According to Ross and Halpern (2011), there are several definitions of dissociation. One of them (referred to as “the general systems meaning of dissociation”) is “the opposite of association” or the disconnection of two or more things that were once associated with each other. Another definition, presented by Steinberg and Schnall (2001), defines dissociation as “an adaptive defense in response to high stress or trauma characterized by memory loss and a sense of disconnection from oneself or one’s surroundings.”

Dissociation occurs when someone disconnects from some part of himself or herself or the environment. It can occur in a number of different ways, including disconnection from one’s emotions, body sensations, memories, senses, etc. A normal and common phenomenon, dissociation can happen in mild forms even when there is not imminent danger or stress. Think of a time you drove somewhere, arrived, and then couldn’t remember the drive because your mind was wandering; an instance when you lost track of time because you were engrossed in a riveting television show; or when you disconnected from body sensations to avoid going to the bathroom when you were on a tight deadline at work.

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Dissociation is something we all do, and it is a vital part of our ingrained survival system. It is a part of the system that helps us to cope with stressful situations, which may otherwise feel overwhelming (Steinberg and Schnall, 2001). It is built in and is not pathological (Ross and Halpern, 2011). However, when a trauma occurs, sometimes this built-in system disconnects to a greater degree in an effort to protect the individual from traumatic material, body sensations, emotions, or memories that may be overwhelming.

Dissociation related to trauma occurs in varying degrees. On the lower end of the dissociation spectrum, for example, let’s say someone was in a car accident. A few days after the accident, the person finds that he or she cannot recall parts of the accident, even though reports of others were that he or she was conscious and responsive during those times he or she cannot recall. On the other end of the spectrum, someone who was severely abused throughout life can dissociate to the point that he or she has more than one personality, all of whom display and contain their own characteristics and who hold different memories associated with the trauma.

The goal in therapy is not to eliminate dissociation completely, but rather to help the brain and body to update to the current circumstances. Specifically, this would include helping a person to integrate current information about the present circumstances in which they live.

For the traumatized individual, dissociation may help him or her to survive circumstances that may have otherwise been intolerable. Dissociation can help a person feel as if situations, his or her body sensations, emotions that would have been overwhelming, etc., are muted and distorted so he or she can then go into “autopilot” mode and survive extreme situations and circumstances. When trauma is ongoing, dissociation can become “fixed and automatic” (Steinberg and Schnall, 2001). When this is the case, integration of memories becomes difficult for the brain, and the brain also continues to send of signals of danger, even when the traumatic situation is over (Steinberg and Schnall, 2001). This can continue for years after a traumatic situation has ended.

According to Steinberg and Schnall (2001), the five central symptoms of dissociation are:

• Amnesia: Loss of memory for short or long periods of time. This can include not recalling all or part of an incident or time period.
• Depersonalization: Feeling detached from yourself, parts of your body, and your emotions—like you are on autopilot or robotic.
• Derealization: Feeling detached from your surroundings and people who were once familiar—like the world around you isn’t real.
• Identity confusion: Feeling “uncertainty, puzzlement, or conflict about who you are” (Steinberg and Schnall, 2001).
• Identity alteration: Alterations in personality and behavior that others notice. Sometimes this manifests as feeling as if you don’t have control over other personalities or your body.

For someone who is concerned that he or she is experiencing a more-than-normal incidence of dissociative symptoms, help is available. Several accurate tests are available through therapists and psychologists who have been specially trained in diagnosing and treating dissociation and trauma.

The goal in therapy is not to eliminate dissociation completely, but rather to help the brain and body to update to the current circumstances. Specifically, this would include helping a person to integrate current information about the present circumstances in which they live. If no danger currently exists, helping the brain and body to learn how to be safe would be one part of treatment. Working toward being able to maintain awareness of the present moment, body sensations, emotions, surroundings, etc.—also known as mindfulness—is one way to start to address dissociation, especially prior to any trauma work that needs to be addressed.

