!
Graciously expressed by all…Thank You.
Thank you very much for helping me understand more about myself and the neglect i experienced as a child. Blessings to you!
Seeing my clients in their bodies is definitely where I will focus more. Noticing their facial, body, vocal tones. I work with a number of ex-spouses and adult children of narcissistic adults and there is a profound sense of defeat and despair as they move toward healing. Thank you so much.
Be cautious not to take a deep dive too soon
very impressive and useful learning. Pl keep it up and stay blessed!
I found this session incredibly informative! The piece that I enjoyed most was the discussion regarding emotional neglect and traumatic neglect, as well as malevolent neglect. These were interesting to me in terms of better conceptualizing trauma that clients may experience.
Thinking about a lot of the college students I work with and starting to reflect on some of those that limit eye contact and proximity. Fascinating and informative. Thank you!
Excellent presentation
Well organized and narrated
As very often I found this presentation and interventions usefull and enlightning. I have been working with intrafamily and sexual violence survivors for quite a few years now and I’ve integrated the psychobodily approach since 2016 through the theory of bioenergetcis by Whilhelm Reich and relaxation. Then I learned and trained to work with sexual violence survivors in 2017. Discovering the effects that the approach through the body and the senses had, bettered the way I practiced. Then I learned about mentalising and it opened new paths for me. I consolidated notions I already knew but it mostly helped me explain to my patients what was happening when we were emotionally aroused. Sharing more general knowledge plays a role in my work. I don’t give lectures of course but sharing that we all function on a similar mode helps not to feel abnormal I think. And it gives a sense of understanding to the patients. My practice is primarily focused on what is experienced by my patients. I share hypothesis with them and we confirm or refute together. I find myself do what Pat Ogden said, before I share a hypothesis or a thought I check in with the patient and I then share what I think. I never ask them to do something. Sometimes I find myself asking them to be careful about what they demand from their own self. In other words, I ask them if they are sure they are ready… I remind them that change doesn’t come with will alone. But I tell them I’ll be there, if they are ok with that, on that path. I try to see and sense “where they are coming from” before proposing interventions. In my practice I use the genogram as a tool. I don’t have an official systemic approach but using a genogram allows them to express in their own words in which environment they grew up in and came to be the way they are today. It allows for triangulation ahead of time. Once it’s on paper it becomes less of radioactive an issue. I appreciated the focus on the specificity of neglect. It is much needed and allows us to better work with our patients and understand them.
So I’m not a practitioner but a would be client that has dealt with rejection from professionals for 14 years due to my substance use, culminating to a really ROUGH year losing my case manager and learning that EMDR would help the most. Which I was offered EMDR from a professional whom said a weekly schedule, hour long sessions would help me because of my history… only to revoke it all on the day we were to start, offering DBT instead (which Dr. Shapiro presented data that DBT does not work on histories of abuse/neglect). Not the first time this has happened, however I begged for skills, ANYTHING, because my violent self abuse episodes were occuring multiple times a month (my neighbors thought it was domestic violence, which requires a partner); she didn’t offer anything because of my safety…
TL/DR skip to ***
Luckily I stumbled across doctor Laurel Parnell (thank you for your work) and her work on EMDR for professionals (thanks local library) which led me to the decision that I attempt self EMDR as well as resource tapping (most of my time is spent disassociated as a autopilot habit. Even now as I type, there is this “distance” to my perception)
But before all this, Bessel Van der Kolk’s The Body Keeps the Score (thank you for your work) really opened my eyes to what I was living with, and led me to Pat Ogden’s site, and to resources like this. (thank you for your work)
AND I WANT TO MAKE THIS VERY CLEAR: please please please do not use this as justification for hiding these resources behind pay walls or other restrictive methods. AND don’t use “patient/client safety” as an excuse; it’s a demoralizing insult which has reinforced my self-hatred and led to more physical acts of violence towards myself (these episodes happen when I am alone, but a few weeks ago I saw a woman hitting herself in the head the same way I do, but she was in public during the day. and whoever she was with shooed me away because I was stunned, wanting to help but I was frozen), which always include verbal abuse of yelling, screaming and mocking. YES, I do understand that these resources are for those with professional training; however I’m desperate and Ill equipped to get help mentally because my substance use is the easy way out, thanks to the opinion based entry in the medical literature that has no data to back it’s stance up but is treated as such. YES, I understand that a therapeutic relationship is “ideal” for EMDR since it is a HARD therapy; HOWEVER 14 years, about 4 new professionals each year, (becoming less stable every year) has made me only want to pursue help from sociopathic classified tendencies in a professional.
