#77: Understanding Depersonalisation and Derealisation with Dr Claudia Hallett

Experiencing a feeling of things being unreal or feeling detached from 'real life' and not sure what to do? This episode can help.

This week, I am talking to Dr Claudia Hallett, Clinical Psychologist and lead of the UK’s only specialist depersonalisation and derealisation service at the Maudsley in London, to demystify DP/DR and offer a practical path through the fear and confusion it creates.

Across a frank, compassionate conversation, we define depersonalisation and derealisation in plain language and explore why these dissociative symptoms show up across conditions like OCD, PTSD, low mood, and neurodiversity. Claudia explains the freeze response, what’s likely happening in the brain and we tackle the most persistent myths: that DP/DR is rare, untreatable, always trauma-led - and share prevalence data that puts DP/DR on par with better-known difficulties. 

Most importantly, we outline what actually helps and hear how values-led action restores identity when chasing the “old me” keeps life on hold, and why grounding isn’t one-size-fits-all. We discuss promising approaches like body movement psychotherapy and mindful movement for safer reconnection with the body, plus the power of peer support through charities such as Unreal. 

Highlights include:

02:31 What DPDR Feels Like

06:26 The Brain, Freeze Mode And Survival

12:38 Neurodiversity And Interoception

24:14 Practical Self‑Help

This week's guest:

Claudia is a highly specialist Clinical Psychologist and accredited Cognitive
Behavioural Psychotherapist. She is currently the clinical lead for the National
and Specialist Depersonalisation & Derealisation service, part of the Centre for Anxiety Disorders and Trauma service at the Maudsley NHS Hospital in South London. She is involved in the teaching and supervision of trainee psychologists on the Clinical Doctorate course at the Institute of Psychology, Psychiatry and Neuroscience and is involved in several research projects with colleagues across SLAM and KCL. She also runs her own private practice where she specialises in helping clients with DP/DR, anxiety and trauma difficulties 

Claudia's instagram

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The Hello Therapy podcast and the information provided by Dr Liz White (DClinPsy, CPsychol, AFBPsS, CSci, HCPC reg.), is solely intended for informational and educational purposes and does not constitute personalised advice. Please reach out to your GP or a mental health professional if you need support. 

Transcript

Naming DPDR And Why It Hurts

SPEAKER_01 0:02

If you're looking to improve your mental health and well-being, then keep listening. I'm Dr. Liz White, a consultant clinical psychologist with over 20 years of experience. Whether you're a transport parent, a stressed out professional, or finding your way through the challenges of mid-life, you're in the right place. Through a mix of solo episodes and insightful conversations with expert psychologists and therapists, I'm bringing you evidence-based tools and strategies to help you navigate life's ups and downs with confidence, clarity, and compassion. This is your space to feel seen, supported and empowered. Welcome to Hello Therapy. Have you ever felt detached, unreal, or like you are living in a dream? Today I'm talking to clinical psychologist Dr. Claudia Hallett about the complex and incredibly distressing experience of depersonalisation and derealisation, two types of dissociation. Claudia is currently the lead of the UK's only specialist, depersonalisation and derealisation service at the Moresley NHS Hospital in London. In this conversation, we talk about the challenges of diagnosis, the overlap with other mental health issues like OCD and PTSD, and what effective treatment and support actually looks like. So if you want to better understand this really neglected topic, this episode offers valuable insights and practical advice for anyone navigating these symptoms or supporting someone who is. So let's dive in. So, Claudia, thank you so much for joining me on the Hello Therapy podcast. Do you want to tell our listeners who you are and what you do?

SPEAKER_00 2:06

I would love to, thanks, Liz. So my name is Dr. Claudia Hallett. I'm a clinical psychologist, and I have half of my time in the NHS in something called the Depersonisation and Derealisation Disorder Service, which is based at the Maudsley Hospital at the Centre for Anxiety Disorders and Trauma, where I lead that clinically. And then I've got another half of my week in private practice and various research commitments.

What DPDR Feels Like

SPEAKER_01 2:30

Okay, brilliant. So yeah, we're here to talk about derealization and depersonalisation or DPDR. A lot of people listening will not have a clue what that is. So can you start by just describing what that means?

