Treating Trauma-Related Dissociation
Trauma-Related Dissociation. How many times have we worked with clients who begin to realize that feeling “good” can be terrifying? There is a risk in therapy that trying to promote experiences to “feel good” may backfire, as certain clients associate it with traumatizing events. Trauma activates primitive defenses which often involve somatic processes. Clients must first learn to associate pleasurable sensations/affects with safety.
Kathy Steele, an expert in trauma and dissociation, believes that therapists must build an essential foundation with clients prior to working on traumatic memories. From her perspective, dissociation is a disorder of non-realization.
Dissociation can be treated as a problem related to survival responses and other defenses used to manage overwhelming trauma. Children have a lower “breaking point” than adults, due to their less developed brains and lack of life experience. This overwhelm means a sense of self doesn’t coalesce.
The Challenge of Where to Begin
When experience doesn’t get integrated, developmental issues arise, keeping our clients in a fragile and fragmented state. In treating trauma-related dissociation, it can be challenging to determine what to focus on first. Kathy defines three equally important phases:
Phase I
Safety, skills building, stabilization and symptom reduction- Establishing the therapeutic alliance
Phase II
- Treatment of traumatic memories and related symptoms
- Working through the transference
Phase III
- Personality integration, mourning and reconnection
- Promoting intimacy
For more information and to register for Kathy Steele’s methodology for treating trauma-related dissociation, CLICK HERE.
We can work with various types of dissociated parts including:
- Frozen child parts
- Angry and hostile parts
- Parts related to shame
- Perpetrator and abuser parts
- Unsafe behaviors
But when a switch between parts occur, Kathy prefers to focus on the process of the switch rather than simply focusing on the part itself. The technique is to facilitate co-consciousness in small ways, helping the client understand “why” a switch in parts may be occurring.
We can plan treatment based on the types of fears and phobias that arise from dissociation, including:
- Attachment and attachment loss
- Inner experience (thoughts, feelings, wishes, needs, sensations, etc.)
- Dissociative parts
- Traumatic memory
- Adaptive change and risk-taking
Conflicts can be hidden within clients, in thinking that express itself as, for example, “I want to know/I don’t want to know. ” It’s important recognize that this struggle does have a purpose and to develop the understanding that both sides are attempting to get relief.
Techniques to Work Past Dissociation
We can’t push forward with clients if they are outside their window of tolerance. Here are few techniques to help clients work past dissociation:
- Top-down Grounding
Counting backwards from 100 by 3’s or Use pre-determined anchors to ground - Bottom-up Grounding
Change position, Squeeze a stress ball or Breathe - Temporizing
“As you relax, notice how time passes…until you feel completely rested/refreshed and can come back…” - Containment Skills
- Imagery: vaults, boxes, space ships
- Imagery should come from the client, not the therapist
- Leave it in the therapist’s office
- Distancing Techniques (adapted in part from Philip Kinsler, PhD)
- Look through the wrong side of the binoculars or tiny TV screen
- Be in a castle, surrounded by a large moat
Treating clients suffering from dissociation and fragmentation requires a carefully planned foundation and a long-term approach. But when we see the process of recovery, the positive results can be so very worthwhile.
If you work with trauma or dissociative disorders, don’t miss our next event with Kathy Steele on Treating Trauma-Related Dissociation. For more information and to register, CLICK HERE.