As a trauma therapist, I have the privilege of holding space for others as they process their experiences—and, at times, of helping carry the weight of that trauma alongside them. We are trained to focus on what happened and how to navigate its lasting impacts. Over years of experience and training, this has remained the core of my clinical work: supporting others as they make sense of and move through what has happened. I likely would have repeated this pattern of processing and solving problems throughout the duration my career- if I hadn’t met Ruth Cohn.

Ruth is a psychotherapist and educator who specializes in recognizing and healing attachment wounds. I had the privilege of attending her workshop at this year’s Psychotherapy Networking Conference in Washington D.C. and the two hours I spent in her company will forever shape my approach to attachment and trauma work. Ruth spoke about holding space for the stories about what did not happen, and the lasting impacts of childhood neglect.

Most of us are familiar with Bowlby’s work on attachment theory and how this shapes our relationships with others as we navigate life, Ruth builds on how avoidant attachment connects to neglect and how we should not assume that individuals who lack a trauma story are trauma-free. In fact, the opposite can be true; individuals who look like nothing is bothering them on the outside, can in fact, experience a great deal of inner turmoil (insert people-pleasing tendencies here).

Those familiar with the work of Dr. Allan Schore likely understand that infant brain development depends on the quality of emotional communication between caregiver and infant. Simply put, giving and receiving attention stimulates a developing brain, when this does not occur, this system is damaged and in particular, there are lasting impacts to emotional development. Over time, children who experience neglect come to expect that no one will show up for them if they are presented with an alternative option, coded by the child as anyone is preferable to them. These children are often prone to self-blame and frequently hold the belief that “everything” is their fault. Disconnection can also result in perfectionism tendencies later in life. When our nervous systems become dysregulated, the best-case scenario is that we will receive comfort and then the system will calm down. This dance of rupture and repair between child and caregiver is how a child learns to self-regulate. When this does not occur, we often see not only emotional dysregulation but tendencies of helplessness, passivity, procrastination, attention deficit order, difficult initiating and completing tasks. These adults are often highly self-reliant, who tend o connect to others without being dependent on them. Lack of connection to others and feeling like you do not matter can propel feelings of hopelessness and even depression.

Working with a skilled therapist can often be helpful for individuals who have experienced childhood neglect. The story of what did not happen is just as important as the trauma stories of what did and should not be overlooked. I work with clients to name and reconstruct their stories, offer emotional support, to foster agency, to integrate their stories into present day and to facilitate closure. While we cannot change what happened or didn’t happen, we can change the body’s response and learn to soothe our nervous systems and to facilitate healthy attachment.