Dissociation in Therapy Sessions

People who have had trauma in their lives dissociate in therapy sessions often, so therapists who work with trauma are quite familiar with it. The most common way to tell when someone is dissociating is by looking at their eyes, which get defocused, and seem to be “pulled inward.” Other, more extreme, examples of dissociation are: When a woman told me she saw my head off to one side of my neck, or when someone switched alters and when the first alter came back, she/he didn’t know what happened during the time the other alter was in charge of the body – which is an experience of losing time. The last example is of someone with DID, but not everyone who disassociates has DID., People who have experienced trauma often dissociate without intention and often without awareness. It’s an automatic defense that is experienced as “just happening,” and it happens when the person feels threatened or unsafe.

When someone eyes defocus, I bring their attention to what happened so they are aware of it, and help them “come back” : changing the subject that is threatening, asking them to intentionally look around the room and say out loud what they see, ask them what percentage of them is in the present, all of which increases self awareness and normalizes the experience. Sometimes when they are back I might ask if they remember what was threatening and ask them/ help them to stay present while they describe it.

When the dissociation is more extreme, I explain what is happening, or just happened, and we talk about it conversationally. The purpose is to empower the person to not feel so unable to control the dissociative experiences and to explain why it happens and assure them it is not intentional, and that sometimes they aren’t going to be able to consciously decide not to do it. Recognizing what happened, naming it and also recognizing that nothing terrible happened because of it is also reassuring.

If you are worried about maybe disassociating in a therapy session, be sure you choose a therapist who has had experience with trauma and who is someone you can rely on to help you.


Once upon a time along time ago there was a little girl who lived under a tree. That is, she lived in the big hole in the side of the tree where the ground was soft and it was dry and not too very cold even when it was cold outside. She lived there whenever her parents got too crazy with her. Sometimes they did get too crazy and they said crazy things and did crazy things and it wasn’t safe to be near them. But she could run away and be safe in her tree. Her tree loved her and it was alive!
It was very wonderful to have some thing that was alive that loved her and would not hurt her and get crazy. She brought her softest blanket there and a bottle no one would miss that had water in it. Sometimes she brought some food that she could steal from the kitchen in the big house. And -OH ! – she knew the tree was alive because it had little new shoots at the tips of the branches every spring, ever since she could remember. Nobody from the big house ever missed her or went looking for her so whenever she wanted she could go to her loving tree.

Sometimes she wondered why she ever did go back to hang around her parents in the big house.  “I guess” she would say to herself, “maybe one of them would change and be loving like my tree.” But they never did.

One day there was a big storm with lots of rain and windy wind. Very windy wind. She went out to her loving tree and it was lying down with it’s roots showing instead of being in the ground. That was scarey, because it changed. Like her parents changed. That was very scarey. She found out that she could still get into the hole but it didn’t seem so good anymore because the hole was lying down too and there wasn’t as much room in there anymore. She knew she couldn’t get the tree to stand up like it used to. It was too big to even budge.  Now the ground did get wet and it was colder than it used to be when it got cold outside. Besides she was getting bigger herself. There really wasn’t enough room.

So one day she sadly said goodbye to her tree and went walking down the road near by.  She was very startled by a boy who she saw walking down the road too. He asked her where she was going and this she told him: “I’m going where the north wind doesn’t blow down good trees and where the people are as nice as good trees.” “Do you know  where that is?” he wanted to know.  “Not for sure,”  she answered, “but it isn’t behind me so I figured it’s got to be up ahead somewhere. So that’s where I’m looking.”  “That sounds right to me” he said, “I don’t like what’s behind me either. Can I come with you?”

” Well, yeah” she said. “But I’m not used to company.”

“Neither am I,” he answered, “but  we will figure it out.”

“Hmm,” she nodded, and so they kept walking together.

Ready to remember?

