The Book

The intentions of this book are threefold: to expand the definition of neglect to include emotional neglect, to create a more profound understanding of the impact of childhood neglect on adult survivors, and to contribute to the training of clinicians who are serving survivors of neglect.

Neglect is the most neglected form of child abuse. Mandated reporters of neglect are taught to look for the obvious signs, as noted at:
childwelfare.gov

Signs of Neglect
Consider the possibility of neglect when the child:

• Is frequently absent from school
• Begs or steals food or money
• Lacks needed medical or dental care, immunizations, or glasses
• Is consistently dirty and has severe body odor
• Lacks sufficient clothing for the weather
• Abuses alcohol or other drugs
• States that there is no one at home to provide care

Consider the possibility of neglect when the parent or other adult caregiver:

• Appears to be indifferent to the child
• Seems apathetic or depressed
• Behaves irrationally or in a bizarre manner
• Is abusing alcohol or other drugs

The bad news is that there are plenty of children who are victims of neglect and emotional abuse that do not display the above symptoms. Often, parents function well enough outside of the home to appear to be good caregivers. This dynamic can be both confusing and crazy-making to a child, and a precursor to self-blame.

Neglect exacerbates abuse. It also sets up a foundation for continued abuse to occur. If a child has no comparison to being treated with respect, that child will be more likely to become victimized. That child will be less capable of trusting adults, and will be more likely to keep abuse a secret. Without a trustworthy adult to process the experience of neglect and abuse, or to provide a comparison for the child, that child is the most likely candidate to develop aftereffects of neglect and symptoms of Post-Traumatic Stress Disorder as an adult.

Dan Siegel, a psychiatrist and the Executive Director of the Mindsight Institute, believes that neglect can lead to other diagnostic symptoms as well. In a lecture at the Garrison Institute on March 2, 2011, he discussed how the brain of a child develops in response to the parents' interactions with the child. If the child is neglected, critical connections in the brain do not occur. These are physiological connections that allow emotions such as empathy, security, the desire to experience new things rather than shrink away from them, and even morality to be integrated in the child's personality. He believes that "every mental disorder in the DSM" can be seen as the result of a lack of attention, or "attunement" between a parent and a child. Dorothy, whose story is later discussed in this book, listened to this lecture. She was most impressed with a wonderful observation that Dr. Siegel made. He spoke about the mind being more like a verb than a noun, and noted that it is never too late to build these connections in the brain, through therapy and other types of interaction.

Dr. Siegel's words ring true for the clients discussed in this book. Through frustration, introspection, and hard work, they have created the lives they desired, despite their neglect histories.

There is no map for healing, and each individual journey is different. Since healing is not linear, its path is usually jagged. Perhaps we walk two steps forward, and one step back. Some of us make behavioral change and wait for our emotions to catch up. Some of us succeed at deep introspective therapy before seeing any behavioral change at all. This book interweaves stories of neglect survivors during the beginning, middle and at the end of their journeys.
Living Past Neglect is meant to replicate a real journey, not a step-by-step map to success. Although it may open wounds, there are numerous success stories and tools offered to gain insight into your particular road, and to close those wounds forever. No one will feel your pain for you if you don't. There is no way to compensate for childhood losses, or to fill the void left in the wake of neglect. Losses need to be grieved, and re-parenting is possible. With experienced clinicians who support and encourage us, we can all cry our last tears about our histories.

Change does not happen overnight. In order to make profound change in our lives, we need to know what we will be losing. Survival skills, aftereffects and defenses have served us well. They often produce secondary gains. This book serves to educate adult children of neglect, as well as their therapists. If you are an adult child of neglect, this book will assist you in deciding what you want to take from your history, and what you want to leave behind, in order to become the best you can be in this life.

Although there are other books available to adult children of neglect and their therapists, none of them emphasize the following four crucial components of healing. The first component is the
resolution of negative self-talk. Resolution of self-criticism is a prerequisite to the development of the compassion toward the self that is necessary to resolve the next three components.

The second component is the disclosing of the
introject - or, the internalized neglectful parent. Helping clients to let their introjects surface involves reading between the lines of their conversations. Introjects can be slippery and elusive. Therapists can assist clients with neglect histories to disclose their deepest fears of becoming like their neglectful parents.

The third topic is
transference - or, the ways in which we repeat old patterns of neglect in order to bring them to the surface. This book will assist clients and therapists in allowing old patterns to surface, so that self-discovery and emotional evolution can occur. The by-products of this introspective work are the ease in which we are soon able to attract loving, supportive, trustworthy people into our lives; the enhanced ability to achieve true intimacy in relationships, and the capacity to break the cycle of neglect with our own children.

The fourth component is for therapists and beginning clinicians in the mental health field: utilize your supervision time to
process your own countertransference issues. If you are a clinician with your own neglect history, it is crucial that you are

aware of your own aftereffects, whether they are completely resolved or not, to work with survivors. Your awareness will prevent the clouding of your lenses as you seek to help others.

I have written this book in honor of the former clients who walked this road with me. Their memory retrieval redefined their histories in their conscious minds. They took difficult and brave actions toward resolution. They overcame their childhood neglect and trauma histories with fidelity and tenacity. And they have all broken the cycle of neglect in their own families, with the help of therapy.