SPEAKER_00 2:45

Um yeah, and the first thing to say is it's a really hard thing to do, is actually to describe these symptoms. And the words I think themselves don't necessarily help in the understanding of it all, but I'll give it a go. So the symptoms themselves are sort of depersonalization is this sense of kind of detachment from oneself. So not feeling kind of real in your body, not um sort of you might recognise you look at yourself in the mirror, um, but not recognize yourself as yourself. So people will often use sort of metaphors to describe them, their symptoms like feeling like they're on automatic pilot, looking at the world between a like a veil and a kind of pane of glass. So the other side of the corn is is derealisation where people feel very detached from the world around them. So the world doesn't seem real, like they're living in a dream, disconnected from other people.

SPEAKER_01 3:41

Yeah, and over the years I've worked with quite a few people now actually that have experienced DPDR. Some who have who are also experiencing OCD, but not all the time. And I'm really interested in your thoughts on what is it that tends to cause or contribute to DPDR in people?

SPEAKER_00 4:01

Yeah, and so kind of to answer that, it's it was also helpful to frame that the the symptoms can be transdiagnostic. So we tend to think in diagnostic categories as psychologically, but these these symptoms can pop up, like you say, across kind of other disorders, like you might have a client who's come to you with OCD, but then they start talking about this, or but I'm a bit worried that I'm not real and get quite caught up in that as a part of their obsessional landscape. And I guess the clients that I might come to see is where DPD and DER symptoms are like the the main thing. So when we'd class it as a kind of disorder in its own right, um, depersonalization, derealisation disorder, where that the symptoms aren't better explained by another sort of mental health disorder, and they're causing kind of significant impairment day to day. But um, I realise that isn't the question you actually asked.

SPEAKER_01 4:51

Well, yeah, yeah, yeah. I guess trying to think about, you know, how would somebody start experiencing that? Is is it a particular type of person or a particular experience that someone might have to have had to go through in terms of you know things like trauma, or can it just sort of come out of the blue? What's your experience?

SPEAKER_00 5:15

Yeah, it's a really it's a really good question. And I think that's the thing that really unsettles clients when they get these symptoms is the like, what what are these symptoms and and where have they come from? And people are trying to make a narrative that that makes sense of them. And I think that's that's what kind of can cause the anxiety that when people type in that to Google, it can kind of say, Oh, this is this is psychosis, and then people worry that actually they're going down a pathway of schizophrenia and and they have lots of kind of intrusive images or ideas about what that might be. But it's important to say that it like it it isn't that, as in it's a dissociative disorder where people uh will experience these symptoms in a way to sort of protect them from the overwhelm of what's currently going on. And so, therefore, when you're thinking about when and why that these symptoms might have popped up in a point in somebody's life, there's often a narrative and a story that goes with that that they've experienced like a particular event where that was a kind of necessary coping strategy or a kind of chronic series of events from kind of often childhood, and and that became the kind of brain's default mode and way of coping and functioning with all of that.

The Brain, Freeze Mode And Survival

SPEAKER_01 6:24

Okay. And you mentioned the brain there. So can you can you tell us a little bit about what's happening in someone's brain when they experience an episode of DPDR? Yes. In layman's terms.

SPEAKER_00 6:35

In layman's terms, because we don't want to get it too complicated, but it's this kind of disconnect from you know the the emotion center of our brain, the amygdala and and the kind of frontal part of our brain, the prefrontal cortex, almost like a bucket of water has been thrown from the the front to the to the back of that emotional centre, where people just aren't feeling those emotions in the same way as they talk about kind of having quite a lot of blunted affect. Like I just don't feel my feelings, I can't feel what's going on inside. And it's this kind of relates to this we would know about automatic nervous system fight, flight, and freeze mode. These are the people who are really stuck in that freeze mode. So often might kind of use analogies of uh that cat and mouse where the mouse has been pinned into the corner by the cat, and the strategies that they have for survival in that moment, they can't use their fight against the cat because they're gonna lose. They can't use their flight to run away because they are pinned in the corner. So they're their only kind of coping is going into this freeze association shutdown mode to give them the best chance of survival. So it's often kind of helping clients to understand that that is a protective mechanism that the brain has used to try and get them out of trouble, particularly at a time when it might have been really necessary and useful for them to do that.

SPEAKER_01 7:53

And in your experience, is it that somebody would have like repeated episodes of derealization and or depersonalization, or is it a sort of state that someone kind of falls into and doesn't come out of kind of thing for a while?

