When a client dissociates in session, there are many grounding techniques we can use to bring them back to the present.
But what can help clients when they dissociate outside of your office – particularly when they report losing chunks of time?
Below, Ruth Lanius, MD, PhD shares a simple yet effective strategy that helps her clients reduce time loss and stay grounded throughout the day. It’s less than two minutes – take a look.
If you’d like to hear more from Ruth Lanius, MD, PhD, as well as Bessel van der Kolk, MD; Pat Ogden, PhD; Peter Levine, PhD; Stephen Porges, PhD; Thema Bryant-Davis, PhD; and other top experts, check out the Advanced Master Program on the Treatment of Trauma.
Now we’d like to hear from you. Do you have a client who could benefit from this approach? 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:
[Infographic] – Three Warning Signs of Structural Dissociation
A Three-Step Approach to Treating Trauma-Related Dissociation, with Thema Bryant-Davis, PhD
Recently a client was referred to me with severe PTSD and his inability to keep track of time has made it very difficult to keep track of his appointments. I have only been able to have one session with him out of 3 attempts. Since I’ve only met him once (virtually),I don’t know him well and so I’m not sure about ruling out a different hypothesis : that he is ambivalent about treatment. This could mean he is just not ready, or I need to be more insightful about using a motivational technique that might reduce his ambivalence. Whatever the explanation behind his not keeping track of appointments, it is a challenge to treat someone with whom it is so difficult to connect with.
Very Interesting.
I started to fall apart more than 4 years ago. I taught literacy for passing the GED test. When it was privatized in 2014 and became the copyrighted property of the multibillion Pearson corporation and I began an obsessive social justice effort to change this and this effort succeeded in in presenting a convincing case that should have worked but didn’t, I became obsessed with a larger agenda and …
I entered the state that has now become like an addiction I can’t shake. Besides the time issue I already had of never being on time, I was now in an intractable downward spiral of losing large tracts of time spent reading all aspects of social justice and impulsivity writing hasty, caustic responses to emails that often took 2 or more hours, would only be read by a few people who often only felt attacked and irritated. And this resulted in further deterioration of any semblance of self discipline and responsibility to others as well as any attention to the ordinary matters of completing the tasks necessary for maintaining my life— relationships, mandatory paperwork like paying bills and my self-care as well. And all my efforts to restore my former behavior of self discipline have failed. I even have 2 therapists!
I’ve tried using the alarm clock methods but only keep resetting it. But at least it brings the passing of time with an approximation of the amount of time passing by. I will try it during the day and see. I am at least pleased to be able to have a psychological category for it instead of just naming it a serious character flaw that causes me crippling shame and fear.
Marcia, thank you for sharing your experience it is so similar to my own & I wouldn’t have even recognized it’s connection to this without your perspective for comparison. Even though you have not yet found the breakthrough solution, it is comforting to know that I’m not alone in this struggle. I wish you all the best & hope that it helps you a bit to know that I’m a world of people who don’t understand why you care so much, there is one and probably many more out there who understand & care as deeply as you do.
I resonate with this too, even now as a Practicioner/coach myself I am still struggling with my time. I have been considering recently ADHD or complex trauma as the reason, with no answers yet. Unlike you, I have never managed to keep a strong routine in my life and always struggled with time and distractions (as well as hyper focus).
I can relate to this struggle and wish answers would come easily. I come to realize that my ability to manage my time has changed over the years. I am 62 and not working outside of my home. I set to start my day with a few other things and added journaling. I use a timer for 15 minutes and see how much I can write down. I have no ambition to be a writer/author and have been interested in how learning involves so much awareness of how much time you spend or not on a task thinking otherwise that you have done enough. I have many planners and they have not been helpful, only recently, to me to keep up with my appointments. Calendars on the wall, and on my cell have been unhelpful. Only the timer has helped much for my 15 minutes of writing. I don’t have autism no adhd, like any students I have helped until now. While timing helps me to focus, my students look forward to this time to rest their minds and to move around then sit and watch the clock beep again.
So to say I am still not sure if using a timer is to remind you and bring you back to where you started. It hasn’t been helpful to me with my appointments and scheduling.
The client only experiences time loss during times of crisis or extreme distress. They have no memory of several weeks at a time during which they were very unwell, were assessed under the MHA and detained in an out of area acute mental health unit and their memory returned later during their stay in their local acute mental health unit having been transferred there when a bed became available. They have also experienced dissociative fugues where they find themselves someone (always the same bridge known for suicide) with no knowledge of how they got there having travelled miles. These experiences are only during times of crisis and they don’t knowingly dissociate at other times. How to keep a client safe when in crisis and likely to dissociate?
The use of a phone or watch timer is an excellent way for grounding and also developing a sense of mindfulness to stay in the present.
I have found this master class so interesting, everything that gas been mentioned so far is exactly the explanations / answers I have been searching for… for once things that have happened now have an explanation, and I am not nuts yet! but for me this new understanding is too late.
What a totally brilliant idea!
I’ve used this technique personally minus the journaling part. Watching time never worked for me, and lost time no matter how hard I tried. And this was in my childhood when I didn’t know I had DID. There used to be a coo-coo clock in the house, and the sound every half an hour brought me back to the present (back then, it was my obsessive compulsion to control my forgetfulness that got me into troubles, though). In my early adulthood, I had timers or watches set to go off every 15 min (Still, as a part of my compulsion). Days still skipped, but this was many years before I was dxed with PTSD, eventually with DID, and did any therapy. The technique itself didn’t contribute to gain any co-consciousness as I’ve done that for many years before I started therapy. For me, it only scared me and confusing to me to find someone else’s handwritings in my notebooks when I was in school. I believe there needs to be some level of acceptance that you are living with other parts who takes over the body before co-consciousness to start happening. I like the idea of jotting down a short journal entry in addition of alarms a lot. I wish I’ve done that when I was in therapy. It would have been helpful to learn more quickly.
Another thing that contributed (and perhaps the most contributing factor) for me to not been able to develop co-consciousness and kept loosing time was that I was still living under the control of the abusers, and I was still dealing with the abuse that made me to have DID on a daily basis. Nothing, even a good therapy couldn’t have helped then.
This was interesting, and will be useful for the work I do. I admire and like Ruth’s way of communicating – tone, facial expression (kind face) straight forward words. Thank you
I enjoy Ruth’s compassionate and none judgemental vocabulary. The words she chooses to talk about experiences invites staying engaged and present.
That was a wonderful help thank you so much!
Thank you for this helpful tip. I have encouraged a diary approach for clients in order to try to track what they last remembered when they have lost time, as well as journaling in general. I love this added idea of using the phone to alert them to track time more routinely in order to facilitate co-consciousness and the experience of continuity of time.
This is a simple, yet powerful way to stay connected with oneself. Another way to do this is with a 7am-9pm sort of appointment book, using it as a planner and as a diary. The use of the cell phone to chime every 15 minutes or so reminds me of the grandfather clock with its chime.
Thanks . I work with people who have had a stroke and think this could also be useful for patients who have cognitive confusion and disorientation following the stroke
This is workable. Good strategy. Thank you!
Hi thanks for reminder Ruth. I have in the past used this strategy of record keeping with clients & some have found it to be very helpful & grounding.
Trish Curtis..