Help With Dissociation Description.

[ghotiff]

Last session with my T was intense, good but intense. But....At one point she asked what I was thinking and I said I was struggling to stay present and not disappear into my head and she misinterpreted.

She interpreted this as me wanting to distract myself, but I would call it more disassociation. She doesn't like me labeling behavior, but likes me to describe it personally. I understand this , but sometimes I don't feel able to , or I just don't do a good job.

So my feelings at the time where that my vision kept clouding out (like pre fainting) and with effort I could clear my vision and stay in the room because I can remind myself that I trust my T. (And at the amount it costs me I should at least be present ).

Her comment made me feel that she thought I kept getting distracted, and that that was on and normal etc. The thing is that it wasn't distraction, to me it was my way of dissociation where I remove myself, and if needed faint.

Can anyone give me better words to describe this to my T. Clearly my description was lacking, but I don't know how to describe it.

 

[Elana]

I would maybe describe it as...the session was really intense, and sometimes when things are too intense emotionally or mentally to stay present, when I'm super overwhelmed, and the present reality is too much to process, I mentally and emotionally "leave", and go to my safer place. Is that kind of what you're feeling?

I've had therapists who were very familiar with this idea...they would check in with me if I seemed to space out...and understood that if something got too intense, we might need to back it up so I could stay present and engaged.

 

[Seasounds]

• :) @ghotiff and @elana, I think both of you descriptions were great.

• I can remind myself that I trust my T. (And at the amount it costs me I should at least be present ).

• @ghotiff, I agree with you. Personally, I like a therapist that helps me stay on the 'associated' side of the line, and somehow, you T mucked things up by asking you to do 'better' :mad: , when you were in a challenged state, already.

• Really truly, do you ever think to look for another T, who isn't competitive with you (asks you to not use the word disassociate, (even though describing the details can be helpful), and working with a therapist who, instead, helps you turn around your disassociation?
• I suggest the above because it took me a while to realize that a therapist that was attuned and compassionate enough, to help me stay associated was no real 'therapist' of mine.
• Sure, I can come into therapy, in a disassociated state, and I might notice that I am getting disassociated in a session; but now my T and I have an agreement to 'back off' and help me feel safe enough to be associated:find home plate, so to speak..

  I can remind myself that I trust my T. (And at the amount it costs me I should at least be present ).

• ;) Your words, above, state the problem, concisely. What is trust? (You may be able to trust T for many things, but not to help you recover from disassociation) What do you want to pay for? (Someone to help you disassociate, or someone who helps you recover and associate?)
• Good luck, with your process. I've meant to be protective of you, and I admit, I have anger at caring therapists who aren't helpful in 'association' processes, but instead, find or cause disassociation. It may be interesting.to them. It isn't therapeutic.

 

[Justmehere]

I think you described what it is like for pretty well. Most well trained trauma therapists, heck, most general therapists treating any client with PTSD would have figured it out very quickly by what you described. If someone is trained in how to handle trauma, they usually notice very quickly when someone dissociates in session. They watch for it. Your words like not being "present" and "crawling up into my head" when talking about anything triggering, are clear signs of dissociation. Keep describing it to her more, and hopefully she will get it.

You could also ask her why she thinks it's distraction (which is a label even if she doesn't want to admit it) rather than dissociation, and maybe that will help you clarify more.

Distraction and dissociation are both ways to escape the pain... so maybe she is on her way towards understanding that this is more than distraction...

It's hard to be misunderstood about things like this. :( Hang in there!

 

[shimmerz]

@ghotiff this sounds like a challenging one. I admire your willingness to appreciate her ways because I personally would want to choke her. :angelic: I wonder if you describe the physical symptom of feeling your eyes get foggy (I get this often) if that would help her at all. I wonder, now that I think about it, if her way is attempting to have you describe what it is doing to you physically, which is the first step of re-association. Just a thought. Not necessarily a good one....

 

[City Slicker]

@ghotiff I thought you described what was happening quite well.

As @shimmerz mentioned, it could be your therapist was attempting to keep you 'associated' by wanting you to describe the feelings and what they felt like to you rather than just a one-word label.

