Am I present?

There is a quality called presence that comes up a lot in therapy. In a one-to-one therapy session, it can be imagined as a precondition for the therapist and the client being relationally connected. Both are being authentic with each other, respectful and attentive to what is going on. At its deepest level, it is what Martin Buber calls an I-Thou relationship [1]. It is a space where change can take place.

What about when we are not present?

A lack of presence can occur when we are physically in the therapy room but not there mentally. This can take different forms; one is called “dissociation”. Mind suggests that when you dissociate, “you may feel disconnected from yourself and the world around you.” [2]

It is tempting to say that something like dissociation is happening a lot of the time inside each of us. We are simply ‘not present’, perhaps prompting the question “Are you with us today?” Dissociation is normally seen as different from inattention[3]. In dissociation, we exist in a state of intense numbness in which everything is happening, but nothing is happening, whereas inattention implies that our gaze is simply falling elsewhere, and we can be brought back into the room by having our attention drawn to it. In this sense, dissociation could be contrasted with other ways of protecting ourselves, such as keeping busy, where we seek to fill the mind. 

Is dissociation a bad thing?

It’s difficult to disagree with the idea that being detached from your feelings, the world, or any sense of core self is a problematic way of being. Like many behaviours, dissociation is an adaptive response. There is a human capacity to “zone out”, whether in response to specific events or as a way of coping with the uncertainty and anxiety in everyday life. It is the best we can do in the circumstances. 

Dissociation can be both something that is originally experienced in relation to specific events but may also be triggered in the here and now by stimuli (e.g. a smell, a look, a noise), without it being possible to relate it to a past experience or understand why it is having an effect on us. It has been suggested that it is linked to situations when we have faced a threat from which there is no escape [4], while others emphasise a more general role in managing the relationship between our sense of self and external experience [5]. A consistent theme is the need to bring together parts of our selves which have been separated and are unexamined.

The therapy room should be a safe space, but sometimes things are moving too fast. Clients may feel the need to retreat and protect themselves. Time is needed for things to unfold. People generally want to heal, but there might also be a conflict between wanting to move forward, whilst fearing the impact. Sometimes we need to veer off to manage our level of contact with reality. I liken this to what? An oscillation, maybe? A constant circling back and around. We are on track, but there’s something which is difficult to approach directly. It may be necessary to tackle it in bite-sized pieces. Gentle exploration to increase awareness may enable current pressures to be seen in a different light. 

References

• [1] Buber. Martin; I and Thou; 1923
• [2] https://www.mind.org.uk/information-support/types-of-mental-health-problems/dissociation-and-dissociative-disorders/about-dissociation/, accessed 14.5.25
• [3] Van Der Hart, Onno et al, Trauma-related dissociation; Australian and New Zealand Journal of Psychiatry 2004; 38:906–914
• [4] (e.g.) Levene, Peter; In an Unspoken Voice; North Atlantic Books; 2010 
• [5] Spinelli, Ernesto; Tales of Un-knowing; PCCS books; 2006