Dissociative Episode- Questions

Apologies for this long post.
I have been seeing my T for about eight months.

Four days ago I had a dissociative episode in therapy. I have dissociated before but not in a long while and never with her.
I was telling T about a hurtful incident...an issue I think I have told her before. I wasn't sobbing or crying. I didn't realize I had "gone" until T said, "How are you feeling right now?" Then I wasn't sure for a few minutes until I discovered I had trouble talking and thinking.

I wasn't expecting to dissociate just from relating information. It felt embarrassing. It felt like having my clothes snatched off in public.

Now I'm scared to talk in therapy.

I am quietly freaking. Ok, I have emailed T that I am freaking.

She replied:

"Understand that it is a part of the process of handling trauma. It is not awful or bad, though it is difficult and disturbing to you. When we get together again this week, let's make a plan for what to do if it happens again...nothing big, just a word or two that signals your vulnerability so I respond with words in ways that help you feel more comfortable."

She told me I can decide whether I come to an appointment or talk, but she is hoping I come to the next appointment. She wants to develop a verbal signal with me to at least let me know she is seeing something out of the ordinary.

I will go to my appt. Friday but I am bringing questions:

1) If dissociating is a part of the process of handling therapy...and not awful or bad...is the goal to encourage dissociation or do we try not to dissociate?
2) How can you help me come back?
3) How do you know you can get me back?
4) What happens if I don't come back before the session is over?
5) How do we know I am safe to drive home?
6) Why would I leave some times and not others?
------
Could you guys tell me how you deal with dissociation in therapy? Can you comment on any of these questions? Do you feel embarrassed when you dissociate in front of T?

Pre

I have never hears any therapist encourage dissociation. It's common in trauma survivors, but it's not an adaptive response once you're no longer being traumatized. They tend to want to focus on grounding skills and on discovering and dealing with the trigger(s) that cause the dissociation.

What's most helpful to me when I'm dissociating is if the person I'm with can get me to talk and move, even if it's just a little bit at first. A lot of people find that strong sensory stimuli (ice, strong scents, strong tastes, etc.) help them ground, but I find that those often cause sensory overload that worsens my dissociation. For me it's all about getting unfrozen and reassuring me that I'm safe. It sounds goofy, but I find reciting things helps--poems I've memorized or even goofy little ditties. (The therapist I worked with on a trauma unit was particularly entertained by one I learned as a theater warm-up, Jerry Lewis's announcer's test.) Moving my fingers and toes helps, and if I can manage to shift my position, that helps even more.

It's kind of a trial and error process to find what works for you, but a good therapist should be able to help.

I often felt embarrassed/ashamed when I dissociated in therapy, but it helped a little to realize that it's actually a pretty common thing for trauma survivors, and it helped when the therapists didn't freak out and act like it was something awful and scary. And it gets easier to manage as you learn skills to deal with it and as you work through your trauma stuff.

Im over the embarrassment. I've done worse things in fromt ofT! One thing that cam help me is to hold an ice pack. I alsso find different sounds like brass bowls and struck crystals helpful.
I agree it may be a trial and erro process.

Bringing the questions is smart and if you can write down the short answers to the questions or you may not remember them. I don't have a host. We are all alters and we take turns being out depending on the situation. My young ones like to go to therapy and some of them will talk. If I didn't dissociate during therapy the only one there would be the one who drove us to our appointment and he really don't care to say one word. If my t did not work with me while I was dissociating the progress we have made would never have happened. It is draining. I started using a recorder that I leave in my car after session so everyone can know what was talked. I haven't told my t that yet. Your t doesn't have to encourage your parts to come out. I don't think that is constructive but if your parts want to talk during session of their own free will I would let them. One point that is very important. If you have a part talk during session it is very important to ground yourself before you leave the office. I use cold water or ice. (my t keeps the ice in her fridge) I will also call my sister because that will cause the part who talks to my sister to become present. That part is in the world and drives. I am mostly exhausted after session but it is important to my young parts to be able to talk to someone. It comforts them and the end goal is that they share their trauma memories so we can all release the feel and release the emotions that separate us. All I can say is if it helps your system to have your parts talk at session let them talk. But grounding is important afterward. Take care. It sounds like you are making progress.

precaryous..,. if my own treatment provider was answering your questions my therapy session would look like this...

