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What is Dissociation?

In general, dissociation is a defense mechanism that everyone uses every day. In its most common form, mild dissociation includes day dreaming, "zoning out," or doing things on "autopilot." For example, when you find yourself staring out the window thinking about what you are going to do after your class, driving a car and not recalling the details of how you got from one point to the next, or getting so caught up in a movie you don't hear someone whispering behind you - these are all examples of normal dissociation. Dissociation is a form of self-hypnosis. Everyone experiences dissociation.

Dissociation, day dreaming, effects and therapy of dissociation in Los Angeles, California    You may dissociate more when you are tired or bored. Think about times when you have been in a boring meeting or a class with a teacher who talks with a monotone voice and doesn't use ways to engage your interest. What do you do? Maybe you start to doodle, you day dream about something that is more interesting or you think about a problem that is on your mind. Dissociation gives you an ability to do more than one thing at a time. While you may be half hearing what is happening in the boring class or meeting, your mind is wandering off somewhere else.

    Dissociation is a wonderful aspect of creativity and imagination. Think about the times when you were able to be the most creative. Sometimes creative folks need to enter into the "twilight zone" of dissociative states to really get their imagination going. Therapy is often best done in dissociative type states. When working with teens, I often encourage them to use a distraction while dealing with difficult issues to help them examine their feelings. It can be very helpful! In fact, the sandtray work I do encourages people to enter into a dissociated state in order to work through conflicts and difficult feelings that may not otherwise come out in therapy. As a therapist, I encourage healthy dissociation.

     But too much of a good thing isn't healthy. Sometimes the ability to dissociate from your emotions is harmful to you and potentially to others. If you live in a fog most of the time, things around you feel surreal. This experience is called derealization. Its almost like you are walking through a movie but it isn't actually a movie - its your life. You don't feel present and connected to what is going on around you. This feeling in fact can be very distressing for some people. For others, people try to induce this feeling through the use of drugs and alcohol, to avoid their feelings. See pain avoidance for more information about this.

    Dissociation is a common symptoms of depression and anxiety. A fact that many therapists don't understand. Many people have sought therapy out for a depressive or anxiety related disorder only to find that therapy and medication don't do enough. The problem often is because the client's dissociation is ignored or unrecognized by a clinician. Thus whenever the depression and anxiety is experienced, you may "check out" - leaving the very reasons you become depressed or anxious unintegrated! It is a huge problem because many clinicians have no idea how important a good understanding of dissociation is in the treatment of more common clinical problems!

   Trauma survivors and abuse survivors often rely too heavily on dissociation as a defense mechanism. Dissociation is a crucial survival mechanism that protects you during a crisis and afterwards. It helps you stay on task so you can protect yourself. If you are able to function without fully experiencing the emotional impact of an event, you can accomplish tasks until it is safer to deal with your emotions. For example, lets say a man comes up to you, points a gun at you and demands your money and jewelry. If you were to feel the terror of having your life threatened, you may not be able to fight him off, run away from him or comply with his demands. In another example, if you were a child who was physically abused, dissociation may have allowed you to endure a highly traumatic experience without having to fully experience it. Abuse survivors often report that they "go away in my mind" or "stop feeling the pain." Without the ability to dissociate, you would feel the full extent of trauma as it happens and afterwards, which could be completely devastating for you. The ability to dissociate is a critical part of people's survival responses.

Dissociation, day dreaming, effects and therapy of dissociation in Los Angeles, California    Think about the level of dissociation it takes to remain in a dangerous situation. Lets say that you are in a war. You have been captured by the enemy and put into a prison. The enemy soldiers are cruel towards you. Perhaps they don't feed you properly, keep you in isolation for long periods of time and physically assault you. In order to survive being held captive, it is important for you to be able to enter a type of dissociative state to cope with the abuse you endure. But, there can come a point when you dissociate so much that you don't take your opportunities to escape when you have the chance, a common phenomenon that occurs in many captive situations of all types.