Many clients who are in therapy for childhood abuse get impatient to know what happened to them. However, everyone needs  to be  prepared to confront trauma, especially their own trauma.  When readiness exists, if any  trauma happened, you will remember it at a time when your external environment and  inner environment are able to support you sufficiently. This way remembering what happened (that was destructive to you in the past), now can help you to heal.

The inner environment is your relationship with yourself.  You need to be able to line up your resources to be PRO- you.  So what are PRO-You resources? Here’s an  example:  your intelligence assists you in understanding that you were not at all responsible for the abuse happening.  That would be PRO-you.  An  ANTI- you resource  would be your  brain coming up with ways to put yourself down.

The outer environment has to do with different things for different people, but usually it includes (1) having the right guide to help you through this difficult healing journey,  (2) being  in a supportive relationship  or out of a bad one, (3) having the time and attention to devote to yourself:  A single mom with  two young kids and no health insurance who is putting herself through a master’s degree program is probably not at the best  time in her life to start incest therapy, right?

Developing your inner environment often takes time, and people have said to me in frustration “Why doesn’t all this just come up and show itself to me on a g#&** video screen! Don’t you guys have drugs to make people remember?”  In fact, the therapy that goes on before information comes to the surface is just as much ‘incest therapy’ as what happens after. Most likely that time is spent repairing your self respect and instilling healthy self love.

I believe therapists in out-patient mental health clinics  should not use techniques  to pry a memory out, or use the therapy hour to work at unearthing it.  Forcing something to come to your awareness before you are truly ready can be overwhelming and destructive. Thank goodness most people have enough defences to prevent this from happening.

Get yourself a therapist who has been  over this terrain with many women and men.  Going this journey takes a special kind of courage and you deserve an experienced guide. The human heart, once broken, can heal itself again.  Therapists are  here to help people take back their lives and live in a different world that, often, they didn’t know was possible.

My best to you.

Stuck Grief : Why is it you are looking into therapy?

A man I work with came up with this phrase, “stuck grief.”   He was referring to himself and why he was having trouble with near psychotic thinking. The “crazy” thoughts were preferable to recognizing what they symbolized: another extremely painful  memory of abuse from his father. He was saying, very articulately, what was going on inside himself: stuck, or unexpressed (and surely unresolved) grief.

I realized that stuck grief was the basis for what goes on in therapy sessions including all of our histories and especially forgotten, denied  or ignored incidents and realities. People avoid what brings pain, and until they have dealt with the pain and resolved it, they tend to continue what ever emotional habits maintain their avoidance  Even very high functioning adults, maintain unhealthy behaviors  because they are not willing to face the truth of their childhoods. Sometimes it is  loss of the relationship with their families that they fear, or having to confront the imperfection of their parents.  Ultimately It turns out to be an avoidance of growing up.

If someone has something that needs grieving, and they avoid the recognition and therefore the grieving, I call that stuck grief. It is  accompanied by some behaviors that aren’t healthy for the person, their children, their spouse, their customers, business associates, someone.  They often use an addiction  to keep the pain out of their awareness, like  drug or alcohol use, over working, lots of sex. It can become confusing to tell the difference between what you need with what is best for your children, and a  handing down of all kinds of human distress.

Stuck grief buried within a person can become the basis for just about anything that might bring someone into therapy.  This is why doing therapy takes courage, and a different kind of courage than many people are familiar with.   So, if you are looking for more than a bandaid, if you really want to understand yourself and make significant change, pick your therapist, your guide, carefully.

Childhood Sexual Abuse is Not A Life Sentence

In my practice I have met people who have been in therapy for childhood sexual abuse, but have not been able to set it behind them and get fully involved with their lives.