As a therapist, I appreciate dissociation as a valuable gift our brains are able to give us when we endure trauma. I emphasize to the people I work with in therapy that dissociation has helped them to survive, and we can acknowledge that this is a defense that has perhaps worked for longer than it was intended. It is important to remember that experiencing more than a regular level or type of dissociation as a result of trauma does not make a person defective. Rather, it shows that he or she has been able to live through and survive extraordinary circumstances that no one would be able to endure without the brain’s ability to dissociate.

References:

1. Ross, C., and Halpern, N. (2009). Trauma Model Therapy: A Treatment Approach for Trauma, Dissociation and Complex Comorbidity. Richardson, Texas: Manitou Communications.
2. Steinberg, M., and Schnall M. (2001). The Stranger in the Mirror. New York, New York: Harper.

My work with people often drives me to explore themes that are currently showing up in my counseling practice. If you are a counselor, you know what I mean. You may have many clients or therapist consultees presenting with the same needs, perhaps some who are saying similar things of late. That’s not to say that these issues are the “same,” for they are not. Nevertheless, there are topics that may repeat themselves. I pay attention to these because I believe that there is much to explore and learn by being aware of patterns.

A pattern I have seen of late is related to eye movement desensitization and reprocessing (EMDR) work, specifically about the process of being “ready” to do EMDR. I have had a lot of therapists inquiring about their clients’ readiness to do EMDR. Keep in mind that if you are doing EMDR, you are always doing EMDR; it just depends on the phase you are in. If you are one of my EMDR clients or therapist consultees, you know how much I emphasize this as key to understanding the EMDR therapy model. Keep this in mind: EMDR is a process, a model, and not a technique.

EMDR’s preparation phase is phase two of the eight phases of EMDR. EMDR therapists look for people to have a minimum of two state-change skills as part of this phase. In phase two we are making sure that the client has the ability to not only tolerate emotion, but also to shift into a relaxed state, a para-sympathetic response. In other words, can the person bring up a disturbing event, be “in it,” but then also utilize a relaxation skill or calming technique to then change states if needed?

Keep in mind that the concept of changing states may be something that sounds easy, but for many it is not. Some folks seeking to utilize EMDR therapy as part of their trauma recovery may need more extensive preparation-phase support. This is especially true in the case of those struggling with dissociation and addictions.

In its simplest form, a state change means being able to utilize a relaxation skill to settle down one’s system. State-change skills can help the EMDR client to become calmer and more settled while still maintaining “dual attention”—i.e., being present while bringing up traumatic disturbance(s). In contrast, and though it may appear like it, the ability to utilize state-change skills does not mean changing states via dissociation. Certainly, one’s ability to dissociate may appear similar to a state-change skill, and is a survival skill, but dissociation keeps us “away from” traumatic material and from integrating the somatic, visual, emotional, and cognitive aspects of it to then heal.

For example, dissociation takes one away from the present moment because the past feels as if it is happening now and it feels safer to leave the present. But to be able to heal and integrate the traumatic material requires that state of being present. We just have to learn the dance between feeling the disturbing material and being able to shift into a contrasting, calmer state.

In exploring the concept of EMDR and state-change skills, addictions can also be explored as an attempt to chemically or behaviorally illicit a state change. I often explain to people that substance abuse is often driven by an ill-fated attempt to chemically dissociate. One can easily become entrenched in the vicious cycle of using addictive substances and behaviors to shift “out” of traumatic material in order to feel something, anything, and everything different from the pain of a traumatic history. And, for many people, addictions have become a way to change states, to feel away from and out of traumatic material.

The bottom line is that to heal, trauma histories beg to be accessed, stimulated, and reprocessed. The challenge can be in our making sure that EMDR clients are fully supported in having the state-change skills in place to be able to come back, to ground, and to stay present first. Therefore, creating and implementing these state-change skills can be the key to supporting EMDR clients in their recovery and throughout EMDR’s eight phases.

