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

Self-neglect may go unnoticed in therapeutic conversations. Not because it isn’t present—but because it can be 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 obvious 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 say, "I neglect myself." More often, they express:

• "I don’t know what I need."

• "I’m exhausted but I just keep pushing myself"

• "I know other people have it a lot worse than me."

These admissions often carry a vacant quality, reflecting a gap in self-awareness. A person’s immediate, lived experiences may feel at odds with their broader, socially shaped self-concepts—how they believe they “should” feel, act, or respond. In therapy, this can show as confusion, avoidance, hesitation, or even a blank stare when asked, “What do you need?” or “How do you feel about that?” It is not uncommon for individuals to struggle to articulate their feelings and needs—not because they are unwilling, but because recognising and responding to them can feel unfamiliar or unsafe.

These behaviours are not signs of resistance or defiance. Rather, they reflect an overwhelmed system that has, perhaps as a survival strategy, learned to turn away from the self. Over time, this learned avoidance can become automatic, making self-neglect subtle yet persistent. In the therapeutic space, noticing these moments with patience and compassion can offer a first step toward helping individuals reconnect with themselves and begin to understand what they truly need.

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 erode an individual’s capacity for self-care, leading not only to emotional distress but also to physical decline. In some instances—particularly among vulnerable groups, such as older adults 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 begins with gentle inquiry into the client’s lived experience. It is not a process that can be rushed; we cannot force someone to name feelings or recognise needs they have long denied. Instead, therapy offers a safe and containing space in which curiosity, reflection, and compassionate attention are prioritised. Through this careful, exploratory approach, clients are gradually able to bring into awareness aspects of themselves that have long been denied or neglected. By acknowledging and exploring these parts, they can begin to move from patterns of self-neglect toward greater connection with themselves, cultivating self-awareness, self-compassion, and the capacity to care for themselves in ways that may once have felt impossible.

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 their experiences and what they feel and believe about themselves.

• Introducing self-compassion: Encouraging practices that foster integration of neglected self-aspects and 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 and worthy. 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 provide a gentle, supportive space to explore these patterns with understanding and compassion. Remember, you are not alone, and your wellbeing is important.

References

•  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.