DISSOCIATION AND TRAUMA
Dissociation is a psychological defense that protects us from overwhelming stimuli. To some degree we all use it, and it can take on many forms that range from normal ‘getting lost in an experience’ to clinical forms that develop in response to traumatic events.
When trauma is repetitive, prolonged and accumulative as in chronic exposure to childhood abuse and neglect, or in situations where a child experiences prolonged fear states, dissociation can save the mind and help the child to function in the world. However, over time it becomes a way of coping that makes it harder for you to deal with stress, emotions, and relationships. Dissociation continues to affect you as if the danger is still present, continuing to shut off parts of your experience and interrupt your ability to be present in their life.
Symptoms of Dissociation
When used in response to trauma, dissociation is characterized by memory loss and a sense of disconnection from oneself and one’s surroundings.
5 core dissociative symptoms:
Amnesia – loss of memory for a significant block of time;
Depersonalization – Perhaps the most common form of dissociation. Feeling detached from your body or emotions; feeling
like a robot or ‘spacey.’
Derealization – a feeling of detachment from your environment, that the familiar has become unfamiliar (including people);
Identity confusion – a sense of uncertainty or conflict about who you are and how you define yourself, including your sexual identity;
Identity alteration – a shift in role or identity, accompanied by changes in your behaviours that are observable to others.
Working with you in therapy
It is important to realize that dissociation is a way of coping and is adaptive in nature. We will develop an understanding of the different ways you may have used dissociation, and increase your awareness of when/how it occurs in your life, and what the triggers are.
Also, the beginning of therapy often involves acquiring skills that help you to stabilize and function day to day. As you become more aware of dissociative behaviours, methods of grounding and body-oriented techniques help increase a sense of control by learning how to come back to the present.
Often there is a focus on developing safety within the therapeutic relationship. People who have experienced childhood trauma have had to dissociate to feel safe – being present with a therapist can bring up intense fear and processing these moments in therapy helps to gain confidence in the relationship.
Working on the Trauma
It is important to understand that working with the underlying trauma needs to occur in a careful and gradual manner. Otherwise, your nervous system will want to revert to dissociative behaviours to cope. It can be hard for some people who have lived their life in crisis mode as you may have a sense of urgency to ‘get it all out’ to find some relief.
Even though it may feel counter-intuitive, it is important to slow down.
During this phase of therapy, attention is given to the level of activation as we process the trauma. If the activation of distress is too high, this will re-traumatize and create a further need to dissociate the traumatic material leaving you unable to tolerate and integrate your experiences.
The goal of trauma work is not to recover and process every memory of trauma but rather to develop a coherent sense of one’s life and experiences, to heal the pain that is interfering in the present and to create a life that you want. We will work on the traumatic material as it arises in the present as you are ready to process it.
As the dissociation reduces and traumatic experiences are released, you will find it easier to tolerate life’s everyday struggles and stresses. It is not uncommon for periods of intense grief to arise particularly when there has been childhood abuse and betrayal. To mourn and grieve is important in letting go and moving on with your life.
The approaches I use involve a mind-body perspective (Somatic Transformation), images, dreams, creative expressions, and mindfulness as useful methods to release the emotional and sensory aspects of the trauma. For more information on the mind-body connection read my Trauma Approach. Other modalities include psychodynamic, existential, Gestalt, Emotionally Focused Therapy.