The shame of dissociation

by | 7 March 2019 | 29 comments

She enters the therapist’s room and there is nothing but terror. Something has happened – she doesn’t know what; the therapist doesn’t know what – but here she is now: here and not here. In a 30-something body, she looks child-like, fragile, vulnerable. The therapist feels the familiar thud of compassion on the inside of her, the almost-overwhelming need to protect and care and repair. Does she move towards her, take her hand, guide her to her chair? Or does she wait, encourage autonomy, let this scene play out? It’s never an easy choice, nor an obvious one. She waits.

The woman’s eyes flick around the floor. Her breath is caught up in her ribs, hardly exhaling. Her fists are clenched. Her shoulders shrug upwards around her neck, protectively. The agony of being is raw on her face. Terror and dread and shame and confusion. She shuffles slightly forwards. Everything seems strange. She’s not sure where she is, what she is doing here. She knows this place, but only as if in a dream. She doesn’t know it now. The ache of dissociation sits heavily in her.

‘Come on in,’ says the therapist softly, not daring to break the tension with too much volume. ‘You look very scared.’

The meaning of the words won’t register in her brain. She doesn’t know what she is supposed to do. Nothing makes sense. She wants to run, but the familiar unfamiliarity of being here is also drawing her in: perhaps there will be safety here, perhaps there will be love. Perhaps there will be rescue. Perhaps there will be hope.

She doesn’t dare to hope.

She stands stuck in the conflict between approach and avoid, wanting to run, wanting to stay. Her breathing jerks in and out as panic rises: the panic of not being able to choose what to do, the stuckness of this freeze, the fear of making the therapist cross, the fear of not doing the right thing. Thoughts crawl slowly, hardly at all, across her forehead. I need to leave. I want to stay. Nothing more than that. She is caught up within her own dissociativity.

‘Come on then,’ says the therapist again, even more gently, and reaches out to take her hand. Unwittingly, she flinches, pulling it away, curling her fingers tight into her palms. She doesn’t want them to be hurt. The therapist holds the motion in mid-air, waiting, patient, understanding. This is a familiar pattern. She knows that what one part fears, another part craves. Eventually, a hand stretches out tentatively, not sure if it’s allowed. She holds it lightly and guides the woman to her chair.

‘What’s happening?’ the woman says, suddenly, as if opening her eyes for the very first time. She looks dazed and sheepish.

‘It’s okay,’ says the therapist, settling back into her own chair, and letting out a silent breath of relief. ‘You got triggered by something on the way in. You’re here now.’

‘I don’t feel very here,’ the woman says, and the shame of that washes over her, bleaching her cheeks.


The therapist watches her closely, weighing things up. What to do? Force some grounding, get the adult present, shake off what’s just happened and go back to Plan A? Or Plan B: does this need exploring? Does someone need to come and talk and be heard? It is a weekly dilemma. She looks for clues in the woman’s body language. She knows if she waits that one option or the other will play out. It is early days still in therapy. Sometimes they work on grounding into the present, so as not to reinforce the helplessness of being hijacked by other parts of the personality: it is important that the woman begins to develop self-leadership and an open-door approach to her parts, where she can choose and engage and collaborate. But she’s not there yet. Parts come by force because if they didn’t, they wouldn’t come at all. Her self-loathing for being dissociative is still too high: she hates her parts, and wants to keep them out of mind. Gently, gently they progress.

The woman sits motionless, apart from flickerings on her face. Her frown, her eyes betray the battle going on in her, like several cars trying to park in the same space, and no-one is giving way. Minutes pass. The therapist sits, trying to breathe normally, aware of her own stress, focusing on staying calm and attentive. She has to stay present to her client, not be overwhelmed by her own sense of inadequacy and fear. She’s not going to get it ‘right’. She can’t be perfect. She can only be good enough. She breathes that out, like a mantra, soothing her anxiety. It will be okay.

Suddenly, dawn breaks: someone has taken control, and out come the words, like torrents of rainfall.

