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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– Signs of structural dissociation (which make so much sense and explain certain people’s behavior, making it seem far less threatening).
– How to identify dissociation without shaming (and how to ask to be treated).
– Do not rush in to identifying dissociation.
Importance of unbending parts before integrating.
– Listen to your own nervous system and consciousness, to have an idea what is going on with client.
– But don’t go with your instincts to do what is more comfortable for you – focus on what is more comfortable for the Client’s parts. Do not focus on building a relationship with Child parts, but rather with Protector parts, what may be hostile to you, and the adult Self.
Oh, my. This session has made me realize I need to 1) be more mindful of the potential triggering effects of directly expressing empathy at the wrong time(s), 2) recognize and address fragmentation as the dissociative symptom it is, 3) do with clients in session any physical action I’ve suggested to them; and 4) slow down more often than not! Thank you so much for this session and series!
I’m a Domestic Violence counselor in California, also a Pepperdine student (MA Clinical Psychology) and I could relate with the observation that empathetic voice can be triggering at times dealing with dissociation, I will definitely watch out for that. I also found it very compelling to hear that as therapists we are assertive to check in with our own nervous system in order to track our inner experience in feeling co-regulatate or dysregulated. A great skill to tune in with patient and gather information on diagnosing dissociation and I feel blessed to know this before I graduate. Thank you, great session!
Thank you for this information. I am the owner of a Brain Balance Achievement Center in Kansas City and a foster/adoptive mom of 7. Over the years, I have worked with so many children affected by trauma. My experience is that is very difficult to find help for them by someone that truly understands the effects of trauma on the brain and body. Everything you are teaching makes so much sense to me and for once I feel like what I know to be true is finally recognized and understood. I wish that more therapists, practitioners, case workers, family members, etc would get this information so they can better understand, relate to and help those suffering from trauma. Thank you…I can’t wait for next weeks session.
I take with me in particular Ruth’s and Janine’s empathy and acceptance of clients. Remembering to accept what the client brings without rushing to fix. I think it might be useful for me, in the future, to think of the window of tolerance as existing in the physical space between the client and myself, to help me hold the client. I also appreciated Thema’s comment about structural processes in society keeping people of colour, women, invisible or devalued.
I’m a Domestic Violence counselor in California, also a Pepperdine student (MA Clinical Psychology) and I could relate with the observation that empathetic voice can be triggering at times dealing with dissociation. I also found it very compelling to hear that as therapists we are assertive to check in with our own nervous system in order to track our inner experience in feeling co-regulatate or dysregulated. A great skill to tune in with patient and gather information on diagnosing dissociation. Thank you, great session!
Excellent presentation! These sessions are making me more aware as I work with children and adults who have experienced trauma. I am learning some new information that will be applied immediately and shared with colleagues. I love hearing from the variety of fields and expertise from their perspectives.
Thanks to all who contributed to this session. I appreciate what I can offer, or how to refer, within my scope, as a structural body worker and yoga instructor. I value and use breath practices and body signals in approaching class and session designs.
It is self-evident that understanding freezing, dissociation and other fallout from trauma, not only has the capacity to heal the patient, but the country and the world.
Realizing that for both of us to be in a shared safe space, I need to give up my authoritarian tendencies to maintain control or to label. And to turn away when I’m being rejected
What you suggest is much more a delicate dance … with both of us engaged in the fullness of a present moment.
I’m especially grateful for the permission and encouragement to be gentle, slow if that’s what’s needed
Valuable takeaways for me – to use ‘matter of fact’ demeanor instead of over-empathizing, and to ‘breathe with’ clients. The selling of the gold package was distracting and off-putting. Thank you.
I feel more empowered to help my clients ground and return to the present, when they disassociate in my office.
What were the 5 types of dissociation? I missed those!
Look in the DSM V
1) Depersonalization
2) Derealization
3) Identity Alteration
4) Identity Confusion
5) Dissociative Amnesia
I also felt that the 5 types were barely mentioned, let alone defined, and that it was a big miss in a talk about dissociation. Everything else I thought as very well discussed, as much as could be done in an hour that is. Maybe add a whole new section on these 5 types alone? I am extremely grateful to receive this knowledge, especially free of change since I am now disabled and unable to work
Thank you very much for this learning opportunity!!
As a newly qualified therapist with very little experience in working with trauma, i find everything extremely helpful and interesting. From todays session i am taking a new knowledge on Dissociative disorder and the red flags that indicates the potential DID. Thank you.
This has been really helpful. I didn’t know much about DID before so seeing the difference between this and dissociation helps.
awesome coverage thank you
Thank you so much! I had no idea I was already implementing some of these skills. I now know and can be more aware in the moment of the skills I am using and what potentially needs to be used. This was a great information and I truly valued it for practice with my clients.
