How to Identify and Treat Dissociation (Even When It’s Subtle)
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with Peter Levine, PhD;
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with Peter Levine, PhD; Ruth Lanius, MD, PhD; Stephen Porges, PhD; Bessel van der Kolk, MD; Thema Bryant-Davis, PhD; Kathy Steele, MN, CS; Janina Fisher, PhD; Bethany Brand, PhD; Pat Ogden, PhD; Ruth Buczynski, PhD
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I cant thank you enough. I’ve only recently begun practicing and have been struggling with feelings of inadequacy and questioning my competency as a practitioner when working with a client with PTSD, who it’s clear has Structural Disassociation. The strategies shared have given me insight into how I have inadvertently triggered her. And, more importantly what I can do differently to best support her, namely slow everything down to go at her pace, not take her criticism OR her idealization personally and possibly offer non shaming/normalizing education. Fabulous training and will be upgrading to the Gold Package!
I’m a parent with a seriously dysregulated adult child — I see that many of my strategies are spot-on, but with others I have probably triggered and escalated his problems. I hope you do a series for parents/parents of adults sometime soon! Thank you for the insight.
Greetings from Maine,
For the 2nd week I am encouraged that so much of what I have thought, felt and reflected so closely aligns with the information you have shared during this session. Attachment fears are very real when those closest around you have spent a life time trying to erase you with regular and debilitating shame through verbal judgements and criticism. I agree with so many strategies you’ve shared to help with dissociation. Thank you for this valuable information. I will reflect this week on all that you have said and think of it as truth that will free me from my enslaved thoughts formed in childhood.
Shalom,
Ann
The quality of the sound is variable. Dr. Van der Bessel is at times difficult to understand partly because of his accent. Subtitles would help a lot. Pat Ogden’s deep voice and audio setup make it at times hard to understand. Kathy, Ruth and Peter are crystal clear. I suggest that measures be taken to make the less comprehensible voices clearer.
I could agree with that! Overall I’m impressed with the editing/pacing and how the producers pull all the disparate comments together. But a good sound engineer could probably give you an enhanced product.
there are subtitles available. there is an icon to click on for the video. it is at the bottom to the right
I will use the questions recommended to stay connected with the clients, also better watch for signs and triggers of dissociation, how to support a dialogue, connection of the two opposing parts . I like the idea of focusing on my own internal body feelings when a client reacts contradictory or in paradox, this can be a great diagnostic resources, thank You for sharing very supportive ideas and strategies for work. Great lesson from all speakers!
Wow that was very big for me. There have been so many mistakes made in therapy in my life. Life as Trauma is the title I would have if I were to write my story.
“When Rabit Howls” Trudy Chase’s book bought me totally undone with absolutely no idea of why some 30 years ago. It began a search of ‘what is wrong with me?’ and a discovery of the shame state.
This segment bought home so much, but the bottom line is that I always feel so ashamed because I can’t seem to reach ‘the expectation of my therapist/s’.
I realise how difficult it is for a therapist to work with me just through listening to this.
I totally support your work and am grateful that you DO make it available for lay people.
I had technical problems so unfortunately only heard 20 minutes of the webinar. It was a very informative 20 minutes!
I hope I can access the beginning.
Thank you very much to all of the presentors.
Maureen Duggan
Absolutely amazing content. I’m working with parents who have experienced trauma resulting from a disordered ex spouse who has alienated them from their children. This is so helpful to help them work slowly and gently back toward the path to themselves to identify the power of the truth vs their thoughts. Thank you.
I have led a Recovery group of male addicts for 7 years. 4 month in-house program so ever-changing group of around 30-38. Listening today affirms I am on track with teaching them about trauma. They are closed to their feelings and recovery requires learning to feel and regulate or manage feelings. I create a safe environment and they respond with openness. I regularly teach them how to breathe from their diaphragm. This is all new to them. Thank you for this training.
An image of a tug of war between the two motivational systems was excellent. Easy way to remember it ofr me.
But my main take away today is about pacing. It is so important for me. I tend to get excited at a perspective of uncovering something and moving the process and then I can move on too quicly, disregarding the client’s pace. Thank you for reminding about this.
This was a very interesting presentation. I will definitely, going forward, be more mindful of such red flags like changes in tone of voice or dress sense.
Many thanks for the insights.
Y’all overexpress a bias about dissociativity that is dangerous. Dissociation is normal for about 15 seconds out of each minute! You might really be stepping in from Nazi eugenicist origins of your field! Please act responsibly in your humanization of normal levels of dissonance and dissociation as you advise our profession!! Don’t let us down!!
Finally, Peter, your comment that “(noone would know) until about 100 years of therapy” makes me want to vomit and take back all my recommendations of your books and videos. Is this the disguise you operate within? What about 10 years of meditation with a qualified teacher?
