What is somatic therapy and how does it work?

We say we are heartbroken, choked up, or unable to stomach something, and we usually mean it as a figure of speech. The body often means it more literally. The ways people hold tension are rarely arbitrary, because we share the same anatomy and move through the same physical world. When we want to hide, for example, many of us hunch to make ourselves smaller; when there is something we cannot say, we may feel it as a tightness in the throat.

Somatic therapy makes the body part of the therapeutic conversation. Alongside what a person thinks and says, it attends to what they sense physically: tension, breath, posture, the small movements that come with a feeling or a memory. It is less a single method than a family of approaches.

Western thought has long assumed a separation between mind and body and valued reason above the felt experience of being alive, and in many ways it still does. Neuroscience no longer supports that split, but ideas so embedded in a culture are slow to change. In Descartes’ Error, the neurologist Antonio Damasio described patients who lost access to their emotions after brain injury and, despite intact intelligence, made poor decisions in everyday life.1 He argued that emotion, and the bodily states that accompany it, are integral to sound reasoning rather than obstacles to it.

What does ‘somatic’ mean?

Soma is Greek for the living body. The philosopher and movement educator Thomas Hanna adopted the term to refer to the body as it is experienced from within, by the person living in it, and called the field that studies it somatics.2 The body in a selfie is the one other people see; the soma is the one you feel from the inside as you dance to your favourite song.

Our culture mostly teaches the outside view. We learn to value the body for how it looks and to judge it against an ideal, often more readily than we notice how it feels or what it needs to be healthy. I often think about how many of our problems, with our bodies and with our lives as a whole, come from observing our lives as a critical bystander rather than inhabiting our experience from the inside. Somatic therapy turns attention inward: toward sensation, and toward posture and movement as expressions of our inner state.

Tension is rarely arbitrary

Somatic therapy starts from the observation that experience, especially overwhelming experience, leaves traces in the body as well as in the story we can tell about it. The psychiatrist Bessel van der Kolk’s book The Body Keeps the Score made the idea widely known.3

Part of this rests on well-established memory research. Alongside explicit memory, the kind we can put into words, we have implicit memory: learned emotional reactions, habits of posture and movement, and bodily responses that run outside awareness. Someone can brace before a difficult conversation without remembering when in their past they learned to.

Somatic Experiencing® adds a model of what happens after overwhelm. Peter Levine observed that animals in the wild go through intense responses to threat and then visibly discharge them, by shaking or breathing deeply. He proposed that when a person cannot complete a fight, flight or freeze response, it stays active in the nervous system.4 In this view, chronic tension, shallow breathing, anxiety or a sense of disconnection can be an expression of a nervous system still bracing against a threat that has passed. Whatever the underlying physiology turns out to be, the model gives therapy something valuable: a way of understanding symptoms as adaptations that once made sense, rather than as flaws.

The model also suggests why these patterns are so often shared. We all have the same survival needs and the same basic set of defences, so an unfinished response to threat, such as bracing, shrinking or holding back a cry, can look much the same from one person to the next. Emotions themselves seem to be mapped onto the body in common ways. When researchers asked around 700 people in Finland, Sweden and Taiwan to colour in where they feel different emotions, the maps were strikingly consistent across people and cultures.5 The slumped posture of shame appears even in athletes who have been blind from birth and so never saw it modelled.6

Stephen Porges coined the term neuroception for the nervous system’s constant, unconscious scanning for signs of safety or danger, which shapes how we feel before we have had a single thought about it.7 The term comes from Polyvagal Theory, whose account of the nervous system is now disputed; the debate is outlined below.

Change happens in the present moment

Talk therapy is a valuable opportunity to make sense of our history and change how we relate to it. Somatic approaches also attend to how an experience lives in the body right now, not only to what happened. For example, a therapist might ask where a feeling sits in the body, or notice that someone’s breath stops each time a particular person is mentioned. The insight behind this is that change can only happen in the present moment, so we turn our attention to the experience of being in the room, here and now, and work with whatever arises.

The philosopher and psychologist Eugene Gendlin offered a bridge between the verbal and bodily registers of experience. He described the felt sense: the vague but whole bodily sense we have of a situation before we have words for it.8 Staying with the felt sense often brings the right words, which is one reason somatic work and talk therapy can be very complementary.

How does somatic therapy work?

Methods vary, but most somatic approaches share a few elements.

• Noticing sensation. Paying attention to what is happening inside: warmth, tension, pulsing, an urge to move, the rhythm of the breath. The ability to sense the body’s internal state is called interoception. Researchers increasingly study it in mental health, and differences in interoception have been found across conditions including anxiety and depression, though much is still unknown.9
• Following sensation. Staying with sensations as they shift and change, and treating them as a form of the body’s communication rather than something to analyze.
• Resourcing. Identifying experiences, inner or outer, that evoke steadiness, strength or ease. Resources act as anchors: they build the nervous system’s capacity and give attention somewhere to return when difficult material arises.
• Titration and pendulation. Approaching difficult material in small doses (titration), and moving attention back and forth between what is hard and what steadies (pendulation), so the nervous system can process without being overwhelmed. Both terms come from Somatic Experiencing®.
• Completing defensive responses. A protective response that was cut short, such as pushing away, turning to run or bracing, can be allowed to complete. The movements involved may be subtle or quite large, and they unfold slowly so the nervous system can take them in.
• Orienting. Slowly turning the head and looking around the room, taking in the surroundings. It is one of the simplest ways to bring the nervous system into contact with the present moment.
• Regulation. The overall aim is to help the nervous system move out of chronic states of high arousal or shutdown and regain its flexibility: the capacity to rise to a challenge and settle again afterwards.

