Has Anyone Conquered Dissociation In Therapy?

[barefoot]

I am at a frustrating point in therapy and am feeling pretty upset about where I am with it now.

I've been seeing my therapist for 2.5 years. I really like her, we get on, I trust her, I respect her, we are generally able to talk about things to do with our relationship/how the work is going, I have made progress with some stuff etc.

My biggest challenge in sessions is dissociation. When we get close to trauma - even just slightly touch near it, not even diving in deep - I get spacey, shut down and dissociate. I can go from being fine to being full-on, severely dissociated, completely "gone" very, very quickly. At it's worst, I can't speak, can't stand (can't feel my legs/feet), there have been a couple of times when I've been shaking violently and uncontrollably. And it's very difficult to get me back. I've been fortunate in that my therapist has been able to let me stay longer on the occasions when it's been most severe - I have stayed for a couple of hours longer a few times, which I know a lot of therapists wouldn't be willing/able to accommodate, and she has finally been able to ground me and get me back in my body, safer to leave. When I have a bad time with it in session, it pretty much writes off the rest of my week, so the impact during and the fallout afterwards are pretty intense.

Anyway...earlier in the year I had been very avoidant in therapy, so we weren't talking about big stuff for quite a while, then I raised it with her and we talked about the avoidance and then we agreed to actively work on the avoidance and to push on and try to do the deeper trauma work again.

I felt good about that discussion and what we'd agreed but, when I tried, it didn't go well. Back came the dissociation and the shaking etc. It was pretty horrendous. We had three or four sessions in a row where I felt hideous as soon as I was in the room, I couldn't stay in relationship with her (I could hardly bear to stay in the same room as her), I couldn't keep my head in the room, she was worried about me getting home safely etc.

For the last couple of months, we've been having lighter sessions to "regulate the space", make it feel safe again, get us back into relationship with each other again etc. Things had then been fine - whatever I'd been freaking out about during those few sessions, it was then suddenly all ok, we were ok, the room felt ok. We haven't ventured near trauma again - we've been largely talking about lighter, here and now stuff.

Anyway - in this week's session, I broached the fact that we'd done quite a few lighter sessions now and everything felt fine and I still don't really know what caused the freak out a couple of months ago... And then she said that this cycle had been going on for a while i.e. every now and then we try to venture to the trauma, "a different aspect of me" (I think she means inner child?) then shows up in session and that part has "a very powerful 'no,'" I then become "inaccessible", we can't then do any work at all as it's just like I'm not there anymore and then, afterwards, I feel horrendous for the rest of my week. And she said the "episodes" I have with her when I dissociate badly are brutal, retraumatising and not in service to me. So, she said that we have to listen to and respect "the no" - which is coming from this "different aspect of me" which shows up and shuts everything else down. So, she is basically saying that I have to accept that I can't do the trauma work - and that may be a no, not now or if may be a blanket no, not ever.

I feel frustrated and distressed about it because I thought that was the whole point of what we were doing and it's what I've been working towards (doing the deeper work) for two years. I've thought that we just have to be patient and persevere and keep chipping away and eventually the "no" will become a "yes" and then dissociation wouldn't kick in and then we can do the work...softly softly, catchy monkey...

So to just hear her say that we need to accept the no and stop trying...it's not what I want to hear!

I'm interested in whether anyone has been able to conquer their dissociation and, if so, how they did that. Were there specific things they/their therapist did? Was it simply a matter of patience? Is it something you can push/force to happen?

Not asking so much about grounding techniques etc to use when you start dissociating to help you "come back" (though if anyone has specific tips, I'd be interested to hear them!) I'm more interested in, if dissociation used to get in the way and stop the work in therapy, how has anyone got round/through that?

Although I can see my T's point that the current cycle isn't healthy/helpful and I do in general trust her experience/professional judgement, I just don't feel ready to give up on the trauma work yet. I want to have another shot at it. I just don't know how to deal with the dissociation, which is totally getting in the way.

Sorry, a very long post. I am in a real tizz about this so if anyone has any ideas that I could talk through with my therapist when I see her next week, I would be so grateful.

Any ideas??

And please - no telling me I must get a new therapist. That's not where I am and what I want to do at the moment and if people pile in and start telling me to see someone else, I'm just going to feel even more upset!

Thanks.

