Finding Choice in the Dissociative Process

Picture baby Leo lying in a bassinet. Like all infants, he’s been born with the ability to dissociate. His entire repertoire of affect regulation and coping skills includes the capacity to zone out, utilize the sucking reflex, and look away to avert a noxious stimulus. If Leo’s caregivers are attuned and responsive to his needs, he’ll soon learn to comfort himself through soothing movement and self-talk, and he’ll lean on external resources when needed. He’ll stop relying on dissociation for regulation, as well as the pacifier and thumb-sucking for self-soothing. In short, he’ll develop the ability to autoregulate.

In contrast, picture a different infant—baby Ava—lying in a similar bassinet. Like Leo, she’s biologically hardwired to reach out to caregivers for comfort, support, and reassurance, but in her case, her attempts to connect go unheeded. Her caregivers are unreliable, unavailable, and reactive. What should be her main source of comfort is a source of pain. It’s like she’s playing a game of tag, touching homebase, and getting an electric shock. Social engagement is not a viable option for her in the hierarchy of survival responses.

As a trauma therapist, I see countless clients who grew up like baby Ava. They had to use dissociation as a survival strategy throughout childhood and continue to use it in adulthood. This is partly because caregivers with dismissive, ambivalent, or disorganized attachment styles didn’t provide them with healthy coping options. The fight, flight, and fawn responses offered them additional ways of coping, but kids know fighting or fleeing can worsen an abuser’s rage and result in more harm. Although the fawn response meant abdicating their own feelings and needs, it often kept them safe. When the fawn response wasn’t an option, they relied on freezing—using dissociation to mentally check out of situations they couldn’t physically escape.

Abuse and neglect at the hands of primary caretakers represents one of the most profound experiences of betrayal a human can endure. In that regard, dissociation is like a superpower. Even when witnessing abuse, it can help people endure what they feel powerless to fix or change. Many of the clients I’ve been privileged to work with simply wouldn’t have survived their horrific family of origin experiences and moved forward with their lives without it. It helped them disconnect from the physical pain of a beating or an invasive sexual violation, as well as the many emotions that get activated with abuse, like outrage, confusion, despair, self-blame, and shame.

And yet, it’s a poignant paradox that the very reflex that saved my clients in childhood and during later adult traumas now adds to their vulnerability, making them like a “deer in the headlights” and creating the potential for revictimization. It also presents a challenge in therapy sessions, as any therapist who works with highly dissociative clients knows. When a client fails to respond to the re-grounding strategies we’re offering them because they’ve “checked out,” we’re likely to experience countertransferential reactions like anxiety, helplessness, and fear.

Despite these challenges, there are steps we can take to help clients increase their repertoire of coping and affect regulation skills in triggering situations. And although helping people grasp the disadvantages of a reliable survival strategy isn’t always an “easy sell,” providing psychoeducation about the costs of dissociation is a critical part of empowering clients.

In a Daze

My client Danny is 47 years old. Both his parents struggled with alcoholism, and his mother left the family when Danny was eight, leaving him in the care of an enraged, depressed, and violent father. After many failed attempts to appease and comfort his father, Danny came to rely more and more heavily on the survival strategy of dissociation that had served him well whenever his parents had fought violently and when his father’s abuse was directed at him.

“I look back on adolescence,” he said, “and I don’t think I was present for any of it. I walked around in a daze. My dad would come home from work, start drinking, yell at me, and I would just check out. Even talking about it now, I can feel myself getting spacey.”

“Okay Danny, go ahead and put both feet on the floor, and press your shoes into the carpet,” I told him. “Can you feel any sensation in your ankles, calves, or thighs?”

“Yeah, I feel the muscles in my thighs tightening. And I can feel tension in my calves.”

“Is it safe to stay with those sensations?” I asked.

“Yeah, it helps me get back into my body,” he said.

“Great. Just stay with that awareness of sensation in your legs until you feel fully back in the room, and then you can stop pressing into the carpet. You know,” I added, “it makes sense that checking out was such a helpful strategy for you when you had no other resources for protection or comfort. It’s kind of like a superpower.”

He smiled. “I never thought of it that way.”

“It’s important to express gratitude for that coping strategy, and how much it helped you in the past.”

“In the past,” Danny echoed, his face turning thoughtful. “Thing is, I still check out now, a lot, especially when I’m scared or triggered, like when we were just talking about my dad and his drinking.”

“I want you to know that I can’t take your dissociative powers away from you, Danny, nor do I want to,” I said. “The goal is to introduce the concept of choice. Once upon a time you had no choice, it was the only viable strategy you had. But now, as an empowered adult, there are times when dissociation isn’t the only strategy you have, and it might actually disempower you because it puts you into freeze. When you started talking about your adolescence, you told me you were feeling spacey. Is that one of the physical harbingers that lets you know that you’re about to check out?”

“I guess so. It feels automatic. I’ve never really dissected it before.”

“Well, maybe we can use what just happened a few minutes ago,” I suggested. “Or you can think of other recent experiences when you reflexively used dissociation to navigate something scary or upsetting. A lot of people come to realize that there are physical sensations directly associated with checking out.”

“Like what?” he asked.

“Some clients talk about a specific headache. Others talk about a feeling of darkness that encompasses them.”

“Darkness!” he said. “It definitely feels like there’s a dark curtain that comes over me. My vision gets blurry, and it feels like it’s hard for me to move my arms or legs.”

“A lot of clients describe feelings of immobility, feeling lightheaded, or dizzy,” I assured him. “These are important signals that you’re getting from your body, and when you have an awareness of what your body does right before you check out, it gives you the opportunity to begin to introduce the concept of choice.”

