Treating Self-Abandonment

Q: In sessions with my female clients, I often hear some variation of, “I don’t know who I am anymore.” These clients feel lonely, resentful, stressed, and overcommitted. How do I address this?

A: As three psychologists in private practice, we’ve noticed that resentment, anger, loneliness, numbness, exhaustion, detachment, and burnout arise in people focused on tending to everyone else’s wants and needs instead of their own. These feelings are compounded when clients don’t trust their own knowledge and wisdom and instead constantly look to others for guidance, opinions, and expertise. This can lead to a cycle of self-criticism and self-loathing—or feeling overwhelming pressure to fit into perfectionistic norms—which deepens feelings of distress, frustration, and shame.

We believe this cluster of experiences illustrates the phenomenon of self-abandonment, which refers to an overarching pattern of consistently dismissing or suppressing one’s own needs, wants, desires, emotions, or identity at the cost of personal well-being, authenticity, and connection. This dynamic doesn’t happen overnight, can be conscious or unconscious, and exists on a continuum from small acts of self-neglect to large losses of personal identity. It happens whenever someone cuts off from themselves and results in exhaustion, erosion of one’s sense of self, mood changes, and a “blah” existence.

Imagine two dials that allow us to make decisions and orient ourselves as we move through life. One is the external guidance system (EGS), which draws our focus towards outside influences: search engines, expert opinions, advice from family and friends, and real or imagined feedback from others. Our external environment is saturated with signals we can use as our EGS, though it also includes expectations, rules, and scripts we’ve internalized. The other dial is the internal guidance system (IGS), characterized by a quiet voice that exists within each of us and provides clarity—but only if we hear it.

Where the EGS communicates in flashy signposts like your mother-in-law’s parenting tips, your company’s “rise and grind” hustle culture, or life hacks to “help” you be more productive and look younger, the IGS makes itself known through bodily sensations like gut feelings—which we sometimes refer to as intuition. Self-abandonment occurs when the volume level on the EGS dial is blasting and the volume level on the IGS dial is at a whisper. While IGS and EGS may sound similar to the concept of internal and external locus of control, they’re different. Locus of control refers to our belief about who has control over an outcome whereas the IGS and EGS describe where we look and who (or what) we consult for guidance.

What Drives Self-Abandonment in Women?

Although some male clients may self-abandon, this pattern of self-dismissal is particularly common for women. Our culture tends to support men who prioritize their own needs and desires, viewing them as manly, ambitious, and strong, whereas women who put their needs, wants, and desires first are frequently viewed as selfish, unfeminine, and even mentally ill. Here are some underlying dynamics that can give rise to self-abandonment, particularly in female clients.

Not enoughness/self-judgment. The belief that we’re somehow not enough—that we don’t measure up, are less than or are worthless—underlies all forms of self-abandonment. You may hear clients say things like, “I’m a mess” or “I bet you think I’m a total disaster” as they talk about common issues and life stressors. In pursuit of enoughness, many women say things like “I’m so lazy/unproductive/broken” or “I’m a complete failure” to push themselves to take on more responsibilities despite feeling exhausted and stretched too thin. Many systems in our culture (namely, patriarchy and capitalism) benefit from women over functioning and leverage not-enoughness to keep women feeling small and disempowered. Self-judgment also makes it harder to cope and function, keeping clients stuck in despair and disconnected from themselves and others.

Fear of discomfort. When we’re afraid of experiencing discomfort, we put ourselves through all kinds of acrobatics to avoid it: staying busy, people-pleasing, overdrinking, overworking, numbing, or stuffing down our truth. You’ll know that clients fear discomfort when they attempt to shift away from an uncomfortable topic. They may arrive late, cancel sessions or resist changing their behavior if it means having difficult conversations with the people in their lives: “I can’t set this rule or my teenager will hate me” or “If I tell my boss I can’t work weekends, I’ll get a bad review.” Avoiding discomfort leads to bypassing fundamental issues and stuffing down feelings which results in abandoning ourselves.

Desire to fix, plan, control. The desire to do something—anything!—to manage our environment means we’re always in motion and have never-ending to-do lists. In therapy, this shows up as difficulty letting go of responsibilities or asking others for help. These clients often carry the cognitive load for their families and may confide, “I’m barely keeping it together, but if I slow down, everything will fall apart.” Some clients may feel an urgent need to “fix” whatever is ailing them and become impatient with the therapeutic process. Others may focus on tasks or projects to deflect their energy from emotional events, such as fixating on decorating their youngest child’s dorm room rather than thinking about what life will be like as an empty nester.

