5 Signs That Dissociation May Be Present in Therapy

Recognizing dissociation through an adaptive lens in therapy.

Posted March 19, 2026 | Reviewed by Margaret Foley

This is Part 2 of a three-part series. Read Part 1 here .

In the first post in this series, I explored a sentence I often hear from trauma therapists: “I treat trauma, but I don’t treat DID (dissociation).”

The challenge is that dissociation often appears in therapy long before anyone names it. Many clinicians are already encountering dissociative experiences in their work without realizing it. Dissociation exists on a spectrum. It is a natural response of the mind when experiences become overwhelming and the nervous system cannot safely integrate what is happening. Dissociation is not a sign that something is wrong with the mind. It is instead often a reflection of how hard the mind has worked to survive. Because of this, dissociation does not always present in dramatic or obvious ways, despite what Hollywood may have led us all to believe. More often, it appears in subtle ways that can easily be misunderstood.

Five signs that dissociation may be present in the therapy room

1. Sudden shifts in a client’s emotional state

A client may move rapidly from feeling calm to overwhelmed, or from emotionally engaged to completely shut down. At times, these shifts can feel confusing to both the client and the therapist. A person who was just discussing something painful may suddenly appear numb, detached, or emotionally flat. What can look like inconsistency is often the nervous system doing its best to maintain safety by shifting between internal states or parts.

2. Clients describing “parts” of themselves

Clients may say things like:

Many therapists hear this language and interpret it as metaphor, or they filter it through models they have been trained in, such as Internal Family Systems (IFS). Sometimes that framework fits. But for trauma survivors, this language can also reflect a lived internal experience shaped by dissociation. With complex trauma, however, dissociative parts hold distinct memories, roles, and experiences, sometimes accompanied by dissociative amnesia. This is not the same as working with parts metaphorically. It reflects a different level of internal organization that develops in response to overwhelming trauma.

Listening closely to how a client describes their internal experience can offer important insight into how their system is organized and how different aspects of self are working to navigate safety.

3. Memory gaps or confusion about experiences

Clients may struggle to recall important events, conversations, or emotional experiences. They may say things such as:

Memory disruption is a common feature of dissociation, particularly when trauma has occurred. These gaps are not simply forgetfulness. They are often protective. In addition to clinical observation, brief screening tools such as the Dissociative Experiences Scale (DES-II) can help identify dissociative patterns that may not be immediately visible in session. While no single measure replaces clinical judgment, tools like the DES can offer a useful starting point for understanding the presence and range of dissociative experiences. Dissociation exists on a spectrum, and dissociative identity disorder (DID) represents one of the more complex expressions of this adaptive process. Your clients' lived experiences will inform you far more than a textbook, so please do not classify all of your clients with dissociative experiences as the same. Listen to each of their own experiences with attunement and respect.

4. Feeling unreal or disconnected from the body

Clients may describe feeling as though they are watching their life from outside themselves or moving through the world in a fog. They may feel numb, disconnected from their body, or unsure whether what they are experiencing is real. These experiences are often forms of depersonalization or derealization, both of which exist on the dissociation spectrum. In clinical work, these experiences are sometimes expressed nonverbally. Through drawing or other forms of creative expression, clients may depict a sense of disconnection from their body or environment, particularly when certain parts do not yet have language for their experience.

5. Therapy progress can seem to repeatedly reset

One of the more confusing experiences for therapists can occur when meaningful progress seems to disappear between sessions. A client may have insight or emotional breakthroughs in one session, only to return the next week feeling disconnected from that experience. This can feel frustrating for both therapist and client. In many cases, however, it reflects the presence of different internal states or parts that hold different experiences and memories. When viewed through this lens, the question begins to shift. Instead of asking, “Why are we losing progress?” we might ask, “What part of the system was present during that session, and what part is present now?”

That shift alone can open the door to a very different kind of therapeutic work.

A shift in perspective

Recognizing dissociation in therapy does not require immediately diagnosing dissociative identity disorder (DID) or dramatically changing one’s approach.

Often, it begins with something simpler:

When dissociation is understood through an adaptive lens, the therapy room can become a place where experiences that once felt confusing or fragmented begin to make sense.

In the final post of this series, I will explore common mistakes therapists make when working with dissociation and how they can approach this work in ways that are both safer and more effective.

Herman, J. L. (2015). Trauma and recovery: The aftermath of violence from domestic abuse to political terror (2nd ed.). Basic Books.

Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.

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Adrian A. Fletcher, Psy.D., M.A., is a licensed psychologist, author, and survivor with lived experience of DID.

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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.