Does somatic psychotherapy work only with the body?
Somatic psychotherapy provides a holistic approach to healing trauma because integrative somatic trauma therapy focuses on the integration of mind, body, and energy. It recognizes the body's experience as the primary pathway to ‘understanding’ what happened, but it does not exclude other elements of experience as holding wisdom and knowledge. Contrary to what many people believe, somatic psychotherapy does not disregard the mind – rather, it focuses on balancing the mind-body-energy system by assigning equal power and importance to all three components of experience. However, to heal the mind-body split, somatic psychotherapy asserts that greater emphasis must initially be given to the body because the body has been neglected since the early twentieth century when psychology and psychoanalysis (the original ‘talk therapy’) became the predominant method to heal mental and behavioural disturbances.
While talk therapy focuses on observing thoughts to change thoughts and behaviour, somatic trauma therapy taps into the wisdom of the body to restore the mind-body connection, asserting that both body and mind should be attended to because both have unprocessed – and often quite distinct – memories that need to be integrated. Somatic psychotherapy supports clients to access an internal sense of safety in their body, provides tools to regulate their nervous system, and helps them process traumatic memories at the implicit level.
Bellicon bungee rebounder to increase nervous system activation and protect the joints (photo: Miranda Mayle)
Trauma is a physical experience as well as an emotional and psychological one.
The body stores traumatic memories in the form of physical sensations – e.g., muscle tension, joint stiffness, headaches, nausea, aches and pains. Researchers such as Bessel van der Kolk have demonstrated that somatic therapy is particularly effective for addressing unresolved trauma because traumatic memories are stored in the body, not in the mind. Talk therapy can address the psychological and emotional aspects of trauma, but it does not address the physical sensations in the body that are directly connected to the person’s experience of the traumatic event.
On the other hand, somatic psychotherapy focuses on the physical sensations felt in present time that are linked to unresolved past trauma. Somatic work helps clients become aware of their sensations (observation and tracking), understand how they are consistent with a trauma response (psychoeducation), and teaches them how to regulate their nervous system (self and co-regulation). This can be done through various somatic techniques such as focusing, breathwork, tracking micro-movements, observing facial expressions and vocal intonation (and responses to them) in present time. Through learning how to regulate their physical sensations when they are activated, survivors can feel more at home in their bodies and in control of their emotional responses.
Client Case Study
I recently began working with a client with Chronic Fatigue Syndrome (CFS). They are Polyvagal-informed, trauma aware and have had many years of psychotherapy due to developmental trauma. They specifically wanted my help overcoming CFS from a nervous system perspective. In our second session I facilitated a process whereby they found themselves in the ventral vagal part of their nervous system. They realised, much to their surprise and without any explanation from me, that they were in ‘safe and social’. They were excited to have a different experience of their nervous system because they had spent 95% of their life in ‘fight or flight’. I affirmed the goodness of the experience, saying, “This is where you will heal.” At the end of the session, we debriefed what happened. It hadn’t occurred to them that I meant, “This is where your body will heal.” They assumed I meant their mind.
Even the most aware clients aren’t readily convinced of the mind-body connection. Social conditioning (indoctrination) causes just about everyone to subscribe to the mind-body dichotomy. People know, but easily forget, that emotional distress causes physical issues, that physical and emotional trauma create mental distress, and that the mind can harm the body. Yet their default thinking is that each affliction must be separately addressed.
My client came to me with concerns about having the capacity to tolerate big physical releases of traumatic energy. However, good trauma work is well titrated and might feel like the gentle hiss of air escaping from an inflatable mattress – not like the frenzied dance that happens when you let go of a blown-up balloon. Furthermore, when it comes to developmental trauma, there is often no physical release, rather, an energetic, emotional, and relational recalibration. With no visible ‘hiss’ at all.
Developmental and relational trauma requires a nuanced approach
Another widespread assumption about somatic trauma psychotherapy is that it is concerned only with restoring the body’s incomplete defensive responses that were interrupted at the time of the trauma. However, this assumption does not take relational trauma into proper account. When it comes to developmental trauma, rarely are there incomplete physical defensive responses. Instead, developmental trauma happens through relational misattunement and is healed through relational repair. Tracking the missing experiences in the client’s developmental history reveals the symptoms of incomplete defensive responses, such as chronic pain, anxiety, and depression. Working with the impulses to get their needs met that were interrupted by caregivers restores the adult client's capacity to respond appropriately in the present moment and changes their thoughts and behaviour.
Philosophical and theoretical comparison between talk therapy and trauma-focused somatic psychotherapy
When it comes to treating trauma, somatic psychotherapy is considered more effective than talk therapy. While traditional talk therapies try to understand current thoughts, behaviours, and emotions by exploring the impact of past experiences, somatic psychotherapy emphasises the client’s experience of the present moment and explores the sensations in their body that are associated with unresolved trauma. Somatic psychotherapy attends to the nervous system, which is responsible for regulating physiological and emotional responses to stress, and when dysregulated, can lead to a wide range of mental health conditions. By observing and tracking bodily sensations, practitioners gain insight into the ways in which their client’s nervous system automatically responds to stress and can suggest appropriate interventions for regulating their system.
Both talk therapy and somatic therapy integrate different theoretical approaches and modalities or may focus solely on one therapeutic modality and clinical perspective. However, in other aspects, they often differ in their approach. Here are some key areas:
Somatic Psychotherapy Talk Therapy
Primarily focuses on the connection between mind and body. Primarily focuses on verbal communication
Addresses psychological issues by paying attention to nervous system patterns of dysregulation of the nervous system. Addresses psychological issues via verbal processing
Requires the client to be present and able to access past and future via implicit and Requires the client to be present and able to access past and future via autobiographical memory and imagination. autobiographical memory and imagination
Attends to the physical sensations in the body associated with unresolved past traumas and Uses thoughts about the past to better understand current behaviours and
patterns of nervous system dysregulation causing emotional distress. emotions
Uses body-based techniques such as Somatic Experiencing® and Brainspotting®. Involves cognitive techniques, such as Cognitive Behavioural Therapy (CBT),
and insight approaches, such as psychodynamic psychotherapy
Emphasises bottom-up processing and recruits the limbic structures of the brain to sense and Emphasises top-down neural processing and recruits the pre-frontal cortex feel experience. to analyse, infer and understand experience
Prioritises the body’s wisdom to reveal body-based memories, unconscious thoughts behaviours, Prioritises memories and emotions to explore and investigate the impact of and embodied beliefs. past experiences and to shape future behaviour.
Experience prior to acquiring language and autobiographical memory (before 18 months of age) Experience prior to acquisition of language and autobiographical memory is explored non-verbally – i.e., somatically and energetically. (before 18 months of age) is dismissed.
Acknowledges the impact of mind, body, and spirit, but focuses on integration of all three Acknowledges that mind, body, and spirit all make an impact, but believe elements by attending to the body first. they differ in degree of impact and importance, with the mind being of
greatest importance.
A good working alliance between clinician and client is essential, and assuming that trust and rapport have been established in the clinical relationship, the choice of modality should be based on the client’s presenting problem as well as the clinician’s preference and comfort with a specific modality.
For this reason, it is important not to dismiss the applicability of somatic therapy programs as an integrative approach to supporting clients with a wide variety of issues. With a focus on integrating mind, body, and spirit, somatic psychotherapy offers a profound therapeutic experience for the client. With the admission of the body into the clinical space – an element largely ignored by conventional psychotherapy – clients feel able to reveal unconventional aspects of themselves in somatic sessions.