 

[NightSky]

The thing I have found most helpful in combatting this is that my T recognizes it so fast and brings me back before I am too far gone and then switches gears. Another thing that might be helpful is broaching your trauma in writing (email, letter...) I write things out that would definitely cause me to dissociate if I tried to talk to her about them. And she prints it and reads it before a session. I go in knowing what to expect and she knows to look for signs of even slight checking out on my part. I have also found that reading a lot about dissociation (such as the book Coping with Trauma Related Dissociation, The Body Keeps the Score, etc) and having a LOT of conversations about the material with my T helps me understand, recognize, and combat it a little better. I also read a lot about my particular area of trauma to learn to have some compassion for myself. Because shame is often what kick starts my dissociative episodes. I used to also dissociate quickly if she would bring up my "inner child" I think because that's where my emotions are locked up. So talking a lot about even becoming comfortable with the concept of my child self and how her needs are ok has been helpful. So much groundwork and skirting the edges of the trauma itself just to help me learn to stay in the room. I know it's hard work and not in your control. But I bet with more foundation laying and lots of exposure to the concepts that are hard for you when you are feeling safe, would help.

 

[Sandstone]

I want to start by saying that I may be writing more about myself than you here. I'm seeing it through the lens of my current position, which is looking at the possibility of starting therapy again and at how to prevent the dramatic and dangerous outcomes I have experienced before when addressing trauma..

Four thought occur to me

1. From one of my favourite papers on Trauma treatment http://www.janinafisher.com/pdfs/stabilize.pdf Janina Fisher writes "A trauma survivor can have a meaningful, productive life without ever remembering or processing the trauma, but she cannot have such a life without doing the work of stabilisation. The message for the patient is a simple one: no recovery from trauma is possible without attending to issues of safety, care for the self, reparative connections to other human beings, and a renewed faith in the universe. " My objective is ultimately that "meaningful, productive life". If learning the lessons encompassed in that second sentence can get me there, then that might be enough for me.
   
   
2. What is the source of your desire to address the trauma?
   Options from my viewpoint include
   Do you really want to be able to speak about it?
   Have you accepted that the gold standard of trauma therapy is to "process trauma"?
   Do you feel trauma has ahold on you that can only be broken by defeating it?
   If you can be clear with yourself about why this is an objective, you may be better able to judge how important it is.
   
   
3. What are the rights of one aspect of you to override the desires of another? That question works both ways between the aspect the wants to work on trauma and the aspect that doesn't. It opens up possibilities of seeing the "no" sayer in different ways. So :-
4. What is the source of the "No"? You suggested this might be your inner child. If that is the case, then the "No" might be coming from fear, and the inner child might be experiencing the approach to trauma as a dangerous threat from the adult you. Or it could be that the resistance comes from an over dominant protecting or even bullying aspect and the you that wants to address trauma is is more of a victim role. For myself, thinking about that works best based around the idea of the ANP and the EP being phobic of one another, and how that phobia can re-inforce itself each time it is experienced. I become as afraid of the idea of addressing trauma as I am of the trauma itself, because I learn that there is pain and risk in the act of working on it.

I do want to say that I feel for you in this and recognise your frustration and distress.

 

[barefoot]

@NightSky - so much of what you have said resonates with me.

I too find it much easier to express myself in writing - speaking things aloud in therapy is such a challenge and my voice often gets hijacked even if I don't then fully dissociate.

I journal a lot and have sometimes shared bits of what I've written with her - either during session or emailing to her beforehand. She has encouraged this, but I worry about being too needy/annoying so I don't do it often.

I have also taken a mini whiteboard with me to sessions for over a year but have only used it a few times. The idea was that, if my voice gets hijacked, I could maybe write some things down instead of trying to say them and then I wouldn't get so stuck. I have used it a few times and it has helped. I think one challenge with it is that I feel shy about getting it out of my bag in the first place. Another is that, if I'm already too far "gone", I can't really get my head around getting the board out of my bag and then bringing my mind to bear to write. So, I'm thinking that maybe I could do a session where I write from the start - I don't even try to speak about the harder stuff. I think this would help me to self-regulate and will help to keep me stabilised, even if we're touching on difficult stuff? I was struggling a bit in my session this week and used the board. I think it did help me to stabilise - without it, I think I would have got more stuck and frustrated/panicky and I suspect I would have ended up dissociating. So, I think that might be worth trying? Not sure if she will think it was weird though if I tell her I want to try just writing for a session?

