The Differences in Dissociation Triggered by Shame and Terror

Some of our most challenging work is with clients who have suffered from trauma – and when a client dissociates, that work can become even more complex.

The way we approach a client’s dissociation may vary based on what triggered it.

In the video below, Bethany Brand, PhD, will share the clues she looks for when distinguishing between two triggers for dissociation – shame and terror. She’ll also walk us through the steps she takes when working with each.

Have a listen.

Click here for full transcript

Dr. Brand: In my experience, I can catch the hyperarousal and the fast breathing and terror more easily than in shame, where that tends to move pretty quickly to shut down. Often, people hide behind their hair, or they hide their eyes, and they slump down very small, so it can look just like collapse. But, if I’m thinking about, “What were we just talking about, if there’s some way I’m understanding in that situation, the person felt humiliated or ashamed, that helps me understand what territory we are in. It’s also possible to feel both at the same time, terror and shame, so if I think the dissociation is due to terror, I’m going to work on orienting them to the present moment. You’re with me, you’re in my office, can you tell me what the current date is? Knowing the client is helpful too, I have some cat figurines that really work beautifully for some people, a crazy air plant for others, you’ll know your client. They may have a grounding rock or a resource that they can hold onto. For some clients, I have them use maybe a watch from adulthood, or if they have a ring that means something, they can touch something, and I’m having them use senses. I’m using techniques that bring them into present reality and bring down the terror and calm them. If I think it’s shame that’s triggering the dissociation, it’s going to be very similar, but I’m going to speculate, “I’m noticing that you started looking down and getting very small when we talked about that, so let’s stop talking about that, and I’m just wondering are you really here in the room with me? Do you feel like you’re fully present here?” I’m going to see if they are all the way in shutdown. If they’re in shutdown, we’re going to work on that. If they can still process a little, like, “Yes, sort of, I’m foggy,” I might say, “Would it be okay to fully know that you’re here with me and you’re safe with me and we can stop talking about that or we can talk about it in little bits? I’m not going to shame you, I’m wondering are you feeling vulnerable or ashamed based on what we were talking about?” I often give them the words for that, and they might be able to nod the tiniest bit and that starts to help us have a way to process it together. “If this is very hard, we’ll go at a pace that’s right for you; you tell me when you need to stop. What can you hear in my voice? Do you hear criticism or derision or disgust?” because they’re often expecting that from me. So I’ll ask them, “Can you really tune into what I sound like?” Then, if I feel like they can do it, “Could you even just take a little glance at me, could you look at me?” It’s usually just a furtive look-up. “Do I look upset, disgusted, revolted?” Really check it out, and that can be a very powerful way of working it through. They expected me to be so grossed out and then I’m not, and that’s a really therapeutic, powerful moment.”

You can hear more about how to work with dissociation (even when it’s subtle) from Bethany Brand, PhD – along with Bessel van der Kolk, MD; Pat Ogden, PhD; Peter Levine, PhD; Stephen Porges, PhD; and other top experts – in the Advanced Master Program on the Treatment of Trauma.

Now we’d like to hear from you. How might you put these techniques into practice when working with a client who dissociates? Please leave a comment below and let us know.

If you found this helpful, here are a few more resources you might be interested in:

[Infographic] – Three Warning Signs of Structural Dissociation

[Infographic] Working with Structural Dissociation

A Three-Step Approach to Treating Trauma-Related Dissociation, with Thema Bryant-Davis, PhD

21 Comments

Cherisse, Social Work, stl , MO, USA says

Massively helpful thank you for your kind demonstration of these expert skills.

Mona Hill, Social Work, CA says

My clients have taught me over the years that my voice, during those times of dissociation has been the one thing that has helped them feel safe.
Voice tone, along with words from us as therapists can be key to helping bring them back to the here and now in a non threatening manner. Thanks for this short video. Appreciated.

Maggi Alaco, Psychotherapy, GB says

Really sensitive distinction, thank you, the eyes usually a key giveaway with shame.

