Dissociation: Defense or Result of Cognitive/Perceptual Disruption?

The term dissociation has been used to describe so many things it at times appears to mean nothing at all. For instance, it has been used to refer to describe a continuum of experiences of detaching from reality that can range from daydreaming and boredom to the fragmentation of the self into separate streams of consciousness such as we see in dissociative identity disorder.

In ISTDP we make several distinctions when dealing with this class of defenses. First of all, detaching and daydreaming are viewed as tactical or repressive defenses when the patient’s anxiety is in the striated muscles. In this case, we point out how the patient detaches from her feelings (repressive defense or character defense) or detaches from the therapist (tactical defense or transference resistance). We point out the defense, help the patient see its price, and invite her to let go of her defense to have deeper contact with her inner life and to have a deeper connection with others.

However, when we address more pathological forms of dissociation (blanking out, derealization, amnesia, or fragmentation of self experience), the anxiety is discharged into cognitive/perceptual disruption. When anxiety is channeled into cognitive/perceptual disruption, we regulate anxiety before addressing the defense of dissociation. We have to restore proper functioning of the brain. In this case, as soon as a severe form of dissociation occurs, we point out the anxiety and regulate it until the patient’s anxiety returns to the striated muscles. Then we will explore feelings again, building the patient’s capacity step by step so that he can tolerate higher levels of feeling without resorting to the defense of dissociation. Once the patient’s anxiety has been completely restructured into the striated muscles, the dissociation will no longer be necessary as a defense.

ISTDP differs in two ways from many other models of working with dissociation. First, when dissociation results from anxiety in cognitive/perceptual disruption, anxiety regulation takes precedence over defense work. Often, anxiety regulation leads to a drop in the defense of dissociation in the moment. Second, ISTDP does not work with the integration of the “multiple” selves. Why? These multiple selves are the results of the defense of splitting. We regulate anxiety until the defense is not necessary. Then we help the patient face and integrate his complex mixed feelings internally without splitting, so those feelings and experiences do not have to be split apart and represented as “multiple” selves. You can read an interesting case of ISTDP with a dissociative man on our resources page, “The Man Who Awoke from a Coma.”



4 thoughts on “Dissociation: Defense or Result of Cognitive/Perceptual Disruption?

  1. Karen Fisher

    Hi Dr. Frederickson. I recently started ISTDP for C-PTSD. During the 4th counselling session I split into at least 8 “selves” or “parts” that I was previously unaware of. 3 are young children who now want to be heard and rescued from a well, a jail cell, and a critical part towering over her. One of the “parts” actually took control over me and I had facial and body gestures and an accent of a part that called himself “the Sherrif”. Correct me if I’m wrong, but according to what I’ve read splitting is something that is to be potentially prevented. My therapist told me she will not address the “parts”; however, the “parts” want to be. My dilemma now is I can’t just put them back and pretend it never happened. My question is two-fold: How should my ISTDP therapist proceed and can ISTDP still help me? I have chronic pain and many “somatic” symptoms that I am desperate to improve.
    Thank you for considering my comments and questions.

  2. Jon Frederickson

    Of course, without seeing the video, all I can do is speculate. If there was this kind of splitting, that would ordinarily indicate that anxiety was getting too high. ISTDP can help this situation, but attention to anxiety is essential, then invitation to experience the split apart feelings, and also addressing feelings toward others that may be coming back upon you in the form of chronic pain and somatic symptoms. Other with these symptoms have recovered with ISTDP. But it may be that your therapist and you are finding the right level of feeling to work at that will be integrative.

    1. Karen Fisher

      Thank you for your very prompt reply Dr. Frederickson.
      The first time I became aware of a part, I saw (an image that seemed to be inside my chest area) of a little girl in a well reaching up with her right arm pleading for help. This was an internal vision not a hallucination. The therapist ignored my sharing of this and later I had thoughts inside of the little girl being angry that the therapist didn’t show the part empathy or acknowledge her distress.

      Just so I uderstand correctly, what if my anxiety isn’t regulated, goes over my anxiety threshold and results in cognitive/perceptual disruption again; for example: the “Sherrif” emerges.
      How is this addressed in therapy? Do you have any examples of this type of “splitting” and how to work with this in your book?

      Again thank you for your time and consideration of my questions.


  3. Jon Frederickson

    I have examples of how to work with dissociation in my most recent book. However, what you describe and how you describe it suggests that your capacity is higher. And that might be a reason your therapist is working differently. Seeing an internal image is not necessarily dissociation and there are other ways to work with that kind of imagery.


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