1) If dissociating is a part of the process of handling therapy...and not awful or bad...is the goal to encourage dissociation or do we try not to dissociate?
2) How can you help me come back?
3) How do you know you can get me back?
4) What happens if I don't come back before the session is over?
5) How do we know I am safe to drive home?
6) Why would I leave some times and not others?

my therapists answers....

1) no therapy isnt for encouraging dissociation. dissociation happens on a normal level, every human being does it. it becomes abnormal when it interferes with a persons life. As it continues to move through the abnormal it becomes a dissociative disorder. the DSM 5 lists what dissociative disorders are recognized here in america.....

http://forums.psychcentral.com/disso...s-dsm-5-a.html

since dissociation is a perfectly normal thing for people to do (on the normal level) then just like everything else you do in life, it normally does happen in therapy too. in therapy it can happen on the normal standards or the abnormal standards depending upon ones own triggers for what causes them to dissociate. some people dissociate very little in therapy others dissociate a lot.

the goal of therapy isnt to encourage or discourage dissociation. its learning how to deal with the problems in your life and if you do have a dissociative problem on the abnormal level to learn how to handle what ever is causing this so that you can get back to being able to handle your own problems without relying on the abnormal levels of dissociation.

2) sorry I cant help you to come back. you must want to come back. example I can sit here and talk about everything sunny and happy but thats not going to get you back if you dont want to come back. my job isnt to bring you back. my job is to help you figure out how to handle what ever triggered you to "leave". you have been dissociative all your life and here you are so if you are not back by the time our session ends well I trust your internal system to continue to take care of you just like it always has.

that said if you know of something that will help you to re ground yourself and bring yourself back during our sessions I will be glad to incorporate that grounding tool in our sessions.

3) like I said I cant bring you back, you bring yourself back when you are ready to come back. I can not force you to stay aware and in the present moment.. Im not here to fix your problems/do the work for you. I am here to help you learn how to do the work so that you can fix yourself. but all is not lost because we do have a very good hospital down the street for those who are so mentally ill that they are unable to take care of their selves. Im guessing since you are sitting here right now in front of me mentally aware/ not lost in perpetual forever dissociated state of mind somewhere inside you, you do have the ability to come back when you are ready to come back. But if you like we can work into your treatment plans of visiting the mental health unit in the event that you are unable to come back.

4) we end the session just like we normally do. Your internal system has taken care of you all these years it will take care of you before, during and after sessions. just the way Dissociative Disorders work.

5) "we" meaning me? I dont but again your internal system must have its way to take care of this problem otherwise you wouldnt be here today safe and sound. If you feel you may have a problem driving home after sessions maybe you can work out an emergency plan with someone else (a neighbor, friend, relative) to pick you up after sessions or take the city transport system (taxi or bus or train...) that way you dont need to worry about it.

6) only you and your internal system knows what and why you leave sometimes and dont other times. maybe you can keep track somehow (journal or otherwise) of those times when you leave. this way you will be able to discover why you leave sometimes and dont other times.

as for the rest of your post....

"Could you guys tell me how you deal with dissociation in therapy? Can you comment on any of these questions? Do you feel embarrassed when you dissociate in front of T?"

sorry no I cant tell you how to deal with dissociation in therapy. I can tell you how.....I.....deal with dissociation in therapy. my therapist and I deal with it like I stated above. we dont try to prevent or force it from happening. we treat it like it is...just a natural part of life. we even joke about it sometimes. last time I spaced off and realized I didnt hear what my therapist said i told her...hold on back up I just went boating and I still dont have my land legs. she smiled and said ok how about a cup of tea? she made tea and I re grounded myself. the same thing when I wasnt integrated. if I happened to become aware during therapy that I had dissociated I would make a comment so that my therapist knew I had left, then we would take a small break from the hard stuff while I breathed/re grounded then we would discuss what had triggered the leaving so that I could learn form that.

