Psychotherapy for Dissociation: Understanding and Healing Through Trauma Therapy

Dissociation is something most people experience in mild forms. You drive a familiar route and arrive without remembering the journey. Your mind drifts completely away from a conversation. You feel briefly unreal, as though you’re watching yourself from a slight distance. These experiences are common and usually pass quickly.

For some people, dissociation goes considerably further. At the more significant end, it can involve sustained gaps in memory, profound disconnection from the body, or the experience of distinct identity states that feel separate from one another.

Dissociation is not a character flaw or a sign of weakness. It is a protective response, developed by a nervous system that needed to manage what couldn’t be processed or escaped at the time. Understanding it as adaptive rather than pathological is usually where the work of healing begins.

Why Does Dissociation Develop?

Dissociation most commonly develops in response to trauma, particularly chronic relational trauma that begins in childhood. When a child’s environment is consistently frightening, unpredictable, or emotionally unavailable, the mind learns to create distance from experience as a means of survival. That might mean switching off emotionally, leaving the body perceptually, or compartmentalising aspects of experience that are too painful or conflicting to hold together.

This capacity doesn’t simply resolve when circumstances change. It becomes a learned response pattern, often operating automatically and outside conscious awareness. In adulthood, dissociation may be triggered by sensory cues that carry associations the conscious mind has no access to: a tone of voice, a particular smell, a quality of light. It frequently surfaces in intimate relationships and in therapy itself, precisely because those are the contexts that most closely echo the relational environment where it first developed.

The Spectrum of Dissociative Experience

Derealisation

Derealisation describes a felt sense that the external world is unreal, distant, or distorted. People describe the world looking flat, dreamlike, or as though there is a pane of glass between themselves and their surroundings. Objects may appear to change size or shape. Familiar environments feel strange. This experience can be brief and fleeting, or it can persist for extended periods and significantly affect daily functioning.

Depersonalisation

Depersonalisation involves a disconnection from one’s own self. People describe watching themselves from outside their body, feeling like an observer of their own thoughts, emotions, or actions rather than the person experiencing them. There may be a sense of emotional numbness, of knowing intellectually that something should produce a feeling but not being able to access it. The body may feel unfamiliar, unreal, or as though it doesn’t quite belong to the person inhabiting it.

Derealisation and depersonalisation frequently occur together and are often the first dissociative experiences people name in therapy. They are also the most commonly minimised, both by the people experiencing them and sometimes by clinicians unfamiliar with the dissociative spectrum.

Dissociative Amnesia

Dissociative amnesia involves gaps in memory that go beyond ordinary forgetting. These may be gaps around specific traumatic events, periods of time that are simply absent, or an inability to recall significant personal information. Some people discover evidence of things they have done that they have no memory of. Others find that their history feels inaccessible or flat, as though it belongs to someone else.

Dissociative Fugue

Dissociative fugue involves travelling away from one’s usual environment, sometimes to unfamiliar places, with no memory of the journey or the period of time involved. It can involve the temporary adoption of a different identity. Fugue states are less common than other dissociative experiences and are often associated with severe or prolonged trauma.

Identity Alteration and Identity Confusion

At the more complex end of the dissociative spectrum, people experience distinct shifts in how they relate to themselves, others, and the world. This can range from noticing different aspects of self that feel disconnected from one another, to the experience of distinct identity states with their own perspectives, voices, memories, and ways of relating. Dissociative Identity Disorder sits at this end of the spectrum and is more common than is widely understood, though it remains significantly underdiagnosed.

When Dissociation Becomes a Difficulty

Dissociation can arise alongside a range of other experiences, including PTSD, anxiety, depression, and the longer-term effects of childhood abuse or neglect. It can also develop following acute trauma in adulthood. You do not need a formal diagnosis to seek support. If dissociative experiences are confusing, distressing, or affecting your daily life, that is sufficient reason to explore them.

Some signs that dissociation may be affecting you more significantly:

Losing time you cannot account for
Feeling unreal or detached from yourself or the world around you
Gaps in your personal history that others can recall but you cannot
Noticing sudden shifts in mood, behaviour, or sense of self that feel disconnected from one another
Finding items you don’t recall acquiring, or evidence of actions you have no memory of

Therapy for Dissociation

Therapy for dissociation is not about pushing toward difficult material or recovering memories. It is careful, gradual work that begins with establishing enough safety and stability to make deeper exploration possible. The first stage is typically about understanding what dissociation is doing, what triggers it, what it has been protecting, and how to develop enough internal resource to work with it more directly over time.

