As I continue to watch more specialty protocols, models, and innovations develop from EMDR Therapy and within EMDR Therapy, there is a message that is sometimes subtle and sometimes very direct.
“Learn our approach to EMDR Therapy and you will not have to worry about your clients dissociating!”
Sigh.
The marketing for many of these approaches, which clearly play to therapists fears that they will break their clients somehow if they let them dissociate, annoys me. As you can read about in my recent piece Selling the Myth of Certainty, I am not opposed to innovation and methods that might make EMDR Therapy and other trauma therapy approaches more palatable and user-friendly to people with complex trauma. Yet when they are delivered with that suggestion of, “Follow this and you’ll get what you want” [in this case, the certainty that your clients won’t dissociate], that is when I fear that we are not raising up intuitive clinicians.
And intuition is what you need to develop and to practice if you are going to get good at addressing and working with dissociation in clinical sessions. Eliminating it is not the answer. My perspective, as a person who lived most of her life with dissociative identities, is that squashing dissociation is not even possible. That is the primary perspective that I want to shed light upon in this article.
One of the reasons that I came out about my own healing and recovery from a dissociative disorder in 2018 (after being diagnosed in 2004), is that I got frustrated by the way that many trauma therapists, specifically EMDR therapists, talked about dissociation. There was a binary, “Dissociation is bad,” and “Mindful presence is good” that came through, and that message can still be heard.
Before we go further, some operational definitions and points of clarification are in order.
Dissociate simply means to sever or to divide. We can sever or divide from the present moment because it is too painful, too stressful, or too boring. Most of us have done it through behaviors like daydreaming, putting ourselves somewhere else in our minds (a technique that is also used therapeutically in approaches like Calm Safe Place), zoning out, or otherwise turning down the volume of the triggers that surround us. Some of us have incorporated assists like scrolling on our phones, drinking too much, or getting lost in an interest, such as watching TV or playing a video game. Getting proverbially lost can help make the present moment more tolerable. Every human being has dissociated and likely continues to dissociate in one or more of these ways. Some of us do it more often than others or with greater intensity, usually in proportion to how great the need is to escape or to take refuge from the present moment.
Therapists and the general public alike can get more confused by the “parts” aspect of dissociation, even if they understand some of the basics of how we all do it. The severing or dividing that defines dissociation can also manifest as a severing or division in the parts or aspects of human experience. This phenomenon is traditionally taught as a “spectrum,” with presentations of dissociative identity disorder (DID) being on the extreme end of the spectrum. Throughout my teaching, I have largely dismissed the spectrum idea because that can imply that DID is the worst manifestation of trauma-based dissociation, complete with the judgmental implications that it needs to be eradicated. The reality is that all human beings have parts and aspects of experience. At the most basic level, the idea that we as humans are bio-psycho-social-spiritual creatures (something you likely learned in graduate school) reflects the idea that we as humans are not just one thing. When, as therapists, we struggle with clients who are too “up in their heads” and not engaged with their body or emotions, that can also be a subtle dissociative response. Because we sever or divide to meet a need or to protect. And for many people, the over reliance on the rational is protective.
Yes, some of us experience our parts in such a way that it feels appropriate to give them names or to call them by the numbers of the ages that best fit them. Many of us who experience parts to this degree of separation can and have met criteria for various dissociative disorders like otherwise specified dissociative disorder (OSDD) and DID. And these conditions can cause problems in our daily life that will create real suffering and need to be addressed therapeutically. Yet the existence of the parts themselves is not the problem or the pathology. The trauma and stress that caused them to develop is the real problem that needs to be addressed.
