What is dissociation?
Psychologists use the term ‘dissociation’ to describe a range of experiences, sometimes associated with trauma. Within psychological literature, dissociation has encompassed:
- Flashbacks and intrusive unwanted memories.
- Intrusive thoughts and feelings.
- Depersonalization and derealization.
- Identity confusion.
- Unexplained medical symptoms.
- Loss of control.
- Identity alteration and multiple identities.
- Reduced awareness of one’s surroundings.
Amongst people who have experienced trauma a common characteristic of dissociative experiences is that one’s attention is drawn away from the here and now, and often towards unwanted memories, or other cognitive or emotional experiences. Grounding techniques help people to direct attention to the present moment and towards safety in the here-and-now. By practising specific techniques, people can learn to direct attention to their body and the senses (Sensory Grounding) or to their thoughts and feelings (Cognitive Grounding).
A brief history the term ‘Grounding’
The term ‘grounding’ first appears in Alexander Lowen’s 1976 book Bioenergetics. Bioenergetics is a psychotherapeutic approach that sees the body and mind as unitary, connected by the ‘energetic’ processes that are part of living: respiration and the creation and expression of energy through movement. Bioenergetics includes physical ‘grounding’ exercises as part of the core treatment approach, incorporating concepts of “verticality (contact with the ground), contact with one’s own physicality, the capacity for emotional holding, and discharge of energy into the ground … being able to understand ourselves, and to connect and relate to others” (de Tord & Bräuninger, 2015). These exercises focus on connecting the individual to the lower half of their body: the stomach, pelvis, legs and feet. Individuals are asked to adopt various postures standing or lying down – flexing the knees, letting the belly relax, pelvic rocking, bending forward – as well as deep breathing techniques (Lowen & Lowen, 1977). According to Lowen, grounding is “feeling contact between the feet and ground… in a broader sense grounding represents an individual’s contact with the basic realities of his existence” (ibid, 1977, p.13). People who are psychologically mature and well-grounded with good body awareness (“in touch with reality”) literally have their “feet on the ground” (Lowen, 1993).
One of the earliest uses of grounding in the sense that contemporary trauma therapists will recognize appears in a description of a group program for survivors of childhood sexual abuse by Blake-White and Kline (1985):
“A woman is prepared for this stage by teaching her “grounding.” Grounding involves any method that keeps her in touch with reality-for example, touching the ground hard with her feet; rubbing her hands on the arms of a chair; having a cold or hot drink in her hand; repeating her name, age, marital status, and the names of her children. The leaders emphatically state that these feelings are not in her adult reality and that the feelings belong to a child responding to a situation that was out of her control. They reinforce the idea that the adult is in control and can manage.”
Psychological models and theory of grounding
From its origins in Bioenergetics, the theory behind grounding has been that it helps people to connect with their inner and outer reality. In doing so, people are then better able to engage with emotional and psychological problems. Within the Bioenergetic framework, grounding is linked to reality testing (Baum, 1997). When an individual is well grounded, they have “a sense of their connection… to the world in which she or lives” (p.66), they can “support a continuous meaningful inner reality” (p.72) and “contact and maintain felt experience” (p.73).
Today, grounding is most commonly understood in the context of dissociation. Kennerley (2009) proposed a clinically useful distinction between different types of dissociation in a model which combined both categorical and continuum approaches, based upon a 2005 model by Holmes and colleagues (2005). Categories from the model are described, with the caveat that “each of these presentations can be experienced along a spectrum of severity from non-pathological to extremely dysfunctional”:
- Detachment can also be described as ‘tuning out’. Examples include depersonalization and derealization, where people describe feeing ‘cut off’ from the world, or from themselves. Detachment often occurs peri-traumatically and may lead to reduced recollection of certain aspects of the trauma.
- Compartmentalization is described as a “deficit in the ability to deliberately control processes or actions that would normally be amenable to such control” (Holmes at al, 2005). Compartmentalization is subdivided into:
- Tuning out. Examples of ‘tuning out’ in compartmentalization include amnesia for certain aspects of an experience, or an unawareness of pain.
- Tuning in includes experiences of absorption and flashbacks.
Dissociation can be described as a shift of a person’s attention away from the present moment. When working with traumatized clients, this shift often occurs away from safety in the present moment, and towards distressing memories and feelings of threat associated with the trauma. This can be extremely distressing, both for clients and for therapists who are unfamiliar with clients who dissociate. Stabilization and the establishment of safety are important parts of therapy for these clients (Herman, 1992). This can include work to widen a client’s ‘window of tolerance’ (Siegel, 1999), and to develop coping mechanisms by teaching skills such as grounding.
Types Of Grounding
By teaching grounding as a skills-development exercise, therapists can help clients to manage dissociative reactions (Kennerley, 1996). Grounding techniques can be divided into:
Sensory grounding techniques, which use the client’s senses to ground their attention in the present moment. For example:
- Stretching your body
- Change posture or adopt specific postures
- Taking a tally of sensory experiences (what can you see/touch/hear?)
- Splashing your face with water
- Touching something that is hot or cold
- Using a strong smell
- Deep breathing techniques
Cognitive grounding techniques, which allow individuals to reassure themselves that they are safe in the present moment. For example:
- Reminding yourself where you are, and the date and time
- Telling yourself that the trauma is over and that you are safe in the <current location> at the <current date>
- Use coping statements that remind them of safety, e.g. “I am safe now”
- Talking to yourself with compassion
- Completing mental exercises, such as counting backwards in threes
- Repeating familiar autobiographical information (name, age, names of friends and family)
- Blake-White, J., & Kline, C. M. (1985). Treating the dissociative process in adult victims of childhood incest. Social Casework, 66(7), 394-402.
- de Tord, P., & Bräuninger, I. (2015). Grounding: Theoretical application and practice in dance movement therapy. The Arts in Psychotherapy, 43, 16-22.
- Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour research and therapy, 38(4), 319-345.
- Ehlers, A., Hackmann, A., & Michael, T. (2004). Intrusive re‐experiencing in post‐traumatic stress disorder: Phenomenology, theory, and therapy. Memory, 12(4), 403-415.
- Herman J. L. Trauma and recovery. 1992; New York: Basic Books.
- Holmes, E. A., Brown, R. J., Mansell, W., Fearon, R. P., Hunter, E. C., Frasquilho, F., & Oakley, D. A. (2005). Are there two qualitatively distinct forms of dissociation? A review and some clinical implications. Clinical psychology review, 25(1), 1-23.
- Kennerley, H. (1996). Cognitive therapy of dissociative symptoms associated with trauma. British Journal of Clinical Psychology, 35(3), 325-340.
- Kennerley, H. (2009). Cognitive therapy for post-traumatic dissociation. In A casebook of cognitive therapy for traumatic stress reactions (pp. 109-126). Routledge.
- Lowen, A. (1976). Bioenergetics. Penguin Books.
- Lowen, A. & Lowen, L. (1977) The Way to Vibrant Health: A manual of bioenergetic exercises. Perennial Library, Harper & Row, London.
- Lowen, A. (1993). Depression and the body. New York, NY: Penguin Compass.
- Sanderson, C. (1991). Counselling adult survivors of child sexual abuse. Jessica Kingsley Publishers.
- Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. Guilford Press.