Informative. As a nurse I was especially interested in how empathy can trigger patients, especially those physically abused as a child. Also helped me understand my reaction (severe anxiety that progressed to tears and sobbing) when I was placed in an environment that reminded me of my own previous trauma. Now I know what to watch for. Thanks.
thank you for these nuggets of info. For the use of hypnosis, distinguishing a disorder from some simple trance states is helpful. To know theres mixed trauma, or something deeper like a full disorder.
added comment – also the matter of fact/ not over empathizing is very helpful.
Thank you for doing a series on the freeze response. I love the pictures, cartoons, and infographics you have created to accompany this series. Such a great speaker line up as well!
This was very insightful, I honestly didn’t know there were more than three automatic responses to threats.
Your work putting this together ind incredible; thank you so much- heart of helping knowledgeable treatment- I’m still integrating this all after prodigous notetaking. my heart goes out to this effort; as a counsellor it is so helpful
a roadmap thank you so much
if I don’t pay this time round it will come, I”m already a member of NICBM- such an awesome society.
Leigh Brousson Nelson, BC Canada
Really like
Becoming more matter of fact rather than too empathic is always an excellent reminder in view of the fact that empathy got me into this business in the first place.
Thank you – a great overview and lots of good information. It has reminded me to ensure use of trauma related questions when undertaking initial assessments and looking out for and working with dissociation throughout treatment, specifically using physical strategies in sessions.
I am not currently working since I am retired. I have left my volunteer counseling position since Covid started but when I return to work I expect it to be helpful!
I have 30 years’ experience. I did not understand how to misdiagnose DID with a personality disorder. Somehow I missed that.
Charlene
BIG TAKEWAY: TOO MUCH EMPATHY AND ATTUNEMENT WITH A CLIENT CAN BE STABILIZING FOR SOME. I AM EXPERIENCING THIS WITH A PARTICULAR CLIENT AT THE MOMENT AND I’VE REALIZED I MAY NEED TO BE A LITTLE MORE MATTER OF FACT AS THE EXPERIENCE OF “BEING SEEN” CAN PUT HER OUT OF HER WINDOW OF TOLERANCE.
As a certified emotionally focused therapist, I truly appreciate the teaching on the paradoxes and contradictions which involve fears related to attachment.
Such a great series, thank you so much for sharing this information with us
The difference between structural dissociation and personality disorders is interesting. It also seems that parts work (eg IFS) could be helpful here.
Useful ideas!
I found it revealing that while the freeze response from the first module may look like the dissociation response from this module in that the behaviors are similar, the inner experience of the client is quite different. It seems in the case of the first, there is terror and paralysis, while in the second there is a shutting down or splitting off of consciousness.
In terms of the window of arousal/tolerance, the first is hyperarousal of the nervous system (but somewhat hidden to the casual observer), whereas the second is hypoarousal (but distinct in function from the restorative or bored types, in that it is protective). I feel that we are bumping into some limits of that metaphor’s ability to capture the phenomena.
I’ve also had some trouble with integrating my understanding of the window of arousal/tolerance model with the polyvagal ladder. The hierarchies of the two metaphors do not match, in that the window has the ideal state in the middle, a balance in terms of level of activation. We strive for “not too hot, not too cold, just right.” In contrast, the polyvagal ladder has the ideal state on top, and as the first module made clear, the path from dorsal to ventral states passes through a risky zone of sympathetic activation.
Thank you for all this valuable practical knowledge!
Throughout this session instances of therapy sessions with clients who have experienced trauma were coming up and I was thinking about what to look for and explore in the upcoming sessions reminded of how a very s l o w pace is sooo important with clients with disorganized attachment… as is not getting close too soon… I am also finding how relieving it is to talk about how the nervous system works and how it soothes shame. My clients are reporting back to me how giving them practical tools about grounding have helped and empowered them immensely. They also report that observing their posture and making adjustments like I have shown them during sessions is helping. I also love the idea that dissociation was in fact a superpower of the client when they were undergoing trauma… and as with all clients, even more so with people healing trauma how important it is to follow their pace and make sure therapy is a safe place where all their parts are respected, cared for and aquainted with eachother.
I look forward to this whole program, thank you so much!
Thanks a lot for that profound information,to see that so concentrated gives me new Thoughts to think about in my work with the clients.Guess i will be more integrate the Bodywork.
Thanks for bringing the topic of dissociation to your program. It is so inspirational to see the leaders in the field of traumatology presenting on best practices for treating the dissociation that goes along with trauma. The roadmaps and worksheets are also appreciated very much. Bringing dissociation to the world of mental health today is akin to bringing the concept of trauma to the world of mental health 2 decades ago. Your program is helping to advance knowledge and best practice, and for that also I am grateful!