Episodic Versus Chronic Patterns

SPEAKER_00 8:10

Yeah, both both and so you can have kind of episodes where this kind of might come up for somebody at times of acute stress, um, overwhelm, trauma, and this is just how they they know that it's kind of all got a bit too much, they go into this kind of dissociative state. But you know, with kind of adjustments and and coming back down to to baseline that that can can resolve. But I guess for the folks that I'll be seeing at a kind of national specialist level, these these people have had this state kind of quite for a long time, and yeah, it's become their default mode and way of operating within the world.

SPEAKER_01 8:43

And it's so distressing, isn't it? For someone because you know, not having a you know, feeling like the world isn't real, for example, um, or feeling like you know, if you're you know in the sh in a shop and suddenly the people don't feel real and you don't feel in your body like that is so so scary for someone.

Stigma, Misdiagnosis And Isolation

SPEAKER_00 9:40

Scary, isolating, terrifying, and also there's there's so much stigma still that exists, sadly, with with mental health, so people can't and really explain or or communicate this often to to loved ones. And and I think sadly, I've had unfortunate experiences in the health system with trying to communicate this to maybe GP at low level, and they've just kind of looked at them with a bit of a quizzical look and not really understood this. And so often clients feel then even further isolated because even the healthcare system isn't sort of understanding offering um treatment that's kind of specific to targeting those symptoms. So, yeah, not only the symptoms themselves can feel really confusing and isolating if people don't really know what they're about and and why they've come on, but also if the system around you reacts in the same way, yeah, my clients feel very detached and the result.

SPEAKER_01 10:28

And the the the people that you tend to see or the people that are referred into your service, are they would they just get a diagnosis of DPDR or do they are they coming in with like other mental health issues?

Comorbidity With OCD And Mood

SPEAKER_00 10:41

Yeah, so comorbidities, comorbidities exist, don't they, across you know, all the clients that we see. So sometimes it's uh this is very much the only thing that's going on, the only thing I wanted to talk about, but very much there'll be other struggles that come along with this presentation as well. So, you know, low mood being being one of them, kind of people have stopped their functioning or activities of daily living as a result of that. But also, as you mentioned, kind of like high correlation with with OCD, sometimes actually it's the obsession about these symptoms that are really now driving an anxiety reaction to them that they are really so panicked by them and desperate to get rid of them that maybe actually an anxiety-specific um formulation and treatment is probably gonna be.

SPEAKER_01 11:25

Yeah.

unknown 11:26

Yeah.

SPEAKER_01 11:26

And do you see a lot of people who are also neurodivergent? Because I I guess also in my experience, there could this there's a big sensory element, or there can be a big sensory element to symptoms, aren't there? And I'm always really interested in how that might show up in I don't know, people who you know are autistic or experience ADHD. Have you do you see that a lot?

Neurodiversity And Interoception

SPEAKER_00 11:52

I see it clinically and I and I really want to do the research on it because there's such a like interception that is is kind of key as as part of all of how any of us feel in our bodies and able to kind of tune in to what's going on within our bodies. And we kind of know with neurodiverse individuals that that as a process can um be problematic anyway. So I'm I'm imagining, oh, I don't think we know the statistics, but there's a high correlation between the two of those that come yeah and present. But I think we need to do more research to to understand that a little bit better.

SPEAKER_01 12:26

Yeah, that would be fascinating research, wouldn't it? And much needed. I think I mean that one of the reasons why I invited you on here is because nobody really talks about this. And as you were saying earlier, it's there's a lot of stigma and people don't really understand. And what would you say are some of the real misconceptions or kind of myths about DPDR?

