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. On Saturday 5th March, Miriam Taylor came to talk to us about these points, and how to look out for dissociation in our clients.
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.
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
“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.