do I feel embarrassed no. my diagnosis was DID. that meant my therapist knew and saw me dissociate before I even knew I had DID. it was my therapist that recognized it and had me go through the diagnostic process. getting the diagnosis didnt change anything, just put a name to what had already been happening. Since I had been dissociating since I was a child, dissociation was my normal, nothing to be embarrassed about in my mind. What embarrassed me was after integration I wasnt switching into an alter for example when stressed at work so it embarrassed me when I did something wrong at work or was stressed at work. you see with me the alters held all my emotions/trauma's things I couldnt handle so I had no feelings/ couldnt express feelings, was numb. but after integration I was able to feel emotions like embarrassment. just how my system worked.

that was very interesting!!!

One of the biggest proplems I had when I was diagnosed with DID was the belief by the treatment community that there is an "original self" who moves aside every now and than for the alters to emerge. That is not me or my system. We are all Alters. I am sure in there somewhere there is the original self, but she isn't known to us. If we didn't disassociate we wouldn't be able to leave the house and work, buy food and get to session. I think you should preface your answer with "for those this applies to". There is no one specific to bring back. If the driver doesn't show up after therapy I will sometimes call my sister. The sister part drivers. Talking to my sister brings her out and once she is comfortable with being out we drive home. I just feel left out in your explanation.

may I ask you a question... are you located outside the USA? reason I ask is that in your post you use the term....disassociate.....to mean dissociate...

you see here in america the two words means two different things....

here disassociate (pronounced dis associate) means to purposely cause yourself to stop doing something, stop engaging in something

here in the USA it is the word dissociate (pronounced dis sociate) isthe automatic response to a trigger, whether that trigger is good or bad.

my point is when we post here on psych central there is no right or wrong way to post as long as you are following the rules of the site. everyone uses the wording and terms of their own locations and the like.

when I write my posts I do in the wording that is of my location and of this websites rules. but if you prefer when you read my post by all means include the phrasing that is of your location if that helps you to understand my posts better....for example when I come across the term dis associate in someones posts I keep in mind that they may mean the term dis sociate rather than my locations definition of dis associate.

that said in relation to my posting about "coming back" here in the USA that term is used to reference the original host. and here in the USA it is believed everyone has times when they are fully focused and aware, non dissociated. but it is also used in reference to the alters....

example when thelma was the one that enters the therapy session then a switch happened where Rainy came out during therapy, then after therapy session was over and someone needed to navigate the subway system (one of NY city transportation system) thelma "came back"

my point of my posting above was that here where I live and work it is believed that its not a therapists job to make sure someone has come back to the way they have entered the therapy session. that job is the responsibility of the host and their own internal system of alters. it is believed that the alters are there to do what ever cant be handled otherwise and a person with DID has had these DID type alters all their life, this internal system of alters has kept the body and the alters alive and functioning all their lives and will continue to do so. thats what DID is and how it works. So if a person/alter is able to get that body/alters through life and to sessions they can do so during therapy and after therapy ends too.

No I actually live in the same state as you. Spell check doesn't always get it right.

Your quote " and here in the USA it is believed everyone has times when they are fully focused and aware, non dissociated. but it is also used in reference to the alters...."
This is exactly what I am talking about. I do not have a time when I am not a part. We do not know the original self. We think she is in there in some type of hell, but we do not know her. We work, drive, eat, argue, laugh etc. We switch a million times a day. Right now the one who sleeps is not showing up all the time. Not sure why but sleep is impossible without her. There is no "focused and aware, non dissociated" self who functions in the world. It took me almost three years reading, and blogging to find out that I am not the only one like this. Even my t has a hard time wrapping her head around this concept because it isn't in DSM V. It's not your way of being so I get that you can't imagine it but it is our way of being and I wish people would understand that we, this type of system exist and that we may never be just one because that original self is unreachable.

I understand what you are saying. and if you would like to discuss this more by pm so we dont take this thread off topic I will be glad to talk more about this with you.

Sorry I don't pm. And I think someone else can benefit from this conversation. I could start a new thread with this topic.