Myths, Prevalence And Clinician Bias

Reframing Goals Beyond Reducing Symptoms

SPEAKER_00 12:50

Finally, you should ask Liz. We're just about to publish a paper on this. Oh, I'm I maybe you didn't know that, but I'm very yeah, excited to talk about this because it's something that we sat down as a clinic and you know thought there's a lot of kind of barriers, first of all, to kind of like help seeking, either from clients who have these symptoms, but also to get them on the right kind of pathway for treatment. And I think we've kind of thought about these three different areas of misconceptions about the symptoms themselves, which can be held kind of by both clinicians and by the client, but then particular misconceptions that are held by the client themselves about the symptoms and and then by clinicians. So if I kind of just broad brushly th talk about um lots of those things, I think the symptoms themselves people still think are really rare, that they're kind of don't really exist that commonly, but you know, one to two percent of the population is their prevalence, and actually that's very similar to other disorders like you know, OCD. So they're not as rare as people think. I think they probably people often think they're really complex kind of pathological symptoms, and that probably comes from perception of the the comorbidity that exists with this. And I think the way that we are taught about dissociation as clinicians is very heavily weighted towards PTSD. If you think back to training, people often think, okay, well, dissociation only comes up when I'm treating a PTSD client, and so people might think, oh, depersonalisation, demonization, that's for people who've got a PTSD diagnosis. And I guess the kind of misconception there is that can sometimes be the case that somebody might be also um kind of meeting criteria for PTSD, but not always that there's a kind of like small T, big T trauma conversation there. And so sometimes people might get pigeonholed in their thinking about where their symptom of dissociation might fit. Um, I think the other thing I was thinking about is how the clients might come in with sort of like quite hopelessness about what to expect from the mental health system, sort of that there's little like evidence base for treatment, that kind of CBT won't be able to help me, and all I need is the symptoms to just go away. And without them, that kind of life life will be better. And that can be a kind of then conversation you need to have at the beginning of therapy with with clients to reassure them, you know, that we are getting some really nice evidence that CBT is effective for this um disorder, these symptoms, but also thinking about the kind of the realistic kind of goal that's gonna come from treatment. So often people just think these symptoms are really dangerous and they're a sign that something bad is really gonna happen, and therefore the solution is we need to we need to get rid of them. But just like we don't promise that with anxiety, you know, it's part of a healthy functioning brain, it's kind of understanding when that is a really useful thing for all of us to dissociate and detach from what's going on around us, making that kind of work for them rather than against them, and for it to not be kind of the chronic mode that they experience the world through.

SPEAKER_01 15:50

That makes sense. I'm gonna ask you about distress in relation to that, but uh, but um we're also gonna think about treatments in a in a moment. But is it possible, do you think, to experience DPDR but not experience the distress associated with it?

CBT Formulation And Maintenance Cycles

SPEAKER_00 16:05

Well, so that's kind of where I want to get people to by the end of treatment. That's really it's a really astute question because yes, I think you know, sometimes people will be like, you know, completely symptom-free. So I do want to give people that message that, you know, you may never kind of experience these symptoms again. But most often people who've had them for a you know, this chronic response for a really long time are going to end up kind of leaving therapy still, still with this as part of their neurosurcule part of part of the world, but they're less bothered by them and they're less less overwhelmed and because they've got a narrative and they it makes sense and it's sort of not associated like as a as a fear, fearful thing in their mind anymore, and they're not so obsessional about it, or they come to terms with it and you know see it in some ways positive, spend a long time thinking, well, look, also what are the pros of these you know symptoms in your life? And yeah, so I think the relationship change to the DPD is really key at the end of therapy, not just symptom eradication, and that can be a kind of hard dance to sometimes have as a conversation with clients who are just obviously struggling and suffering for so long with these that they are that is what they're looking for, the solution of the magic wand. And they often have to start and say, I wasn't given a magic wand in training. I'm afraid that does that.

SPEAKER_01 17:20

And what would you say tends to keep symptoms going for people? Like, is have you seen certain things that are or in the research the kind of key key things that that keep them going, would you say?

Relapse Tolerance And Skills

SPEAKER_00 17:33

Yeah, so that's where you come your formulation is is going to come in. So it's really idiosyncratic to each individual. But I think what we're looking at through a CBT lens is looking at the appraisals that people have over the symptoms. So they're kind of in a similar way to a panic model, you might be thinking about the misattribution or misinterpretation of the catastrophic kind of sensations that people make. So very typically and classically in DPD, people are worried that these symptoms are a sign that my brain is broken, that I'm going mad. And so there's a lot of kind of psychoeducation you might need to do about actually what are the symptoms are and how they aren't a sign inherently that anything's dangerous or or wrong, quite the opposite in some ways. And then associated with that is the kind of the typical maintenance cycles that you might see with people of like rumination kind of going over and over. Maybe the onset event. There's a lot of sometimes in people's histories, like a particular event, like a cannabis episode where they've taken some drugs or a particular um traumatic incident that they will have a lot of self-blame and self-attack on. Like if I I hadn't have done that, what if that hadn't gone that way? They might be really, really beating themselves off about that. So you might spend some time unpacking that together. Reassurance seeking, you know, the classic ones of just Dr. Google and trying to work out all the things I can do and spending all their money on you know things to try and find these quick fixes and solutions, which you know makes sense because people are desperate to get rid of these sensations because they think that's what the answer is. But yeah, lots of unhelpful behaviours and in that sense, um, avoidance of lots of things. So people put up put off their lives because of this. You know, I've had people say to me, Well, I can't get married until I know that I'm gonna feel the feel myself on the day and be really present, or definitely I can't have children because what if I don't feel present in my parenting or I feel detached from my kids? And so people do, yeah, really avoid moving forward and I guess in their lives as a result of their beliefs about the symptoms.