The attachment disorders explained at first I already knew of because any positive, upbeat, smiley behavior and I emotionally latch onto. But I am wanting to learn more and more about abuse/neglect/trauma to help myself because parts of my past are blank but are expressig themselves through my dreams (which my dreams have ALWAYS been vivid, with full recollection of dreams being stored as memories… however memories of traumatic events that I remembered by sheer force are disappearing, including more current memories), which a few years ago started to become more and more violent, with heavy affect from dreams being remembered by my body, and the latest dream issue has been sleeping for an hour and a half, maybe two hours BUT dream time last for days/weeks. Coupled with violent, sometimes excruciating pain experienced which persists into waking has made me afraid of going to sleep… I can’t keep living this way,
***No one should have to live this way, I’m gay so I don’t have any kids (and I would only want to have them IF I was 100% sure I wouldn’t repeat on them what was done to me, by my mom. Not all parents love their children, karma/a-just-world doesn’t exist [or if it does, a person can avoid repercussions by staying ahead or putting others/things to take the blows])
Very informative and valuable information. Understanding the skill needs with neglect versus other forms of traumatic experiences is so important. The nuances how the brain processes our different experiences and how it plays out in the body as well as the mind and guides our healing. Thank you!!
I am a social worker, working with slightly mental handicaped mothers in the Netherlands,
I will try:
• practising with small steps in daily practical executive functions more than focusing on stress-reduction (like calming exercises)
• knowing that confirmations are often meaningless because they don’t have a template for that,. We will try helping the mothers to
give their children a thumbs up sticker instead of asking them to vocalize their approval.
• trying to gain trust by telling them what we see and hear them, acknowledge them in our meetings.
I was very interested in the discussion around Eye Contact. When conversing online many people do not look at the camera because they are looking into the eyes of the other person on their screen. Ruth was for the most part looking at the camera and might consider passing her technique on to her interviewees.
The camera on my computer is just above the screen and when on a video call, I arrange for the image of the person at the other end to be below the camera. A smaller image allows the eyes to be nearer the camera. If both parties do this, eye contact is much improved.
Exactly. I am forever reminding supervises how to setup for online working to optimise their ability to attune to their client as much as possible. It is important for the person on screen, (whether that be you on the client’s screen or the client on your screen), that the top of their head/hair is at the very top of their screen view of themselves. That ensures as much a possible that your and their eyes are as close to the camera to the top of the screen.
Richard
Thank you very much for making this wonderful program available for ‘the world’. It is giving me insights about different ways of presentation of trauma in patients. I am a Feldenkrais practitioner and physical therapist and often get close to clients because things emerge through touch and I am eager to learn more and more to be able to understand and act according to the situation.
At the same time I feel a bit awkward to say, but still will do: some presentors during this session are very difficult to understand, most of them speak clear and some are difficult to follow because of speed of talking, accent, way of prononciating (very glottal and with an echo in the sound). I am not a native English speaker, therefore it is an item for me. When I decide to buy the programme will there be a transcript of the interview and talks? That would make it much easier to follow the spoken text.
I hope you understand my comment as a non-judging notice and I am very glad and feel fortunate with all the work you have done to make this serie possible.
Sincerly, M. Paul
I too am a physical therapist and feldenkrais practitioner and find that clients open up and have emotional responses to our work. I regularly engage in somatic psychotherapy platforms to learn best practice for being with these experiences. I’ve found that observing and connecting without a goal or action can be very helpful in itself. I’m grateful this work is being done and we’re learning what humans need.
