Reenacting trauma patterns in therapy: neglect

 

Navigating attachment and dependency in therapy has always been difficult. Developmental trauma just adds a deep sense of desperation to the problem and makes it more complicated. There is a lot written about unhealthy dependency in therapy and how to avoid it. Today I want to shine a light on the effect that chronic neglect in childhood can have and how this old pattern can sometimes be reenacted in the therapeutic relationship without anyone being aware of it.

 

Some traumatized people tend to feel helpless, powerless and out of control of their life. They look for someone who will fix it all for them, take care of their problems and make them feel better.

When there is a history of chronic neglect we might also develop the opposite pattern. We learned that we get more needs met when we take care of them ourselves. So we get competent in many areas of life to make sure that we never ever need someone. We just do it alone. Asking for help won’t get us anywhere anyway. Hidden behind this hyper-independence is usually a fear of rejection and vulnerability. It is a lot safer not to need anyone.

When it comes to DID, we usually find both tendencies held by different parts. Those who manage daily life can be hyper-independent while younger parts often have a deep longing for attachment. In both kinds of parts we will find feelings of neglect.

 

 

Hyper-dependent parts

It is a personal observation that at least some degree of dependency is prefered by most therapists. It seems like it is more common in people with anxiety and depression and they are just more comfortable with it. Things get tough when needy child parts get activated and they relive their old experiences within the therapy session. Their needs are bottomless and nothing but being there 24/7 could ever be enough for them. The more they are taken care of the more a Host might step back and let that happen without getting engaged anymore. That reinforces the dissociation and destabilizes the system. Ts need to set boundaries.

Which will leave us in a place of despair. It is normal for traumatic memories of neglect to come up in this situation. Old beliefs will flood us (‘I am bad and don’t deserve help’, ‘I am too much and she will leave me’, ‘it would be better to die/run away/cut contact/punish myself’ etc.)

What is happening isn’t actual neglect through our therapist. We just get confronted with all the old neglect that we experienced. It can feel absolutely overwhelming when we are stuck in the perspective and experience of a child.

 

What helps

When needs are stuck in the past, it is impossible to meet them today. That means that parts who despair in their fear of attachment loss need to get grounded in the present. They need to learn that the body grew up, trauma is over, they are safe now, former abusive caretakers are gone and the present looks different.

Next we need to get incredibly good at reality checking. What is really going on? Who is the T we are expecting to take care of us? What is the job Ts do and why does that include free time, boundaries and not taking care of us? What did they really say when they expressed a boundary? Literally. They never said they would leave. Our next appointment is in 3 days etc

Child parts tend to confuse old experiences with the current one and they need to discriminate the situation otherwise they will just stay stuck. It often takes time to figure this out.

The more parts of us learn to take care of the needs of other parts, to comfort them and be with them, the less we have to rely on outside people (help for that). Those who are capable of caretaking can focus on getting better at it. A team that works together will be less affected by old needs that get triggered.

 

Healthy boundaries are not neglect. Our Ts do a job that comes with these boundaries. They get paid to help us learn how to work together, not to be our parent. These feelings of neglect are usually old feelings of the past and a T who sets boundaries will not reinforce the neglect pattern, it just gets re-activated.

 

 

Hyper-independent parts

The greater danger of reinforcing old neglect patterns is with the hyper-independent parts. They became the way they are today because they had to, no one else took care of things. Now they know quite well that they can do it all alone, that they don’t need anyone, they are strong and smart and… lonely. In need of support. Maybe bitter but probably at least cynical about help. The longing for support isn’t gone. It is just covered up with high-functioning behavior. Sometimes we have reached a point where we don’t even want to let anyone in anymore, we reject offers of support and joke about it but deep down, the isolation, loneliness and the pressure of having to do it all alone is crushing us. It is the same taste of despair that hyper-dependent parts get, just the over-controlled version of it, but it isn’t less painful.

