Psychologists use the term ‘dissociation’ to describe a range of unusual experiences, often 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.
Kennerley (2009) proposed a clinically useful distinction between different types of dissociation in a model which combined both categorical and continuum approaches, and which was based upon a 2005 model (Holmes et al., 2005). Categories of the model are described below, 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’, and to develop coping mechanisms by teaching skills such as grounding.
The term ‘grounding’ was coined by Alexander Lowen in his 1976 book Bioenergetics. Lowen’s theory proposed that people are “physically, emotionally, and energetically grounded to the earth” (de Tord & Bräuninger, 2015) and that 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). Lowen described grounding as serving “the same function for the organism’s energy system that it does for a high tension electrical circuit. It provides a safety valve for the discharge of excess excitation. In an electrical system the sudden buildup of charge could burn out a part or cause fire. In the human personality the buildup of charge could also be dangerous if the person were not grounded. The individual could split off, become hysterical, experience anxiety, or go into a slump”.
Bioenergetics currently defines itself as a “specific form of body-psychotherapy, based on the continuity between body and mind, founded by Alexander Lowen” (IIBA, 2013). Grounding forms an essential pillar of the approach, and incorporates 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).
Grounding techniques are now used by psychological therapists working with survivors of trauma. Key symptoms of post-traumatic stress disorder (PTSD) include unwanted memories (flashbacks) which intrude into consciousness. These can also be accompanied by varying degrees of detatchment from the present moment. For some people, intrusive memories and sensations can be so strong that it feels as though the traumatic events are happening again in the present moment (Ehlers & Clark, 2000; Ehlers, Hackmann & Michael, 2004).
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). Grounding is described as “any methods that keeps her in touch with reality – for example, touching the ground hard with her feet; rubbing her hands on the arm 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.” A brief description of grounding in the treatment of psychological trauma also appears in the 1991 edition of Counselling adult survivors of childhood sexual abuse (Sanderson, 1991).
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.
- Cognitive grounding techniques, which allow individuals to reassure themselves that they are safe in the present moment by, for example, telling themselves that the trauma is over and that they are safe in the <current location> at the <current date>
This illustrated Grounding Techniques Menu handout very briefly describes dissociation, and the rationale for using grounding techniques to ‘help you to come back to the present moment’. It provides eight categories of grounding techniques, with multiple examples of each. Clients who experience dissociation, or any other distress that takes them away from the present moment, can be encouraged to try a range of techniques, to see which works most effectively for them.
“Do you ever have any experiences where you have unwanted memories, ‘space out’, or feel detached or disconnected from what is going on? The term for anything that takes your attention away from the present moment is ‘dissociation’. We all do it from time to time – daydreaming or concentrating hard are both types of dissociation which can feel quite nice – but when dissociation is unpleasant or takes you to places where you don’t want to go, we can do something about it.
One way of thinking about dissociation is that it is a survival mechanism. It kicks in when you aren’t physically able to escape a situation – your mind may ‘escape’ by detaching from the experience. Once that has happened during a traumatic experience, it is as if your mind has found out how to do it, and you might notice that you dissociate at other times too – perhaps at times that are not traumatic but are stressful.
I would like us to try some ‘grounding techniques’ together. Would you be willing to give them a try?”
Grounding requires practice to work effectively. Clients should be encouraged to attempt a range of techniques to find out which are most effective for them. Carefully graded exposure to triggers can be attempted in therapy sessions and combined with the use of grounding techniques to help clients to practice their skills. Clients should be encouraged to carry grounding objects with them (e.g. essential oils, grounding objects).
- 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.
- Fisher, J. (1999). The work of stabilization in trauma treatment. Trauma Center Lecture Series, Boston, Massachusetts.
- 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. (1993). Depression and the body. New York, NY: Penguin Compass.
- Sanderson, C. (1991). Counselling adult survivors of child sexual abuse. Jessica Kingsley Publishers.
- Wieland, S. (1998). Techniques and issues in abuse-focused therapy with children & adolescents: Addressing the internal trauma. Sage.
- Zerubavel, N., & Messman-Moore, T. L. (2015). Staying present: Incorporating mindfulness into therapy for dissociation. Mindfulness, 6(2), 303-314.