    Think of a more common captivity situation, like child abuse or domestic violence. Victims of abuse are in a captive state psychologically. They dissociate to cope with being abused. Dissociation during sexual abuse is a classic example. Many people who have been sexually abused as children report leaving their bodies and watching the abuse from above themselves. This is a more extreme form of dissociation than simple daydreaming. This is the mind's ability to cope with horror at its best. Instead of having to be emotionally experiencing sexual abuse, the mind helps your soul escape. Your experience of being is not in your body, but on the ceiling somewhere witnessing abuse that is happening to you.

    There are varying levels of dissociation:

    In its most extreme form, dissociation can actually cause a sense of fragmentation or various self-identities within one person. This happens to children who endure horrifying torture and extreme forms of abuse. Instead of leaving one's body, an entire separate identity is created to handle the abuse the child has to endure. It isn't uncommon for children who develop different self-states to form several personalities to take on various roles. The more personality states created, the more abuse has occurred. This form of dissociation only happens in childhood, when children are most vulnerable, and endures through adulthood unless therapy is sought out. Therapy can help people with multiple identities to either learn to manage the fractured pieces of themselves more effectively and improve their overall quality of life, or to integrate the fractures into one sense of Self. 

    For dissociation that interferes in your quality of life, therapy can be extremely helpful. Traumatic dissociation happens when you are overwhelmed by a traumatic event or a series of traumatic events. It is self-protective. The problem is that in order to put the past to rest, the painful feelings of the past trauma have to be re-integrated into your sense of self, and a new sense of the integrated trauma needs to be internalized. Therapy is the most effective way to work through trauma. A combination of talk therapy, creative therapy, sandplay therapy and EMDR along with body movement therapy is the most effective treatment for trauma in general, unless you have Dissociative Identity Disorder. Therapy helps trauma and abuse survivors integrate traumatic material, improve your sense of well-being, help you learn to manage difficult emotions that arise when unintegrated trauma gets triggered, and helps prevent past trauma from interfering in your present life.

    Therapy for Dissociative Identity is different than traditional trauma therapy. I am trained in the treatment of Dissociative Disorders through the International Society for the Study of Dissociation (ISSD). I follow the ISSD guidelines for diagnosing and treating Dissociative Disorders. For someone who has either Dissociative Identity Disorder or Dissociative Disorder, NOS, I use the following steps. This is a general idea of what you can expect in treatment with me, not an exact layout of my treatment plan. First, I help establish a sense of safety within therapy. This takes a lot of time as building a sense of trust and emotionally safety for someone who has been tortured significantly is difficult to do. I try to establish a safe enough working relationship with a client and we negotiate through the boundaries of therapy. During this time we may work on getting to know one another, establishing the ground rules for therapy and work on practical issues dealing with Dissociation. This is a time for skill building and practicing new skills, mapping the system, and taking time to get to know different alters in a system. For some people who have a lot of fragmentation or who are not used to allowing outsiders to meet their alters, this may sound strange and confusing. It is only by establishing a relationship with different alters that I can help become a member of a healing internal team. If you are too fragmented, we'll negotiate this as you need. Don't let this stop you from seeking help.

   This period of time is a stabilization and restructuring time. An alter system may be set up in such a way that worked during a time when you were being abused. If you are out of the abusive situation, your system needs to adapt to a different way of being. This takes time and is the main focus of treatment. Then, only when you are ready do we do trauma work. Trauma work is slow and usually structured. We may decide to work on a specific memory during a session and have a couple of other sessions for regrounding. Not all material will be re-integrated. It isn't possible, but enough of it can be worked through to help rebuild a more cohesive sense of self and life experience. The majority of therapy work is done during the first phase - working with the system, not in the trauma phase. The third phase is integration or learning to function as "one." For most therapists, integration is the end goal of treatment, however you may or may not want this. This is a personal choice. If you do opt for integration, the final phase of therapy is adjusting to life as an integrated Self.

    I do work with people who have dissociative problems as a trauma specialist. I do individualized care for people with dissociative problems and work with dissociation from a client's stated goals and needs, not from the "textbook" form of treatment. If you are ready to do this work, I am ready to work with you!

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