Abstract

Research has highlighted the effects of early neglect and abuse on the development of clinically significant problems in attachment, emotional self-regulation, and dissociative symptoms.

Years of research on the neurobiological basis of post-traumatic stress has placed dissociation along a hierarchy of defensive responses to threat. However, recent reviews of the developmental literature on dissociation suggest there is a “dual developmental pathway to dissociation.” One pathway follows from defensive reactions to states of fear and a second pathway involves intersubjective and attachment-related aspects of mother child interactions. Many clinicians are surprised to learn that two longitudinal studies of high-risk mother-infant dyads found that clinically significant dissociative symptoms – as measured by the DES-II – at age 19 are best predicted by the quality of the mother-infant interaction, specifically a lack of positive affective involvement and maternal flatness of affect. These studies found that early hostile and intrusive maternal behavior were not significantly related to later dissociation. (Guérin-Marion, Sezlik & Bureau, 2020).

The specific effects of neglect remain a somewhat hidden story. There is dramatically more research on posttraumatic symptoms and treatment interventions intended to lessen negative affect states by metabolizing memories of past adverse and traumatic experiences than research for overcoming the deactivating effects of the absence of mother-infant play, warmth, and affection or for directly helping survivors learn to tolerate and assimilate positive affect.

This research disparity parallels relatively neglected clinical issues on the inability of survivors of early neglect to tolerate and integrate actual positive interpersonal experiences into positive emotional states, interpersonal scripts, or self-concepts. These deficiencies, characteristic of those with insecure dismissing and disorganized attachment, generate and maintain profound psychological, medical, and social problems that limit the ability of individuals with these histories from progressing in psychotherapy.

Skills development models have emphasized distress tolerance, acceptance, and mindfulness training for patients with persistent negative affect states. The limited research on the benefits of therapeutic interventions to increase positive affect indicates they promote prosocial behaviors and creativity, broaden the scope of attention, reduce emotional symptoms and behavioral problems, and improve physical health. (Miguel-Alvaro, et al, 2021)

Similarly, research on EMDR therapy has focused on metabolizing adverse and traumatic memories. The sparse research on EMDR procedures to increase positive affect has focused on resource development and installation procedures to increase access to positive affect-related memories and images. There is no research on EMDR therapy procedures to help survivors of neglect learn to feel good about current positive emotional interactions.

More research is needed to identify optimal interventions to help survivors of early neglect learn to tolerate shared positive affect and to lessen deactivating and dissociative responses.

Through a review of essential research on the effects of neglect and positive affect focused interventions, case vignettes, small and large group discussions, this workshop explores the less visited domain of interventions for promoting capacities for tolerating positive affect states and ways to help clients to learn to feel good about positive emotional interactions.

Potential to Distress: No

This recorded conference session was originally presented as part of a live conference in April 2024.