“How do I do that?” he asked. “It feels like I never have a choice.”

“It’s about slowing down the process. When you dissociate, you lose executive functioning and get lost in the limbic system where there’s no critical thinking, decision-making, or insight. So as soon as you have an awareness of those physical sensations, name them as dissociation or checking out. Naming it helps to light up the front part of your brain.”

“So, when I feel that darkness or blurry vision or that I can’t move my arms and legs, I’m supposed to say to myself I’m dissociating?” he asked.

“It’s the first step,” I said. “Once you recognize what’s happening, the next step is to ask yourself an important question: Is it in my best interest to check out, or would I be more empowered if I stayed grounded and present? That question is also going to help keep your executive functioning online because answering it requires reasoning and analysis.”

“You’re saying if I decide it’s in my best interest to check out, I can?”

“Yes! The idea is to give you genuine control of the process. And we can practice strategies that help to ground you and short-circuit dissociation for times when you do decide that it would be more empowering to stay present.”

“I have to be honest,” he said, “it’s hard for me to imagine a situation where staying present would be safer than checking out.”

“I get it. I’m suggesting the thing that saved you is at times the thing that might hurt you. That’s confusing. But when you’re a deer in the headlights, it means you can’t use your voice, walk away, disagree, or take a stand and advocate for yourself. We both know how helpful checking out was in the past. Are you able to see that going into freeze in certain situations might actually work against you?”

Danny was quiet for a while. Then with tears in his eyes, he said, “I’m just thinking about all the times my boss has yelled at me at work and accused me of things I wasn’t responsible for, and I just stood there and took it. Frozen. I never defended myself or told him to stop yelling. It always left me feeling stupid and incompetent.”

“It’s understandable that being yelled at and falsely accused would trigger the need to check out. It’s been your safest go-to strategy.”

“Yeah, but I think it’s an example of what you’re saying. It doesn’t allow me to push back or insist that he treat me with respect. I wind up getting hurt more,” he said. “I’m also sitting here realizing that whenever my wife gets angry with me, I check out rather than staying in the conversation and expressing my point of view. She sees it as a serious flaw and criticizes me for it. And often I feel traumatized by that as well.”

“Is it possible that until right now you didn’t realize you had a choice about checking out?” I asked gently. “Now you’re beginning to learn that there are other options.”

“I’m not sure how to stay present when I want to. You’ll need to teach me,” he said with both anger and determination. “But sometimes I might still choose to check out.”

Without engaging in a power struggle, in subsequent sessions we began to explore some alternative options.

Grounding and Somatic Resourcing

What are effective grounding strategies? Sometimes the simplest ones work the best. Aromatherapy is a fast and effective way to reground if the client can find a scent they love, one that has no associations to prior trauma or abuse. The olfactory part of the brain is closest to the sensory-emotional memory part of our brain, and scent can instantly evoke either positive or negative memories and feelings.

Danny chose a citrus scent that he felt flooded his body with good energy. He carried around a small vial of orange-blossom essential oil, lit citrus candles at home, and used a citrus-scented lotion on his body. It was also helpful to have the scent on hand for therapy sessions to address dissociation and quickly get him “back in the room.” Other clients are easily re-grounded by a particular piece of music, a safe image, or positive affirmations on their phone.

Teaching clients somatic resourcing is also helpful as it doesn’t require external objects to reground. Danny learned simple breathing exercises that incorporate counting, placing one hand on their heart and one hand on their belly, and bringing comfort through rocking or swaying. We went over tapping from EFT and the butterfly hug from EMDR—a bilateral self-soothing technique.

Another effective strategy comes from the work of psychologist Milton Erickson. It’s called 5,4,3,2,1. It’s designed to simultaneously activate the prefrontal cortex and limbic system, which helps keep clients in the optimum window of arousal. Either out loud or silently, clients say five things they see, hear, and either somatically or emotionally feel. Then four of each, three of each, two of each, and one of each. It’s fine if they repeat things. The point is that it quickly lights up the front part of the brain and reorients them to the present.

Setting a timer and coloring a mandala or a picture in an adult coloring book is also re-grounding. The act of coloring lights up the limbic system and choosing the colors is an executive function that keeps the prefrontal cortex online.

Both in and out of session, Danny continued noticing the physical harbingers of checking out, named the process as dissociation, and remembered to ask himself if it was in his best interest to stay present or not. He told me there were still times when he was tired, didn’t want to deal with his wife’s criticism or his boss’s anger, and chose to check out. He also started sharing more experiences of choosing to stay grounded and present, and he was genuinely surprised and delighted by the sense of agency and empowerment that he felt in that. For those times, we created some scripts for self-advocacy and practiced assertive verbal and nonverbal communication.

“For the first time in my life, I actually feel like an adult,” he recently said. “I have so much more power and control when I don’t check out and escape. But when I have to sit through a meaningless three-hour meeting at work, I’m going to keep using my superpower!”

There are still times when Danny and other clients who are trauma survivors will reflexively begin to dissociate when they become triggered or dysregulated. Earlier in my career, this was always a source of anxiety and fear. I wasn’t sure how to work with it, and it would often hijack the session. Now that I understand the protective intention behind dissociation and can offer simple, effective ways to re-ground, I can use their impulse to dissociate as a teachable moment. I invite clients to be curious about the context. “What were the thoughts, feelings, or somatic sensations that set in motion the need to check out?” And the more we work in session to practice the skills that offer comfort without compromising a sense of agency and self-advocacy, the more they can consciously choose to stay present and experience the positive reinforcement of genuine empowerment.