I’m so impressed with you! First of all, in spite of your fear of being judged, you have taken the very courageous step of writing in with your question. Second, it sounds like the daydreaming and fantasizing have served as a very adaptive behavior—you have been able to get some relief from the depression and low self-esteem by escaping into your imagination. Unfortunately, it seems like this coping strategy has taken on a life its own and become somewhat of an impediment to your ability to function in your daily life.

In some ways, what you are describing isn’t completely dissimilar to how substance-abuse issues can develop—someone is in discomfort, seeks relief in alcohol or drugs in order to escape the discomfort, and ultimately comes to depend on the substance to an extent that it interferes with life. That said, one critical difference between what you are describing and substance abuse is that there is quite likely some real value in what you are using to escape. Most successful people begin their journey toward success by imagining it—they dream about their success and then they begin creating goals (and working toward them) that will move them toward their dream. I suspect that the life you have created in your imagination is closer to the life you desire than your actual, current life is. If my suspicion is accurate, then it makes sense to do what you can to start moving toward the life you have imagined for yourself.

Given your struggles with depression and self-esteem, you might be thinking: easier said than done! This is certainly true, but it does not mean that it is impossible to live a life closer to the one you imagine; it simply means that you need to get treatment to address the depression and self-esteem. Right now, these issues might be all that is keeping you from working on making your fantasy life a reality.

This brings me to your fear of disclosing your fantasy world to a therapist. First, there is no shame in the fantasy life that you have created; in fact, I believe it will ultimately serve as a road map to move you to the life you have been dreaming about. However, if you are still feeling anxious about sharing this world with a therapist, know that you don’t have to in a first, second or even third session. In fact, I would say if disclosing it is so anxiety provoking that it is preventing you from seeking treatment, do not disclose it until you are confident that you have a trusting, therapeutic relationship with a therapist. Sometimes when people disclose too much before a really strong working alliance is established, they feel exposed and vulnerable to an intolerable degree and they leave therapy prematurely.

You can avoid this by finding a therapist who you believe could be a good fit for you and setting up an initial session. You might even set up an initial session with a couple of different therapists and see who you feel most comfortable with. Once you believe you have a good match, work on building a strong therapeutic relationship and when you feel ready, open up about your fantasy life. As the depression and self-esteem issues begin to be addressed and you open up about your fantasies, you just might find that these very fantasies will become your road map and your therapist will serve as a supportive guide as you follow the map to your dreams.

All my best,
Sarah

Integrating live animals into the therapeutic process has been gaining recognition as a viable and effective approach in a clinical setting. Equine-assisted therapy is a widely popular form of therapy that has shown remarkable results with clients who do not respond well to other types of treatment. Similarly, children who are resistant to traditional therapies have demonstrated improvement in animal-assisted therapies. For individuals who experience disassociation, animals represent an unconditional source of love and acceptance. For people who may have experienced early life trauma, especially trauma or abuse that undermined attachment relationships, animals can replace missing secure attachment bonds.

Although animals as therapy adjuncts, even pets, can help reduce anxiety, depression, loneliness, and isolation, owning or working with an animal may not be a viable option for everyone in need. Therefore, stuffed animals, which represent a source of comfort in times of stress for young people, may serve as a suitable replacement. Rose M. Barlow of the Department of Psychology at Boise State University in Idaho wanted to see if stuffed animals would serve clients equally as well as live animals. In a recent study, Barlow surveyed a sample of high and low dissociative female college students and those with dissociative identity disorder (DID) about attachment to live and stuffed animals. She found that the DID women had significantly stronger attachments to both live and stuffed animals than any of the other women. She also found that those with high dissociation and those with DID reported higher levels of attachment to stuffed animals than live animals when compared to the low dissociative group.

