"They thought I was just making it up": Dissociative individuals' understandings of their dissociation, perceptions of their clinicians' conceptualizations of dissociation, and discrepancies between them.

Abstract

Objective: Dissociation is thought to be traumagenic, though this conceptualization is not without misunderstanding and stigma. There is little research regarding people's conceptualizations of their dissociative experiences and client-clinician discrepancies in understanding dissociation.

Method: An online survey assessed 208 self-reported dissociative participants' understandings of their dissociation and their beliefs about their clinicians' understanding of dissociation via two open-ended questions. Template analysis, a codebook thematic analysis approach, was employed to explore and compare the ways people understand their dissociation and their perceptions of their clinicians' conceptualizations.

Results: Four themes were developed to capture participants' perspectives: (1) Dissociation as Stigmatized and Underexplored (n = 83; 39.90%); (2) Dissociation as Individualized and Normalized Lived Experience (n = 173; 83.17%); (3) Dissociation as Clinical and/or Pathological (n = 112; 53.85%); and (4) Dissociation Through Etiological Frameworks (n = 67; 32.21%). Overall, 73.48% of participants indicated discrepancies between their understandings of their dissociation and those of their clinicians. Participants understood their dissociation through a lens of individualized and normalized lived experiences (100.00%) more often than their clinicians (23.12%). They believed their clinicians held more clinical understandings of dissociation (81.25%) than themselves (69.64%).

Conclusions: Given the perceived discrepancies between clients' and clinicians' understandings of dissociation, clinicians should engage in discussions with their clients about their dissociation-related lived experiences with awareness that they may have been misunderstood by previous providers. Client-clinician discrepancies should be addressed, as failure to do so could lead to misunderstandings and ruptures in the therapeutic relationship. (PsycInfo Database Record (c) 2024 APA, all rights reserved).