Session content is exceptionally valuable. Agree with how much this type of work can be helpful in the way past traumatic events related to current issues we are facing racially, politically, and economically can trigger many of us and the people we help emotionally, intellectually, and spiritually.
Thankyou. I am taking this for myself and looks like it may also help me with understanding break-downs in relation with sister where we both were fosterhood survivors in separated settings.
I find it helpful to hear aspects identified in an everyday manner as it contributes to feeling these periods are within a norm when events before have caused these results. It contributes to self acceptance and less out of body moments. It also helps consider aspects I witnessed in mom who had been placed in orphanage 5 years.
Thanks
I appreciated the discussions of both integration *and* un-blending—so important to maintain awareness that enmeshment is not integration. Also, the comments about how empathy can sometimes be over-arousing, at a given stage of therapy, in a given moment, for some parts, are resonant with what I have observed and experience with some of my patients.
The part of this presentation that was the newest to me was the idea of finding a blended posture that allows two parts to be co-present, rather than one part overriding another. That’ll keep me pondering for a good while!
Thank you!
Really loved this session and appreciate all of your time, insight, and wisdom. I’ve been a practicing social worker and counselor for 10 years and this is (sadly) my first hour-long session on dissociation. So very necessary. I have many clients who will benefit from the knowledge I gained today. I’m thinking about one in particular who, through this session, I had many A-HAs about her and the fact that her having trouble making decisions, the push pull reflex, is dissociation. She has been hesitant to get into her trauma with me and now I have some new strategies to help meet her where she is. Thank you again for all you do!
Mor Regev, LCSW
Very useful: had a cx go hypo when empathizing recently, will use matter of fact tone to help in future.
I missed the questions for assessing DID after loss of time and feeling disconnected from body. Can anyone help me fill the gap?
The ones I wrote down were:
1. Do you ever lose chunks of time?
2. Do you remember what happens when you lose time?
3. Do you ever feel detached from your own body?
4. Does your body ever feel like it doesn’t belong to you?
I learned that a person dissociates for many reasons not just trauma. Uncomfortable or threatening situations including racism, sexism and classism can trigger someone. Uncertainty probably triggers a lot of people too. Thank you!
Lots of useful information. I was especially interested in the under diagnosed structural dissociation description.
Thanks a lot for sharing these useful tools with us! Everything was very interesting.
Thankyou. I am taking this for myself and looks like it may also help me with understanding breakdowns in relation with sister where we both were fosterhood survivors in separated settings.
I find it helpful to hear aspects identified in an everyday manner as it contributes to feeling these periods are within a norm when events before have caused these results. It contributes to self acceptance and less out of body moments. It also helps consider aspects I witnessed in mom who had been placed in orphanage 5 years.
Thanks
This is ALL so helpful for my work with clients and students. I notice that I have made some mistakes in the past, like when I was helping at a mine disaster in 2006 in NE Mexico. The persons (relatives of the miners buried in the mine) when they were out of control, I would touch their shoulders, an have them look at me (which they couldn’t do) and ask them to breathe with me, as I counted the breaths. I learned that my the 20th breath, they had calmed down, and could return my gaze. It worked, I believe. But now I know, that I should not touch them, or tell them what to do, the gaze is to intimate or threatening. Also today, I lerned that my empathatic voince might be triggering past trauma, so I should just be more “matter of fact.”
THANKS.. from Saltillo, Coahuila, Mexico.
if it worked you probably did ot right 🙂 Not all traumatized people dissociate there personality this way (some just the the timeline and episode of the trauma), and not all traumatized people have a problem with eye contact, touch and empathetic voice – in a disaster it would normally be the right thing to do, except if you notice it makes the person getting in a worse state instead of relaxing them more.
There is a differens between people being at a disaster and being traumatized and people who is already traumatized with e.g. sexsuelt assult. Fore some people the reason touch, eye contact and empathetic voice can be too much is shame and the “empathetic” voice and touch being part of the trauma.
Thank you so much These broadcasts , although some are out of my field, most of this information can be used to help people and lead them to a better quality of life. It gives me knowledge of referrals to others qualified to deal with issues. I always stay within my limits , but it is helpful to be able to recognise when a person is ovewhelmed or zoning out and not able to cope helps me to know where they are at and when it is advisable to refer. Compassion and wanting the best quality of life for others is demonstrated here and I will use the information I can to help create that. With best regards and much gratitude
Thanks again
Another amazing session.
First of all, I will notice the distinction between DIDand dissociation.
