6 Ways to Stay Grounded If You Experience Dissociation in Therapy

A couple of weeks ago, I came out of therapy wondering what happened. I had this sense that I hadn’t even had my session. I couldn’t recall anything about it. It felt like I was completely checked out, an observer of my own body from some planet in outer space. I have had enough therapy to recognize what was happening… I was dissociated. But why?

• What is PTSD?

What is dissociation?

Dr. Bruce Perry, co-author of the book “What Happened to You?” describes dissociation as a stress response that occurs “when there is inescapable, unavoidable distress and pain. Your mind and body protect you. Because you cannot physically flee, and fighting is futile, you psychologically flee to your inner world.” It’s a powerful coping strategy for trauma and something that can become programmed into our bodies whenever we feel overwhelmed.

For myself, I had been feeling increasingly overwhelmed by not just daily stressors in life, like finances and car problems, but more increasingly a sense of hopelessness over world events that appear to be a nonstop barrage of stress. After over two years of COVID, the war in Ukraine, mass shootings, global warming, the reversal of Roe v. Wade, etc. my brain simply couldn’t take any more. And my well-honed coping strategy to dissociate kicked in. Better to not feel at all than to feel helpless and out of control. So I messaged my therapist telling her what was happening and we agreed to discuss it at my next session.

The first order of business was to establish why I was dissociated. I had already identified that sense of overwhelm, but like any good therapist, she wanted to make sure that therapy itself wasn’t contributing to my dissociation. Often, particularly in trauma therapy, a patient can get overwhelmed if they are processing traumatic memories too rapidly. It’s like your body and mind get flooded so you pull the proverbial rip cord rather have to re-experience those memories. It’s crucial that trauma work be done at the right pace and therefore it’s necessary to check in with your therapist if you feel like you cannot stay present in your body during your sessions.

Additionally, a therapist will want to establish if there is something they are doing or saying that is triggering you into the dissociative state. They may inadvertently be using a word, tone of voice or body language that reminds you of your abuser or a neglectful caregiver. This kind of transference can harm the therapeutic alliance and cause a rift between you, making the environment of the therapy room feel unsafe.

Once we established that neither of these were the case, we discussed ways in which we might work together to keep me connected and emotionally regulated in session. While not every therapist has the capacity, education, or ability to do all of these, they are options that you can suggest if you are feeling dissociated in session with your therapist.

1. Walk and talk during therapy.

This option is contingent upon the location, capacity to maintain privacy, and the therapeutic modality of your therapist’s practice, and therefore not always feasible. But, in more rural areas with options to conduct a session away from other people, getting out into nature and being able to move your body while talking about distressing topics can help to keep you quite literally grounded. My therapist’s office is located next to a nature preserve and park, so we have the opportunity to do this and when the weather permits we will definitely be taking advantage of it.

2. Shaking and body-centered work.

Clinicians and trauma specialists are far more aware of the connection between the mind and body than they have ever been. Even if your therapist isn’t trained in a body-focused modality like somatic experiencing, they can guide you through some basic breathing exercises and body-focused exercises. And one of the most uniquely effective ways of discharging stress from your body and regulating your nervous system is by gentle inner shaking and trembling. This technique was originally proposed by Dr. Peter Levine in the 1960s. His theory was based on observing animals in nature. After experiencing a state of heightened danger, say being chased by a predator, once an animal returned to a state of safety, they would shake their whole bodies from top to bottom. This helped dispel all the pent-up fear and allowed the body to resume a state of symbiosis. When we become triggered, our bodies engage our innate stress response, which in the case of dissociation is an extreme form of freezing. Shaking our bodies can help us regulate our nervous systems and bring us back into our bodies.

3. Identify and utilize a “safe place.”

Safe place is a technique that is part of the “preparation” phase of the eye movement desensitization and reprocessing (EMDR) therapy protocol. Its purpose is to help keep a patient grounded and therefore not dissociated while processing traumatic memories. The goal is to identify a place that engenders a sense of calm and security within the patient and then to “install” it through the use of bilateral stimulation. Once this is accomplished, the safe place can be called upon when a patient begins to experience emotion dysregulation, thereby returning them to their bodies and enabling them to resume a state of emotional balance. We have often used safe place in session even as just a guided imagery exercise to help me feel less activated.

4. Try play therapy.

While play therapy is generally thought of as a modality used with children to help them feel safe and more capable of talking about difficult things, there’s no reason why it cannot be used with an adult patient. Tapping into our inner child helps us to connect with them and activates our creativity. This is one space where a bit of dissociation can actually be adaptive. This can be achieved in any number of ways from drawing and coloring to LEGOs. It’s really up to what you enjoy and what your therapist has on hand in their office.

5. Practice the 5-4-3-2-1 ground tool.

This is a grounding technique that can be called upon at anytime, but can be particularly useful and instructive to do with your therapist if they observe you becoming dissociated during your session. While doing deep breaths, identify five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can get taste. By tuning into your five senses and shifting the focus to the present (hello mindfulness), you can reconnect your mind and body and help slow down the train of thought in your brain that’s overwhelming you. My train is like a high-speed rail so I definitely need some brakes to slow it down.

6. Utilize cold therapy.

This is a technique that is derived from dialectical behavioral therapy (DBT), the gold standard for working with patients who have borderline personality disorder (BPD). The idea is to build distress tolerance and regulate extreme emotions by activating your parasympathetic nervous system, in essence resetting the nervous system as a whole. To accomplish this, fill a bowl with ice water and either dunk your face or hand into the ice water for 30 seconds. While it seems extreme, it can be incredibly effective. Please note: It’s not recommended for anyone with a heart condition.

While not every one of these techniques will work for you or you might need more than one in succession to do the job, they can be powerful additions to your toolbox of coping strategies to help mitigate dissociation and make therapy more tolerable. I encourage bringing these ideas into therapy with you and discussing them with your therapist to see what they are willing and able to implement and to assess if they have other recommendations that you can incorporate into your work together. The most important thing is to identify that you are experiencing dissociation and to make sure your therapist is aware it’s happening.