Why the body matters

June 27, 2022

By Katie Bascuas

Somatic therapy, or therapy that incorporates the body into the therapeutic process, continues to grow in popularity. This is likely due to the evolving nature of our understanding of trauma and the need for various approaches to treat the impact of traumatic experiences, which often have a significant physiological impact on the body, especially the nervous system. But as a relatively new therapeutic approach, which lacks the equivalent evidence-based research to support its efficacy compared to other modalities, somatic therapy is not without skeptics. Many clinicians who use it, however, advocate for its ability to help clients, especially those who may have tried other modalities with mixed results and those who are processing traumatic experiences. 

Incorporating somatic techniques into psychotherapy work came almost second nature to Kimberly Hanson, a licensed professional counselor (LPC) in Charleston, South Carolina, and a trained dancer. 

“I understand a lot about the body, and how our emotions can be reflected through our body and vice versa,” says Hanson, who uses movement exercises and breathwork as part of her work with both adults and children. 

“I’ve done exercises where [clients] stand up, and they’ll stretch their arms up to the ceiling and then drop down and swing them on the floor and bring them back up, all while focusing on their breath,” Hanson says. She also incorporates modern dance techniques such as expanding and contracting the body into her clinical work. For example, she once worked with a client to process a fear of taking up space and using his voice by asking him to stand up, spread his arms and move in a circle to establish his own personal zone. “We did some expansion work with that and coupled it with some breathwork, and I’d ask him what he noticed when he took up territory and established his own personal boundaries,” Hanson recalls. “That was very impactful for him.”

Hanson has found that pairing body-based techniques with other more talk-based therapies to be incredibly effective when working with clients. “It can give [counselors] a lot of information,” she explains. “We are a three-part being. We are body, mind and spirit, and all of those things integrate together, so why don’t we incorporate that into our therapeutic process?” 

Using a somatic approach may look different depending on the counselor’s training and preferences. Some clinicians may be fully certified somatic experiencing practitioners (SEPs) trained in the somatic experiencing (SE) program based on the work of Peter Levine, whereas others, such as Hanson, may be trained in other modalities but incorporate somatic-based techniques such as mindfulness, movement and breathwork into their therapeutic work. Even the pathways to incorporating somatic techniques can look different to most counselors. However, one thing that many of these clinicians have in common is their belief that the results of body-based techniques often speak for themselves.

Brain-body connection

Mike Wendt, an LPC at Sherman Counseling in Appleton, Wisconsin, has been doing SE work since 2019 and says that it has transformed his therapeutic orientation. “It’s gotten to the point where this is my main modality,” he notes. “It’s really that powerful. It just floors me with what I’ve seen in practice.” 

Wendt, who has a background in neuroscience and is certified by the Biofeedback Certification International Alliance in the use of electroencephalographic (EEG) biofeedback, says that neurofeedback was his gateway into therapy. “I was very interested in the mechanics of how the brain works and the neurological patterns associated with things like anxiety, depression and trauma,” he says. While fine-tuning his neurofeedback skills, however, he kept encountering clients with a lot of trauma markers in the brain. For example, alpha brain waves, which can be detected with an EEG, show up differently in traumatized and nontraumatized clients, he explains. When a client who has not experienced trauma closes their eyes, the EEG shows a healthy increase of alpha waves in different parts of the brain, he says, but for a traumatized client, the rise in these waves may be blunted or absent. And for some severely traumatized clients, it may even decrease, he adds. 

After noticing these neurological markers among several clients presenting with trauma, Wendt says that he began looking for other modalities to help treat traumatic experiences. “There haven’t, historically, been a lot of effective ways to work with trauma, so I thought if I’m just going to keep encountering these neurological markers, I better come up with an effective way to work with it outside of neurofeedback,” he recalls.

Wendt later stumbled on some writing about SE while researching neurofeedback and decided to attend a training session in 2019. “It was incredibly eye-opening how everything with SE just tied together with neuroscience and changes in brain pathways — so using the body to train the brain and not the other way around, which is where I was coming from with the neurofeedback,” he says. “This tied things all together for me when we brought the body on board.”

When he first began incorporating SE into his practice, Wendt would start a session with neurofeedback until he noticed a client’s physical reactions, and then he would shift into more somatic work. “There’s always a somatic reaction when trauma is brought to the surface,” Wendt explains. “Later on, I would just skip the neurofeedback entirely and just go into what is a person’s body language saying to me.”

He once worked with a 16-year-old female client who was experiencing chronic physical pain and was referred to Wendt for his expertise in neurofeedback. In working with the client, Wendt also incorporated SE and was able to help the client to reduce the pain to a level where she could focus on other issues, such as an eating disorder. 