Lori Bennett, LCSW
August, 2011


Dynamic Psychotherapy with Adult Survivors

Living Past Neglect

Table of Contents

Acknowledgements
Preface
Introduction

Part One: Listening for Neglect

Chapter 1 - "But Nothing Happened!" - Redefining Childhood Neglect
Chapter 2 - PTSD Revisited
Chapter 3 - Magical Thinking - Finding Power in Helplessness
Chapter 4 - Weight Matters - Using Food for Comfort
Chapter 5 - Gone Too Soon - When Death Leads to Neglect
Chapter 6 - At Home with Incest: The Paved Road from Neglect to Abuse
Chapter 7 - The Broken Promise of Love: Addicted Parents and Neglect
Chapter 8 - Adoption and Neglect

Part Two: Working with Neglect

Chapter 9 - "It Wasn't That Bad!" - Working with Defensive Structure
Chapter 10 - The Integration of Deprivation -Intrusive Thoughts and Hypervigilance
Chapter 11 - Working with the Introject
Chapter 12 - Neglect in the News
Chapter 13 - Grief and its Relationship to Neglect and Abuse
Chapter 14 - Understanding Developmental Theory in Relation to Neglect
Chapter 15 - Developing Object Constancy in Adults

Part Three: Overcoming the Neglect Scenario

Chapter 16 - Working Through Transference in Relationships
Chapter 17 - Working Through Countertransference Issues
Chapter 18 - Correction by Projection
Chapter 19 - Therapeutic Tools for Working with Adult Survivors of Neglect
Chapter 20 - The Therapeutic Environment
Chapter 21 - For Therapists with Neglect Histories

Appendix: Notes
Resources
Bibliography
Index

Excerpt from CHAPTER ONE:

"But Nothing Happened!" - Redefining Neglect

Sun's Up

One of the first memories that I have is of waking up early in the morning. I can remember getting up in my crib and standing with my hands on the bars looking down at our two big dogs lying on the floor in my bedroom. I would try to reach down through the bars to pet them and usually they would get up and lick my hands and thump their tails on the floor. My parents' bedroom was right next to mine so I would start to call "Mom, dad, sun's up" over and over until one of them came in and let me out of the crib to be with the dogs. Usually one of them would just come in, set me on the floor, and tell me that breakfast would be later. They either told me to be quiet or I just knew because I tried to stay as silent as possible, even placing a pillow or blanket under where the dogs' tails might hit the floor. I really loved the time I got to spend with "Basil" and "Todd" in the mornings. I didn't realize until much, much later that the need for quiet in the early hours of the day in our house was due to my mother's hangovers and depression.

I'm not sure if there was a particular incident that forced the change in my sleeping arrangement with the dogs, or if it was just one of my mom's mood swings, but eventually my parents took the sun and the dogs away. My father constructed some kind of light-blocking shades out of cardboard and tin foil and secured them to the outside of my bedroom windows one night after I had fallen asleep. I remember being confused when I woke up, just waiting for the sun to come up. I was still and quiet for what seemed like a really long time and I could not understand why the sun wasn't doing its usual thing. That's the first time that I remember getting that sick, anxious feeling in my stomach. I thought something was really wrong, like it could have been the end of the world. I said the dogs' names very quietly, just to make sure they were with me. They were. I heard them rustle and I felt Basil's breath go by the bars looking for me. Soon after, my dad made a big dog bed so that the dogs could start sleeping downstairs. My mom said that they had been panting too loudly. I stayed in that dark, silent, dogless room until my brother was born. It was then that I began to understand that every thing that I cared about could be taken away on a whim, depending on my mother's mood, and that I was a nuisance.

Sarah's Story

The first-born daughter of two alcoholic parents, Sarah was confined in her crib in a darkened room for hours at a time when she was a toddler. Although her parents had a great deal of money, Sarah was often hungry, learning to feed herself breakfast on her own while her parents recovered from drinking the night before. When Sarah couldn't reach the cereal, she improvised by eating cat food. Sarah became the primary caregiver for her brother when he was born, and started drinking "wine water" with support from both parents when she was twelve years old. Sarah was told that the "wine water" would calm her nerves. She was offered the drink on the first day of a new school year, and could never find her classes without assistance. She was offered the drink before a big test, with disastrous results. Sarah would force herself to sit in the front row of class, to try to prevent herself from falling asleep from the effects of the wine-water mixture. One time when her efforts failed, Sarah was found asleep in the front row. Her teacher contacted Child Protective Services after smelling alcohol on Sarah's breath. Although a case worker conducted monthly visits to Sarah's home, the agency eventually closed the case. Sarah's comfort came from her family's pets. She learned unconditional love from the two large dogs that lived in her home, and as an adult, she has chosen a career that allows her to rescue abused and neglected animals.

Sarah's story is unique, but she is not alone. There are countless women like her, who are coping with their neglect histories in every aspect of their adult lives. The focus of this book is not on the adult who was so severely neglected in childhood that s/he was removed from the home. The focus of this book is on the adult whose story never made headlines, but who was subjected to a persistent lack of empathy, emotional distance and abuse throughout childhood, to the extent that s/he felt unwanted, unloved, ignored and invisible.