A qualitative meta-analysis on therapist responsiveness to dissociation: Introducing the dissociation-responsive therapy model.

Abstract

Although it is common to encounter dissociative clients in the therapy room, little is known about how clinicians adapt therapy for these clients. The present study is a qualitative meta-analysis investigating how therapists are responsive to dissociation-that is, how they tailor therapy to meet dissociative clients' needs in and across sessions. We conducted a systematic search for qualitative studies on therapists' experiences working with clients who dissociate, yielding 16 eligible studies with at least 239 therapists represented across the studies. We used a critical-constructivist grounded theory method to build a hierarchy that represented patterns across studies, then generated clinical principles for practice through a hermeneutic analysis. Results indicated that therapists paradoxically honored dissociation as a coping mechanism while also promoting clients' agency over working through it. They gradually did so by (a) initially prioritizing alliance-building actions tailored to dissociation, (b) promoting clients' self-reliance in managing symptoms and safety, (c) repairing systemic harm by bearing witness to stigmatized forms of trauma and dissociation, and (d) strategically enhancing clients' capacity for accessing and experiencing emotion. By engaging in this developmental process, therapists sought to empower clients to heal from traumatic pain. This four-phase model may inform clinical decision making, training, and future research to improve treatment processes and outcomes for dissociative clients. Caution should be taken when applying these findings to child, non-Western, non-English language, and nonindividual psychotherapy settings. (PsycInfo Database Record (c) 2026 APA, all rights reserved).