Traumatic experiences can have a profound impact on the ways in which a person interacts with the world around them. One common response to trauma is dissociation, a defence mechanism that allows people to detach from distressing thoughts, emotions, or memories.
Ahead of our upcoming workshop: Resparking: Working courageously with trauma and neglect with Graham Music on Friday 19th April 2024 via Zoom (with catch-up available), this article explores the link between trauma and dissociation, reflects on the spectrum of presentations and symptoms, and provides ideas for how psychotherapists can effectively work with dissociative clients.
Linking trauma and dissociation
Dissociation refers to a disconnection between thoughts, identity, consciousness, and memories. It is a coping mechanism the mind employs to shield itself from unbearable distress. In the context of trauma, dissociation often occurs as a survival strategy during the traumatic event.
Bessel van der Kolk, author of The Body Keeps The Score, explains:
“Dissociation is adaptive: it allows relatively normal functioning for the duration of the traumatic event and then leaves a large part of the personality unaffected by the trauma.”
While this can be a healthy and protective response, for some people it can become a habitual response to stress, leading to long-term difficulties in processing emotions and forming healthy relationships.
The relationship between trauma and dissociation is profound. Traumatic experiences can be so overwhelming that the mind “splits off” certain aspects of the experience, creating a fragmented sense of self. As a result, they may feel disconnected from their emotions or have gaps in their memory surrounding the traumatic event. This disconnection can profoundly impact their quality of life and hinder their ability to function normally.
Big T and Little t Trauma/trauma
Trauma and dissociation exist on a spectrum, with manifestations ranging from mild to severe. The distinction between big T trauma and little t trauma lies in the severity and impact of the traumatic events experienced.
Big T trauma typically refers to major life-threatening or highly distressing events, such as physical or sexual abuse, natural disasters, war, or witnessing a violent crime.
These events can lead to profound and lasting psychological effects, often diagnosed as Post-Traumatic Stress Disorder (PTSD). The symptoms of big T trauma can be intense and pervasive, disrupting a person’s daily life and functioning.
Psychotherapist and author Gabor Mate explains how :
‘trauma isn’t what happens to you, it is what happens inside you’.
The responses to and the symptoms of trauma help us to understand how significant a traumatic experience has been. The level of dissociation could be a clear indicator of the severity of the trauma.
On the other hand, little t trauma refers to less severe but still distressing experiences that can accumulate over time, contributing to psychological distress and potentially leading to emotional struggles. These experiences may include emotional neglect, ongoing criticism, bullying, or other forms of psychological harm. Emotional neglect, for instance, involves not receiving the emotional support, care, and attention that are crucial for healthy development. This can have long-term consequences on self-esteem, emotional regulation, and interpersonal relationships.
Katherine Stauffer’s work sheds light on the concept of developmental trauma, which emphasises the critical role of early childhood experiences in shaping psychological well-being. Stauffer highlights how disruptions in attachment, inconsistent caregiving, and emotional neglect during a child’s formative years can lead to significant emotional and psychological challenges in adulthood. This underscores the importance of addressing not only the “big T” traumatic events but also the “little t” traumas that can accumulate and deeply affect mental health.
Developmental trauma is closely tied to the notion of Complex PTSD (C-PTSD), a condition that arises from prolonged exposure to traumatic events, often in a relational context. Unlike traditional PTSD, which is associated with single traumatic incidents, C-PTSD is characterised by a complex interplay of symptoms that can include emotional dysregulation, difficulties with interpersonal relationships, distorted self-perception, and an overall impaired sense of safety and trust. This condition recognises that the effects of ongoing, repeated traumas, especially during developmental stages, can lead to a more intricate and enduring pattern of psychological distress.
The spectrum of dissociation
Similarly, dissociation also spans a spectrum, encompassing different levels of detachment from one’s thoughts, feelings, sensations, or identity. On the mild end, someone might experience temporary spacing out or daydreaming, which is a natural response to stress. In more severe cases, dissociation can involve dissociative amnesia, identity confusion, or dissociative identity disorder (DID).
For therapists, being able to identify dissociation in clients is a useful tool, as it can influence the therapeutic approach. Dissociation can sometimes be challenging to detect, especially in clients who have developed coping mechanisms to protect themselves from overwhelming memories or emotions.
Some common signs of dissociation in therapy include:
- Memory Gaps: Clients may have difficulty recalling significant events, particularly those related to traumatic experiences, leading to disjointed narratives.
- Emotional Numbness: Someone might struggle to connect with their emotions, appearing emotionally detached or unaffected by distressing memories.
- Depersonalisation: Clients may describe feeling disconnected from their own bodies or emotions, as if they are observing themselves from a distance.
- Dissociative Triggers: Certain situations or stimuli may cause clients to dissociate, such as loud noises, specific smells, or physical touch.
- Time Distortions: Clients might lose track of time or feel as if time is passing too quickly or too slowly during dissociative episodes.