Marlene Furey M.Ed., MSW, RSW
Halifax, NS, Canada
I felt very curious about the whole body experience of fragmentation and how different parts of self build up to survive as a result. The term oppositional has suddenly come to life rather being a worrying ‘label’ that was applied to me in training. Very grateful for the free and lower cost aspects of what you offer. Thank you.
I am left thoughtful. But also tasting into the sensory. When Pat Ogden spoke about the sensations, I was aware of really noticing this link and it amplified what I have found in my own journey. In particular, it was not hearing voices, but becoming aware of scent. I smelt roses and mustard in the room that was occupied by my research professor. Sadly he committed suicide. I have yet to experience that type of sensation with a client, but I regularly have strong visual imagery and sometimes sound distortion, which feels close to hearing change. I am experiencing one sided age related hearing loss.
As a long time substance use disorder counselor I’d like to remind clinicians to screen for substance use based memory blackout when periods of memory loss are reported. Helping clients identify that memory loss events coincide with substance use episodes can be a valuable awareness for the client of possible substance use disorder related problems.
Personality changes can also be related to substance use and should be screened for that possibility.
Rick Matz, CRADC
Reassuring that I am on the right track listening to my clients and their pace, and becoming aware of when I go too fast, and adjusting the intervention, going really slow. And experience how that totally changes the mood and the feeling of the session, and how it progresses.
I learn so much from clients at the moment.
Also the clients are often the courageous ones that break the chain in the family, and are actually the healthy ones, but who has had to carry the burden of the whole family`s disorder.
And great to learn about DID.
Also: Many people diagnosed with for example borderline personality disorder has a background of traumatization, which may have well been overlooked in the general medical care system, and therefore not addressed in the treatment.
Retired Doctor Allison Miller of Victoria BC Canada spent much of her career treating people who were abused by perpetrators who intended to create and structure their victim’s dissociative identifies to have conditioned responses to certain external stimuli to have better control of their victims. She considers DID to be a brain injury, rather than a disorder. She has several books out. “healing the unimaginable”. “From the trenches” “Becoming Yourself”. These resources may be useful if you are dealing with a highly structured and organized dissociative person. These persons are a little more challenging to identify, since they are often high functioning and the switches between dissociative states are far more subtle than persons whose dissociative parts were not assigned internal roles by their perpetrator.
Do you have any education or information on this type of highly structured and organized dissociative system?
Thank you so very much for the great learning experience. I am working with a client who cannot recall ten years of his life.I often asked myself whether this was a positive adaptation that should remain in amnesia. I am not skilled enough (yet) to apply many of the suggestions offered today.
I am 73 yo and still have a small practice to augment my Social Security. I am wondering are there scholarships available as I am not able to afford the training.
Thank you in advance for your consideration,
Thank you for this great presentation and information.
I have a 49 yr old, developmental trauma as well as adult sexual trauma client I have seen for quite some time, and wondered about dissociation. When posting a question on the EMDR sites, all the feedback was she has DID. I screened for DID which I do not believe she has, i.e., no lost blocks of time. But she has this spacing out thing she does, and she often can’t give me a number for the change in SUD’s level. Sometimes she can just tell me that it does feel better than it did. I have stopped the EMDR for now, and am just in a supportive role for the time being, as she has had numerous physical ailment complaints, injuries, etc. She also has the paradoxical reactions to benzo’s, anti-depressants, etc. It makes so much sense though about the times where I feel lost, dysregulated, etc. Will definitely have to be more aware of my own grounding before seeing her.
I am no psychologist, but I am a person who has dealt with dissociation my whole life. I am just like the client you talk about with developmental trauma as well as childhood sexual abuse. I did the spacing out thing and also had difficulty giving SUDs. I do not have DID but was told by a psychiatrist that I was actually in a state of derealization, which made perfect sense to me. During that particular period of dissociation, I felt like I was in a dream state, which frightened me a lot. For example, sometimes when I was driving in that state it felt like if I swerved into oncoming traffic, there would be no consequences when the rational part of me knew that was not the case and there could be horrible consequences. It’s hard to describe now that I’m out of that state (thank God!) but it all felt so surreal all the time and I struggled to get back to “reality” by sheer force of will which never worked, much to my frustration. I hope that by telling you a bit of my story that I was able to give you some hint of what might be going on with your client.
I was really struck by how I noticed that the outworkings of dissociation are often met with scorn eg ‘you’re spaced out,’ ‘you’re ignoring me’, ‘you’re never really here’, ‘they’re compartmentalizing and not addressing the issue’… I really appreciated the wording around, “oh the spacy part is here!”. I also appreciated and will use the grounding and reconnecting – ‘coming home to myself’ – strategies as validating and honoring alternatives.
I am not a practitioner but a survivor of and recovering from a traumatic childhood (at 60…amazing how it never leaves you) Thank you so much for making these sessions available and free to not practitioners. It really has been informative and helpful; you have put words, understanding and methodology to something I have realised about my coping mechanism that I now understand may be DID; certainly a lot of things fell into place. It has also allowed me some much needed compassion and understanding of myself. A brilliant resource for both practitioners and surviving victims. Thank you.