‘We couldn’t … when it … the … the … when the other ones … we couldn’t … because the … every time when … if they … when the people come … all of it … we can’t … and … we can’t … but they … and they … we can’t, we can’t, we can’t …’





It’s like a thunderclap of agony in the room, all of it pouring out, none of it making sense. The woman – she is hardly a woman now, but has somehow become an inconsolable child – shifts uncontrollably in her seat as if being stabbed by knives, the pain of what she’s trying to say, incomprehensible, broken, expressing itself through her body, her faltering voice, the raspy gulps of air that she’s trying to suck into her lungs between words. Her body is shaking with unbearable emotion.

The therapist feels herself being activated: panic, pain, compassion, fear. She almost doesn’t want to know what’s coming. She doesn’t want to make sense of what is being said, to fill in the gaps, to put herself back there with her client. It’s an overpowering dread and every part of her wants to run. Should she ground? Get the woman back again, to end this discharge of pain? It would be easier. It would be less terrible. Pain is sitting like a smog between them. But unshame is in connection, so in connection is where she’ll be.

She breathes, steadies herself. If the woman went through it, the least she can do it is sit with her. She chooses approach rather than avoid.

‘Oh dear,’ she says, and as the words come out she regrets how lame they sound, but she also knows that their tone carries the gravity of compassion. She just needs to make contact. It doesn’t matter what she says. She just needs to be with.

The child-woman is intense now, rising to a frenzy, her body twisting, arching away from something that is happening again, right here, right now, even though it was there and even though it was then.

‘I’m here with you now,’ the therapist says, pushing warmth and presence into every word. ‘It’s not happening now.’ She doesn’t expect the words to penetrate, just for their tone to be a bridge for connection. ‘You’re safe here. I’m with you.’

More words, trying to stuff together a sense of it, to explain, to tell the story, to vomit out some horror-ful awfulness. ‘The people … when they … and I couldn’t … if it doesn’t … we couldn’t … all of them … they’re coming … he’s going to … mummy … but I didn’t want to …’

‘No, you didn’t want to.’ The therapist doesn’t know what it was the child-woman didn’t want to do, but it hardly matters. The point is, she shouldn’t have had to. A lancet of rage stabs the therapist in the chest. She feels it, senses it trying to take over her entire body, and breathes through it. This is the client’s trauma, not hers. She has to lean in to the client, but lean back from the trauma. She’s no good if she gets caught up in it herself. She has to mentalise, notice it, observe it, but not react to it. She breathes, and breathes, and deliberately relaxes the muscles in her tummy that have unconsciously gone tight.

The woman’s distress is unabating. Out bundles a broken narrative, of things too terrible to mention, of human rights atrocities that no person, let alone a child, should witness and suffer. The therapist pushes into it, against her instincts to defend herself from the knowing of it. It is painful to listen, painful to hear. It takes all the energy she has not to absent herself from it, to sit back, be critical, be dismissive, be unbelieving. She can’t not believe what she is hearing. The now-ness of it is too real, too immanent. This pain that she is witnessing could not be acted: it is subconscious, primal, and the body is telling its story. The woman’s skin is both flushed and pale; beads of sweat on her forehead; clammy cold hands; quivering legs; narrow pupils. This is physiologically true. And anyway, there is nothing to disbelieve: the narrative is too disjointed to make much sense. All that is clear is that the child-woman is remembering some horrendous trauma, of being forced against her will to do things which shattered her sense of self.

The words dry up, as if the child-woman is being strangled by her own emotion. Rage is coursing up through her, but rage – the therapist realises, sadly – at herself. Her arm flails around to beat herself with, or to inflict pain in some way. The therapist reaches out to catch her hand, holds it gently, squeezes it tight. ‘You’re okay, I’m here, you’re safe now.’ All she can do is keep being with. All she can do is to keep being calm, like a parent soothing a baby.

