What You Need to Know When Clients Dissociate — Part 2

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In Part 1 of this series, we identified dissociation as a biologically wired survival mechanism that automatically kicks in when a client perceives a person or situation as fundamentally threatening to their safety and well-being.

Helping a client to re-frame their “zoning out” experience as dissociation is an important first step; it de-pathologizes the experience and actually begins to put them back into their pre-frontal cortex. This is the part of the brain that does executive functioning tasks including reasoning and analysis, cause and effect thinking, and mindfulness and empathy. Reconnecting with this part of their brain moves them out of the freeze state of the limbic system and enables them to accurately label and understand the dissociative phenomenon.

In addition to understanding the context of triggers — interpersonal, environmental, and situational — therapists should also help a dissociative client identify the physical harbingers that signal the beginning of their “zoning out” process. It helps a client to understand how their somatic experiences can alert them to the onset of their dissociative process. When a client can connect physical sensations to mentally checking out it creates the potential opportunity to intervene and short-circuit dissociation before it fully takes over.

Consider the following experiences that your client may have when identifying potential physical cues:

• “Tunnel vision” that causes a loss of peripheral vision
• A sense of “floating” or dizziness
• Feeling a weighted heaviness that makes it hard to move arms or legs
• A headache that is unique to zoning out
• Feeling “darkness” is enveloping them
• No longer hearing what is being said
• Feeling that people and objects are moving further away from them

Along with identifying triggers and physical harbingers, it’s equally important to offer your client some psychoeducation regarding the paradox of the freeze response. The necessary and creative coping strategy that enabled them to survive a traumatic past is the very same strategy that now re-traumatizes. Being a deer in the headlights means they can’t use their voice, formulate an escape strategy, or advocate for their best interests.

In the present, dissociation perpetuates helplessness and disempowerment. However, given the fact that it’s always felt like a lifelong necessary survival strategy, it’s important to reassure a client that you can't and won't take their dissociative process away from them. Instead, therapy can introduce the concept of choice.

When feeling threatened, ask your client if it’s in their best interest to zone out or if they would be more empowered staying grounded and present. Typically, a lot more can be accomplished when a client remains present. The following simple strategies can help with grounding:

• Using a scent that is associated with feeling safe and calm
• Holding an object that is warm or cold
• Tuning in to textures or the weight of an object
• Standing up and moving, jumping jacks, arm swings
• Listening to soothing music
• Using a visual image that evokes safety and calm
• Saying out loud what they see and hear in their surroundings

When a client can master staying present they begin to understand, on a visceral level, how much more they can do to actually protect themselves. The goal is to use dissociation only when it truly is the safest and the only response to a threat. And in almost all cases, being proactive — being able to think and feel and move — will feel much more empowering and productive than getting stuck in a freeze response.

Missed Part 1 of this series? Click here.