SPEAKER_01 19:30

Because there can be a real distrust in your senses and your feelings, it can't there? When when you've experienced even just like one episode of of DPDR, I think it it really erodes that trust in yourself that that things are are real or that you are you are who you are. And and I think in my experience, it you know, once that's there, it it really can grow legs, can't it? Yeah, yeah. Um creates such anxiety about oh, when's the next episode or attack gonna happen? Um, and then it sort of feeds itself, doesn't it?

SPEAKER_00 20:07

Yeah, no, absolutely. People are exactly that if they're an episodic kind of presentation, that they're very anxious about that that reoccurrence and and people's ability to cope and tolerate and manage whether their relapses is all about you know, skilling people up with the confidence and the knowledge to be like, okay, I know that'll probably come up again in the future. But actually, what is important is my ability to tolerate and to cope and to to manage those. Um, so not to be fearful of those kind of reoccurrences because all of us will have kind of setbacks and knocks in the future where our mental health will decline, but actually, people's kind of yeah, confidence and ability to cope with that, I think, is really important to address in therapy.

SPEAKER_01 20:43

So, what does help DBDRs? You've talked you've mentioned CBT. Can you give us a sense of um like the options for treatments?

What CBT For DPDR Looks Like

SPEAKER_00 20:52

Yeah, well, I want to say that there are options for treatment. So, first of all, that might be new to people, like that this is treatable, something that we know about in the the land of mental health, and we've got kind of emerging and good evidence that um CBT in particular is that psychotherapy can be effective. So, yeah, there are clinics like ours that are specialist services in in the UK, but also I would be encouraging primary care clinicians to pay attention in you know, our IAP services, we are seeing it, and kind of just need to upskill sometimes clinicians who are a bit anxious about this work and because it feels different, but in in effect, it's kind of the same kind of bread and butter work that we're all doing anyway. So, um, yes, help is available within the NHS for this. Pharmacologically, there is kind of weaker evidence as any particular medication that will be the silver bullet. And but you know, we're constantly thinking of ways to improve our psychotherapies and yeah, potential new avenues to explore different psychotherapies. So it's a it's a really uh ripe area for researchers who are interested um in improving our treatments in this area.

SPEAKER_01 21:54

And so, in terms of the evidence base, is it only CBT or I guess I'm thinking about acceptance and commitment therapy and and therapies like that?

SPEAKER_00 22:05

No one's doing the the research, it's not getting researching, is the answer, but we are trying. And so um, I guess the most recent research study that I think is is it really promising and interesting is the use of kind of body movement psychotherapy, actually. If we're thinking of trying to get people reconnected to their bodies, thinking about like a dance-based intervention and how actually that might help people more ground into so I'm I'm thinking a lot about like mindfulness strategies and thinking about how we can augment our CBT with with that kind of work to help people reconnect them to their sense of self. Yeah, so watch this space, I guess.

SPEAKER_01 22:41

So, in a in a such a very brief nutshell type way, what what would CBT for DPDR like look like for someone? What would they what would they expect in a session with you in your service?

Practical Self‑Help And Grounding Nuance

SPEAKER_00 22:55

Yeah, we've got a lovely team of um us who are really committed to, I guess, helping contain people's anxiety about these the symptoms. And so we're always going to be starting with a kind of collaborative formulation, which is a bit of a therapy jargony word for just like making sense of these um symptoms, right? Of like given what's happened to you and your kind of experiences today, how does it make sense that these are the things that you're struggling with now and why haven't they gone away given everything that you've been trying and things that you're you're currently doing? And so I think that in and of itself is a huge part of the work, it's the containment around the narrative. People, I think also my feedback from from clients is that it's just the process of talking to somebody who knows and about this stuff and kind of doesn't freak out about it or dismiss it or kind of go like look at them quizzically is a real key part of I think feeling better about this stuff. And so that's kind of why I'm coming on to talk about it is because I want to encourage other clinicians to get really interested and curious in this work because there's such need, and possibly like fewer clinicians who are going towards doing this work, so yeah.