I have a question regarding Trauma pertaining to abandonment & neglect and how these manifest when only one of the two parents neglected & abandoned the child.
For Context:
I am a single parent of two sons now 26 and 29. I left their father when my sons were 3 and 5. The last time they saw their father was when they were 5 and 7 years old.
Without any explanation, their father stopped his Sunday visitation (though that could be sporadic) and went no contact. He never acknowledged birthdays or Christmas for the rest of their lives. He didn’t call to talk to them on the phone. And he did not pay his child support. They were completely abandoned and neglected.
I worked hard and provided for us three alone. Money was always tight and at times we were on public assistance, I felt like I had to work all the time. But I provided for them, there was stability, safe housing, always food, summer camp, Cub Scouts (I was a leader), presents at Christmas and a lot of love. They also had their grandparents and my exte
I really enjoyed the first session .Learned a lot. The descriptions filled in gaps of my knowlege and helped with context.
Looking forward to the other sessions.
Hi – wow – just listened to the first session. Not a therapist – very interested in the subject and in my experience of others in the voluntary work I am involved in am increasingly aware of the impact of trauma in people’s lives and want to increase my own trauma awareness.
On a personal level I have been impacted greatly: by trauma; by circumstantial emotional neglect due to caregivers experiencing the same trauma; the overlay and interweave of generational abuse/emotional neglect; and resultant adaptive patterns of being. I’m gay and all of the above combined with socio-cultural factors which resulted in bullying and abuse.
Having experienced much healing though talking and body based therapy over a considerable period, this session gave me important new jigsaw pieces of insight into the picture that has been forming for some time around who I have been, how I have functioned – adaptively, and how I might continue the healing journey.
In my voluntary work it will support how I am / who I am / how I interpret what I experience with those I engage with.
I would add – I am a low income attendee with the gold package beyond the scope of my means. I have a memory disability which means I need to write it down but often lose some of what I want to write before I am able to capture it. I would have loved the opportunity to re-watch if only for a limited time to pause, complete my notes, and then continue to play. I understand why this isn’t possible.
Hi Gerard, I guess that this module will get repeated 3 times at an interval of 3 hours on 4th Oct and same timings on 5th Oct as well. You may attend the repeat telecast.
Presentation:
First, I must say having waded through many ads about buying the program, I was surprised at the many verbal ad plugs inserted into the content. Maybe ok to do so at start and end, but the random insertions were like shark attacks. Will they be on the videos too?
Second, I really appreciate the multiplicity of presenters and the case studies.Would have liked the names on the screen of the assessment measures. Will these be listed separately with the videos.
Content:
I appreciated the distinction between what generates hypoarousal vs hyperarousal. It was good to realise that telling them to be calm is not always the right thing; that I am not alone in being afraid to make eye contact & why I was afraid to look into my parents’ eyes, although we loved each other.
Also interesting: metabolic reasons for starveling children with obese care-givers in low socio-economic neighbourhoods- what to watch for.
I will try to use noticing and welcoming statements with my fiance – ‘I see you are sad’ and build ways to remind myself and him that we do not have to live under a life sentence.
Thank you for this.
For the highly cognitive patient, this session is worth while. Please consider make some version of this generally available, perhaps on a private youtube channel, then post links to that channel on forums where people are already seeking self help.
***
One modifier of neglect: For some neglect is intermittent. This in some ways is more destructive, as it teaches the client attachment is dangerous. This makes it far more likely that the will not form more than shallow relationships.
You mentioned Reactive attachment disorder, as well as the standard attachment styles. In childhood, therapists talk about disorganized attachment where the child in effect tries things at random. This isn’t talked about much in adults. I think this form can become what I would term “dynamic attachment” I hypothesize that patients can use all four styles — secure, fearful avoidant, dismissive avoidant, pre-occupied anxious — on demand, changing their styles depending on the “return on investment” they get from a given style. Moreover I suspect that most people do this, but tend to do it more slowly. E.g. It may take years to move from secure to dismissive with their partner, instead of a week or a day.
