Pacing

How many of you are trained in working with dissociation? I expect a lot of you are. Along the way, I’ve picked up tips from renowned trauma experts. But, I’ve learned the most from clients.

I’m thinking of one person from years ago. He and his wife wanted couples therapy. At the onset he warned me, “I dissociate, and I might need help grounding.” That was helpful, and his warning was astute. I didn’t want to assume anything, because often when people self-diagnose, they’ve come to their conclusions in a non-scientific way. It usually involves a lot of Googling, pop-psychology and contradicting opinions from all the professionals they’ve seen over the years. 

“Dissociation” and “trauma” are words that get thrown around in the common vernacular. The other day, my 15 year-old daughter said, “Ok, I’m just going to dissociate right now” because she was annoyed with her brother. She continued to go about her day with the safety of her snug airpods. I laughed, but maybe I shouldn’t have. People who have trouble staying “in the room” have endured great suffering.

Back to my client: during sessions he would give very obvious dissociative signals. His eyes got wide and I could sense that he could no longer follow the conversation. The flow came to a halt. Luckily, we had an agreement. During the intake, I asked if I could check in every now and then. I was transparent about the way I wanted to do it. “On a scale of 0-10, how much are you here or not here? 0 is not here at all, 10 is all the way here.” And then, I asked what that scale actually meant to him (while he was present). He told me that a 4 or 5 was in the danger zone. I don’t think we ever got below a 6. 

You can imagine it was difficult for his wife. While she had compassion and understanding, she never knew what would trip the wire. This left her feeling like she wasn’t good enough and could never make a wrong move. So, in a way - his trauma response hit them both at the same time. It had a huge relational impact.

I remember working with the wife and glancing over at the husband. He was pinching his hands, trying to stay in the room. I said, “I see you trying to be here. What’s your number?” He said “Six.” At that point, his wife reached her hand over to grab his. I lost track of what we were working on. 

This is where my client taught me something important. Instead of trying to push through with whatever it was we were slowing down, I dropped it. I didn’t feel like I had an option. Something about the wisdom of his fingers pinching his own hand struck me. He was both slipping away and trying to be present. This self-inflicted pain is the perfect metaphor for his internal struggle. It would have been easier to fade into the back of the couch and tune out. But, he was willing to pinch himself in order to feel something and stay engaged. He desperately wanted to work on his relationship with his wife.

*You’re not wrong to be wondering about a history of self harm. To read the best and least pathological explanation of cutting - read a General Theory of Love.

I said, “I think what’s happening right now is more important than anything else we could do. What’s it like to feel yourself slip away, try to be here and have your wife reach to hold your hand?”

Trauma therapists know what happens next. There’s shame associated with needing help. But, there’s also relief in being seen. 

It required more slowing down, but at the end of the session, the husband said, “A part of me wants you to hold me.” And that was all it took. The wife reached across the couch, pulled him close and kissed his forehead again and again.

We never went past the window of tolerance - at the end of the session he was an 8. The smallest moment became a pretty big moment. This pacing felt good to me - to my nervous system! What this client taught me is that I can apply this to clients that don’t “require” it. There’s more room for error with clients that don’t dissociate easily. But, when I lose my focus and get a little too comfortable - I’m exhausted at the end of the session. 

I wish I could trick myself into thinking every client required that laser sharp focus and slow, yet active pacing. Maybe writing it here can help all of us. Let’s remember: slower is faster. More focus equals less energy in the long run. And, of course - there’s room for rupture and repair, with yourself and your clients.

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