I also relate to what you say about shame and inner child. Both seem to flick a major switch for me, too. The very idea of inner child completely freaks me out (not sure why) but I don't really know a whole lot about it (so maybe that's why it freaks me out?!) So, perhaps it would be useful for me to learn/understand more about the concept/theory (by reading or talking it through with her) If I feel less weirded out (which I suppose means frightened really...but I don't know why I would feel that) perhaps I calm calm things down around it and perhaps that would have a positive knock on effect re dissociation?

Thank you for sharing - very helpful and encouraging to read that you made progress with this yourself. And I've bought those two books so will have a read up before my next session.

 

[NightSky]

I would let your T know you bought the books so you can process anything triggering with her. They aren't easy to read quickly.
I'm glad some of it resonated with you. I am also freaked out by the idea of a younger me with needs. I have spent a lot of sessions talking about my fear of being needy. It's a major stumbling block for me. We spent our entire last session with her going over and over how she chose this profession and loves it and likes seeing me (I'm not the nuisance I always feel like I am). I think I need a lot of that before I really feel like I can stay present when we talk about hard stuff. That's another thing to look at- i know you like your T. How safe do you feel with her, on a deep level? I realized recently I love mine and trust her, but still fear abandonment and have to clue how to feel truly safe in the presence of another person.
I like what you do with a white board. I still feel so frozen, physically, in session, that I imagine I wouldn't pull it out of my bag. But writing beforehand or even right when I get home from a session and tell her what I wasn't able to say has been so helpful.
Keep plugging away!
Really interesting points from @Sandstone as well!

 

[Teamwork]

Great article that you included in this, very helpful. For us when someone is actively stopping talking to the therapist we do one or two things. Ask inside what would happen if you let me talk, then listen, leave a journal open and write what the answers are. We leave art supplies out and do the opposite and say, don't talk just draw. We've seen that work much better than the journal. Once it is drawn the stopping of the talking about it is lessened. Hope that helps.

 

[amosmorris]

@barefoot I can relate: my T and I have slid back to having to work on our relationship after a couple sessions in which we started to touch more closely on traumatic material including my having some auditory flashback during session. I could just not stay with it, ugggh it was awful, and feel like we've kind of regressed in the weeks since. I have just gotten back into my loop of not trusting her, drowning in shame over my child-like needs, and so on...as I write this out I know I'm not offering tools for coping, but I am saying I hear you and feel you and I'm with you.

One thing that I (hope) is ultimately going to help is that I'm being more honest about how I struggle behind the scenes. She is pretty good about catching me as I fade out--"where'd you go just then?"--but there is more that I hadn't been expressing to her about my own dissociation. So I admitted last week that I can't typically remember what color she was wearing moments after I leave a session and that I have a hell of a time mentally calling up her face when she's not in front of me. I was/am embarrassed about this stuff. But when we had to adjust our schedule this week due to the holiday and we were going to do a phone session instead, I admitted the phone unnerves me (not being able to see her face) and so maybe we should just skip the session--she suggested instead a video call, which I felt really was generous and supportive about this thing that I'm ashamed to be struggling with....and that she's never done a video chat before and had to figure it out--ashamed as I am of having the need in the first place, I was also very moved and grateful. It also helped me a ton, way better than a phone conversation.

So--the thing that I hope is going to move me forward is honesty about the stuff I'm hiding or experiencing behind the scenes that my T can't know about (without being a straight up mind reader)....I feel like this could be your just admitting that you feel shy about taking the whiteboard out of your bag, or that writing and not talking during a session makes you feel self-conscious but...that you want to see if perhaps it could help. I felt like a weirdo for admitting my difficulty with talking on the phone, and my mind-blank on her physical appearance, but frankly the video session was such a better alternative that no matter how I am struggling for getting to it....well I also can't deny that we had a way more productive session than we would've if I couldn't see her face.

Hope that helps. :hug:

 

[barefoot]

@Sandstone - those are all good, thought-provoking questions. Thank you.

So:

1) Thank you for sharing the Janina Fisher link. I've just had a read - very interesting and I will revisit it. And that's a great quote you pulled out. Perhaps I don't need to put myself under so much pressure about having to directly do the deeper trauma work...? Stabilisation...yes...hmm...!