Self-doubt. When ruled by self-doubt, we constantly question ourselves and become paralyzed by decisions, leading to a vicious cycle: The more we doubt ourselves, the harder it is to connect with ourselves, and the more disconnected we are from ourselves, the greater our self-doubt. Clients mired in self-doubt will often show up to therapy wanting to improve their self-confidence, saying, “If I were more confident, I’d be able to (fill in the blank with any number of behaviors).” They might also seek reassurance for their choices or ask pointed questions like, “Do you think this is a good idea” or “What do you think I should do?” In these cases, the therapist is at risk of playing the role of the client’s EGS. To truly build confidence, we can’t look outside ourselves for validation. Replacing self-doubt with self-trust is an inside job.

Recognizing self-abandonment helps us respond with interventions tailored to this issue. Here are some underlying factors to keep in mind:

Clients get stuck in their heads. It’s easy and exhausting to get lost in thinking, analyzing, worrying, or ruminating—getting bogged down with “shoulds,” “oughts,” and “musts.” When we’re in our heads, we ignore everything below our necks. We’re so focused on our thoughts that we ignore our actual physical bodies, our sensations, our emotions, and our intuition. We become disembodied, like a head floating in space. Clients who get stuck in their heads will often get caught in planning/problem solving mode rather than dropping into their bodies and connecting with themselves. They may become paralyzed by intellectualizing and over-thinking rather than taking action and moving forward.

Numbing. Some common ways people numb include abusing alcohol, scrolling endlessly on social media, binge watching TV shows, overeating or undereating, and oversleeping. Clients who numb themselves might not be aware that they’re doing it but may feel exhausted and lose track of time. As a therapist, you may notice your mind wandering or feeling bored during sessions with clients who numb as they may not have much to say, and what they do say might feel disengaged or empty. When clients numb, they don’t have to be present for who they are, how they feel, the people around them, or whatever is going on in their lives.

Willful disengagement. Rather than directly asking for what they need or communicating a boundary with others, clients simply stop participating in the moment. In therapy sessions, rather than staying connected to themselves and their values or trying to collaborate with you to find a workable solution, they may throw their hands up, say, “This therapy isn’t working,” and retreat into themselves. They believe they’re “right” and know what “should” be done, so they physically or emotionally separate themselves by detaching, withdrawing, or stonewalling. At its core, willful disengagement is an attempt to set limits and meet needs, but our self-abandoning clients end up doing so in a way that’s indirect and maladaptive.

Trying to “improve” themselves. Ironically, when self-improvement becomes a never-ending Sisyphean task, it can lead to self-abandonment. In therapy, this self-improvement cycle may show up as constantly seeking the fountain of youth in the form of fitness programs or beauty regimens or seeking fulfillment through landing the next big deal or job promotion. Self-improvement driven by not-enoughness leads to self-abandonment. When we believe we must fundamentally change ourselves to belong, have value, or be worthy, we’re likely to abandon ourselves.

The most common ways we abandon ourselves in interpersonal relationships are people pleasing, caretaking, looking to experts and authority figures for guidance, answers or solutions, blaming others/being the victim, and fierce independence. Though these behaviors are attempts to manage relationships and regulate distress, they end up distancing clients from their needs and experiences. Here’s what self-abandonment looks like in relationships:

People-pleasing/Caretaking. People-pleasing and caretaking are acts of suppressing our needs, wants, or interests to make others happy. Clients might hide or change parts of who they are to please others or avoid conflict, tension, or discomfort by focusing on trying to be a “good client.” Underneath people-pleasing, there’s a fear of being judged and rejected. This constant outward focus on what others think can block clients’ access to their IGS, making it impossible to stand up for—or even be aware of—who they are and what they need.

In addition, many women are conditioned from early childhood to take on a caretaker role and prioritize the wants and needs of others as more important than their own. In adulthood, this type of caretaking can show up as a client asking the therapist about herself, expressing concern about being “too much,” or apologizing for crying or expressing intense emotion. People pleasing/caretaking clients may focus on talking about other people’s problems rather than their own, repeatedly cancel their own plans to help someone else, or feel anxious or guilty whenever someone is upset. If our female clients’ worth is largely contingent on them doing for others, there’s not much space for them to do what they need to do for themselves.