Again, panic leaps through her: is this harming the client, to be reliving it like this? Possibly, but what is the alternative? She can’t shout at her to stop. She can’t walk off and refuse to engage until the client has calmed. Her words won’t register. Better to be with, she reasons – better to be present and attuned and show kindness and compassion and empathy and care, and to do her best to allow this emotional vomit to come, but to contain it. Because it’s here now; it’s happening. Theories from books don’t apply in this moment. All she can do is to stay present, and hold.

And maybe by doing that, she reasons, maybe at least she will transmit some new sense of safety, that the child-woman isn’t abandoned in this agony, that there is a witness to this untold story, that she has not had to face this pain alone. Because she knows that these flashbacks happen outside the therapy room too, when no-one is there to soothe or to help. They happen at night-time, and there is no-one to hold the flailing hand that would self-harm; there is no-one to reassure that it’s not happening now. So at the very least, maybe by doing that here, it will offer an alternative experience, one of soothing within the distress, rather than avoiding the distress altogether.

At least she hopes so. She doesn’t know. So much of this work is in the failing, the worrying, the not-knowing, the being unable to control what goes on. All she can control is herself, by breathing, by grounding, by staying present. All she can do is not feel ashamed of her own inadequacy. She resists – with difficulty – the urge to control the client, to make this agony stop. It’s not the client she wants to reject, but the awfulness of the trauma. She doesn’t have the luxury of dissociation: the therapist is feeling the full weight of this disclosure. She works hard to stay present. It’s all she can do.

Her soothing continues. Minutes pass, nearly an hour: a constant battle with panic that she’s not doing the right thing, that someone better than her should be conducting this therapy, that maybe she should refer on. But also a sense that this is all that can be done. And in between the sobs come some moments of stillness, a more coherent narrative and state of mind. Gradually, breath by breath, the client begins to calm. Eventually she switches to another part.

‘That wasn’t very nice, was it?’ says this part, and the therapist is tempted to laugh because it’s so incongruous. ‘Not very nice’ is not how she’d describe it. But there’s a fresh, invigorating straightforwardness about this part, as if they’ve seen it all before and they’re not going to be fazed by it. The therapist wonders why this part has come, rather than the woman returning. Perhaps she’s not ready to yet. Yes, that seems to fit. She needs to be two doors removed from that trauma. This part has come to fill the gap.

They talk about what’s just happened. This part – who calls ‘himself’ Switch – is earnest and frank and connecting. He seems to have a bird’s eye view of the experience of the previous, distressed part. He pulls various aspects of the narrative together into a coherent whole, explaining it, with an aching sense of hurtful loneliness, but without the same obliterating distress. So they step back from it, talk about it, process some of it. Switch is able to draw on the relational support from the therapist to think it through in whole sentences, with occasional tears. It’s raw and ragged, but whereas the previous part was lost in their own distress, Switch is connected as if with a steel braid to the therapist.

They talk about how to bring the woman into the loop. She can’t stay on the outside, the therapist explains: this is her trauma too. Switch is thoughtful but anxious. ‘She won’t cope with it yet,’ he says, with an edge of panic. The therapist accepts this, but pushes again: ‘How can I help her be ready to cope with it?’

‘It’s not the badness of it,’ Switch says, at last. ‘It’s not the trauma.’

The therapist looks at him, surprised. The horrendous evil of it is what would make her want to not know. She prods at him with her eyes, enquiring.

‘It’s the shame,’ says Switch. He doesn’t make eye-contact; he never does. He fumbles over his words for a while, as if he fears being in trouble for revealing a secret. ‘She can’t cope with it because she’s so ashamed of it,’ he says, in almost a whisper.

How could anyone be ashamed of this? the therapist thinks. It wasn’t her fault. She didn’t cause it. She’s a victim. That’s all. It’s not her shame. She knows this, but every time it surprises her, because of the gap between how she sees the woman, and how the woman sees herself.

She picks her words carefully, like stealing money from a piggy bank. ‘So how can I help her feel less ashamed, so that we can process this trauma?’ she says.

