gmusic@nurturingnatures.co.uk

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This blog is to critically introduce, and contextualise, new research findings from developmental research, neuroscience, attachment theory  and other areas of psychology that are topical or are likely to whet the appetite of  anyone interested. The aim is to discuss research which will feel relevant and which might even, if lucky, make a differenc...e to how we approach our work or other areas of our lives. More

Neglecting Neglect: Why Therapists Do It & How We Can Break the Cycle 

A version of this blog recently appeared on the Psychotherapy Execellence Website  here  

 

Why Neglect?

In Nurturing Children I use clinical stories to illustrate essential elements of good therapeutic work. Ultimately therapeutic success depends on a good alliance, empathy, compassion and mutual resonance, alongside carefully gleaned skills and understanding. Yet some patients leave us feeling de-skilled, hopeless, even dreading sessions. I find this especially when working with people with histories of neglect, who have experienced insufficient growth-inducing experiences. This is different to those who are victims of, for example overt abuse or violence, who tend to be more reactive and challenging,

 

The feelings stirred up in us can be hard to own up to if our personal narratives include being ‘caring’, ’interested’ and ‘empathic’.

  • With such clients we often feel flat, bored and dulled-down.
  • They appear 'empty', inhibited, passive, self-contained, with minimal capacity for mentalizing.
  • They show little pleasure, rarely inspiring hope, affection or passion.
  • They can be thought of as 'under-looked' or 'unenjoyed', or after Alvarez, ‘undrawn’ rather than ‘withdrawn’.
  • They slip out of minds, stirring up little interest or worry.

 

Spectrum of neglect

  • from extremely deprived orphans to milder forms,
  • such as those with very emotionally avoidant, or depressed parents.

True I risk conflating symptoms and causes, as similar histories do not necessarily lead to the same symptoms, but there are sufficient commonalities to describe a common clinical experience.

 

Double deprivation

Neglected children initially receive scant attention, and later further deprive themselves by barely recognising life-enhancing relationship opportunities. While born with the same preconceptions of lively interpersonal exchanges as anyone, the lack of good experiences leads to lifeless internal objects, with little hope of introjecting anything good. They seem to project little too, having surprisingly little effect on others.

 

Nervous systems and brains

Inadequate early experience leads to ‘dampened down' nervous systems, the opposite of hyperactive aroused people. Emotional deprivation profoundly affects brain architecture, and programs our neurochemical system. (eg releasing less oxytocin).  Many develop autistic-like symptoms, lacking empathy and avoiding intimacy. We see deficits in right orbitalfrontal region, central to attachment patterns and emotional regulation, and less prefrontal left brain activation, central to agency and pleasure.

 

Countertransference

Such people evoke less interest than those with better developed autobiographical and emotional capacities. Our words and gestures, given with meaning, can feel denuded of life. It is in one’s countertransference that one really learns about these clients, and what it is like to be them, but our attuned resonance can lead us to feel as dead as them. We can say things in therapy just to escape their lifeless worlds.

 

Clinical technique

We must sustain an empathic stance without being drawn too far into such lifelessness, to stay psychologically animated enough to breathe life back into their psyches, while avoiding the trap of a 'going-through-the-motions'  faux  psychotherapy. Research even shows that anyone interacting with avoidant people becomes less interested in people generally!

 

With such patients we need a more ‘active’ technique. They often know little about positive emotional experiences such as enjoyment, excitement, attunement, playfulness or joy. To develop an interest in oneself and others, someone must have been interested in us. In therapy we tend to work a lot with clients’ defensive and fear systems, helping to manage difficult feelings. However, with these patients we also need to build their ‘appetitive’ seeking systems, via mutually enjoyable interactions, allowing aliveness to flourish.

 

Summary

Humans are born ‘experience expectant’, primed for interpersonal interaction, but emotional development is stymied without growth-inducing relationships. In therapy we need to find a way to encourage agency and positive affect, and the paradoxically, step back from lifeless encounters to empathically be in touch with such lifelessness. With them we walk a delicate tightrope between amplifying aliveness, agency and enjoyment while not being too intrusive, manic or seductive.

 

This blog describes children and adults I feel particularly worried about, who rarely inspire passion and therapeutic zeal, who have been neglected emotionally in their early lives, and often then evoke further neglect. The long-term sequelae of such neglect can be 'deadly' serious, probably more harmful, yet less noticed, than more visible trauma. Neglected children and adults I have worked with often ‘warm up’, get livelier and more real, given sufficient adaptation to our practice, and the courage of emotional honesty.

 

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Joining forces; Telomeres, social, psychological and political challenges

 

In the last few days I came across yet another interesting article [1] showing that prenatal stress is linked with  shorter telomeres. Telomeres are those caps on the end of chromosomes that can fray and shorten with stress and age [3], are a classic biomarker for health. Shorter telomeres are bad news, heralding ill health, and indeed, early death, or in other words early stress might program the body to develop a faster metabolism, which also leads to faster ageing and more physical and mental illness. One recent meta-analysis looking at over 40 papers corroborated how early adversity, such as abuse or neglect, links with shorter telomere length [2].

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Death penalty for being abused? The price is too high for society and disadvantaged young people

 

Young people who had been in the care system are far more likely to die in early adulthood than their peers, a report showed last week; indeed they are at least 7 times more likely to die prematurely, before the age of 21. The BBC story about this highlighted poor access to mental health services, the lack of general support available, and the consequent over-use of drugs, alcohol and other forms of unhealthy self-medication and attempts to manage stressors.

I have worked with children in the care system for over 30 years and at least the research is showing what we have always known clinically. Bad early experiences lead young people to use drugs, alcohol, take risks in sexual and other behaviours, but also to struggle academically, socially and in their emotional wellbeing generally. Most of my most worrying cases in the NHS have been in the care system, and major crises often occur at the age when they are supposed to become ‘independent’ at the age when most well-adjusted children from loving families in fact rely on their families more than ever.

 

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Obesity, unhappiness, and poverty: the urgent need to avoid simplistic solutions

A version of this blog can also be found on the Tavistock and Portman NHS Foundation Trust website here, 

An NHS Trust in Yorkshire recently decided to deny non-urgent treatment to obese patients and also to smokers. A recent guardian article called this a form of discrimination similar to racism. It is true that we are facing an epidemic of obesity and linked health issues including diabetes and heart conditions. The solution is not to discriminate against or blame people who in many ways are already victims. There is a danger that our discourses about food and obesity become another way of blaming the poor for their poverty and its effects. People are criticised for being lazy, greedy, lacking control or selfish, yet often what drives eating is far outside consciousness and has sensible explanations.

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Brexit, project fear, brains, racism inequality and the other

Many of us are shocked to the core by the referendum result, and even more so by the campaign and the way it was conducted, especially its racist undertones. In many ways this was a protest vote, and whatever his weaknesses Corbyn has understood that inequality, uncertainty and the increasing power of smaller elites has impacted powerfully. What the left seem not to have learnt from its history lessons is how at times of serious crisis people become inward and conservative and indeed, often xenophobic and distrustful of the other. This makes more sense when we understand just what fear, anxiety and anger does to the brain.

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Austerity and neoliberalism are bad for our health and wellbeing

 

Goodness, what a turn-up for the books! The International Monetary Fund has now stated that neoliberalism and its accompanying policies of austerity and rising inequality are a bad thing, even for the economy let alone for people’s mental and physical health and wellbeing. Inequality is recognised as particularly pernicious, and it has increased drastically via a system that has bettered the financial lot of the very very few at the expense of most people, and also at the expense of a thriving economy. The health and mental health effects of this have been shocking, as I show below.

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