The findings of this study have several important clinical implications. Even though comorbid issues such as depression, anxiety, and bipolar were not considered in this research, the evidence suggests that stuffed animals may be particularly helpful to those with high levels of dissociation. Because symptoms of dissociation, even disorganized attachment, can begin in childhood and result from emotionally unavailable parents, divorce, or abuse, integrating stuffed animals into therapy for young children can provide a sense of security and help to rebuild impaired attachment bonds. “Animals, live or stuffed, can aid therapy for both children and adults by providing a way to experience and express emotions, a feeling of unconditional support, and grounding,” Barlow said.

Reference:
Barlow, Rose M., Lisa DeMarni Cromer, Hannah Prairie Caron, and Jennifer J. Freyd. Comparison of normative and diagnosed dissociation on attachment to companion animals and stuffed animals. Psychological Trauma: Theory, Research, Practice & Policy 4.5 (2012): 501-06. Print.

One of the reasons many children do not tell anyone about being sexually abused is because they fear that their loved ones will not believe them. Often, their abuser is a friend or family member, and although children may know that what occurred is wrong, they may be confused and worried that their caregivers will think they have misconstrued the behavior. Children who feel neglected or maltreated by caregivers may feel reluctant to disclose abuse, and many abusers threaten children, creating more reasons for nondisclosure. However, when children do reveal abuse, getting them to explain the abuse in a way sufficient to lead to prosecution can be challenging.

Various methods of interrogation are used on child-abuse victims, including open-ended questions, yes/no questions, “What happened?” questions, and “How did that make you feel?” questions. For the most part, open-ended questions and “what” questions tend to provide the least amount of detail. Children often are unable to articulate the details of their abuse. And while “how” questions that prompt children to reveal their physical reactions and feelings allow them to detail their personal experience in great detail, this is the most rarely used form of interrogation. To explore which method would provide the most accurate recollection of abuse and elicit emotional responses that could demonstrate credibility to jurors, judges, and therapists, Thomas D. Lyon of the Department of Psychology at the University of Southern California recently examined transcripts from more than 100 child-abuse cases.

Lyon discovered that when children were asked closed-ended questions such as yes/no, their responses were narrow and they exhibited little emotion. Similarly, when they were asked “What happened?” they were hesitant to reveal details and appeared emotionally undisturbed. But when children were asked how the abuse made them feel and what their physical reactions were, the responses were extremely vivid and consistent. They demonstrated emotional responses and used words such as angry, sad, afraid, confused, “sick to my stomach,” and dirty. They manifested facial and physical reactions that allowed those interviewing them to see the damage of the abuse in ways that the children could not articulate when prompted with direct questioning. “Children can be surprisingly articulate about their reactions to sexual abuse, despite their apparent lack of affect in describing the abuse itself,” Lyon said. He hopes that these findings will motivate interviewers, prosecutors, and mental health professionals to evaluate physical and emotional reactions of abuse as a means to gather details from child sexual abuse victims.

Reference:
Lyon, Thomas D., Nicholas Scurich, Karen Choi, Sally Handmaker, and Rebecca Blank. ‘How did you feel?’: Increasing child sexual abuse witnesses’ production of evaluative information. Law and Human Behavior 36.5 (2012): 448-57. Print.

There are a number of different experiences that can cause a child to develop maladaptive coping tendencies. Children who are emotionally or physically abused, neglected, or raised in extremely stressful environments may internalize their emotions. Likewise, children who have experienced sexual abuse may dissociate as a way of defending themselves from the psychological harm that results from sexual abuse. Trauma suffered in childhood increases the risk for dissociative behaviors. Auditory hallucinations are one form of dissociation and are evident in individuals with mental illnesses such as schizophrenia. To better understand how childhood trauma, dissociation, and hallucinations are related, F. Varese of the School of Psychology at Bangor University in the United Kingdom recently led a study comparing the dissociative behaviors, childhood traumas, and cognitive discrimination of 45 individuals with schizophrenia and 20 participants with no prior hallucination history.