In my sessions, noticing sensation is often where things begin to change. When people first turn their attention to it, there can be a bit of an “aha” moment: they see clearly how a situation in their life, or an emotional experience, connects to where they are holding tension in their body. It can be quite illuminating. I experienced this myself on my first Vipassana retreat, and for me it was earth-shaking. Often there is an immediate sense of relief, whether the sensation is pleasant or unpleasant. People feel more landed in themselves and more congruent, and the tension may begin to shift just from having been noticed.

The main somatic approaches

Body psychotherapy goes back to the 1930s, when the psychoanalyst Wilhelm Reich began treating posture and chronic muscular tension as expressions of emotional defence. His student Alexander Lowen built Bioenergetic Analysis on that work.10 Reich’s later theories were widely rejected, but his attention to the body shaped much of what followed. The approaches most often grouped as somatic psychotherapy today include:

• Somatic Experiencing®. Peter Levine’s approach to resolving overwhelm in the nervous system, developed from the 1970s, and the one I work with most.4
• Hakomi. Developed by Ron Kurtz, a mindfulness-based method that uses small experiments to explore how core beliefs show up in the body.11
• Sensorimotor Psychotherapy. Developed by Pat Ogden, who trained in Hakomi. It brings the body into trauma and attachment work, combining mindful exploration of posture, movement and sensation with cognitive and emotional processing.12
• Focusing. Eugene Gendlin’s method for working with the felt sense.8

Alongside these are somatic approaches that come from education and bodywork rather than psychotherapy:

• The Feldenkrais Method. Developed by Moshe Feldenkrais, a physicist and judo teacher, it uses slow, attentive movement to refine awareness and ease. Thomas Hanna studied with Feldenkrais, and his own approach to somatics grew partly from that work.13
• The Alexander Technique. Developed by F.M. Alexander, an actor who kept losing his voice in the 1890s and traced the problem to habitual tension in how he held his head and neck. It teaches people to notice and release habits of tension in everyday movement.14
• Body-Mind Centering. Developed by Bonnie Bainbridge Cohen from the 1970s, it explores movement and awareness through the body’s systems, such as the bones, organs and fluids, and through early developmental movement patterns.15

Biodynamic Craniosacral Therapy is a close relative with a different root: it grew out of the cranial osteopathy of W.G. Sutherland, and Franklyn Sills and others developed it further. It is a hands-on approach in which the practitioner uses light touch to attend to subtle rhythms in the body, which in the biodynamic view supports the body’s own capacity to regulate and heal. As a Registered Craniosacral Therapist (RCST®), I offer it as its own kind of session, incorporating principles of Somatic Experiencing®.

What the evidence says

Somatic therapy is popular, and popularity can run ahead of research, so it is worth saying what is currently well supported. Freezing and collapse are recognized parts of the human response to threat, alongside fight and flight.16 Mindfulness practices that train attention to sensation hold up well against established treatments.17 Across 18 randomized trials, body psychotherapy showed a medium effect on psychological symptoms.18 For Somatic Experiencing®, the evidence is promising but early: in a small 2017 trial, 44% of participants with PTSD no longer met the criteria for it after treatment.19

The genuinely contested part is Polyvagal Theory. Many physiologists now reject its account of how the vagus nerve evolved and works, though Porges disputes their reading.20 Somatic Experiencing® came before it, and its methods do not depend on it.

I think of Polyvagal Theory much as I think of the triune brain model, the idea, long abandoned by neuroscience, that the brain is built in reptilian, emotional and rational layers. It may not be anatomically correct, but it can still be functionally useful: a simple map can help someone recognize the state they are in and use that information to consciously shift it. In my practice I use sound, touch, orienting and a felt sense of connection to support regulation, none of which depends on the anatomy of the vagus nerve itself. To me, what matters is the experience of wellbeing that emerges when we can bring our nervous system states into alignment with present reality, rather than living in an embodied re-enactment of the past.

Finding a somatic therapist

“Somatic therapist” is not a protected title, so it is worth asking any practitioner about their training, their professional registration, and how they bring the body into their work. Good somatic therapy is carefully paced. Attending to the body can bring up strong sensations and emotions, and a skilled practitioner will help you approach them gradually, at a pace you can stay present with.

Somatic therapy in my practice

I work primarily with Somatic Experiencing®, bringing it together with other influences, including attachment work, practical attention to lifestyle, and my background in philosophy. Somatic sessions can take different forms, from mostly talking, with pauses to notice what is happening in the body, to a contemplative process of slowing right down and listening inward, to imaginative and creative play. I see clients in person in Nelson and online in British Columbia. You can read how I bring somatic work into counselling and craniosacral sessions, and who it can help, on my somatic therapy page.