A therapist is shown hosting a therapy session with her client, who's unfortunately not looking better due to feelings of dissociation.
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Dissociation in Therapy: Understanding and Overcoming the Challenge

Dissociation is a psychological phenomenon that often emerges in therapy, particularly among individuals who have experienced trauma. It involves a disconnection between thoughts, feelings, memories, and sense of self, leading to altered perceptions of reality (Dalenberg et al., 2012). In therapeutic contexts, dissociation can manifest as emotional numbing, detachment, or profound memory gaps, which can obstruct the healing process and complicate treatment.

Understanding Dissociation And Its Benefits For Therapists

Understanding dissociation is essential for therapists. It typically serves as a coping mechanism, allowing individuals to distance themselves from overwhelming emotions or traumatic experiences (American Psychiatric Association, 2013). For example, a client recounting childhood abuse might unexpectedly feel detached or as if they are watching themselves from outside their body, a classic sign of dissociation. This disconnection can hinder their ability to process emotions, engage with the therapeutic process, and establish a coherent narrative about their experiences (Van der Kolk, 2014).

How Therapists Can Better Help Their Clients

To help clients overcome dissociation, therapists must adopt a multifaceted approach focusing on safety, grounding techniques, trauma processing, and self-compassion.

Establishing Safety and Trust

Creating a safe therapeutic environment is paramount. Clients must feel secure enough to explore their dissociative experiences without judgment or pressure (Siegel, 2012). Open communication about dissociation can help clients understand that it is a typical response to trauma and not a sign of weakness or failure. This normalisation can reduce stigma and promote a sense of belonging within the therapeutic relationship.

Grounding Techniques

Grounding techniques are invaluable in helping clients reconnect with the present moment. Simple exercises, such as focusing on the breath or engaging in sensory activities, can anchor clients in reality. For instance, a therapist might instruct a client to describe five things they can see, four they can touch, three they can hear, two they can smell, and one they can taste. This technique encourages mindfulness, helping clients regain control over their experiences (Kabat-Zinn, 2003).

Trauma Processing

Addressing the underlying trauma is also crucial. Therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) or Internal Family Systems (IFS) can facilitate the processing of traumatic memories. EMDR, in particular, uses bilateral stimulation to help clients reprocess distressing memories while maintaining a sense of safety (Shapiro, 2017). By revisiting these memories in a controlled environment, clients can begin to integrate their experiences, reducing the likelihood of dissociative symptoms.

Fostering Self-Compassion

Encouraging self-compassion is essential for clients struggling with dissociation. Many individuals who dissociate carry feelings of shame or guilt, believing that their coping mechanisms are failures. Therapists can guide clients in developing a kinder inner dialogue, helping them acknowledge their experiences without self-judgment. Techniques such as positive affirmations or journaling about strengths and achievements can foster self-acceptance and resilience.

Conclusion

Dissociation is a significant barrier to healing in therapy, often rooted in trauma. However, by establishing a safe therapeutic environment, employing grounding techniques, facilitating trauma processing, and promoting self-compassion, therapists can help clients navigate their dissociative experiences. Through these approaches, individuals can gradually integrate their fragmented selves, reclaim their narratives, and ultimately foster emotional resilience.

If you think you can benefit from professional support on this issue, you can reach out here.

Yasmine Bonnici has obtained a degree in nursing (Hons) and a Master’s in Counselling (Melit) from the University of Malta. She was drawn to counselling because she felt that in the medical field, there is a tendency to focus on one’s physical needs and neglect the psychological aspect. Thus, this led to her achieving her temporary warrant in counselling.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Dalenberg, C. J., Brand, B. L., Gleaves, D. H., et al. (2012). Evaluation of the evidence for the trauma and dissociation theory of dissociative identity disorder. Psychological Bulletin, 138(3), 550-588.
  • Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.
  • Shapiro, F. (2017). Eye movement desensitisation and reprocessing: Basic principles, protocols, and procedures (3rd ed.).
  • Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are.
  • Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

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