May

18

2016

What Counsellors Need to Know About Dissociation

What is dissociation? Why does dissociation happen? How can we help our clients who dissociate? This article looks at dissociation and its relationship to trauma.

Ahead of our upcoming workshop: Dissociation: Trauma as Personal & Collective Experience with Miriam Taylor on Saturday 7th October 2023 via Zoom (with catch-up available), we are revisiting this article which provides essential insights into working with client Dissociation.

What is dissociation?

Dissociation is an experience of being disconnected from feelings, feeling numb, dead or shut down.

We all have the ability to dissociate. When driving, we sometimes don’t remember the journey from A to B because we have switched off to what is going on around us. This is a way of dissociating from the monotony of the drive.

When dissociation is connected with a traumatic experience, clients can experience a complete shutdown of sensory experience. Clients describe living in a fog most of the time, or barely existing, being completely detached from feelings. Dissociation can be a withdrawal inside or a complete withdrawal somewhere else. Clients who dissociate might have difficulty with sensory awareness, or their perceptions of senses might change. Familiar things might start to feel unfamiliar, or the client may experience an altered sense of reality (derealisation).

An example of this can be when a client loses large periods of time, or has total memory loss of traumatic events. Alternatively, the client may experience things as though they are happening to somebody else (known as depersonalisation), such as when a client describes floating on the ceiling watching the traumatic event taking place.

 

We all experience dissociation, but for those who have undergone trauma this can lead to memory loss, depersonalisation, or Dissociative Identity Disorder.

Dissociation as a response to trauma

Dissociation is very common in clients who have suffered from trauma, and can be seen as an extremely successful survival strategy used by somebody who has been through a traumatic event.

When a person experiences trauma, their nervous system goes into survival mode, and their sympathetic nervous system takes control and releases hormones to help them survive (which may be experienced as increased heart rate or shallow breathing). When the threat is no longer around, the parasympathetic nervous system takes over and brings the person back to a more relaxed state.

In cases of huge or long running trauma, the trauma keeps happening, so the threat is never removed, or the trauma is so huge and powerful that the person’s nervous system does not return to the relaxed state. This can mean that the person stays in hyperarousal (such as feeling panicky, on edge or experiencing racing thoughts), or in hypoarousal (feeling deadened, absent or foggy). Dissociation is a form of hypoarousal. A person can often turn up to therapy after experiencing trauma, having learnt to dissociate as a way of managing the trauma. This is a necessary function of coping with the traumatic experience and can be seen as a form of pain management.

How to spot dissociation in clients

We can notice if a client may be dissociated if we look out for the following cues:

  • If the client feels in a fog
  • The client consistently asks therapist to repeat the questions
  • The client feels as though they are a long way away
  • The client cannot hear your voice, or you sound faint
  • The client loses time, or cannot remember the previous session
  • The client cannot tell what is real
  • The client feels empty or ‘nothing’

As the therapist, our client may be dissociated if we notice:

  • Our mind goes blank
  • Feeling dizzy/spacey
  • We pull away
  • Feeling disconnected
  • Feeling sleepy with a client
  • Feeling confused
  • Feeling numb
  • Feeling bored of client
  • Feels like the client has gone somewhere else
  • A sense of chaos
  • Things don’t add up

If we notice any of these states in a client, or indeed in ourselves, it is important recognise that the client may be experiencing dissociation. We need to clock this, as well as noting the fact that the client may have been through trauma that we either know or do not know about.

Dissociative Identity Disorder

If a person experiences chronic trauma through childhood, and they use dissociation as a survival mechanism, this can develop into Dissociative Identity Disorder. Dissociative Identity Disorder (DID) exists when an individual has two or more identities or personalities, each with its own way of being. These personalities are persistent and consistent over time and may alternate in having control of the individual’s behaviour. These personalities are referred to as ‘alters’.

This condition develops as a way of coping with traumatic or overwhelming life experiences, such as childhood sexual abuse. The psyche breaks into more than one part to deal with overwhelming and distressing trauma and develops into more than one identity.

Possible indicating factors that a client may have Dissociative Identity Disorder are…

  • loss of memory of childhood, or losing memory in their day to day life
  • hearing voices in the client’s head
  • using ‘we’, or ‘us’ instead of talking about ‘I’, or ‘me’
  • if the client feels they may be going mad
  • if the client feels like they are sharing their body with somebody else
  • being extremely forgetful, forgetting important events, dates, meetings, or counselling sessions.

We all have distinctive parts, or self states. But a person with DID will experience these parts as fragmented and not fluid or continuous.

Tasks for the therapist when encountering dissociation in a client

Miriam Taylor’s book offers many insights into dissociation.