There seems to be 3 stages of healing from this horrific crime against you as a child: (1) Being a Victim,  (2) Experiencing Yourself as a Survivor, and (3) Becoming The Person You Were Meant To Be. Let me explain what I mean:

When you are a Victim, you are reacting and suffering from the effects of the abuse. You may or may not be fully aware of what happened to you as a child.  You are strongly effected by the abuse and it has left you with a myriad of issues. These include problems with relationships and trust, sexual dissatisfaction, substance abuse, low self-esteem and more.  You may or may not have been in therapy, but you haven’t resolved the the pain and effects from the past.

When you are a Survivor you most likely have had a good bit of therapy. You are proud of yourself  and you deserve to be. You have worked courageously to own your  life, you have gained quite a bit of self understanding and confidence.  You have made progress and have a right to be proud of it.  Survivors are  warriors and stand tall.  The truth of your abuse is a fact of life, and a pretty conscious one. You may find yourself telling people about it,  feeling righteously angry that this injustice was done to you. And you have every right to feel this way.

But you are not over the abuse, it is not in your past, yet. It is a present, daily fact of your life and you are conscious of it every day.  “How can I not be?” you might demand, “Don’t you understand  how devastating that all is?” What I am saying, very gently, is there is another place to be with the truth of your abuse. You can get past being enraged and involved in what it did to you.  You  can get on with the rest of your life and be primarily involved with new challenges and self actualization: becoming the person you were meant to be.  At this stage of your healing you are invested in your life now as it unfolds before you.  I find myself saying to others when they ask about my family of origin: ” I didn’t have a normal childhood. But it’s OK, I don’t live there any more.”  You are truly finished with the work of your abuse  when you “don’t live there anymore”.

I wish I could say that the sexual abuse is no longer at the core of your personal growth as you continue on with your life.  It is.  You may wisely recognize that today’s problem or stuck place is stemming from what happened to you in your past. You might go back to a therapist to deal it.  But you don’t identify yourself as  a survivor anymore.  Now you are more involved in things like learning to be more assertive and getting the respect that your deserve at work, or raising your children better, the normal problems and growth areas  of regular life.

Your childhood abuse isn’t a life sentence.  Joyfulness and  deep satisfaction are  out here for you.  If you haven’t found them, keep looking.

Recovering from Childhood Sexual Abuse

Recovering from Childhood Sexual  Abuse

Common Beginning Questions:

I think I might have been abused but I’m not sure. Does that mean that I probably was?

Not necessarily, but maybe.  In a way, your job is the same whether you were abused or not:  I would recommend you get into therapy (with someone who has experience with survivors of sexual abuse and who clicks with you) and do the therapeutic work about what ever is interfering with you having the life you want now.  If there was any abuse, and you are ready to deal with it, it will come up into your conscious awareness and you can address it.

What does it mean to be ready to work on abuse? 

Readiness has to do with being in the right place, internally and externally,  so that when you find out the reality of your own abuse,  you will profit from the therapy work and not be unduly  beaten down by it.   Abuse that you had to repress (forget happened) is likely the experience from your childhood that was the most destructive to your self-esteem.  Being ready to deal with this and having it be a healing experience takes readiness.  Left to your own devices, you  very probably won’t remember anything you aren’t ready to deal with.  This is why I don’t use hypnosis with my clients who want to remember what happened to them.

So being “ready” to work on abuse means that  the relationship you have with yourself  ( your internal environment)  is strong:  Your resources inside are lined up PRO YOU. You spend more time supporting and validating yourself than putting your self down.   No matter what else,  in the end you basically like yourself, enough anyway, so that you can help yourself through this process.  You can remember painful things that happened to you and heal from them rather than being over whelmed or  becoming self-destructive.   The good news is that once you are through this work,  you will like yourself,  love yourself,  more than you ever have.

What is this “outer environment” part?   This  could be about relationships and if you have good support, for example  being  in a good relationship or out of a bad one. It can be about finances and when you have the money for baby sitters or transportation or the therapist’s fees.  It is probably also about timing so that you can afford an occasional day off  when you truly need a mental health day.  Therefore  it’s probably not when you are a single parent of young children and working part time and going to school at night.