When Life Feels ‘Too Big’: Developmental Deficits and Dosing Down

Imagine a world where everything is too big and too heavy for you. When you want to sit down, the chair you are trying to move into place for you weighs too much. When you are cooking a meal, you can only just reach the worktops and shelves on tiptoe. The steps of your staircase are too high and require hauling yourself up, knowing that your leg muscles will be painful and aching for days. Trying to go on a walk with other people means you are having to run, panting, to catch up all the time… and so on.

I think if we mentally translate this into the realm of psychological functioning, we get a sense of how life can be for those who were neglected children. One of the most devastating consequences of deficits in early development as a result of emotional neglect is the sense of never really having the wherewithal to live the life of an ordinary adult, and instead always having to struggle to do things without feeling confident of one’s ability to cope. It is as though an emotionally neglected person is trying to live in an adult world with the body of a child.

Let me stay with the physical image for a moment: somebody who finds things too big and too heavy for them will probably be advised to exercise in order to strengthen their muscles and create a greater sense of confidence in their own ability to cope. This is basically good advice. However, it can go very badly wrong if the person is not also advised to take the exercising slowly and gently. Many people view taking things gently as indulgence and as an approach for wimps. They are not aware, or forget, that there needs to be a relationship between the existing strength of the muscles and the magnitude of the challenge that muscles can cope with in order to build strength.

I will illustrate this with another metaphor: imagine that you want to push a stone around. You may find that the stone is very heavy and requires you to greatly strain your muscles. If you keep pushing the stone around regularly for a period of days and weeks, your muscles will build up and pushing the stone will become easier, or you will become able to push larger stones. This is what happens if your muscles were able to cope with the weight of the stone in the first place, and it is the normal effect of regular training.

But there is another possibility: the stone may be too heavy for you to push at all. And if you now try to push it and continue to exert all your strength, you will eventually collapse because your muscles will be overwhelmed by the effort. You will be left with aching muscles and a sense of failure and futility. If you repeat this exercise regularly over a period of days and weeks, your muscles will progressively become inflamed, painful and probably rather weaker. The psychological effect of so much failure and futility may be considerable and may itself create a desperate wish to avoid the situation.

This second possibility is, again in the realm of psychology, a possible experience of people with developmental deficits who are trying too hard to build up more resources in a way that doesn’t take into account how much challenge their psyche can actually rise to.

Creating achievable challenges by ‘dosing down’

Now I hope that my description is already beginning to suggest how the exercise programme needs to be modified in order to move the person in the right direction: the challenges need to be smaller. In body psychotherapy we would call this ‘dosing down’. It is possible to find the right dose by experimenting with smaller and smaller challenges, until the person has a sense of ‘Yes! I got it now’. This is not predictable, and it is not easy to describe in theoretical terms, but it can be experienced by anybody. When a person has the experience they will recognise it.

This is what you are aiming for when you are trying to work with a person with developmental deficits. You want to find challenges that give the person this sense of achievement, this experience of successfully rising to a challenge. Once you reach it, the person’s resources will start to grow, and they have a chance of filling in some of their developmental deficits. In terms of a person’s psychological ‘muscle’, this means that the beneficial effect of exercise is in the felt sense of achievement, of having ‘got it’, which creates a feeling of being able to gain strength and succeed.

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