2) I started therapy because I felt depressed and anxious and I was really struggling because of it (at work, particularly). I felt confused by a lot of stuff - how I felt and some odd behaviours. And I was ruminating on some old stuff, which was all very confused/confusing but it was like it was endlessly playing on a loop and it was driving me nuts. Although trauma/PTSD wasn't remotely on my radar (because I didn't really know about it, plus I didn't think my experiences had been that bad) my therapist was very certain that my symptoms were caused by/part of PTSD so, to effectively tackle the symptoms, we needed to explore/process the past traumas. So, I suppose I think that the driver for directly working on traumas is that it will help me feel better. Because they are the root cause of my symptoms - so tackling the root cause sounds more effective than simply trying to manage the symptoms while leaving the root cause alone?

3) Yes, I was thinking about this yesterday and feeling that it was unfair (I feel like an 8 year old writing that!) that I have to listen to and respect and accept the no from a part of me that seems small, insignificant, irrelevant to me in every other way apart from when it shows up as an obstacle in therapy. I feel like I (the "normal", current, adult me, which feels like the only version of me there is for 99% of the time) want to be listened to, respected and accepted. But that I'm being told that that other, smaller part's no is more important than my conscious, adult yes. I really resent that. I don't feeL I have a right to override it as such. More that I feel it's holding me to ransom and, as a result, my intentions don't matter, what I want doesn't matter and I don't get to be heard.

4) I'm thinking inner child as that's what my therapist has mentioned before. She's said the IC is frightened and needs reassurance and compassion. But we haven't got into IC stuff any further than that. T has also said this "aspect" is trying to protect me. I don't know what ANP and EP are - will look them up!

Thanks for getting me thinking more.

Though I'm starting to think that after 2.5 years of therapy, there's so much I don't know/understand that maybe I should. Crap!

 

[Sandstone]

I don't know what ANP and EP are - will look them up!

Sorry - I thought you had been part of one the Structural Dissociation threads. Apparently Normal Part and Emotional Part. For me it is an easier idea to live with than a (demanding) inner child. The ANP is the bit that gets on with everyday life, often ignoring the existence of trauma, while the EP holds that trauma and the associated feelings and responses.

 

[barefoot]

@NightSky - yes, the "needy" thing is a very big deal.

I love my therapist and feel very attached to her (ugh!)

I think in general I trust her and feel safe with her. However, when I was freaking out in sessions a couple of months ago, I didn't feel safe and ok in the space but I'm not sure why.

I suppose, also, although I'd say I trust her, I can also lose that trust very quickly. E.g. If she mishandles something or doesn't do what she says she's going to do etc, I feel totally devastated and angered about her messing up/letting me down and I'll really quickly start to construct loads of evidence for why she isn't trustworthy. Hmm...I don't think that makes me sound very nice, does it?!

We are also at a bit of a crossroads in our work in that a long block of pre-paid sessions is coming to an end in a few weeks and I can't afford to pay her full fee after that. I really, really want to carry on working with her but can only do that if she can offer me a reduced fee that I can afford. She has previously said we could work something out but this week I didn't get any sense of certainty around that. I actually came away feeling very worried that she thought it would be best if we stopped because the dissociation is getting in the way so much. I have already emailed her about my concerns around stopping and my hope that we can sort out an arrangement that means we can continue. We'll discuss next week. But I guess it's interesting that I'm currently in a place of loving her and desperately wanting to keep working with her while also feeling that I can't trust her and that she has lied about wanting to work something out financially and that she now wants to stop the work because time and the original money has run out. Jeez. It's so exhausting!

Re the whiteboard - I do find it helpful and did actually tell her about feeling awkward about getting it out of my bag. So a while ago, we agreed that I would get it out right at the start of sessions - not wait until I needed it - and she would remind me if I didn't get it out myself. We kept that up for a few weeks. Then I think she forgot about it and I just started leaving it in my bag again <eye roll>

 

[barefoot]

Thanks @Sandstone - that sounds like something I might be able to wrap my head around without freaking out so much! Will look into that more.

I remember seeing something about it here before but if I've massively contributed to a thread on it, I must be more dissociated that I think! ;-)

 

[barefoot]

Thank you @Links
I sort of like the idea of asking inside what would happen if you let me talk. But there's something quite scary about that idea too...?

Talking is definitely a big challenge. Writing helps a lot. I haven't tried art/drawing. I'm not actually any good at drawing. Does that matter?!