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What Does Dissociation Look Like in Therapy?

Updated: Aug 1, 2020

Dissociation is a mental process of disconnecting from your thoughts, feelings, memories, or your sense of who you are. There is normal dissociation, and dissociation that can be a symptom of trauma, PTSD or dysregulation. There are several manifestations of dissociation during therapy:

  • The one that happens most commonly and it’s easy to observe is the one where the client goes blank —happens to most of us. In sessions, when the client goes blank in an instant, it shows avoidance to talk or address something that has normally been blocked in the client. Some clients yawn instead, or their eyes go away, or they change the topic without even noticing. That may indicate a well-rehearsed strategy —unconsciously perhaps— needed previously, and developed in order to keep away from getting activated, engaging in conflict, facing reality, or re-experiencing something painful.

  • Another one is to have the person getting into an ego-state that is not in the present. That could be scary and destabilizing for the client and confusing for a dissociation unskilled therapist. Imagine the client is talking about an event that happened in childhood, and all of a sudden the client “becomes” the child, embodies posture, voice, mentality, and emotions of the child, and goes into living the experience again without noticing that s[h]e is in the room with you or you with them. That’s probably the scariest dissociation to happen in a session. I know clinicians that have had that happening to them and not knowing how to bring the client back. A clinician with an understanding of dysregulation would know how to work with the associated part during the session and then, bring the client back into the present before the session ends.

  • The less obvious to notice for a therapist is a dissociation that has to do with the level of deactivation of the nervous system of the client. Some clients are in such a hypo-arousal state that their mind is absent from the interaction with the therapist. These individuals seem pretty normal, can communicate cohesively, but there is no mental energy in the room. Many clinicians report that there is a moment where they can’t keep their eyes open, not out of boredom or lack of interest, but out of a sensation of disconnection. What I have concluded is that the client’s dissociation in terms of energy is so strong, that the therapist attunement gets into it and feels that disconnection as an instruction to “shut down.” Sometimes that’s the indication for the clinician to intervene in ways that bring some sympathetic activation in the client to help with the collapse type of activity of the parasympathetic nervous system.

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