Between the Fog and the Depths: Understanding Derealization and Depersonalization in Therapy

Derealization and depersonalization can feel like watching your life through glass — disconnected, disembodied, unreal. For clients living with DPDR, healing often starts with safety and grounding. But beneath the surface, there's often more: parts trying to protect, and a self-trying to reconnect. This post bridges practical support with deeper psychodynamic and IFS-informed understanding, offering hope for those learning to “breathe in deeper waters.”

Some clients enter the therapy room and quietly describe something difficult to name.

They say things like: "It feels like I’m watching life from behind glass."

" Like I’m not quite here."

"Like my voice isn’t mine, or my hands don’t belong to me."

These are not symptoms of psychosis. They are signs of derealization and depersonalization, two deeply unsettling but surprisingly common responses to overwhelming stress or trauma, and they can be profoundly isolating.

But here’s the good news: they are also treatable.

Grounding in the Present

For someone feeling disconnected from the world or from themselves, the first therapeutic task is not to analyse, it’s to stabilise. To help them anchor in the now.

Practical techniques like:

• Using tangle toys or silly putty

• Naming five things you can see, four you can touch, three you can hear...

• Holding a cold object

• Or simply counting colours in the room

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These tools aren’t childish. They’re regulatory technologies for the nervous system.

We don’t dive into the deep until the boat is steady. We start where the client is and often, that means beginning with simple sensory experiences that remind them they’re here, now, in a body.

Acceptance Over Avoidance

Some of the most helpful resources frame the work not as "fixing" derealization, but relating to it differently:

• Acknowledge that the experience is happening.

• Accept that it’s unpleasant, but not dangerous.

• Drop the frantic checking and problem-solving, and move with it, not against it.

• Reassure: "You’re not going crazy. You’re not broken. This is a sign of your system trying to protect you."

And Beneath the Surface...

Of course, derealization doesn’t come from nowhere. Jake Freedman’s psychodynamic work offers a deeper lens:

• DPDR often begins in early relational trauma—emotional neglect, parental enmeshment, or the chronic need to perform in order to be loved.

• Clients may have developed what Freedman calls "identification with the observer": a defensive way of seeing themselves through others’ eyes rather than inhabiting their own.

• They feel they exist only when performing or being recognised. When that recognition falters, so does their sense of reality.

  
  

What begins as a survival strategy in childhood, avoiding unbearable emotion, dissociating from danger—becomes in adulthood a disconnection that no longer protects, but imprisons.

Therapy as Reconnection

This is where depth work meets regulation.

Psychodynamic therapy doesn’t rush the depths, it tracks them, gently. It notices micro-expressions, subtle shifts in tone, brief flickers of feeling. It invites clients to wonder: What might be beneath that numbness? What feeling was once too dangerous to feel?

Many clients with DPDR show signs of alexithymia, difficulty naming or recognising emotion. It’s not resistance. It’s protection. And therapy can offer a new experience: to risk feeling, and discover it’s survivable.

Not just survivable, but perhaps even connecting.

From an Internal Family Systems (IFS) perspective, derealization maybe understood as the work of a protective part, a part that has learned to pull the system offline to avoid overwhelm. IFS doesn't pathologize this; it honours it. Therapy becomes an invitation to get to know that part with compassion, not to banish it, but to ask: What are you protecting? And what do you need now?

Seen this way, derealization is not sabotage. It’s strategy. It’s the nervous system saying, “Too much.” And as trust builds, the part may no longer need to do its job so extremely. There can be room for curiosity, and eventually, for integration.

The Double Lens: Safety and Meaning

We don’t have to choose between practical tools and psychodynamic insight. We can offer both:

• Grounding and structure

• Acceptance without urgency

• Curiosity about the body’s wisdom

• And an attuned awareness that what seems like "just" disconnection often hides something far more tender: a need for safety, dignity, and emotional truth

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From an existential perspective, depersonalization touches a deeper thread, the fear of non-being. It’s not just the world that feels unreal, but the self. Therapy, in this light, becomes not only a relational and emotional task, but an ontological one. To help clients feel that they exist—not only in the eyes of others, but in their own.

As therapists, we walk with our clients through the fog, holding both their discomfort and their depth.

Not to rush the journey. But to make it possible.

Because healing often begins not with forcing clarity, but with saying: “I see you. Even here. Even now.”