"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

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. 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. 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%). 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).