Dissociation During Therapy Sessions

[JBug]

Hi -

I am new here and still trying to figure things out. I think that I capitalized my title correctly this time; we'll see! Anyway, I posted something similar in a different section yesterday, but didn't get much of a response. Maybe this is a more appropriate forum for this question. I am having a difficult time with dissociation during therapy sessions. I am in therapy twice a week, and during every session, I seem to have some element of dissociation. Sometimes it's simply not be able to access feelings or respond to a question, sometimes I zone out enough that I don't even hear what's been said or asked of me, and on two occasions, it's progressed to a full flashback, with a subsequent inability to come back and finish the session. My therapist is great, knows exactly what's going on, and is trying to help me figure out what triggers the start of it before it becomes full-fledged. The problem is, the trigger is not always clear. If we actually approach the topic of the trauma and what happened then, that's automatic dissociation. If we touch on the incredible self-hatred and blame I continuously feel, there's a good chance that I'll zone out. But sometimes, we're just talking about basic, non-threatening background information and it happens. His office is also on a busy street and the sound of sirens gets me almost every time. The confusion and embarassment associated with the dissociation is bad enough, but I also feel like it's impeding my progress in therapy. My therapist has made to clear that he doesn't believe that "real therapy" can really start until I can sustain a conversation with him and he can feel comfortable that I can stay safe once I leave his office. I've resorted to some minor self-harming behaviors in the hour or so before a session, just so that I can have a better chance of staying alert and giving him the impression that I'm more able to handle the hard stuff. But I know that's not a good coping strategy and that it doesn't give him an accurate picture of what I'm really feeling that day. I am planning to discuss this with him soon, but wanted to know what experiences others have. How do you cope with dissociation during sessions and what do you do if it's impeding the progress that you need to be making?

 

[Healing Survivor]

My therapist is really aware of the signals I am dissociating and will stop and help me get grounded. She also is aware that I dissociate without signals so she will stop periodically during our session and ask how my body feels. She also gives me these rings with peppermint smell that helps ground me. You could try that...bring in an essential oil that you smell when you're dissociating. That helps to ground me, anyway. I also push my feet into the floor really hard and I will interrupt my therapist to tell her that I am dissociating, or about to. I have a lot of body signals that help me know when I am dissociating, so that's kinda helpful. Anyway, I hope this helps at all. Good luck!

 

[James B.]

You could try that...bring in an essential oil that you smell when you're dissociating. That helps to ground me, anyway. I also push my feet into the floor really hard and I will interrupt my therapist to tell her that I am dissociating, or about to. I have a lot of body signals that help me know when I am dissociating, so that's kinda helpful.

That sounds like some good advice.

Remember dissociating in my first T’s office back in 1990, or ‘91. We were addressing aspects of incest and I “left the room”. Recall standing on the beach, hearing the gulls, smelling the salt air. Then, from a great distance I heard my T’s voice calling... “James, where are you?”. Slowly, as if leaving one room and entering another, I came back. There I was, sitting in a chair in front of my T. He knew what had happened. It was a powerful experience, telling me a lot about how my brain dealt with numerous explosive, invasive and violent situations while very young.

 

[Ananda]

I don't know that I have a good answer for you - I've been given the same advice as Healing Survivor mentioned in using smells, or sounds - or something to hold on to as anchors to stay grounded. I can at least say that I have been having the same trouble - dissociating during session - esp. when talking about the main traumatic event. My therapist would have tried EMDR with me if we could have brought up an emotion to center on - but I have deal with the dissociating first. I thought it was interesting - my PTSD is from repeated traumas experienced from early 20's to almost 30. My therapist mentioned that he was curious about possible childhood trauma because dissociation is easier learned when very young. I don't recall anything that happened - so I have no idea about that.

Another interesting thing that came up -- before I found out that my insurance wont cover the out of network visits with this therapist and I had to quit seeing him suddenly -- we were trying Naltrexone to reduce the dissociation and numbing -- 25mg-50mg and hour before session has been shown to help in some cases. I only tried it 3 times and I still dissociated during session -- we would have tried it a bit longer before deciding it wasn't going to work at all. This along with bio-feedback, which he does every session to help reduce anxiety and to get some readouts on what's going on with the brain. He gave me some resource material to give to the prescribing Dr - if anyone is interested in doing more research on the subject (naltrexone to reduce dissociating & numbing). I was very disappointed to have to quit sessions w/him - hoping the insurance situation will change in the future!

~~hugs & good luck

 

[Maggie]

I have a question- I had my first incident of intense dissociation in therapy a few days ago, but it was completely unexpected and I'm not sure what it means. My therapist was asking me about my childhood and specifically asked if I remembered anyone who I was particularly afraid of as a child and when I tried to remember and started thinking about it, I suddenly became extremely dissociated. The floor started growing and shrinking, my body went numb, nothing felt real at all. I felt as if the room was something I had constructed by my mind and my therapist was a creation of my imagination. I am dissociation-prone in everyday life, but I had never dissociated that intensely before. I started to feel a little off when I started thinking about my irrational fears, but once she asked me if there was anyone I remember being particularly afraid of, I dissociated. I felt as if there was a block up around what I was trying to remember, in a way that feels a little different from normal memories. But the memories I was trying to access may have also been from when I was very young, so that may be part of it. But I was wondering if this could be indicative of a repressed memory? Or is the dissociation common or random when accessing memories?

