Does your therapist notice your dissociation before you do?

ninja

MyPTSD Pro
This is a weirdly difficult one for me.

I have a skilled and highly observant therapist who I've been working with for a couple of years now. She's the first therapist I've seen who specializes in trauma and also the first therapist I've seen who specializes in eating disorders - it has been a vastly different experience from other therapy because she seems to really know how to handle those things. She is showing me different sides of myself that I either didn't know existed or didn't allow out. It's like when you've only read a word in your head and so the first time saying it aloud comes out weird - the first time seeing these parts of myself, outside of my head, that I didn't really realize I was hiding continues to be uncomfortable. Along that vein, acknowledging the fact that I dissociate during session is still hard. Acknowledging that my T is almost always (if not always) able to catch it happening (or predict and prevent it) before I do is harder. I understand that it is actually her job to help me notice dissociation, especially when I wouldn't otherwise notice, but it's still just hard . ..it causes me to feel as though I don't have control of myself. Then as she tries to get me to ground and come back, my immediate reaction is to feel like a failure.

Anyway, I'm thinking that maybe it would help for me to develop a more solid idea of how normal it actually is for the therapist to be the one to notice dissociation first, and if that is something that bothers others. It makes sense that the therapist would notice first at the beginning because I think it can be difficult to catch when in the midst of it... it also makes sense that eventually it might even out, so that the client might notice first almost as often as the therapist. Largely just curious what everyone's experiences have been like with this.
 

Movingforward10

MyPTSD Pro
Reading your post @ninja , what comes up for me is perhaps you having feelings of loss of control, shame and trust in your T?
And wonder if those are things to explore with this?

In terms of my T noticing it before I do. She has a very annoying and uncomfortable way of being right. She does notice before I do, and/or we have both learnt about how it comes on for me, and she has worked out a way to bring me back in certain ways. It's gotten better all round.

Your T sounds amazing. Really intune with you. Is there a way you can build the trust with this? Shift the narrative from feeling like a failure to seeing that this could be the safe place to heal in new ways? Because it's not a failure that someone else has noticed your feeling state before you. I understand how it might feel like that, given how you might have tried to protect yourself from abuse previously. But this is a safe non abusive relationship where those old defences aren needed.
 

Givrali

MyPTSD Pro
My first therapist usually either don't share her observations or said me but I wasn't able to register it. So impossible to know if she discovered it before me. To be fair I start consulting her as a 7 already very traumatized girl who only started to talk after she gave me no other choice. Dissociation was so part of my daily life it was completely normal to me
 

Sideways

Moderator
**Apologies - this is a longer answer than I wanted to give, but I'm trying to work through this myself.

The Ts that I've had who are trauma-focused (as opposed to, say, Ts that were mood-focused) frequently notice me dissociating and will comment. Much like them noticing that I've stopped breathing - they bring that to my attention as well.

It doesn't bother me too much because I find it really helpful. There's all sorts of different physiological and body-language things we can do when we dissociate. I've found it really helpful to have people tell me what signs I can look for when I'm checking in with myself outside therapy, and most of those signs have been ones that Ts have pointed out to me in the kind of situation you've described. One of my Ts will also monitor my Assistance Dog, and tell me what he was doing when I checked out, which has been crazy helpful.

The other reason I find it helpful is it's a recognition that we need to pause momentarily (when it happens in therapy, you can bet that I've dissociated because of my distress levels). As far as practicing coping skills go? That's been aces helpful for me. They're helping me practice (1) noticing there's an issue; then (2) stopping the distressing thing, and checking in to get the distress under control. That's very similar to what a lot of CBT Ts do with SUDS checks, or DBT does with STOP moments. It's awkward and makes me feel vulnerable, but I can replicate it almost exactly as a coping strategy outside therapy - have I just checked out, if so, stop what I'm doing and focus on getting okay instead.

That doesn't mean it's my most favourite moments in therapy though. It makes me feel vulnerable. It makes me feel a little like my precious armour has failed me!

One of the things that has been really confronting for me in therapy is having someone notice me. The things I do when I dissociate aren't new. And some of them are very odd, very noticeable, if you pay even a modicum of attention. And yet it's taken decades for someone to actually sit across from me and pay enough attention to actually notice these things, and that I'm not okay. That's uncomfortable because it's new. But it also speaks volumes of the types of relationships that have been my norm up till I started therapy. It even speaks to how I survived as a child - it takes a skilled, experienced practitioner to actually notice "this person just stopped being okay".