“A dissociated victim may be able to tell their story in a disconnected way, but the truth of it cannot be known and integrated until it can be fully felt.” – Miriam Taylor, Trauma Therapy and Clinical Practice, 2014

It can be very distressing to experience dissociation, and clients often hope to be able to reconnect with their feelings in therapy. When a person is a survivor of trauma, it is argued that they cannot process the trauma without becoming connected to their feelings. The main tasks for the therapist when working with dissociation are as follows:

Task 1 – Therapist self awareness

The therapist needs to be aware of his or her own relationship with dissociation. We all dissociate, and most of us have events in our past that were traumatic. It is highly important that the therapist is able to explore their own response to trauma and dissociation. If the therapist is able to recognise when they use dissociation, they are more likely to notice if they are doing this with clients. A self aware, well-resourced therapist will be better equipped to work with dissociation.

Task 2 – Helping the client ground in the present

When a client dissociates, it is really helpful to help them to come back into the here-and-now. This helps the client come towards a more adaptive and less rigid dissociative state. If a client is dissociating in the session, simple exercises can help ground them. You could ask a client to find three red objects in the room, or ask the client to listen out for three sounds and identify them. Sound can be a safe bridge back into the here-and-now. Inviting the client to open their eyes (if they are shut) will help bring the client back into the here-and-now. Anything that brings the client into the relationship with you as the therapist can really help.

Task 3 – Helping the client come back to their body

Clients often dissociate from their physical state (as being in the body can be extremely difficult for survivors of trauma). It is helpful for the therapist to bring the client back to their body, so that the client can connect with their embodied experience of the trauma. This can be beneficial, as the client may really need to be in touch with their body in order to keep safe from physical harm. A client could be so dissociated that they no longer feel physical pain, which could put them at physical risk. Simple body awareness exercises can help ground the client. Ask the client to push their feet down into the floor and to notice where they feel this movement. Something as simple as this can be a safe way to reconnect with the body.

Task 4 – Helping the client to manage their different self-states

When working with a client who has a fragmented sense of self due to dissociation, it is essential to accept and welcome all parts of them. If there is conflict between the parts, then it is helpful to re-establish a sense of inner dialogue and work towards a collaboration of the different parts. Self-states tend to have a beneficial intention for the whole system, so it is important to allow each part to be seen. This helps to form a cohesive whole. It is not the therapist’s intention to get rid of the parts, these are extremely important in the person’s survival structure. However, it is beneficial to find cohesion between the parts. This helps to support a central, healthy and wise adult to emerge.

Upcoming Workshop

Join us for our upcoming workshop – Dissociation: Trauma as Personal & Collective Experience with Miriam Taylor on Saturday 7th October 2023 via Zoom (with catch-up available).

In this session you will learn from Miriam Taylor, an expert in working with trauma, about working with dissociation in the consulting room and how to better help people experiencing trauma.

This workshop with consider dissociation from personal, relational, neurobiological and contextual perspectives. Taking a non-pathologising approach, we will provide some theoretical ways of making sense of dissociative processes and will include an introduction to the Structural Dissociation Model. Understanding the phenomena of dissociative experiences will form a core focus of the day, and we will further consider the therapist’s experience in working with a dissociated client.

In addition, there will be a wide range of practical resources offered for use with clients, some of which will be taught experientially. Examples from clinical practice will be offered, illustrating specific learning points.

 

Did you enjoy this article?

You can also learn more about working with dissociation through our online, on-demand CPD training – Trauma Masterclass via Therapy Education Online.

 

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13 Comments

  1. Jean Brunson on 2017-05-10 at 11:44 PM

    Thank you for writing about dissociation. I have worked with victims of SRA for 17 years, so I have met close to 100 alters. I find this work rewarding, but often difficult. I do plan to share it. I hope we can connect on Facebook to share our experiences, the victories and the challenges.

    • Brighton Therapy Partnership on 2017-05-12 at 5:05 PM

      Thank you Jean! Keep up the fantastic work, you’re doing a great job.

    • Bernadette Donohoe on 2022-08-11 at 1:54 PM

      Hi i live in Ireland and suffer bad with disscociation due to severe trauma going back to childhood , i am finding it hard to get therapist whom specialise in this

    • Jessica Bimshas on 2023-05-15 at 7:56 PM

      I cried. I started to get teary-eyed and then the tears. Everything in this article is the words I could never find and describe to any medical provider. I’m struggling right this very moment and if I don’t put this out there now I won’t later. It’s real. Every bit of it. I feel like I’m going crazy right now I feel isolated and meaningless and I am reaching for that one sincere warm helping hand that seems to make things better. Yes, this will eventually go away but as I’m crying and saying this I wish there could be a way to better control this. Meaning the anxiety omg the anxiety the pit in the middle of the chest. I have a great doctor now who treats me. However, my gut nudges me when I comprehend there is more out there that can help me become healthier and stronger especially when I get these bouts. Things become more intense for some reason. I don’t know how to even make clear how this feels to others I don’t feel real I feel out of it but it’s so intense and all the time and then the random episodes say randomly because to me they come in without anything out of the ordinary. I want it to stop now. I’m tired of being tired. I’m thinking why not try hypnosis? Or possibly look into ketamine infusions to help the depression the anxiety. I feel im going mental inside what kind of life is this? I miss walking thru the woods for the hell of it or fishing I loved fishing I still do but ugh 😒 I physically feel like I can’t. And that is another thing. Being so tired. It’s more than tiring. Lethargic? I want to sleep all day and still don’t feel rejuvenated. I’m on ADHD meds. No energy with the stimulates.