I work with CPTS, and I find Dissociation states quite a lot in my work with clients, so this video is been very supportive.
The screening/ assessment process, and the working within window of tolerance. Also, how to recognise that it’s too much for the client.
I am going to discuss structural dissociation with my supervisor in connection with two specific cases.
I am also interested in strategies for working with the concept of how emotions have been dissociated and then show up as physical pain in the body. This is very clear for two other clients.
Just wondering if there is someway to make a financial contribution, if paying for the Gold package isn’t an option?
Thank you insights on treating trauma and dissociation. I work with Veterans and work injury patients diagnosed with PTSD. Appreciate importance of gentle approach and significance of dissociation as coping mechanism.
This was great information. I took an intro EMDR course and wonder, after this, how much more info I’m lacking as I consider working with trauma clients. Perhaps I should start with a basic trauma treatment program first…
I am not a practitioner but I am a patient of a practitioner who is currently treating me using EMDR therapy. She referred me to this particular video and I found it so informative and interesting. Thanks to all those who contributed and a big thanks to all professionals who have dedicated their lives to helping people like me. You have no idea what a tremendous impact you are making. I get to live both literally and figuratively because of this work. It has given me so much hope. Thanks again.
Thank you so much for a thorough, practical session.
I found the section highlighting the tug of war between attachment and defences eye opening.
I especially enjoyed hearing from the various experts and the practical examples they gave, like working with posture.
My take away is ‘don’t do something physical without doing it with the client” as well as the “coming home to yourself” metaphor.
So many good tips here!! Loved being reminded to not ask a client to do something I don’t do…Like Breathe!! Thanks
Thank you for making this content available to those without financial resources. I know that the organization needs to be funded to bring this information together, so I want to thank all those who subscribe and make this possible too. In every line of service work we all need to be trauma informed and while we are not a substitute for therapy, we are out here working to support our loved ones and our neighbors.
Excellent practical advice as to what to do and not do. I will add the sigh to the deep breathing as that technique was new to me. The various types of voices for DID vs schz. was very informative for me. June M
Thank you. I now know better how to deal with patients who may be triggered by medical examinations or interventions.
I have a patient of whom I believe has structural disssociation but others think she is on the autistic spectrum. You say that trauma and disassociation is often diagnosed as PD but in your experience is this the same as autism being over diagnosed?
I too have a child client who I believe has structural dissociation, but school believes is on the spectrum. Thank you for your question.
I am going to begin early to work with window of tolerance, learning how to be aware of when clients are outside it. I am also going to be more aware of physical signs that my client is overwhelmed.
Please don’t spend so much time selling the gold package.
Those of us who cannot afford the package treasure these sessions as the only way we can find this knowledge.
Please consider offering the gold package for $100 for those who cannot afford $297.
Thank you.
Agreed. It is a little off-putting to hear about how buying the Gold Package makes the content available to therapists around the world who cannot afford it. *I* cannot afford it!
I, too, agree with both you Alice and Patricia. I am a grad student in practicum ( I work with survivors of sex trafficking) and these videos could truly help me help others…but I simply cannot afford it.
I am in the same boat. Can’t afford to miss client sessions and can’t afford to buy the gold. So how is all the money people pay for the gold helping provide scholarships for those who can’t watch live? Or maybe the sessions can just be …. Free. To listen to whenever. A thought to consider.
Looking for triggers and the problems the client tries to solve with self-harm: very inspiring
Great information, Identifying and treating Dissociation and DID.
breathing together WITH the client – so he/she/@ doesnt feel stared at. Beautiful!
thank you for this session 🙂
Any (other) Belgian practicioner on this forum, familiar with this work?
Ben of ken je een Belgische practicioner die vertrouw is met dit werk en wil samen werken ?
Y-a-t-il d’autres praticiens belges sur ce forum ?
Contact: Veronique biunkens@mail.be
Wow. What great insights on this weeks video. I know posture can make a difference in how we feel even about ourselves and finding middle ground on that never occurred to me. Something so simple but so helpful in understanding how to reach full integration. Thank you all again for these videos. They are like gold.
I found the whole session very interesting. The adult- and child-self gets blended and confused with past trauma. The therapist needs to help the patient to separate the two as well as separating truth from thoughts, i.e. inner reality and outer reality. These thoughts were particularly interesting and relevant.
Thank you to all the contributors!
Suzanne Blundell, Child & Adolescent Psychotherapist.
Thanks for sharing; I can see how importan is to help the patient to separate these two selves while in therapy.
Thank you for today’s session.
Please confirm the time of the next broadcast?
It was amazing for me to learn how empathy could backfire with a person with dissociation ..thank you for the very professional & deep modules