Dissociation in trauma and how to work with it in therapy

In my previous blog, I wrote about the freeze response. Freeze can be your body’s most wise response for protecting yourself in an unsafe situation. However, when a situation is so overwhelming, your body may respond in an even more profound way to keep you safe: dissociation.

We humans can naturally compartmentalize our thoughts. Harsh events can take this natural ability to compartmentalize to this next level. 

For example, you may even not remember an event: that’s called dissociative amnesia. You may have been in a car accident and don’t remember much, if anything.  Or – sadly and  too common – dissociation can happen through violence or strong abuse – as a child or as an adult. Or you can learn to dissociate through ongoing circumstances, whether from things like racial injustice, a global pandemic, or other adverse situations.

Explaining dissociation from a childhood perspective

Here’s an example  to explain dissociation. Imagine as a child, your caregiver does something that is unbearable and horrific. It causes distress and cognitive dissonance in you because you have naturally developed a loving attachment to that parent or caregiver, which is a normal part of child development. As a result, you may compartmentalize or even “forget” the trauma because you need to maintain a relationship with your caregiver. After all, this is the person you rely upon to maintain your so-called normal everyday life, where you can feel safety, predictability, and bonding relationships, because this is what you need as a child. So, your neural pathways become compartmentalized or split.  You wind up having one side of yourself who seeks normalcy and bonding, while your other part now – and with hypervigilance  – monitors for danger. However, we need to integrate our two sides back together to have wholeness and well-being, so that the side monitoring for danger does not overtake our lives.

How do you know if you have a dissociative disorder?

If you have experienced trauma in your past, you may be wondering if your symptoms point towards dissociation.  Some may assume  these symptoms are pointing towards “PTSD” –  but dissociation is much more than that. But, before I give you examples, please keep in mind that you don’t need to figure this out on your own!!  Nor do I think it’s helpful for anyone, professional or not,  to say “Aha – this is what you have!” The reason I’m writing about this topic is so you don’t feel alone and you realize that there is hope.

Here are just some symptoms that may be part of dissociation. You may have self-worth and shame issues. You may, too often, experience intense emotions or memories. You sometimes get triggered when someone expresses compassion to you. You have unexplained physical pain. You may feel shame. Anxiety can shoot up rapidly from an otherwise peaceful state. Your anxiety may feel more like terror.  You can’t handle being on a patient bed in a medical clinic. You have nightmares – and too often. You can quickly change from a place of high confidence to self-hatred. You may even hear voices, which, by the way, does not mean these voices are a psychotic response. More commonly, they are your echo originating from a childhood  trauma. 

How a trauma therapist guides dissociation towards healing

There’s nothing simple nor straightforward about dissociation symptoms. Unfortunately, dissociation is difficult to detect and treat by most therapists and medical professionals – but it can be done with training. 

I believe it takes a trauma-informed therapist, trained in dissociation, to be the most effective in treatment. 

Here are just a few short examples of what I may do in therapy. If someone is experiencing dissociation during a therapy session, it may show up through a certain eye expression or through shallow breathing. Or when the attention fades or there is agitation, or other behaviors. When someone is experiencing duress,  I will probably not respond with warm statements of empathy, as these expressions can often trigger trauma-based memories for clients. Instead, I may ask, “Are you with me?”. Or I may start deep breathing, leading by example, and ask the client to breathe with me. I communicate that the space is calm and safe, and make small requests that need just a bit of response, slowly working towards a place of ease.

Online resource on working with dissociation

In this video, Bethany Brand, PhD, shares the clues she looks for when distinguishing between two triggers for dissociation – shame and terror. She also walks through the steps she takes when working with each. If you are interested in learning more about the brain and dissociation, you can learn more at NICABM’s website  (National Institute for the Clinical Application of Behavioral Medicine). Even though this site is for professionals, NICABM’s resources can be helpful for others.  

Contact me

I specialize in trauma-focused therapy here in Portland, Oregon. Currently I am offering this therapy via telehealth and I continue to experience remarkable results.  I invite you to contact me  to learn how my treatment approach, that frequently includes Accelerated Resolution Therapy, can help you heal. Or, please feel free to contact me for your first appointment. Together we can change your life.