Now bear with me! Put on your seat belt, this post gets a bit technical…but I am trying to keep it practical. By the end of this post you should have a big picture about dissociation so that the more practical blogs that follow (or precede) this one have a place to slot into.
There are several schools of thought around what dissociation is. An altered state of consciousness? A light trance state? Spacing out? Living with a barrier between you and your feelings? Not connecting with yourself (or others)? Disengaging from the here and now? All of these could describe dissociation, yet that is probably not specific enough to be useful to clinicians.
The approach I take is influenced by a number of writers, and by my own experiences of dissociation, and my experiences of working with clients who dissociate.
Dissociation develops in small children who have experienced trauma. This trauma may be relational trauma, or it may be a form of overt abuse. Usually a person who is highly dissociative has a disorganised attachment style.
I see dissociation as existing on a continuum. All of us dissociate from time to time. When you watch a movie, read a novel, play a computer game or drive your car home along a familiar route you are most likely dissociating at least some of the time. You may have had the experience of arriving home in your car, only to realise you “missed” the entire trip! Some people say, “The car knew the way home…I sure didn’t drive.” Of course you did drive, but a part of your brain did the driving while the rest of you was elsewhere. Common occurrence. It’s a way we get totally involved in an activity, and it gives us respite from the rest of our day. In fact, dissociation is necessary so we can function day to day.
D Richard Chefetz says that we use dissociation unconsciously every day to sort out what is useful right now, and what is not. Association is the process that draws our attention to stuff. Then he says: Dissociation tells us we need not pay any attention.
Children are natural dissociators; some are better at it than others. Were you accused of constantly day-dreaming in class as a child? Perhaps you were good at dissociating. (And perhaps you needed to so you didn’t die of boredom!) Many children who experience childhood abuse or neglect dissociate to a greater degree than others to escape what is otherwise inescapable: they have no other way out. Then the brain remembers this pattern of escape within; it becomes embedded in the neural structures of the brain, and thus in the life of that person.
Most writers are in agreement that dissociation can become problematic when it interferes with healthy daily functioning: as an individual, as a worker, or in relationships. Dissociation is in many ways the opposite of mindfulness. (Mindfulness is a practice which requires a constant return to the present moment, without judgement of whether it is good or bad. It is an exquisite experience of noticing what IS, and being curious and present with that.)
It can be confusing when you first try to understand what dissociation feels like for the client, and to what extent your client’s life is limited by their spacing out. Russell Meares (an Australian writer in this field) (See Books) narrows dissociation down to two main categories:
- Detachment (He calls this Primary Dissociation)…Note: I think this is more like feeling floaty/ detached etc. More on that later!
- Compartmentalization (He calls this Secondary Dissociation)…
Note: Some writers call this second category Structural Dissociation, and further subdivide this category into primary, secondary and tertiary structural dissociation. No matter what you call it, this category is more about the structure of the personality, and to some degree, the sense of internal coherence the client experiences. Think of “parts of self” becoming more and more complex and discrete as you move from primary structural dissociation to tertiary structural dissociation.
Russel Meares’ model is useful because it draws attention to two different experiences which may occur together, but which need somewhat different responses and different case conceptualisation.
You have probably noticed there are times when a client will “check out” momentarily, either losing the thread of what they were saying, or by going completely blank. These may be small clues to a bigger issue, but they might not be. It’s good to take note when it happens. Learn what triggers you to lose track in sessions too.
Some clients do this in a more noticeable way. The most disconcerting ones are when a client falls asleep (Howz that for disappearing?), when the client goes away into their mind and you can’t make contact (earth calling client!) or when one part of self goes in, and a child or enraged part speaks to you in a different voice. The latter is a clear indication of structural dissociation; the first two are probably indications of structural dissociation, but not necessarily.
There are several “dissociative disorders” listed in the DSM: with the new edition some have new names and modified descriptors. There are several Dissociative Disorders listed in the DSM-V.
The two I am focussed on here when I say dissociative clients are DID (Formerly MPD) and OSDD (Formerly DDNOS).
DID is marked by the person not being aware of the other parts’ existence, or when they “come to the front” and take over the body. OSDD is similar, in that there are many distinct parts (as in DID) but that the person out the front is usually not taken over by other parts, outside of the client’s awareness. Both DID and OSDD clients may be initially unaware of the existence of other parts: those parts may only become evident after many sessions. But if you don’t look for them, they will hide, or not feel ok to be in the room with you.
This is only an introductory glimpse at dissociation.
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