      This was a great article I’m glad I bumped into it. You’ve explained in great detail things I had no clue about. I just wish I could meet someone such as yourself who actually may know more about this. You have some advice that change my whole world around so much so that I may be able to live a life. I miss living. I miss people. I want to finally have answers to this craziness I feel.

      One thing you’ve mentioned over and over is childhood trauma(here are the dam tears again like a big ol’ baby) Trauma The word trauma makes me feel sickening inside. Vile. I’m going on 43 in June and I feel like I haven’t lived at all. I haven’t really. I’m now remembering bits and pieces of past events that I don’t wish to think back to. I had a childhood with sex drugs rock n roll and I was the oldest which made me very shielding over my siblings.

      I’m so embarrassed I know going on. This hit a cord. Maybe because I’m going thru what you’re speaking about right here. Reading and rereading some areas thinking “OMFG BINGO! NAILED IT! 😲😁😆”

      I’m glad I was able to get a chance and read this. Couldn’t have been a better time. This mental health crisis has finally opened up and now it’s being vocalized BOLDLY🦋 I’m happy to know I’m not alone. I know I’m not. this is another example of how I am. I know I’m not alone. Deep down I feel I am and I feel uncomfortable and I just don’t fit in. I don’t know who I am. The personalities you mentioned well holy crap cuz my eyes opened so big. That’s it that’s exactly how it feels. Oh, I wish I could explain all to you. This has given me a warm feeling. You give a f¥ck✨ I lost a bit of hope for humanity and you showed me that writing this is coming from a caring heart. You made time to encourage others. So thank you. Thank you so very much

      I had a childhood that was f¥cked up. I wouldn’t exaggerate something like this. Not this topic. I DO remember thinking many times im leaving at 18 no matter what and that this is not normal. So much toxicity so much violence so much so my grandmother will tell me things that I say didn’t happen but did happen but I block out.

      I miss life

      🦋✨ Jess

  2. Anne Marie Yates on 2017-06-13 at 1:33 PM

    Really useful article

  3. Steph Davies on 2017-10-17 at 7:21 PM

    I’m so glad my google search led me to this page. Very useful and informative. Thank you.

  4. Mark on 2018-03-08 at 3:48 PM

    The best therapist comes with personal experience, that’s what’s needed to begin the understanding. In my experience that understanding builds trust , to have suffered trauma in it’s true form and not just simply lost track of time whilst driving home , i was insulted when my therapist said this , how on earth could you bring that to the table and expect to build trust is beyond belief. Depersonalization and derealisation are both very hard to part with and be free of , it takes a lot of time to not only find trust in your therapist, but yourself when everything around you wreaks of PTSD. Mindfulness is a great start as it begins to ground the sufferer in the here and now and begin meditation to relax . My memory disappeared for ten years and I still sit upright being unable to relax , but I’m determined to not let the past ruin the rest of my life . I.ooking forward to reading your book and will let you know how much I take from it .

  5. Collette otoole on 2021-01-18 at 4:53 AM

    Thank you for the above comments Mark and also Jean!
    The best therapy comes from personal suffering in my mind to be able to give true empathy and compassion and healing!

  6. Kameron Kerr on 2021-02-28 at 5:05 PM

    I dissociate every day it happens in therapy and my therapist is very good at noticing it when it happens it’s very scary so thank you for this post

    • Ms Dubois on 2022-08-13 at 2:10 PM

      What do you find the most useful?

  7. Ellie on 2021-04-09 at 2:07 AM

    This is an extremely well researched and well written article, thank you. As a client with DID in long term therapy, my therapist uses all of the techniques you mentioned above to bring me back to the present, and they really help. I tend to notice I’m starting to dissociate when I start to find it hard to look at her and then I start to feel floaty. I get the sense of my body and myself departing or overlapping in the same space… also starting to feel like I’m looking down on my body. It can be really disorienting. We are practicing being in the body in therapy but it’s very hard as a client as I want to do the opposite usually, even if that makes the dissociation worse!

  8. Anthony on 2021-04-20 at 6:30 AM

    Thank you for this. I experienced a shocking dissociative episode during therapy a couple years ago and this helped me understand it better. Man, it was really like a psychedelic trip, interesting and completely terrifying.

    • Peter R on 2021-11-26 at 1:21 PM

      On one occasion I just went outside for some fresh air which just felt like a few minutes. When my partner got home I realised I’d been sat on the grass in subzero temps for a few hrs. Thankfully I was dressed for the weather. That said the whole experience was scary. When I’m like this it is best to just leave me and I’ll come back to the present in my own time.

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