I now that in several cases coworkers that I felt very secure with (mutual support in life critical tasks) became my boss. Secure attachment (platonic) quickly moved to fearful avoidant.
Consider the 13 year old teenager who can go from “I hate you” to “thanks mom” in the space of an hour. Most people as they mature learn to handle these, find that hte secure attachment anchors them to change overall more slowly. Teens are insecure at the best of times, but if they have a prior foundation of secure attachment, they build on that most of the time, and the insecure forms are just temporary swings. Without that secure foundation though, the swings can be wilder, and also can teach the teen that changing styles is a quick and easy way to deal with people.
childhood trauma questionnaire
The ‘Maltreatment and Abuse Chronology of Exposure’ (MACE) scale for the retrospective assessment of abuse and neglect during development , Teicher
Vex – R – The Violence Exposure Scale for Children
I couldn’t hear exaclty what was the one that sounded like NMBS.
This was a response to someone who asked what the resources were that were referred to!
I think the distinction made between traumatic neglect and emotional neglect may be very useful in identifying and supporting individuals who grew up or are existing it what appears to be the “perfect” family. Both the parent and the child may be fully unaware of this type of neglect ( based on parental learning history). Family relationships can be complicated and multifaceted, of course, and I think that sometimes, one child may be emotionally neglected when others are not. This could also be an indicator of trauma in the parent at that life phase, or disrupted parenting due to physical/mental health intrusions. this was very interesting and insightful, as always.
Excellent presentation. Engaging, dynamic, filled with research and practice information. I especially liked the case examples. Glad I signed up for the Gold Package before I started.
Thanks
Excellent session today. Some ideas I will use are to become more aware, stay positive as much as possible, and stay focused on healing.
I very much appreciate the differenciation in 7 different forms on neglect. It’s seems promissing to me to expand my vocabulary about neglect and about relational, social and intra – family circumstances of neglect and trauma. I didn’ yet get the notions very clearly. I might have to subscribe for the Gold Version …
Thank you for the broddcast. It was an aha! moment for me to realize how much differnce a statement like “I see you are sad” etc. can make, and how much of an effect it can have.
This was all very helpful! THANK YOU VERY MUCH for making this available for the world. I live in a small city in Mexico, and don’t have access to learning more in person on how to help my clients, the mayority of low socio-economical background experiencing neglect and abuse. I don´t have the resources to buy the Gold Packet, even with the discount. If there is a way to get it for free, I would appreciate it greatly. Very interesting was the part of not putting so much emphasis on stress reduction/calming techniques, but to first adress cognitive interventions. Also, on how some have the unability to feel what is going on inside, but have that numbness or feel invisible, on aideas on how they can feel SEEN. Also helpful for me is about clients that can´t make eye contact and how to approach this in a non- threathening way. I see lots of parents, so the way to address their disciplining techniques was helpful, in a way of not feeling judged. To distinguish the different types of neglect was very helpful. GRACIAS!!!
Fascinating to hear about the different responses to eye contact, what happens in the brain and learn how to gently approach. This module has helped me understand more where my clients may be coming from and why they behave the way they do.
Thank you to Dr Eboni Webb for validating the awareness of systemic neglect in practice, where in =South Africa, for example an abuser cannot be kept away from a victim as there are 5 people sleeping in one room – being AWARE of this in practice is so vital. THANK YOU to all presenters for affirming the power of techniques that are often missed – ASKING parents/caregivers how they were parented, disciplined, attached…such important messages that you are sharing. And thank you for making these legends of trauma available to those of us who cannot afford the USD prices as African psychologists and trauma experts.
Cognitive intervention, are not going to work when you are disconnected with your feelings. It is very frustrating that CBT are often used in an attempt to help, my reasoning is that the practitioner miss the correct diagnosis of c- PTSD. Very grateful for the work of NICABM.