Working with Dissociation in Psychotherapy
“Trauma is personal. It does not disappear if it is not validated. When it is ignored or invalidated, the silent screams continue internally heard only by the one held captive.” – Danielle Bernock
Clients who have experienced trauma often develop intricate defence mechanisms which can emerge during the therapeutic process. These mechanisms are often employed unconsciously, used as a means of self-preservation, attempting to shield themselves from the distressing and painful memories associated with their traumatic experiences.
These mechanisms can manifest as dissociation, avoidance, denial, intellectualisation, creating barriers that impede the exploration of deeply rooted emotions. They may even use substances or self-harm as a defence mechanism.
It’s important for therapists to recognise that these defences and resistances are not impediments to progress but rather adaptations that once served a crucial purpose. By approaching these processes with compassion and understanding, therapists can create a safe space for clients to gradually unravel these protective layers, fostering a trusting therapeutic relationship that ultimately empowers clients to confront and heal from their traumas.
In therapy, eventually the goal can be to gently challenge these defence mechanisms while honouring their role in helping clients survive their traumatic past.
Addressing these defences and resistances is an integral part of the therapeutic journey towards resilience and recovery, but it is a delicate balance to strike.
Sitting with a client who is entrenched in their trauma requires a nuanced approach from therapists. While it’s essential to gently guide clients towards exploring their painful experiences, therapists must be attuned to the client’s pace and readiness for delving into discomfort. Pushing too far and too fast can risk re-traumatisation, where the client becomes overwhelmed and experiences a setback in their healing journey. Recognising the signs of distress, such as increased anxiety or emotional shutdown, allows therapists to adjust their approach and create a secure environment that ensures emotional safety.
Healing is not necessarily about pushing – it’s about creating a space where clients feel safe to let go.
Addressing the therapist’s own trauma is also paramount, as unresolved personal issues can inadvertently influence the therapeutic dynamic. In her book Deepening Trauma Practice, Miriam Taylor writes “The state of ‘knowing and not-knowing’ about trauma is co-created in the therapy”.
Therapists need to engage in self-awareness and personal therapy to avoid projecting their own experiences onto clients. By tending to their own wounds, therapists can better support clients in navigating their trauma, offering a steadying presence and a path toward healing. They can also use their own experience to support the work, rather than acting as a barrier.
Therapists can play a critical role in helping clients with trauma-related dissociation. Here are some potential approaches for working with dissociation in psychotherapy:
- Establishing Safety and Trust: Creating a safe and supportive therapeutic environment is paramount for someone dealing with dissociation. Trust between the therapist and client is crucial in building a foundation for healing.
- Psychoeducation: Providing clients with information about dissociation and its link to trauma can be empowering. Understanding their experiences can help clients gain insights and reduce feelings of shame or confusion.
- Grounding Techniques: Therapists can teach clients grounding exercises to help them stay connected to the present moment and their surroundings during dissociative episodes.
- Identifying Triggers: Collaboratively identifying triggers and discussing coping strategies for managing them can empower clients to navigate challenging situations more effectively.
- Trauma-Focused Therapy: Modalities like Eye Movement Desensitisation and Reprocessing (EMDR) or Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) can be particularly beneficial in addressing trauma-related dissociation.
- Integrating Dissociative Parts: In cases of DID or complex dissociation, therapists can work with clients to integrate dissociative parts and facilitate co-consciousness, fostering a sense of internal cooperation.
The link between trauma and dissociation is a complex and multi-faceted one, with both existing on a spectrum of presentations and symptoms.
By understanding the intricacies of dissociation and recognising its signs, therapists can tailor their approach to effectively support clients on their healing journey.
Through a combination of safety, trust and education, therapists can empower clients to navigate trauma-related dissociation and foster resilience and growth.
Join us for our upcoming workshop – Resparking: Working courageously with trauma and neglect with Graham Music on Friday 19th April 2024 via Zoom (with catch-up available).
This workshop will focus on people (adults and children) who have experienced neglect or trauma and who appear in therapy to be flat, dulled down, even numbed. They may be hard to reach in therapy and challenging to work with. We may find ourselves feeling less than enthusiastic about our work with them.
In this workshop, Graham Music will share his experience of working for 35 years with children and adults, and the research he has undertaken in writing his book “Respark: Igniting hope and joy after trauma and depression” (Jan 2022).
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You can also learn more about working with dissociation through our online, on-demand CPD training – Trauma Masterclass via Therapy Education Online.
Friday 1st March 2024. ONLINE via Zoom and CATCH-UP for 28 days. Event Times: 10.00am – 4.00pm GMT (London)/ 11.00am – 5.00pm CET (Paris)/ 5.00am – 11.00am EST (New York).…
Friday 22nd March 2024. ONLINE via Zoom and CATCH-UP for 28 days. Event Times: 10.00am – 4.00pm GMT (London)/ 11.00am – 5.00pm CET (Paris)/ 5.00am – 11.00am EST (New York).…
Friday 19th April 2024. ONLINE via Zoom and CATCH-UP for 28 days. Event Times: 10.00am – 4.00pm GMT (London)/ 11.00am – 5.00pm CET (Paris)/ 5.00am – 11.00am EST (New York).…
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