Dana Stewart Shunatona LCSW, Social Work, DALLAS, TX, USA says

Thank you so much, I really enjoyed this video.

elizaBeth Simpson, Coach, Urbana, IL, USA says

So much difficulty is arising as people feel shame for not engaging earlier with climate, politics, etc. These prompts are extremely helpful to support people in staying engaged in much needed community work.

- Anonymous says
  
  Very useful connection you made…thank you.
  
Eva E, Other, So Cali, CA, USA says

I’m so stoked to see Dr. Bethany Brand as part of this series! I have learned so much in the past from her work, and I am so hopeful to see her knowledge be made available in this way in a greater society. It’s about time!

Peter, Counseling, Gloucester, MA, USA says

I read that adult couples in the UK have been finding that nursing at the breast, on demand, and/or PRN is having beneficial affects on their anxiety, etc. This seems to be related to the release of oxytocin. This has been confirmed by research. Could technique be incorporated in the treatment of trauma, anxiety, etc?

Lindsey Cartwright, Coach, AU says

Thank you Bethany for sharing these insights. This short clip will help me immensely with my Executive coaching clients as I assist them to be the leaders they’ve never been. There is so much hidden trauma in Corporate environments which can sometimes come up in Leadership coaching. Much appreciated x

Paula Maddison Green, Counseling, GB says

I’ve been watching your videos and I completely agree with everything you say. These will help my clients who are in disassociated states. Thank you so much. Paula Maddison Green MD of Trauma Stop UK CIC

Kathryn Shulman, Naturopathic Physician, Tempe, AZ, USA says

This is incredibly helpful information for me. So many of my patients are experiencing physical conditions and ailments that originated from traumatic events. When we begin to discuss their symptoms – I recognize with this video, that sometimes I am witnessing terror and/or shame arise. Now I have more skills to offer and provide help in those vulnerable moments.

Jennifer Y., Other, Van Nuys, CA, USA says

I could when having a fellow consumer, as a peer advocate, or client, and or as just a human being friend, consider these tactics and the issues of whether they’re having shame or terror

concha de Luna, Medicine, ES says

Thank you so much. I´m a pediatrician and it´s very useful for my practice (more with parents, than with children).

Esther Brandon, Coach, Jamaica Plain, MA, USA says

As someone who has done years of repair and recovery work, I Think what is missing from this verbal cognitive approach is embodiment . Both Shane and terror are sensations in our body, and the experiences may have been pre- verbal.
Esther, Esther Brandon Life Coaching

- Eva E, Other, So. Cali, CA, USA says
  
  Remember, Esther, this video is about “dissociation”. Dissociated people cannot feel the bodily sensations. They are not in their body, and that’s part of the problems. The body tend to be a trigger of itself as well, so bringing attention to bodily sensation can overwhelm them and push them further into dissociation.
  
  - Maple Wong, Psychotherapy, HK says
    
    Totally agree! How can we bring back our clients from dissociation without using those embodiment exercises. They will be triggered by the body scan or movements.
    
Pamela Voysey, AU says

Great tutorial. I like the way you can make the client feel in the right place.

hannah sherebrin, Psychotherapy, CA says

This is a grewat reminder, especially for disociation. The giferentiation betwee shame and terror does not exist if you work with people that had early childhood trauma of rape especially with family members. The sensory trigers may bring out protective alters, and it is then neccessary to concentrate on protection and yes, on bringing back to here and now. Lookiing forward to Wednesdays webinar. most helpful sessions!

- Eva E, Other, So Cali, CA, USA says
  
  I agree – terror exists with shame, and it’s not either-or situation. I hope Dr. Brant will address the interpersonal nature of traumas that people with dissociative disorders carry, and implications that causes in therapy because of that.
  
Sara Gilbert, GB says

Excellent strategies from Bethany. Very helpful and to the point

Nigel Jenkinson, Counseling, GB says

This was really useful about getting the client back into the here and now and letting them know I am not reacting negatively to the content. I would give them some space and acknowledge it seems scary/awkward etc for them. Empathy is key for me and letting them know I am not judging them.

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21 Comments