What avenues exist for people who dissociate when pursuing therapy?

That is a great question! Thank you for allowing me the chance to answer it!  Treatment Resistance is part of the therapeutic process. Many people want to make changes but very few people are willing to actually make the changes necessary to see a different outcome. During therapy staying motivated for change is going to be necessary to create lasting change. Recognizing the reasons you are seeking treatment, your motivation, is one step to overcoming treatment resistance. Once you know your motivation, recalling with intention in moments where you are feeling less driven to make changes will help you refocus. As you begin to discuss your stressors and concerns, the best advice I can give is to be honest, open, and willing to explore.  Motivation may come and go, so finding the reason for you to dig deep into finding the solution will be important to staying connected even when this feels uncomfortable or challenging beyond your normal comfort-level.

During the process of therapy, Cognitive Behavioral Therapy (CBT) makes the connection between our thoughts and behaviors. Cognitive Behavior Therapy is a therapeutic approach which helps re-train the brain through changing thought patterns and altering behaviors or outcomes. Therapists often take the approach of "teaching" new coping strategies or skills that can help to change experiences. If we can change our thoughts then we can change our behaviors... or the opposite, if we change our behaviors then we can change our thoughts. Often at the beginning of therapy, I start with this "teaching" technique.  This helps clients to identify skills they already had as well as learn new strategies.  As you learn these new strategies, being open to new techniques that may not seem like they will work or be beneficial will be important to broadening success.

The feeling of dissociation can be confusing and complex for many people.  It's a moment when you are mentally disconnected from the present moment, the here and now.  When someone recognizes they are feeling disconnected or experiencing a moment of dissociation, there are coping strategies that can be practiced to bring oneself back to the present.  These skills are generally called "grounding techniques" as they anchor or tether you to the present moment through the senses, grounding you to the moment.  One of the most common grounding technique is called "5-4-3-2-1" which has you become detail oriented to the space around you by naming five things you can see, four things you can feel (not emotions, but rather physically feel), three things you can hear, two things you can smell, and one thing you can taste. Identifying the smallest details, instead of general details, will be more grounding. So for example identifying things like "I see the different shades of green colors of the blanket threads," instead of "I see a blanket," will be more effective. 

Make sure you keep practicing your coping strategies. This will be important because they often don't come naturally at first. Practice them regularly, even when you don't feel it's necessary.  This helps the body and the brain get accustomed to the new behaviors so that when you need them, your body will be more likely to know how to respond.  CBT is about re-wiring the brain, making new pathways for improved thoughts and behaviors. Just like a path in the woods, that takes time, energy, consistency, and work. I wish you good luck in your journey! Keep asking for help and support, keep exploring new ways to respond, and if you haven't already, consider therapy!