How to Identify Childhood Emotional Neglect in Your Clients

For Mental Health Professionals

As clinicians, we all know how to see and diagnose depression, anxiety, phobias, substance dependence as well as a myriad of other disorders in our patients. We watch for a certain cluster of symptoms, compare the number and severity with the description of that disorder in the DSM or the ICD-9, and presto. Sometimes it’s pretty simple and clear; other times, it’s complicated.

But it’s never as difficult as with Childhood Emotional Neglect (CEN). Here’s why:

It’s not memorable: The adult symptoms of CEN are not caused by childhood events. In contrast, they are in fact caused by childhood non-events. They’re a direct result of a parent’s failure to respond enough to a child’s emotional needs. Since this is not something that happens to a child, but is instead something that fails to happen for a child, the child’s eyes don’t see it and her brain doesn’t record it. The adult patient in your office has no memory of it. This makes it really difficult to see. It’s not visible: CEN is often buried beneath depression, anxiety, phobias, substance abuse, or some other, more obvious or florid condition. It can also be buried beneath childhood trauma, which is far more obvious and memorable. Your client will likely be asking for relief from these more widely-known, visible symptoms. There aren’t words for it: Many of the symptoms of CEN are quite difficult to put into words. People seldom spontaneously report and describe feelings of emptiness, the Fatal Flaw, counter-dependence or Alexithymia the way they might report panic attacks, difficulty sleeping or alcohol abuse. It’s not well-known: Much of the public has been educated about the most common mental health maladies. Many people are able to recognize when they are depressed or anxious. Until now, CEN has received little to no attention. People don’t know it exists, or how to see it in themselves. It is my mission to try to change this, with your help.

Fortunately, there are ways to deal with all of these barriers. Here are the first five things (from the For the Therapist chapter of Running on Empty) to watch for to help you identify CEN in a client:

One of the first hints that I am sitting with a CEN client is a sense that the clinical picture doesn’t add up. For example, the client’s adult struggles seem inexplicable in the context of his description of his childhood. Since CEN is not typically remembered, many CEN patients describe their childhood as “fine,” leaving me wondering how these lifelong symptoms developed. Watch for a client to feel guilty, or even angry at himself, for simply having feelings. CEN clients received a powerful message in childhood: Don’t Have Feelings. The adult will therefore blame himself and feel ashamed of his emotions. Watch for a patient to be highly protective of her parents. Many CEN people’s parents were actually quite loving, and provided well for their children. The adult looks back upon childhood and sees the love and the material comfort, but can’t see what the parents didn’t provide: emotional validation and support. CEN clients can be fiercely defensive of their parents. Many CEN patients doubt the substance of their childhood memories. “I feel like I’m probably exaggerating, it wasn’t really that bad.” “Isn’t this boring for you to listen to?” “I don’t know why I’m telling you this, it’s probably not that important.” These are all common statements from CEN people who are relating events from childhood. Watch for Alexithymia, or Low Emotional Intelligence. People who grow up in homes that are blind to emotion don’t learn how to tolerate, identify, respond to or manage emotion. This is one of the most observable telltale signs in the therapy relationship. Of course, identifying CEN is only the start. It can also be difficult to help your client see that he has CEN. This is why I wrote Running on Empty. My hope is to help people everywhere and their therapists identify what’s going on under the surface, put it into words, and join together to correct it. In the book, I cover the ten primary struggles of the emotionally neglected child in adulthood, the twelve types of parents who are likely to emotionally neglect their child, and a full section on how to heal, including a chapter For the Therapist.