Staying Present: Incorporating Mindfulness into Therapy for Dissociation

Abstract

© 2013, Springer Science+Business Media New York.Dissociation involves retreating from the experience of the present moment through various processes, while mindfulness cultivates the ability to stay in the present moment. We argue that mindfulness is thus uniquely well suited for treatment of dissociation. This paper delineates the theoretical relationship between mindfulness and dissociation, discussing how incorporating mindfulness into psychotherapy can improve outcomes for dissociative clients. Mindfulness can provide clients with specific techniques for enhancing prediction of and control over dissociation through building awareness of dissociative processes and offering a tool for staying in the present moment. Mindfulness reduces reliance on avoidance, which in turn diminishes the need for dissociation. In addition, taking the position of the observer, which is a key feature of mindfulness, is itself a capability associated with dissociation. We discuss the application of mindfulness to three types of dissociative processes: detachment (e.g., depersonalization, derealization), absorption (e.g., daydreaming, “blanking out”), and compartmentalization (e.g., amnesia, conversion symptoms). Three mechanisms underlying the effectiveness of integrating mindfulness into treatment of dissociation are proposed: (1) the techniques of mindfulness (e.g., observing, staying present), (2) the metacognitions of mindfulness (e.g., acceptance, nonjudgment), and (3) the emergent processes of mindfulness (e.g., reperceiving, dialectical thinking). Challenges to implementation of mindfulness with dissociative clients are also explored. Information and recommendations are provided to guide applications to intervention.