Looking to experts and authority figures. A powerful socio-cultural element shaping our EGS is all the “expert” information we’re inundated with on a daily basis. There’s absolutely nothing wrong with asking others for advice, consulting loved ones for their point of view, looking to experts or authority figures for information, or simply utilizing that super accessible online know-it-all, Google. The problem arises when engaging in those behaviors becomes a substitute for our IGS. It’s important to be tuned into this tendency with self-abandoning clients, because they’re likely to see you as an authority figure and look to you for solutions and advice.

Blaming others/being the victim. When we take on the victim role, get stuck in self-pity, or carry the belief that everything happens to us, we relinquish control over our own lives and give our power away. In therapy, clients may repeatedly complain about others’ behaviors, focusing on what the other person should change. In addition, they may take on the victim role and make statements like, “This is just how my life is—I don’t have a choice” or “Why bother trying because nothing will change anyway?” When we externalize blame or refuse to own up to our part in conflict, communication issues, or negative outcomes, we set ourselves up for continued self-abandonment in relationships.

Fierce independence (counter-dependence). People-pleasing, caretaking, and looking to experts orient our clients to the world outside themselves. These behaviors entail relying on other people while ignoring oneself. Fierce independence is on the other end of the dependence spectrum. Fiercely independent individuals may refuse to allow anyone to see their vulnerabilities and, in turn, disconnect from people around them. This reinforces isolation, loneliness, and anxiety. In therapy, these clients are likely to refuse medication and prematurely decrease frequency of visits because they believe they should be able to do it on their own. They may become overly reliant on themselves when they don’t feel worthy of help or are unable to trust other people. As humans, we’re wired for connection. Fierce independence not only causes us to disconnect from others but also from the parts of ourselves that crave belonging.

While self-abandonment can show up alongside depression, anxiety, trauma, eating disorders, or relational difficulties, it isn’t listed in any diagnostic manual. Rather, it’s a helpful framework for understanding an experience many people have. We’ve noticed that many of our clients have found naming this phenomenon to be validating and empowering. Once it’s identified, this concept is easily integrated into any modality of treatment clients are using to improve their connection to themselves and others.

Working with Self-Abandonment in Therapy

With clients who exhibit this ongoing pattern of disconnection, the overarching goal of therapy is to help them connect: first to themselves, then to others.

In the therapy room, we help our clients identify what they truly feel, need, and want—often for the first time—so they listen to and trust themselves again. Meditation and mindfulness are wonderful tools to help clients slow down enough to notice what they’re feeling and needing in real time. A client who says they can’t feel anything in their body might gradually learn to pick up on the way they clench their jaw whenever they agree to attend events they’d rather decline. Someone who has no idea what they want may practice voicing “low stakes” wants, like what to eat for dinner.

Instead of reflexively prioritizing others, clients practice checking in with themselves, first—honoring their own IGS. Clients can come up with daily rituals, like mentally reviewing the moments, however small, when they cared for themselves. They can ask themselves, first thing each morning, before scrolling through texts or emails, “What’s a small thing I’d like to do today just for me?”

Self-compassion is a powerful antidote to self-judgment and the not-enoughness underlying self-abandonment. Replacing self-criticism with compassion allows clients to remain emotionally present with themselves even when they make mistakes or feel uncertain. Simple but powerful ways to increase self-compassion include repeating mantras like “This is hard,” “I’m doing my best,” and “How can I be kinder to myself in this moment?”—all statements that encourage compassion and normalize challenges. By attuning to your client and the activities they already enjoy or wish they had more time to do—like cooking, journaling, painting, taking walks, or spending time with pets—you can help clients cultivate compassion organically, in a way that feels authentic rather than like therapy homework.

In addition, we’ve found embodiment work—any practice that quiets the mind and increases a client’s somatic awareness—to be incredibly effective in addressing this phenomenon. Body-based practices help clients notice sensations that accompany self-abandonment—for example, fogginess in the head, fatigue in the arms, or heaviness in the chest. Once clients recognize their own somatic markers for these experiences, they can make a conscious choice to respond differently to a situation where they typically people-please, ruminate, numb out, blame themselves, seek guidance from an authority figure, or caretake. Ultimately, they can practice attending to their discomfort instead of avoiding it.

Communication and boundary setting strategies are essential in managing self-abandonment. A client who respectfully communicates to her boss or partner that she can’t do a report or pick up the laundry is combating the self-abandonment she’s experienced in the past by chronically saying “yes” when she’s already stretched too thin. Therapy can reframe setting boundaries as acts of care for oneself and others. Working with clients to help them ask for help, say no, and hit the “easy button”—allowing themselves to relax and enjoy downtime—reinforces the importance of intentionally prioritizing their own time, space, and resources. Ultimately, this translates into making themselves a priority.