More than unreal : clinicians\u27 practice experiences with clients affected by chronic depersonalization and derealization

Despite a growing awareness of their prevalence, depersonalization (DP) and derealization (DR) – the persistent or recurrent experience of consciously feeling detached from one\u27s mental processes, body, and/or surroundings – are two types of dissociative experiencing that remain mysterious, if not unknown, to most clinicians and clinical researchers alike. This qualitative study was undertaken to explore how a particular group of experienced clinicians have conceptualized their clients\u27 chronic depersonalization and derealization symptoms, and subsequently approached therapeutic treatment. Semi-structured interviews were conducted with 12 licensed clinicians that had specializations in treating trauma and/or dissociative disorders, and identified working with clients that have experienced DP/DR symptoms. Participants were asked to reflect on the source of their knowledge regarding DP/DR; to define these symptoms and their relationship to dissociation; to discuss their assessment of what contributed to their clients\u27 symptoms; to identify both effective and ineffective interventions and modalities they have utilized; and the impact of DP/DR on the clinician in terms of countertransference. Study results indicated that clinicians have successfully supported clients in ameliorating their depersonalization and derealization symptoms through keen attendance to alliance and rapport building, as well as consciously using transparency and use of self to mitigate the various dynamic interpersonal barriers to effective treatment. Clinicians noted that relational, intersubjective, and psychodynamic theoretical lenses consistently informed their understanding and treatment of DP/DR, and described the influence of ego state therapy as well as somatic, body-based intervention techniques on their approach to the clinical work. These findings were in contrast with existing literature that has framed DP/DR as treatment resistant to therapeutic intervention, and suggests the need for future research of the impact of clinical encounters on experiences of DP/DR, as well as increased education and training for those in the fields of mental health and social work regarding these types of dissociative symptoms