My experience:
Distraction from a painful subject is a 'normal' thing in the context of therapeutic session when PTSD isn't an issue. But dissociation when the issue is PTSD is an entirely different thing. Distraction implies choice to focus on something else. Dissociation and depersonalization in my experience are anything _but_ focussing on something else, almost characterized by an inability to focus on anything else.

I remember reading the book One Flew Over the Cuckoo's Nest where the Chief described the 'fog' that would gradually come over him...he couldn't see, things felt very far away, all the while trying to make a connection through the fog. He wasn't distracted - he was disconnecting, feeling fractured and trying to stay connected. I remember thinking what an awesome way to describe dissociation although at the time I didn't know that's what it was and it was well before the awareness of PTSD.

You mentioned that session was a good one so perhaps a follow up with her about what happens when you dissociate and the inherent struggle to stay connected when this happens.

It's helpful to clarify misunderstandings and misinterpretations - you will get a better sense also of how much she understands about dissociation and depersonalization as it relates to PTSD. It's a really good thing it's come up because it's an opportunity to see how she deals with the discussion.

She's either a good therapist or she will get lost in a 'competitive' power struggle with you and I really hope she's a better therapist than that.

 

[Seasounds]

First, I want to say that this may not be the case with your therapist, but it is informative to know, relating to:

You could also ask her why she thinks it's distraction (which is a label even if she doesn't want to admit it) rather than dissociation

@ghotiff, on this subject, of a therapist being ignorant of dissociation, I want to add that some therapists, (truly-I had one), believe that it is helpful to encourage trauma clients to deny 'dissociation' and 're-frame' symptoms as 'distraction'; they think it is a way of helping patients "normalize" and "decrease" their symptoms.

I wasn't wise when my therapist was taking this tactic. In fact, I originally went along with it. But eventually and fortunately, I paid attention to my own mindbody signs, and I realized that I was being discounted, the T wasn't working with my wording and was "telling" me what I was feeling, every time I went into deep feelings, the T changed the subject.

As I followed this problem, through pressing conversation with my T, it came out that my T belongs to a group of therapists (agree in theory) who never really acknowledge early traumas as real (and rarely tell clients), because there is no hard evidence of them (but in the client's mind).:confused:

One of their main approaches is to 'reframe', 'avoid dealing with feelings', 'ignore dissociation', since they, for legal reasons, never want to be accused of helping clients exaggerate or 'confabulate' symptoms, if brought to court. 'Interrupting symptoms' is there 'stimulus-response' archaic means of 'expiring' a symptom. This process creates deeper pathology, decreasing trauma clients' self-trust, making it more difficult for them to recover.

Personally, I think these therapists are poison, for PTSD folks. The original creator of this movement was someone by the name of Loftus, Ph.D. It was in reaction to some therapists, in the 80's-90's, who's clients used their therapists' sessions to support bringing their perpetrators to trial. Loftus et al, wanted to make sure therapists weren't brought into this situation again. I think the therapists that are in this camp are afraid of feelings, and don't have the maturity to ground trauma clients in the abuse they endured.

Since that time, and even in spite of that psychological, minimizing trend, fortunately, there are many therapists who treat patients' symptoms as real; letting the transformation begin. :)

 

[Chava]

So if you're dissociating I wonder why your therapist doesn't want to hear you just say that you're "dissociating" or that you have been...maybe pressure to help ground you if she doesn't know how? Any ideas on what that's about? Anyway, I agree with others about explaining the physical sensations. They are probably individual, but sometimes I can say I feel far away, fuzzy, spacey, floating, stuck or frozen. In the moment I can't describe much more (the weird compression of sensations and disconnection) because one of the first features seems to be I can't really talk and I am very disconnected. But my therapist can ask yes or no questions (sometimes a few times) and I can nod. She finds ways to help ground me. I don't know if this is a common thing for you, like in your daily life or just in therapy, or if it happens often in therapy...but I'd think part of your therapist's job would be helping you find ground or stay present. These are helpful tools. Maybe her asking you to describe it to her is one way to actually do that. I know as I can speak, even just single words, it pulls me back into the present and the connection with my therapist...vs me off in some other far away land.

 

[Seasounds]

Respectfully, the T may never share their reasons, and they may not know why, either. (It can always be interesting and informative).

However, I don't think the 'why' is really important; I think the fact that it happens, more than once, is knowledge enough. A bad counseling behavior (T asking, to use different descriptors) was DEMONSTRATED, at more than one session. When ghotiff is describing that it isn't helpful, that is where my protective mechanisms engage.

