In our last installment of Choose Your Own (Therapy) Adventure, we covered an introduction to some of the well-known trauma therapies. One of them was somatic experiencing, a form of therapy that aims to help people recover from trauma by gradually helping them to feel safer and more present in their bodies. Somatic experiencing, as one might guess from the name, is a somatic therapy – that is, a form of therapy that combines mindfulness and embodiment in addition to a cognitive (thought-based) and emotional approach to healing. Somatic therapies often pick up where talk therapies leave off, creating connections between our minds, hearts, and the physical sensations we feel in our bodies, to help us approach life in a more integrated, grounded, and present way.
Why Is a Somatic Approach So Important?
Taking the body into account in therapy, in my opinion, is an incredibly important part of the process. This is because, as more and more research shows, we’re not just brains walking around in a meat suit. Our thoughts and emotions have a profound impact on our bodies – and vice versa. In fact, the connection between body and mind is so profound that in When The Body Says No, Dr. Gabor Mate explores in great detail the impact that one particular emotional and physiological state – stress – can have on our bodies, and how it interacts with diagnosis such as arthritis, cancer, ALS, multiple sclerosis, and heart disease, to name a few.
An understanding of the mind/body connection is integral to trauma work. Trauma is experienced in our body, and our most traumatic experiences are often simultaneously those that are the most difficult to put words to – which we’ll also get into in our next installment, which will cover the creative and expressive therapies. But even if the help that you’re seeking in therapy is not specifically about trauma, I think it’s important to remember – especially in the aftermath of 2020 and the…let’s just say intense…beginning to 2021 – that all of us are likely experiencing chronic stress all the time. Chronic stress is an inherent part of living under a systems as oppressive as capitalist cisheteropatriarchy and white supremacy, and the more marginalized identities you hold, the more the stress compounds.
The somatic therapies can help give you the skills and support you need to proactively manage that stress – a process that is ongoing. When somatically oriented therapists talk about stress, we often talk about resolving the stress cycle (see: Emily Nagoski’s “Burnout) and moving the stress out of your body. Here is what we mean.
Sensorimotor psychotherapy was developed by Pat Ogden, who first became interested in the mind-body connection while working as a tech and yoga instructor in a psychiatric hospital in the 1970s. As part of her observation, she noted that some of the approaches at the time seemed to agitate or exacerbate – or trigger – some patients symptoms of PTSD, a condition which already had many of them trapped and reliving the painful events of the past. (Remember – this was also an issue that Peter Levine noted about prolonged exposure therapy, a type of cognitive behavioral therapy sometimes used to treat trauma, which was noted in the first installment of this series.)
Like somatic experiencing, which was discussed earlier, the point of sensorimotor psychotherapy is to relieve a patient of the bodily sensations associated with trauma. Also like somatic experiencing, sensorimotor psychotherapy focuses on an understanding of what happens in our bodies when we’re under stress – fight, flight, freeze. In addition to this, sensorimotor psychotherapy also incorporates an understanding of attachment theory (how we were modeled and learned about care and intimacy, starting from our relationships with our caregivers in early childhood), as well as cognitive exercises and neuroscientific foundations, to achieve the ultimate goal of helping the patient re-experience the traumatic event not in an uncontrollable flashback but rather in a safe, contained environment, regulating their physical response, in order to experience and embody closure in the present. Sensorimotor psychotherapy also helps patients incorporate an awareness of how things like movements and postures may indicate where trauma or memory is “stuck” in the body and, once aware, to devise and practice actions that might help “complete” the process in an embodied way.
The Hakomi Method
Dr. Ogden was also involved in the creation of the Hakomi Method, collaborating with co-creator Ron Kurtz and co-founding the Hakomi Institute in Colorado. It’s full name is the Hakomi Method of Experiential Psychotherapy, and it “combines somatic awareness with experiential techniques to promote psychological growth and transformation.”