Someone really noticing me, seeing past the external, smiling armour I use with everyone, and checking with me that I'm okay when they notice that I'm really not (when no one else in my life had ever noticed!)? That's not easy to get comfortable with - but it is what we have deserved all our lives, too often from the very people who caused us to have ptsd in the first place.

People prioritising my well-being falls well outside my comfort zone. People noticing and caring can be a real head trip if you come from a history of abuse.
 
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Charbella

Confident
No mine does not notice before me. I wish he was better at anticipating because then I could use some of the skills we go through. I get to far into the system and my response is anger that I can’t just...whatever it was I was supposed to be doing. Then the stubborn part kicks in and I’d rather just call it a day.

Can you reframe how you feel about it? Can your T teach you what it is they’re seeing so you can stop yourself? If they’re anticipating it maybe yell you that? Are you able to pinpoint what you were thinking right before? I can only guess you’d like to control or be rid of the problem sounds like your T can help you put out the campfire before it burns down the forest.
 

arfie

MyPTSD Pro
i never thought to ask, but i believe 100% of my therapists and most of my peer supporters were able to tell before i was during those early years. probably not so much as my awareness of dissociation and skills with the therapy tools have grown. my work with peer supporters has me pretty convinced that the outward tells other people see are more obvious than the inward tells i can only feel. body language really does communicate important messages more accurately than words and we don't get to see our own body language.
 

barefoot

Sponsor
I used to dissociate a lot in therapy. I’d go really fast and really deep and it would often end up being a pretty brutal experience, which would pretty much write off the rest of my week. It was quite a shock when, prior to therapy, I’d never heard of dissociation, didn’t know what it was, let alone realised that I did it.

The feelings it brought up for me were largely around shame and embarrassment - because I had lost control of myself.

And also anger and frustration with myself that I had ‘wasted’ time and money in another session.

So, feelings that came up for me were turned inwards towards myself really, rather than having feelings towards my therapist about it.

She certainly noticed before I did and intervened (sometimes successfully, often not) to ‘bring me back’. I guess it makes sense that they notice first as they are present and we are not if we’re dissociating. Plus, they are looking at us, so have visual cues that we are not able to see for ourselves.

If it helps at all - I made a lot of progress over the years with dissociation and now don’t get into that deep state. I can stay much more present. I sometimes still get a bit trancey/spacey, and feel tired after the session as a result. But it’s not that full-on, totally gone, brutal experience where I didn’t know where I was, could barely stand or speak, and which floored me for a week afterwards. Now, if I get spacey, my T picks up on it straight away and I’m generally able to refocus.

I used to get so frustrated that I couldn’t control it, and it felt like it would just always stay that way. But things did shift a lot.
 

Friday

Moderator
Acknowledging that my T is almost always (if not always) able to catch it happening (or predict and prevent it) before I do is harder. I
Anyway, I'm thinking that maybe it would help for me to develop a more solid idea of how normal it actually is for the therapist to be the one to notice dissociation first, and if that is something that bothers others.
All the trauma T’s I’ve worked with have been able to read me. Which is a big part of why I chose to work with them.

I’m the opposite to bothered… I looooooove and adore when I’m working with a T who can & does do that.
 

ninja

MyPTSD Pro
Thank you everyone. It’s been very helpful to read about your experiences and perspectives, and I am beginning to feel a bit less resistance towards broaching this in session with my T.
I'm very rambly in this post though - my apologies.
In terms of my T noticing it before I do. She has a very annoying and uncomfortable way of being right. She does notice before I do, and/or we have both learnt about how it comes on for me, and she has worked out a way to bring me back in certain ways. It's gotten better all round.
I'm so glad to hear it's gotten better - that is really hopeful. It can really make a difference to find the 'right' approach.
I think it also really helps to catch it as soon as it starts.
My T is also the annoyingly uncomfortably right type - I commiserate!
Your T sounds amazing. Really intune with you. Is there a way you can build the trust with this? Shift the narrative from feeling like a failure to seeing that this could be the safe place to heal in new ways? Because it's not a failure that someone else has noticed your feeling state before you. I understand how it might feel like that, given how you might have tried to protect yourself from abuse previously. But this is a safe non abusive relationship where those old defences aren needed.
Thank you so much. I think I need to read and say this over and over and over again - It's not a failure that someone else has noticed my feeling site before me. My T is there to help me notice my feeling states, not to get mad at me for not noticing. It's not a failure, it's a moment of expanding awareness. In a safe relationship.
That doesn't mean it's my most favourite moments in therapy though. It makes me feel vulnerable. It makes me feel a little like my precious armour has failed me!
It's not pleasant in the moment, but it does help, I agree!