Wendt says that he brought in body work to help treat the eating disorder by reflecting the client’s posture and how it changed when she discussed her journey dealing with disordered eating. He would notice how her hands would fold over stomach, for example, as she discussed different parts of her experience, especially the time she was hospitalized and when discussing her body image compared to her friends, whom she thought had a more “normal” body weight and physical condition. After reflecting what he noticed, Wendt says that he then asked the client to try moving her hands out away from her stomach as she talked. “What I had her do is experience what it was like in her body when she would put her hands out a little further, so she would be more open physically and less threatened emotionally, and then she would bring them back again and feel her anxiety rise and fall,” Wendt explains. “And she’d also feel the comfort of having her hands folded around her stomach as security.” 

He also helped this client work on developing positive coping strategies using SE, and over time as the client continued to experience and process the anxiety, she was able to move her hands away from her stomach completely without fear or hesitation. When this happened, Wendt recalls that the client looked at him and said, “Did you trick me?” He asked her what she meant, and she explained that “the feelings of how she looks and how others see her weren’t there anymore.” And eventually, the client felt comfortable enough to engage in activities she might have previously passed up such as wearing a bathing suit at the beach. 

Improving self-regulation 

For Nancy Skocy, an LPC and SEP in Tucson, Arizona, SE became part of her clinical work after she experienced its effects via her own personal therapy. 

“I worked with other kinds of therapy and personally have been in therapy myself, and what I had discovered in my own work is that I could understand a concept — for example, the concept of setting a boundary — yet when it came to doing it, I would have the words [to verbalize the boundary], but it seemed that something was missing in that I didn’t know how to be effective around setting [or enforcing] the boundary.”

Skocy also has a background in equine therapy, and she says that working with horses, combined with her personal experience with somatic therapy, helped her to see the possibility for helping clients work on emotional regulation.

“If you are emotionally dysregulated when you’re trying to work with a horse, the horse reads that emotional dysregulation in your body,” she explains. “Taking those types of nuances into the SE world is when I started realizing that many times when I was communicating with family members or loved ones and I was upset emotionally, I would communicate in a dysregulated way and it would not be effective.”

She says that she noticed a similar theme among some of her clients who struggled with emotional dysregulation, which affected their communication styles as well as their relationships. “What I noticed was that a lot of my clients had a hard time shifting to taking responsibility for self-regulation,” Skocy recalls. There’s often a belief that other people will regulate us, she adds, especially in clients who have experienced trauma. 

She finds that having clients track their bodily sensations, in addition to their emotions, helps them improve their ability to self-regulate. “Tracking emotions isn’t the same thing” as noticing physiological responses, she says, “because if I’m tracking my emotions — I’m angry, I’m hurt, etc. — I will then justify my reasons for attacking someone else.” Taking this extra step of noticing bodily sensations and then regulating the nervous system response allows clients to come from a more empowered and controlled place when responding to emotionally triggering people or situations, she adds. 

One way Skocy shows clients how to regulate their emotions is by helping them shift negative bodily sensations into more positive ones. For example, if a client reports feeling tense or constricted, Skocy may prompt them to remember a time when they were happy or to think about a loved one and to notice how their body feels. She may also ask clients to explain how they know they feel happy, which may be because their cheeks feel warm or they notice that they’re smiling. 

“Finding the positive is where you restore the balance,” she says. “When I think about someone that loves me or a happy time that I had, I can learn how to shift things myself, and I can settle into a more regulated state and think about how I want to approach communicating with someone.”

In that sense, clients then have more autonomy around how they show up in the world, including the boundaries they set. “A boundary is no longer telling somebody, ‘When you do this, I’m going to confront you,’” Skocy says. “It now becomes, ‘It’s important for me to take care of myself and to protect myself in my relationships as well as to consider the other.’” 

Filling a gap 

Whitney Norris, an LPC and SEP in Little Rock, Arkansas, and co-owner of Little Rock Counseling & Wellness, was also drawn to SE work after experiencing the benefits firsthand through her own personal therapy. She later completed the three-year SEP training, which had an effect not only on her therapy worldview but also on how she presented herself as a clinician.

“The first thing that I noticed with SE training was the way that I showed up in the room, noticing my own reactions to what was going on in the room and noticing and differentiating what was going on with the client even if I didn’t speak any of it,” Norris says. “I felt like I was more present.” She adds that SE training and learning more about her own nervous system helped her to expand her capacity to sit with different things that may come up in a session or that might happen in her own life. 

Norris, who specializes in trauma work, says SE also helped her fill a therapeutic gap that she felt was missing in her work. She had some clients from whom talking about their experience was not that helpful and others who found eye movement desensitization and reprocessing (EMDR) to be too intense. She says using SE is especially helpful for these clients — ones she admits “might have otherwise been falling through the cracks treatment-wise” — because it incorporates the client’s bodily response in a way the other therapies do not.

Although she occasionally runs into a client who is initially hesitant to try somatic techniques — largely due to the fact that they may differ from anything the client has tried before — she finds that most clients are willing to engage in SE and are typically surprised at the results. In fact, clients often tell her, “I have no idea how that worked, but I feel like it did” or “I don’t understand what we just did, but that felt helpful.”

