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What is Dissociation and how does it relate to my trauma? 

Dissociation occurs when our brain creates parts out of experience such as when driving on a highway, arriving at our exit but realizing we cannot remember driving for the last 5 minutes. We did not crash because a part was driving while another part of us engaged a daydream. Our brain will create parts for emotionally painful or dangerous experiences and keep them from us so we can carry on with life. When they are triggered we may end up “leaving”- going somewhere else rather than re-experience such suffering. We may only partly leave and experience ourselves as not being real (depersonalization) or it may seem our surroundings are not real (derealization). These are all forms of dissociation and are a normal reaction to extreme distress. Avoidance such as “leaving” keeps us from dealing with the issues we need to confront in order to heal. An option is learning and applying effective coping and grounding combined with mindfulness so one can safely stop all dissociation and begin to reprocess the root source(s) of distress.

I think something bad happened to me but my memory is poor.

I am not sure if something happened to me or I am just dreaming this. I don’t know if it is real or not?  Can I trust my memories?                                 

Lots of people who have had bad things happen especially at very young ages have trouble remembering but may have a ‘sense’ something happened. It is normal for survivors who do remember to want validation. They too ask “was this real?” Recently, NY Mets’ ace pitcher R.A. Dickey published a book in which he comes out with his story of surviving abuse. The title of his book is:  Whenever I Wind Up: My Quest for Truth, Authenticity and the Perfect Knuckleball. His quest for truth and authenticity is the quest for every person who has survived unthinkable events, more unthinkable if they were by the very people charged with our protection and safety. In therapy, I will work with the challenges presented; authenticity often finds its place at the table in the process whether real or a dream.


What is Re-enactment & how do I know if I’m doing it?

Re-enactment, technically known as dissociative re-enactment is when we act out abuse that happened to us, re-manifesting a situation where we are revictimized or perpetrating the abuse on someone else.  We may be aware of what we are doing but lack control over doing it, no matter how horrible we may feel about it or how great the risk is to our life, relationships, employment etc. Young children being sexual with other children is a form of acting out what has happened to them. I know of happily married adults having a sexual affair with a stranger and are clueless as to why they did this. Others have put themselves at risk or even perpetrated or attempted to perpetrate abuse on another adult or child. They are not attracted to do this because they want to inflict harm on someone else. They in fact are repulsed and horrified that they would engage in such behavior. When we are abused as children, who we are is fragmented into parts. Some parts act as protectors and only appear when we are about to feel something or get close to feeling something. If I am a sexual abuse survivor and I am in a situation where I can become intimate with someone and that may involve sexual relations. It may trigger memories of abuse, so the protector part will sabotage that relationship. A re-enactor part is compelled to make sense of what happened, even if it happened long ago. These parts or fragments of self, are not part of our awareness or consciousness as they are dissociated. When they act out we are hacked and helplessly watch ourselves do unthinkable things. Re-enactment stops when parts work is done to mediate some of the needs of the acting out parts and /or when those traumatic memories are processed.

Can I come in for therapy if I am still using, cutting?

Yes, yes, and yes!!! Coping methods such as drinking, drugging, cutting, burning or other mal-adaptive behaviors may generate shame or only work for a brief period. We know the long-term effect of using substances can impact family, employment and result in legal and medical problems. If using substances is as a form of self-medication for intolerable stress, then it has served a function of keeping you alive. Ditto for self-injury. We are not proud of such coping methods but the role they play must be honored. More effective coping will provide longer lasting relief and such behaviors will change automatically (substance dependence is an exception, EMDR for Addiction and 12 step support is additionally recommended). Coming to a session while intoxicated however will yield no benefit.  A commitment to treatment requires a commitment to sobriety during the sessions..

Is medication right for me ?

Medications may be indicated when symptom presentation is so strong that functioning is severely impaired. An example is experiencing depression that keeps one in bed and from eating or sustaining.  We live in  “take a pill” culture so a caution is that we do not want medicate that which we can work with in therapy. Feeling states are part of normal experience, both difficult ones and happier, joy filled ones. Some medications are frequently given out that can mask feeling states and foster dependency at the same time. Such are in the Benzodiazapine class and include brand names such as Valium, Ativan, Xanax and Klonopine. They are prescribed to provide relief from anxiety and for “Borderline Personality Disorder“ but there are effective non-pharmacological ways to deal with anxiety that work faster than any pill and help change one’s brain to work better at managing such stress. SSRIs, antidepressants such as Prozac, Paxil, Zoloft, Wellbutrin, Celexa, Seroquel or Abilify may be good alternatives to treating anxiety if medications are indicated. It is best to have an informed discussion with a psychiatrist or nurse practitioner if you think you need such help, especially if it makes doing the hard work of therapy possible. Mood stabilizing medications (Lithium, Depakote, Neurontin, Lamictal and Seroquel) are prescribed for Bipolar Disorder. Bipolar Disorder is often misdiagnosed but if you are on these medications and they are helping, stay on them as they will not have any impact on therapy at therapeutic doses.

Getting Help for Dissociation

If you are having issues with dissociation and are ready to get some help, contact me today. Click here to use my contact form or call me at (631) 697 9850.