Dissociation can be tricky to spot.
On top of that, it can look awfully similar to freeze or shutdown. And to complicate things further, a patient might dissociate when they’re in either one of those trauma responses.
But being able to detect when a client is dissociating is critical for providing effective treatment.
So in the video below, Thema Bryant-Davis, PhD, will name three key signs of dissociation – and will walk you through a three-step process for treating it.
Take a look.
There is not a sense of emotional presence or emotional connection to what they are sharing. And we can also see it in terms of people being disconnected from their bodies.
So, some of us are of the mind or approach where, when you start to ask questions, you’re trying to help people connect emotions to physical sensations. And for some people, that is very difficult and it’s very foreign because they are not experiencing the body or their bodies as a part of themselves.
So, thinking about it and the way people tell the story, looking at content. Then, looking at affect as it relates to what people are speaking. And then, when we do interventions or questions related to our clients’ bodies and there is a challenge with making that connection – those are some indications related to dissociation.
So then, when we start talking about the healing and how we do the work, a part of it is in the mindfulness.
So, beginning to ask those deeper questions about how we hold tension in our bodies. And we hold it in different places. As you sit now, are you aware of generally where you hold tension in your body? Are you aware of where you may be holding tension now? So that takes me out from here, being concerned about this, and into the body. And suddenly becoming aware of the tension in the lower back, or that I’m holding my jaw or my neck and my shoulders. Because often we were not aware. So, it’s not only tuning into the body, but also making the observation, “You’re not breathing.” And saying to your client, “You want to take a breath?”
And sometimes that can’t happen until we name it. Because a person is used to operating in that space, so they’re not even aware. Like some clients will say, “How’d you know that?” And we’ll think, “Well, I’m looking at you. And I know some of what it is like to be in a space of not breathing.” So, the breathing, connecting to the muscles, and then also getting into what I really feel.
And a part of that becomes psychoeducation. Because some people only know what it feels to be mad, sad, or happy. So sometimes, when people are giving us what we are perceiving as a surface-level answer, it’s not that they’re trying to give us the runaround. It’s that many people are not fluent in emotion because there was not space for that in their past.
So, to help clients expand some of their language, it can help to ask, “What do these words mean?” which can remove some of the shame as we start to think about what feelings were unacceptable in their house, or what feelings may have even been unacceptable for their religion.
And so giving that permission and space. One of the important pieces about dissociation is what some are calling embodied healing. Some people call it somatic healing. And this says that a violation, an abuse, or a trauma affects us holistically. Mind, body, spirit.
Much of our work focuses on mind and heart if we want to call the heart the center for emotion. But there’s no acknowledgement of people’s meaning making or spiritual ruptures in the aftermath of trauma, and no acknowledgement of the physical ways that we are holding it.
And I do want to say here that ethnic minorities are more likely to have somatic complaints. So not naming it as depression, but having migraines, having backache, muscle ache, feeling nauseous.
So, it is in the body. So, to connect with the trauma and with myself and my healing, we can incorporate embodied healing, which can take the form of dance, of movement, of yoga, as playing with different postures – being in those positions that represent different aspects of our experience and allowing any emotions to come. There’s going to be that tide coming in of the emotional response, of, “Oh, what does that feel like?” And so, it’s about helping clients become able to let that come up and then allow the tide to go back down.
So, I would say: 1) breathing, 2) education and de-stigmatization of emotion, and 3) connecting with the bodily responses and engaging in embodied healing.”
If you’re looking for more ways to identify and work with dissociation, take a look at the Advanced Master Program on the Treatment of Trauma.
In this advanced program, you’ll hear from Bessel van der Kolk, MD, Peter Levine, PhD, Stephen Porges, PhD, Pat Ogden, PhD, Thema Bryant-Davis, PhD, and other top experts.
Each week, we do a deep dive into a critical part of working with trauma. This week, we’re getting into how to work with the subtle ways that clients might dissociate in a session. To join us, just click here.
Now we’d like to hear from you. What are some strategies you’ve used to help clients come out of dissociative states? Please let us know by leaving a comment below.