What is Dissociation?
Dissociation is a disconnection between a person's sensory experience, thoughts, sense of self, or personal history. People may feel a sense of unreality and lose their connection to time, place, and identity. An individual may feel disconnected from their body or feel that their surrounding environment is fuzzy and surreal.
The Freeze Response
When a traumatic event happens to us we can experience three different reactions: fight, flight, or freeze. Fight or flight is the hyperarousal reaction. Our heart starts racing, we go to fight back, or we run away, we may experience panic attacks or intense anxiety.
The other way that a reaction to trauma can manifest is hypoarousal. This is the shutdown response, also known as the freeze response. When something traumatic happens to us, dissociation is the lack of reaction. We shut down, involuntarily, as survival mechanism. (Read more about this on my post about the Window of Tolerance)
Peter Levine discusses in his book, “Waking The Tiger”, (an excellent book on trauma) about the impala and the lion. One of the ways that the impala copes if he gets caught by a lion is by playing dead and disconnecting from it's body. This is a coping strategy so that if it starts to attacked by the lion, it doesn't have to physically feel the pain.
A Protection Mechanism
If you think about this from the perspective of a trauma survivor, maybe somebody who has experienced sexual or physical abuse, disconnecting from the body, or freezing, is actually a very helpful way in which the brain responds. By freezing, the survivor does not feel either the physical sensations or the emotional affect that might have been so uncomfortable at the time of the trauma that it was too difficult to process.
What unfortunately can happen with dissociation, is that once the brain learns how to dissociate, it can actually do it again and again, without any awareness or without any willingness for it to occur (ongoing dissociation affects present day functioning). This is where adaptive behavior turns into maladaptive behavior. What was helpful in the past, is keeping a client feel stuck and not able to effectively function in the present.
What does dissociation look like?
Dissociation can often times look like depression. This is a way for clients to numb out and not feel anything. Dissociation can also look like spacing out. Many individuals report that they're losing moments of time. They look at the clock Notice it's 2:15, for example, and then look again, and all of a sudden, it's 3:00. The individual has no awareness of the time that has passed.
How does Dissociation Affect EMDR Therapy?
The important thing to understand is that at one time, dissociation was really helpful. It was a way for the individual to survive a very uncomfortable or threatening experience; however, it can be much less helpful when we're trying to reprocess a traumatic event in counseling. The more we try to think about something (PTSD is a lack of time orientation) the dissociation is going to still try to jump in to try to protect you. So before reprocessing anything in phase 4, you first have to decrease the dissociation.
It's helpful with all clients with a history of trauma to assess levels of dissociation prior to any reprocessing. This can be done with the DESI-II (Dissociative Experiences Scale) as a way to measure dissociation. This assessment is also helpful in guiding your history taking with clients so that you can fully layout the clinical landscape.
How do you decrease Dissociation Levels?
This is why resourcing (Phase 2 of EMDR, also referred to as stabilization) is so important. Mindfulness skills are the best way to decrease dissociation. We have to help our clients strengthen their ability to be present. In doing so, we help to strength their window of tolerance and improve their readiness for reprocessing.
One of my favorite resourcing exercises is the 5-4-3-2-1. It helps to enhance a client's awareness of the present. Some of my other favorite resourcing techniques include the container, calm place, the light-stream, and the emotional remote control. Consultation is also great way to learn more resourcing exercises that will help your individualized cases.
It's important for everyone to understand how dissociation can impact the ability to overcome a trauma. More often than not, individuals who do have levels of dissociation report feeling stuck. It's the difference between knowing something but being able to actually do it. It's very important for both clients and clinicians to understand the dissociative model when working with any trauma survivors.
About the Author
Dana Carretta-Stein is a Licensed Mental Health Counselor and founder of Peaceful Living Mental Health Counseling, PLLC, and Carretta Consulting in Scarsdale, NY. She specializes in clinical psychotherapy to treat children, adolescents and adults with anxiety, behavior and trauma difficulties.
She is a certified EMDR therapist, consultant in training, and Regional Coordinator of the Westchester EMDR Regional Network. Dana is also a business coach for wellness practitioners who are looking to build and grow their private practice. For more information, visit dana.carretta.com #EMDRTherapy #VirtualEMDR #EMDR #Telehealth #mentalhealth #Counseling #MentalHealthCounseling #TraumaTherapy #Anxiety #PTSD #Wellness #Scarsdale #Eastchester #Westchester #WestchesterTherapists