Episode 377: Preparing for Couples Therapy & Managing Depersonalization and Derealization

Hello friends!

In Episode 377, we tackle two profound listener questions that shed light on unique mental health and relationship challenges.

Our first discussion revolves around a listener gearing up for couples therapy. They share their apprehension about conveying years of experiences within the confines of therapy sessions. We explore strategies for effective communication, the importance of preparation, and utilizing therapy as a starting point rather than a complete solution. The conversation also touches on the usefulness of additional resources like therapy workbooks and individual therapy in enhancing the couples therapy experience.

The second question comes from a 23-year-old male experiencing derealization, depersonalization, and occasional panic attacks. These symptoms make him feel detached from his environment and himself, as if living in an unreal world. We dive into understanding these phenomena, identifying possible triggers, and discussing various coping methods. These include sensory grounding techniques, mindfulness practices, and the potential roles of therapy and medication in managing these dissociative experiences.

Your questions continue to add depth and insight to our discussions on mental health. If you have any questions or topics you’d like to share, please send them to duffthepsych@gmail.com. For full show notes and additional resources, visit http://duffthepsych.com/episode377.

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Question 1:

Hello Dr. Duff!

My husband and I are preparing to start couples therapy in a month, and I find myself feeling worried, even though this is something I’ve wanted for us for years. I worry that after everything I’ve been through with my husband over 5 years, it will be impossible to accurately get my experience across to someone. Especially having only an hour every other week to talk. Do you have any tips or approaches I can take to go into this in the best frame of mind? Do you have any episodes on preparation for therapy as a couple? Thank you.


Embarking on couples therapy is a commendable and significant step towards nurturing your relationship. It’s wonderful that you’re both taking this journey, despite the uncertainties and worries that come with it. Keep in mind, therapy, like many things in life, might require some trial and error. Finding the right therapist can be a process in itself – they may be an instant match or might not align with your needs immediately. However, the commitment to change and improve is a monumental step in itself.

Your concerns about effectively communicating your accumulated experiences in therapy are valid. It’s true, an hour every other week may seem insufficient to unravel years of shared life. But remember, the therapy sessions are just the beginning of the process. To make the most of your sessions, a bit of preparation can be immensely helpful. Consider keeping a journal to jot down thoughts, incidents, feelings, or patterns you wish to explore in therapy. This not only helps you organize your thoughts but also ensures that important issues are not overlooked during your sessions.

Discussing your aspirations for therapy with your husband can also be beneficial. Shared goals, even if approached from different perspectives, can provide a clear direction for your therapy. In therapy, remember, you don’t need to have all the answers. That’s the role of your therapist. The aim is not to solve everything instantly but to gradually build trust and understanding.

Much of the work in therapy actually happens outside the therapy room. Engaging with resources like the ‘Couples Therapy Workbook’ by Kathleen Mates-Youngman, or playing interactive games like ‘Let’s Get Deeper’ or ‘We’re Not Really Strangers,’ can significantly enrich your therapy experience. These tools help you maintain the momentum of therapy, even in between sessions.

Homework assignments from your therapist are an integral part of this process. These could be discussions or activities to do together – ensure you actively engage in these tasks. Additionally, enhancing the positive aspects of your relationship can be equally important. Set aside time to connect, share enjoyable experiences, and build on the positives in your relationship.

Consider individual therapy as well. While couples therapy focuses on the relationship, individual therapy provides a space for personal exploration and support. Depending on your specific concerns, learning new skills such as active listening or understanding cognitive behavior therapy principles can be helpful. For instance, active listening strategies, as discussed in episode 217, can smooth out communication challenges.

Lastly, understand that therapy is not necessarily a quick fix. It’s a journey of exploration and decision-making for the wellbeing of both individuals and the relationship as a whole. The process need not be laser-focused from the start. Allow yourselves the space to explore and use these tools to amplify the impact of your therapy sessions. Remember, the more effort you put in, the more you’ll gain from the experience.

Question 2:

Hi Duff!

I enjoy your show, you give really good insight and I want to start by thanking you for what you do. I am a 23 year old male and for the last 3 years I have been experiencing derealization and depersonalization pretty frequently, along with panic attacks here and there. It manifests in the feeling that everything feels fake or that I am watching myself exist. Here’s my question: what are some ways I can tame these uncomfortable feelings. Thank you again!


Navigating the unsettling waters of derealization and depersonalization can be daunting, and it’s commendable that you’re seeking ways to manage these feelings. Understanding what these experiences are is a crucial first step. Derealization involves a sense of detachment from your surroundings, making the world seem unreal, like a dream or a movie. Depersonalization, on the other hand, is a disconnection from yourself, where you might feel like an outside observer of your own life or that you’re on autopilot.

These forms of dissociation can be triggered by various factors, ranging from physical conditions like sleep deprivation or neurological issues to psychological causes such as trauma, anxiety, or depression. Your experiences, especially in the context of panic attacks, suggest a link with mental health triggers.

First and foremost, it’s important to acknowledge that these symptoms, while distressing, are not inherently dangerous. They’re inconvenient and often scary, but they don’t pose a direct threat to your well-being. However, it’s always prudent to consult a doctor to rule out physical causes.

When it comes to coping strategies, there are several approaches you can explore. Some people find that a sharp sensory experience can help realign the mind and body. This could be something as simple as splashing cold water on your face or holding ice cubes in your hands.

Grounding techniques are also incredibly effective. Sensory bingo, for example, involves engaging each of your senses in turn. Whether it’s tasting something distinctive, listening to a particular type of music, or touching different textures, these activities can help anchor you in the present moment.

Mindfulness practice can also be a valuable tool, though its effectiveness can vary based on what typically triggers your dissociation. Mindfulness helps in recognizing when you’re dissociated and gently guides your focus back to the present, without giving undue attention to the sensation of dissociation itself.

Deep breathing and relaxation exercises can also alleviate symptoms, especially if your dissociation stems from anxiety. Paying attention to your overall stress levels and making lifestyle changes if necessary can also be beneficial.

Therapy can expedite the acquisition of these coping skills and address deeper underlying issues. Working through a traumatic history or understanding the reasons behind feelings of vulnerability that lead to dissociation can be pivotal in managing these experiences.

Medication may also be a viable option for some, helping to reduce the frequency of dissociation episodes.

Lastly, exposure therapy, a method that involves gradually facing the source of your anxiety, can be instrumental in building tolerance and reducing the intensity of anxiety and dissociation symptoms.

For additional guidance on managing panic and learning more about exposure work, resources like my online course on anxiety or various podcast episodes on the topic can offer further insights and strategies.

Remember, each person’s journey with derealization and depersonalization is unique, and finding what works best for you is a process of exploration and patience.

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