How does the Hakomi Method do this? Like sensorimotor psychotherapy, the Hakomi Method draws on other psychological theories such as Gestalt therapy, structural bodywork, and Reichian breathwork, and incorporates them with Eastern philosophy of Buddhism, Taoism, as well as mindfulness. According to Kurtz, our bodies – our posture, our movements, gestures, facial expressions, etc. – all contain insight into our “core materials” or the images, memories, dreams, feelings, conscious and unconscious, that make us who we are. Using mindfulness diligently and deliberately, patients learn to focus their attention to the information their bodies are transmitting to them in order to learn about their “core material,” that is, the core of who they are.
PBSP Psychomotor Therapy
I first learned PBSP (Pesso Boyden System Psychomotor) Therapy when I read The Body Keeps the Score last year. Bessel Van Der Kolk devotes an entire chapter (“Creating Structures”) to this extraordinary sounding therapy, which “heals past emotional deficits using a process called ‘structures’ and ‘microtracking’…to create ‘new memories’.”
How in the world does this work? In The Body Keeps The Score, Van der Kolk describes attending a group therapy session in which the patient selected “actors” from their group members and set the stage. (Importantly, these are not professional actors, but other group members who, according to the PBSP site, “temporarily suspend their own personal needs in order to focus exclusively on the needs of a single client and to be in service to” them.) For example, you might select someone to play your mother, and your father, and your sibling. As a client, you would be asked to position these actors in space, including yourself in the scene. Then, the therapist would make observations to you about the spatial location of each family member – Why is your mom situated closer to you than your dad? Why is your brother facing away from you? With the guidance and support of the therapist, clients are prompted to reflect on the scene they themselves set. Clients are able to process, for example, the feelings that arise when orchestrating and viewing the tableau of a painful argument between parents – and are then encouraged to give the actors instructions in resolving the scene in the direction of closure and completion (just as in sensorimotor psychotherapy!), and in doing so, imagine and experience the emotional triumph or relief of that closure in the present and witnessed by their groupmates.
Is a Somatic Approach for You?
Based on some of the comments we’ve gotten on earlier pieces in this series, it really seems like a somatic approach as resonated and worked for many of you – which is unsurprising. Many clients find that incorporating body awareness and somatic practice into their therapy really closes the gap or pushes them past the stuckness we can often feel in talk therapy.
It’s important to note, too, that some of the methods listed here may not be for everyone. The Hakomi Method, in particular, is at times reported to be contraindicated with other diagnoses. According to GoodTherapy.org, “the Hakomi Method is grounded in exploration of and cooperation with the unconscious self,” which can make it an intense form of therapy for those who are “actively experiencing trauma” and also for those with diagnoses of borderline personality disorder or narcisstic personality disorder. (Luckily, DBT exists – and was specifically created for – those with a diagnosis of borderline personality!)
Another barrier to these more specific types of therapy could possibly be whether or not insurance will cover the lesser-known approaches. Some insurances will only cover 8-12 sessions of CBT, because of its standardized and evidence-based track record. As with the trauma therapies, it can be challenging to find a therapist specifically trained in some of the less widely known somatic therapies – for example there are only eleven therapists listed in the PBSP directory for American clinicians, and all of them appear to be white or white passing, which can be another hurdle for BIPOC clients.
If you think a somatic approach might be for you, ask your prospective therapist about it! Ask them what their values are with regard to mind/body connection, and incorporating body awareness into their approach to therapy. You might also look for therapists who have also worked as yoga or movement instructors. Many sex therapists, educators, and coaches also incorporate somatic elements to their work, which might be another route to look into if finding a therapist in your area is difficult.
Ask yourself, too, what your expectations are for a somatic approach to therapy: Do you want to be prompted and guided by your therapist in each session to bring awareness to your body? Do you have a somatic practice of your own? One of the best things about somatically oriented therapies, in my opinion, is that – unlike the more structured and formal therapies like CBT – we can find little ways into increased body awareness into our own lives. The wisdom of your body is uniquely your own, though a therapist can help hold space for you at the beginning stages of healing, especially when being in your body can feel overwhelming. But one of the core tenets of somatic therapy is that our bodies are wise, and are always working to help us survive. And befriending your body, thanking it for its wisdom, and taking even a small moment each day to listen a little more closely to it, are all things you can start to do right now.