Thank you so much for sharing this work for free.
I have wanted to join your courses for a while now. “But have no money at present to do so – I see my childhood deficits have left me resource-less over the years.
Every little bit of information helps my neuro-plasticity, and hopefully one day will help me become a member of the village – I’m working on it.
Looking forward to the next recording
Thank you for the opportunity to be part of these sessions. I am a lay counsellor in Namibia (Africa). Currently studying at The South African Seminary as a Pastoral Counsellor. My biggest take from today’s session was the part about emotional neglect and how someone reacts because of this. Their disconnect and inability to express themselves in words but also their diminished drive for attachment. The importance of attending and helping the person feel noticed, not rushing at first to help someone ‘feel’ is also important.
Thank you for the opportunity and blessing to be part of these sessions.
Blessings
Esmé
thank you, i will certainly use the tips i heard here, today, with my patients. i will change the office chairs, take a blanket there to mediate the felling of containment, i will use some postures and gestures to help people experience the care, the sence of protection and empowerment that they haven’t.
Was thinking about this idea of using somatic interaction and remembered my neighbour is a music therapy worker – african style drums. We could work with this with groups of clients.
Also was thinking of gestures with fun in them like a “high five” at the end of a session, to express connection and warmth without threat. (made me think of the messaging and work of the handshake when it is used – manylevels of connection and calibration for safety going on?)
Also – wondering about an arm wrestle with some clients (I have wondered with some neglect/abuse clients – if client is invited to undo a knotted/tangled piece of rope or silk scarf – with one hand, whilst arm wrestling with me simultaneously? Yes that is probably too much but both symbolically came to mind as somatic work that might bring fun whilst also take the eye contact intensity away but build connection and acceptance.
The different from of neglects were completely new for me like-
1. Emotional neglect
2.Traumatic neglect
3. Systemic neglect
4.Societal neglect.
All these forms of neglect will help a lot to do assessment and the relevant interventions all of YOU suggested here.
please, keep broadcast free for us, mostly those who are working in developing countries like me. Now I am working in Rohingya response in Cox’s Bazar Bangladesg. All these will heplp a lot to work with all these severely traumatised people.
Excellent delivery and helpful insights. I would becconerned about misunderstanding and misinterpreting the presentation,behaviour and vitally yje aetiology of those clients on thecautistic spectrum.
Thank you for the opportunity to be part of these sessions. I am a lay counsellor in Namibia (Africa). Currently studying at The South African Seminary as a Pastoral Counsellor. My biggest take from today’s session was the part about emotional neglect and how someone reacts because of this. Their disconnect and inability to express themselves in words but also their diminished drive for attachment. The importance of attending and helping the person feel noticed, not rushing at first to help someone ‘feel’ is also important.
Thank you for the opportunity and blessing to be part of these sessions.
Blessings
Esmé
As a lay person THANK YOU. I was kept in a pram in a shop for the first 10 months of my life and have spent most of my adult life in therapy trying to find out what was wrong with me. The work you all have done is so helpful. With deep gratitude from a survivor of early childhood neglect who is almost healed from Sydney Australia.
Very helpful delineation of the types of traumatic neglect that human beings experience…The emotional, physical, societal. Being attuned to which ones the client experienced will determine the type of intervention I use.
Wondering if you’ll be incorporating Polyvagal theory into this exploration of trauma and it’s treatment? I’ve found that when clients understand the autonomic responses of the CNS they become less judgmental and ashamed at the fight, flight, fawn or freeze response they used during traumatic experiences.
As a physician Psychotherapist from Canada , I agree with you and find Dr. Stephen Porgess work of PolyVagal Theory extremely useful in soothing the patient’s ANS ,thus rewiring the brain. The Wandering Vagus nerve’s role in Rebalancing Psycho, Neuro , Immuno, Humero,Bio systems of our Evolutionary Nervous System over Millenia.
You can access lot of work done with Therapist Deb Dana on that basis,
free on you tube