Dissociation can be tricky to spot.
On top of that, it can look awfully similar to freeze or shutdown. And to complicate things further, a patient might dissociate when they’re in either one of those trauma responses.
But being able to detect when a client is dissociating is critical for providing effective treatment.
So in the video below, Thema Bryant, PhD, will name three key signs of dissociation – and will walk you through a three-step process for treating it.
Take a look.
And sometimes that can’t happen until we name it. Because a person is used to operating in that space, so they’re not even aware. Like some clients will say, “How’d you know that?” And we’ll think, “Well, I’m looking at you. And I know some of what it is like to be in a space of not breathing.” So, the breathing, connecting to the muscles, and then also getting into what I really feel.
And a part of that becomes psychoeducation. Because some people only know what it feels to be mad, sad, or happy. So sometimes, when people are giving us what we are perceiving as a surface-level answer, it’s not that they’re trying to give us the runaround. It’s that many people are not fluent in emotion because there was not space for that in their past.
So, to help clients expand some of their language, it can help to ask, “What do these words mean?” which can remove some of the shame as we start to think about what feelings were unacceptable in their house, or what feelings may have even been unacceptable for their religion.
And so giving that permission and space. One of the important pieces about dissociation is what some are calling embodied healing. Some people call it somatic healing. And this says that a violation, an abuse, or a trauma affects us holistically. Mind, body, spirit.
Much of our work focuses on mind and heart if we want to call the heart the center for emotion. But there’s no acknowledgement of people’s meaning making or spiritual ruptures in the aftermath of trauma, and no acknowledgement of the physical ways that we are holding it.
And I do want to say here that ethnic minorities are more likely to have somatic complaints. So not naming it as depression, but having migraines, having backache, muscle ache, feeling nauseous.
So, it is in the body. So, to connect with the trauma and with myself and my healing, we can incorporate embodied healing, which can take the form of dance, of movement, of yoga, as playing with different postures – being in those positions that represent different aspects of our experience and allowing any emotions to come. There’s going to be that tide coming in of the emotional response, of, “Oh, what does that feel like?” And so, it’s about helping clients become able to let that come up and then allow the tide to go back down.
So, I would say: 1) breathing, 2) education and de-stigmatization of emotion, and 3) connecting with the bodily responses and engaging in embodied healing.”
If you’re looking for more ways to work with dissociation, take a look at How to Identify and Treat Dissociation (Even When It’s Subtle).
In this advanced program, you’ll hear from Bessel van der Kolk, MD; Peter Levine, PhD; Stephen Porges, PhD; Pat Ogden, PhD; Thema Bryant, PhD; Ruth Lanius, MD, PhD; and other top experts.
Now we’d like to hear from you. What are some strategies you’ve used to help clients come out of dissociative states? Please let us know by leaving a comment below.
If you found this helpful, here are a few more resources you might be interested in:
The Differences in Dissociation Triggered by Shame and Terror – and How to Work with Each
[Infographic] – Three Warning Signs of Structural Dissociation
Thank you for sharing this representation. It reminded me a young lady I have who told that she couldn’t recall anything about her childhood. Any recommendation you would have for further intervention?
Thanks for your clear explanation and 3 steps to work on dissociation!
My dissociated client always says “Don’t know” and is very scared to get in touch with her body. She is not willing to track her body sensation nor do any body movements. Will you suggest some ways to bring her back from dissociation other than breathing exercises? Thank you!
Excellent points and suggestions in this concise video!
very thoughtful and well explained.
Thankyou. A brilliant description and helpful stratedgy.
Can a disassociated state stay in the mind for years and the memories locked unable to come out! Everything around that period is remembered but the trauma of the actual event is gone! This was in a medical setting! Unable to bring a block of memories from my mind! Very concerned with this kind of situation!
Yes, this is very possible; many personal accounts have been written about it, despite naysayers saying your brain can’t pick and choose what to remember and what to shield from your conscious memory.
They will also say that someone who has experienced something traumatic could not, then, be unable to “bring it to mind.” There are many examples of this, however; it’s not as rare as some believe.
It is puzzling, though, why a person with a great memory may not be able to recall parts of their life that seem to have no connection to trauma. For example, a woman expressed a long-held desire to live in a charming small town in her home state. When her sister responded, “But you did live there for several years!” the woman had no conscious memory of ever living there, although she clearly was aware of her marital status and what jobs she’d had during that time period.
In another case, after a wedding ceremony concluded, a member of the bridal party was thanked for stepping up and completing the musical number begun by another woman who started the song but was overcome by emotion and could no longer sing. The attendant protested that she had no memory of doing this and could not have done so because she didn’t know the lyrics and was even uncertain of the tune. Nevertheless, everyone present had seen and heard her performance. A quarter century later, she still had no conscious memory of her musical debut.
