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Dissociation can be a difficult experience for both the client and the therapist. This guide will help explain how to best support a client who is dissociating in a therapy session. Understanding what dissociation is, why it happens, and how to provide support can help create a more successful and safe therapeutic relationship.

It is important to remember that each person experiences dissociation differently, so there is no one-size-fits-all approach. However, using these general guidelines can help you better understand and support your clients who are experiencing dissociation.

What is dissociation and how can it manifest during therapy sessions?

Dissociation is a common response to overwhelm, trauma triggers or emotional overwhelm when in a therapy setting. It can present itself as spacing out, feeling disconnected from the body, or having difficulty remaining grounded in the here and now.

During therapy these signs may be noted and provide insight into how powerful an overwhelming emotion or past experience can be. In order to allow clients to process their distressing emotions safely, gradual exposure to distressing and overwhelming emotions relating to past trauma can be beneficial in creating safety in processing past experiences in therapy.

Gradual exposure to intense emotions and experiences can look like spending 2-5 minutes discussing a traumatic memory or event and then intentionally engaging in a grounding skill or distraction with the client to create emotional space from the distressing experience.

How can you recognize signs of overwhelm and dissociation in clients in the moment?

As a clinician, it is important to be able to identify when a client is beginning to feel overwhelmed. There are some common signs to look for, such as a change in the client’s tone of voice, an increase in fidgeting, or a decrease in eye contact. If you notice any of these changes, it is important to ask the client if they are feeling overwhelmed and if they need a break.

It is also important to be aware of dissociation as a way that clients who have experience past trauma may cope with overwhelm. Dissociation can look like spacing out, staring off into the distance, or feeling disconnected from one’s body. If you notice any of these signs in a client, it is important to validate their experience and offer support.

How can you remain present with the client and keep them grounded?

Effective grounding techniques with clients can promote a sense of safety and contentment in the present moment. This includes focusing on sensory experience, such as grounding exercises that encourage the client to mindfully observe and identify five things they notice in their environment. This can help clients connect to the present.

In addition, paced breathing (deep breathing where the exhale is longer than the inhale) helps with grounding the client, as well as bringing focus to the body and an awareness of one’s physical self. Allowing enough time for grounding exercises can build trust in the therapeutic relationship and make space for greater mindfulness.

Tips for grounding exercises that can be done during or after sessions

Grounding exercises can help clients stay centered and in the present during or after sessions. Examples of effective grounding strategies include focusing attention on a favorite object or item, describing aspects of it aloud or silently; grounding through the five senses by taking in environmental stimuli; creating positive self-talk scripts to say to oneself during difficult times; and progressive muscle relaxation, which involves tensing and releasing each muscle group from head to toe.

It can also be helpful for clients to have physical objects on hand that make them feel safe and soothed, such as soothing stones that can be held in the hand when feeling overwhelmed. Inviting clients to share ideas for new self-soothing and grounding practices is also a great way to personalize sessions and create an individualized approach reflective of a client’s unique needs.

How to help the client process their experiences and integrate the past into their lives?

It is essential to understand the process of helping a client work through their experience and integrate it into their life. Taking time to encourage them to reflect deeply on their feelings and experiences can help give them insight into how they have been affected by past trauma, as well as potentially provide guidance on how to continue to ground in the present and create feelings of safety as you build rapport in the therapeutic relationship.

Validating the emotions they are experiencing while educating client on the trauma response in the brain and that their feelings are entirely valid response to trauma can be very helpful in creating a safe environment for them to process past experiences. Additionally, helping a client normalize the situation by openly discussing healthy coping strategies is vital to helping them process and successfully navigate their way through the difficulties. Overall, building a sense of trust between a clinician and a client is key for being successful at helping someone confront, accept, and work through challenging experiences in order to move ahead with greater resilience through their healing journey.

In conclusion, dissociation can be difficult to recognize and address in therapy sessions, and by remaining present with the client and encouraging grounding exercises, practitioners can be better equipped to manage these experiences. Acknowledging and validating the client’s experience is key to helping them process their pain, as well as providing additional resources and skill building for support beyond the session.

With effective strategies in place, therapist can ensure that clients feel safe during sessions and are provided with ongoing support on a regular basis. Thus, by both therapist and client practicing grounding exercises in the therapy session, greater connection and safety can be created in the therapeutic relationship to assist with processing and healing from past trauma.

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