Both, depending on the level of dissociation. there are some grounding techniques that work and a lot that don't. My t generally knows when I'm not there as she says my facial expression and voice tone changes. She says even if I'm not talking and just listening to her, she can see a change in my eyes. Sometimes she'll leave me to come out of it on my own and other times she'll ask me to try grounding and will talk me through it.