Shirah Vollmer MD

The Musings of Dr. Vollmer

Dissociation

Posted by Dr. Vollmer on June 7, 2012

Olivia, twenty-two, comes three times a week, but from session to session, I never know who I am going to see. Sometimes we laugh together, as she amuses me with funny stories. Other times, she rages at me, although I am never quite sure what I did that triggered her upset. Other times, she is profoundly sad, but again, I am never clear about the trigger. If I remind her of how different our dynamic feels to me from session to session, she says “I know, but I can’t help it.” Her knowing, at first made me think that this is not dissociative, but over time, I have begun to wonder that as coping with stress can be so difficult, that for some, developing different personality styles is a way of coping, similar to dissociation where, often because of severe trauma, one has to “leave” oneself in order to cope with the devastation. Olivia’s quickly shifting relating styles makes me wonder about her history of trauma where she might have felt the need to have different senses of herself, with little threads of continuity, in order not to process the pain of disappointment in her important relationships with her early caretakers. Dissociation is taking denial one step further. Bringing her personalities together, helping Olivia develop internal continuity is our work. This internal continuity is critical for self-confidence and trust in oneself. Peter Fonagy in London has said this multiple times in his work on mentalization. One must be able to think about oneself in a cohesive way in order to enjoy one’s life and not chronically suffer from painful confusion. Olivia knows she needs help with her confusion. That is a good first step.

3 Responses to “Dissociation”

  1. Shelly said

    It sounds to me like Olivia does not think about her behavior at all, cohesive way or not. Apparently she feels that she cannot control her behavior. I am reminded by my Asperger child’ therapist that everyone, even those with PDD, can control their impulses and behaviors, and so can Olivia. I understand that this blog is about the triggers of Olivia’s different personality styles and discovering those triggers as keys to uniting her behavior and making it cohesive. Does Olivia see that having these various personality styles impact her day to day living?

  2. ashanam said

    You still need a sense of self, even if what you know about your life and yourself is dissociated, so you develop different ways of seeing yourself and of being so that no matter what information you have access to at that moment you can continue to feel like a person. In other words, the facts are held apart, and it’s from the facts about ourselves (how we feel, how we’ve acted, what we’ve thought, how we’ve been treated) that we come up with our understanding of who we are. So we end up creating different selves.

    There are also times when you “learn” things about yourself or the world at traumatic moments that are incompatible with what you learn at other traumatic moments, or they are simply incompatible with living. And yet they were learned during very intensely emotional moments and can’t simply be set aside as not making sense. So these are held apart in the mind, resulting in a different sense of oneself. At least that has been my experience. The trauma has to be addressed before the personality can be integrated, but they occur together.

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