This is part 2 of a three part series. Read Part 1 Here.
In the first post of this series, I explored a phrase that I hear often injury therapists: “I treat trauma, but I don’t treat DID (dissociation).”
The problem is that dissociation often occurs in it therapy long before anyone names it. Many doctors already encounter dissociative experiences in their work without realizing it. Dissociation exists on a spectrum. It is a natural reaction of the mind when experiences become overwhelming and nervous system what is happening cannot be safely integrated. Dissociation is not a sign that something is wrong with the mind. Instead, it is often a reflection of how hard the mind has worked to survive. Because of this, it’s not always as dramatic or obvious as Hollywood has led us all to believe. Often, it comes in subtle ways that are easily misunderstood.
Five signs that there is dissociation in the therapist’s room
1. Sudden changes in the client’s emotional state
The client may quickly go from feeling calm to sad, or from feeling emotional to completely blacked out. Sometimes, these changes can feel confusing for both client and therapist. A person who was just discussing something painful may suddenly appear numb, detached, or emotionally flat. What may seem like inconsistency is often the nervous system doing its best to maintain safety by switching between internal states or compartments.
2. Clients describing their “parts”.
Customers may say things like:
- “Part of me wants to move forward, but another part of me is afraid.”
- “Sometimes I feel like two different people.”
- “There’s a part of me that turns everything off.”
Many therapists hear this language and interpret it as a metaphor or filter it through the models they have been trained in, such as Internal Family Systems (IFS). Sometimes this frame fits. But for trauma survivors, this language can also reflect an inner experience shaped by the separation. With complex trauma, the dissociative parts have different memories, roles, and experiences that are sometimes accompanied by dissociative amnesia. This is not the same as working with parts. It reflects the different levels of internal organization that develop in response to acute trauma.
Listening carefully to how a customer describes their internal experience can provide important insights into how their system is structured and how different aspects of self-management work to navigate safety.
3. memory omissions or misunderstandings about experiences
Clients may struggle to recall important events, conversations, or emotional experiences. They may say things like:
- “I know something happened, but I don’t fully remember it.”
- “I feel like parts of my life are missing.”
- “I know I should remember it, but I can’t access it.”
Memory disruption is a common feature of dissociation, especially when it comes to trauma. These shortcomings are not just forgetfulness. They are often protective. In addition to clinical observations, brief screening tools such as the Dissociative Experiences Scale (DES-II) can help identify dissociative patterns that may not be immediately apparent in a session. Although no single measure replaces clinical judgment, instruments such as the DES can provide a useful starting point for understanding the presence and range of dissociative experiences. Dissociation exists on the spectrum and dissociative personality personality disorder (DID) is one of the complex expressions of this adaptation process. Your clients’ life experiences will tell you more than a textbook, so please don’t classify all your clients as having the same dissociative experience. Listen to each of their personal experiences with respect and dignity.
4. A feeling of unreality or detachment from the body
Clients may describe feeling as if they are watching their lives from outside or moving around in a fog. They may feel numb, disconnected from their body, or unsure that what they are experiencing is real. These experiences are often forms of depersonalization or derealization, both of which exist on the dissociation spectrum. In clinical work these experiences are sometimes expressed verbally. Through drawing or other forms of creative expression, clients may describe a sense of separation from their body or environment, particularly when certain parts lack language for their experience.
5. The progress of the treatment can be reset again and again
One of the most confusing experiences for therapists can occur when meaningful progress disappears between sessions. A client may have insight or emotional breakthroughs in one session, only to feel disconnected from the experience the following week. This can be frustrating for both the therapist and the client. However, in many cases, it reflects the existence of different internal states or internal parts that have different experiences and memories. When viewed through this lens, the question begins to change. Instead of asking, “Why are we losing progress?” we can ask “Which part of the system was present in this session and which part is present now?”
This shift alone can open the door to a very different kind of therapeutic work.
A change in perspective
Recognizing dissociation in therapy does not immediately require a diagnosis of dissociative personality disorder (DID) or a radical change in approach.
Often, it starts with something simpler:
- Slow down.
- Customer Resources.
- Stability support.
- Becoming more curious about the inner world of the client and ourselves as clinicians.
When dissociation is understood through an adaptive lens, the therapy room can become a place where experiences that once felt confusing or fragmented make sense.
In the final article of this three-part series, I explore common mistakes therapists make when working with dissociation and how clinicians can do so in ways that are both safer and more effective.
