Grounding Dissociation in Telehealth
Dissociation during telehealth sessions presents unique challenges that require practical, evidence-based strategies. This article explores effective grounding techniques that mental health professionals can implement through virtual platforms, drawing on insights from experts in the field. Learn how simple methods like the 3-2-1 sensory technique and cold touch can help clients reconnect with the present moment during remote therapy sessions.
Ground With 3-2-1 and Cold Touch
One telehealth-friendly grounding protocol I use is orienting my client back to the present moment paired with sensory anchoring. I might say, “Let’s pause for a moment. Look around and name three things you can see, two things you can hear, and one thing you can physically feel right now,” then gently orient them to the date, location, and the fact that they’re safe. After this, I will invite the client to press their feet into the floor or hold something cold, with ice being especially effective if they have access to it. This is a way to help the body reconnect and send a signal of safety to the nervous system. Usually within a minute, their voice steadies, eye contact improves, and they report feeling more present. We briefly reflect on what helped before continuing the session.
Use Screen Timer for Slow Exhale
Paced breathing can be made easier in telehealth by using a timer visible on the screen. The clock or a simple moving bar gives an external rhythm that helps the mind stay present. A pattern like four seconds in and six seconds out is slow enough to calm the body without strain. The therapist can count softly or the client can follow a beep or color change to keep the pace.
If the head feels light, the next round can use shorter counts while keeping the flow steady. A brief check after each minute can notice warmth in the hands or a softer jaw as signs of settling. Set a one-minute timer and try three easy rounds right now.
Recite Date Time Place and Purpose
Orientation to the present can start with simple facts like the date, time, and where the body is sitting. Saying the therapist’s name and the purpose of the meeting adds another anchor that is easy to hold. The chat box or a sticky note on the screen can pin these details, so eyes can return to them when focus drifts. Looking around the room and naming three safe objects helps the brain link words to the current place.
A calendar or clock on screen can be shared for a moment to make the cues more concrete. Repeating the facts once more in a calm tone gives the nervous system a chance to catch up. Say the date, the time, your location, and why you are here out loud right now.
Set Pause Plan and Backup Signal
A clear pause plan reduces fear when fog or numbness shows up during a video session. A short cue word or hand signal can mean “please pause,” so no extra talking is needed. The plan can include turning off camera for one minute, taking three breaths, and then checking back in. If the call drops, a backup path like a phone call within five minutes prevents panic and guesswork.
Writing the steps in the chat and saving them gives both people the same map to follow. Practicing the signal once at the start of each meeting makes it feel normal and safe. Choose a cue and a backup contact method before your next session.
Add Small Moves and Tactile Boosts
Small on-camera movements can bring the body back when thoughts feel far away. Pressing feet into the floor, rolling shoulders, or placing a hand over the heart can wake up useful sensations. The therapist can mirror the movement, which adds safety and helps with pace.
Each reset can be brief, about twenty to thirty seconds, with a simple check for any change in temperature or tension. A sip of cool water or the feel of a textured object can add another cue that says “present.” Noting which two moves work best builds a quick menu for future sessions. Pick one movement and try it for thirty seconds during your next video visit.
Let Calm Voice Lead Breath and Space
In telehealth, the sound of the therapist’s voice can serve as a steady guide for the nervous system. A slower pace, gentle tone, and clear pauses invite breaths to lengthen without effort. Brief phrases like “here, now, okay” said on the out-breath can set a rhythm that is easy to follow. Audio settings that reduce background noise and the use of headphones can make these cues easier to hear.
The therapist can match the current speed of speech for a moment and then lead it down to a calmer tempo. Short silences between sentences give space for the body to notice settling and warmth. Ask for slower speech and soft pauses in your next call.