Switch shrugs. Shame is normal. Shame just is. It’s like a membrane surrounding the being. It doesn’t seem as if life is possible without it. It is a protein structure around the soul: without it, we fear annihilation.

‘She can know about the trauma a little bit,’ he adds at last, ‘but she can’t know it with you. That’s what’s so shameful.’

The therapist nods. Whilst alien, this idea at least makes sense. Shame is a two-person emotion. But if she could process this trauma on her own, she would have done it by now. The shame will only metabolise in the presence of a catalyst: another person. The therapist, whose ‘withness’ is so shaming. It is Catch-22.

Suddenly, the therapist has a thought. ‘But you don’t feel too ashamed to talk about it with me,’ she says.

Switch freezes, as if caught out, guilt creamed all over his face.

‘I’m not real, though,’ he says, nearly crying.

An eternity of sadness sits in the room between them.

‘I understand that,’ says the therapist, and it’s all she can do not to cry. ‘You can only cope with the shame by dissociating from it. You can only bear to connect with me by not being real. In a moment, when she comes back, she will deny your very existence.’

Switch nods glumly. But for once he feels understood.

Later, the therapist talks to the woman. She is frustrated that she has ‘lost’ almost her entire session.

‘What do you remember from earlier?’ the therapist asks.

The woman looks down at the floor. ‘Nothing really. Not a lot. Not much.’ She can’t decide which phrase is most apt, because she knows that there are flashes of memory there, but she doesn’t want to look at them. A nauseating sense of shame is keeping them at bay.

‘You know, shame drives dissociation,’ says the therapist softly, ‘and the dissociation drives shame. They are both ways of surviving by disconnecting.’

I look up, curious. I had never seen them as connected before. I know that I feel terribly ashamed that I ‘lose’ chunks of my session like this, that I step back into myself and fall down a hole, like Alice in Wonderland, and reality ceases to be. I am ashamed that I need to do that. I am ashamed of not being able to stop it. And more than anything, I am ashamed that sometimes I don’t want to stop it.

‘How do we fix it?’ I ask, because finding a solution is easier than facing it.

The therapist smiles and sighs. ‘We just keep doing what we’re doing. We keep connecting. And eventually, if I keep connecting with your parts, maybe I can be a bridge for you, for you to connect with your parts. And then you won’t need to feel ashamed of them any more.’

What a thought. What a strange, strange thought. Is it even possible to not be ashamed of your parts? Is it even possible not to be ashamed of yourself? Of being you?

But I look at the therapist and there she is, at home with herself, all comfy within her own skin. She knows she doesn’t have all the answers, but she isn’t ashamed of that. She knows she isn’t an expert, but she’s willing to learn. She can accept herself, flaws and all. So it’s possible, at least, for other people to accept themselves, I decide.

So why not me? Could I accept myself, my parts, and not be ashamed of them, not be ashamed of dissociation?

Why not me?

It’s the strangest of thoughts, but at least I’ve thought it now. Why not me? Indeed. Why not me?


A word of explanation

I had therapy mainly between 2006 and 2015. These blog posts are not verbatim accounts of sessions, but rather the client equivalent of ‘case studies’ - amalgamations of various sessions, ‘narratively true’ rather than ‘historically true’. Although often written for stylistic purposes in the present tense, they are very much from a past period of my life. Ideally they should be read within the wider context of other blog posts, articles and my book, to give a more integrated and rounded sense of where I was at, where I’m at now, and the process that took place between those two points. I have been on a journey of recovery, and the difference in me from when I was in therapy (especially at the beginning) to now is testament to the brain’s ability to recover from even the most appalling suffering.

My primary work now is writing, followed closely by training therapists, counsellors and other professionals to support survivors of trauma. Regrettably I cannot provide one-to-one support but our charity framework PODS (Positive Outcomes for Dissociative Survivors) provides a helpline and a range of other services: please go to for more information, and if you are looking for support.