Many of the contributors that I interviewed in my now well-known book Dissociation Made Simple: A Stigma-Free Guide to Embracing Your Dissociative Mind and Navigating Daily Life (2023) offer the wisdom of lived experience that may better explain what I’m most trying to impart in this article. Several contributors noted that the cruel things that people, including therapists, will say about their tendencies to dissociate are more hurtful than the experiences of dissociation themselves. Others emphasize that the existence of dissociative parts is not just evidence of the brain’s amazing capacity for survival; the parts remain active and alive to help a person/system adapt to life in more creative ways. One contributor shared a line that has stayed with me since I originally interviewed her: Dissociation is both a superpower and a disability. Many contributors commented that the key is learning to address the places where dissociation (and the trauma/stress that caused it) causes issues without squashing a person’s dissociative responses, many of which are highly creative, altogether.
There is a fear-mongering that continues to concern me in the way that EMDR and other trauma therapists can talk about dissociative responses. The message often comes through from trainers, consultants, and other thought leaders that dissociating is one of the worst things that a person can do, and that it will always get in the way of trauma processing. When I hear things float around EMDR circles like, “Don’t let your clients dissociate,” my first response is laughter.
You are not that powerful. If a person needs to dissociate they are going to. And just because a client dissociates or switches parts during sessions does not necessarily mean that you did anything wrong. Yes, trainees and consultees can be taught ways to respond if a dissociative experience should happen. We can teach you methods for recognizing the signs of a potential dissociative collapse early. Yet avoiding the dissociation altogether is not realistic. For many of us, knowing we can do it is the safety valve that might make approaching something as daunting as EMDR Therapy more palatable. A myth I’ve tried to bust since coming out myself is that the presence of common dissociative responses or a part coming out does not automatically shut down what you can do with EMDR Therapy.
Some of us need a light degree of dissociation in order to safely tolerate processing. During these moments, you as the therapist can check in more frequently, use interweaves more abundantly (especially because the sound of your voice can be an anchor), and remind people that their resources for anchoring can be accessed at any time as they process a target. EMDR Therapists can also work with their clients who dissociate to determine which targets might be most palatable at any given time in their process (e.g., starting with a more present-pronged event; using methods like Mosquera’s Progressive Approach or other modifications; Flash techniques; EMD or other restricted processing modifications; asking a client what part of the target memory they are willing to work on instead of going in at the worst part).
And now to open up one of the biggest areas of debate amongst EMDR Therapists: can you do reprocessing with a dissociative part if they should show up, or is a part fronting a sign that a person is “too dissociated” to continue? For those of us who live with dissociative identities and have not chosen a path of classic integration to heal (cooperation amongst the parts instead of integration is a valid healing path), the mere question can sound ridiculous. For many of us, our parts are not pathology. If a part is showing up during EMDR Therapy there is a reason that they are showing up. Asking them to just step aside, or worse yet, shutting down the entire EMDR process, can be detrimental. Several contributors in Dissociation Made Simple shared their concern about how many trauma therapists will not even talk to younger parts, assuming that their presence is problematic.
Naturally, learning to work with the presence of dissociative parts in EMDR Therapy is a complex and layered manner that, in my view, takes consultation to get good at navigating. So many issues around dissociation and parts work within EMDR Therapy are nuanced and cannot be mastered by simply learning a protocol or the latest spin-off approach emerging from EMDR Therapy. And no technique, no matter how masterful, is going to stop a person from dissociating when they need a break from the very real intensity that the work can elicit.
You have every right to disagree with me based on what you’ve experienced within your clientele. I hope that you will at least consider the following insight: Many of us who are systems have a powerful get shit done/Ms. Perfect/tell them what they want to hear/be a good client part who can appease you with their compliance. Could some work get done when we are in this mode? Quite often, yes. Speaking for myself, my first intensive round in trauma/EMDR Therapy did yield some good results when I led with this goal of keeping it all together, a process that I’ve since referred to as staying “zipped up” so that I could lead as normal a life as possible. Yet the walls eventually cracked and when authenticity became the fueling force in my treatment some 12 years after getting diagnosed, I made a conscious decision to no longer be ashamed of my dissociation. And I’m glad I found a provider who met me in that process to work with my parts as they were/are and to not see dissociation as a dirty word.