Some people have said they have such a remarkable memory that if they can’t recall it, then it never happened. It is quite disconcerting for them, then, when many other people can corroborate what happened in a chunk of time that they cannot recall.
IFS and Parts Theory explain this perfectly. Each Part of us can develop skills and abilities it may not share with the central Self.
Exiled Parts can be highly influential and unknown.
Just like someone who has never studied or trained to play piano, may sit down one day and plays a piece.
There’s more to you than you think.
Thank you for this wonderful and concise video helping identify dissociation: lost time is my number one “aha”” but I so appreciate your excellent point about how cognition and narrative can keep going with the person not fully present! Also appreciate the three-pronged solution. Can’t solve it til you recognize it though.
Thanks for your reply understand have same dilemma
A wonderful presentation, nice rhythm to your talk.
Thank you!
This could not have come at a better time…working with an individual displaying dissociation. Thank you!
Very Helpful! Thank you.
Thank you Thema for your personable, clear and hoeful video. I liked your calm, cogent and friendly presentation.
The emphasis on the importance of Psych-Education was particularly relevant and one I find both personally and professionally helpful.
Peace & Joy
Peter ( BACP Accredited Therapist, Shropshire UK )
This was helpful as clients are getting proficient in this form of dissociation given our recent history since the pandemic. Even the mask is a way to realize the significance of this repression accessory. It has seemingly caused a disrupt from the onset of work with those a remarkable rapport had been built.
This helps me more understand the change and why my own neuroception erupts as my mask also is a barrier. Have seen this early on in the pandemic. Even spoke of it with clients early when the masks came on, but putting in the form of dissociation more fully might help me be more prepared as it is only getting worse, especially with next generation of caseload. Safety will take longer with them.
Also the overwhelming blame mental health professional were getting in the news for so long. I think those naive to counseling are already afraid of the actual profession, which causes me severe grief to bring home each night. Propaganda was a topic in past history papers. This knowledge seems to help in this new era
Thanks, Thema
So very true👍TY
This is so clear! Thank you, Thematic!
Sorry, that was meant to be Thema. But it is perhaps thematic!
The dissociation can really be difficult to spot in one consultation, because each protection of the psyche allows the client to reduce the level of anxiety and function more adequately than it was at the time of the traumatic event.
The direction of psychotherapy that I have studied – psychoorganic analysis – includes the basic idea of the unity of psyche and body. Therefore, it is natural for me to observe the client’s physical manifestations, to reflect them, to help the client to get to know and manage them. I know how it helps the client to come into more realistic contact with themselves and the world.
Since breathing is one of the few bodily activities that an individual can control (consciously controlling heart rate or digestion, or hormone production is much more impossible), it is usually possible for the client. And yet – the client can learn to feel how breathing affects the entire functioning of the body.
My next step after discovering and reducing the dissociation that the client needs to do is to become aware of the fracture caused by the trauma. Fisher’s psychodynamic and dialectical approach helps me. I use the description of the injury provided by the client and the awareness of my countertransference. Together, we look for conflicting life contracts (such as “Any relationship is hurtful” and “I can’t survive without the other person”), the negative and positive messages they contain, and the opportunity to dialectically combine the positive (such as “I can choose who I build relationships with and with which I stopped to feel safe ”).
Nice! Thanks for sharing.
I have used CIPOS to reduce the risk of dissociation to strengthen present orientation and then graded exposure to trauma memories. So the threat system is not triggered, and the client becomes confident in going in and out of their trauma memories.
I also use the Flash Technique, or the EMDR Bomb, to reduce clients distress, before commencing the standard EMDR protocol. Thus reducing the risk of dissociation.
If a client is dissociating, I would use the Back of the head scale, and ask them to indicate where they are on this scale. They have to move their arm snd hand which can be enough to bring them back. I would also ask them to take a breath, and a drink. This stimulates the parasympathetic system, between Bilateral simulation and can soothe clients.
If they are dissociating, I would ask them to focus on their senses in the room, or play a game of catch with me, or squeeze a soft stress ball in their hands. We can play the catch game even working remotely.
I like your 3 indicators for Diss. I also use, clients slowing down, eyes start to wonder (mostly their left), their energy is not fully present – so I ask them “where are you” – and I accept their answers, “don´t know”, “out-of-my-self” (where? left or right outside?), and I USE this to ask them what they can see/observe from there – and then I also teach them how to “leave the body and come back again”
greetings Erik JArlnaes, Denmark
Excellent, she has just described the symptoms of a great many people at this time. And its very hard to treat trauma when the media is constantly fearmongering .