For training, please see our range of live courses at, and our online courses at We also publish a range of resources to support recovery from trauma, which you can see at My first book, Recovery is my best revenge, is available to buy at




  1. Thank you for sharing. I am a psychotherapist working with a client with DID.
    So helpful.

  2. Thank you deeply, Carolyn ………..

  3. I can’t say how moved I was to read this thank you for sharing

  4. “It’s like a membrane surrounding the being. It doesn’t seem as if life is possible without it. It is a protein structure around the soul: without it, we fear annihilation.”

    Yes – that!

    Thankyou Carolyn,

    • I agree. For me that membrane is semi-permeable, where ‘stuff’ leaks through at times of vulnerability.

  5. I cried buckets reading this. Thank you.

  6. Thank you.

  7. Thank you Carolyn. A tender, truthful post from both sides of the therapy room.

  8. This is so moving and feels so so true. Thankyou for putting this out there Carolyn. It’s everything all together, raw, vulnerable, moving and full of hope. As a survivor and therapist this is so helpful. It captures something so essential and needed. I do relate to the acute vulnerability and the need for therapists to be real – both really there and really human x

  9. Respect and admiration to you Carolyn,

    Thank you,


  10. I don’t remember much about my first therapy session to my healing journey. I do remember the terror and carefully avoiding Paula’s hand when she reached out to shake mine. I remember drifting in and out of the room and feeling confused and not daring to hope she might be able to help me stop the chaos.

    It was almost six months before I remembered Paula’s name or even where her office was in the clinic where she worked. I relied on the little appointment cards and alters to get me there. I could see the concern and confusion in Paula’s eyes when I first began seeing her. She told me later she wasn’t sure what was happening, but she had a major theory.

    Six months after I began to see Paula, in February 1990, she gave me the diagnosis of what was then called multiple personality disorder. I had seen the movie Sybil, and I was afraid and yes, I was ashamed.

    My shame centered around my small knowledge about how Sybil supposedly formed DID. I knew my grandfather had been sexually inappropriate, but I didn’t think it was “that bad”. However, I had been having horrific flashbacks long before I approached Paula for therapy and realized that he must have done much more than I knew at first.

    The shame, blame, and denial kicked in and it hurt.

    I was ashamed of what had happened to me. I was ashamed of my memories and how I was telling Paula about them. I was a liar, I just knew it, and I was telling those stories to get attention. I was weak. I was stupid. I was crazy. I didn’t belong in this world at all and never did.

    Thank you for this article. It helped me to look back to the beginning and realize just how far I have come.

  11. As always, so encouraging and supportive. To hear the inner thoughts of the therapist to be so close to my own is such helpful feedback…and increases my confidence to stay, to hold, and to go with. Thanks.

  12. This piece evokes a myriad of feelings and thoughts to be processed. Most importantly it as if it’s the voice I find so very difficult to find when in my therapy sessions. The rawness of this piece totally explains what I can’t. Thank you.

  13. Thank you for this Carolyn. Despite being a sad piece of writing to read, I also took comfort from it as a therapist in reminding myself that in those moments, it is connection as a human being that really matters, and to feel inadequate and panicking that I am not enough for that client is a normal reaction to something you witness where you constantly question how can you be good enough for your client.

  14. Thank you Carolyn. I was able to feel the shame and distress. Thank you for finding the words, so often they evade us. Thank you for helping me to understand what my clients may not be able to vocalise. Most of all thank you for sharing with us all

  15. My granddaughter lives with me, she has a range of parts. I am worn out with them, she is worn out with them.
    We just keep on keeping on, talking through whenever she is up to it.
    I find your posts really helpful. Thank you.

  16. Thank you Carolyn for sharing such insightful, helpful work in this area of trauma and shame. Working with such brokenness and consequent dissociation is extremely challenging for therapists and does cause us to question ourselves at a deep level. I’m so thankful that I have the privilege of reading your blogs.

