Dissociation is a word that scares many. As a trauma therapist, I have learned to normalize dissociation. Everyone dissociates. Binging Netflix, highway hypnosis, and mindless eating are all ways people do this.

There are many different ways to define dissociation. It is a protective mechanism that removes a person from a painful experience. 

For therapists, there can be many signals that can indicate dissociation. 

Stories that do not quite track. A lack of connection with any affect when discussing traumatic experiences or a loss of time can also be indicators. A long history of unsuccessful therapy may also indicate this. 

There are a few resources to assess for dissociation. The Adverse Childhood Experience (ACE) can tell you the level of trauma a client faced in their younger years. If they score high, they may have used dissociation to cope. The Dissociative Experiences Scale (DES) and The Multidimensional Inventory Of Dissociation (MID) can give more precise indicators of dissociation. The MID is more thorough; if you access the link in the resources, you can get more information on how the dissociation manifests. 

Best practices for trauma treatment involve using a Phase-Based approach. You start with stabilization, which means getting the client to a place where they can maintain a window of tolerance for trauma processing. Remaining in your window of tolerance means you can think and feel at the same time. There are many ways of doing this, including teaching grounding techniques, psychoeducation, and doing parts work. 

 

I help clients stabilize by utilizing parts work with EMDR resourcing techniques sprinkled in. I work from the Internal Family Systems model, which believes we all have parts. These parts consist of protector parts that try to help our system avoid pain and exile parts that hold our burdens. Dissociative parts are protectors trying to keep the system from feeling emotional pain. 

When I work with clients, we address their dissociative parts from a place of curiosity. We ask those parts what they are trying to avoid happening. What are their fears? A standard intervention is time orientation, which involves working with the part to help it understand that it is not in the time of the trauma but the present time. Time Orientation is an essential aspect of trauma treatment and working with dissociation. I have included a diagram explaining a few different ways to do this. 

In this blog post, I demonstrate the Back of the Head method from Jim Knipe. This method helps clients show their dissociation level and is used in his Constant Installation of Present Orientation and Safety (CIPOS) protocol.

In this blog post, I demonstrate the Back of the Head method from Jim Knipe. This method helps clients show their dissociation level and is used in his Constant Installation of Present Orientation and Safety (CIPOS) protocol.

 

Resources

DES with color-coded tabs

This shows what areas of dissociation the client is scoring higher on.

MID-60 instructions to clients

This is an instruction sheet to use when using the MID 60

Version for the client to complete – MID-60

This is a spreadsheet version that the client can fill out

MID-60 pdf form client

This is a PDF version of the MID-60

Clinician scoring template spreadsheet – MID-60

Dr Mary-Ann Kate’s video for the MID-60.

Dr. Kate is responsible for many of the resources above and more. She shares it all on her Google Drive.

EMDR Chicago resources on dissociation

Jim Knipes Constant Installation of Present Orientation and Safety (CIPOS)

Books

The book resources are affiliate links to Amazon, and I receive a small stipend if you click and buy. These are all books I use a lot!

Healing the Fragmented Selves of Trauma Survivors by Janina Fisher

This book focuses on structural dissociation and must be in the trauma library. It has great appendices with great client resources, though the book can be overwhelming.

Dissociation Made Simple: A Stigma-Free Guide to Embracing Your Dissociative Mind and Navigating Daily Life Jamie Marich PhD 

This book is on dissociation by a therapist with lived experience

How to Use Fraser’s Dissociative Table Technique to Access and Work With Emotional Parts of the Personality

Martin, Kathleen M. Journal of EMDR Practice and Research Vol 6 Issue 4, DOI: 10.1891/1933-3196.6.4.179

EMDR and Dissociation: The Progressive Approach Paperback by Anabel Gonzalez (Author), Dolores Mosquera (Author)

All of these authors also have training available, and I have attended some by all of them, and they have been very helpful.