I do agree, that asking a client to describe their symptoms can sometimes work, to help association. But if it isn't helping, in the spirit of 'doing no harm', the therapist needs the agility and ability to stop, and create a safe, non-invasive (questions scan seem like that), grounded setting.

Therapists are people, in the process of becoming conscious, like many of us. They are also professionals who need to protect themselves, who have the rights to privacy, and they may also be limited by their training, and their emotional maturity.

As we can't make people including therapists change, best to sometimes, just skip the questions, and find a better therapist-client fit.

 

[ghotiff]

Thanks everyone.

You could also ask her why she thinks it's distraction (which is a label even if she doesn't want to admit it) rather than dissociation, and maybe that will help you clarify more

This is a great way to open the conversation, thanks.

I wonder, now that I think about it, if her way is attempting to have you describe what it is doing to you physically, which is the first step of re-association.

I understand why this is a valid point, but in this instance that is not what was going on. In fact she has never done this (no one has) so I don't know how it would work for me. This approach actually scares me a little.

She's either a good therapist or she will get lost in a 'competitive' power

I'm confident that this won't be a problem. We have had other miscommunications that were sorted out, so I'm confident this can be too, I just need to work out how.

some therapists, (truly-I had one), believe that it is helpful to encourage trauma clients to deny 'dissociation' and 're-frame' symptoms

Thanks for this information. This certainly would be a disaster for me.

because one of the first features seems to be I can't really talk and I am very disconnected

Exactly :) this is why I didn't explain myself well enough at the time. Fuzzy is a good word for me to use.

A bad counseling behavior (T asking, to use different descriptors)

Interesting thought. I need some more time to respond to this.

 

[sun seeker]

As I followed this problem, through pressing conversation with my T, it came out that my T belongs to a group of therapists (agree in theory) who never really acknowledge early traumas as real (and rarely tell clients), because there is no hard evidence of them (but in the client's mind).:confused:

One of their main approaches is to 'reframe', 'avoid dealing with feelings', 'ignore dissociation', since they, for legal reasons, never want to be accused of helping clients exaggerate or 'confabulate' symptoms, if brought to court. 'Interrupting symptoms' is there 'stimulus-response' archaic means of 'expiring' a symptom. This process creates deeper pathology, decreasing trauma clients' self-trust, making it more difficult for them to recover.

@change, thank you, this insight is so helpful. It might explain some strange behaviour on the part of a few therapists I have worked with. I've thought there was a tendency to sugar-coat, or reframe symptoms so "anything goes" and no matter how hard I would try to express how much I was struggling, they wouldn't seem to react. For me, it's not only unhelpful but actually retraumatizing at worst because I spent so much time beating my head against a wall trying to get my family to take me seriously, only to find a therapist who won't take me seriously either!

The original creator of this movement was someone by the name of Loftus, Ph.D. It was in reaction to some therapists, in the 80's-90's, who's clients used their therapists' sessions to support bringing their perpetrators to trial. Loftus et al, wanted to make sure therapists weren't brought into this situation again. I think the therapists that are in this camp are afraid of feelings, and don't have the maturity to ground trauma clients in the abuse they endured.

I looked up this Loftus and found she was involved in the False Memory Syndrome Foundation. That explains everything. I wonder... the last therapist I had was badly under-informed about how to work with recovered memory, but when I asked her where she stood on the FMSF she said she had never heard of it. I wonder whether the training being given these days deliberately skirts around certain areas without even telling therapists in training that those areas exist? That would explain a lot.

 

[sun seeker]

(And at the amount it costs me I should at least be present ).

Could you reframe this? I'd think of it more as, at the amount it costs you, the therapist should be helping you integrate your trauma so you are able to be present. I think it's important to explain that it isn't a choice, or something you have control over, and that you do want help with it.

I've described it as being "gone." I'm not anywhere else, just gone.

Perhaps more to the point would be what can she do to help when this is happening? I just started with a new therapist and in the first session brought up the problem of dissociating when talking about something too intense; I described what happens for me and what someone observing is likely to see, and said when I get like that I want her to gently bring me back and help me get back in my body. Could you tell your therapist what you want from her at those times?