  17. Thank you so much Carolyn. To read the comments, thoughts and fears of failure of the therapist has been so encouraging and enlightening. To know that therapists don’t have all the answers, don’t always know what to do and sometimes are grossly aware of their limitations and inadequacies has given me the strength and courage to continue to work with DID clients. I so often have these feelings too and somehow always assumed I just don’t have the skill and knowledge of other therapists. What a relief to know I’m not alone! I so appreciate the honesty of your writing.

  18. Thank you Carolyn, I too was this therapist. I struggled to breathe when reading this. It was like you were in the room observing sessions over the past 4.5 years! I am now able to be that bridge. The Woman now accepting and open towards all parts bar the youngest, (we’re almost there though).
    The other parts now trusting the adult woman to look after them as she reassures them that they are now safe. That is old stuff and also giving them permission that it’s ok not to be ok.
    Self harming has ceased and shame is giving way to rage against others, perpetrators who stole her childhood, stole her personality, stole her innocence but can no longer steal her future.
    We are getting there, one session at time for as long as it takes. Thank you for giving me the courage to keep going. The privilege of joining my client on her journey and for my own healing along the way.

  19. Thank you Carolyn.

  20. Please know that your writing has touched levels of unchartered thoughts and realizations.
    Thank you for the opportunity and perspective.
    And also sharing of yourself, it is immensely tender and terrifyingly accurate.

  21. Wow
    Finally someone who can articulate the wrestling match that goes on inside
    Yes I want to run and hide but also I want someone to stay with me and stop the panic spreading, someone to reassure me that I’m not mad! My brain becomes so scrambled that I too struggle to form a sentence or to articulate the pain. However some part is always on watch and somehow has a birds eye view!
    Thank you for sharing I feel less mad each time I read one

  22. Awful and brilliant; brilliantly awful. Vivid, painful truth. ‘Shame is a two person emotion’ and hence the ‘Catch 22’. Why the instinct to isolate is so strong…..even and especially from my husband and children. That shame monster needs slaying and you are showing the way…….

  23. I know just how debilitating it is when i go of on one of my jollies as I call them. Not jollies at all. Some times a child or an adult amongst familier faces or are they! Whoever comes and goes it’s so different each time, but always ends with me losing my life. Usually horrifically. Not only me at times either my children to. It’s so restricting can’t shop,walk in town. Carry be left with my grandson been known to throw things thinking they are a ball. Life is so hard. Thank you for writing this artical so good for me to hear I’m not on my own.

  24. Thank you Carolyn

  25. Wow! I just forwarded my therapist this blog with a huge “Thank You!” I never realized the magnitude of turmoil that she must go through to be there for all of us. I didn’t have a choice about going through this trauma, but she does and she continues to fight the good fight with me, even so. 💜

  26. Oh my good gracious this rings too true. Thank you for being here, the validation given and the meaning given – that I may actually “be” … be all my selves. Thank you for helping me to grow very slowly towards recognising and in time accepting all of them. If I survive Anorexia which as an adult I am unable to secure any help with, poses huge risk to life, you have inspired me in trying to do whatever I can to enable change/instigate understanding where is is desperately needed e.g. within our mental health system. Bless your heart x and all those who “suffer”

  27. This was a beautiful, painful, account of both sides of the session. As a therapist, only starting out on the journey of helping clients to heal, this gives me strength and hope that I too will be able to make a difference one day with a client.

  28. Such a wonderful insight into what is going on. I often feel inadequate when working with dissociation but hearing you describe the balance between attending to you own feelings whilst being there with the client are so reassuring. I found this incredibly powerful. Thank you


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More from Carolyn…

I can’t, I couldn’t, and I can

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Why can’t I just get over my trauma?

‘If I could just get over it, I would,’ I say, and I’m trying not to sound irritated or hurt but I’m not quite sure what emotion my face is displaying and my throat is tight and my fists are clenched and really I’d rather not be here, and neither am I convinced that I’m a good enough actor to hide all of this.

It’s a pain: the physical impact of trauma

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