01/12/2024
𝐃𝐢𝐬𝐬𝐨𝐜𝐢𝐚𝐭𝐢𝐨𝐧 & 𝐄𝐦𝐛𝐫𝐚𝐜𝐞 𝐨𝐟 𝐃𝐢𝐦𝐞𝐧𝐬𝐢𝐨𝐧𝐚𝐥𝐢𝐭𝐲
TLDR: Without intention, this "brief post" became a "brief essay" on this area of expertise. The point: we are multidimensional in our personhood, and dissociative experiences can be an embraced part of that. Therapy can honor this and helps clients with dissociative experiences navigate themselves and the experiences in a non-stigmatizing way.
Naturally, we develop strategies for supporting ourselves through life. This occurs even without our awareness throughout the dimensions of our personhood. We learn. We grow. We create. We live. And anything that does not resonate with a need of ours, naturally there can be a desire to use our abilities or strengths to avoid it, whether it be boredom, difficult tasks, uncomfortable situations... the list goes on. But what do we do when we cannot physically avoid the experience, when we have no control to change, prevent, or stop the experience? In cases like this, as well as other scenarios, our mind-body-soul may support us by dissociating.
When traumatic and highly distressing experiences occur, our natural ability to avoid and disconnect with our mind-body-soul goes beyond the typical range of dissociating that may occur (think, 'highway hypnosis,' daydreaming, imaginative play, zoning out). Dissociation beyond this range includes experiences identified as derealization, depersonalization, dissociative amnesia, identity confusion, identity alteration, somatoform dissociation, not to mention a variety of other dissociative experiences. Some of these appear as symptoms of a mental health diagnosis (for instance, PTSD dissociative subtype) while some together form a condition (like Dissociative Identity Disorder).
As a therapist specializing in treating complex trauma, I have learned to appreciate the adaptive and protective supports that these experiences have provided to clients of mine. I've also witnessed how distressing, upsetting, interruptive these experiences can be for clients, that they cause clients to feel they've lost control and no longer feel safe. I've seen where these experiences of the mind-body-soul which were once helpful in some way are now beginning to lead to impairment or create barriers to the person connecting to what is meaningful to them.
When working with clients who dissociate, I prioritize developing a space and therapeutic relationship with them that feels safe, secure; one that is genuinely relationally warm and relaxing; one that promotes autonomy, connection to self-power and self-healing; one that replaces shame with empathy, self-compassion, self-love. Sometimes this involves helping the client learn how to tolerate healthy and safe spaces, connection and relationship, because this may feel threatening at first for some having learned in past relationships or experiences that these connections have strings attached. Before any therapy progress can be made, clients who dissociate need to know they are safe... or at least in the beginning can agree they are safe enough while knowing their strengths, abilities, dissociative dimensions of self, System, or protectors can be present nearby to support as needed.
Clients with dissociative systems (e.g., DID, sometimes OSDD, sometimes UDD) may be concerned about being forced to integrate, merge or fuse together the various dissociative dimensions of themselves (some people refer to these as alters, identities, parts, selves, states, etc.). Wholeheartedly, I affirm that we as humans are multidimensional, always growing, learning, evolving, and that at times we experience ourselves having different parts, sides, identities, whether at a level that is functional and meaningful or at a level that is impairing and impeding meaningful life. My goal as a therapist supporting clients with dissociative systems is helping the client to identify what “healthy,” “functional,” “meaningful” looks like for them and their system. I believe that Functional Multiplicity or Plurality can be healthy, functional, and meaningful. I also believe it is important for the client to determine the direction that they want to pursue with their System as well as validating them at any point they make a change (i.e., for instance, starting with Functional Multiplicity as the goal and then they desire or experience integration/fusion, or vice versa).
Therapy approaches I use to support my clients are variable depending on what they feel they connect with. I introduce to my clients several approaches known in the treatment of dissociative disorders as well as others useful for the unique goals they’ve identified for their own therapy journey unrelated to dissociation, and we discuss which aligns best with them. This is an important part of the client having autonomy and choice in their therapy, while also increasing collaboration with them as not just a client but as someone with authority, investment, and self-knowledge. Proceeding forward, I focus on helping the client develop and use skills to promote connection, communication, and collaboration with their dissociative symptoms and, if applicable, their dissociative system.
