Trauma and Adult Depression

Adult depression often has its roots in childhood trauma. One misunderstood symptom is dissociation and how it affects people with trauma.

What is Dissociation?

Technically, dissociation means detachment from physical or emotional reality. Many people are aware of more extreme kinds of dissociation like depersonalization, derealization, or dissociative identity disorder (“multiple personality disorder”). However, a much more common form involves detachment from one’s feelings. I think most of us dissociate to one degree or another at times. Yet, people who have experienced trauma often protect themselves from painful feelings by dissociating them. They know that they’ve had painful experiences, but they don’t feel the pain.

Do People With Disassociation Seek You Out?

Generally, people don’t know that they’re dissociating, so they don’t come to therapy to get help with dissociation. However, many people with adult depression did experience early trauma that causes them to dissociate. So, people with dissociation seek me out because they’re depressed. Over the course of the therapy, they realize how many emotions—both negative and positive– they haven’t been feeling.

How Do People Manifest Disassociation?

Disassociation takes many forms. Some people intellectualize as a way of avoiding their feelings. Some people act as if everything is okay. They put on their “happy face”, as one client described it to me. Some people become confused. They know they’re suffering, but they can’t understand or communicate how they’re feeling.

How Do You Help These Clients?

That’s the really important question. There are several steps to the process. The first and most important step is to help people feel safe enough to begin exploring their feelings. I can’t overemphasize how important this is. People for whom dissociation is an issue are generally people who have experienced trauma. The trauma can be anything from surviving a natural disaster to growing up with an abusive parent.

The painful feelings associated with trauma usually feel overwhelming. This is especially true for people who never had anyone who could help them process their feelings.

Asking a client to immediately open up about painful, overwhelming feelings is inviting her to feel traumatized all over again. So, the first step is to go at the client’s own pace. I make it clear that she doesn’t have to talk about anything that feels too uncomfortable. Over time, as she begins to trust me, it will become easier to begin to explore painful feelings.

Do You Have An Example?

I once worked with a man who had survived a terrible natural disaster. He was quite depressed and couldn’t focus on his work or on getting things done in his daily life. He knew that he had been traumatized, but he couldn’t understand why he was having so much trouble taking care of himself.

My client talked about himself in a way that was very vague and, most of the time, I couldn’t tell what he was feeling or what he wanted to work on. Eventually, I began to feel that he was exhibiting characteristics of someone who had been emotionally neglected. He couldn’t identify his feelings or talk about his problems as if they were important. Once I identified this issue and we began to talk about it, it became clear that this man had had to raise himself. His parents were both highly successful professionals who were rarely home and expected their children to fend for themselves. My client never felt that his needs were important or that anyone cared about him.

Once we were able to put this piece of the puzzle together, my client realized that he didn’t expect that anyone would care about his experience, so, even when he told people what happened, he spoke with no emotion and didn’t take in other people’s emotional responses to him. Over time, he was able to talk about these feelings with me. His depression lifted and he was able to work, to take better care of himself, and to have emotionally fulfilling relationships.

What Should People Do?

Trauma is very isolating. Like my client, you feel unsafe talking about your experience and may not recognize how deeply it’s affecting you. Finding a therapist with whom you feel safe is a crucial part of the healing process.  Of course, no therapist is perfect and you may sometimes feel unsafe with whoever you choose. But, if your therapist is open to talking with you about this and wants to work to create a safe environment for you, you can feel less traumatized and affected by adult depression, and more able to have a fuller emotional life.

Click here to learn more about treatment for adult depression with Dr. Jane Rubin.

Jane Rubin, Ph.D., is a clinical psychologist in Berkeley, California. She works with individuals in Berkeley, Oakland, the East Bay and the greater San Francisco Bay Area who are struggling with depression and anxiety. She also specializes in working with people who are trying to find meaning and direction in their lives.