The therapeutic relationship is central to this process. Dissociation that developed inside early relationships tends to shift most significantly inside a reliable, consistent, and genuinely safe relational context. That is not something that can be replicated by a technique alone or rushed.

My approach is psychodynamic, paced carefully, and informed by extensive specialist training in dissociation. I work with adults across the full dissociative spectrum, including complex dissociative presentations and DID. I hold the SCID-D qualification, the most comprehensive clinical instrument available for assessing dissociation, and I draw on this training to inform my clinical work with clients. I also offer clinical supervision to therapists working with dissociation, including those encountering more complex presentations for the first time.

If you’re unsure whether what you’re experiencing is dissociation, or whether therapy might help, I’d be glad to have an initial conversation. Get in touch at samanthamerry.co.uk/contacts.

Resources for Clients and People Exploring Their Own Experience

Dissociation Made Simple by Jamie Marich, a stigma-free, clinically grounded guide written with warmth and without pathologising language, accessible to anyone new to understanding their dissociative experience
Amongst Ourselves by Tracy Alderman and Karen Marshall, a practical, survivor-centred resource for people living with dissociation
Got Parts? by ATW, written by and for people with DID, offering an inside perspective on living with and understanding a dissociative system
First Person Plural (firstpersonplural.org.uk), a UK-based charity supporting people with dissociative conditions and their families. Whilst the charity is now closed their website still offers useful resources.
The Crappy Childhood Fairy on YouTube, Anna Runkle’s channel covers C-PTSD and dissociation in a direct, relatable tone
Therapist Uncensored podcast, with several episodes on trauma, dissociation, and the nervous system presented accessibly for a general audience

Resources for Professionals

The Haunted Self by Onno van der Hart, Ellert Nijenhuis, and Kathy Steele, the foundational clinical text on the Theory of Structural Dissociation of the Personality, essential reading for anyone working with complex dissociative presentations
Treating Trauma-Related Dissociation by Kathy Steele, Suzette Boon, and Onno van der Hart, a practical clinical companion to The Haunted Self, with direct application to therapeutic work across the dissociative spectrum
Trauma and Dissociation Informed Psychotherapy by Bethany Brand and colleagues, grounded in the ISSTD guidelines and offering a phased treatment framework with strong evidence support
Rebuilding Shattered Lives by James Chu, particularly useful for clinicians working with the relational and attachment dimensions of complex dissociative disorders
The International Society for the Study of Trauma and Dissociation (ISSTD, isst-d.org), the leading professional organisation in the field, with training, guidelines, a therapist directory, and an annual conference
The Pottergate Centre for Dissociation and Trauma (pottergate.co.uk), a UK-based specialist centre offering training, consultation, and supervision for clinicians working with dissociative disorders
ESTD-UK (https://estduk.org) is the UK professional network of the European Society for Trauma and Dissociation, for clinicians, academics, and researchers with a professional interest in complex trauma and dissociation
CDS UK, the Clinic for Dissociative Studies (clinicds.org.uk), a national specialist service and registered charity offering assessment, treatment, supervision, training, and consultation across the UK, and an independent provider to the NHS. A key referral point for complex dissociative presentations and a source of specialist clinical consultation.
The CTAD Clinic, the Complex Trauma and Dissociation Clinic (ctadclinic.co.uk), based in Cheshire with a satellite clinic in central Manchester. Offers specialist assessment, therapy, supervision, and training for complex trauma and dissociative disorders, works alongside NHS Integrated Care Boards, and follows ISSTD treatment guidelines. Their YouTube channel is also a useful CPD resource.

Samantha Merry is a BACP Senior Accredited Psychotherapist and Clinical Supervisor in private practice in Bromley, South East London. She holds the SCID-D qualification and has specialist training in dissociation from the Pottergate Centre, the European Society for Trauma and Dissociation, and the Tavistock and Portman NHS Trust. She is currently undertaking a Professional Doctorate in Psychotherapy and Psychological Trauma at the University of Chester. samanthamerry.co.uk