Dissociation is a word clinicians use to describe the lack of connection between things which are normally connected or associated. This can include thoughts, feelings and actions. Essentially something which is dissociated is not linked into ones sense of self. For example a person may be able to talk about a traumatic memory, but not experience any feelings about the event and may feel numb when discussing it. Alternatively another person may have no memories, but overwhelming emotional responses to a trigger. This can leave people feeling very confused and sometimes out of control.
Dissociation is something any human being can experience, given the right circumstances. The experience of trauma appears to be a significant risk factor for the development of dissociation. In fact dissociation is can also be seen as a response which was adaptive at the time of the trauma.
Trauma-related dissociation can include feeling separate from trauma related memories and emotions, an altered sense of reality, altered perceptions of self, the body and the world. For example, when stressed or triggered, some survivors report symptoms such as:
- ‘watching themselves from the outside’,
- a feeling of ‘floating above their body’,
- a loss of sensation in parts of their body;
- a feeling that the trauma ‘did not happen to them’;
- a sense that memories or feelings ‘come out of nowhere’ and are ‘not theirs’;
- unexplained loss of time or periods of feeling ‘not there’ or ‘blacked out’;
- suddenly ‘coming aware’ and realising they are not where they expected to be; and/or
- a sense that one’s self is made up of different parts, with parts holding different memories, emotions and roles.
These are all symptoms of trauma related dissociation. Survivors who experience dissociation are often confused and frightened by the symptoms but therapy can provide symptom relief and assist the survivor on ‘putting the pieces back together’.
Therapy for severe and complex dissociation is a specialist area and I undertake regular training, study and supervision to ensure my skills in this area are regularly updated and improving. I base my therapy on well-accepted models and theories of dissociation such as Structural Dissociation of the Personality (Van der Hart, Nijenhuis and Steele, 2006) and Trauma Model Therapy (Ross and Halpern, 2009). I have also studied for 4 years with Dr Janina Fisher and am very influenced by her specific approach to trauma and dissociation, which utilises mindfulness and body-based strategies along with ‘talking therapies’. I am also a member of the International Society for the Study of Trauma and Dissociation (ISSTD) and gain much from the expertise and support in this Society.
Coming to therapy for dissociative symptoms can feel particularly scary for survivors and, knowing this, I endeavour to work slowly and gently with my clients to ensure that therapy is a helpful and positive experience.