It's uncomfortable to realize that I don't always know what's good for me even though I may feel pretty sure that I do? I often tend to feel like it's a good idea to "go into" the feelings/memories, but my T will start to pull me out because she sees a trauma vortex coming for me. In those moments, I tend to think that I am completely okay, and it's not really until I realize that I actually physically cannot speak or necessarily move that I have to acknowledge I'm not okay. I can't seem to generate enough momentum to get the words to break through the "door" of my my mouth. I'm not sure that makes any sense.
It has happened enough times that we both know it's better not to rely on me to know where my limits are. I can acknowledge that, but STILL in the moment I will feel sure that going into the feelings is the right move and confused about why T is asking me if I can feel the chair underneath me.
I am noticing faster than I use to though, and I'm better about following T's lead.
It's hard to say this all aloud here

When your armour fails, you have to start to integrate reality? Maybe where I'm at is - I dissociate and it's hard for me to recognize it, and that makes me feel uncomfortably reliant on my T, but I am working on it. This gets to what you were saying, movingforward:
Reading your post @ninja , what comes up for me is perhaps you having feelings of loss of control, shame and trust in your T?
And wonder if those are things to explore with this?
I think you hit the nail on the head.
It feels uncomfortable to own that there are moments where I do not have control my reactions, and sometimes those reactions can be rather visible. Denial/minimization is definitely a bit of a go-to for me, but I think it's starting to break down. I sent my T an email a few weeks ago and in it shared some things I hadn't shared before, and when we talked in session she was very upfront with me about her perspective, and since then there's been less "room" (in and out of session) for my doubt/minimization/denial. I think I'm now in the process of trying to accept and trust that maybe she's right about the cptsd thing while also sort of beginning to see it. I don't like the idea of having it, but if it's right, I'm hoping that accepting it will mean I can start to have a greater sense of control over dissociation (and shame!).
One of the things that has been really confronting for me in therapy is having someone notice me.
Oh.....Yeah.
Notice me. Notice the symptoms. Notice the struggles. Notice the strengths. Care. Be kind. Show compassion. Have patience. Insist on making the hour about me. Over and over and over again.
It is really confronting. Still, several years in! (It takes time, ninja. Lots of relearning, and only so much can go in at one time.)
It hurts when she refuses to believe that it was my fault. When she doesn't blame me for being weak.
I wish I didn't react this way, I wish I could just receive her kindness. But I will get there.

I love that your T comments on your doggo's behaviour - I can imagine that being immensely helpful!
And yet it's taken decades for someone to actually sit across from me and pay enough attention to actually notice these things, and that I'm not okay. That's uncomfortable because it's new. But it also speaks volumes of the types of relationships that have been my norm up till I started therapy. It even speaks to how I survived as a child - it takes a skilled, experienced practitioner to actually notice "this person just stopped being okay".
Ahh... what comes to mind when I read this is - maybe it doesn't make sense to expect a kid to know to notice something about their internal experience that no one else noticed? Or to continue noticing?
Someone really noticing me, seeing past the external, smiling armour I use with everyone, and checking with me that I'm okay when they notice that I'm really not (when no one else in my life had ever noticed!)? That's not easy to get comfortable with - but it is what we have deserved all our lives, too often from the very people who caused us to have ptsd in the first place.

People prioritising my well-being falls well outside my comfort zone. People noticing and caring can be a real head trip if you come from a history of abuse.
I don't know that I have the words to really describe how this landed (is landing), and the words I do have feel pithy. Thank you for normalizing this.
 

Freida

MyPTSD Pro
Yep.
At first she mentioned it to me -but now she usually pauses until I figure it out.

It makes me kinda crazy, but it helps me see the signs so when i'm not in the office I can try to be more aware of it on my own
 
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