Book Review: Emotional neglect and the adult in therapy: Lifelong consequences to a lack of early attunement

Kathrin A Stauffer
W.W. Norton & Company

Reviewer:  Dr Toyin Okitikpi

The author of this interesting volume has stumbled upon a distinct area of psychotherapeutic practice, which is not often seen as an entity in itself. This book focuses specifically on the experiences of emotional neglect of those who have been ignored children, exploring the impact of their caregivers’ unavailability on the child as they grow up, and how these early experiences manifest in adulthood.

The book aims to explain how ‘the traumatization of the neglected person is characteristic and distinct from that of an abused victim’ (p. xiii). The explicit premise of the book does recognise that there are many children who experience both emotional neglect and other forms of abuse, but states that what is not so widely acknowledged is that there is a group of children ‘who may not have been rejected or abused earlier in their lives’ (p. xii), but whose presence, from infancy, was ignored. They never felt welcomed or loved, nor experienced any positive responses from their caregiver. It is this explicit deficit that the book addresses.

The nature and impact of emotional neglect is explored in six chapters, and in order to get the best out of the book it is worth taking each chapter sequentially. Chapter one sets the scene and reinforces the point about how inevitably our early childhood experiences affects later life. While this is not a big revelation in itself, the author offers a different way of looking at the experiences in relation to emotionally neglected or ignored children. In chapter two the author lays out different scenarios of emotional neglect, characterised by absent caregivers, depressed caregivers, and preoccupied caregivers. What unites the children of these caregivers are the developmental deficits, their unparenting, their uncared for experiences and the heavy burden they are imbued to endure.

It is not until chapter three that the author gives the reader the psychotherapeutic theories about ignored children which they may have been craving, and references biodynamic psychotherapy, models of the mind, developmental deficits, attachment theory, avoidant attachment style, emotional self-regulation and the schizoid character style; there are a number of concepts and ideas discussed to keep readers’ cerebral cortex engaged. In chapter four the author combines her psychotherapeutic professional experience and her scientific background to explore the increasing collaboration between neuroscience and psychotherapy. Stauffer considers polyvagal theory, as well as the dorsal vagal complex (DVC) and the ventral vagal complex (VVC), and the relationship between the two, with one acting as an immobilizer while the other is the mediator of bonding. Also, there is reference to affect regulation in infancy and the role of the automatic nervous system (ANS), with its astonishingly versatile and powerful role in regulation of affect.

In chapter five there is, what I regard, a useful guide to help practitioners understand what they need to be aware of, and the approach to consider when working with adults who were ignored or emotional neglected as children. In chapter six the author discusses her own experience as a therapist of what has worked, for her, in her interventions with adults who have been ignored children. Although she acknowledges there is a dearth of therapeutic approaches tailored to clients with developmental deficits, and that different therapies may be possible, she has found that body psychotherapy, amongst others, can in particular be adapted for this group of clients.

Overall, I found there was very little to disagree with either about the form or the content of this book. It is one of those volumes that one comes across and finds so many aspects of the descriptions that are recognisable. In essence, as is very much evident in the very last section of the book, entitled ‘concluding remarks’, there is a plea for the recognition of this group of clients who, because of their background, are prone to being ignored or emotionally neglected; implicit in the book is the idea that we live in a world that appears to value and valorise iconoclasts, bombasts and those who beam with self-confidence, individuals that are able to demand and make their needs known, however inarticulately. But for the emotional neglected or ignored children theirs is a silent world of extreme vulnerability, where guilt, crippling shame and high-anxiety cause feelings of inadequacy and disconnection.

This book is informative, sensitive, and important in its capturing of the life experiences of adults whose early upbringing, and experiences of being ignored, children, have had such a profound impact on their adult life. There are many ideas and suggestions within that would be of interest to therapists and counsellors, but I think lay readers would also find many areas in the book that would grab their attention.

Dr Toyin Okitikpi sits on several tribunal panels including the Mental Health Review Tribunal. He was Principal Lecturer and Head of Social Work at London South Bank University. He is a regular contributor to Contemporary Psychotherapy and his profile can be found here.
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