SPEAKER_01 24:07

And there isn't a it's it's not like you know, CBT for insomnia or CBT for eating disorders. There isn't like a a CBT protocol, is there for DBDR? It's more just applying the model to the symptoms.

SPEAKER_00 24:21

Yeah, so we're working on that, but also we're thinking it it's so heterogeneous in its presentation that kind of reducing it into a you've got to do this in a formulated protocol way would really not capture the the nuances of it. So our kind of hopes are to develop kind of clinical guidance papers for like different types and iterations of this um presentation in the in what we see. But I I guess I want to encourage kind of the CBT clinician that you've got so many skills and tools within your toolkit that will enable you to do this work perfectly well without needing a kind of step-by-step guide.

SPEAKER_01 24:56

So, someone that's listening who is experiencing these symptoms, what tips would you have for someone like that who's really struggling with this and maybe isn't in therapy, doesn't know what grounding is, you know, what what would the sort of initial things be for someone to help themselves?

SPEAKER_00 25:13

I mean, first of all, take a deep breath and to reassure yourself that, you know, this isn't you going mad and something that will be forever as awful as it currently feels right now. I think you need to find somebody to trust and confide and talk to who's gonna listen and take it seriously. And often people will have, you know, a network that they're not just tapping into with their resources, you know, who's gonna really want to hear about that so that they're not, I guess, struggling on their own. Because I think a lot of this is isolation. People will just think I'm weird, crazy, and that won't want to talk to me. But I think there are people out there who um would like to, and and the work of Unreal is a specific DPD charity that runs wonderful kind of peer support groups where people can go and experience that sense of oh, it's not just me. So I'd encourage them to go and link into that and then finding a kind of kind of clinician that you can speak to who yeah will help you make sense of of your journey so far with these symptoms. It's really important.

SPEAKER_01 26:12

And when someone's like in the midst of a DPDR episode or is you know is really feeling feeling it, what's what are there some things that they can do? Is it is it based around being able to kind of get into your body in terms of that kind of grounding experience, or is it more about managing the anxiety in the moment? Because you know it can really trigger off panic attacks, can't it, for people? Um, and things like that. So, and I know I'm I feel like I'm trying to push you into it, right? What's one tip?

SPEAKER_00 26:43

One thing that will work everything, isn't it? Exactly. I'm gonna and I'm gonna be that annoying because it's one of the goes, yeah, it depends because you know, you're right to say like grounding in one way might work beautifully for one person, and then for the other person may that feel no, that makes me feel even more like out of body. And so this is why it's a nuanced conversation within within your therapeutic kind of space to work out what is it for me that's gonna work in this moment to help me calm down about what's going on, and it's framed in that whole, you know, if you've got a formulation that makes sense to you, then when you have kind of your episodes of overwhelm, you're not gonna get that height and anxiety kind of more quickly. So it's actually not about just extinguishing that anxiety in the moment. But yes, of course, there are kind of things that we can do with our grounding strategies to help people feel more connected to the to the present and grounded um in where they are if if they're finding that is possible. But again, lots of the folks I talk to kind of they're in this chronic state and it's less episodic. Um so that's a more kind of slower process of like unfreezing over time um as they kind of try out new behavioural things to do.

SPEAKER_01 27:47

So with some, so with people like that, yeah, it's it's about like getting back to life, right? In in the sense of, I mean, I get I'm very act. So it would be for if that was me, it would be like you know, thinking about your values and um values guided actions and and that kind of thing. Yeah.

SPEAKER_00 28:04

Yeah, totally. And that's the way I would kind of go set with people too, and thinking about and often people have lost sight of that, lost touch of that because they've been so overwhelmed by these symptoms. Actually, the who am I question, what do I want from this world? Like is quite uh overwhelming. And so tuning into that stuff does then really connect us to our sense of self and our identity again, sort of like what have I stopped doing that that would have defined me and I do really enjoy? And so then they kind of make the link of, yeah, it's no wonder I don't feel like me, given that I have stopped kind of living my life in my way that would be consistent with my values. So really integral part of getting better would be yeah, to be thinking about these things.

