What You Need to Know When Clients Dissociate, Part 1

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When working with trauma survivors, it’s not unusual to witness clients suddenly “checking out” during the session. Eye contact is broken, the conversation comes to an abrupt halt, and clients can look frightened, “spacey,” or emotionally shut down. Clients often report feeling disconnected from the environment as well as their body sensations and can no longer accurately gauge the passage of time. Clinically, this is called dissociation, and it’s best understood as a well-honed childhood coping strategy; mastering the ability to mentally escape when it’s impossible to physically escape a potentially threatening situation.

It’s not uncommon for well-meaning therapists to either patiently wait for the client to “come back,” or choose to ignore the episode altogether for fear that it will make the client too self-conscious, embarrassed, or ashamed. Yet it’s essential that the client’s dissociative experience is identified and addressed during the session, as this can be the safe context that is necessary for clients to understand dissociation and begin moving in the direction of consciously choosing to stay grounded and present when threatened. Although it is important to be gentle and compassionate when discussing the topic, ignoring dissociation keeps clients in a disempowered state and colludes with the inaccurate idea that zoning out is still a necessary response.

Keep in mind that dissociation always happens because the client is feeling threatened. It's the primitive freeze response that automatically kicks in even when the client’s sense of threat is completely subjective; meaning there is nothing objectively unsafe about the situation or the interpersonal interaction. And yet, if the client feels the need to mentally escape, it means they are feeling unsafe. Therefore, identifying and understanding the catalysts, as well as knowing how to intervene and re-ground the client, helps to restore a sense of safety during the session and within the therapeutic relationship. Since dissociation is not an arbitrary response, it always helps to put the dissociative reaction in context. Consider the following questions when assessing for triggers:

• What was the subject matter? Who and what were you discussing?
• Was the client experiencing a specific emotion right before checking out?
• Were there any physical body sensations that might have felt threatening?
• Were there any external stimuli or sensory cues such as a loud noise, a certain scent, or a change in lighting that could be associated with a prior unsafe scenario?
• Was there an internal thought process that occurred right before they checked out?
• Was there visual imagery that felt unsafe or frightening?

These questions represent the first phase of the work as the clinician and client begin to understand the internal and external triggers that evoke a dissociative response. Processing the potential catalysts creates the opportunity for therapists to do psychoeducation; normalizing dissociation as a hard-wired survival response that had to be repeatedly accessed throughout an unsafe childhood.

In the next installment of this series, we’ll look at the ways in which dissociation can manifest and what therapists can do to help their clients learn how to stay grounded and present when faced with a triggering event.

Read Part 2 of this series here.