Hidden in Plain Sight: Understanding and Addressing Self-Neglect in Psychotherapy

Self-neglect often goes unnoticed in therapeutic conversations—not because it isn’t present, but because it is difficult to articulate. Clients might describe feeling “stuck,” “numb,” or “uncertain about what they need.” The words aren’t absent due to a lack of significance, but because the very act of recognising one’s own needs may have been absent due to childhood conditioning or, over time, become unfamiliar. As a psychotherapist, I’ve come to view self-neglect not merely as a set of behaviours, but as a profoundly complex and psychologically rooted experience of self-abandonment.

What Is Self-Neglect?

Self-neglect can be broadly defined as a consistent failure to care for one’s own basic physical, emotional, or psychological needs. But beyond the surface, it often reflects a more profound inner conflict. Drawing on Capaldi and Elliott (2023), we can begin to see self-neglect as a form of hostile neglect—where individuals habitually negate or minimise their own needs, dismissing their worthiness of care and kindness.

It isn’t always loud or dramatic. It can show up in more subtle ways—through the minimisation or negation of one’s feelings, the refusal to rest when exhausted, the inability to ask for help, or persistent patterns of passivity and overwhelm. This isn’t about laziness or a lack of motivation. Rather, it often stems from a history of emotional abandonment or chronic invalidation, where one learns—sometimes unconsciously—that their needs don’t matter.

Why Is Self-Neglect So Hard to Spot?

One of the most challenging aspects of addressing self-neglect in therapy is that it often goes unnoticed, despite being right in front of us. Clients rarely present with statements like, "I neglect myself." More commonly, they say things such as: "I'm not sure what I need," "I just keep pushing until I burn out," or "Other people have it worse."

There is often a vacant quality to these admissions—what Capaldi and Elliott (2023) describe as a gap in self-awareness. This gap reflects a fractured self-relationship, where immediate moment-to-moment experiences are at odds with more abstract, socially shaped self-concepts. In therapy, this can look like confusion, avoidance, or even a blank stare when asked, “How do you feel about that?”

These aren’t signs of resistance—they’re signs of an overwhelmed system that has learned, perhaps for survival, to turn away from the self.

The Emotional Roots of Neglect

Self-neglect often grows in the soil of emotional overwhelm and unworthiness. When someone has internalised the belief that their needs and emotions are “too much” or “not important,” they may start to adopt avoidance strategies. These might include:

• Minimising their distress (“It’s not a big deal”)

• Validating criticism over compassion

• Placing disproportionate weight on others’ opinions and needs

• Withdrawing from relationships or responsibilities

• Feeling chronically uncertain about what they want or need

Over time, these patterns can undermine one's ability to practise self-care, resulting not only in emotional distress but also in physical decline. In some cases—especially among vulnerable groups such as the elderly or those with complex mental health histories—this has been recognised as a significant public health concern (Dong, 2017; Lauder et al., 2005).

Addressing Self-Neglect in Therapy

Therapeutic work with self-neglect must begin with gentle, persistent inquiry into the client's lived experience. We can’t rush people into naming feelings and needs they’ve long denied. Instead, we create space for curiosity and reflection, allowing the neglected parts of the self to emerge at their own pace.

Some guiding principles include:

• Validating emotional experience: Helping clients recognise that their needs and feelings are real, valid, and worthy of care.

• Exploring implicit patterns: Noticing how self-neglect shows up in the client’s life—even in the therapeutic relationship.

• Developing self-awareness: Supporting clients in bridging the gap between what they feel and what they believe about themselves.

• Introducing self-compassion: Encouraging practices that foster kindness towards the self, particularly in moments of struggle.

As Capaldi and Elliott suggest, the journey out of self-neglect lies in reconciling the divided parts of the self—bringing into dialogue those inner voices that contradict, compete, and often cancel each other out. This is not easy work. But with time and care, clients can begin to access a more integrated and compassionate sense of self.

Moving Forward

Self-neglect isn’t just a clinical issue—it’s a human one. It touches on the core of what it means to feel seen, worthy, and whole. As therapists, we must remain attuned to its quiet presence in the room. And as individuals, we must all learn to ask ourselves: “Am I tending to my feelings and needs, or quietly pushing them away?”

By recognising the hidden nature of self-neglect, we can begin to respond—not with judgement, but with understanding. And perhaps, in doing so, we create space for something long overlooked: the permission to care for ourselves, fully and unapologetically.

If this resonates with you or someone you know, therapy can be a supportive place to explore these themes. You are not alone—and you deserve care, too.

References

• Capaldi, K. (2024). Decoding negative treatment of self: Comprehensive measurement and diverse presentations in socially anxious clients (Doctoral thesis, University of Strathclyde).

•  Capaldi, K., & Elliott, R. (2023). Negative Treatment of Self in Socially Anxious Clients. Person-Centered & Experiential Psychotherapies, 23(1), 101-121.

•  Dong, X. Q. (2017). Elder self-neglect: Research and practice. Clinical Interventions in Aging, 12, 949-954.

•  Lauder, W., Anderson, I., & Barclay, A. (2005). Housing and self-neglect: the responses of health, social care and environmental health agencies. Journal of Interprofessional Care, 19(4), 317-25.

•  Lauder, W., Davidson, G., Anderson, I., & Barclay, A. (2005). Self-neglect: the role of judgements and applied ethics. Nursing Standard, 19(18), 45-51.