Is this dissociation?

[Lilac5598]

Hi. I've been seeing a therapist for a bit over 2 months. I have times where when talking to her, I have periods of time where I know she is talking but I can't really hear her. While that is happening, I notice that I don't quite feel like I'm there anymore, like I'm insulated somehow. Also, during that time, I know my eyes are open but I can't remember anything I'm seeing.

I've asked her about dissociation and PTSD but she won't give be a difinitive diagnosis yet. Not knowing what is going just makes me feel more lost.

This hasn't just happened around her. It has been happening for years. I've talked to her about that and what triggers it when I'm away from her office. Can anyone give me any insight?

 

[Teamwork]

Well if it was me I’d say I had partially dissociated. As in moved away inside and did not give full attention. So if it were me describing what you experienced I’d ask myself what happened before I slipped off? Did I sense she was heading somewhere that I perceive to be unsafe. It would then be that I’d work with that info and call it a trigger. I’d have to explore what causes me to feel unsafe with a trusted safe person so that I use an old mechanism to not enter fully into the dialogue.

 

[user50913]

Hi. I've been seeing a therapist for a bit over 2 months. I have times where when talking to her, I have periods of time where I know she is talking but I can't really hear her. While that is happening, I notice that I don't quite feel like I'm there anymore, like I'm insulated somehow. Also, during that time, I know my eyes are open but I can't remember anything I'm seeing.

I've asked her about dissociation and PTSD but she won't give be a difinitive diagnosis yet. Not knowing what is going just makes me feel more lost.

This hasn't just happened around her. It has been happening for years. I've talked to her about that and what triggers it when I'm away from her office. Can anyone give me any insight?

That sounds a lot like derealization to me! (That's a kind of dissociation. There are a lot of other kinds too, I have a more severe kind, but "parts of me" experience derealization and/or depersonalization.) I would look them up in some kind of official diagnostic criteria for those types of dissociation. There is a disorder called Depersonalization/Derealization Disorder (DP/DR). BUT I AM NOT TRYING TO DIAGNOSE YOU WITH THAT IN ANY WAY!! I'm NOT qualified and plus even if I was I wouldn't have enough information from your post. But I think those types of dissociation are described in detail in the DSM-5, I'm pretty sure DP and DR are the types of dissociation most commonly associated with PTSD.

IMPORTANT: I WOULD NOT under any circumstances look anything mental health related up on Wikipedia. I've gotten myself in a LOT of unnecessary trouble doing that.

I don't know much about good therapists except for what the two I have now are like, but it's likely that if you have only been seeing her for 2 months, she may want to assess you more before giving you a definitive diagnosis. I would talk to her about it when you're feeling grounded. One way to feel more grounded is to put both your feet on the floor and try to feel the soles of your feet/shoes against the floor. Another is to mentally name 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell, and 1 thing you can taste (I usually bring an iced coffee for that purpose, I also usually forget it's there until the session is over lol!) Another way is to name all the colors in the room that you can see that start with a random letter, change the letter every time if you need a challenge. I get it, when you're dissociated it's super hard to even be present enough to remember any of those things.

One last idea that my friend who is also a trauma survivor uses with her two teenage daughters who have both been complex trauma survivors since birth (SHE is a really great mom and listened to them, and got them away from their father and divorced him maybe 3-4 years ago?)--she was in a PTSD psych education class I was in at the Medicaid clinic and she taught us this (it really helps me when I'm "completely gone")-- Find something (a picture on the wall, for example) to focus on. A lot of the time when you're dissociated you're kind of "staring at nothing". Let yourself stare at it, really try to focus on it and see it, for like 30 seconds (or count to 30 or slowly to 10--sometimes I forget how to count, so I have 10 fingers, that's a good number.) Notice details. Name details about the picture/object in your head or out loud. Then allow your gaze to generalize SLOWLY to the wall/area in the near surroundings to the object. Slowly expand your gaze until you've "returned" to the room and see if you can hear your therapist by then...

Good luck and I hope your therapist turns out to be helpful!

 

[joeylittle]

I'm pretty sure DP and DR are the types of dissociation most commonly associated with PTSD.

Actually, no. A flashback (whether physical, aural, visual, emotional, or some combination of those) is the most common type of PTSD dissociation.

Well if it was me I’d say I had partially dissociated. As in moved away inside and did not give full attention. So if it were me describing what you experienced I’d ask myself what happened before I slipped off? Did I sense she was heading somewhere that I perceive to be unsafe. It would then be that I’d work with that info and call it a trigger.

This is so well-put, and that question - "what happened before I slipped off" - that's the key. Because sometimes, we "zone out" (dissociate) when we're tired, or hungry, or being distracted by something that's on our mind....sometimes the human brain just checks out for a moment. None of these are clinically significant.

@Lilac5598 -

I've talked to her about that and what triggers it when I'm away from her office.

Can you share more about this?

 

[coraxxx]

I tend to zone out with my psych when I start to say stuff that really upsets me and feel rather vulnerable. I can really feel myself pulling away, dive inside myself and the wave of emotions cuts. Generally she sees it and asks me to come back. For me it's quite efficient to have this on cue.

 

[Lilac5598]

Well if it was me I’d say I had partially dissociated. As in moved away inside and did not give full attention. So if it were me describing what you experienced I’d ask myself what happened before I slipped off? Did I sense she was heading somewhere that I perceive to be unsafe. It would then be that I’d work with that info and call it a trigger. I’d have to explore what causes me to feel unsafe with a trusted safe person so that I use an old mechanism to not enter fully into the dialogue.

