From "Not Trauma Alone: Therapy for Child Abuse Survivors in Family and Social Context (Series in Trauma and Loss)"

A somewhat more complex manifestation of dissociation is a traumatic flashback. As in simple absorption, a flashback involves some degree of unawareness of and unresponsiveness to external stimuli. However, in this case it is specifically accompanied by the recall of a traumatic event, retrieved so powerfully that it is reexperienced rather than merely cognitively recalled, which obscures contact with the immediate present. In its most extreme forms, flashbacks of trauma may almost entirely eclipse orientation to the present. In the throes of a particularly realistic flashback, the trauma is revivified so intensely that the person consumed by it may compellingly experience actually being back in the time and place, and regressed to the age, at which the event originally took place. Frequently, therefore, observable signs of being disconnected from the here and now associated with dissociative absorption will be accompanied by indicators of immersion in vivid and intensely distressing reverie. In the midst of a flashback, the client may flinch, cower, or curl up in a fetal position. Instead of displaying a dazed or vacant expression, he or she may grimace or wince in terror or pain. Where the revivified trauma is one of interpersonal victimization, such as sexual molestation or physical abuse, the client may talk as if the perpetrator is present (e.g., "No! Stop! Please, don't hurt me! Leave me alone!").
In actuality, when therapy is conducted within a contextual framework, it is much less likely that flashbacks will arise in session than if a trauma-focused approach is used. Alternately stated, the risk of evoking flashbacks is much higher when intervention centers on the review and processing of frankly traumatic material. In most cases in which a family context model is used, therefore, episodes of dissociative absorption are much more likely to be encountered than are intense flashbacks. However, in those rare instances when flashbacks do occur in session, it is imperative that the practitioner be prepared to help the client attenuate and manage them.
It can be appreciably more challenging to reorient a client engulfed in a flashback to than one engrossed in dissociative absorption. In instances in which the client spontaneously verbalizes, furnishing the practitioner with some notion of the nature of the event being experienced (e.g., "No! Don't! He's going to get me!"), these cues can be a valuable tool in the reorienting process. The more compelling the flashback, the less likely immediately speaking to the client from a current-day perspective is to successfully penetrate the dissociative state, although there is usually no harm in attempting this. If, however, this approach is unsuccessful, it may be necessary to "enter into" the event by speaking as if one is "there" with the client. The following dialogue approximates the type of interchange that might ensue between therapist (T) and client (C).
C: No! Don't! He's going to get me!
T: [Matching the sense of urgency in the client's voice, but with a tone of reassurance.] Don't worry! We can get away! Come with me! [It may seem a minor point, but it is generally best to try to emphasize joining with the client rather than taking an explicitly protective stance, using language such as "We can get away" rather than "I'll save you!" and "Come with me!" instead of "Follow me!"]
C: No! He'll get you too!
T: [Purposely remaining vague about particulars such as whether the locale is indoors or outside, to avoid incongruence with the client's experience.] It's okay! Come with me! See over there? Look! We can get away! Can you see? Let's go!
C: [Fearfully.] Are you sure?
T: Yes! Come on! It's okay! Let's go! Are you with me?
C: [Hesitantly.] Yes. . . okay.
T: [Emphatically.] Come on! Here we go! Stay with me now!
C: Okay.
T: Keep up with me! Are you with me?
C: Yes. . .
T: We're almost home free! Can you see?
C: Yes!
T: Come on, come on . . . are you with me?
C: Yes.
T: See? We're safe now.
C: [With a tone of relief.] Yes! Yes!
Throughout this interchange, the therapist should be vigilant for signs of reduction in the client's arousal level, adjusting her or his tone and statements to optimize the probability that the client will feel reassured and perceive her- or himself to be out of danger. At that point, the protocol that has been described for reorientation from dissociative absorption can be initiated. This protocol culminates in transmitting strategies to the client for her or him to use to disrupt dissociative experiences as they arise outside of therapy.