Because dissociation is recognized as a pathway for hallucinations and an outcome of childhoodtrauma, Varese sought to determine if the frequency and type of trauma influenced hallucinations and the capacity to determine real and imagined events in the participants. Using a signal detection performance task (SDT), Varese found that the participants with a history of childhood sexual abuse were the most likely to experience dissociative behaviors that resulted in hallucinations. The frequency of abuse was directly related to the level of dissociation, with the most severely abused participants exhibiting the highest levels of hallucinations. The findings also showed that the participants with infrequent hallucinations had lower levels of abuse and dissociation than those who experienced more hallucinations. Varese believes that further research is needed to determine if adult stress and trauma rather than childhood trauma contributed to the intermittent hallucinations in the participants with sporadic dissociative behaviors. In sum, these results suggest that a better comprehension of the type of abuse suffered may be the key to developing effective treatment strategies for individuals who experience hallucinations. Varese added, “Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g., deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.”

Reference:
Varese, F., Barkus, E., Bentall, R. P. (2012). Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychological Medicine, 42.5, 1025-1036.

Psychotherapists and clients who are working with issues of dissociation talk about being grounded a lot. What we usually mean by grounded is the experience of feeling present and aware in our bodies and being able to interact with the world around us with a clarity of our senses. There are even formulas that seem to have developed for how to be present—“feel your feet on the floor, your butt in your chair, and breathe.” Sometimes this is enough, but often it’s not.

Moving your body is a much faster and more reliable method for becoming grounded. Although movement in general is often helpful for restoring awareness to the body and breaking free of dissociation, centered and well-organized movement is even more useful.

Try the following experiments to see if you can notice the benefits of grounding movement:

1.  Jump up and down and side to side while waving your arms wildly. What was that like for you? What did you notice physically and emotionally, both during and after the exercise? How satisfying was that?
2. Now try standing with your feet shoulder width apart and begin rotating in your hip joints. Twist side to side, letting your arms follow the movement of your torso. (Some people find it helpful to imagine that they are a washing machine). What was this like? What were your physical and emotional sensations? Did you find this movement satisfying?

People typically report that the second exercise helps them bring their surroundings into focus and reduces anxiety and fearfulness. They feel more grounded and less dissociated.

This works because it offers an organized and nonthreatening way to quite literally expand the body and bodily awareness.

Dissociation is a flight response to a perceived threat. Checking out, via either partial or total amnesia, or switching into another part of the self, makes awareness of the threat disappear. This is a very handy skill for small children who are not able to adequately protect themselves. This is less useful for adults who have developed habits of dissociating—whether the threat is present in the moment or remembered.

The problem with dissociation is that adults, who are capable of protecting themselves, lose access to that protective ability when they split. As a colleague of mine likes to say, if there’s a tiger in the room and you pretend it’s not there, that doesn’t actually make the tiger disappear. Dissociation doesn’t make you more safe, and it actually makes you less safe.

But, clients often tell me, if I don’t dissociate and I choose instead to be present, then I’ll be stuck in my fears—how does being petrified make me any safer? Good point, I reply. They’re right, after all. Being frozen with fear is not any more effective than dissociating is for dealing with that oncoming tiger. What is effective for safety is being present and grounded.

Here’s another experiment you can try which demonstrates this point:

1.  Imagine that you’re afraid. It might help to recall a time when something scared you—perhaps a loud noise, a spider, or something else that frightened you a little bit. Notice what happens in your body (pay attention to your breathing, posture, and points of tension).
2. Now imagine that you’re safe and satisfied. Pull up a memory of an experience of being warm and secure and loved. What’s going on in your body this time?

In general, people report that when they’re afraid, their bodies constrict and collapse, their stomachs tighten, breathing becomes shallow, jaws clench, and they notice tension in their arms, chest, legs, and/or back. When doing the second exercise, they typically feel their bodies open up and relax.

The feeling of safety is a lot like the feeling created by the washing machine exercise at the beginning of this article. This suggests that being present in our bodies is the path to safety. Instead of having to only choose between dissociation and petrifaction, people working with dissociation can make use of movement to come into a state of groundedness and safety.