 

[Ananda]

Just from what I understand about it, I think you have the right idea. It's a defense mechanism to help avoid being overloaded with memories or emotions that are too much for us to handle. It can get more intense when touching around sensitive ground - from my experience with it.

 

[Maggie]

Well, for me, it's a little alarming- the original trauma that I've been dealing with and that brought me to this forum was a medical procedure I was aware of when I was three and a half. I don't have any memories of any other abuse. So really, I have absolutely no idea what exactly it is that's making me dissociate. I'm guessing if there's a memory in there, it'll get triggered at some point and come out. But it still drives me crazy...it probably isn't wise to wish so, but I want to know if something happened. I -need- to know the truth.

 

[Abstract]

Hi Jbug,
I am also new and also largely driven here as a result of new realisations about dissociation and all of this. I dissociate through almost the entire session every session to some extent or other. It was driving me nuts as it makes me feel unable to deal with the interpersonal stuff with my therapist as well as feeling powerless and vulnerable.
I have come to realise that the interpersonal stuff itself is triggering me and I need to feel safe with that first before moving on.
What also helped was that someone told me that dissociation can be a v helpful tool in therapy. That it is a sign that things are going to fast or that something triggering has occured. A bit like signposts that one can learn to read. It tells us when we don't trust someone or don't trust a situation as well as when meories or feelings are too intense. I am much more accepting now as I have tried everything and realise I can't force it. My mind won't let me. I will go at the rate my mind allows me to go.

My therapist is using drawings and crayons and the use of a sandtray to help me and this is making me feel a little more empowered and less incapacitated. Apparently fiddeling with something whilst speaking can help too.
Sometimes I just draw the dissociative experience if am able to move and then she can sometimes use that to lead on to a few things. Very slow and very frustrating.
I hope you can be accepting of where you find yourself as I think that helps.

 

[kers]

When I first started treatment, my therapist and I tried like the dickens to get prevent and stop the dissociation in sessions. It didn't help; it was like having my fingers trapped in one of those straw traps--the more I pulled, the more I stayed dissociated.

Finally we both stopped fighting it and instead recognized it as a well-used and needed defense. We worked on getting me to say when I was feeling scared so I could avoid the dissociation, but when I get really set off, I dissociate, and he lets me. When I come back, we discuss why I felt threatened. I definitely dissociate a lot less than I once did, although it's still my #1 coping technique.

 

[ericka29]

I have a question- I had my first incident of intense dissociation in therapy a few days ago, but it was completely unexpected and I'm not sure what it means.

Hi Maggie, this happened to me a couple of years ago while I was in a therapy session, I would say it's not uncommon to dissociate due to some of the questions being asked. As my current therapist has explained to me our minds can block out certain incidents that are to painful. When I first dissociated I was sitting in the chair at the Psych doc's office and all of sudden I couldn't really hear what he was saying anymore and the room just seemed to get narrow, and it as if my doctor was slipping away from me further and further until I couldn't hear him anymore but his mouth was moving - I was frozen and couldn't move - it happened twice after that I decided not to therapy again because I was so scared I have never had that happen to me. That was almost 10 yrs ago and now I've decided to try therapy once again because I want to get to the root cause of my issues. I think a combo of therapy and medication is the best thing.

 

[Omnia vincit amor]

I have regular dissociations, also sometimes during the therapy sessions, amd obviously it is a self protection against overload. Though it is fightening, I experience it in a way positive as well because at least for a while nothing bothers, nothing hirts. My therapist said that fighting against takes a lot of energy, and I agree with him. The techniques with tabasco etc do not work for me because they are either too weak stimuli or I do not have to use them.

 

[Deleted member 14359]

I have periods of dissasociation, generally when I am having a tough time, when I have pushed myself too far. This is something new though. I used to (back in February through to May) dissasociate pretty much all day, mainly while at work - I guess because i didn't feel safe and I was taking 999 calls too!

I dread counselling/therapy sessions, they are painful. I always dissasociate on Tuesdays. Worst one ever was when my supervisor came to take me to counselling one Tuesday. The day started with me taking my son to school. I was already in a bad place, too many memories and questions, and torment. I got home around 08:30 and went for a bath and got back into clean pj's and did my hair (I hate strands of hair on my clothes). At some point between doing my makeup and getting dressed I had lost it!

My supervisor came by my house at 11am for my appointment at 11:30. I was not answering my door or phone. She eventually let herself in and found me on my sofa dissasociating, had got tears on my face, curled up and hugging pillows in my pj's....embarrassing!!! I have no idea what my mind was trying to process. I couldn't really recall all the stuff i had been through at that time. I only knew I was crying because my face was stinging.

I eventually came round, not long after she arrived. I scared her. I feel sooo guilty for that. I kind of knew she was there with me before I truly came round. I didn't even look at her and said 'ah, it's Tuesday'. She said 'yes' and asked 'if i wanted to go to counselling'. I said 'I didn't know', so she told me to 'get up before she beat me at a pillow fight'. Then I frightened her again...I bounced off the sofa and said 'yep lets go!!' I got dressed.

I had flashbacks and dissaociated all the way in her car. Sighing between them and saying 'oh, f*ck' between each one.

Inside the waiting room I sat and disaasociated again and didn't hear my name called. Ouch. Counselling was difficult for that session but was probably the best too. I had lost the ability to control what I was thinking and it all came flooding out....got sooo much covered in 45 minutes.