By: Lauren Rudolph, LPC
As a therapist, I feel my journey continues to be finding out what I don’t know yet. Starting out in the field working with addictions, I realized, wow, there is a lot of trauma we are not treating. And, as I went on to become trained to treat trauma, I realized, wow, there is a lot of dissociation needing to be addressed. And, now that I have spent more time learning about complex trauma and dissociation, I’m noticing how pervasive these experiences are among the clients who we’re treating for mental health.
Let’s briefly review trauma. Trauma is the Greek word for “wound.” When we talk about psychological trauma, it can be a wound that is physical, psychological, or spiritual. Although the DSM 5 TR has criteria for defining what qualifies for a PTSD Diagnosis, trauma is a term that can encompass much more. Trauma used to be thought of as events such as natural disasters, near-death experiences, or sexual assaults. And while all of those events can be traumatic, trauma can be “less obvious” than that. In fact, some clinicians in the field use terms like “Big T” and “Little T” to refer to different kinds of trauma. For example, a “Big T” trauma refers to an event that is more intense and acute, e.g., being physically abused as a child, and a “Little T” trauma refers to non-life-threatening events like being bullied or the death of a pet. However, one thing I hope when using these terms is that it doesn’t minimize what trauma is. Someone once said, “Pain is pain,” which I take to mean that no matter what your trauma is if you are in pain, that pain is just as real as someone else’s pain.
In talking about trauma, I think it is important to add that trauma is not just about what happens to someone, it is about their subjective experience of that event, what happens inside of them as a response, and how they are able (or not able) to process that experience. Lastly, trauma can also be what doesn’t happen to someone, for example, the absence of a loving caregiver, not having enough attention, enough support, or enough validation. These experiences can create what are called “attachment wounds” which are nothing short of trauma as well.
So, what is the role of dissociation in the experience of trauma? Dissociation comes from a Latin root, “dissociatio,” meaning to “severe” or “to separate.” In a nutshell, this means we can separate from the present moment, or as a more intense experience, we can separate from our core self. Dissociation is essentially a powerful coping mechanism. In fact, it’s our mind’s biggest, baddest defense. When all else fails, our minds can take us away from situations that are too overwhelming or painful. We don’t even have to try or ask our minds to do this for us, it will happen automatically. Especially for children who experience overwhelming situations, their best coping mechanism is dissociation because “fight” or “flight” may not be an option or may cause even more harm.
Because trauma can leave such a wound and because dissociation is there to take us away from that pain, it’s extremely important for clinicians to know to look for dissociation when working with individuals who have experienced trauma. Because dissociation can be very effective in taking us away from pain, someone who has been traumatized may present as if they’re “fine,” when in fact, they may be experiencing trauma-related dissociation.
How can you spot if this may be happening? First, please know that when an individual is dissociating, they may or may not be aware that they are - and so as clinicians, it’s helpful not to assume that a client will report that to us. We need to be able to look for signs of dissociation and know what questions to ask. Here are a few examples of what you could pick up on in a session. A client may be able to talk about a traumatic situation without any effect. This of course could be a sign that the individual has processed that trauma. However, sometimes, the trauma hasn’t been processed at all and they have learned to separate from those painful emotions or body sensations. The individual may not recall important parts of the traumatic event, also known as amnesia - a type of dissociation. Or the individual may be able to talk about what happened as if it happened to someone else, not them, which is another type of dissociation called depersonalization/derealization.
I hope all clinicians can learn, as I have, that more often than not, there is some level of dissociation being experienced by the individual presenting with trauma. And it’s not the client’s job to report that to us. In fact, they may not even be aware of what dissociation is or why that happens. As clinicians, we can empower ourselves and our clients by learning more about trauma-related dissociation, spotting it, learning about the role of dissociation in that individual’s life, and treating any dissociation that is interfering with the individual’s recovery and daily functioning. If dissociation is there to block out the pain, and trauma treatment is about healing that pain, we need to have ways to work with that dissociation, so the individual can fully heal and grow.
Lauren Rudolph, LPC is an EMDR Certified Therapist and EMDRIA Approved Consultant. She has worked as a clinician in the field of Clinical Psychology for the past 10 years and currently works for an Intensive Outpatient Program where she developed trauma-focused group therapies. She also has a private practice in Exton, PA specializing in the treatment of complex trauma and dissociation. She is passionate about utilizing EMDR, Ego State Therapy, and Clinical Hypnosis in the treatment of complex trauma and dissociation.
Join Lauren in the new year for the upcoming advanced training Gaining Confidence & Skills in Treating Complex Trauma, Dissociation, and Clinician Self Care.