She was definitely heading somewhere I wasn't comfortable with. She does realize what triggers me, well some of them since I'm not sure of them all. I know when this happened, when I was able to, I guess come back, she was apologizing. She wanted me to talk to her about what had just happened but happened but I wouldn't and she let it drop.

@Lilac5598 -

Can you share more about this?

The last time I seen my therapist and I slipped away from her, she had brought up some photos of my family and had asked me if I had any feelings when I seen them. My mind went to a particular picture and how clearly I could remember the situation of it being taken, like I felt I was back in that very moment. I felt completely overwhelmed by her question.

 

[Lilac5598]

I feel like my original post wasn't as clear as I intended. It's hard for me to describe what actually happens during these episodes. I have two main situations that they happen in, one being my therapists office and the other being around my family, especially my parents house.

When I'm around my family, when I feel triggered, I tend to just freeze, I suppose. I know my breathing slows down and I don't move and I think I end up just staring at one spot (that part I'm not sure of). I do know that it feels like I'm in a tunnel, that I can still see and hear things but that they are so far away they don't affect me. I know I must me hearing things on some level because I know when it's safe to return because the subject has changed. While I'm in that state, I don't remember what was being said or what was happening around me.

With my therapist, there are similarities. Since she knows of how I slip away, she kind of watches for it. She knows of some of the triggers. But when I am triggered, I tend to close my eyes and physically pull away from her. I know I get very tense and then I slmply feel like I'm insulated against what is being said. I'll stop hearing her, I'll stop seeing the office. I think I end staring at one thing.

I know that its a defense mechanism that's doing its job amazingly well. I honestly don't want it to stop. She is trying to teach me healthy coping skills but I have a hard time using them. I think she is waiting for me to use them when I'm in a session with her without her prompting me, I don't know.

 

[joeylittle]

I know that its a defense mechanism that's doing its job amazingly well. I honestly don't want it to stop.

If that's true, then you have a decision to make. Either you keep going with this therapist, and tell her what's going on with you and that you're willing to try doing the things she's asking; or, you keep things the way they are, and (probably) leave therapy - unless your therapist is willing to table working on your dissociation as a coping mechanism.

I know that's very black and white of me - but it sounds like you don't see there being a problem with it. If you don't consider this an unhealthy coping skill - if it's not interfering with your ability to get through your day - then I'm not sure there is a reason to change it, especially as it's only happening in two limited environments.

Just IMO.

 

[Sideways]

she was apologizing. She wanted me to talk to her about what had just happened

Yeah, sounds to me like she potentially has a pretty good idea of what's happening for you. And trying to help you move forward, then pull up at the point where she's realised you've checked out.

Because I think that's probably close to being an almost universal response when someone is in trauma therapy talking about something too close to the bone.

So, yes, sounds like a dissociative reaction to stress. And it also sounds like your T knows is happening and is trying to help you work past it.

 

[Lilac5598]

If that's true, then you have a decision to make. Either you keep going with this therapist, and tell her what's going on with you and that you're willing to try doing the things she's asking; or, you keep things the way they are, and (probably) leave therapy - unless your therapist is willing to table working on your dissociation as a coping mechanism.

I know that's very black and white of me - but it sounds like you don't see there being a problem with it. If you don't consider this an unhealthy coping skill - if it's not interfering with your ability to get through your day - then I'm not sure there is a reason to change it, especially as it's only happening in two limited environments.

Yeah, sounds to me like she potentially has a pretty good idea of what's happening for you. And trying to help you move forward, then pull up at the point where she's realised you've checked out.

Because I think that's probably close to being an almost universal response when someone is in trauma therapy talking about something too close to the bone.

So, yes, sounds like a dissociative reaction to stress. And it also sounds like your T knows is happening and is trying to help you work past it.

Are you saying that she is intentionally asking these things knowing it could cause me to check out?

 

[Movingforward10]

Are you saying that she is intentionally asking these things knowing it could cause me to check out?

She might be trying to work it all out with you?

My T said that I very quickly went into another state and she wanted to work out with me how to remain. Because it came on suddenly.

I think they know, but they don't know everything or why or how intense etc, because they can't read our minds. But they have their experience and training so they can see certain things. But not our individuality without us working it through together. If that makes sense?

I utterly understand the not wanting to let go of this coping mechanism. For me, it's scary to let go. I told my T that it felt like free falling of a cliff , if I didn't have my coping mechanisms anymore. What else is there to help protect me if not disassociation? So it was fear stopping me.
And I can now hear what my T was trying to tell me. It's "turning the tap on and off, letting it out drip by drip". I didn't understand that at the time as 'black and white' thinking took over.

So I don't think your T is asking you questions to deliberately destabilise you, but to work it through together.

 

[Sideways]

Are you saying that she is intentionally asking these things knowing it could cause me to check out?

She's intentionally asking you questions that are difficult, yes. And, you'd hope so. That's the nature of therapy. We don't go for a friendly chat. We go to solve difficult problems. Uncomfortable problems.

But what I was suggesting was the opposite. You said that she apologised when she noticed it happened. So, it sounds like (as best as can ever be examined in hindsight by someone hasn't met either of you and wasn't there) is she's trying to help you work on the stuff that needs work, and pull up when she's recognising you won't go any further.

Personally, I've found building up my distress tolerance skills has been necessary to get anywhere with therapy, because I do the same thing. When the going gets tough, I'd check out of the conversation. These days, I'm better at managing that, so we can work on stuff that I didn't have the capacity to deal with before.

How you handle it moving forward is your call.

But no, I wasn't trying to suggest for a second that she's deliberately trying to upset or trigger you. There'd be little point in that, since you can't make much progress in therapy while you're checked out. To me, it sounds like she's being a reasonably competent and experienced therapist - helping you confront the hard stuff, and stopping when she realises you've checked out.