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Lisa Ferentz, LCSW-C, DAPA

How to Treat the "Shaming Aspect" of Dissociation

When a child or an adult uses dissociation or the freeze response by “checking out,” “going to the ceiling,” or disconnecting from their body during abuse or a life-threatening situation it helps them manage and survive physical pain, confusing sexual feelings, terror, rage, or the devastating emotional betrayal that can accompany the abuse or threat. This is particularly necessary when the abuser is supposed to be a trusted or safe person. It’s important for clinicians to understand that clients who were abused in childhood often continue to berate themselves for using the freeze response because they are looking at childhood experiences through the lens of adult eyes. Believing they could have “fought back” or used their voice is often a reflection of imagining themselves abused now, not realizing how innocent, trusting, physically small and powerless they were when they were younger.

It’s also an unreasonable expectation for adult victims of crime who find themselves threatened with a perpetrator’s deadly weapon. In these situations, fight or flight are both impossible and potentially extremely dangerous survival options as they can lead to an exacerbation of harm. In so many life-threatening scenarios either dissociation or complete acquiescence are the wisest and only viable options.

Assessment and strategies for dissociation.

Most clinicians understand the importance of teaching dissociative clients strategies for staying grounded and present. It’s equally important to assess for the possibility of residual guilt and shame as it relates to using dissociation in response to a traumatic event. Rather than recognizing that their dissociation was life-saving, clients often equate freeze responses with “copping out,” and therefore label themselves as “cowardly” or “weak.” This mindset fuels a sense of shame, and continues to inform their distorted internal narrative, negative self-talk, and sense of worthlessness.

As clients process traumatic life events in therapy, shame and self-blame can manifest both verbally and non-verbally. When therapists use psycho-education to normalize and even celebrate the wisdom of a client’s past freeze response as the only viable survival option, it begins to dissipate their debilitating shame. Validating and acknowledging how life saving it was in the past helps the client recognize the value of using freeze when there was no other way to navigate or survive.

In many ways, dissociation is a kind of superpower, and it’s essential that therapists reassure the client that they have no intention of taking that superpower away.

There is, of course, a challenging balancing act in all of this!  What was once life-saving, morphs into a strategy that can actually be disempowering, making survivors vulnerable to subsequent victimization when they freeze in situations where they actually could have a sense of agency and make proactive choices.

The key to working with dissociation.

Helping clients to discern between situations where it would make sense to “freeze” and situations where using their voice, walking away, setting a limit, etc. would be safe, beneficial, and empowering. Engaging in the process of quickly assessing the safest course of action- going to the ceiling or staying grounded and present- also helps to reduce shame. Rather than the response being a habituated and reflexive one, it becomes a response rooted in genuine choice. Rather than the decision being rooted in past experiences of helplessness, it becomes a decision that accurately takes into account the present moment and the client’s current internal and external resources. When clients learn to choose whether or not to dissociate, they gain a greater sense of agency, and expand their repertoire of behaviors that promote self-protection and self-advocacy.

Clinician's Tips When Working with Dissociation:

- Reassure client you can’t take away their ability to dissociate

- Validate and acknowledge how life saving it was- in the past- to get through a traumatic event

- Teach clients to identify their physical harbingers and to name the process as “dissociation” when they start to get spacey, to help reactivate the pre-frontal cortex and executive functioning

- Introduce the concept of “choice.”  In the past they had to dissociate, in the present it is one of many options.

- Introduce the paradox that what used to keep them safe, now can disempower them and perpetuate helplessness, victimization, and the potential for additional trauma

- Invite clients to assess whether or not it’s in their best interest to “go to the ceiling” or if it would be more empowering to stay “grounded and present.”

- Teach re-grounding strategies to practice in and out of session

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