Skepticism

That sense of mystery behind somatic therapy and how it works, coupled with a lack of research compared to other modalities, can contribute to a feeling of skepticism. Some critics argue that there is not enough research to prove the effectiveness of somatic-based techniques. 

In a 2021 literature review of the effectiveness of SE published in the European Journal of Psychotraumatology, for example, Marie Kuhfuß and colleagues found preliminary evidence suggesting positive effects of SE for the treatment of symptoms related to posttraumatic stress disorder (PTSD) as well as affective and somatic symptoms, yet they also noted that the quality of research surveyed was mixed due to risk of bias. The authors recommended further research through randomized controlled trials. 

Meanwhile, a 2017 randomized controlled study of SE — billed as the first of its kind — found evidence to suggest that it is an effective treatment modality for PTSD. The study, published in the Journal of Traumatic Stress by Danny Brom and colleagues, randomly assigned 63 participants living in Israel, all of whom had reported traumatic experiences within the previous four years, to two groups: one that underwent 15 sessions of SE and another that was assigned to a waitlist. In the post-session analysis, researchers found significant effects of SE on posttraumatic and depression symptom severity among participants assigned to the treatment group.

Danny Brom and colleagues also noted, however, that the small sample size as well as the difficulty in measuring the effectiveness of a treatment that does not adhere to a strict protocol were both limitations to the research. 

Unlike a modality such as EMDR, which is protocol-driven and more black-and-white in its approach, Norris says, SE is less linear and looks different to various practitioners who may incorporate a variety of techniques based on their own preferences or the needs of a client, making it harder to research. But “it doesn’t necessarily mean that it’s ineffective because there isn’t that type of research out there,” she says. “It may mean that it doesn’t lend itself to be able to be researched in that way.” 

Challenges

Skepticism and the need for more research aren’t the only challenges counselors may face with somatic-based work. “I frequently run into people not wanting to have a relationship with their body,” Skocy says. In fact, she points out that some clients may have a dislike or even hatred of their own bodies and feel shut down physically. 

Hanson agrees and notes that she sometimes encounters clients who are resistant to trying a somatic technique or who don’t experience any immediate benefit. When this happens, she says that she often tries to use the resistance or the lack of effect as a catalyst for further exploration. “As a trauma professional, I’m trained to understand those blocks, so we’ll do something else to try and access why they’re not getting anything or why they feel numb,” she explains.

Both Norris and Wendt agree that the learning curve associated with somatic therapy provides another challenge. “There’s a reason the [SE] training is spread out over three years — you need to have time to integrate each piece,” Norris says. Because she didn’t learn about the nervous system or the body in her graduate program, she had to catch up on those pieces, all while learning the specific SE techniques.

Not only is there sometimes a knowledge gap, but the work also takes practice. “It is very much an art form,” Wendt says. “If you push someone too quickly, they might shut down and go into that freeze or collapse state, and you’re most likely not going to get them back in that session.”

The possibility of triggering someone while doing SE emphasizes the importance of creating safety for clients. Wendt says that he uses mindfulness skills such as body scans to help clients safely connect to their bodies, and he encourages clients to think of a pleasant experience or a safe person that they can focus on when they want to feel safe and relaxed during a session. 

“That way we have something that they’re able to tether to because the goal of SE is not to approach trauma to the point of being overwhelmed, but to approach the outer orbits where can we feel the first whiff of that signal in our body that tells us that something isn’t right,” Wendt says. “Oftentimes we don’t need to go any further than that, but we want to have a tether because if we go too far, the person can shut down very quickly and then you have to start over again.”

Try it for yourself

Some clinicians are hesitant to try somatic approaches because they fear retraumatizing or triggering a client. Yet many who support the work have been able to move through that fear, and they say that the results they see among clients are worth it. 

The counselors interviewed for this article all recommend that clinicians who are interested in delving into somatic therapy should try it for themselves as part of their own personal therapy. They suggest that practitioners read, research, and take training and continuing education courses about the practice of somatic approaches and body-based interventions to gain a deeper understanding of this approach and how it can be helpful to clients. Counselors can also find a therapist who specializes in somatic work and try a session or a series of sessions. 

“That really tipped me over the edge of being convinced,” Norris says. “I had done a lot of therapy up to that point, and it was all helpful, but once I started doing my own SE therapy, it was just beneficial in ways that other stuff I was doing wasn’t.”

She and Hanson also make the point that without doing the work yourself, it can be hard to fully comprehend how the techniques work and why they can be effective. 

“You can’t do these techniques without understanding it from a personal level,” Hanson says. “There’s just no way. You can try, and it will either feel forced or feel too rigid, and the client will pick up on that and know that this isn’t what you do.” 

She adds that the essence of this type of work is experiencing — being present with the feelings and sensations of the body as they arise — and that needs to feel genuine. “Part of the goal of these processes is that they’re organic and that it feels natural, so the therapist must be very comfortable with these types of interventions in order for the client to feel comfortable with it,” Hanson says. And “you have to do it yourself to get that understanding.”