I get it, things you do when you are no longer able to pull yourself back or when you can't hear the redirects. I think my brain quits therapy before I get to this point...I think this is my built-in control mechanism that make my therapy difficult for my T but safer for me.

For me I think tactile stimuli is what I used to avoid totally dissociating. I think I start rubbing my palm on the arm rest. When the fabric stimulus is not enough I resort to deeper pressure using my thumb knuckle, fingernail or my keys if I am holding them. A little noxious stimuli seems to redirect my attention to the hear and now. Then I focus on my breathing. If I get to the noxious stimuli point, I typically discontinue on that topic and move to an easier one. Its funny, I never really thought about this pattern before, I wonder if my T sees it happening. She's commented on my squirming pattern before. Now that I think about it she probably does see it because when I get to this point she just sits silently and gives me a chance to settle myself. She also doesn't push.