It just looks very different on the outside. We are the ones nobody is ever worried about. People trust us to manage tricky situations without supervision. Since we don’t come running for help we are probably fine. We are left to figure things out for ourselves because we are smart like that. We’ve had therapists leave us alone with everything related to parts because they just expected us to figure it out somehow and we did, so everything was fine. No need to get extra training then. Weeks can pass without contact or appointments and nobody pays attention to it. In clinics, we might vanish from the minds of a whole team. Because we don’t approach with a problem, there can’t be one. We end up sitting in our rooms struggling unnoticed and we wouldn’t even dream of looking for help because we are so used to there not being any. Why bother. ‘Other people’ might have vanished from our pattern of problem-solving completely so we don’t even know this is an option.

And when help is offered we might not have a concept of how to make use of it. Even if someone is with us, we cannot transform that presence into something helpful for ourselves because we don’t know how to let others in or take part. We sometimes get accused that we don’t let anyone work with us, when we literally don’t know how. We are not the kids who are crying anymore, we are the kids who have resigned and don’t even recognize people as possible attachment partners or source of something good.

Ts who take our hyper-independence as a sign that everything is ok will reinforce the inner pattern of neglect. They will leave us alone and miss the cry for support that is hidden by functioning. The golden rule in DID is: If you can’t see the drama, it is happening in silence.

 

What helps

Hyper-independence is not healthy because it is not adaptive. We can’t know and learn everything that is ever needed in life. People need each other. It is normal to have needs and to want support. When we work on accepting normal human needs we can get more flexible in our behavior and try to seek help more often.

To make new experiences we need to give people a chance to respond. That means we need to communicate and express needs. Giving up some of our hyper-independence doesn’t mean we will suddenly get totally dependent. It is more like we are getting to a place of healthy independence. Over-controlled parts are rarely at danger to give other people that much control over their life…

A difficult situation that will come up often is when we ask for help and we don’t get it. People have other responsibilities, no time or energy etc. It can be incredibly hard to ask a second time when we were rejected before. When we try to replace old convictions like ‘I am all alone. Nobody is ever there for me’ we cannot replace them with ‘people are always there for me’ because that is not true and doesn’t reflect reality. People are there for us, sometimes. And many times we don’t get the help we need. It needs thorough reality checking here to see what the statistics are. Maybe 10% of our approaches are successful. That’s 10% and not nothing. We can limit our expectation of how much support will be available accordingly. That is still painful, because it leaves us alone for the majority of situations, but if we make sure we get the numbers right, it helps us to not dive into the sense of neglect. There is help available sometimes. Not ideal, but it is there. If there are less positive responses than that we need to find new people to approach. Maybe we are asking the wrong ones.

Sometimes the urges to withdraw and not approach anyone for help get overwhelming. Why bother when the success rate is so low anyway. When we decide to stop reaching out we need to make it clear to ourselves that this is our choice. We choose that we prefer to do it alone instead of risking a 10% success rate. There would be some support available but we consciously decide not to look for it. We control the situation by choice. That awareness will protect us from reinforcing the neglect pattern too. It isn’t neglect when we are the one willingly rejecting help.

 

 

A word for Ts

If your patient creates noticeably less work than you would expect, it would probably be time to double-check what is going on. It is not automatically a success or something to be glad about. They might need help and not be able to initiate an interaction or even realize there is a possibility of an interaction to solve this. Waiting for hyper-independent patients to come to you kind of isn’t working. That is the whole problem with hyper-independence. Check in, invite, ask questions, offer choices. In our experience, inviting testing does little to help when the basic inner concept of support is lacking. Pushing just increases our avoidance, but not checking can be devastating and corrode the therapeutic relationship in utter silence, without anyone doing anything. Just because you can’t hear us doesn’t mean we are ok. Neglected children are used to withdrawing into silence and creating as little work as possible. That is the whole point of neglect. If you don’t check on us and just wait, we will withdraw more. Doing nothing is the worst you can do.