SPEAKER_01 28:37

And do you see any patterns with you know, people that do improve in the long term versus people that do stay kind of stuck with it? Is there anything that you've seen or in the research that shows us that?

SPEAKER_00 28:52

Yeah, I mean, I'm thinking just that the chronicity and the severity of things that people have experienced, you know, we we can't change what's happened to people in the way that they've been attuned to in their parenting or the way that they've been neglected, you know, there's so much of that that is something they have to rebuild in their adult life, right? Kind of changing their relationships and their attachments to people who give them a kind of corrective experience from that. And so, yeah, like with all our clients, they're gonna have a variety of we call kind of protective factors and um resources in their environments and in internally and externally, right? And so I think all of those factors combined equals you know long-term good outcomes for our clients.

SPEAKER_01 29:37

I think what I would say is that, and I think I suppose you could say this for any difficulty, but I think particularly DPDR is in my experience the people that get a bit stuck with it, are the people that are really kind of trying to chase getting back to who they were before. And I guess I'm talking less about the really chronic type people that you might see in your service, but yeah, sort of really wanting to get back and holding on to that uh tightly rather than lightly, which is what I would be saying to people, you know, can you hold that lightly so that we think more about how you want to live your life now and the person that you want to be now, even with these experiences that you're having of DPDR.

Key Message And Accessing NHS Support

SPEAKER_00 30:17

Is that that totally? Yeah, I'll have that conversation a lot because that there might be an onset event and they were 18 at a festival and they tried this thing, and if only they could get back to their 18 year old selves. And you know, you have to have this conversation about the the rose tintedness often of life was uh all so good just before that incident, and now it's all awful, it's quite black and white, yeah, and so. Actually zoning into what what life would have been like actually at that time and and the reason for that protective mechanism coming online probably less idealised than people probably first think, but it's the kind of grief of like I feel like I've missed out on kind of real real living since that time, and so yeah, the chance to kind of re-rebuild and and look forward, like none of us can go back in time, we're always moving forward. So it's a conversation about okay, from what from that time was meaningful about the way that you were living life, and how can we get back there to the to the future given what's changed?

SPEAKER_01 31:11

Absolutely. So I'm gonna ask the question about one thing. So, what's one thing from our conversation that you want someone who's struggling with this to kind of go away with? Like, what's what's your key message?

SPEAKER_00 31:26

Um, you're okay, you're not going that. This is understandable, treatable, helpers available. Please don't suffer in silence. I think that sounds very cliche as I say that, but genuinely I think for these, you know, clients, there is such a sense of isolation and uh real terror of these symptoms. Like I can't under under say that enough. Like how overwhelmed people are living with these symptoms. And you know, the joy of psychotherapy work with this population is to bring that anxiety down and contain people and give them a kind of psychological understanding of what's going on and and helping them back on the road to to living life that's connected again.

SPEAKER_01 32:04

Yeah. And just a super practical thing around the NHS service that you work in. Because you work privately as well, but both, yeah. Yeah. But the NHS service that you're in, how easy is it to access that service?

SPEAKER_00 32:19

Um depends where you live. Okay. I can't speak for every single person's journey, but but as a national specialist service, you know, like across the NHS, they are um tricky to get. You need to have your funding kind of commissioning approved um by your local um GP for that. So I think some people's journeys are more straightforward than it is into that.

SPEAKER_01 32:43

And and that would be a process of going to a GP and asking to be referred to the service. Yeah.

SPEAKER_00 32:50

Yeah, we've got a website that kind of explains what the treatment is that we offer, and there's a referral form on there, and people are very welcome to call in and like to discuss if they think um they need our support to do that. But yeah, it should be straightforward from that point of view. Yeah, okay.

SPEAKER_01 33:06

Well, Claudia, thank you so much for this conversation. I'm I'm sure that a lot of people are gonna really benefit from it. So thank you. And a pleasure, Liz. Thank you so much for having me. Thank you for tuning in to this episode of Hello Therapy. We'd love for you to join our growing community over on Substack. You can sign up for free or become a paid subscriber for access to exclusive perks, like never before seen video interviews and downloadable guides designed to support your mental health. If you enjoyed this episode, make sure to subscribe so you never miss a new release. And if you got value from this episode, it would mean the world if you left a five-star review. As always, check the show notes for my full disclaimer. Thanks again for listening.