Totally agree Francis. I am so grateful. Sometimes I feel that as a trauma victim of childhood and life, one almost needs to understand the language of psychology to try to express your own ‘natural’ psychology that has been so warped by the life. Then needing to fit that in the boxes that are presented to you in therapy.
And then feeling such shame because of the confusion that follows and the hopelessness that it will never change. Age 72
I’m a psychotherapist but I watched this in order to better understand how trauma has effected me. I’m 67 yrs. old and it’s through this presentation that I learned that my difficulty making decisions, large or small, and my pattern of making the preparations but not taking the actions is probably from the traumas that I experienced. Throughout my adult life I’ve been so critical and judgmental of myself re:this behavior. Thank you so very very much.
Interesting and really well organized presentation, and very clear. Being a Bioenergetic Analyst, I’m very impressed with what I watched and listened to this evening. My understanding and way of working with dissociation has a lot to do with the actual body, with meeting the cut-off or freeze or un-feeling from the body, and then coming back to it. In a way that promotes safety: grounding, working with the feet, , touching the body, learning to notice when you’re on the “edge” or drifting, by getting very familiar with the borderline states, grounding with voice (calm voice, to begin with, but sometimes – as Porges says – you have to do through sumpathetic arousal and discharge to go from dissociation (dorsal arousal) to grounding, and that may come as deep crying, or fast breathing, or lots of tremors etc. See you next week, thanks!
I am not a mental health practitioner; I am a secondary school administrator who works often with students who have experienced trauma. I have seen all three red flags identified in today’s session in my office, and am fairly successful with recognizing and calming dysregulated youth (and their parents) before things get out of hand. However, having no formal training in psychology, I look forward to consciously using the somatic, experiential and cognitive approaches to working with students who are presenting with dissociation – rather than “winging it.”
I am a patient not a practitioner. This session has covered many of the things that I have learned with my therapist over the last few years. Being a suspicious person, no surprise, it very much helps me to see that what I have lived with most of my life is relatively common and treatable. I will be attending the other meetings in this series and want to thank everyone involved. This outreach is helping and will continue to help me to learn more about myself and how I can change.
Feel free to change it in your own reaction / response to dr Van der Kolk. Why should he have an obligation to react to your wish to change his examples? If it touches a chord with you – analyze the why, and get to the bottom of it. That would be my recommendation to you.
Working with a challenging case of complex trauma with someone from a Hassidic community caught between wanting to “exit” or stay. This webinar was useful to get me looking at her case with a different lens, adjusting my target to including some of the aspects of dissociation discussed here. Thank you!
I’m working with a person who has been deeply traumatized by an all-consuming and very critical mother. She’s not a client, but rather in a 12 step support program where I sponsor or mentor her. I can’t do therapy with her(I’m a retired therapist, anyway) but want to be as supportive as possible. Not being overly empathetic and being cognizant of her increasing arousal when we’re texting is helpful information. She has a therapist and a psychiatrist. She trusts the therapist byt he doesn’t appear to have trauma training. The psychiatrist is new but so far she has felt listened to. She’s in another country. Any suggestions? I sometimes think I can’t possibly help her and yet she seems to trust me because I listen to her. Thank you for your work.
This was a fantastic training and will use many of the points made. I’m so glad I learned the importance of the negative effect of using empathy too much or at the wrong time. Additionally, it was a great refresher about this diagnosis. Thank you for the wealth of knowledge and look forward to the next session.
Thank you so much for this very informative and thought provoking presentation!!!
I will take what I’ve learned into todays session to become more self aware and empower the client to have the voice they need to actively participate in there on wellness and healing from past trauma….
Very helpful information in particular helping client identify their window of tolerance. Very appreciative of the work all of you do and for sharing the information with us : )
I am not a licensed professional provider. I am currently under therapy at 76 yrs of age and my therapist is wonderfully open to my investigation and education, with the caveat that I bring questions to her at our next weekly session or in between if needed. I am thrilled for this opportunity!! I only regret that I missed the first session but my retirement income level precludes my buying the gold package, Amy chance of me getting a one-time link so I can catch up to what I missed by finding out about this too late? I would SO appreciate it if you could make this possible. Thanks from Joan Ross @ jlrss@aol.com
Thank you so much. I recognize some mistakes I’ve made with clients and family members and myself! The piece on empathy really hit home. I could see how the individual was checking out and didn’t realize my efforts contributed to it. Thankfully, we used mutual breath-work to slow things down. So grateful to all of you.
I appreciated the warning about how empathic contact can sometimes stimulate parts the client may not be ready to reintegrate. I will definitely be more mindful of this in my trauma sessions!