WORKING WITH DISSOCIATION: When reconnecting is not enough

As a medical undergraduate, I found Psychiatry to be such a strange abstraction, that seemed to be about types of people that I’d never met. I was taught that neurosis was something that was within normal human experience, but that psychosis was not. It just didn’t prepare me to deal with patients in General Practice who suffered from extreme forms of dissociation, and I felt ill equipped to help. Somewhere in the next 10 years I discovered how to see the person, not the DSM category, and got to know many interesting individuals, who reminded me of a lot of people I had met in my life. I could see that my part in actively building our relationship helped them. When I then began to learn about Solution Oriented Therapy and then the work of Milton Erickson, I finally discovered that there were ways that I could be more useful.

Now, another 16 years on, I would have some things to say to my younger self. I would tell her that dissociation is in fact a normal human experience. I would remind her of the imaginary games she played as a kid where textured stories unfolded and it was as if these things were really happening.  I would remind her of her daydreams, where quite bizarre realities could feel very real. I would remind her of the time she had a fever and floated around the ceiling looking down on herself, managing not to be afraid because of the soothing voice of her mother. I would remind her of the time when she was sitting in the sun in the family room and saw her old grey tabby cat out of the corner of her eye, and then, when she turned to talk to him, it was just a bundled up jumper, not even the right colour really, and she was so surprised at how real he had seemed that she tried to get that vision again out of the corner of her eye… but couldn’t. I would remind her of the creative spaces she would get into, drawing, building, creating, with ideas that defied logic, as the “real world” disappeared and time sped up, or slowed down. Then there were those optical illusions, and magic eye images. If she could be so easily tricked, couldn’t anyone?

She knew then, that in the moment of perceiving, there was no way of knowing the difference between an illusion and reality, so what was so hard to understand about someone hallucinating, or getting stuck in an unhelpful delusion. By seeing dissociation on a spectrum of normal everyday experiences it is easier to understand, and therefore easier to connect with clients who experience it.

Dissociative skills are helpful when fear and trauma drive someone to want to get out of their own experience. Dissociation becomes a haven, an escape from an unwanted bodily experience, but the mood of this dissociating is sometimes very different to a playful daydream. It is a very useful skill while the danger and damage is still happening, but can be problematic if it is hanging around when the danger has passed. The most remarkable description of the protective nature of dissociation I have heard was from a man who’s childhood was a constant barrage of verbal, emotional, physical and sexual abuse, and yet somehow he managed to really believe that he was lovable. He let himself experience love, sometimes in magical ways. In primary school he pretended that his loving teacher was actually his father, and every morning his teacher greeted him he felt it as a ‘good morning’ from a loving father. He went on to have a successful life, married and had children, and had fulfilling relationships with all of them. He developed enough control of his dissociation that it became psychologically protective in any dangerous situation, and shielded him from pain. If that was possible for him, just imagine what we are able to co-create in a therapeutic relationship.

Most people have daydreamed in class but remain aware enough of “reality” that they hear their name if asked a question, even if they weren’t present for what was said. People rarely wet themselves because they were so absorbed in a daydream that they didn’t attend to a full bladder. You can be absorbed in a book, but still answer the phone when it rings, adjusting quickly to the new reality.

Neuroscience informs us that what the brain practices it gets good at, and people with extreme dissociation have certainly practiced. If there were a competition for dissociative skills, these people would be the Olympic team. Olympians, however, leave their skills on the field. They don’t tend to hurl javelins at the dinner table, and so don’t appear strange to us.

My take on dissociation, when it is a problem, is just that control has been lost. Fear gets in the way of learning, so the more ordinary we can make these experiences, the more connections to everyday examples we make, the easier it is to learn, and to reclaim control.

I have noticed that people who dissociate in a problematic way, very often have learned a few tricks to stay in the room. I had a client who would scratch his palm with the fingernails of the same hand, another who placed a hand on her shoulder under her shirt and kept the awareness of the touch. Others who pick at clothing. I have noticed that complimenting them on finding a way to stay in the room often surprises them as they don’t know they are doing it, but as soon as they realise they are more in control. I then wonder with them what other things they do that they don’t even know they are doing, and often surprising rememberings appear.

The phenomenon of dissociation can be seen in all problems that clients present with, from learning difficulties in school children, through fears and phobias, trauma responses, to the more extreme end of the spectrum of dissociative disorders, and schizophrenia. Most therapy models generate an experience of reconnection, so that a client goes from a disconnected (all over the place like a mad woman’s knitting) experience, to a connected (cooking with gas) experience, where client resources become available again, and learning can happen. However, when the client does not have control of their own dissociative experience, simply generating reconnection will not be enough.

Dissociation is a powerful skill, that can veer out of control when no-one is in the drivers seat. By understanding and utilising this ability, a therapist can work with a client to enable them to grasp the wheel of their own experience. When helping a client to explore the phenomenon of their own dissociation, we can be a useful mentor in the passenger seat of the client’s experience as they discover that they can drive.

 

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