Working Through Dissociation in Therapy
Previously, we discussed the basics of dissociation and why it happens. Here, we’ll talk about different types of dissociation and their presentation. We will also learn about the three ways we work through dissociation in therapy.
2 main types
As previously discussed, dissociation refers to a shutdown of sensory experience.
There are two main types of dissociation, which include shame and terror dissociation.
Both are developed in response to severe or ongoing trauma.
This means that during a traumatic event, or a series of traumatic events (such as we often see in survivors of childhood abandonment, neglect, or other types of abuse), our best option was to disconnect.
All humans instinctively try to avoid pain.
When you are powerless to escape from extreme pain, dissociation shows up as an internal survival strategy to protect you from the brunt of it. It’s like wrapping your arms around your body when you’re cold, or visualizing a warm beach to escape to in your mind. At its extreme, you may believe that the beach is real, the sand is under your feet, and you were never freezing after all.
Dissociation is not a long-term solution to living with trauma.
Your body still needs real warmth to survive. As I discuss below, trauma therapy helps you to find your warmth.
Terror dissociation might look like:
Vacant expression or unfocused gaze
Unresponsive, or giving odd responses that don’t quite fit the situation
Wide-eyed
Fast, shallow breathing
Muteness
…might feel like:
Hyperarousal
Tunnel vision
Racing heart
Difficulty focusing or hearing what people are saying
Unable to notice cues of safety
Feeling locked inside yourself
Frozen in fear
Shame dissociation might look like:
Collapsing into yourself; making yourself smaller
Hunched shoulders
Head hanging low
Hiding your face behind hair, hoods, or scarves
Hiding your body inside baggy or shapeless clothing
Sobbing uncontrollably
Muteness
…might feel like:
A sense of falling or being unreachable
Self-hatred or disgust
Giving up
Trapped inside traumatic childhood moments, especially those where you were most helpless or hopeless
Unable to accept comfort or believe anything good about yourself
Unable to find words or connect to those around you
Feeling dead inside
A sense of being trapped behind glass or underwater; experiencing the world at a great distance
These are by NO MEANS exhaustive lists, but simply a way of capturing common symptoms of dissociation.
If you’ve experienced a good handful of these in the aftermath of a trauma trigger (or if you can’t remember any type of trigger, but still connect with many of these symptoms), you might have had a dissociative episode.
3 ways of working through dissociation in therapy
Finding you: As a trauma therapist, it’s my job to find you, wherever you’ve escaped to in session. Maybe you’re stuck in a room in your childhood; maybe you’re all alone. Before we move forward, I have to find you. Learning about the spaces you travel to will help me to understand more about your trauma, the extent and nuances of your wounds, and how to bring you back.
Understand how you got there: There’s a reason you needed to escape. Together, we explore the moments leading up to the dissociative escape so that we can understand your trauma triggers, what felt dangerous in session, and how to move forward more safely.
Reorienting to the present moment: I work from an attachment and nervous system perspective to help you find your way back to the present moment, back to your body, and back to a sense of safety and stability in the therapy room. These skills eventually translate to your real life, giving you a greater sense of agency and strengthening your ability to find safety and connection when you need it most.
What’s Next?
If trauma therapy feels like something you’re interested in, please take advantage of our free consultations. This is a space where you can speak with one of our therapists on the phone and decide whether or not to move forward with a session to learn more about trauma therapy. We provide virtual online therapy and have therapists who are trained in emdr therapy. We also offer many different types of trauma therapy groups and all of our therapists specialize in trauma informed care, and informed trauma therapy.
For many trauma survivors, therapy feels like too big of a step at this stage in their journey. Maybe it sounds too risky, too much of a commitment, or maybe you have concerns about opening up or being “unfixable.” If this sounds like you, a good next step may be trauma-focused self-help literature. I would recommend Pete Walker’s books: Homesteading in the Calm Eye of the Storm or The Tao of Fully Feeling (read excerpts and other free material online here), Beverly Engel’s It Wasn’t Your Fault, Peter Levine’s Waking the Tiger, or Alice Miller’s The Drama of the Gifted Child.
Want to read more about dissociation? Here is another blog for you.
What is dissociation and why does it happen?
Did you know that dissociation is part of the “freeze” trauma response?
Read more about the 4 trauma responses here: The 4 Trauma Responses
All therapists at Woven Together Trauma Therapy are trauma-informed and specialize in treating all forms of trauma. We also offer EMDR therapy, Ketamine Assisted Psychotherapy, and Brainspotting therapy which all have shown to be extremely effective in treating and healing trauma. Want to read more about our unique therapy options?
These blogs talk more about the basics of EMDR therapy:
You can read more about Ketamine Assisted Psychotherapy here:
If you would like to learn more about Brainspotting therapy, check out our blog: What is Brainspotting?
Read more by Ruth:
