Why Do I Dissociate During Therapy Sessions? A Therapist’s Guide to What’s Really Happening

By Annie Wright, LMFT · Licensed Marriage & Family Therapist (#95719)Clinically reviewed May 2026

LAST UPDATED: APRIL 2026

Why Do I Dissociate During Therapy Sessions?

The Neurobiology: Why Your Body Leaves Before You Decide To

Bessel van der Kolk, M.D., has described dissociation as the “escape when there is no escape.” This phrase captures both the neurobiological logic and the developmental context of the response. (PMID: 9384857)

From a polyvagal perspective — drawing on the work of Stephen Porges, Ph.D. — dissociation corresponds to the activation of the dorsal vagal complex, the oldest branch of the autonomic nervous system. When the nervous system detects threat that can’t be fought or fled (which is the defining condition of childhood trauma — you can’t fight or flee your own parents), it drops below fight-or-flight into the freeze/collapse response. Heart rate decreases. Blood pressure drops. The system essentially plays dead, and consciousness — the experience of being present in the body, in the room, in this moment — partially shuts down. (PMID: 7652107)

This is an ancient survival strategy. In the animal kingdom, it’s what a mouse does when caught by a cat: go limp, stop struggling, reduce metabolic demand, conserve energy, and wait. In a human child trapped in an abusive or neglectful home, it manifests as emotional numbing, detachment from the body, the ability to “go somewhere else” mentally while remaining physically present. It’s not weakness. It’s a highly efficient survival adaptation that kept you alive in conditions where the alternative — staying fully present and feeling everything — would have been unbearable.

The problem, as van der Kolk and Janina Fisher both emphasize, is that the survival response doesn’t know the war is over. It was encoded during a period of genuine danger, and it fires automatically when current conditions resemble the original threat — not in their content but in their structure. The therapy room, paradoxically, can structurally resemble the conditions of childhood trauma in several key ways: you’re in a room with an authority figure, you’re expected to be vulnerable, you’re discussing emotional material, there’s an implicit power differential, and you can’t easily leave (both literally and because your attachment system has engaged).

Your nervous system doesn’t evaluate these parallels consciously. It evaluates them through neuroception — the subcortical process Porges describes as the body’s automatic scanning for safety and threat. When neuroception detects structural similarity between the current context and the conditions of original trauma, it activates the old survival protocol. In Vivian’s case: emotional intimacy + authority figure + vulnerability = danger = dissociate. The equation runs in milliseconds, below the level of conscious choice.

How This Shows Up in Driven Women

I want to talk specifically about how dissociation manifests in driven, ambitious women, because the presentation is often subtle enough to be missed — by therapists and by the women themselves.

When most people picture dissociation, they imagine something dramatic: a blank stare, a total loss of responsiveness, an inability to speak. And sometimes it does look like that. But in driven women — women who have spent decades learning to maintain performance under internal duress — dissociation often looks like continued functioning. The lights are on, but nobody’s home. They’re still talking. Still making eye contact. Still forming coherent sentences. But internally, they’ve stepped back from the experience. They’re narrating rather than feeling. Analyzing rather than inhabiting. They’re present in form but absent in substance.

Vivian describes it as “going to my commentator’s booth.” She can observe the therapy session, form opinions about it, even offer what sounds like emotional insight — “I think the reason that bothers me is because it reminds me of my father” — while being completely disconnected from the emotional reality of what she’s describing. She’s intellectualizing. And she’s so good at it, so fluent and articulate and composed, that a therapist who isn’t specifically trained to recognize dissociation in its subtle forms might not notice that the woman on the couch isn’t actually processing anything. She’s performing processing. It looks like therapy. It isn’t.

This is one of the reasons I’m so insistent that therapists working with driven women need to be trained in somatic awareness and dissociation. Because these women won’t show you their dissociation in the ways your textbooks described. They’ll show it in the flatness beneath their articulate narrative. In the slight glazing of the eyes while the mouth keeps forming perfect sentences. In the quality of their emotional descriptions — technically accurate but experientially hollow, like reading a restaurant review instead of tasting the food.

Elaine, another client, didn’t realize she was dissociating in therapy for the first six months of our work. “I thought I was just calm,” she told me. “I thought that’s what processing looked like — talking about hard things without falling apart.” It was only when I asked her, mid-session, what she was feeling in her body — not what she was thinking about, but what she could actually feel — and she looked at me with genuine bewilderment and said, “I don’t think I feel anything right now,” that we both recognized what was happening. She wasn’t calm. She was dissociated. And the difference matters enormously, because calm can process. Dissociation can’t.

This distinction — between genuine emotional regulation and dissociative detachment masquerading as calm — is one of the most clinically important distinctions in trauma therapy. And driven women, who have spent their lives cultivating the appearance of composure, are experts at the masquerade. Not because they’re being dishonest. Because the survival strategy is so deeply embedded that they can’t tell the difference themselves. They genuinely believe they’re regulated when they’re actually numb. They interpret the absence of feeling as the presence of calm. And unless someone names it — gently, precisely, without judgment — they’ll continue performing emotional work without actually doing it.

Why Therapy Specifically Triggers Dissociation

It’s worth asking the question directly: why does this happen in therapy specifically? If dissociation is a survival response to perceived threat, what is it about the therapy room that the nervous system reads as threatening?

The answer lies in the structural parallels between therapy and the conditions of relational trauma, and it’s more nuanced than it might initially appear.

Emotional intimacy. For someone who grew up in an environment where emotional closeness was accompanied by pain — where vulnerability was met with dismissal, criticism, or exploitation — the experience of being emotionally known by another person can activate the same alarm system that the original relationship did. The therapist isn’t threatening. But the intimacy is, because intimacy and danger were linked in the neural circuitry long before the client arrived in the therapy room.

The power differential. However egalitarian the therapeutic relationship is designed to be, there is an inherent asymmetry: the therapist holds professional authority, sets the frame, controls the clock, asks the questions. For someone whose childhood trauma involved a parent misusing their authority — through control, unpredictability, or emotional dominance — the structural features of the therapeutic relationship can trigger the same adaptive responses the child used with the parent. Including dissociation.

Approaching trauma material. This is the most obvious trigger and the one most people think of first. When the conversation in therapy turns toward traumatic memories, emotions, or body sensations, the nervous system may activate the same defense that was used during the original trauma. This is not a flaw in the therapy. It’s the trauma revealing itself. The dissociation is the material — it’s showing the therapist exactly how the client survived, and exactly where the edge of their current processing capacity lies.

Being seen. For some clients, the most activating aspect of therapy isn’t what they say. It’s the experience of being witnessed while they say it. Being truly seen by another person — having someone attend to your emotional reality with warmth and precision — can be overwhelmingly activating for someone who grew up invisible, misattunned to, or punished for being known. Elaine once told me, “The hardest thing about therapy isn’t talking about my mother. It’s that you’re actually listening.“

Hope. This one is rarely discussed, but I see it clinically: for some clients, the possibility that therapy might actually help is itself destabilizing. If you’ve protected yourself for decades by not hoping — by keeping expectations low, by never fully investing in the possibility of change — the emergence of hope feels dangerous. Hope means vulnerability. Vulnerability means the possibility of disappointment. And disappointment, for someone whose early relationships taught them that expecting care would only lead to pain, is a threat worth dissociating to avoid.

Both/And: Dissociation Is Protective and It Needs Attention

I hold two truths about dissociation simultaneously, and I invite you to hold them with me.

Dissociation saved you. When you were a child in an environment you couldn’t escape, dissociation was the most sophisticated survival strategy available to your developing nervous system. It allowed you to endure the unendurable. It preserved your functioning when full emotional presence would have been overwhelming. It wasn’t a malfunction. It was engineering — your brain’s way of partitioning unbearable experience so that the rest of you could keep developing, keep learning, keep surviving. Any framework that treats dissociation as a “symptom to eliminate” without honoring its protective function is missing the full picture.

And: dissociation, when it continues to operate in contexts where it’s no longer needed — like the therapy room, where you are safe and supported and choosing to be — can become a barrier to the healing it was originally designed to protect. You can’t process what you can’t feel. You can’t integrate what you can’t stay present with. If your nervous system keeps pulling you out of the room every time the work approaches something important, the therapy circles around the wound without ever reaching it. The defense that once saved you can, in adulthood, become the wall between you and recovery.

Both things. At once. Without resolving the tension between them.

In my work with Vivian, we’ve spent a significant portion of our time learning to relate to her dissociation with curiosity rather than frustration. Instead of “Why can’t I stay present?” the question becomes: “What is this part of me protecting me from? What does it need to know about the current situation that would help it relax its guard?” This is the language of parts work — specifically Internal Family Systems (IFS) — and it has been transformative for clients who previously experienced their dissociation as a shameful adversary.

When Vivian’s dissociation arrives in session now, we don’t fight it. I don’t say “stay with me” or “try to focus.” Instead, I say something like, “I notice something just shifted. Can you feel it?” And sometimes she can — a lightness in her head, a numbness in her hands, a sense of watching from outside herself. And we stay there, at the edge. We don’t push through the dissociation. We don’t retreat from it. We practice being at the boundary, noticing it, describing it, staying in relationship while it’s happening. Over time, this practice of being with the dissociation — neither fighting nor following it — gradually widens Vivian’s capacity to stay present with emotional material that used to send her to the ceiling.

The change isn’t dramatic. It’s incremental. Where she used to dissociate at fifteen minutes, she now sometimes makes it to thirty. Where she used to leave and not return for the rest of the session, she now sometimes floats and then comes back — sometimes within the same breath. Each return, each moment of staying present a little longer than the time before, is a neural pathway being rewritten. It’s the nervous system learning, one tiny increment at a time, that proximity to emotional material doesn’t have to end in danger. That being seen doesn’t have to mean being hurt.

The Systemic Lens: Why “Just Stay Present” Isn’t the Answer

There’s a popular framing in wellness culture that treats presence as a personal achievement and dissociation as a personal failure. Mindfulness culture, in particular, can inadvertently reinforce this binary: being present is good, being absent is bad, and the solution is more meditation, more breathing, more willful attention.

This framing ignores the systemic reality that dissociation doesn’t develop in a vacuum. It develops in response to conditions — relational trauma, childhood neglect, systemic oppression, environments where staying fully present would have been psychologically dangerous. Telling a trauma survivor to “just stay present” without acknowledging why their system learned to leave is like telling someone with a broken leg to “just walk normally.” The instruction ignores the injury.

This is particularly relevant for women of color, queer women, and women who have experienced systemic marginalization, for whom dissociation may function not only as a response to familial trauma but as a response to living in a world that routinely demands their emotional labor while simultaneously invalidating their experience. The capacity to “check out” — to go through the motions while protecting one’s inner world — can be an essential survival skill in environments where being fully seen is dangerous.

A trauma-informed therapist understands this. They don’t pressure their clients toward presence as though it were a moral virtue. They recognize that dissociation has a context, a history, and a function, and they work with the conditions that make presence feel safe — gradually, collaboratively, at the client’s pace — rather than demanding presence as a prerequisite for treatment.

The broader cultural expectation that women, in particular, should be emotionally present and available at all times — to their partners, their children, their employers, their therapists — is itself a systemic demand that can make dissociation feel like betrayal. When you live in a world that expects your constant emotional availability, the experience of not being able to stay present feels like you’re failing at womanhood itself. This is not incidental. It’s a gendered overlay on a neurobiological phenomenon, and naming it matters.

Elaine articulated this beautifully: “Everyone wants me to be here. My kids, my husband, my team at work, my therapist. And I want to be here. But my body has its own timetable. It decides when I’m here and when I’m not, and I’m just the last to know.” That experience — of being caught between the demand for presence and the body’s insistence on protection — is not a personal failing. It’s the lived reality of navigating the world in a nervous system shaped by trauma.

A Path Forward: Working With Dissociation, Not Against It

So what should actually happen when you dissociate in therapy? What does a skilled trauma therapist do? And what can you, as a client, begin to practice?

What a skilled therapist does:

First, they notice. A therapist trained in dissociation will be watching for the subtle signs — the slight unfocusing of the eyes, the shift in breathing, the change in vocal tone, the quality of the client’s narrative becoming more abstract or intellectualized. They don’t wait for dramatic indicators. They read the body, not just the words.

Second, they name it gently. Not with alarm, not with correction, but with warm curiosity. “I’m noticing something just shifted. Can you feel what’s happening?” This naming serves a dual function: it validates the client’s experience (someone sees what’s happening) and it invites the client back toward contact with themselves (the act of noticing the dissociation is itself a form of presence).

Third, they orient to safety. Janina Fisher’s approach emphasizes helping the dissociated client reconnect with present-moment safety cues: the solidity of the chair, the temperature of the room, the therapist’s calm face. This orientation activates the ventral vagal system — the social engagement system that brings people back online — through sensory, body-based channels rather than cognitive ones. Because cognitive channels are offline during dissociation. You can’t think your way back. But you can feel your way back, through the soles of your feet, the warmth of a tea cup, the sound of a calm voice.

Fourth, they adjust the pace. The dissociation is a signal that the material has exceeded the client’s current capacity. A skilled therapist responds by slowing down, moving away from the activating content, and returning to stabilization. This isn’t avoidance. It’s clinical precision. You don’t force a system that’s gone offline to process material it can’t yet hold. You widen the capacity first, and then approach the material again.

Fifth, they treat the dissociation as clinical material, not as an obstacle. Fisher writes extensively about how the dissociation itself — the quality of it, the timing of it, the specific triggers that evoke it — contains essential information about the client’s trauma history and the protective strategies their system developed. A therapist who is curious about the dissociation rather than frustrated by it will learn more from the moments when the client leaves than from the moments when the client stays.

What you can begin to practice:

If you’re the client experiencing dissociation in therapy, here are some things that may help — not to prevent the dissociation (that’s not the goal) but to build your capacity for noticing it and gently returning from it.

Learn your early warning signals. Dissociation doesn’t arrive without precursors. There are usually subtle body signals that precede the full departure: a tingling in the hands, a change in visual clarity, a sensation of lightness or heaviness, a ringing in the ears, a sense of distance from your own voice. These vary by person. Learning your specific signals gives you a narrow window — a few seconds, sometimes — in which you can anchor before the dissociation completes.

Use sensory anchors. Keep something with tactile interest nearby — a textured stone, a piece of ice, a small object with weight. When you notice the early signals, bring your attention to the object. Not as a distraction from the material, but as a bridge between the material and your body. The goal is to stay connected to your body while approaching the emotional content, rather than having to choose between the two.

Tell your therapist it’s happening. This is hard. It requires breaking the performance of being fine and saying, in real time, “I think I’m starting to float” or “I can feel myself checking out.” But saying it — while it’s happening — is itself a form of staying present. The words become an anchor. And your therapist’s response — calm, unsurprised, welcoming — teaches your nervous system something new: someone can see me leaving, and instead of punishing me or ignoring it, they help me come back.

Don’t judge the leaving. The shame about dissociation is often more damaging than the dissociation itself. When you add self-criticism to the already disorienting experience of losing contact with yourself, you compound the distress and make it harder to return. Practice something closer to observation: There it goes. My system is doing its thing. That’s interesting. Not bypassing, not forcing positivity, just reducing the punitive layer. Over time, that neutral observation creates more space for the nervous system to do something different.

Practice returning slowly. When you come back from dissociation — when the room sharpens and your body reasserts itself — don’t rush immediately into content. Take a moment. Feel your feet. Look around the room. Make eye contact with your therapist. Let your system resettle. The return is as important as the departure, because it’s in the return that your nervous system learns: I can leave and come back. I can approach the hard thing and survive. The world is still here when I return. And so am I.

Vivian and I have been working together for eighteen months. She still dissociates in sessions, but the quality has shifted. It’s shorter, less complete, and — most importantly — she can name it while it’s happening. “I’m going,” she’ll say, sometimes with a rueful half-smile. And I’ll say, “I see you. Take your time.” And she comes back. Faster each time. Each return is a small revolution — the nervous system learning, one synapse at a time, that presence doesn’t have to equal danger.

If you’re the woman in the therapy room who keeps leaving — who keeps floating up, zoning out, disappearing behind the performance of processing — I want you to know: your nervous system is not betraying you. It’s protecting you with the only strategy it had when the original danger was real. The work isn’t to defeat that protection. It’s to gradually show your system that the conditions have changed. That this room is different. That this person is different. That you can stay — not because you should, not because it’s the “right” thing to do, but because it’s finally, genuinely safe enough to.

That takes time. It takes a therapist who knows how to work with dissociation rather than against it. And it takes a fundamental shift in how you relate to the parts of yourself that learned to leave — from shame to gratitude, from frustration to curiosity, from “what’s wrong with me” to “what did this part of me survive?”

The answer to that question, when it finally arrives, won’t come as a thought. It’ll come as a felt sense — a settling, a warmth, a quiet return to your own body — that lets you know: I’m here. I stayed. And it was okay.

References

Peer-Reviewed Research (Vancouver)

1. van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, et al. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One. 2024;19(1):e0295926. doi:10.1371/journal.pone.0295926. PMID: 38198456.
2. Porges SW. Polyvagal Theory: Current Status, Clinical Applications, and Future Directions. Clin Neuropsychiatry. 2025;22(3):169-184. doi:10.36131/cnfioritieditore20250301. PMID: 40735382.
3. Reisz S, Duschinsky R, Siegel DJ. Disorganized attachment and defense: exploring John Bowlby's unpublished reflections. Attach Hum Dev. 2018;20(2):107-134. doi:10.1080/14616734.2017.1380055. PMID: 28952412.

Books & Cultural Sources (Chicago Author-Date)

• Fisher, Janina. Healing the fragmented selves of trauma survivors. Taylor & Francis Group, 2017.

About the Author

Annie Wright, LMFT

LMFT · Relational Trauma Specialist · W.W. Norton Author

Helping ambitious women finally feel as good as their résumé looks.

Annie Wright is a licensed psychotherapist (LMFT #95719) and trauma-informed executive coach with over 15,000 clinical hours. She works with driven, ambitious women — including Silicon Valley leaders, physicians, and entrepreneurs — in repairing the psychological foundations beneath their impressive lives. Annie is the founder and former CEO of Evergreen Counseling, a multimillion-dollar trauma-informed therapy center she built, scaled, and successfully exited. A regular contributor to Psychology Today, her expert commentary has appeared in Forbes, Business Insider, Inc., NBC, and The Information. She is currently writing her first book with W.W. Norton.

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