We have a global population of traumatized hyper vigilant , reactive ,threat focused rewired brains.
The awareness of the fear is key and the start of transmuting it to presence.
This is so true, I appreciate the concise way you expressed this. I know I need to be more concise in treatment with those traumatized which I need to work on more strategically.
Thank you, Thema Ma’am, it was insightful listening to your thoughts on three steps to work with clients with Dissociation
very clear description of dissociation in client’s physical presentation.
Thankyou.
I really like this video. Very clear, down to earth and helpful in terms of how this issue affects the whole body. Very helpful! I agree with this approach.
In TCM the shen reflects the affect. Observation of the shen (spirit and vitality of the patient) It gives information about the voice, emotions, and presence of the person. It is one of the diagnostic methods that the practitioner uses to evaluate condition of the body and spirit (mind state). So your description of this type of work is similar to TCM in that respect. I am so glad that these practices in holistic medicine are being recognized and used more and more each day.
Yes, I guess most of us are these days.
I am glad I was able to work myself out of this for most of my time, it’s well worth it!
I am so pleased to hear about healing the “spiritual belief” as well as the body/ mind. Shame comes from other peoples concepts of right and wrong. Religious abuse is not talked about enough. Dogma can be extremely harmful to a child who is looking for comfort and safety in what is told to them as Gods domain and God is Love. Confusing for a child who gets told that its their fault and God punishes bad kids. They should be ashamed for damaging the last safety place a child could believe in.
Took me years to be able to tell about the abuse from priests. Not sexual but spiritual abuse. I was exorcised for a suicide attempt at 5 and denied my confirmation (RC) publicly humiliate by being the last in the procession and not allowed to wear the garb nor have my hand in prayer but at my side.
I guess you see i still have huge resentment on this issue.
I have worked diligently for over 40 yrs on my CT developmental issues and thank goodness for your programs because I cannot get this amazing knowledge from the therapeutic system we have now. Only the very well to do can get real professional service. Our healthcare system allows the government working therapist a minimal amount of freedom in exploring treatment. We are categorized by disorders and if you have complex trauma, Good luck. Medication compliance is a big issue with me because they don’t work for a body/ mind/ energy trauma. Its a bandage solution.
Many many thank you’s to all who work so hard to help the world become less Traumatized. It is getting more and more prevalent in a world where power and control are the main goal of Achievement.
Suzanne, I am so sorry for the trauma caused to you by the Catholic Church. It is natural you have resentment for these soul destroying experiences. May you continue to move toward the healing of your mind, body and spirit.
Suzanne, I am so sorry for the trauma caused to you by the Catholic Church. It is natural you have resentment for these soul destroying experiences. May you continue to move toward the healing of your mind, body and spirit.
Hi Suzanne, You describe very clearly your experience and also your needs in therapy. That is a big issue I think, having a broad range of therapies available, particularly ones that work through the body and respect and treat the individual rather than diagnose, as in ‘categorize by disorder’. Sometimes knowing how some common human experiences generally manifest can be informative, but as background information, not something imposed on the person suffering – and certainly not as a solution to their suffering.
I was brought up a Catholic in 1950s & 60s Ireland and the mixed messages relating to a loving god who also punishes were not helpful. Our parents at that time still tended to practise ‘spare the rod and spoil the child’, all in the name of love and beating the evil out of children or beating them into obedience/submission to ‘save their immortal soul’. Generally more destructive of soul than body unless used to ‘excess’ (I was slapped but never beaten; but physical punishment is totally unacceptable and illegal here in Ireland now, and rightly so). It was a warped way of looking at things and even more so in the case of some of the clergy, who were on a power trip, as in your experience. It was the rare person back then who would stand up to them. That’s also part of a wider (patriarchal) culture which is only getting mended now. But it’s good to see that it’s harder to get away with such extreme, cruel and irrational behaviour now.
You might not agree with me given your final comment. It’s certainly more visible now and I live in hope that if it seems worse, it’s because ‘it gets worse before it gets better’ like a boil ready to burst. I wish you well.
Dissociation can be tricky to spot. There are a few signs to look for which can be quite subtle. Look at the eyes, do they dart? Are there slow movements; turning of the head,are the eyes following something, movements of the hands in a wrinkling motion, are there repetitive movements, if the client smiles quickly, or facial expressions change rapidly and you notice it does not fit with the current situation, they are probably in a dissociative state. After a few sessions can you notice a pattern, when things get overwhelming does the client yawn, touch their face, stretch, etc this can signal a switch.